MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

How many times have we heard from practitioners of alternative medicine, particularly chiropractors, that their patients are more severely ill than those of conventional clinicians. The claim is usually that they have tried all that conventional medicine can offer and eventually, as a last resort, they turn to the alternatives.

But is this true? If so, it would explain why these patients do no better or even worse than those treated conventionally.

Here is a new article that goes some way in addressing these issues.

For this study, Danish chiropractors and general practitioners recruited adult patients seeking care for low back pain (LBP). Extensive baseline questionnaires were obtained and descriptive analyses were performed to define the differences between the two populations.

Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out of five patients had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often female, and generally worse on all disease-related parameters than chiropractic patients. All the disease specific parameters showed a statistically significant difference between general and chiropractic practice. Patients in general practice were generally more severely affected. They had higher pain intensity (mainly for leg pain), longer pain duration, more previous episodes, more sick leave, more activity limitation on the disability scale, slightly higher level of depression, slightly more fear-avoidance beliefs, and a poorer self-reported general health. All these differences were statistically significant.

The authors concluded that LBP in primary care was recurrent, causing sick leave and activity limitations. There were clear differences between the chiropractic and general practice populations in this study.

I know, I know: these findings are from Denmark and therefore they cannot be generalised to other countries. However, the authors point out that similar findings have been reported from the US. Furthermore the observations relate to chiropractors and must not be applied to other alternative practitioners. Nevertheless they do show that, in this specific scenario, patients opting for the alternative are not more but less severely ill.

The next time an alternative practitioner claims ‘my patients have worse outcomes because they are sicker’, I will insist on seeing the evidence before I believe it.

3 Responses to Another bogus claim by chiropractors debunked

  • “How many times have we heard from practitioners of alternative medicine, particularly chiropractors, that their patients are more severely ill than those of conventional clinicians.”

    I’ve never heard that. Just the opposite – particularly regarding low back pain. The normal over here seems to be conventional medicine for crisis, and what many consider ‘alternative’ for after the crisis is dealt with (the things that conventional med can’t measure, and are therefore irrelevant in that system).

    But maybe that’s just here.

  • The article discusses the possible reasone here:
    “There could be several reasons for the found differences between the populations, and they may vary between countries [23] although similar differences have also been demonstrated in the USA [24]. Since consultations in general practices are free of charge in Denmark, economic considerations are likely to influence choice of care provider, which could partly explain the higher education and the predominance of males among the chiropractic patients, which is in line with previous surveys [5, 22]. Apart from the economic considerations, there are no differences in access between the two types of care. There is a wide geographical spread of both groups across the country and no referral or approval is needed for either. However, several other factors may influence choice of healthcare provider: comorbidities might tempt patients to choose their general practitioner, who is acquainted with the previous health history; social factors are likely to play a role, since recommendations from family and other acquaintances probably influence the choice of nonmedical treatment; patients with higher education could be more motivated to return to work early and are therefore more active care seekers; considering the high recovery expectations in chiropractic practice, differences in illness perception might also play a role; and finally, the choice of provider might have historical reasons since chiropractic is a relative newcomer in health care compared with medicine. Whatever the reason, the consequences of the different choices of care should be investigated and the gained knowledge included in a reconsideration of the present organization of the health care systemto optimize the use of both financial and human resources [25, 26]. The study had obvious weaknesses: there was no data on nonresponders in chiropractic practice and the timing was different in the two settings, since chiropractic patients filled out the questionnaire before the first consultation and general practice patients aſter. Both of these shortcomings hamper the validity of the comparison between chiropractic and general practice patients. Furthermore, as inmany other studies, both types of practitioners were asked to include “consecutive patients,” but the large variation in recruited patients per practitioner indicates that this did not happen. There was no recording of all patients during the sampling period and therefore differences between invited and not invited could not be explored, and thus the practitioners’ conscious or subconscious selection bias is unknown. Nevertheless, for the descriptive purpose of this study, it was a conclusive strength that patients from both settings whichare entrance pathways to theDanishhealthcaresystem for patientswithLBPwere included. Furthermore, the sample is relatively large with an extensive baseline questionnaire, allowing descriptions of many parameters.”
    Prof Ernst stated:
    “The next time an alternative practitioner claims ‘my patients have worse outcomes because they are sicker’”
    I have never heard or encountered this in 25+ years in practice. Working closely with doctors there are clear clinical guidelines and an ascending referral up through the system depending on the patients severity of symptoms and response to care. Initially there is GP, pain killers and anti-inflammatory medication (usually in the acute phase) and/or chiropractic and physiotherapy. If the patient does not respond to chiro, physio and GP, or their condition worsens, then they are referred up the medical food chain. If they come from the chiro and physio then the patient goes through the GP. This is usually followed by injections, specialist pain clinics and finally surgery. The neurosurgeon I refer to the most 90% of the time will refer them back saying he is not prepared to operate yet and keep working on them.
    Thus the severity of the patients symptoms will dictate where they are within the system!

  • Great article, thanks for posting. Of course, every time another ChiroClaim is debunked they just move the goal posts, plead and such.

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