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Edzard Ernst - One of the best experts on this subject based on the ideXlab platform.

  • chiropractic Spinal Manipulation what does the best evidence show
    Focus on Alternative and Complementary Therapies, 2012
    Co-Authors: Edzard Ernst
    Abstract:

    Background The evidence of effectiveness of chiropractic is controversial. Objectives To summarise all Cochrane reviews of chiropractic Spinal Manipulation. Methods The Cochrane database was searched for all Cochrane reviews of chiropractic Manipulation. Cochrane reviews with the terms ‘chiropractic’, ‘Manipulation’ or ‘manual therapy’ in the title, abstract or keywords were considered. Protocols of reviews were excluded, as were studies that did not focus specifically on chiropractic Spinal Manipulation. Data extraction was performed by the author according to predefined criteria. Results Five Cochrane reviews were eligible for inclusion. Due to clinical and statistical heterogeneity, a meta-analysis was not possible and the findings of the reviews were discussed narratively. The five reviews related to the following conditions: low back pain, asthma, dysmenorrhoea and neck pain. Each review included between three and 39 primary studies. Cautiously positive conclusions emerged for low back pain and neck pain. For the two non-Spinal conditions, the conclusions were negative. Conclusions Cochrane reviews, generally considered to be the most reliable evidence, provide limited evidence that chiropractic may be effective for low back and neck pain, but failed to support the use of chiropractic for non-Spinal conditions.

  • serious adverse events after Spinal Manipulation a systematic review of the korean literature
    Focus on Alternative and Complementary Therapies, 2010
    Co-Authors: Byungcheul Shin, Myeong Soo Lee, Taeyong Park, Edzard Ernst
    Abstract:

    The aim of this systematic review was to summarise adverse effects after Spinal Manipulation reported in the South Korean literature. The Korean literature was searched for relevant articles. Twelve articles met the inclusion criteria. They reported a total of 18 cases. In most instances, the patient made a full recovery. The implicated treatment was frequently a Spinal Manipulation technique that is an integral part of traditional Korean medicine. It is concluded that adverse effects after Spinal Manipulation are not specific to chiropractic but occur with most types of Spinal Manipulation. Incidence figures can, however, not be derived from the data available to date.

  • chiropractic Spinal Manipulation for whiplash injury a systematic review of controlled clinical trials
    Focus on Alternative and Complementary Therapies, 2010
    Co-Authors: Edzard Ernst
    Abstract:

    Keywords: Chiropractic; controlled clinical trials; Spinal Manipulation; systematic review; whiplash

  • adverse effects of Spinal Manipulation a systematic review
    Journal of the Royal Society of Medicine, 2007
    Co-Authors: Edzard Ernst
    Abstract:

    Objective To identify adverse effects of Spinal Manipulation. Design Systematic review of papers published since 2001. Setting Six electronic databases. Main outcome measures Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports. Results The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between Spinal Manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature. Conclusions Spinal Manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of Spinal Manipulation.

  • ophthalmological adverse effects of chiropractic upper Spinal Manipulation evidence from recent case reports
    Acta Ophthalmologica Scandinavica, 2005
    Co-Authors: Edzard Ernst
    Abstract:

    . Objective: Upper Spinal Manipulation (USM) is frequently used by chiropractors and other health care professionals to treat minor complaints. This systematic review aimed to summarize ophthalmological adverse effects of USM recently reported in the medical literature. Methods: Five electronic databases were searched for all case reports of ophthalmological adverse effects after USM published between January 1995 and April 2003. No language restrictions were applied. Key data from the primary publications thus located were extracted and critically evaluated. Results: Fourteen case reports were found. Clinical symptoms and signs were diverse and included loss of vision, ophthalmoplegia, diplopia and Horner's syndrome. The underlying mechanism was arterial wall dissection in most cases. The eventual outcome varied and often included permanent deficits. Causality was frequently deemed likely or certain. Conclusion: Upper Spinal Manipulation is associated with ophthalmological adverse effects of unknown frequency. Ophthalmologists should be aware of its risks. Rigorous investigations must be conducted to establish reliable incidence figures.

