Chiropractic Research
The Rand Study
The Koes Clinical Trial
The AHCPR Guidline
In 1994, the Agency for Health Care Policy and Research (AHCPR), now the Agency on Health Research and Quality (AHRQ), an arm of the U.S. Department of Health and Human Services, released a clinical practice guideline for the treatment of acute low back problems. The guidelines recommend the use of spinal manipulation as an effective method of symptom control. The researchers developing the guideline found that “manipulation…is safe and effective for patients in the first month of acute low back symptoms without radiculopathy [disease of the spinal nerve roots].”3
The Manga Study
This study researched both the effectiveness and cost-effectiveness of the chiropractic management of low-back pain. Dr. Pran Manga, the study’s author, found “on the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatment for LBP [low-back pain]. Many medical therapies are of questionable validity or are clearly inadequate.”4
The Duke Study
Based on a literature review of several headache treatment options, a panel of 19 multidisciplinary experts concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headaches and had significantly fewer side effects and longer lasting relief of tension-type headache than a commonly prescribed medication. Researchers concluded the following: “Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity.“5
The Boline Study
This randomized controlled trial compared six weeks of spinal manipulative treatment of tension-type headache by chiropractors to six weeks of medical treatment with amitriptyline, a medication often prescribed for the treatment of severe tension headache pain. Researchers found that chiropractic patients experienced fewer side effects (4.3%) than the amitriptyline group (82.1%) and while both were effective during the treatment phase of the study, only the chiropractic patients continued to report fewer headaches when the treatment ended.6
The Nelson Migraine Study
This study compared chiropractic spinal manipulation to amitriptyline (a medication often prescribed for the treatment of headache) for the treatment of migraine headaches. The researchers found that “spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.” The researchers also found that in the weeks immediately following treatment, patients who had received spinal manipulation had a 42% reduction in headache frequency compared to only 24% of those who took amitriptyline.7
A Study of Education
This study examined the education provided in medical school to that provided in chiropractic school. The researchers found that “considerable commonality exists between chiropractic and medical programs.” Surprisingly, it was found that more time is spent in basic and clinical sciences in chiropractic education. Not surprisingly, chiropractic education spends more time in nutrition, while medical education spends more time in public health. In addition, little time in medical school is devoted to the study of the neuromusculoskeletal system and related problems; this is a major focus in chiropractic education.9
Chiropractors go through an immense amount of schooling to recieve a “Doctor of Chiropractic” degree (also known as a D.C.). Their collegiate agenda is as follows: A Chiropractor may opt to choose to advance their degree in an area of specialty. This chart shows an example of the number of hours served under study by Chiropractic students and Medical students. |
| Chiropractic Student Hours | Class Description | Medical Student Hours |
| 520 | Anatomy | 508 |
| 420 | Physiology | 326 |
| 271 | Pathology | 335 |
| 300 | Chemistry | 325 |
| 114 | Bacteriology | 130 |
| 370 | Diagnosis | 374 |
| 320 | Neurology | 112 |
| 217 | X-Ray | 148 |
| 65 | Psychiatry | 144 |
| 65 | Obstetrics & Gynecology | 198 |
| 225 | Orthopedics | 156 |
| 2,887 | Total Hours | 2,756 |
| 1,598 | Specialty Courses | 1,492 |
| 4,485 | Entire Total Hours | 4,248 |
A further study compared Chiropractic and Medical Education as follows:
Comparisons of the Overall Curriculum Structure for Chiropractic and Medical Schools
Chiropractic Schools | Medical Schools | |||
Mean | Percentage | Mean | Percentage | |
| Total Contact Hours | 4822 | 100% | 4667 | 100% |
| Basic science hours | 1416 | 29% | 1200 | 26% |
| Clinical science hours | 3406 | 71% | 3467 | 74% |
| Chiropractic science hours | 1975 | 41% | 0 | 0 |
| Clerkship hours | 1405 | 29% | 3467 | 74% |
Source: Center for Studies in Health Policy, Inc., Washington, DC. Personal communication of 1995 unpublished data from Meredith Gonyea, PhD.
