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

Excellent journals always publish excellent science!

If this is what you believe, you might want to read a study of chiropractic just published in the highly respected SCIENTIFIC REPORTS.

The objective of this study was to investigate whether a single session of chiropractic care could increase strength in weak plantar flexor muscles in chronic stroke patients. Maximum voluntary contractions (strength) of the plantar flexors, soleus evoked V-waves (cortical drive), and H-reflexes were recorded in 12 chronic stroke patients, with plantar flexor muscle weakness, using a randomized controlled crossover design. Outcomes were assessed pre and post a chiropractic care intervention and a passive movement control. Repeated measures ANOVA was used to asses within and between group differences. Significance was set at p < 0.05. Following the chiropractic care intervention there was a significant increase in strength (F (1,11) = 14.49, p = 0.002; avg 64.2 ± 77.7%) and V-wave/Mmax ratio (F(1,11) = 9.67, p = 0.009; avg 54.0 ± 65.2%) compared to the control intervention. There was a significant strength decrease of 26.4 ± 15.5% (p = 0.001) after the control intervention. There were no other significant differences. Plantar flexor muscle strength increased in chronic stroke patients after a single session of chiropractic care. An increase in V-wave amplitude combined with no significant changes in H-reflex parameters suggests this increased strength is likely modulated at a supraspinal level. Further research is required to investigate the longer term and potential functional effects of chiropractic care in stroke recovery.

In the article we find the following further statements (quotes in bold, followed by my comments in normal print):

  • Data were collected by a team of researchers from the Centre for Chiropractic Research at the New Zealand College of Chiropractic. These researchers can be assumed to be highly motivated in generating a positive finding.
  • The entire spine and both sacroiliac joints were assessed for vertebral subluxations, and chiropractic adjustments were given where deemed necessary, by a New Zealand registered chiropractor. As there is now near-general agreement that such subluxations are a myth, the researchers treated a non-existing entity.
  • The chiropractor did not contact on a segment deemed to be subluxated during the control set-up and no adjustive thrusts were applied during any control intervention. The patients therefore were clearly able to tell the difference between real and control treatmentsParticipants were not checked for blinding success.
  • Maximum isometric plantarflexion force was measured using an isometric strain gauge. Such measurements crucially depend on the motivation of the patient.
  • The grant proposal for this study was reviewed by the Australian Spinal Research Foundation to support facilitation of funding from the United Chiropractic Association. Does this not mean the researchers had a conflict of interest?
  • The authors declare no competing interests. Really? They were ardent subluxationists supported by the United Chiropractic Association, an organisation stating that chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation, and subscribes to to the obsolete concept of vitalism: we ascribe to the idea that all living organisms are sustained by an innate intelligence, which is both different from and greater than physical and chemical forces. Further, we believe innate intelligence is an expression of universal intelligence.

So, in essence, what we have here is an under-powered study sponsored by vitalists and conducted by subluxationists treating a mythical entity with dubious interventions without controlling for patients’ expectation pretending their false-positive findings are meaningful.

I cannot help wondering what possessed the SCIENTIFIC REPORTS to publish such poor science.

45 Responses to One of the best science journals just published one of the worst chiro-studies

  • Sadly those who don’t pay attention to the pseudoscientific endeavors of cranks like Haavik are often simply unable to tell when they are being asked to believe magic with a straight face. The extraordinary bias of this study as well as the utter lack of clinical applicability and implausibly of the hidden agenda will never be properly understood by those who don’t follow these authors in detail

  • Answer: Money.

    From the SR web site:
    “Scientific Reports is an open access journal. To publish in Scientific Reports, authors are required to pay an article processing charge (APC).
    The APC for all published papers is as follows, plus VAT or local taxes where applicable:

    £1,290 (UK)
    $1,790 (The Americas, China and Japan)
    €1,490 (Europe and rest of the world)”

  • Well, Scientific Reports seems to be working hard to ruin its reputation… I remember this publication:
    https://www.nature.com/articles/s41598-018-31971-9

    • I thought this paper was being considered for retraction for fraudulent results, but there’s no mention now. What’s happened?

      • Just nothing…
        No reaction to the criticism (almost all cites are critical reactions), the editor’s note of Nature is there under the article (initially it had appeared in the header) and it happened – nothing…
        I’m watching all the time, so does Retraction Watch.

  • @Prof. Ernst,
    I disagree in one respect:
    Scientific Reports does not belong to the best science journals imo. As an indication, it´s impact factor (IF) is not very high (4.122 in 2017). Although the value of the impact factor is debatable, I am certain that the editorial and the peer review process of “real high-impact” journals like Nature, Science, Cell, etc. is far more stringent than the editorial and peer reviewing procedure done by Sci. Rep. and similar journals.

    I have been reviewer for several journals with similar IF´s and I think that there is a general problem with today´s publishing process.
    The “publish or perish” mentality of most researchers (forced by the institutes, Universities and funding organizations) has led to an increase in the numbers of suboptimal papers being submitted to journals. Concomitantly, publishers have noticed that to be a great opportunity to make more money, therefore Journal numbers have skyrocketed over the last years (including clearly fraudulent journals that will publish anything as long as they are being paid).
    Of course, no journal that I am aware of pays any money for getting high-quality peer reviews. It is expected that scientist do this important job for the journal for free.

    Several years ago, I have decided that I will not accept any request from journals to do a paper review anymore (except if I am really interested in the topic or I know the editor and do him/her a favor). The reason is that (depending on the scope and complexity of the paper) I need ca. 5-15 hours to do a review that I find adequate.

