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Government
Studies on Chiropractic
There have been a
number of large investigations conducted on chiropractic by the American,
Canadian, New Zealand, Swedish and Australian governments over the last few
decades. In all cases, their findings have supported the effectiveness and
efficacy of Chiropractic.
Canada's 1993 Manga Report strongly recommended chiropractic care over medical
care for the treatment and management of most low-back conditions. The 1994
AHCPR Study from the U.S. Department of Health and Human Services suggested that
chiropractic spinal manipulation was a conservative and safe treatment for many
low-back conditions and should be utilized prior to any surgical interventions
in most cases.
Doctors of Chiropractic have now become integral to the development of
governmental guidelines for the treatment of back conditions in Canada and the
U.S. In addition, many hospitals are extending privileges to chiropractors and
referrals between medical doctors and chiropractors are becoming increasingly
common.
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, 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:
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Conservative treatment such as spinal manipulation
should be pursued in most before cases considering surgical intervention;
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Prescription drugs such as oral steroids,
antidepressant medications and colchicine are not recommended for acute
low back problems. |
Other interesting
finds included:
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The risk of serious complications from lumbar spinal
manipulation is rare; |
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There is currently no evidence supporting the
use of trigger point, ligamentous and facet injections, needle acupuncture or
dry needling as treatment for acute back problems; |
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The panel found no evidence of benefit from the
application of physical agents and modalities such as ice, heat, massage,
traction, ultrasound, cutaneous laser treatment, transcutaneous electrical
nerve stimulation (T.E.N.S.) and biofeedback techniques. |
Acute Low Back Problems in Adults. Clinical Practice Guidelines.
Bigos S, et al. Agency for Health Care Policy and Research Publication No.
950642 (1994) -
U.S.
Department of Health and Human Services.
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THE
MANGA 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:
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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;
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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; |
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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
nonchiropractic professionals; |
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There is an overwhelming body of evidence indicating
that chiropractic management of low back pain is more cost-effective
than medical management; |
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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; |
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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;
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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; |
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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; |
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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:
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effectiveness and cost effectiveness of chiropractic management of low back
pain |
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untested, questionable or harmful nature of many current medical therapies
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economic efficiency of chiropractic care for low back pain compared with
medical care |
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safety of chiropractic care |
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higher satisfaction levels expressed by patients of chiropractors.
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The following recommendations were also included in the report:
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There should be a shift in policy to encourage and
prefer chiropractic services for most patients with low back pain; |
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Chiropractic services should be fully insured under
the Ontario Health Insurance Plan; |
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Chiropractic services should be fully integrated into
the health care system; |
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Chiropractors should be employed by tertiary hospitals
in Ontario;
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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; |
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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; |
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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; |
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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;
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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; |
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Chiropractic education in
Ontario should be in the
multidisciplinary atmosphere of a university with appropriate public finding;
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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 (The Manga Report). Pran Manga and Associates (1993)
- University of Ottawa,
Canada.
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THE NEW ZEALAND COMMISSION REPORT
This 377 page report,
Chiropractic In New Zealand, was the most comprehensive and detailed
independent examination of chiropractic ever undertaken at that time. The report
withstood judicial hearings and extensive investigations by the Commission in
New Zealand, the United States, Canada, England and Australia.
According to the researchers,
"We entered
into our inquiry in early 1978. We had no clear idea what might emerge. We knew
little about chiropractors. None of us had undergone any personal experience of
chiropractic treatment. If we had any general impression of chiropractic it was
probably that shared by many in the community: that chiropractic was an
unscientific cult, not to be compared with orthodox medical or paramedical
services. We might well have thought that chiropractors were people with perhaps
a strong urge for healing, who had for some reason not been able to get into a
field recognized by orthodox medicine and who had found an outlet outside the
fringes of orthodoxy."
"But as we prepared ourselves for this inquiry it became apparent that much lay
beneath the surface of these apparently simple terms of reference. In the first
place it transpired that for many years chiropractors had been making strenuous
efforts to gain recognition and acceptance as members of the established health
care team. Secondly, it was clear that organized medicine in
New Zealand
was adamantly opposed to this on a variety of grounds which appeared logical and
responsible. Thirdly, however, it became only too plain that the argument had
been going on ever since chiropractic was developed as an individual discipline
in the late 1800's, and that in the years between then and now the debate had
generated considerable more heat than light."
