| The
Agency on Health Care Policy and Research Study:
On December 8, 1994, the Agency for Health Care Policy and
Research (AHCPR) of the US Department of Health and Human
Services released Clinical Practice Guidelines for the management
of acute low back pain. Their guidelines were developed
after extensive study of diagnostic and treatment methods
for acute low back pain.
The
guidelines were created by the AHCPR panel to provide primary
care clinicians with information and recommended strategies
for the assessment and treatment of acute low back problems.
The AHCPR panel was made up of 23 members consisting of
medical doctors, chiropractic doctors, and nurses, experts
in spinal research, physical therapists, an occupational
therapist, a psychologist, and a consumer representative.
The
following conclusions were made in this landmark study:
- Conservative
treatment such as spinal manipulation should be pursued
in most before cases considering surgical intervention;
- Prescription
drugs such as oral steroids, antidepressant medications
and colchicine are not recommended for acute low back
problems.
- Other
interesting finds included: The risk of serious complications
from lumbar spinal manipulation is rare.
Acute
Low Back Problems in Adults. Clinical Practice Guidelines.
Bigos S, et al. Agency for Health Care Policy and Research
Publication No. 950642 (U.S. Department of Health and Human
Services) -1994.
The
Rand Corporation Study:
Members
of the Medical Community Recognize Chiropractic's Effectiveness
This
study, conducted by the prestigious RAND Corporation, marks
the first time representatives of the U.S. medical community
have gone on record stating that chiropractic is an appropriate
treatment for certain low back pain conditions. A second,
all-chiropractic panel's ratings show agreement with the
multidisciplinary panel that spinal manipulation is appropriate
for specific kinds of low back pain. A utilization study
examining chiropractic patients' charts in multiple geographical
locations in the United States is now underway. This will
allow investigators to examine actual clinical cases and
learn how prevalent each condition is in practice.
The
RAND Corporation ("Research and Development")
is a nonprofit private corporation in Santa Monica, California.
They conduct research and development for the U.S. government
and private sector, commanding international respect. Its
research programs include classified defense research for
the military, applied economics, education, sociology, and
civil justice and health sciences.
The
Appropriateness of Spinal Manipulation for Lower Back Pain.
Shekelle PG, et al. RAND Corporation, Santa Monica, California
- 1992.
The
Magna Report
As
the largest existing analysis of scientific literature on
low back pain, the 1993 Ontario Ministry of Health commissioned
study drew international attention when it recommended the
management of low back pain be moved from medical doctors
to chiropractic doctors.
Due
to serious financial problems with the Canadian governments,
the different types of treatments for low back conditions
were evaluated in an effort to reduce and contain health
care costs. Their findings showed chiropractic manipulation
was the most cost effective and efficacious care for low
back pain.
The
researchers also stated that studies on the prevalence and
incidence of low back pain suggest that it is the leading
cause of disability and morbidity in middle-aged persons,
and is by far the most expensive source of workers' compensation
costs North America.
The Canadian Government report concluded with the following
findings:
- On
the evidence, particularly the most scientifically valid
clinical studies, spinal manipulation applied by chiropractors
is shown to be more effective than alternative treatments
for low back pain. Many medical therapies are of questionable
validity or are clearly inadequate.
- There
is no clinical or case-control study that demonstrates
or even implies that chiropractic spinal manipulation
is unsafe in the treatment of low back pain. Some medical
treatments are equally safe, but others are unsafe and
generate iatrogenic (doctor-induced) complications for
low back pain patients. Our reading of the literature
suggests that chiropractic manipulation is safer than
medical management of low back pain.
- Indeed,
several existing medical therapies of low back pain are
generally contraindicated on the basis of the existing
clinical trials. There is also some evidence in the literature
to suggest that spinal manipulations are less safe and
less effective when performed by non-chiropractic professionals.
- There
is an overwhelming body of evidence indicating that chiropractic
management of low back pain is more cost-effective than
medical management.
- There
would be highly significant cost savings if more management
of low back pain was transferred from physicians to chiropractors.