Gert Bronfort - One of the best experts on this subject based on the ideXlab platform.

  • cost effectiveness of Spinal Manipulation exercise and self management for Spinal pain using an individual participant data meta analysis approach a study protocol
    Chiropractic & Manual Therapies, 2018
    Co-Authors: Brent Leininger, Roni L Evans, Gert Bronfort, James S Hodges, Karen M Kuntz, John A Nyman
    Abstract:

    Spinal pain is a common and disabling condition with considerable socioeconomic burden. Spine pain management in the United States has gathered increased scrutiny amidst concerns of overutilization of costly and potentially harmful interventions and diagnostic tests. Conservative interventions such as Spinal Manipulation, exercise and self-management may provide value for the care of Spinal pain, but little is known regarding the cost-effectiveness of these interventions in the U.S. Our primary objective for this project is to estimate the incremental cost-effectiveness of Spinal Manipulation, exercise therapy, and self-management for Spinal pain using an individual patient data meta-analysis approach. We will estimate the incremental cost-effectiveness of Spinal Manipulation, exercise therapy, and self-management using cost and clinical outcome data collected in eight randomized clinical trials performed in the U.S. Cost-effectiveness will be assessed from both societal and healthcare perspectives using QALYs, pain intensity, and disability as effectiveness measures. The eight randomized clinical trials used similar methods and included different combinations of Spinal Manipulation, exercise therapy, or self-management for Spinal pain. They also collected similar clinical outcome, healthcare utilization, and work productivity data. A two-stage approach to individual patient data meta-analysis will be conducted. This project capitalizes on a unique opportunity to combine clinical and economic data collected in a several clinical trials that used similar methods. The findings will provide important information on the value of Spinal Manipulation, exercise therapy, and self-management for Spinal pain management in the U.S.

  • dose response of Spinal Manipulation for cervicogenic headache study protocol for a randomized controlled trial
    Chiropractic & Manual Therapies, 2016
    Co-Authors: Linda Hanson, Darcy Vavrek, Brent Leininger, Roni L Evans, Leslie Takaki, Craig Schulz, Gert Bronfort, Mitchell Haas, Moni B Neradilek
    Abstract:

    Background Cervicogenic headache is a prevalent and costly pain condition commonly treated by chiropractors. There is evidence to support the effectiveness for Spinal Manipulation, but the dose of treatment required to achieve maximal relief remains unknown. The purpose of this paper is to describe the methodology for a randomized controlled trial evaluating the dose–response of Spinal Manipulation for chronic cervicogenic headache in an adult population.

  • exploring patient satisfaction a secondary analysis of a randomized clinical trial of Spinal Manipulation home exercise and medication for acute and subacute neck pain
    Journal of Manipulative and Physiological Therapeutics, 2014
    Co-Authors: Brent Leininger, Roni Evans, Gert Bronfort
    Abstract:

    Abstract Objective The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction. Methods This study was a secondary analysis of patient satisfaction from a randomized trial of Spinal Manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression. Results Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal Manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care ( r = −0.75 to −0.77; R 2 = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided ( r = −0.65 to 0.67; R 2 = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak ( r = 0.17-0.38; R 2 = 0.08-0.21). Conclusions Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during Spinal Manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak.

  • supervised exercise with and without Spinal Manipulation performs similarly and better than home exercise for chronic neck pain a randomized controlled trial
    Spine, 2012
    Co-Authors: Roni Evans, Craig Schulz, Gert Bronfort, Michele Maiers, Yiscah Bracha, Kenneth H Svendsen, Richard H Grimm, Timothy A Garvey, Ensor E Transfeldt
    Abstract:

