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Research

Like all health professionals, Chiropractors are constantly searching for more effective ways to treat the conditions of their patients. Scientific research is a key to discovering new methods, techniques, and procedures. Through the Chiropractic Foundation for Spinal Research (CFSR), chiropractors privately fund and conduct health related science research. Also, many university scholars are involved in areas of research important to improving chiropractic. Through joint research projects, chiropractors work with Canada's best scientific minds on areas of common interest and concern.

Effectiveness and Cost-Effectiveness: CANADIAN CHIROPRACTIC ASSOCIATION 1997

Few (if any) other health care interventions have been assessed as extensively as chiropractic spinal manipulation, both in terms of safety and effectiveness. Furthermore, few other health care professions have been as thoroughly researched as chiropractic. There have been at least six formal government inquiries into chiropractic worldwide over the last 25 years (including Canada, Australia, New Zealand and Sweden). All have concluded that contemporary chiropractic care is safe, effective, cost-effective and have recommended public funding for chiropractic services. In addition to government inquiries, there have been many scientific clinical studies (randomized controlled trials included) assessing the appropriateness, effectiveness, and/or cost-effectiveness of spinal manipulation or chiropractic manipulation (most notably for back pain).

Examples:

Patient Satisfaction

In today's consumer driven health care environment, patient satisfaction is an important health outcome measure. There have been several surveys conducted in recent years assessing patient satisfaction with chiropractic care, which was found to be extremely high. In addition, these surveys invariably found that the level of satisfaction was significantly higher for care received from chiropractors in comparison to the medical profession. Surveys have also indicated that chiropractic patients are willing to return for chiropractic treatment for a similar condition and would recommend chiropractic treatment to friends, family and colleagues.

Examples:

Government Recommendations for Management Protocols

In today's evidence-based health care environment, governments are engaged in developing scientific protocols for the management of various health care conditions. Interventions provided by health care professionals are now being scrutinized and examined as never before, to ensure that effective, efficacious and safe health care interventions are available and given priority in the public's best interests. The chiropractic profession encourages guideline development based on scientific research.

Recent government guidelines continue to support the previous studies on the effectiveness, cost-effectiveness and safety of chiropractic spinal manipulation, recommending chiropractic management for acute low back pain, for example, as the preferred approach:

Utilization

Over 3 million Canadians sought chiropractic care at least once in 1996, translating to about 30 million visits made to chiropractors. These utilization figures are increasing moderately from year to year, and studies consistently show chiropractic utilization being between 8 to 15 percent of the general population annually. Approximately $500 million dollars were spent on chiropractic services in 1995. The use of non-traditional, or "unconventional" health care has risen dramatically over the last several years, as society is becoming more aware of alternative approaches and making more informed choices on matters of health. For the purposes of this section, the terms "alternative" and "unconventional" are to be interpreted as NOT the traditional medical approach. "Alternative" or "unconventional" SHOULD NOT be interpreted as necessarily lacking scientific basis.

Chiropractic and Back Pain

Back pain occurs in most adults at some point in their lives and is one of the leading causes of disability in Canada. Low back pain is a pervasive medical, social and economic problem afflicting about eight out of ten Canadians at some time in their lives. Estimates of point prevalence, that is the number of people actually suffering from low back pain at a given time, range between 5% to 30% of the population. Recent reputable studies have also found that back pain is a condition occurring amongst school children and adolescents with a similar prevalence.

Low back pain has a tremendous impact on Canadians and is a major socio-economic burden. It is one of the leading causes of visits made to health care providers and of time lost from the workplace. Nearly every scientific study on any aspect of low back pain refers to it as being the single greatest area of social and economic loss. A recent Health Canada study (Economic Burden of Illness in Canada, 1993) revealed that musculoskeletal disorders ranked second after cardiovascular disease in terms of highest cost of burden of illness in Canadian society, at over 17 billion dollars or 13.8% of the total (direct and indirect) cost of illness in 1993. Musculoskeletal conditions were found to account for over 35% of indirect costs (over 15 billion dollars) of long-term disability, by far the highest of all conditions. Morbidity costs due to back and spine long-term disability were estimated at over 4 billion dollars in 1993.

The total direct costs attributed to physicians, drugs and hospitals in the management of musculoskeletal conditions was estimated at roughly 2.5 billion dollars in 1993. Traditional medical management of back pain has been costly and ineffective. The need to shift to chiropractic care for low back pain management becomes even more apparent from a health policy perspective in light of the high costs, failure of many medical interventions, concerns about inappropriate surgery, hospitalization and prescription of drugs, and growing recognition and evidence of the efficacy of spinal manipulation.

Summary Remarks

Infantile Colic and Chiropractic

"An important new trial from the University of Southern Denmark, Odense, published in October in the Journal of Manipulative and Physiological Therapeutics (JMPT) provides compelling evidence that the disorder labeled 'infantile colic' has been misunderstood.  The pain and other symptoms of colic seem to have a musuloskeletal rather than a gastrointestinal origin. 

This new randomized, controlled trial confirms and expands the findings of a large multicenter study from Denmark 10 years ago in reporting that:

  1. Chiropractic management of newborns with infantile colic is safe and effective.
  2. Such management, involving palpation of the entire spine then adjustment of vertebral joints found to have restricted range of motion, is significantly more effective than standard medical treatment with dimethicone.

Dimethicone was used to decrease foam building in the gastrointestinal tract.  For this reason it has been presumed to reduce intestinal gases and be useful to the treatment of infants with colic.  However previous studies,3,4 and now this trial, have not been able to provide any greater effect than a placebo effect.  Manipulation causes a somatovisceral spinal reflexes that can affect motility or movement of the contents of the GI tract.  Chiropractic manipulation has now been demonstrated to be significantly better than a placebo."

* The images and information were contributed by the Canadian & Ontario Chiropractic Associations
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