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A Question of Ethics
Recently, after I had finished teaching a class on ethics, I  read a blog post on the AAAOM
website regarding "gainful employment." The published information made me reflect on what I had just discussed with the students — the acupuncturists' ethical responsibility to the patient, the profession and the public.
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Chiropractic Research Review

Neck Pain: Manipulation Plus Exercise Better Than Either Alone

Neck pain afflicts roughly 70% of adults at some point in their lives; for nearly 14%, the pain is chronic. This randomized clinical trial studied the effectiveness of spinal manipulation alone compared to the combination of spinal manipulation plus rehabilitative exercises and to a high-tech rehabilitative exercise program for treating neck pain.

The study involved 20- to 65-year-old subjects with mechanical neck pain of at least 12 weeks duration. All patients completed 20 one-hour appointments over an 11-week period. The 191 patients were randomized into three groups, as follows:

* Spinal Manipulation Therapy (SMT) Alone: Spinal manipulation and light soft-tissue massage from experienced chiropractic clinicians.
* Manipulation Plus Rehabilitative Exercise: Spinal manipulation as described above, plus rehabilitative exercise from trained exercise therapists. Sessions included warm-up, stretching and dynamic neck exercises consisting of extension, flexion and rotation movements while wearing headgear with 1.25- to 10-pound weight attachments.
* MedX Rehabilitative Exercise: Warm-up stretching exercise and neck exercises using a variable resistance, cervical extension and rotation machine, designed by the MedX Corporation of Ocala, Fla.

Subjects were evaluated by self-report questionnaires, neck range of motion, neck strength and neck muscle endurance at baseline and five and 11 weeks after beginning treatment. At three, six, 12 and 24 months following treatment, subjects completed self-report questionnaires, such as the Neck Disability Index and the SF-36 D form, on pain, satisfaction with care and disability. Satisfaction was determined on a seven-point scale, ranging from "completely satisfied" to "completely dissatisfied."

Patient-rated pain differed between groups, in favor of the two exercise groups. SMT plus exercise provided greater satisfaction than SMT alone or MedX exercises, however. The advantage of both SMT/exercise and MedX over manipulation alone continued over the two-year follow-up period. Overall, the exercise groups benefited more regarding pain, disability, improvement and health status.

The researchers admit that the pain results fall slightly short of clinical significance, yet note that clinically significant differences favoring SMT plus exercise over both other treatments were seen for patient satisfaction.

Evans R, Bronfort G, et al. Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain. Spine 2002:27(21), pp. 2383-2389. www.spinejournal.com

Chiropractic Research Review

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