    Study design Randomized controlled trial using mixed methods. Objective To evaluate the relative effectiveness of high-dose supervised exercise with and without Spinal Manipulation and low-dose home exercise for chronic neck pain. Summary of background data Neck pain is a common global health care complaint with considerable social and economic impact. Systematic reviews have found exercise therapy (ET) to be effective for neck pain, either alone or in combination with Spinal Manipulation. However, it is unclear to what extent Spinal Manipulation adds to supervised exercise or how supervised high-dose exercise compares with low-dose home exercise. Methods Two hundred and seventy patients with chronic neck pain were studied at an outpatient clinic. Patients were randomly assigned one of the following interventions: (1) high-dose supervised strengthening exercise with Spinal Manipulation (exercise therapy combined with Spinal Manipulation therapy [ET + SMT]), (2) high-dose supervised strengthening exercise (ET) alone, or (3) low-dose home exercise and advice (HEA). The primary outcome was patient-rated pain at baseline and at 4, 12, 26, and 52 weeks. Secondary measures were disability, health status, global perceived effect, medication use, and satisfaction. Results At 12 weeks, there was a significant difference in patient-rated pain between ET + SMT and HEA (1.3 points, P 0.05; ET vs. HEA, 0.3 points, P > 0.05), linear mixed model analyses incorporating all time points yielded a significant advantage for the 2 supervised exercise groups (ET + SMT vs. HEA, P = 0.03; ET vs. HEA, P = 0.02). Similar results were observed for global perceived effect and satisfaction. Conclusion Supervised strengthening exercise with and without Spinal Manipulation performed similarly, yielding better outcomes than home exercise particularly in the short term. Various stakeholders' perspectives should be considered carefully when making recommendations regarding these therapies, taking into account side effects, preferences, and costs.

  • supervised exercise Spinal Manipulation and home exercise for chronic low back pain a randomized clinical trial
    The Spine Journal, 2011
    Co-Authors: Gert Bronfort, Craig Schulz, Roni Evans, Michele Maiers, Yiscah Bracha, Kenneth H Svendsen, Richard H Grimm, Timothy A Garvey, Edward F Owens, Ensor E Transfeldt
    Abstract:

    Abstract Background context Several conservative therapies have been shown to be beneficial in the treatment of chronic low back pain (CLBP), including different forms of exercise and Spinal manipulative therapy (SMT). The efficacy of less time-consuming and less costly self-care interventions, for example, home exercise, remains inconclusive in CLBP populations. Purpose The purpose of this study was to assess the relative efficacy of supervised exercise, Spinal Manipulation, and home exercise for the treatment of CLBP. Study design/setting An observer-blinded and mixed-method randomized clinical trial conducted in a university research clinic in Bloomington, MN, USA. Patient sample Individuals, 18 to 65 years of age, who had a primary complaint of mechanical LBP of at least 6-week duration with or without radiating pain to the lower extremity were included in this trial. Outcome measures Patient-rated outcomes were pain, disability, general health status, medication use, global improvement, and satisfaction. Trunk muscle endurance and strength were assessed by blinded examiners, and qualitative interviews were performed at the end of the 12-week treatment phase. Methods This prospective randomized clinical trial examined the short- (12 weeks) and long-term (52 weeks) relative efficacy of high-dose, supervised low-tech trunk exercise, chiropractic SMT, and a short course of home exercise and self-care advice for the treatment of LBP of at least 6-week duration. The study was approved by local institutional review boards. Results A total of 301 individuals were included in this trial. For all three treatment groups, outcomes improved during the 12 weeks of treatment. Those who received supervised trunk exercise were most satisfied with care and experienced the greatest gains in trunk muscle endurance and strength, but they did not significantly differ from those receiving chiropractic Spinal Manipulation or home exercise in terms of pain and other patient-rated individual outcomes, in both the short- and long-term. Conclusions For CLBP, supervised exercise was significantly better than chiropractic Spinal Manipulation and home exercise in terms of satisfaction with treatment and trunk muscle endurance and strength. Although the short- and long-term differences between groups in patient-rated pain, disability, improvement, general health status, and medication use consistently favored the supervised exercise group, the differences were relatively small and not statistically significant for these individual outcomes.

Paul G Shekelle - One of the best experts on this subject based on the ideXlab platform.

