Chiropractic research, particularly on the use of instrument assisted adjusting, has come quite a long way since the first instruments were being tested. There is now an abundance of case reports, clinical trials, and even some meta-analyses that lend credence to the fact that patients who receive instrument assisted adjustments see greater levels of improvement than those who receive either no chiropractic treatment or only manual adjustments.
That being said, feasibility studies must develop and continue for chiropractic to be seen as a viable, safe,
noninvasive treatment alternative for a wide variety of acute and chronic ailments.
What are feasibility studies?
Feasibility studies can be thought of as the next step up from a case report or a case series, which will generally only involve one to three patients. Such studies examine treatments that did or did not work for a specific condition.
Feasibility studies can include more than three patients, but not enough to qualify for a full clinical trial.
These studies attempt to discern patterns within the patient outcomes to determine if there is enough of a trend to move on to larger clinical trials with more patients. In essence, the feasibility study asks if there is enough evidence available to make it feasible to expand the research in hopes of finding even stronger evidence.
Feasibility studies for instrument adjusting
The fall 2007 issue of the Journal of Chiropractic Medicine reported on the outcomes of 11 elderly patients to examine the effect of chiropractic intervention on the risk for falls (six patients) compared to balance exercises (five patients). Each patient had two, 15-minute visits per week for eight weeks.1
At the beginning of the study, five of six chiropractic patients, and four of five exercise patients, were at moderate risk of falling. By the end of the study, only two of the chiropractic patients were still at moderate risk, compared to one of the remaining three exercise patients.
The researchers concluded: “Further investigation of the possible role of chiropractic care in reducing fall risk in this population appears feasible. Future studies are needed to explore the optimal frequency and duration of care required to reach and maintain the level of function indicating a decreased risk for falls.”
A 1994 study in the Journal of Manipulative and Physiologic Therapies measured intervertebral movement during low-force, high-frequency instrument adjustments to the spinous process of three patients. One patient was healthy, but the other two had been diagnosed with degenerative disk diseases in the lumbar region. An intervertebral motion device attached to pins at the L34 or L45 regions measured the amount of movement that occurred when four thrusts were delivered.
By looking at these movement patterns in both the healthy and the ill subjects, the researchers concluded that there was a potential benefit from instrument adjusting, so would be feasible to study further.
While large clinical trials can provide the strongest evidence in favor of instrument adjusting, feasibility studies provide a very important intermediary step between case reports and the larger trials.
Hawk C, Pfefer M, Ramcharan M, Strunk R, Uhl, N. Feasibility study of short-term effects of chiropractic manipulation on older adults with impaired balance. Journal of Chiropractic Medicine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647095/. Published 2007. Accessed 2014.
Keller TS, Nathan M. Measurement and analysis of the in vivo posteroanterior impulse response of the human thoracolumbar spine: a feasibility study. Journal of Manipulative and Physiologic Therapies. http://www.ncbi.nlm.nih.gov/pubmed/?term=1994+and+J+manipulative+and+intervertebral+device. Published September 1994. Accessed 2014.