"By the end of the inquiry we found ourselves irresistibly and with complete
unanimity drawn to the conclusion that modern chiropractic is a soundly based
and valuable branch of the health care in a specialized area..."
Their report
includes the following findings:
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Chiropractic is a branch of the healing arts
specializing in the correction by spinal manual therapy of what chiropractors
identify as biomechanical disorders of the spinal column - they carry out
spinal diagnosis and therapy at a sophisticated and refined level;
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Chiropractors are the only health practitioners
who are necessarily equipped by their education and training to carry out
spinal manual therapy; |
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General medical practitioners and physiotherapists
have no adequate training in spinal manual therapy; |
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Spinal manual therapy in the hands of a registered
chiropractor is safe; |
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The education and training of a registered
chiropractor are sufficient to enable him/her to determine whether there are
contraindications to spinal manual therapy in a particular case, and whether
the patient should have medical care instead of or as well as chiropractic
care; |
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Spinal manual therapy can be effective in relieving
musculoskeletal symptoms, such as back pain and other symptoms known to
respond to such therapy, such as migraine; |
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In a limited number of cases where there are organic
and/or visceral symptoms, chiropractic treatment may provide relief, but this
is unpredictable, and in such cases the patient should be under concurrent
medical care if that is practicable; |
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In the public interest and in the interests of
patients, there must be no impediment to full professional cooperation
between chiropractors and medical practitioners; |
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It is wrong that the present law, or any medical
ethical rules, should have the effect that a patient can receive spinal manual
therapy which is subsidized by a health benefit only from those health
professionals least qualified to deliver it; |
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The responsibility for spinal manual therapy
training, because of its specialized nature, should lie with the chiropractic
profession and part-time or vacation courses in spinal manual therapy for
other health professionals should not be encouraged. |
New Zealand
Report. Hasselberg PD. Government Printer,
Wellington
- 1979.
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THE
SWEDEN REPORT
Up until the late 1980's,
Sweden had
no legislation regulating the practice of chiropractic, although there were
approximately 100 chiropractors in
Sweden
educated in accredited chiropractic colleges. In 1987, a commission on
Alternative Medicine in Sweden conducted a detailed investigation of
chiropractic education. They had the scientific literature assessed by
university medical faculty and additionally commissioned a demographic survey by
Statistics Sweden. Subsequent to the report, the Swedish government passed
legislation recognizing and regulating the chiropractic profession in
Sweden.
Then, together with the governments from
Denmark,
Finland and Norway, it established a school of chiropractic at the
University
of Odense in Denmark to provide a regional chiropractic college for students
from those countries.
The reports findings included:
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Doctors of chiropractic should become registered
practitioners and be brought within the national insurance system in
Sweden; |
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Training for Doctors of Chiropractic follows a 4-5
year course of university level training and was found to be the equivalent
to Swedish medical training - chiropractors have "competence in
differential diagnosis" and should be regulated on a primary care basis";
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"Measures to improve cooperation between
chiropractors, registered medical practitioners and physiotherapists are
vital" in the public interest. |
Ref 11 Supra.
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THE AUSTRALIAN REPORT
In July of 1984 the
Australian Federal Minister for Health asked their Medicare Benefits Review
Committee to "consider requests for extending the scope of Medicare
(government-funded health care) arrangements to provide benefits for certain
paramedical services" - which included chiropractic services.
The Committee recommended funding for chiropractic in hospitals and other
public institutions, and stated:
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"We are aware of the very considerable organizational
and professional obstacles... orthodox practitioners and, indeed, some
chiropractors may initially find the experience an uneasy one, but we consider
the differences that currently exist to be unreasonable and efforts should be
made to bridge the gap." |
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"... the continuing schism between the two professions
does little to help improve the health of the many Australians who might
benefit from a joint chiropractic/medical approach to their problems."
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Second
Report Medicare Benefits Review Committee. Thompson CJ. Commonwealth Government
Printer, Canberra, Australia, Chapter 10 (Chiropractic) - June 1986.
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