study: chiro manipulation causes pain in the neck
Spine. 2005; 30(13): 1477-84. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM.
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This abstract from Spine is really weak on study information. The full article (not available) could clear things up significantly, but the abstract info leads to speculation. First, 336 patients doesn't seem a huge number to outweigh the apparent amount of stratification in the analysis (seriousness of initial injury causing pain, with and without heat or EMS, time of adverse reaction, etc.) Then, apparently only 83% of the 336 patients completed the subjective self-assessment survey after two weeks. Seventeen percent didn't complete the questionnaire (nothing to complain about?), the clinically significant report for adverse events was at 24 hours after initial treatment - but this information isn't reported by the subjects until 2 weeks later. Not knowing all of what and how the patient survey was all about also leads to speculation. Several other uncontrolled factors could have biased the results as well. Patient prior experience with chiropractic, disparity in manipulation or mobilization treatments at the four sites, level of acute or chronic condition of the neck pain, and prior or concurrent treatment. Could 280 participants effectively control for all of this? Also, the abstract report is silent on comparing long-term outcomes (events) and patient overall satisfaction despite adverse effects, and provides no information on several listed data points.I take the publication of this report in Spine as pro-chiropractic as it provides complete inference that chiropractic treatment is mainstay for all neck pains. I am not convinced that the study design and protocols were not unbiased to begin with, but that shouldn't matter, data is data and this is a valid study and the author's conclusions are valid: manhandling versus simply moving a sore neck increases the chances of making it feel worse the next morning, especially if it was really sore to begin with.
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This abstract from Spine is really weak on study information. The full article (not available) could clear things up significantly, but the abstract info leads to speculation. First, 336 patients doesn't seem a huge number to outweigh the apparent amount of stratification in the analysis (seriousness of initial injury causing pain, with and without heat or EMS, time of adverse reaction, etc.) Then, apparently only 83% of the 336 patients completed the subjective self-assessment survey after two weeks. Seventeen percent didn't complete the questionnaire (nothing to complain about?), the clinically significant report for adverse events was at 24 hours after initial treatment - but this information isn't reported by the subjects until 2 weeks later. Not knowing all of what and how the patient survey was all about also leads to speculation. Several other uncontrolled factors could have biased the results as well. Patient prior experience with chiropractic, disparity in manipulation or mobilization treatments at the four sites, level of acute or chronic condition of the neck pain, and prior or concurrent treatment. Could 280 participants effectively control for all of this? Also, the abstract report is silent on comparing long-term outcomes (events) and patient overall satisfaction despite adverse effects, and provides no information on several listed data points.I take the publication of this report in Spine as pro-chiropractic as it provides complete inference that chiropractic treatment is mainstay for all neck pains. I am not convinced that the study design and protocols were not unbiased to begin with, but that shouldn't matter, data is data and this is a valid study and the author's conclusions are valid: manhandling versus simply moving a sore neck increases the chances of making it feel worse the next morning, especially if it was really sore to begin with.
posted by nawledge at
11:34 PM
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