  • a review of the evidence for the effectiveness safety and cost of acupuncture massage therapy and Spinal Manipulation for back pain
    Annals of Internal Medicine, 2003
    Co-Authors: Daniel C Cherkin, Karen J Sherman, Richard A Deyo, Paul G Shekelle
    Abstract:

    Background: Few treatments for back pain are supported by strong scientific evidence. Conventional treatments, although widely used, have had limited success. Dissatisfied patients have, therefore, turned to complementary and alternative medical therapies and providers for care for back pain. Purpose: To provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. Data Sources: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. Study Selection: Systematic reviews of randomized, controlled trials (RCTs) that were published since 1995 and that evaluated acupuncture, massage therapy, or Spinal Manipulation for nonspecific back pain and RCTs published since the reviews were conducted. Data Extraction: Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors' conclusions). Data Synthesis: Because the quality of the 20 RCTs that evaluated acupuncture was generally poor, the effectiveness of acupuncture for treating acute or chronic back pain is unclear. The three RCTs that evaluated massage reported that this therapy is effective for subacute and chronic back pain. A meta-regression analysis of the results of 26 RCTs evaluating Spinal Manipulation for acute and chronic back pain reported that Spinal Manipulation was superior to sham therapies and therapies judged to have no evidence of a benefit but was not superior to effective conventional treatments. Conclusions: Initial studies have found massage to be effective for persistent back pain. Spinal Manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or Spinal Manipulation, may reduce the costs of care after an initial course of therapy.

  • a review of the evidence for the effectiveness safety and cost of acupuncture massage therapy and Spinal Manipulation for back pain
    Annals of Internal Medicine, 2003
    Co-Authors: Daniel C Cherkin, Karen J Sherman, Richard A Deyo, Paul G Shekelle
    Abstract:

    Massage seems to be effective for persistent back pain, Spinal Manipulation has small clinical benefits equivalent to those of other common back pain therapies, and the effectiveness of acupuncture...

  • congruence between decisions to initiate chiropractic Spinal Manipulation for low back pain and appropriateness criteria in north america
    Annals of Internal Medicine, 1998
    Co-Authors: Paul G Shekelle, Eric L Hurwitz, Alan H Adams, Ian D Coulter, Barbara Genovese, Silvano Mior, Robert H Brook
    Abstract:

    Background: Recent U.S. practice guidelines recommend Spinal Manipulation for some patients with low back pain. If followed, these guidelines are likely to increase the number of persons referred f...

  • the appropriateness of chiropractic Spinal Manipulation for low back pain a pilot study
    Journal of Manipulative and Physiological Therapeutics, 1995
    Co-Authors: Paul G Shekelle, Eric L Hurwitz, Alan H Adams, Ian D Coulter, Barbara Genovese, Robert H Brook
    Abstract:

    OBJECTIVE Spinal Manipulation is an efficacious therapy for some patients with low back pain (LBP). In this pilot study, we tested the feasibility of assessing the appropriateness of chiropractic Spinal Manipulation for patients with LBP. METHODS Criteria for the appropriate and inappropriate use of Spinal Manipulation for low back pain were developed using the RAND/UCLA appropriateness method. Two separate expert panels, one multidisciplinary and one all chiropractic, each rated a comprehensive array of clinical scenarios for appropriateness. A random sample of practicing chiropractors was selected, and data were collected from ten randomly selected office records from each participating clinician. Assessment of the appropriateness for the use of Spinal Manipulation was made by comparing the care delivered with the appropriateness criteria determined by each expert panel. RESULTS Eight of thirteen (62%) eligible chiropractors agreed to participate. For the remainder, by the multidisciplinary panel's criteria, 38% of care was appropriate and 26% of care was inappropriate. By the all-chiropractic panel's criteria, the same cases were judged 74% appropriate and 7% inappropriate. The two panel's appropriateness ratings were in agreement on 48% of all cases. CONCLUSIONS In this geographic area, the rate of appropriate care is between 38% and 74% and the rate of inappropriate care is between 7% and 19%, depending on the criteria used to assess appropriateness. Data from other geographic areas of the U.S. will be needed before inferences to a larger population may be drawn, and we have demonstrated that such a study is feasible.

