Research
Meade et al (1995) Randomised comparison of
chiropractic and hospital outpatient treatment for
low back pain: results from extended follow up. BMJ
311; 349-351
Funded by the MRC, confirmed the findings of the earlier report.
RCGP (1999) Clinical Guidelines for the Management
of Acute Low Back Pain
Funded by the Royal College of General Practitioners proved
that the risks of manipulation are very low in skilled hands and
it can provide short-term improvement in pain and activity
levels and higher patient satisfaction.
UK BEAM Trial Team (2004) United Kingdom back
pain exercise and manipulation (UK BEAM)
randomised trial: effectiveness of physical
treatments for back pain in primary care. BMJ
329:1377
Funded by the MRC, showed that exercise was better than “best
care” in general practice at three months. Adding manipulation
there was further improvement at three months and at 12
months.
UK BEAM Trial Team (2004) United Kingdom back
pain exercise and manipulation (UK BEAM)
randomised trial: cost effectiveness of physical
treatments for back pain in primary care. BMJ
329:1381
Spinal manipulation is a cost effective addition to “best care”
for back pain in general practice. Manipulation alone probably
gives better value for money than manipulation followed by
exercise.
NICE (2006) IPG 183 – Non-rigid stabilisation
techniques for the treatment of low back pain –
guidance
Results showed that chiropractic intervention and posture
training can limit episodes of acute pain. Spinal rehabilitation
can also be beneficial.
Department of Health (2006) Musculoskeletal
Services Framework
Showed that chiropractors provide evidence-based, timely and
effective assessment, diagnosis and management of certain
musculoskeletal disorders.
Low back pain: early management of persistent non-
specific low back pain
NICE guidelines May 2009
The evidence-based recommendations include the following:
Provide people with advice and information to promote self-
management of their low back pain.
Consider offering a course of manual therapy including spinal
manipulation of up to 9 sessions over up to 12 weeks
Consider offering a course of acupuncture needling comprising
up to 10 sessions over a period of up to 12 weeks
Consider offering a structured exercise programme tailored to
the individual.
European Commission Research Directorate General
(2004) European Guidelines for the management of
chronic non-specific low back pain in primary care
(2004)
Recommendation: Consider a short course of spinal
manipulation/mobilisation as a treatment option for chronic
low back pain.
European Commission Research Directorate General
(2004) European Guidelines for the management of
acute non-specific low back pain in primary care
Findings were not to prescribe bed rest but advise patients to
continue normal activities and take pain relief and muscle
relaxants, as required. Also to consider referral for spinal
manipulation.
- See
Research 1
UK BEAM Reportfor more information.
Research 2
Headachesfor more information.
Research 3
Manga Reportfor more information.
Research 4
Tendonopathy & Neo-vascularisation for more information.
Diagnostic Imaging
What we treat & how Where indicated, Diagnostic Imaging is sought including MRi, Ultrasound, CT Scanning and X-ray.
NW3 Chiropractic Refers to London Imaging (Wimpole St) and Sports Care Clinic at the London Independent Hospital, Stepney Green E1.
Magnetic Resonance Imaging is a non-invasive, non-contact multi-planar imaging technique which does not involve radiation. MRi is capable of producing high resolution, high contrast images in serial contiguous slices. This aspect of MRi allows us to ‘scroll’ through a body or body part and enables specific identification of normal and abnormal anatomy and its position. MRi also allows us to view both soft tissue and bony tissue (with specificity depending on settings eg T1, T2, FSE etc).
Tendonopathy & Neovascularisation
Ultrasound and Doppler Flow investigations, in cases of chronic tendonopathy (such as the Patellar and Achilles), have shown neo-vascularisation (new vessel formation) and tendon thickening. ‘C’ pain fibres associated with these new blood vessels are thought to be main mediators for pain in chronic sufferers. Additionally, an increase in the Type III : Type I Collagen Fibre ratio is thought occur which may be a precursor to eventual calcification of the tendon.
Click here for more information.
Injections of high volume Homeopathic/Cortisone solutions intratendonously, are designed to physically destroy the new blood vessels and arrest what appears to be an otherwise self-propogating phenomenon. At NW3 Chiropractic, we use vibration therapy to mimick in part the destruction of neovascularisation. It should be noted that we have conducted no clinical trials to support this hypothesis as yet. We have found however, that patients suffering tendonopathy respond positively to vibration therapy.
Manga Report
The Manga Study
Manga P, Angus D. “Enhanced Chiropractic Coverage under OHIP as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services.” Report to The Ontario Ministry of Health. February, 1998.
The Manga study evolved in response to the deterrent effect of high insurance co-payments or user fees for chiropractic care which represented a major barrier to access for most Ontarians (Canada). Patients were often steered away from chiropractic care to medical management which is free under OHIP.
