Tuesday, July 07, 1998
Study assesses limitations of chiropractic care
"A lot of people still think it's quackery and it's not going to give you any help," Sil Mior, dean of graduate studies and research at the Canadian Memorial Chiropractic College, said in an interview.
Mior helped oversee the work of 42 Canadian chiropractors in a U.S.-driven study to determine the appropriateness of manipulation of the spine for patients with low-back pain. Of 1,310 patients assessed at five metropolitan sites, 420 were from the Toronto area and the rest were from the U.S.
The study, which involved research by medical doctors, a psychologist and chiropractors, is in the current issue of the Annals of Internal Medicine. It found that nearly half of patients were being treated appropriately for low-back pain -- a rate that's "in the same ballpark" as the findings for certain medical procedures, says Dr. Paul Shekelle, an internist based at the West Los Angeles Veterans Affairs Medical Centre.
But the study also found that 29 per cent of patients were treated "inappropriately" and care was "uncertain" among the remaining 25 per cent, noted Shekelle.
"Chiropractors are appropriately treating some patients, and those patients are likely to benefit as a result of their care," Shekelle concludes about the study, which involved analysing the records of patients who sought care for low back pain between 1985 and 1991.
But he added: "Clearly, a 29 per cent inappropriateness rate is too high and should be decreased."
The study was undertaken with the help of RAND, a U.S. non-profit institution involved in research.
Chiropractic -- Greek for "accomplished by hand" -- dates back to 1895 when an Iowa healer named Daniel David Palmer was credited with curing a janitor's deafness by manipulating his displaced vertebra back into place, says the Guide to Cures and Treatments by Reader's Digest of Montreal. There are now about 4,000 chiropractors in Canada and two schools -- Toronto's Memorial College and a centre in Trois-Rivieres, Que.
But despite the fact chiropractic visits are covered at least partially by provincial health and private insurance plans, chiropractors have an undeserved reputation for "living in their own world and not being interested in any research," said Mior.
However, Pat Vollrath, a Philadelphia chiropractor commenting on the latest study, said he has seen a change in medical doctors' attitudes toward his profession.
"The medical profession does seem to appreciate that the chiropractic profession didn't get their degrees out of a Crackerjack box," he added.
Part of the bad rap can be blamed on the belief, once common among chiropractors, that spinal manipulation helps almost every ailment. The idea is that a properly aligned spine allows nerve impulses to flow unimpeded to the rest of the body.
Many physicians such as orthopedists and rehabilitation specialists also still feel chiropractic has the potential to do more harm than good, notes the Guide to Cures and Treatments.
An increase in computer use, which can result in poor posture and lead to back pain, is one reason chiropractors have heavier patient loads.
Ron Gafni, a Toronto courier-company owner, said he's "a sporty guy" who visits a chiropractic intern every month or so -- paying $10 above the provincial health plan per visit -- "just to keep my back in line." He initially was treated for low back pain at the Memorial Chiropractic College, and it took about a month for him to get relief.
But the profession suffered a setback last February when 20-year-old Laurie Jean Mathiason died in Saskatoon from an apparent stroke after having a neck adjustment at a chiropractic clinic. A coroner's inquest into the death is expected to begin Sept. 8 in Saskatoon.
Death is rare in the history of chiropractic, notes Mior. A more common adverse reaction may be soreness or discomfort that "resolves itself within a short period of time," he adds.
Because of stepped-up research in recent years, which has shown that chiropractic has its place in health care especially in uncomplicated cases of back pain, the majority of the profession has learned its limitations, stresses Mior.
Most patients still are referred to chiropractors through friends who've benefited from treatments, he says.
Facts about chiropractic:
Origins: Linked to energetic hands-on therapy widely practised by ancient healers. Chiropractic is traced back to a systemic method of spinal manipulation developed at the end of the 19th century by an Iowa healer named Daniel David Palmer.
How it works: Based on the belief that good health is founded on the unhampered flow of nerve impulses that originate in the brain and spinal cord and then travel to all parts of the body. Therapy begins with analysing the patients' spinal column for abnormal alignments of the vertebrae. Misalignments are corrected by hand-manipulation (called adjustments) to restore normal flow of nerve impulses. Many chiropractors also make recommendations about nutrition and exercise, but they don't prescribe drugs or do surgery.
Practitioners: Chiropractors are now licensed in all provinces, and there are two training centres -- in Toronto and Trois-Rivieres, Que. Studies stress the biomedical sciences and provide special training in manipulation techniques. There are about 4,000 chiropractors in Canada.
Coverage: Covered up to a point by various provincial health plans (most chiropractors charge above health-plan scales, usually from $10 to $20 a session) and private insurance plans.
Who it helps: Years ago many chiropractors believed spinal manipulation to be the preferred treatment for virtually every ailment. In recent years, most have come to recognize the therapy's limitations and research is zeroing in on when chiropractic is best (for instance, for acute low back pain). Most people consult a chiropractor because of pain that appears to originate in the musculoskeletal system, usually the neck and-or back. But chiropractic has also been shown to be useful for a range of other health problems.
Source: Guide to Medical Cures and Treatments (Reader's Digest, Montreal), Canadian Memorial Chiropractic College.
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