By Arlan W. Fuhr, DC
For years, chiropractic clinicians have seen patients with low back pain get well. Yet in spite of this repeated, positive experience we still had a challenge: there was no randomized controlled clinical trial to back up our practical experience.
We wonder why we have for so long been ignored by the medical profession when it comes to integration of chiropractic into the overall worldwide healthcare system. I suggest that it is directly related to one important phenomenon: we have operated based on clinical experience, absent the hard evidence that would prove to the general healthcare world that we offer an effective method for treatment of musculoskeletal conditions.
I am encouraged to report that this state of affairs is changing for the good. United Health Care has recently presented its well-documented findings that suggest that spinal manipulation used early in an
episode effectively improves outcomes and reduces overall treatment costs. Specifically, the study says:
“Manipulation is the only service, which if not provided at any time during a spinal episode, appears to lead to higher total episode costs.”
“Total episode cost appears to be lower for episodes where manipulation is introduced within the first 10 days of the episode.”
“Episodes where a chiropractor was the first provider seen are characterized by treatment well-aligned with clinical evidence; the least fragmentation of care; low rates of imaging, injections and prescriptions medications; and low total episode cost [emphasis mine].”
From my perspective, the outcomes are not surprising; those of us who are clinicians can testify to having achieved similar results. What is most significant here is that an independent organization has conducted verifiable, reproducible research with resulting data that verifies our clinical experience.
There is more good news. In study published in The Spine Journal, chiropractic spinal manipulation was compared to physician directed usual care in the treatment of acute mechanical low back pain using evidence-based clinical practice guidelines. This is the first randomized controlled trial using clinical practice guidelines; it was conducted by medical and chiropractic researchers at the Vancouver Hospital University of British Columbia, Canada.
Ninety-two patients were recruited. One group received four weeks of chiropractic manipulation; the other group received physician directed usual care (UC). The usual care ranged from narcotic analgesic medications (16 weeks later 78% were still taking narcotics) to opioid use (80%) and passive modalities (60%).
Patients were evaluated according to the unadjusted mean improvement in the Roland-Morris Disability Questionnaire. The primary outcome: improvement in acute low back pain was significantly
greater in the Clinical Practice Guidelines group that used chiropractic manipulation. The group that received manipulation also showed improvement at sixteen and 24 weeks.
Again, the significance here is that this is the first reported randomized controlled trial that used full clinical practice guidelines-based treatment to compare spinal manipulative therapy administered by chiropractors to family physician-directed usual care. It is certainly critically important that the outcomes showed that chiropractic manipulation is an effective intervention for acute low back pain; I posit that it is perhaps even more significant to the profession of chiropractic that the study was conducted
As chiropractors who believe in the effectiveness of our work, we have a duty to participate in and encourage these kinds of comprehensive studies. Consistent, verifiable data is the single most effective way to convince the health care world that chiropractic deserves to stand shoulder-to-shoulder
with other disciplines as an accepted and welcomed mode of treatment.
Optum, “Innovations in Conservative Care: Getting to the Right Provider First.” Arizona Association of Chiropractic, June 8, 2013.
Bishop PB, Quon JA, Fisher CG, et al. The Chiropractic Hospital Based Interventions Research Outcomes (CHIRO) Study: A Randomized Controlled Trial on the Effectiveness of Clinical Practice Guidelines in the Medical and Chiropractic Management of Patients with Acute Mechanical Low Back
Pain (2010) The Spine J 10:10551064.
Also available through PubMed at http://www.ncbi.nlm.nih.gov/pubmed/20889389