Government Study – The Manga Report
“Most Effective”
In 1993, the Ontario Ministry of Health funded a Canadian research project to study if chiropractic could help lower the costs of work-related injuries or improve the rehabilitation of disabled or injured workers.
This study specifically explored the effectiveness of chiropractic management of low back pain. Based on a historical review of the most significant clinical studies, the panel of researchers concluded that the approaches employed by chiropractic doctors were more effective than traditional forms of treatment. In fact, they found the most common used medical treatments have questionable value.
Besides revealing that chiropractic patients were able to return to work more quickly than those who received traditional treatment, chiropractic patients reported a high level of satisfaction with their care.
One of the most persuasive findings was the issue of safety. The study concluded that chiropractic care is safer than medical management of low back pain.
Based on the evidence, the researchers recommended that chiropractic services be fully covered under the Ontario Health Insurance Plan. Further, they concluded that chiropractic doctors should be engaged at the highest levels to assess policy and review standard and care recommendations for workers with back injuries.
The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Pran Manga, Ph.D., Douglas Angus, M.A., Costa Papadopoulos, M.H.A., William Swan, B.A., Funded by the Ontario Ministry of Health. August 1993.
“Recommended”
The results published in 1994 by the United States Agency for Health Care Policy Research, reviewed that many treatments for acute low back pain in adults. The panel consisted of medical doctors, osteopaths, nurses, physical therapist, and others familiar with the treatment of low back pain. The results of their five-year study concluded that relief “can be accomplished most safely with non prerscription medication and/or spinal manipulation.”
The panel screened over one hundred published studies relating to spinal manipulation. Using the criteria of symptomatic and functional improvement, the researcher concluded that spinal manipulation is helpful for patients with acute low back pain.
Perhaps more significant were treatments found to be ineffective and of unproven value. The panel found no evidence of benefit from physical therapy, massage, traction, ultra-sound, laser treatment, transcutaneous electrical nerve stimulation, or biofeedback techniques.
More invasive procedures were dismissed as well. There was little evidence to support the use of injections, muscle relaxers, steroids, acupuncture, or early surgical intervention. The panel found that even prolonged bed rest (more than 4 days), should be avoided.
Upon review of countless controlled randomized clinical trials, the panel concluded that restoration of spinal biomechanics, using methods like those used by chiropractic doctors, to be helpful and highly recommended.
Bigos, S., Bowyer, O., Braen, G., et al. 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. December 1994.
The British Study
“Lasting Benefits”
A three year British study involved 741 patients. Roughly half received traditional medical treatment and the other half received chiropractic care. The 1990 report observed that patients seen by chiropractic doctors were significantly better within six months and remained so during the two year follow-up period. This, and other evidence, led researcher to conclude that chiropractic care compares more favorably than traditional outpatient hospital treatment.
Published in the prestigious British Medical Journal, this study is especially important due to its size and independent nature. Besides revealing the effectiveness of chiropractic in the short-term, the lasting effect of treatment two and three years later was significant.
Researchers used the Oswestry Pain Disability Questionnaire and the results of objective range of motion testing to confirm their findings. The patients’ progress was measured by their ability to walk, lift, sit, and conduct their lives. Not only did the chiropractic patients experience better results for a longer period of time, they missed less time from work.
Based upon patients consulting chiropractic doctors instead of receiving hospital treatment, the researchers concluded that reduced absenteeism could save millions in lost production each year. Because of its effectiveness and long-term benefits, they recommended that including chiropractic in the British National Health Service should be considered.
Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment, T.W. Meade, Sandra Dyer, Wendy Browne, Joy Townsend, A.O. Frank, British Medical Journal, Volume 300, June 2, 1990, Pages 1431-1437.
“Lower Costs”
The purpose of this 1992 published study was to compare the costs between chiropractic doctors and alternative medical practitioners. Conducted by the Robins School of Business at the University of Richmond, researchers concluded that for many common back-related health problems, chiropractic is a lower cost option.
Researcher compared chiropractic care with treatment rendered by a cross-section of other types of providers during the year 1980. These included general practitioners, internists, surgeons, physicians, and non-physicians. They compared treatment of specific conditions, number of visits, costs of visits, and total money spent. When the treatment costs were compared, chiropractic care was the lowest.
Besides having the lowest per visit charges, researchers discovered that total treatment costs were lower for those receiving chiropractic care, than for those receiving care from other types of practitioners.
Researchers concluded that if chiropractic care was covered by insurance to the degree of other types of care, it would be the first choice by many patients.
A Comparison of the Costs of Chiropractors Versus Alternative Medical Practitioner, David H. Dean, Ph.D., Robert M. Schmidt, Ph.D., Bureau of Disability Economics Research, Robins School of Business, University of Richmond, January 13, 1992, Page 25.
The New Zealand Report
“Remarkably Safe”
In 1979, the government of New Zealand published an objective study of chiropractic. The purpose of its inquiry was to determine the merits of including chiropractic in its Social Security and Accident Compensation programs. Many issues were studied, including cost effectiveness, chiropractic education and training, safety issues, and patient satisfaction.
Among other things, the resulting 377 page document concluded that chiropractic would have a positive influence on the health of a country. One of the chapters was devoted towards the safety of chiropractic spinal adjustments.
The commission investigated two safety issues that had been commonly raised by chiropractic critics. The first being the safety of chiropractic spinal adjustments, and the second, the notion that seeking chiropractic care delays medical treatment. After extensive inquiry the researchers found both safety concerns to be unfounded. Because of the lack of evidence of the contrary, the commissioners determined chiropractic care to be remarkably safe.
Chiropractic in New Zealand Report of the Commission of Inquiry, 1979, Page 78.