The Ontario Chiropactic Association, Canada proposed improved access to chiropractic services through enhanced coverage under OHIP. Specifically that OHIP would cover 75% of the fee per visit, 100% for the elderly and the poor. This reform will result in the doubling of the proportion of the public that visits chiropractors in Ontario from 10% to 20%. It will also mean that these patients will visit chiropractors sooner for their problems. Currently 4 out of 5 chiropractic patients have had their disorders for over 6 months and many have already had extensive medical diagnosis and treatment.
This study postulates that this expenditure to improve access to chiropractic services and the changed utilisation patterns it produces, will lead to very substantial net savings in direct and indirect costs. Direct savings to Ontario’s health care system may be as much as $770 million, will very likely be $548 million, and will be at least $380 million. The corresponding savings in indirect costs – made up of the short and long term costs of disability – are $3.775 billion, $1.849 billion and $1.255 billion.
The reasons why such substantial savings will accrue include:
Approximately 95% of chiropractic practice in Ontario involves the management of patients with neuromusculoskeletal disorders and injuries.
Musculoskeletal disorders and injuries are the second and third most costly categories of health problems in economic burden of illness studies. Musculoskeletal disorders are also among the most important reasons for activity limitations and short-term disability. They rank first in prevalence in chronic health problems and first as a cause of long-term disability.
Musculoskeletal disorders rank first as a reason for consultation with a health professional in Ontario, and rank second as a reason for the use of prescription and non-prescription drugs.
The poor and lower-middle income groups and the elderly are low users of chiropractic mainly due to the deterrent effect of the high copayments or user fees. Yet the prevalence of neuromusculoskeletal conditions is highest among these socio-economic groups.
There is considerable empirical support for the cost-effectiveness and the safety of chiropractic management of musculoskeletal disorders. This means that chiropractic care can bring about improved health outcomes at a lower cost.
The proposed reform is consistent with the Government of Ontario’s health care reform agenda and business plan. The reduction in health care costs is consistent with the Government’s emphasis on value for money and its objectives of reducing hospital and drug expenditure, and the fiscal objectives of reducing the deficit and the levels of taxation.
An interesting variation and an improvement on the OCA’s proposed reform is to make the patient’s first visit to a chiropractor free of any co-payment. This would further enhance access and increase net savings. It has been suggested that The Ministry of Health of Ontario should employ chiropractors on a salaried basis in hospitals, community health centers, and long-term care institutions.
More workers with neuromusculoskeletal disorders covered by the Workers’ Safety and Insurance Board should be channelled to chiropractic care.
Medical doctors and chiropractors are both substitutes for and complementary to each other in the management of neuromusculoskeletal conditions and injuries. Interprofessional relations between the two have improved over the years, and is evidenced by official pronouncements and greater inter-referral of patients between the two professions.
Significant reduction of health care costs, improved health outcomes, and equitable access to services are all important objectives for the Ontario health care system. Any one would be sufficient reason for the proposed reform in funding for chiropractic services. The fact that this reform meets all three objectives makes the case urgent and compelling.
Headache
Headaches HEADACHE RESEARCH – Clinical Trial Shows Chiropractic Helps Migraines
A clinical trial reported in Medical-News.net on May 22, 2005 showed that 72% of migraine sufferers experienced either ‘substantial’ or ‘noticeable’ improvement after a period of chiropractic care. The study was a randomized clinical trial completed over a 20 year period. Dr. Peter Tuchin, was the chief researcher and presented his results in a thesis at Macquarie University in Australia.
The study involved 123 migraine sufferers, which was reduced down from aproximately 1000 who applied to be part of the study after responding to a television program about the research. The 123 participants were further divided into two groups. One group received chiropractic care while the other group was a control group who did not receive any actual care but were told they were receiving a form of electrical physical therapy.
In commenting on the results, Dr. Peter Tuchin, a chiropractor for the past 20 years stated, “Around 22 per cent [of patients] had substantial reduction – which means that more than 60 percent of their symptoms reduced during the course of the treatment. What makes this a really strong result is that this was a very chronic group – the average length of time they’d had migraines being 18 years. To get a change of that sort of magnitude in a really chronic group was quite amazing.”
In this study Dr. Tuchin went to great lengths to document the results. He explained, “Both groups kept a record of their migraines for the whole six months, noting down how often they got them, how severe they were, how long they lasted, and if there was anything they could think of that contributed to them,” Tuchin explains. “For two months prior to any treatment they just diarised their migraines, followed by two months of treatment and then two months of post-treatment”
Dr. Tuchin summed up the results of the study by saying, “Chiropractic is not the be all and end all, but for a good percentage of migraine sufferers the neck is a significant contributing factor, and for them chiropractic treatment is really effective. I’m not saying that everybody’s going to be cured, but there’s very little to lose.”
Other studies by Dr Peter Tuchin include CHIROPRACTIC MANAGEMENT OF MIGRAINE WITHOUT AURA
A Case Study
Peter Cattley, B.Sc. and Peter J. Tuchin, B.Sc., Grad.Dip.(Chiro.), Dip.(O.H.S.).
Visit: PubMedCentral – CHIROPRACTIC MANAGEMENT OF MIGRAINE WITHOUT AURA for more information.