Safety of chiropractic manipulation of the cervical spine: a prospective national survey (original) (raw)
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Outcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial
Spine, 2013
Study Design. Blinded parallel-group randomized controlled trial. Objective. Establish the frequency and severity of adverse effects from short-term usual chiropractic treatment of the spine when compared with a sham treatment group. Summary of Background Data. Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, as a result of design limitations in previous studies, particularly the lack of sham-controlled randomized trials, understanding of these adverse events and their relation with chiropractic treatment is suboptimal. Methods. We conducted a trial to examine the occurrence of adverse events resulting from chiropractic treatment. It was conducted across 12 chiropractic clinics in Perth, Western Australia. The participants comprised 183 adults, aged 20 to 85 years, with spinal pain. Ninety-two participants received individualized care consistent with the chiropractors' usual treatment approach; 91 participants received a sham intervention. Each participant received 2 treatments. Results. Completed adverse questionnaires were returned by 94.5% of the participants after appointment 1 and 91.3% after appointment 2. Thirty-three percent of the sham group and 42% of the usual care group reported at least 1 adverse event. Common adverse events were increased pain (sham 29%; usual care 36%), muscle stiffness (sham 29%; usual care 37%), and headache (sham 17%; usual care 9%). The relative risk (RR) was not signifi cant for adverse event occurrence (RR = 1.24; 95% CI: 0.85-1.81), occurrence of severe From the adverse events (RR = 1.9; 95% CI: 0.98-3.99), adverse event onset (RR = 0.16; 95% CI: 0.02-1.34), or adverse event duration (RR = 1.13; 95% CI: 0.59-2.18). No serious adverse events were reported. Conclusion. A substantial proportion of adverse events after chiropractic treatment may result from natural history variation and nonspecifi c effects. Outcomes of Usual Chiropractic Harm • Walker et al Spine www.spinejournal.com 1727 *Pain/stiffness: sham = 3, chiropractic = 0; gluteal strain: sham = 2, chiropractic = 0; joint swelling/pain: sham = 2, chiropractic = 0; dizziness: sham = 2, chiropractic = 1; disturbed sleep: sham = 1, chiropractic = 0; muscle spasm: sham = 0, chiropractic = 1.
Chiropractic Clinical Research: Progress and Recommendations
Journal of Manipulative and Physiological Therapeutics, 2006
Objective: The purpose of this white paper is to help inform the chiropractic clinical research agenda with a focus on the United States. Methods and Discussion: The recommendations and action items from 2 previous articles published in 1997 are discussed within the context of 3 broad topics: research culture, research infrastructure, and clinical research studies. Progress made toward the action items in these areas is summarized. A summary of findings is presented of the most influential clinical research studies during the past decade performed by or with major contributions by chiropractic investigators. In light of the current evidence and previous recommendations, new clinical research recommendations are proposed. Conclusions: Based on the assessment of the scientific literature and research currently underway, it is evident that members of the chiropractic research community have made important progress in becoming active players in the clinical research arena. During the past decade, the work of chiropractic researchers has contributed substantially to the amount and quality of the evidence for or against spinal manipulation in the management of low back pain, neck pain, headache, and other conditions. (J Manipulative Physiol Ther 2006;29:695-706)
Safety of Chiropractic Interventions
Spine, 2009
Study Design. Systematic review of reported adverse events. Objective. To evaluate the tolerability and safety of chiropractic procedures. Summary of Background Data. Despite the increasing popularity of chiropractic, there are few properly designed prospective controlled trials, and there is a disproportionate lack of evaluation of its safety profile. The literature reports multiple neurologic complications of spinal manipulation, some of which are clinically relevant and even life threatening. Methods. We performed an electronic search in 2 databases: Pubmed and the Cochrane Library for the years 1966 to 2007. All articles that reported adverse reactions associated with chiropractic were included irrespective of type of design. The outcome measures were the type of adverse events associated or attributed to chiropractic interventions and their frequency. Results. A total of 376 potential relevant articles were identified, 330 of which were discarded after abstract or complete article analysis. The search identified 46 articles that included data concerning adverse events: 1 randomized controlled trial, 2 case-control studies, 7 prospective studies, 12 surveys, 3 retrospective studies, and 115 case reports. Most of the adverse events reported were benign and transitory, however, there are reports of complications that were life threatening, such as arterial dissection, myelopathy, vertebral disc extrusion, and epidural hematoma. The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations. Conclusion. There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic. Further investigations are urgently needed to assess definite conclusions regarding this issue.
An independent review of NCCAM-funded studies of chiropractic
Clinical Rheumatology, 2011
To promote an independent and critical evaluation of 11 randomised clinical trials (RCTs) of chiropractic funded by the National Centre for Complementary and Alternative Medicine (NCCAM). Electronic searches were conducted to identify all relevant RCTs. Key data were extracted and the risk of bias of each study was determined. Ten RCTs were included, mostly related to chiropractic spinal manipulation for musculoskeletal problems. Their quality was frequently questionable. Several RCTs failed to report adverse effects and the majority was not described in sufficient detail to allow replication. The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile.
Chiropractic: A Summary of Concerns
Science Based Medicine, 2014
Although obscured by controversy, there is evidence to indicate that spinal manipulation can be as effective as conventional treatment methods in relieving low-back pain. 1,2,3,4 This grain of truth mixed with chiropractic vertebral subluxation theory that encompasses a broad scope of ailments makes it difficult for the average person to distinguish between appropriate and inappropriate use of manipulation by chiropractors. A person who is satisfied with chiropractic manipulative treatment for back pain might be led to believe that the same treatment can be used to treat a variety of organic ailments by correcting "vertebral subluxations." Such treatment is usually described as a "chiropractic adjustment."
