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Chiropractic Research Review

Research Vital at the Chiropractic "Crossroads"

Chiropractic is the principal and most-regulated form of complementary and alternative medicine (CAM). There are currently about 60,000 DCs, and this number is expected to reach 100,000 by the year 2010.

The profession is at a "crossroads," however, exhibiting characteristics of both an alternative health care system and a mainstream form of health care.

This review of chiropractic briefly covers the history, training, methods, research, and future of chiropractic. The authors point out several important facts and figures reflecting professional trends. For example, the percentage of Americans who use chiropractic increased from approximately 3.6% in 1980 to 11% in 1997; over 50% of HMOs and over 75% of individual health insurance plans currently cover chiropractic services; and Australia, Canada, Denmark, Great Britain, and South Africa all offer at least one government-sponsored chiropractic college, yet all chiropractic colleges in the U.S. remain privately funded.

This study highlights the necessity of research in furthering the profession, and claims that 73 randomized clinical trials on spinal manipulation are found in the English literature. The authors write, "Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation." They offer key figures from this group of studies:

* Forty-three randomized studies on the efficacy of spinal manipulation at treating low back pain (LBP) have been published; 30 of these showed manipulation to be favorable to other treatments, 13 found no major effects, and none showed manipulation to be less effective than the comparison treatment.
* Eleven of the LBP studies included a placebo group; of these, eight indicated an advantage of manipulation over placebo.
* Regarding neck pain, 11 randomized, controlled trials have shown that manipulation had insignificant effects in seven cases, and improved findings in four cases.
* Seven of the nine studies on the efficacy of manipulation for treating headache showed positive results.
* Serious complications from adjustments are rare: about one per 100 million lumbar adjustments, and one per 400,000 to 10 million cervical manipulations.

Conclusion: "In today's dynamic health care milieu, chiropractic stands at the crossroads of mainstream and alternative medicine. Its future role will probably be determined by its commitment to interdisciplinary cooperation and science-based practice," the authors conclude.

Note: This is one of just two articles on chiropractic ever published in the Annals of Internal Medicine. While it is intended to be an overview of the profession, chiropractors will find some of the information summarized nicely for discussions with other health care providers.

Meeker WC, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine 2002:136(3), pp. 216-227.

Chiropractic Research Review

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