Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study

BMC Musculoskeletal Disorders

Eric L Hurwitz³  Roderic P Rochester²  Kirk Eriksen¹ 

[1] Chiropractic Health Institute, PC, Clinic Director, 2500 Flowers Chapel Road, Dothan, AL 36305, USA;Chiropractic Spine Center of North Georgia, Inc., Clinic Director, 475 S. Washington, Street, Suite C, Clarkesville, GA 30523, USA;John A. Burns School of Medicine, Department of Public Health Sciences, University of Hawaii, Mānoa, Honolulu, Hawaii 96822, USA

关键词: Upper Cervical;    Manipulation;    Symptomatic Reactions;    Adverse Effects;    Chiropractic;   

Others  :  1151916
DOI  :  10.1186/1471-2474-12-219

 received in 2011-07-27, accepted in 2011-10-05,  发布年份 2011

【 摘 要 】

Background

Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.

Methods

Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included 1) Neck pain disability index (100-point scale), 2) Oswestry back pain index (100-point scale), 3) 11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain, 4) treatment satisfaction, and 5) Symptomatic Reactions (SR). Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.

Results

A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.

Conclusions

Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks.

【 授权许可】

   
2011 Eriksen et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Senstad O, Leboeuf-Yde C, Borchgrevink CF: Side-effects of chiropractic spinal manipulation: types frequency, discomfort and course. Scand J Prim Health Care 1996, 14(1):50-3.
• [2]Senstad O, Leboeuf-Yde C, Borchgrevink C: Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997, 22(4):435-41.
• [3]Leboeuf-Yde C, Hennius B, Rudberg E, Leufvenmark P, Thunman M: Side effects of chiropractic treatment: a prospective study. J Manipulative Physiol Ther 1997, 20(8):511-5.
• [4]Barrett AJ, Breen AC: Adverse effects of spinal manipulation. J R Soc Med 2000, 93(5):258-9.
• [5]Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW: The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study. J Manipulative Physiol Ther 2007, 30(6):408-18.
• [6]Thiel HW, Bolton JE, Docherty S, Portlock JC: Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine 2007, 32(21):2375-8.
• [7]Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon H: A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine 2001, 26(7):788-99.
• [8]Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH: A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health 2002, 92(10):1634-41.
• [9]Evans R, Bronfort G, Nelson B, Goldsmith CH: 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):2383-9.
• [10]Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM: Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study. J Manipulative Physiol Ther 2004, 27(1):16-25.
• [11]Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM: Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine 2005, 30(13):1477-84.
• [12]Gemmell H, Miller P: Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial. Chiropr Osteopat 2010, 18:20. BioMed Central Full Text
• [13]Senstad O, Leboeuf-Yde C, Borchgrevink C: Predictors of side effects to spinal manipulative therapy. J Manipulative Physiol Ther 1996, 19(7):441-5.
• [14]Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW: Predictors of adverse events following chiropractic care for patients with neck pain. J Manipulative Physiol Ther 2008, 31(2):94-103.
• [15]Vohra S, Johnston BC, Cramer K, Humphreys K: Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics 2007, 119(1):e275-83.
• [16]Miller JE, Benfield K: Adverse effects of spinal manipulative therapy in children younger than 3 years: a retrospective study in a chiropractic teaching clinic. J Manipulative Physiol Ther 2008, 31(6):419-23.
• [17]Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM: A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. Arch Phys Med Rehabil 2010, 91(9):1313-8.
• [18]Christensen MG: Job analysis of chiropractic. A project report, survey analysis and summary of the practice of chiropractic within the United States. Greeley, Colorado: National Board of Chiropractic Examiners; 2000.
• [19]Eriksen K: Upper cervical subluxation complex: a review of the chiropractic and medical literature. Baltimore: Lippincott Williams & Wilkins; 2004.
• [20]Eriksen K, Rochester RP: Orthospinology procedures: an evidence-based approach to spinal care. Philadelphia: Lippincott Williams & Wilkins; 2007.
• [21]Gleberzon BJ: Chiropractic "name techniques": a review of the literature. J Can Chiropr Assoc 2001, 45(2):86-99.
• [22]Sigler DC, Howe JW: Inter- and intra-examiner reliability of the upper cervical x-ray marking system. J Manipulative Physiol Ther 1985, 8(2):75-80.
• [23]Knutson GA: An examination of the premises for chiropractic specific upper cervical technique. J Vertebral Subluxation Res 2005, 1-7.
• [24]Sansone M, Wooley JR, Grannis GH: Inter- and intra-examiner reliability of upper cervical X-ray marking system. J Manipulative Physiol Ther 1986, 9(4):285-6.