Physicians’ perspectives on chiropractic treatment
The Journal of the Canadian Chiropractic Association, 1996
The objective ofthis study was to examine general practitioners' opinions and behaviours concerning chiropractic. The study was a secondary analysis ofthe data collected in a cross-sectional survey of400 general practitioners from Alberta and Ontario that assessed opinions and behaviours concerning several types of complementary medicine. The response rate was 52%. Twenty-eight percent indicated they had considerable knowledge about chiropractic, overall 58% found chiropractic useful or very useful and 43% believed that chiropractic is efficaciousfor neck and back problems. Forty-four percent ofthe total sample stated they referred patients to chiropractors, primarilyfor back pain, musculoskeletal indications in general and chronic pain. Efforts need to be made to further improve the relationship between general practitioners and chiropractors and, thus, establish chiropractic as a viable treatment option. (JCCA 1996; 40(4):214-219) K E Y W OR D S: chiropractic, physician, complementary. Cette etude portait sur les opinions des omnipraticiens et sur leurs attitudes face a' la chiropratique. L'etude repre'sentait une analyse secondaire des donnees recueillies au cours d'une enque'te transversale portant sur un echantillon de 400 omnipraticiens de l'Alberta et de l'Ontario et visait a e'valuer les opinions et les attitudes concernant les nombreux types de medecine douce. Le taux de re'ponse e'tait de 52 %. Vingt-huit pour cent des praticiens interroges ont indique' qu'ils avaient d'importantes connaissances en chiropratique, 58 % consideraient la chiropratique utile ou tres utile et 43 % declaraient que la chiropratique est efficace contre les problemes cervicaux et lombaires. Quarante-quatre pour cent de tous les praticiens interroges ont de'lare' qu'ils dirigeaient des patients vers les chiropraticiens, surtout pour des douleurs lombaires, des signes generaux musculosquelettiques et des douleurs chroniques. On doit deployer des efforts pour ameliorer davantage la relation entre les omnipraticiens et les chiropraticiens et ainsi considerer la chiropratique comme une option de traitement viable. (JCCA 1996; 40(4):214-219) M OT S C LES: chiropratique, medecin, medecine douce.
BMC Musculoskeletal Disorders, 2011
Background: Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes. Methods: Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included 1) Neck pain disability index (100-point scale), 2) Oswestry back pain index (100-point scale), 3) 11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain, 4) treatment satisfaction, and 5) Symptomatic Reactions (SR). Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure. Results: A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty-eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event. Conclusions: Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks.
Predictors of Adverse Events Following Chiropractic Care for Patients with Neck Pain
Journal of Manipulative and Physiological Therapeutics, 2008
Objective: This study examines which variables may predict adverse events in subjects undergoing chiropractic treatment for neck pain. Methods: This was a prospective, multi-center, cohort study. All new patients, 18 to 65 years of age with neck pain of any duration, who had not undergone chiropractic care or manual therapy in the prior 3 months, were eligible. Sources of data were questionnaires administered during the first 3 treatments. In all, 60 putative prognostic variables were examined, including descriptors of the patient, chiropractor, and type of treatment delivered. Adverse events were defined as either a new complaint, or the worsening of an existing complaint by more than 30% on an 11-point numerical rating scale. Multivariate random coefficients logistic regression analyses were conducted to determine predictors for the following outcome variables: (1) any adverse event after any of the first 3 visits, (2) any type of adverse event after the first visit only, and (3) specific types of adverse events after the first visit only (ie, headache, increased neck pain, pain and/or stiffness at the treated area). Results: In total, 579 patients were recruited, of whom 529 fulfilled the inclusion criteria. The reported use of a manipulative technique involving cervical rotation, and working status of the patient (sick leave or workers' compensation) were moderately associated with an adverse event after any of the first 3 visits. Patients who had visited their general practitioner in the 6 months before treatment, however, were less likely to have an adverse event. A longer duration with neck pain in the preceding year was moderately associated with specific types of events after the first visit, namely, headache or worsening of the presenting neck pain. Increased neck pain after the first visit was the easiest outcome variable to predict (area under the curve, 0.88; 95% confidence interval, 0.84-0.91). Conclusions: Of the 60 independent variables examined, only 4 were found to be predictive of adverse events after chiropractic treatment for neck pain, one of which was found to be protective. The chiropractic practitioner can identify 3 of these variables before initiating treatment.
Chiropractic: A Critical Evaluation
Journal of Pain and Symptom Management, 2008
Chiropractic was defined by D.D. Palmer as ''a science of healing without drugs.'' About 60,000 chiropractors currently practice in North America, and, worldwide, billions are spent each year for their services. This article attempts to critically evaluate chiropractic. The specific topics include the history of chiropractic; the internal conflicts within the profession; the concepts of chiropractic, particularly those of subluxation and spinal manipulation; chiropractic practice and research; and the efficacy, safety, and cost of chiropractic. A narrative review of selected articles from the published chiropractic literature was performed. For the assessment of efficacy, safety, and cost, the evaluation relied on previously published systematic reviews. Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition. Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence. Its cost-effectiveness has not been demonstrated beyond reasonable doubt. The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.