The Lancet
July 28, 1990, p. 220

The editors of THE LANCET review the June 2nd 1990 British Medical Journal article by Meade [immediately above], Low back pain of mechanical origin:

randomized comparison of chiropractic and hospital outpatient treatment.

The study used 741 patients. The editors of THE LANCET note:

The article “showed a strong and clear advantage for patients with chiropractic.”

The advantage for chiropractic over conventional hospital treatment was “not a trivial amount” and “reflects the difference between having mild pain, the ability to lift heavy weights without extra pain, and the ability to sit for more than one hour, compared with moderate pain, the ability to lift heavy weights only if they are conveniently positioned, and being unable to sit for more than 30 minutes.”

“This highly significant difference occurred not only at 6 weeks, but also for 1, 2, and even (in 113 patients followed so far) 3 years after treatment.”

“Surprisingly, the difference was seen most strongly in patients with chronic symptoms.”

“The trial was not simply a trial of manipulation but of management” as 84% of the hospital-managed patients had [physiotherapy] manipulations.

“Chiropractic treatment should be taken seriously by conventional medicine, which means both doctors and physiotherapists.”

“Physiotherapists need to shake off years of prejudice and take on board the skills that the chiropractors have developed so successfully.”

KEY POINTS FROM THIS ARTICLE

1) “The high incidence of back pain, its chronic and recurrent nature in many patients, and its contribution as a main cause of absence from work are well known.”

2) “For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management.”

3) The benefit of chiropractic is seen mainly in those with chronic or severe back pain.

4) In this study, the authors x-rayed all patients with back pain to rule out major structural abnormalities.

5) “Virtually all the patients treated by chiropractors received chiropractic manipulation with high velocity, low amplitude manipulation at some stage.”

6) “Patients treated by chiropractors received about 44% more treatments than those treated in hospital.”

7) In this study on back pain, some chiropractic patients were treated as long as 30 weeks.

8) Oswestry scores between the two treatment groups “shows that the change for those treated by chiropractic was consistently greater than that for those treated in the hospital.”

9) Fewer patients treated in the hospital were satisfied with their treatment or relieved with their symptoms than by those treated chiropractically.

10) If all back pain patients without manipulation contraindications were referred for chiropractic instead of hospital treatment, there would be significant annual treatment cost reductions, a significant reduction in sickness days during two years, and a significant savings in social security payments. [Important]

11) “There is, therefore, economic support for use of chiropractic in low back pain, though the obvious clinical improvement in pain and disability attributable to chiropractic treatment is in itself an adequate reason for considering the use of chiropractic.”

12) “The results leave little doubt that chiropractic is more effective than conventional hospital outpatient treatment.”

13) “The confidence intervals for the differences in Oswestry scores were wide, but the degree of improvement recorded for many of the secondary outcome measures suggests that chiropractic has appreciable benefit.”

14) “The effects of chiropractic seem to be long term, as there was no consistent evidence of a return to pretreatment Oswestry scores during the two years of follow up, whereas those treated in hospital may have begun to deteriorate after six months or a year.” [Important]

15) “Chiropractic was particularly effective in those with fairly intractable pain-that is, those with a history of severe pain. Although we have discussed the results in terms of differences at the various follow up intervals, the full effects of treatment are better thought of as an integrated benefit throughout the two year follow up period.” [Important]

16) “It is unlikely that the benefits of chiropractic are the result of biased outcome assessments or of a placebo effect.”

17) “Patients treated by chiropractors were not only no worse off than those treated in hospital but almost certainly fared considerably better and that they maintained their improvement for at least two years.” [Key Point]

18) This article “showed a strong and clear advantage for patients with chiropractic.” The advantage for chiropractic over conventional hospital treatment was “not a trivial amount.”

19) “This highly significant difference [of chiropractic over hospital management of back pain] occurred not only at 6 weeks, but also for 1, 2, and even 3 years after treatment.”

20) “Chiropractic treatment should be taken seriously by conventional medicine, which means both doctors and physiotherapists.”

21) “Physiotherapists need to shake off years of prejudice and take on board the skills that the chiropractors have developed so successfully.”