An explanatory sequential mixed methods study with three separate phases was conducted in Danish patients with lumbar radiculopathy receiving a standardized chiropractic care package (SCCP). Lumbar radiculopathy is pain and other neurological symptoms caused by the pinching of nerve roots where they leave your spinal cord in the lumbar region. 
Phase one of the study was a quantitative analysis based on a survey in a prospective cohort of patients with lumbar radiculopathy in an SCCP from 2018 to 2020. Patients rated their satisfaction with the examination, information, treatment effect, and overall management of their problem on a 0–10 scale. In phase two, six semi-structured interviews conducted in 2021 were used to gain further explanatory insights into the findings from phase one. Data were analyzed using systematic text condensation. In phase three, the quantitative and qualitative data were merged in a narrative joint display to obtain a deeper understanding of the overall results.
Here I am only interested in the patients’ perception of the treatment effect. Of 303 eligible patients, 238 responded to the survey. Of these, 50% were very satisfied with the treatment effect.
The authors stated that patients in their study expected a rapid and persistent decrease in symptoms, which, unfortunately, does not match the prognosis of lumbar radiculopathy. Although the prognosis is considered good, the improvement happens gradually and often with fluctuating pain patterns, and it is not unusual to have milder symptoms for three months or longer.
So, only half of the patients who had chosen to consult chiropractors for their lumbar radiculopathy were very satisfied with the treatment results. In most patients, the symptoms decreased only gradually often with fluctuating pain patterns, and the authors comment that symptoms frequently last for three months or longer with a SCCP.
Impressive?
Might I point out that what is being described here looks to me very much like the natural history of lumbar radiculopathy? About 90% of patients with back pain caused by disc herniation see improvements within three months without therapy. Are the authors aware that their observational study is in accordance with the notion that the SCCP does nothing or very little to help patients suffering from lumbar radiculopathy?
34 Responses to More evidence to suggest that chiropractic is useless
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Not wishing to be pedantic, but I cannot agree with “So, only half of the patients who had chosen to consult chiropractors for their lumbar radiculopathy were very satisfied with the treatment results.”
50% of 238 = 119.
Of 303 eligible patients, 119 (39.3%) stated that they were very satisfied with the treatment.
We don’t know, and shouldn’t guess, what the other 65 (303−238) eligible patients would have stated if they had responded to the survey.
So, only
half39.3% of the patients who had chosen to consult chiropractors for their lumbar radiculopathy stated that they were very satisfied with the treatment results.See: https://en.m.wikipedia.org/wiki/Whiskas
not at all pedantic but a good point!
“Almost half had visited another care provider for their current problem, most often their GP, and around 80% were currently taking pain medication.
Almost all patients explained that they had consulted the chiropractor in the expectation of a rapid decrease in symptoms that was expected to be permanent.”
So we have a subgroup where pain meds weren’t enough so some sought a chiropractor for a quick fix. It didn’t happen so they weren’t very satisfied. Apparently they weren’t very satisfied with the pain meds either.
Not only useless, but potentially harmful because patients are misled into thinking there is ‘innate’ which can be manipulated in some beneficial way by chiropractic techniques (and osteopathic too – the differences are too subtle for me to distinguish).
I revert to my old inquiry: Why do some folks study ‘chiropractic’, learn ‘chiropractic methods’, and practice ‘chiropractic’ – and not osteopathy, physiotherapy, or medicine and surgery?
To give informed consent, their patients must be informed.
What percentage of patients seeking help from a chiropractor are properly informed?
How about we stick to the paper?
DC: Apologies for not sticking to the paper.
Should have considered:
“Chiropractors provide no useful mediation of health conditions – other than through the warm feelings provided by TLC and placebo responses”.
Perhaps, DC, you can tell us who you are and why you took up chiropractic and not osteopathy, physiotherapy, or medicine?
DC is a variant of ChatGPT called ChiroTrollGPT.
My career choice isn’t relevant to the paper at hand.
What is interesting from the paper is that those who went to the chiropractor for this study:
1. 77.5% had been to a GP
2. Of those 77.5%, 80% were scripted a pain medication
3. 55.9% had been to a physiotherapist
4. 24.5% had been to a prior chiropractor
5. At 8 weeks out, 68% reported high satisfaction with chiropractic treatment effect
6. Patient expectation of chiropractic care was “a rapid decrease in symptoms that was expected to be permanent.”.
Now, for me, a few questions arise:
1. Why were so many given pain medication if the natural course is self-resolution? (and what were they given?)
2. Why didn’t the pain medication provide sufficient relief?
3. What did the PTs do, if anything, other than reassurance?
4. Why did the PT approach not provide sufficient relief/assurance?
5. For those who were not “very satisfied” of chiropractic care was it due to unrealistic expectations?
DC,
It appears that your questions 1 thru 4 are outside the scope of the paper being discussed, to which you want to stick to. Is this is another example of you being evasive?