• [25]Jackson BL, Barker W, Bentz J, Gambale AG: Inter- and intra-examiner reliability of the upper cervical x-ray marking system: a second look. J Manipulative Physiol Ther 1987, 10(4):157-63.
• [26]Jackson BL, Barker WF, Gambale AG: Reliability of the upper cervical x-ray marking system: a replication study. J Clin Invest Res 1988, 1(1):10-3.
• [27]Rochester RP: Inter and intra-examiner reliability of the upper cervical x-ray marking system: a third and expanded look. Chiropr Res J 1994, 3(1):23-31.
• [28]Rochester RP, Owens EF: Patient placement error in rotation and its affect on the upper cervical measuring system. Chiropr Res J 1996, 3(2):40-53.
• [29]Harrison DE, Harrison DD, Troyanovich SJ: Reliability of spinal displacement analysis on plain x-rays: a review of commonly accepted facts and fallacies with implications for chiropractic education and technique. J Manipulative Physiol Ther 1998, 21(4):252-66.
• [30]Eriksen K: The Sigler and Howe study? Vector 1999., 2(4)
• [31]Leboeuf-Yde C, Axén I, Ahlefeldt G, Lidefelt P, Rosenbaum A, Thurnherr T: The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. J Manipulative Physiol Ther 1999, 22(9):559-64.
• [32]Hoiriis KT, Pfleger B, McDuffie FC, Cotsonis G, Elsangak O, Hinson R, Verzosa GT: A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther 2004, 27(6):388-98.
• [33]Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B: Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens 2007, 21(5):347-52.
• [34]Rochester RP: Neck pain and disability outcomes following chiropractic upper cervical care: a retrospective case series. J Can Chiropr Assoc 2009, 53(3):173-85.
• [35]Hains F, Waalen J, Mior S: Psychometric properties of the neck disability index. J Manipulative Physiol Ther 1998, 21(2):75-80.
• [36]Gay RE, Madson TJ, Cieslak KR: Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain. J Manipulative Physiol Ther 2007, 30(4):259-62.
• [37]Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001, 94(2):149-58.
• [38]Gouveia LO, Castanho P, Ferreira JJ: Safety of chiropractic interventions: a systematic review. Spine 2009, 34(11):E405-13.
• [39]Barsky AJ, Saintfort R, Rogers MP, Borus JF: Nonspecific medication side effects and the nocebo phenomenon. JAMA 2002, 287(5):622-7.
• [40]Reidenberg MM, Lowenthal DT: Adverse nondrug reactions. N Engl J Med 1968, 279(13):678-9.
• [41]Khosla PP, Bajaj VK, Sharma G, Mishra KC: Background noise in healthy volunteers--a consideration in adverse drug reaction studies. Indian J Physiol Pharmacol 1992, 36(4):259-62.
• [42]Dvorak J, Orelli F: How dangerous is manipulation to the cervical spine? Case report and results of a survey. Man Med 1985, 2:1-4.
• [43]Durrett LC: Management of patients with vertebrobasilar ischemia. Chiropr Technique 1994., 6(3, 95-7)
• [44]Assendelft WJ, Bouter LM, Knipschild PG: Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract 1996, 42(5):475-80.
• [45]Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001, 165:905-6.
• [46]Klougart N, Leboeuf-Yde C, Rasmussen LR: Safety in chiropractic practice, Part I; The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988. J Manipulative Physiol Ther 1996, 19(6):371-7.
• [47]Klougart N, Leboeuf-Yde C, Rasmussen LR: Safety in chiropractic practice. Part II: Treatment to the upper neck and the rate of cerebrovascular incidents. J Manipulative Physiol Ther 1996, 19(9):563-9.
• [48]Haldeman S, Kohlbeck FJ, McGregor M: Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J Neurol 2002, 249(8):1098-104.
• [49]Haldeman S, Kohlbeck FJ, McGregor M: Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine 2002, 27(1):49-55.
• [50]Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ: Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. J Manipulative Physiol Ther 2009, 32(2 Suppl):S201-8.
• [51]Best practices and practice guidelines. Arlington, VA: International Chiropractors Association; 2008.
• [52]Giles LG, Muller R: Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther 1999, 22(6):376-81.
• [53]McMorland G, Suter E: Chiropractic management of mechanical neck and low-back pain: A retrospective, outcome-based analysis. J Manipulative Physiol Ther 2000, 23(5):307-11.
• [54]Wood TG, Colloca CJ, Mathews R: A pilot randomized clinical trial on the relative effect of instrumental (MFMA) versus manual (HVLA) manipulation in the treatment of cervical spine dysfunction. J Manipulative Physiol Ther 2001, 24(4):260-71.
• [55]Giles LG, Muller R: Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003, 28(14):1490-1503.
• [56]Eriksen K, Owens EF: Upper cervical post x-ray reduction and its relationship to symptomatic improvement and spinal stability. Chiropr Res J 1997, 4(1):10-7.
• [57]Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, Kominski GF: Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study. Am J Public Health 2002, 92(10):1628-33.
• [58]Hurwitz EL, Morgenstern H, Yu F: Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study. Spine 2005, 30(19):2121-8.