Comparison of Hours of Basic Sciences Education in Medical and Chiropractic Schools
Subject | Chiropractic Schools | Medical Schools | ||
| Hours | % of Total | Hours | % of Total | |
| Anatomy | 570 | 40 | 368 | 31 |
| Biochemistry | 150 | 11 | 120 | 10 |
| Microbiology | 120 | 8 | 120 | 10 |
| Public Health | 70 | 5 | 289 | 24 |
| Physiology | 305 | 21 | 142 | 12 |
| Pathology | 205 | 14 | 162 | 14 |
| Total Hours | 1,420 | 100 | 1,200 | 100 |
Source: Center for Studies in Health Policy, Inc., Washington, DC. Personal communication of 1995 unpublished data from Meredith Gonyea, PhD.
The contrast between the two programs is dramatic in the area of clinical clerkships, which averaged 3,467 hours in medicine versus 1,405 hours in chiropractic. In medicine this comprises, on average, 74 percent of the total contact hours, while in chiropractic it comprises only 29 percent (Table 9). Part of the difference can be explained by the way in which the programs are structured. In chiropractic 41 percent of the program (averaging 1,975 hours) is allocated to chiropractic clinical sciences, which consists of extensive laboratory and hands-on training in manual procedures and has no equivalent in medicine. Combining the chiropractic clinical sciences with the clinical clerkships, the percentage of a chiropractic program devoted to clinical education is 70 percent compared to medicine’s 74 percent. The major difference therefore is in didactic teaching and clinical experience.
Thus, on average, medical students receive twice the number of hours in clinical experience but receive over 1,000 fewer hours in lectures and laboratory education. However, if the medical residency is included, the total number of hours of clinical experience for medicine rises to 6,413.
Source: Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M. A comparative study of chiropractic and medical education (Submitted for publication).
The IPA Study
A survey of patients of chiropractors in an independent physicans’ association found that, when asked if they would recommend their Doctor of Chiropractic to others, 95.5% of the patients said “yes.”
Other results were as high:
- Length of time to get an appointment – 84.9% said Excellent
- Access to the office by telephone – 95.5% Excellent or Very Good
- Length of wait at the office – 92.4% Excellent of Very Good
- Time spent with the doctor – 95.5% Excellent or Very Good
- Explanation of what was done at the visit – 95.5% Excellent or Very Good
- Technical skills of the provider – 98.5% Excellent or Very Good
- Personal manner of the chiropractor – 100% Excellent or Very Good
- Overall visit – 100% Excellent or Very Good
The Burton Study
Researchers interested in the value of manipulation for the treatment of lumbar disc herniation compared it to chemonucleolysis, a common medical treatment involving enzyme injection into the disc. It was concluded that “manipulation produced statistically significant greater improvement for back pain and disability in the first few weeks.” Researchers also found that manipulation provided “overall financial advantage.”11
References
Shekelle PG, Adams A, et al. The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel. RAND Corporation, Santa Monica, California 1991
Koes BW, Boulter LM, et al. British Medical Journal. March 7, 1992; Vol. 304, No. 6827, pp. 601-605.
Bigos S, Bowyer O, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14, Rockville, Maryland: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0642; December 1994.
Manga P, Angus D, et al. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. The Ontario Ministry of Health, Ottawa, Ontario, Canada, August 1993.
McCrory DC, et al. Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke University Evidence-Based Practice Center, Durham, North Carolina, January 2001.
Boline PD, Kassak K, et al. Journal of Manipulative and Physiological Therapeutics. March/April 1995; Vol. 18, No. 3, pp. 148-154.
Nelson CF, et al. Journal of Manipulative and Physiological Therapeutics. October 1998; Vol. 21, No. 8, pp. 511-519.
Wiberg JMM, et al. Journal of Manipulative and Physiological Therapeutics. October 1999; Vol. 22, No. 8, pp. 517-522.
Coulter I, et al. Alternative Therapies. September 1998; Vol. 4, No. 5, pp. 64-75.
Gaumer GL, Walker A, Su S. Journal of Manipulative and Physiological Therapeutics. May 2001; Vol. 24, No. 4, pp. 239-259.
Burton AK, et al. European Spine Journal. June 2000; Vol. 9, No. 3, pp. 202-207