Actually, the answers to the questions I raised would provide insight to the results.
No they won’t. They act as a distraction that you so badly need.
Badly need?
We have a group who apparently didn’t get satisfied results from MDs, PTs, a few DCs or self care/do nothing for radiculopathy.
Around 50% were very satisfied with the chiropractic treatment effects even after others tried without much/any benefit.
“Around 50% were very satisfied with the chiropractic treatment effects even after others tried without much/any benefit.”
Using the actual data, not the manipulated dichotomised BS version: of 303 eligible patients, only 51 (17%) stated that they were very satisfied with the treatment.
Ernst comments:
“Here I am only interested in the patients’ perception of the treatment effect. Of 303 eligible patients, 238 responded to the survey. Of these, 50% were very satisfied with the treatment effect.”
“So, only half of the patients who had chosen to consult chiropractors for their lumbar radiculopathy were very satisfied with the treatment results.”
chiro‑troll wrote: “What is interesting from the paper is that those who went to the chiropractor for this study: …”
Statements 1. – 6. are all BS; resulting from misuse of the manipulated data espoused in the rhetoric.
E.g. “1. 77.5% had been to a GP”, which is utter BS.
Baseline data, Table 1
Seen by another healthcare provider for the current problem (yes)
GP: n = 79
E.g. “5. At 8 weeks out, 68% reported high satisfaction with chiropractic treatment effect”, which is utter BS.
From the study: “However, at 8-weeks follow-up only 68% of the 182 responders (data not shown)[*] reported high satisfaction with treatment effect”
68% of 182 ≈ 124, which is nowhere near 68% of the study participants.
[*] As to this statement “(data not shown), let’s see [my formatting for clarity]
Patient satisfaction was explored using four questions and measured on a scale from 0 ‘Very dissatisfied’ to 10 ‘Very satisfied’:
1. “How satisfied are you with the examination performed by the chiropractor?”;
2. “How satisfied are you with the information you received about your problems?”;
3. “How satisfied are you with the effect of the treatment you received for your problems?”;
4. “Overall, how satisfied are you with the chiropractor’s management of your problems?”.
Analyses and data management
Patient satisfaction was analysed with descriptive statistics and visualised with graphics. When merging with the qualitative data and in the presentations, we dichotomised satisfaction into ‘Very satisfied’ (≥ 8 on the 0–10 scale) and ‘Less satisfied (< 8)’. The cut-point was arbitrarily chosen to identify the top 30% of the scale as very satisfied.
Using the actual data, not the manipulated dichotomised version, we get: Of 303 eligible patients, 51 (17%) stated that they were very satisfied with the treatment.
Yes, of those who sought a prior healthcare provider, 77.5% saw a GP. I should have added that for clarification.
That would have provided neither clarification nor the truth, which from the non-manipulated data is:
Of 303 eligible patients, 79 (24%) stated that they had seen a general practitioner for their current problem.
Correction: 79 (26%)
Yes it’s very interesting how very few went to a GP for the current condition.
Some may find it noteworthy that, of the patients who previously visited a chiropractor for their current condition, 100% found the treatment they received to be ineffective; unsatisfactory.
“ of the patients who previously visited a chiropractor for their current condition, 100% found the treatment they received to be ineffective; unsatisfactory.”
Where in the paper was this breakdown reported?
What a marvellous, far more than adequate, illustration of why ‘DC’ took up chiropractic and not osteopathy, physiotherapy, or medicine. 🤣
Well done!
Now answer the question.
ROFL 🤣🤣
You still haven’t a clue as to the astonishing depth of belligerent stupidity on display in your comments. Nor as to how much you are blinded by your quasi-religious zeal.
As commentator Admedical said to Logos-Bios: “your debating technique is like that of a small child. It’s amusing.”
Thanks Pete for a wonderfully example of how to be ironic.
chiro‑troll wrote: “2. Of those 77.5%, 80% were scripted a pain medication”
Really? What does the data tell us:
Of 303 eligible patients,
• 79 stated that they had seen a general practitioner for their current problem.
• 108 stated that they were currently taking prescription medicine for back or leg pain.