  • Spinal Manipulation for low back pain
    Annals of Internal Medicine, 1992
    Co-Authors: Paul G Shekelle, Eric L Hurwitz, Alan H Adams, Mark R Chassin, Robert H Brook
    Abstract:

    Abstract ▪Purpose:To review the use, complications, and efficacy of Spinal Manipulation as a treatment for low-back pain. ▪Data Identification:Articles were identified through a MEDLINE search, rev...

Roni Evans - One of the best experts on this subject based on the ideXlab platform.

  • exploring patient satisfaction a secondary analysis of a randomized clinical trial of Spinal Manipulation home exercise and medication for acute and subacute neck pain
    Journal of Manipulative and Physiological Therapeutics, 2014
    Co-Authors: Brent Leininger, Roni Evans, Gert Bronfort
    Abstract:

    Abstract Objective The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction. Methods This study was a secondary analysis of patient satisfaction from a randomized trial of Spinal Manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression. Results Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal Manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care ( r = −0.75 to −0.77; R 2 = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided ( r = −0.65 to 0.67; R 2 = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak ( r = 0.17-0.38; R 2 = 0.08-0.21). Conclusions Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during Spinal Manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak.

  • supervised exercise with and without Spinal Manipulation performs similarly and better than home exercise for chronic neck pain a randomized controlled trial
    Spine, 2012
    Co-Authors: Roni Evans, Craig Schulz, Gert Bronfort, Michele Maiers, Yiscah Bracha, Kenneth H Svendsen, Richard H Grimm, Timothy A Garvey, Ensor E Transfeldt
    Abstract:

    Study design Randomized controlled trial using mixed methods. Objective To evaluate the relative effectiveness of high-dose supervised exercise with and without Spinal Manipulation and low-dose home exercise for chronic neck pain. Summary of background data Neck pain is a common global health care complaint with considerable social and economic impact. Systematic reviews have found exercise therapy (ET) to be effective for neck pain, either alone or in combination with Spinal Manipulation. However, it is unclear to what extent Spinal Manipulation adds to supervised exercise or how supervised high-dose exercise compares with low-dose home exercise. Methods Two hundred and seventy patients with chronic neck pain were studied at an outpatient clinic. Patients were randomly assigned one of the following interventions: (1) high-dose supervised strengthening exercise with Spinal Manipulation (exercise therapy combined with Spinal Manipulation therapy [ET + SMT]), (2) high-dose supervised strengthening exercise (ET) alone, or (3) low-dose home exercise and advice (HEA). The primary outcome was patient-rated pain at baseline and at 4, 12, 26, and 52 weeks. Secondary measures were disability, health status, global perceived effect, medication use, and satisfaction. Results At 12 weeks, there was a significant difference in patient-rated pain between ET + SMT and HEA (1.3 points, P 0.05; ET vs. HEA, 0.3 points, P > 0.05), linear mixed model analyses incorporating all time points yielded a significant advantage for the 2 supervised exercise groups (ET + SMT vs. HEA, P = 0.03; ET vs. HEA, P = 0.02). Similar results were observed for global perceived effect and satisfaction. Conclusion Supervised strengthening exercise with and without Spinal Manipulation performed similarly, yielding better outcomes than home exercise particularly in the short term. Various stakeholders' perspectives should be considered carefully when making recommendations regarding these therapies, taking into account side effects, preferences, and costs.

  • supervised exercise Spinal Manipulation and home exercise for chronic low back pain a randomized clinical trial
    The Spine Journal, 2011
    Co-Authors: Gert Bronfort, Craig Schulz, Roni Evans, Michele Maiers, Yiscah Bracha, Kenneth H Svendsen, Richard H Grimm, Timothy A Garvey, Edward F Owens, Ensor E Transfeldt
    Abstract:

