I realize that this article is not about educational research but it does illustrate a number of research related items that we have talked ablout in class. I have underlined some parts that I think are relevant to our discussions on research methods.
LA Times -- October 8, 1998
Challenging the main reason people go to chiropractors, a major medical journal today is releasing a study showing that spinal manipulation eases back pain no better than specialized physical therapy and only a bit better than doing next to nothing.
The study--led by University of Washington researchers and published in the New England Journal of Medicine--goes against the growing acceptance of chiropractic spinal manipulation as a treatment for acute low back pain. In recent years, a federal health agency has endorsed such treatment, and many insurance companies now cover it.
The new research tracked 321 diagnosed back pain patients, and did so longer than any previous large study comparing chiropractic to an active treatment such as physical therapy or exercise. After two years, chiropractic spinal manipulation was no more effective than physical therapy or benign medical neglect at reducing missed work or preventing relapses.
In the same journal, a second study, funded by chiropractic groups, debunks the notion that spinal manipulation can ease asthma symptoms in children. Some practitioners and chiropractic textbooks have reported success with the technique.
Taken together, the two studies "temper some of the irrational exuberance on the part of the chiropractic community and their patients for spinal manipulation," said Dr. Paul Shekelle, an internist at the West Los Angeles Veterans Affairs Medical Center and a Rand Corp. analyst. He is a coauthor of several dispassionate studies of chiropractic's costs and benefits.
Chiropractic experts said they welcomed the studies as a sign that the once-scorned practice is maturing into a scientific discipline. But they also criticized the studies as unfair, saying that the chiropractic treatment was limited to just one type of spinal adjustment. By contrast, practitioners say, they typically perform many services to foster recovery.
Invented in 1895, chiropractic is based on the theory that spinal misalignments interfere with nerve function and thus contribute to a wide range of disorders. Accordingly, "adjusting" the spine fosters the body's innate healing powers.
About 20 million Americans visit chiropractors annually, and the number of practitioners has nearly doubled in the last two decades, to 55,000 in the United States, according to the American Chiropractic Assn.
Of the two studies made public today, the back pain research is the most significant, researchers said. Back pain or injury is a leading cause of disability and lost work, costing the nation tens of billions of dollars, and it is the leading reason that people visit chiropractors.
In 1994, the U.S. Agency for Health Care Policy and Research endorsed chiropractic manipulation as one of the few effective treatments for some forms of low back pain. But questions and controversy have remained. Some researchers say that the studies cited in that endorsement were too brief, did not include adequate control groups and tended to involve veteran chiropractic patients, who would have strong faith in the procedure.
The new study, funded by the same federal agency, was run by a team of researchers including a physician, a nurse practitioner, statisticians and physical therapists. They randomly assigned back pain patients who had not previously undergone chiropractic therapy to receive one of three "treatments": chiropractic spinal manipulation, a form of physical therapy involving exercises and posture changes known as McKenzie therapy, or a booklet about back pain and no further care.
On an 11-point scale of "bothersomeness," both of the treated groups improved four points after the first month. That was only slightly better than the "booklet" group, whose agony score dropped three points.
After two years, there were no significant differences among the three groups in numerous measures. For instance, they were equally likely to lose at least a day of work to back pain or to have a full relapse.
Chiropractic and physical therapy "probably do offer some marginal benefit in terms of pain relief and satisfaction with care, but . . . that doesn't translate into a significant impact on daily activities like return to work" in the long term, said Dr. Richard Deyo, a University of Washington internist and a coauthor of the study.
Moreover, he said, "care" for the untreated group cost just $1, compared to $226 for the chiropractic visits and $239 for physical therapy. "Given the limited benefits and high costs, it seems unwise to refer all patients with low back pain for chiropractic or McKenzie therapy," the researchers wrote.
Shekelle, of the VA Medical Center, said the study confirms that chiropractic spinal manipulation does provide a modicum of short-term relief for some back pain patients.
However, he said, it also "punctures" the "cherished belief" among chiropractors that the treatment is more effective and less expensive than standard medical care.
The medical journal's second study was conducted by 10 researchers based at McMaster University in Hamilton, Ontario, the Canadian Memorial Chiropractic College in Toronto and the Los Angeles College of Chiropractic.
Eighty children with mild to moderate asthma received either a legitimate chiropractic spinal adjustment or a sham treatment, where a practitioner merely moved their shoulder blades and legs.
Both "treatments" helped clear the patients' airways the same small amount, suggesting that chiropractic's previously observed successes with pediatric asthma were not the result of spinal adjustment itself. Rather, patients may be responding to the warmth and attention of the caregiver--the so-called placebo effect.
The study's lead author, Dr. Jeffrey Balon, a medical doctor and chiropractor, said this rigorous research indicates the maturing of chiropractic: "We're not afraid to critically look at what we do and live with the results, whatever they may be."