    In the past, I always found it very enlightening to read the comments of the other peer-reviewers after the review process was completed. I have noticed that these reviews sometimes were extremely superficial in my opinion. But guess what: you get what you pay for! I am therefore not at all surprised that sometimes papers of very poor quality slip through the peer review, especially in low/mid impact journals.
    As a first step in the right direction, journals should start paying peer reviewers for their work, because I think that you cannot expect great work for free.

    • @Jashak is on target. SR has a history of publishing research where methods were adequate at best but the interpretation of results by authors far exceed what is supported by their results, and citing SR as if it were the journal Nature is always a red flag for agenda-drive argument.

  • Some of those methological issues were mentioned or addressed in the study. And your assumptions of conflict of interest could be applied to many research papers.

  • They define vertebral subluxation as segmental dysfunction. Are you trying to say that segmental vertebral dysfunction is a myth? Seems like a semantics issue more than anything, and thats the basis of most of your criticism.

    • 1) it’s not my only criticism, contrary to what you claim.
      2) chiropractic subluxation is a myth, no matter how you define or diagnose it
      3) your email address ‘edzardisagayname’ is enough reason for me to ban you from this site. cherio!

    • @Bill: I would humbly add; “dysfunction” is an arcane, impossible-to-accurately define word-concept…it’s a nice escape-route to keep the myths of manual-therapy alive and scheming. “Ahh, we modern therapists are too sophisticated to fall prey to “subluxation”…we instead discover vertebral dysfunction”…as if THAT has any reality either. Perhaps Stuart McGill Phd has words which may resonate: “…chiropractors attempt to identify segments that are not moving “correctly”, or are “blocked or stiff”. Interestingly stiff joints are by definition quite stable, and would require a very large perturbation to become unstable. The goal of manipulation is to restore normal motion but more motion means less stability. There may be a peril in manipulation producing too much motion, which compromises stability and produces another set of concerns”.
      And of course the ominous reality that any such “dysfunction” is inevitably deduced with the victims lying down….with the muscular components eliminated. I’d say most if not all chiroquackers and manual-therapists are finding and cracking hyper-mobile, or normally moving segments…as the dysfunctional ones don’t move….even IF they could be “palpated”….a very unlikely and pointless endeavor.

      • Interesting that McGill was one of the main speakers last weekend at Parker seminars…a chiropractic conference.

        • @DC: so your point? Perhaps you’re suggesting that his appearance at a chiroquacker convention proves his endorsement of: upper cervical, AS/PI, leg length analysis, motion palpating, lasers, chiroquacker-neurology…and on and on and on? I’d perhaps suggest he was attempting to educate away from the scheming reliance on passive interventions and to embrace exercise and self-reliance.
          He does sell education and his own seminars…and chiroquackers do have credit cards.
          I didn’t read that he had been crucified so he probably slipped out the black door when he finished?

          • I didn’t attend the conference so I don’t know the specific contents of his lecture. He will be the key note speaker this fall at another chiropractic conference which I plan to attend.

            Most evidence based chiropractors that I know (around 8000) don’t appear to have any major issues with his views.

  • Your comments are indeed of interest but the way you dismiss even the slight chance of good quality study coming from the Chiropractic community shows again that you are on a mission. You and I both know I can find worst papers by MD’s and Physios etc. When you will give credit for excellent chiropractic research you will earn the place to critique bad studies and I admit the sham model is poor in this case.

    • This was not set up to be a sham adjustment. It was designed to see if the HVLA portion had an additional neurological effect.

      “This control intervention was primarily intended to act as a physiological control for possible changes occurring due to the cutaneous, muscular or vestibular input that would occur with the type of passive and active movements involved in preparing a participant/patient for a chiropractic adjustment.”

      • @CD: “…most evidenced based chiroquackers I know (about 8000)….”. Your trenchant, self-aggrandizing validation of your “evidenced-based” lifestyle continues to make me chuckle (then gag). And who “knows” 8000 people? By name? By facial recognition? By smell? HTF do you know what they all do and say to their marks each day? Do you all practice together in a dirigible hanger?
        How prey-tell does a quack adopt “evidence” and continue to define themselves as a quack i.e. DC?
        WTF defines “chiropractic evidence”? Who’s evidence? The “evidence” Dr Ernst and most other objective scientists CAN’T find to give approbation to the chiroquacker profession or premise….or spinal manipulation which Cochran reviews, year after year suggest has no effect past nothing else? Your arrogance is equaled only by your nonsense…and desperate need to be taken seriously.
        Being paid to wait out symptomatic-fluctuations is quite a legacy I’m sure.

  • Looking at the instanteneous axis of rotation in a 3 joint complex where you have facet degenerative changes or internal disc derangement in the anterior column proves that such hypo mobile segment does exist. Or do you consider White &Panjabi also pseudo scientists???

  • I have to agree with all you say here Edzard.
    One of the biggest problems with Heidi is that she should be defending her research and body of work from all the BS attributed to it by the vitalists. Instead she goes to the vitalistic conferences like RubiCON and feeds their bias.
    I cannot count the number of times I have asked subbie chiro’s for evidence and they cite Heidi saying that her research proves that subluxations exist.
    I then ask them “have you actually read her research?”
    Most have not.

    • Haavik is the last author listed on the paper.

      Most of Ernst comments are his assumptions. The only possible comment worth considering is the use of a strain gauge. Yes there is a subjective component to the test, as there is with tests that measure physical function. Thus, one looks at the reliability and validity of the test. Ernst didn’t even bother to discuss it.

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