MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

This study was aimed at evaluating group-level and individual-level change in health-related quality of life among persons with chronic low back pain or neck pain receiving chiropractic care in the United States.

A 3-month longitudinal study was conducted of 2,024 patients with chronic low back pain or neck pain receiving care from 125 chiropractic clinics at 6 locations throughout the US. Ninety-one percent of the sample completed the baseline and 3-month follow-up survey (n = 1,835). Average age was 49, 74% females, and most of the sample had a college degree, were non-Hispanic White, worked full-time, and had an annual income of $60,000 or more. Group-level and individual-level changes on the Patient-Reported Outcomes Measurement Information System (PROMIS) v2.0 profile measure were evaluated: 6 multi-item scales (physical functioning, pain, fatigue, sleep disturbance, social health, emotional distress) and physical and mental health summary scores.

Within group t-tests indicated significant group-level change for all scores except for emotional distress, and these changes represented small improvements in health. From 13% (physical functioning) to 30% (PROMIS-29 Mental Health Summary Score) got better from baseline to 3 months later.

The authors concluded that chiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better (“responders”). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.

These conclusions are worded carefully to avoid any statement of cause and effect. But I nevertheless feel that the authors strongly imply that chiropractic caused the observed outcomes. This is perhaps most obvious when they state that this study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.

To me, it is obvious that this is wrong. The data are just as consistent with the opposite conclusion. There was no control group. It is therefore conceivable that the patients would have improved more and/or faster, if they had never consulted a chiropractor. The devil’s advocate therefore concludes this: the results of this study suggest that chiropractic has significant detrimental effects on functioning and well-being of patients with low back pain or neck pain.

Try to prove me wrong!

PS

I am concerned that a leading journal (Spine) publishes such rubbish.

10 Responses to Harmful effects of chiropractic on functioning and well-being of neck- and back-pain patients?

  • I like and heartily agree with your re-conclusion.
    As is typical of these partisans…or better, reprobates, Chiropractic is “named” but not “delineated”…? I’m sure manipulation may have been included (which isn’t chiropractic….chiropractic is any thrusting-theatric aimed at a misaligned or “dysfunctional” segment to ensnare patients…. though this dysfunction can of course never be proven and remains propaganda for the profession). So “drop-tables”, Activators, blocks, lasers, energy-Techniques, AK, posture-traction, Decompression etc etc could ALL have been administered along the way…thus these authors can allow the profession to continue to use the blanket-statement “chiropractic works”. Or more nefariously; Chiropractic “manipulation” may be better than those “other” non-chiropractic professionals who steal our stuff but can’t make it work like us.
    Very crafty, but of course like all sorcery, unethical and pointless to science.

  • But have you met an “Osteopractor” yet?

    • I’d never before heard of an ‘osteopractor’ and wondered if this might be a joke. So I googled, and found this web page, headed ‘What is an osteopractor?’ It seems “The word ‘Osteopractor’ translates to ‘bone practitioner’ and they are therapists trained in diagnosing and treating neuro-muscluo [sic] -skeletal disorders. [A diploma in Osteopathic Physical Therapy] is given to a doctor or physical therapist who has completed an intense course of study that includes Certificates in Spinal Manipulation and Dry Needling, as well as IASTM (Instrument Assisted Soft Tissue Mobilization) and Extremity Manipulative Therapy. These techniques are proven to heal tissue, reduce joint impairment, and lessen pain.”

      Of course, no trace of evidence is provided to support the last sentence.

      • Have any of you here bothered to have a look at the authors, what professions they belong to and where they work?
        Ian Coulter:
        https://www.rand.org/about/people/c/coulter_ian_d.html
        Karen Spritzer:
        https://www.researchgate.net/profile/Karen_Spritzer
        Cathy Sherbourne;
        https://www.rand.org/about/people/s/sherbourne_cathy_d.html
        Gery Ryan:
        https://www.rand.org/about/people/r/ryan_gery.html
        Ron Hayes:
        https://www.rand.org/about/people/h/hays_ron_d.html
        “As is typical of these partisans…or better, reprobates”
        Really Michael Kenny
        NOT ONE IS A CHIROPRACTOR.
        Ah then it must me a vast chiropractic conspiracy?
        RAND must be biased/partisan/paid off in some way.
        The word “chiropractic” was in the title so the authors must be chiropractors and therefore cooking the data.
        I recommend you all do your homework first.

        • ‘you all’ = carpet bombing???

        • @uncola: And so what are “they” trying to prove, these non-DCs? There are actual PhDs still searching for Noah’s ark and the Holy Grail as well.
          Non-DCs can also be deluded into believing things e.g. one person can, with magic-hands “treat” away another’s pain and “improve” internal healing, it requires a vastly overblown “college” education and vastly inflated costs-per-encounter AND must be rife for frauds, scammers, reprobates and bait-and-switch religiousness.
          YOU are a DC but YOU didn’t do your homework before becoming one clearly, as you decry the degree. Are you sure you understand “homework”?
          “We” undereducated ones here are still waiting for YOU to tell US WTF Chiropractic IS…?
          Is the spine something that “needs” to be aligned? Do YOU possess the profound, Supra mundane skills to find said alignment-issues….And “fix” them? And if, even remotely “yes”….can you prove it matters one Jot to health, well being, function or longevity? Do these NON-DCs know?? Let me posit my answer: Nope.

          • @Michael Kenny
            “Non-DCs can also be deluded into believing things”.
            Researchers from RAND Health???
            Your questioning RAND Health’s OBJECTIVITY????
            Face palm.
            “Is the spine something that “needs” to be aligned?”
            Bone out of place argument now?
            You are definitely mired in the early 19th century along with the vitalists.
            The irony that you both employ the same arguments seems to elude you.
            “YOU are a DC but YOU didn’t do your homework before becoming one clearly, as you decry the degree.”
            Carpet bombing again. I decry the BS merchants within the profession. I also support the researchers, reformers and educators who are moving the profession forward. You on the other hand look on researchers whether they are chiro’s or non-chiro’s as acceptable collateral damage.

  • I was able to briefly attended an Osteoquaker spectacle but exited quickly when I realized they were not using a saxophone, harmonica or accordion as the instruments to “assist in soft tissue mobilization”…
    instead they had simply stolen the Activator and Artho-stim from the Chiroquackers. And I had worn my best dance shoes too, how disappointing.

  • “These improvements over 3 months are consistent with prior estimates of minimally important group-level differences of about 2-3 points for PROMIS measures (19-20).“

  • @uncola: Uh, you did attend a college, correct? Perhaps studied a moment or two of logic, critical thinking and perhaps the “law” (I mean a real college not Chiroquacker school). It’s just that from your responses it isn’t apparent.
    Are you suggesting based on where someone ‘works’ they must be unbiased and indubitably correct?
    You are against the “BS merchants”, but my point is simply this: faffing about on the spine of a homo sapien-sapien under the delusion that it can deduce something (and IF NOT “mal-alignments, WTF are you looking for, you never explain your “Non-BS” motivation for your “treatments”) AND that deduction leads to a medically-valuable and proven intervention rendering valid and viable health, function and longevity improvements….AND said faffing requires a 4 year $200,000 “education” and inclusion in most public health-insurance…..That IS THE BS, Merchant.

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