RESEARCH: SAFETY & EFFECTIVENESS
U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department of Health and Human Services (1994 study)
A panel of MD’s and other health professionals performed a research review to developed federal guidelines. After the review was completed the panel endorsed spinal manipulation for acute low back pain in adults creating a new guide line for the treatment of low back pain.
Clinical Practice Guideline # 14: Relief of low back pain can be accomplished most safely with spinal manipulation, and/or nonprescription medication.
1993 Canada Manga Report
The largest existing analysis of scientific literature on low back pain, conducted by 3 health economists (led by Pran Manga, Ph.D.). The study was conducted in hopes of sharing information about ways to reduce the incidence of work-related injuries, to assess the most appropriate use of available health care resource, and to address cost-effective ways to rehabilitate disabled and injured workers. The 1993 Ontario Ministry of Health commissioned study drew international attention and shock when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.
Findings: Higher patient satisfaction levels with chiropractic care rather than with medical treatment alternatives; “Evidence from Canada and other countries suggests potential savings of hundreds of millions annually,”; “The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability.”
Conclusions: The Manga Report overwhelmingly supported the efficacy, safety, scientific validity, and cost-effectiveness of chiropractic for low-back pain and recommended that the management of low back pain be moved from medical doctors to chiropractic doctors.
The New Zealand Commission of Inquiry Report
A landmark study of chiropractic that was conducted between 1978-1980. In its 377-page report to the House of Representatives, the Commission called its study “probably the most comprehensive and detailed independent examination of chiropractic ever undertaken in any country.” It was based on investigations in New Zealand, the U.S., Canada, the United Kingdom, and Australia.
Commission’s View of Chiropractic Before the Inquiry: “chiropractic was an unscientific cult, not to be compared with orthodox medical or paramedical services.”
Conclusions: Spinal manual therapy in the hands of a registered chiropractor is safe; Spinal manual therapy can be effective in relieving musculoskeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine; Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy; “In the public interest and in the interests of patients, there must be no impediment to full professional cooperation between chiropractors and medical practitioners.”
Commission's View of Chiropractic by the End of the Inquiry: “irresistibly and with complete unanimity drawn to the conclusion that modern chiropractic is a soundly-based and valuable branch of health care in a specialized area...”
The Meade Studies
Two studies published in the British Medical Journal conducted by T.W. Meade, M.D. comparing medical treatment to chiropractic care for low back pain. One 2-year patient monitoring study in June 1990 and a 3-year patient monitoring study in1995.
Conclusions: Patients seen by doctors of chiropractic were better within 6 months and remained better over a 2-year period; “for patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management.”; After 3 years, chiropractic cared patients’ improvements were 29% greater than medical cared patients.
Rand Study on Low Back Pain
The RAND Corporation is one of America’s most prestigious centers for research in public policy, science and technology. In 1994 it conducted a four phase study exploring indications of low-back pain utilizing 2 different expert panels of researchers included both MD’s & DC’s. These panels reviewed 35 years of research.
Conclusions: Both panels agreed with each other that spinal manipulation is an appropriate and effective treatment for many kinds of low back pain.
1985 University of Saskatchewan Study
283 patients “who had not responded to previous conservative or operative treatment” and “who were initially classified as totally disabled” were treated with daily spinal manipulations.
Findings: “81% ... became symptom free or achieved a state of mild intermittent pain with no work restrictions.”
Florida Workers’ Compensation Study
A 1988 study by Steve Wolk, Ph.D., reported by the Foundation for Chiropractic Education and Research reviewed 10,652 Florida workers’ compensation cases.
Conclusions: “a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors.”
Utah Worker's Compensation Study
A Utah State workers’ compensation study performed by Kelly B. Jarvis, D.C., Reed B. Phillips, DC, Ph.D., and Elliot K. Morris, JD, MBA, reported in the Journal of Occupational Medicine (Aug. 1991). It compared the cost of chiropractic care to the costs of medical care for conditions with identical diagnostic codes.
Conclusions: Costs were significantly higher for medical claims than for chiropractic claims, and the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.
Oregon Worker's Compensation Study
A case review study of Oregon State workers’ compensation cases conducted in 1991 by Joanne Nyiendo, Ph.D.
Findings: The median time loss days (per case) for comparable injuries was 9.0 for patients receiving treatment by a doctor of chiropractic and 11.5 for treatment by a medical doctor.
Stano Cost Comparison Study
A study by Miron Stano, Ph.D.presented in the Journal of Manipulative and Physiological Therapeutics (June 1993). It involved 395,641 patients with neuromusculoskeletal conditions comparing the cost of chiropractic care to other medical treatments for common back problems.
Conclusions: Over a 2 year period, patients who received chiropractic care incurred significantly lower health care costs than did patients treated solely by medical or osteopathic physicians.
Virginia Comparative Cost Assessment
An economic assessment of mandated health insurance coverage for chiropractic treatment within the Commonwealth of Virginia, performed by L.G. Schifrin, Ph.D. (1992) and reported by the College of William and Mary, and the Medical College of Virginia.
Conclusions: Chiropractic provides therapeutic benefits at economical costs; Chiropractic care had the lowest per-visit and total treatment costs; The assessment recommended that chiropractic be a widely available form of health care.
1992 America Health Policy Report
Journal of American Health Policy (1992) reviewed data from over 2,000,000 users of chiropractic care in the U.S.
Conclusions: “chiropractic users tend to have substantially lower total health care costs” and “chiropractic care reduces the use of both physician and hospital care.”