Pete: Of 303 eligible patients…
“A total of 303 patients with lumbar radiculopathy were invited to participate in the survey, of which 238 (79%) were included in the final study population.”
Hence, the n and percentages reported are based on the 238, not the 303.
You wrote ” 2. Of those 77.5% [who had been to a GP], 80% were scripted a pain medication”
You made that up; it’s called lying.
Where is the data that shows
“of the patients who previously visited a chiropractor for their current condition, 100% found the treatment they received to be ineffective; unsatisfactory.”
Predictably, in chiro-troll’s quasi-religious zeal to defend the indefensible from each and every perceived attack, he threw away important information; especially information that contains context and clues that are essential to forming understanding. In this instance, he threw away the important information I’ve highlighted in boldface type:
Some may find it noteworthy that, of the patients who previously visited a chiropractor for their current condition, 100% found the treatment they received to be ineffective; unsatisfactory.
I was simply lampooning his increasingly asinine comments by using a triple entendre, which on one level included a statement of the bleedin’ obvious: something that is self‑evidently true.
QUOTE
“There are stupid questions”
The article Ink Out Loud: There’s no such thing as a stupid question,’ and other ailments lavender cures defines stupid questions as:
…
• Questions of which the answer should be painfully obvious to any person with a pulse who has lived on this Earth for more than a decade.
https://en.m.wikipedia.org/wiki/No_such_thing_as_a_stupid_question
Could this be a reason for some to switch chiropractors?
“The SCCPs are part of a collective agreement negotiated by the Danish Chiropractic Association and Danish Health Authorities [14] and specify a higher proportion of reimbursement of the patient fee (40–60%) for patients in the SCCP compared to regular fees (9–18%). “
Nah, cost is never a factor.
“Could this be a reason for some to switch chiropractors?”
Congratulations on yet another diversion from the article on which you are commenting: More evidence to suggest that chiropractic is useless.
And your attempted diversion from your statement:
You made that up; it’s called lying.
with the assumptions that you present as “facts” it’s almost like you are becoming what you hate.
Lying by omission, otherwise known as exclusionary detailing, is lying by either omitting certain facts or by failing to correct a misconception. This was explained to chiro‑troll following a previous deployment here.
The truth: 79 patients (26% of the 303 eligible patients; 33% of the 238 survey respondents) stated that they had seen a general practitioner for their current problem.
chiro-troll made that up; it’s neither in the data nor in the rhetoric. Lying by omission combined with fabrication.
The truth:
• 108 patients (36%; 45%) stated that they were currently taking prescription medicine for back or leg pain. Yet only 79 patients had seen their GP for their current problem!
• 71 patients (23%; 30%) stated that they were currently taking over-the-counter medicine for back or leg pain.
• 50 patients (17%; 21%) stated that they were currently taking no medication for back or leg pain.
The truth: 57 patients (19%; 24%) stated that they had seen a physiotherapist for their current problem.
The truth: 25 patients (8%; 11%) stated that they had seen a chiropractor for their current problem.
Lying by omission again.
The truth: However, at 8‑weeks follow‑up only 68% of the 182 responders (data not shown) reported high satisfaction with treatment effect, which is still lower than the other satisfaction parameters measured.
• 56 [238−182] patients (18%; 24%) were lost to follow-up.
• 124 [68% of 182] patients (41%; 52%) who responded to the 8‑weeks follow‑up “reported high satisfaction with treatment effect”, but without the data, the term “high satisfaction” is undefined. Neither is it clear to me whether “high satisfaction” was determined before or after the application of the following to the patients’ statements:
When merging with the qualitative data and in the presentations, we dichotomised satisfaction into ‘Very satisfied‘ (≥8 on the 0–10 scale) and ‘Less satisfied‘ (<8). The cut‑point was arbitrarily chosen to identify the top 30% of the scale as very satisfied.
• 58 [(100−68)% of 182] patients (19%; 24%) responded to the 8‑weeks follow‑up, but their reported satisfaction level with treatment effect has been withheld.
Misleading.
Expectations regarding consultation and treatment effect
Almost all patients explained that they had consulted the chiropractor in the expectation of a rapid decrease in symptoms that was expected to be permanent.
I.e. the patient’s expectation of the chiropractor currently being consulted, not their “expectation of chiropractic care“. An important distinction, especially if the patient had received ineffective, unsatisfactory, treatment from a previous chiropractor.
Also note that the term “chiropractic care” is fatuous:
The SCCP does not stipulate a particular treatment or type of care….