A Sleuth of Research Supports Chiropractic

1. EFFECTIVENESS AND COST-EFFECTIVENESS
   Chiropractic spinal manipulation has been assessed extensively , both in terms of safety and effectiveness. Few other health care professions have been as thoroughly researched as chiropractic. Research has proven that chiropractic care is safe, effective and cost-effective.
   
   There has 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). Articles:
   Manga, P., Angus, D., Papadopoulos, C., Swan, W. (1993) The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Kenilworth Publishing, Ottawa.
   
   Meade, T.W., Dyer, S., Browne, W., Townsend, J., Fran, A.O. (1990) Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment", British Medical Journal, Vol. 300, pp. 1431-37.
   
   Meade, T.W., Dyer, S., Browne, W., Frank, A.O. (1995) "Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow Up", British Medical Journal, Vol. 311, pp. 349-251.
   
   Shekelle, P.G., Adams, A.H., Chassin M.R., Hurwitz, E.L., Phillips, R.B., Brook, R.H. (1991) "The Appropriateness of Spinal Manipulation for Low Back Pain. Project Overview and Literature Review", RAND, Santa Monica, California.
   
   Stano, M., Smith, M. (1996) "Chiropractic and Medical Costs of Low Back Pain", Medical Care, Vol. 34(3), pp.191-204.
   
   Jarvis, K.B., Phillips, R.B., Morris, E.K. (1991) "Cost per Case Comparison of Back Injury Claims of Chiropractic versus Medical
   Management for Conditions with Identical Diagnostic Codes", Journal of Occupational Medicine, Vol.33(8), pp.847-852.
   
   Mosley, C.D., Ilana, G.C., Arnold, R.M. (1996) "Cost-Effectiveness of Chiropractic in a Managed Care Setting", The American Journal of Managed Care, Vol.2, pp. 280-282.
   
   
2. 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. Articles:
   
   Carey, T.S., Garrett, J., Jackman, A., McLaughlin, C., Fryer, J., Smucker, D.R. (1995) "The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen By Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons", New England Journal of Medicine, Vol. 333, pp.913-917.
   
   Shekelle, P.G., Markovich, M., Louie, R. (1995) "Factors Associated with Choosing a Chiropractor for Episodes of Back Pain Care", Medical Care, Vol.33, pp.842-850.
   
   Cherkin, D.C., MacCornack, F.A. (1989) "Patient Evaluations of Low Back Pain Care from Family Physicians and Chiropractors", Western Journal of Medicine, Vol.150(3), pp.351-355.
   
   
3. 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. Articles:
   
   Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
   
   Rosen, M. et al. (1994) Back Pain. Report of a CSAG Committee on Back Pain, HMSO, London, England. Bigos, S., Bowyer, O., Braen, G., et al. (1994)
   
   Spitzer, W.O., et al. (1995) Whiplash-Associated Disorders (WAD): Redefining Whiplash and its Management: Quebec Task Force on Whiplash-Related Disorders.
   
   Royal College of General Practitioners(1996) Clinical Guidelines for the Management of Acute Low Back Pain, Great Britain.
   
   
4. UTILIZATION
   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.
   
   Research suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million).
   
   Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient. Extrapolation of research results suggests a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Articles:
   
   Eisenberg, D.M., Kessler, R.C., Foster, C., Norlock, F.E., Calkins, D.R., Delbanco, T.L. (1993) "Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use", New England Journal of Medicine, Vol. 328, pp.246-252.
   
   Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC (1998). "Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey."JAMA Nov 11;280(18):1569-75
   
   MacLennan, A.H., Wilson, D.H., Taylor, A,W. (1996) "Prevalence and Cost of Alternative Medicine in Australia", The Lancet, Vol. 347. Pp. 569-573.
   
   Millar, W. (1997) "Use of Alternative Health Care Practitioners by Canadians", Canadian Journal of Public Health, Vol. 88(3), pp.154-158.
   
   
5. CHIROPRACTIC & BACK PAIN
   Low back pain is a pervasive medical, social and economic problem afflicting about eight out of ten people at some time in their lives. Back pain occurs in most adults at some point in their lives and is one of the leading causes of disability in North America.
   
   At any given time, between 5% to 30% of the population suffers from low back pain. Low back pain has a tremendous impact on Americans 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. 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.
   
   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.
   
   
6. SUMMARY REMARKS
   Research shows that a change from managing patients with low back pain with rest and medication (as in the traditional medical paradigm) to spinal manipulation, early activity and exercise (as in the chiropractic paradigm), is now essential from the perspectives of both patient and payer.
   
   Industry, insurance and governments can save millions of dollars annually, with a shift in policy to prefer chiropractic services for patients with low back pain, since it has been scientifically proven time and again that for low back pain, chiropractic provides clinical results, cost-effectiveness and patient satisfaction.
   
   Health care policy makers must now start taking the responsible and needed leadership for making policy changes that ensure chiropractic care is available and the preferred management approach for low back pain
   

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