    Abstract Background context Several conservative therapies have been shown to be beneficial in the treatment of chronic low back pain (CLBP), including different forms of exercise and Spinal manipulative therapy (SMT). The efficacy of less time-consuming and less costly self-care interventions, for example, home exercise, remains inconclusive in CLBP populations. Purpose The purpose of this study was to assess the relative efficacy of supervised exercise, Spinal Manipulation, and home exercise for the treatment of CLBP. Study design/setting An observer-blinded and mixed-method randomized clinical trial conducted in a university research clinic in Bloomington, MN, USA. Patient sample Individuals, 18 to 65 years of age, who had a primary complaint of mechanical LBP of at least 6-week duration with or without radiating pain to the lower extremity were included in this trial. Outcome measures Patient-rated outcomes were pain, disability, general health status, medication use, global improvement, and satisfaction. Trunk muscle endurance and strength were assessed by blinded examiners, and qualitative interviews were performed at the end of the 12-week treatment phase. Methods This prospective randomized clinical trial examined the short- (12 weeks) and long-term (52 weeks) relative efficacy of high-dose, supervised low-tech trunk exercise, chiropractic SMT, and a short course of home exercise and self-care advice for the treatment of LBP of at least 6-week duration. The study was approved by local institutional review boards. Results A total of 301 individuals were included in this trial. For all three treatment groups, outcomes improved during the 12 weeks of treatment. Those who received supervised trunk exercise were most satisfied with care and experienced the greatest gains in trunk muscle endurance and strength, but they did not significantly differ from those receiving chiropractic Spinal Manipulation or home exercise in terms of pain and other patient-rated individual outcomes, in both the short- and long-term. Conclusions For CLBP, supervised exercise was significantly better than chiropractic Spinal Manipulation and home exercise in terms of satisfaction with treatment and trunk muscle endurance and strength. Although the short- and long-term differences between groups in patient-rated pain, disability, improvement, general health status, and medication use consistently favored the supervised exercise group, the differences were relatively small and not statistically significant for these individual outcomes.

  • 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
    Co-Authors: Roni Evans, Gert Bronfort, Brian Nelson, Charles H Goldsmith
    Abstract:

    STUDY DESIGN Randomized clinical trial. OBJECTIVES To compare the effects of Spinal Manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or Spinal Manipulation alone in patient self-reported outcomes over a two-year follow-up period. SUMMARY OF BACKGROUND DATA There have been few randomized clinical trials of Spinal Manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes. METHODS One hundred ninety-one patients with chronic neck pain were randomized to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement, satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3, 6, 12, and 24 months after treatment. Data were analyzed taking into account all time points using repeated measures analyses. RESULTS Ninety-three percent (178) of randomized patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain with no group-time interaction was observed in favor of the two exercise groups [F(2141) = 3.2; P= 0.04]. There was also a group difference in satisfaction with care [F(2143) = 7.7; P= 0.001], with Spinal Manipulation combined with low-tech rehabilitative exercise superior to MedX rehabilitative exercise (P = 0.02) and Spinal Manipulation alone (P < 0.001). No significant group differences were found for neck disability, general health status, improvement, and OTC medication use, although the trend over time was in favor of the two exercise groups. CONCLUSION The results of this study demonstrate an advantage of Spinal Manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus Spinal Manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how Spinal Manipulation compares to no treatment or minimal intervention.

  • the efficacy of Spinal Manipulation amitriptyline and the combination of both therapies for the prophylaxis of migraine headache
    Journal of Manipulative and Physiological Therapeutics, 1998
    Co-Authors: Craig F Nelson, Gert Bronfort, Roni Evans, P D Boline, Charles H Goldsmith, A V Anderson
    Abstract:

    Background Migraine headache affects approximately 11 million adults in the United States. Spinal Manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown. Objective To measure the relative efficacy of amitriptyline, Spinal Manipulation and the combination of both therapies for the prophylaxis of migraine headache. Design A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period. Setting Chiropractic college outpatient clinic. Participants A total of 218 patients with the diagnosis of migraine headache. Interventions An 8-wk course of therapy with Spinal Manipulation, amitriptyline or a combination of the two treatments. Main outcome measures A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period. Results Clinically important improvement was observed in both primary and secondary outcomes in all three study groups over time. The reduction in headache index scores during treatment compared with baseline was 49% for amitriptyline, 40% for Spinal Manipulation and 41% for the combined group; p = .66. During the posttreatment follow-up period the reduction from baseline was 24% for amitriptyline, 42% for Spinal Manipulation and 25% for the combined group; p = .05. Conclusion There was no advantage to combining amitriptyline and Spinal Manipulation for the treatment of migraine headache. Spinal Manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

E Ernst - One of the best experts on this subject based on the ideXlab platform.

