Research Update from the FCERSome people call chiropractic research a contradiction in terms; others say, "How can you research a belief system?"
The truth is that chiropractic research is making some impressive strides. Slowly but surely, chiropractic is building its research capacity and beginning to shed light on the efficacy and cost effectiveness of its treatments.
Evidence has been mounting for some time that doctors of chiropractic are far more effective than doctors of medicine in returning injured workers to work. In 1975, C. Richard Wolf, M.D., published a retrospective study which demonstrated that chiropractors were twice as effective as MDs in treating injured workers. A similar result was found in a 1972 study published by Roland A. Martin, M.D., for the Oregon Workmans' Compensation Board.
In 1987, a study of more than 17,000 patients in Italy, done by MDs and chiropractors, revealed that chiropractic treatment could reduce absences from work by more than 75 percent and could also reduce the number of hospitalized patients by more than 80 percent when compared to such treatments as surgery, drugs, and physiotherapy. Other studies have confirmed these findings.
A study funded by the Foundation for Chiropractic Education and Research (FCER), "Chiropractic Versus Medical Care: A Cost Analysis of Disability and Treatment for Back-Related Workers' Compensation Cases," found that the duration of temporary, total disability, represented by the average length of the compensation period, and the indemnity payments for work days lost were substantially less for claimants treated by chiropractors when compared to those treated by medical doctors. These results have been widely distributed throughout the profession.
A remarkable study published in the British Medical Journal on June 2, 1990, has done much to establish the superiority of chiropractic treatment when compared to standard hospital out-patient treatment for managing low back pain of mechanical origin. Some 740 patients were included in this randomized controlled trial. The study was under the direction of a medical physician working with chiropractors. It compared chiropractic manipulation to physiotherapy interventions, i.e., Maitland mobilization or manipulation, or both. The results showed chiropractic to be far superior.
An important thing to note from this study is that the authors found that chiropractic could save at least $100,000,000 in treatment costs when compared to the costs associated with medical doctors and physiotherapists.
From the above examples, it can be seen that research is beginning to demonstrate efficacy and cost-effectiveness of chiropractic treatments. However, in today's health care environment, retrospective treatments are not sufficient to demonstrate a particular treatment's worth. Randomized clinical trials will be needed to convince the people who are paying the bills, government agencies, and the public. That is why the British study mentioned above is so important.
FCER did not fund the British study due to methodological flaws in the design. Nevertheless, it has proven to be an enlightening study and one that can be built upon.
The FCER is the only organization that has funded bona fide chiropractic clinical trials. In the United States, FCER has funded five clinical trials on chiropractic treatments; great pains have been taken to be certain that each trial is methodologically correct. Since the medical profession and many of its sympathizers seem to hold chiropractic up to a higher standard than they do for themselves, it is absolutely essential that the studies funded by FCER be as close to flawless as possible.
The FCER funded clinical trials are as follows:
- "Conservative Care for the Relief of Low Back Pain." Gerald N. Waagen, Ph.D., Palmer College of Chiropractic. Status: completed.
- "A Collaborative Clinical Trial on Low Back Pain." Malcolm H. Pope, D.C., University of Vermont. Status: Completed.
- "A Randomized Clinical Trial on the Efficacy of Spinal Manipulation for Chronic Low Back Pain of Mechanical Origin." John Triano, D.C., M.A., Practice Consultants Clinical Research Center at National College. Status: In Progress.
- "A Randomized Clinical Trial Comparing Chiropractic and Conservative Medical Treatment Regimens for Industrial Injuries to the Lower Back." William C. Meeker, D.C., M.P.H., Palmer-West/The Advantage Clinic. Status: In Progress.
- "Spinal Adjustments and Pharmaceutical Therapy: A Randomized Clinical Trial for the Treatment of Chronic Muscle Contraction Headaches." Patrick Boline, D.C., Northwestern College of Chiropractic. Status: In Progress.
A sixth clinical trial comparing chiropractic spinal adjustment with two types of exercise versus a pharmaceutical regime was approved for funding at FCER's June Board meeting.
Two of FCER's funded clinical trials were recently completed. The results of these studies are being presented to prestigious peer reviewed journals for publication. Publication in peer reviewed journals is tantamount to a seal of approval by other scientists. Publication in scientific journals must come before data is released to the general public, at which time FCER will release the enlightening information to the media.
As you can see from the above list of projects, some excellent applied research is under way to help validate chiropractic. Six clinical trials sound impressive, however, in reality they are far from enough to do the job. Trials are needed in a host of areas in which chiropractors treat patients. FCER is limited in its funding only by the money it is able to raise.
Another meaningful development in chiropractic research is the establishment of the Practice Consultants Clinical Research Center (PCCRC) at National College of Chiropractic. This was made possible by a $1.2 million grant to FCER by William M. Harris, D.C., and Practice Consultants, Inc., of Roswell, Georgia.
The PCCRC is a place in which clinical trials, as well as important and exciting basic research, can go forward. A recent visit to PCCRC by FCER's Director of Research, Steve Wolk, Ph.D., was most gratifying. In addition to making excellent progress on a randomized clinical trial, scientists at PCCRC are progressing well on a project concerning the mechanical modeling of the spine, and a project to refine clinical outcome measures. Another noteworthy study now under way at PCCRC is a study by Patricia Brennan, Ph.D., which has demonstrated that spinal manipulation may have a positive effect on the immune system.
In the future, FCER must address several critical issues concerning chiropractic research. They are as follows:
- There is a severe shortage of scientists in chiropractic institutions. FCER must find ways to raise additional money to create a critical mass of well-trained clinician/investigators.
- FCER needs to develop greater financial resources to fund more practical research designed to shed light on the efficacy of chiropractic treatments.
- FCER must find ways to encourage collaborative studies with scientists in related fields such as biomechanics, pathokinesiology, physical therapy, and osteopathy.
- FCER needs to place more emphasis on studying the delivery of health care, specifically chiropractic health care.
In order to do a better job of meeting the chiropractic profession's research and educational needs, FCER has embarked on a comprehensive program of strategic planning. Corporate Health Policies Group (CHPOG), who have also been contracted to evaluate federal funding policies in relation to chiropractic, have been retained to guide FCER's strategic planning process.
FCER's program to fund research and build research capacity within the chiropractic profession will soon pay big dividends. The results of its many studies will prove useful to the legislative, public relations, and lobbying efforts of the profession. The data now being generated will also be a help to the profession in its relations with third-party payers, government agencies, and in dealing with managed care. FCER's program is not research for research's sake, but rather research for the advancement of chiropractic health care.
Stephen R. Seater, C.A.E.
FCER Executive Director