Evidence from Canada and other countries suggests potential
savings of many hundreds of millions annually.
- Workers'
compensation studies report that injured workers with
the same specific diagnosis of low back pain returned
to work much sooner when treated by chiropractors than
by medical physicians.
- There
is good empirical evidence that patients are very satisfied
with chiropractic management of low back pain and considerably
less satisfied with medical physician management.
- The
use of chiropractic has grown steadily over the years
and chiropractors are now accepted as a legitimate healing
profession by the public and an increasing number of medical
physicians.
In
our view, the following offers an overwhelming case in favor
of much greater use of chiropractic services in the management
of low back pain:
- The
effectiveness and cost effectiveness of chiropractic management
of low back pain
- The
untested, questionable or harmful nature of many current
medical therapies
- The
economic efficiency of chiropractic care for low back
pain compared with medical care
- The
safety of chiropractic care
- The
higher satisfaction levels expressed by patients of chiropractors.
The following recommendations were also included in
the report:
- There
should be a shift in policy to encourage and prefer chiropractic
services for most patients with low back pain.
- Chiropractic
services should be fully insured under the Ontario Health
Insurance Plan.
- Chiropractic
services should be fully integrated into the health care
system.
- Chiropractors
should be employed by tertiary hospitals in Ontario.
- Hospital
privileges should be extended to all chiropractors for
the purposes of treatment of their own patients who have
been hospitalized for other reasons, and for access to
diagnostic facilities relevant to their scope of practice
and patients' needs.
- Chiropractic
should have access to all pertinent patient records and
tests from hospitals, physicians, and other health care
professionals upon the consent of their patients.
- Since
low back pain is of such significant concern to workers'
compensation, chiropractors should be engaged at a senior
level by Workers' Compensation Board to assess policy,
procedures and treatment of workers with low back injuries.
- A
very good case can be made for making chiropractors the
gatekeepers for management of low back pain in the workers'
compensation system in Ontario.
- The
government should make the requisite research funds and
resources available for further clinical evaluations of
chiropractic management of low back pain, and for further
socioeconomic and policy research concerning the management
of low back pain generally.
- Chiropractic
education in Ontario should be in the multidisciplinary
atmosphere of a university with appropriate public finding.
- Finally,
the government should take all reasonable steps to actively
encourage cooperation between providers, particularly
the chiropractic, medical and physiotherapy professions.
The
Effectiveness and Cost Effectiveness of Chiropractic Management
of Low-Back Pain. Pran Manga and Associates. University
of Ottawa, Canada - 1993.
The AV-Med Study
In
this study, 80 patients who previously received medical
treatment were subsequently referred to the Silverman Chiropractic
Center. Of the 80 patients, 21 percent had just been diagnosed
with spinal disc problems, 12 percent had been diagnosed
as requiring surgery and 5 percent had received emergency
room treatment. Following chiropractic treatment, none of
the patients were required to have surgery, 86 percent of
the patients needed no further care, and the estimated health
care savings in the group of 80 was estimated to be $250,000.
The
Av-Med Study - 1993.
The
Midwest Research Institute Study
This
study examined clinical trials published in the professional
literature between 1930 and 1981.
The
researchers concluded that:
- Manual
therapy was superior to placebos,
- There
was greater mobility following manipulation,
- The
duration of treatment was shorter for the manipulated
groups,
- There
was improved lateral flexion and rotation after manipulation,
- The
numerous case studies throughout the literature report
the satisfaction of chiropractic patients with the outcome
of treatments.
Chiropractic
Evaluation Study Task III Report of the Relevant Literature.
MRI Project No. 8533-D. MacDonald MJ, Morton L. For Department
of Defense, OCHAMPUS, Aurora, Colorado - 1986.
The
Annals of Internal Medicine Study
The
Third Most Widely Read Medical Journal Finds Chiropractic
a Winner in Low Back Pain
The
use, complications, and efficacy of spinal manipulation
for low back pain was reviewed in the Annals of Internal
Medicine, the third most widely read medical journal. The
article concluded that spinal manipulation clearly helps
patients with uncomplicated, acute low back pain.
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