At first, I thought this survey would be yet another of those useless and boring articles that currently seem to litter the literature of alternative medicine. It’s abstract seemed to confirm my suspicion: “Fifty-two chiropractors in Victoria, Australia, provided information for up to 100 consecutive encounters. If patients attended more than once during the 100 encounters, only data from their first encounter were included in this study. Where possible patient characteristics were compared with the general Australian population…” But then I saw that the chiropractors were also asked to record their patients’ main complaints. That, I thought, was much more interesting, and I decided to do a post that focusses on this particular point.
The article informs us that 72 chiropractors agreed to participate (46 % response rate of eligible chiropractors approached). During the study, 20 (28 %) of these chiropractors withdrew and did not provide any data. Fifty two chiropractors (72 % of those enrolled) completed the study, providing information for 4464 chiropractor-patient encounters. Of these, 1123 (25 %) encounters were identified as repeat patient encounters during the recording period and were removed from further analyses, leaving 3287 unique patients.
The results that I want to focus on indicated that chiropractors give the following reasons for treating patients:
- maintenance: 39%
- spinal problems: 33%
- neck problems: 18%
- shoulder problems: 6%
- headache: 6%
- hip problems: 3%
- leg problems: 3%
- muscle problems: 3%
- knee problems: 2%
(the percentage figures refer to the percentages of patients with the indicated problem)
Yes, I know, there is lots to be criticised about the methodology used for this survey. But let’s forget about this for the moment and focus on the list of reasons or indications which these chiropractors give for treating patients. For which of these is there enough evidence to justify this decision and the fees asked for the interventions? Here is my very quick run-down of the evidence:
- maintenance: no good evidence.
- spinal problems: if they mean back pain by this nebulous term, an optimist might grant that there is some promising but by no means conclusive evidence.
- neck problems: again some promising but by no means conclusive evidence.
- shoulder problems: no good evidence.
- headache: again some promising but by no means conclusive evidence
- hip problems: no good evidence.
- leg problems: no good evidence.
- muscle problems: no good evidence.
- knee problems: no good evidence.
As I said, this is merely a very quick assessment. I imagine that many chiropractors will disagree with it – and I invite them to present their evidence in the comments section below. However, if I am correct (or at least not totally off the mark), this new survey seems to show that most of the things these chiropractors do is not supported by good evidence. One could be more blunt and phrase this differently:
- these chiropractors are misleading their patients;
- they are not behaving ethically;
- they are not adhering to EBP.
Yes, we (I mean rationalists who know about EBM) did suspect this all along – but now we can back it up with quite nice data from a recent survey done by chiropractors themselves.