MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Chiropractors have become (in)famous for making claims which  contradict the known facts. One claim that we find with unfailing regularity is that “regular chiropractic treatments will improve your quality of life“. There are uncounted websites advertising this notion, and most books on the subject promote it as well, some are even entirely dedicated to the theme. Here is a quote from a typical quote from one site chosen at random: “Quality of life chiropractic care is the pinnacle of chiropractic care within the chiropractic paradigm.  It does not solely rely on pain or postural findings, but rather on how a persons life can be positively influenced through regular adjustments… A series of regular adjustments is programmed and continual advice on life improvement is given.  It is designed as a long term approach and gains its strength from the regularity of its delivery.”

Given the ubiquitous nature of such claims, and given the fact that many chiropractic clients have back problems which reduce their quality of life, and given that back pain is just about the only condition for which chiropractors might have something to offer, it seems relevant to ask the following question: what is the evidence that chiropractic interventions affect the quality of life of back pain sufferers?

Some time ago, an Italian randomised clinical trial compared chiropractic spinal manipulations with sham-manipulations in patients affected by back pain and sciatica. Its results were disappointing and showed “no significant differences in quality of life and psychosocial scores.” But this is just one (potentially cherry-picked) study, I hear my chiropractic friends object. What we quite clearly need, is someone who takes the trouble to evaluate the totality of the available evidence.

Recently, Australian researchers published a review which did just that. Its authors conducted thorough literature searches to find all relevant studies on the subject. Of the 1,165 articles they located, 12 investigations of varying quality were retained, representing 6 studies, 4 randomised clinical trial and two observational studies. There was a high degree of inconsistency and lack of standardisation in measurement instruments and outcome measures. Three studies reported reduced use of additional treatments as a positive outcome; two studies reported a positive effect of chiropractic interventions on pain, and two studies reported a positive effect on disability. The 6 studies reviewed concentrated on the impact of chiropractic care on physical health and disability, rather than the wider holistic view which was the focus of the review. On the basis of this evidence, the authors conclude that “it is difficult… to defend any conclusion about the impact of chiropractic intervention on the quality of life, lifestyle, health and economic impact on chiropractic patients presenting with back pain.”

So….

What should we make of all this? I don’t know about you, but I fear the notion that chiropractic improves the quality of life of back pain patients is just another of these many bogus assumptions which chiropractors across the globe seem to promote, advertise and make a living from.

11 Responses to Chiropractic improves quality of life: another bogus claim?

  • I’m sure it improves their quality of life no end. The idea of “maintenance adjustments” must be a brilliant cash cow!

  • It is a tough claim to defend and why I don’t use it when speaking to my patients. I find it difficult enough to define “Quality of Life” – it’s a very subjective thing. One patient may define quality of life as “being able to go to the pub and have a beer and a bet” where as another may define it as reduction in pain, others may define it as an ability to perform normal daily tasks.
    Conclusion: don’t say it.

    • good on you!
      but most chiros and the entire chiro-literature does make such claims.
      measuring QoL is not all that difficult, plenty of validated instruments are available.

  • Before chiropractic treatment; regular back, shoulder, neck pain.

    Inability to drive safely; can’t look right or left at times.

    When shoulders got stuck; can’t lift my arms to even dress myself.

    Back pain like a knife permanently lodged in the middle lower back.

    Can’t sit, can’t sleep, can’t work.

    Worsening depression and hopelessness.

    Complete mistrust and disillusionment with the impotence of the medical establishment that failed to treat me for years, decades at end, including GP’s, specialists and several physios.

    Enter chiropractic treatment by a recently qualified bright young lady and gradually no pains anywhere whatsoever and ever since.

    Thank you chiropractors everywhere for giving me back my life.

    Congratulations on becoming a member of the Royal Society; you fully deserve it with your dedication and care.

    From one very grateful patient whose QUALITY OF LIFE has been changed beyond recognition.

    I wish you every success in the future and hope that you go from strength to strength.

  • But we also see the same claims coming from NHS physiotherapy departments!
    see https://www.royalfree.nhs.uk/physiotherapy.aspx?top_nav_id=1&tab_id=1094

  • The problem with comparing anything to anything else is in the methodology and a strict adherence to standards. Conventional doctors/PhDs studying alternatives or chiropractic can find innumerable studies; studies that support them are accepted while studies that do not support them are ignored. Studies are designed with a particular outcome and prejudices built into the methodologies.

    Science, like Justice, is supposed to be blind. It is not. Studies are initiated eyes wide open and ideologies coloring every process from the beginning to the conclusion.

    Finally, there is the influence of $$$. When the bottom line is $$$, ideologies bend and twist and fold over onto themselves to please the greed.

  • The author of this article totally misguided the readers. In the Italian study, the title is :”Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.” They fail to tell us what a simulated spinal adjustments are. The author in this article call it a Sham manipulation. That is not what the research article calls it. He is not citing the paper correctly.
    Also, here is the conclusion of the article. “CONCLUSIONS: Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion”. Here is the other positive results fom the study. Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05). Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001).
    Come on, if you are going to reference an article, do it correctly.

    Also, your comments on the Australian review of the literature. Wow! they looked at 6 studies and these studies all had positive affects on the patients if you read the article. The articles they used did not even focus on the quality of life like you are talking about. It is even in the conclusion. "The 6 studies reviewed concentrated on the impact of chiropractic care on physical health and disability, rather than the wider holistic view which was the focus of the review."

    Come on buddy. I would like for you to email me what your ideas of what chiropractic actually are and I would like to see if you actually know what chiropractic is. What the true science is. If you can do that, email it to me at sigchandler@gmail.com

    • shawn wrote: “I would like for you to email me what your ideas of what chiropractic actually are and I would like to see if you actually know what chiropractic is. What the true science is.”

      According to Edward Rothman, DC, a senior lecturer at the UK’s Anglo European College of Chiropractic (AECC), this is what chiropractic is these days…

      Quote:
      “…it is my perception that there are very few rational chiropractors willing to leave, what I have termed, the ritual induced placebo of our manipulative techniques, the monotherapeutic nature of the profession, and the unethical practice building…I am an American currently working at a chiropractic school in England. For me, AECC has been a little utopia because of the talented and dedicated people I work with. However, in the four years I have been in England, I have seen a change come over the profession there as more and more people take on American practice building methods and are attracted to irrational, illogical techniques and treatment pursuits, e.g., “occipito-sacral decompression in chiropractic paediatrics” (don’t even try to understand that one).”
      Link: http://tinyurl.com/32l9o5e

      To me, it looks like he’s saying that it takes five years’ study to master a placebo intervention (which carries an unacceptable risk). In support of his views, here’s what three chiropractic staff members at the University of Glamorgan have to say:

      Quote
      “…we know patient satisfaction scores are usually quite favourable following chiropractic care, but it has also been shown that patients are very pleased and satisfied with chiropractic care whether they get better or not. Is it so bad that patients get well despite what we do?…Furthermore, it has been said that chiropractic’s greatest contribution to health care has been the development of a solid doctor-patient relationship. So, let’s not kid ourselves. It may not be what we say (subluxation, pinched nerve, tilted pelvis, herniated disc, sacroiliac syndrome, etc.), but simply the way in which we say it that stimulates some measurable change in patient’s general health care status. Some studies support this view.
      http://web.archive.org/web/20041215180456/www.familychiropractic.co.uk/news/Articles/article3.htm

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