  • Spinal Manipulation for asthma a systematic review of randomised clinical trials
    Respiratory Medicine, 2009
    Co-Authors: E Ernst
    Abstract:

    Some clinicians believe that Spinal Manipulation is an effective treatment for asthma. The aim of this systematic review was to critically evaluate the evidence for or against this claim. Four electronic databases were searched without language restrictions from their inceptions to September 2008. Bibliographies and departmental files were hand-searched. The methodological quality of all included studies was assessed with the Jadad score. Only randomised clinical trials of Spinal Manipulation as a treatment of asthma were included. Three studies met these criteria. All of them were of excellent methodological quality (Jadad score 5) and all used sham-Manipulation as the control intervention. None of the studies showed that real Manipulation was more effective than sham-Manipulation in improving lung function or subjective symptoms. It is concluded that, according to the evidence of the most rigorous studies available to date, Spinal Manipulation is not an effective treatment for asthma.

  • chiropractic Spinal Manipulation for infant colic a systematic review of randomised clinical trials
    International Journal of Clinical Practice, 2009
    Co-Authors: E Ernst
    Abstract:

    Some chiropractors claim that Spinal Manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

  • a systematic review of systematic reviews of Spinal Manipulation
    Journal of the Royal Society of Medicine, 2006
    Co-Authors: E Ernst, P H Canter
    Abstract:

    Objectives: To systematically collate and evaluate the evidence from recent systematic reviews of clinical trials of Spinal Manipulation. Design: Literature searches were carried out in four electronic databases for all systematic reviews of the effectiveness of Spinal Manipulation in any indication, published between 2000 and May 2005. Reviews were defined as systematic if they included an explicit and repeatable inclusion and exclusion criteria for studies. Results: Sixteen papers were included relating to the following conditions: back pain (n=3), neck pain (n=2), lower back pain and neck pain (n=1), headache (n=3), non-Spinal pain (n=1), primary and secondary dysmenorrhoea (n=1), infantile colic (n=1), asthma (n=1), allergy (n=1), cervicogenic dizziness (n=1), and any medical problem (n=1). The conclusions of these reviews were largely negative, except for back pain where Spinal Manipulation was considered superior to sham Manipulation but not better than conventional treatments. Conclusions: Collectively these data do not demonstrate that Spinal Manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that Spinal Manipulation is a recommendable treatment.

  • chiropractic Spinal Manipulation for back pain
    British Journal of Sports Medicine, 2003
    Co-Authors: E Ernst
    Abstract:

    The effectiveness of chiropractic Spinal Manipulation for back pain is uncertain Sports medicine clinicians with varied training include joint mobilisation and Manipulation among their therapeutic skills. Examples include chiropractors, physiotherapists, and osteopaths, not to mention the doctors and massage therapists who treat various joint pathologies. Although athletes rarely have osteoporosis, the broad field of sports medicine includes the use of exercise therapies and treatment of the musculoskeletal system in people of all ages. Therefore this leader focuses on the role of chiropractic joint Manipulation. Back pain sufferers from more than 60 countries consult chiropractors.1 A booklet by the British Chiropractic Association boldly states that “95% of back pain is mechanical in origin, and can be treated by a chiropractor in a primary care setting”.2 Yet there are many who doubt such promotional statements. A recent, perhaps more sober, assessment of the data reads differently: “43 randomised trials of Spinal Manipulation for treatment of acute, subacute and chronic low back pain have been published. 30 favoured Manipulation over the comparison treatment in at least a subgroup of patients and the other 13 found no significant differences”.3 However, these trials used mostly non-chiropractic Spinal Manipulation. The only systematic review of exclusively chiropractic Spinal Manipulation concluded that “the available RCTs provided no convincing evidence of the effectiveness of chiropractic for acute or chronic low back pain”.4 Since the publication of this article, the emerging trial data have not tended to be encouraging. The effectiveness of chiropractic Spinal Manipulation for back pain is …