CHIROPRACTIC RESEARCH INVESTIGATION:

50) Muller R, Giles LG. ‘Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes.’ J Manipulative Physiol Ther. 2005 Jan;28(1):3-11. “ CONCLUSIONS: In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit.”

51) Hoving JL, Koes BW, de Vet HC, et al. ‘Manual Therapy, Physical Therapy, or Continued Care by a General Practitioner for Patients with Neck Pain. A Randomized, Controlled Trial.” Ann Intern Med. 2002;136(10):713-22 “ CONCLUSION: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner (medication).” "At 7 weeks, the success rates were 68.3% for manual therapy, 50.8% for physical therapy, and 35.9% for continued care. Statistically significant differences in pain intensity with
manual therapy compared with continued care or physical therapy ranged from 0.9 to 1.5 on a scale of 0 to 10. Disability scores also favored manual therapy, but the differences among groups were
small. Manual therapy scored consistently better than the other two interventions on most outcome measures." http://www.annals.org/cgi/reprint/136/10/713.pdf

52) ** Koes BW, Bouter LM, et al. ‘A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures.’ J Manipulative Physiol Ther. 1992 Jan;15(1):16-23. “ Manual therapy showed a faster and larger improvement in physical functioning compared to the other three therapies (physiotherapy, a general practitioner(medication), and placebo therapy).”

53) Koes BW, Bouter LM ‘Randomised clinical trial (with placebo) of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.’ BMJ. 1992 Mar 7;304(6827):601-5. “ CONCLUSIONS--Manipulative therapy and physiotherapy are better than general practitioner (medication) and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.”

54)Hoiriis KT, et al. ‘A Randomized (Placebo-Controlled) clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.’ J Manipulative Physiol Ther. 2004;27(6):388-98. “ Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing Global Impression of Severity Scale.”

55) Hemmila HM, et al. ‘Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: a randomized controlled trial.’ J Manipulative Physiol Ther. 2002 Feb;25(2):99-104. “ CONCLUSIONS: Traditional bone-setting seemed more effective than exercise or physiotherapy on back pain and disability, even 1 year after therapy.”

56) Giles LGF, Muller R. ‘A Randomized Clinical Trial Comparing Medication Acupuncture and Spinal Manipulation.’ Spine 2003;28(14):1490-1503 “ The results of this efficacy study said just that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for the successful treatment of patients with chronic spine pain syndrome…."

57) Niemisto L, Lahtinen-Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H. “A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain.” Spine 2003; 28(19):2185-91. “Conclusion: The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation (with educational booklet) alone. The present study showed that short, specific treatment programs with proper patient information may alter the course of chronic low back pain.”

58) Triano JJ, McGregor M, Hondras MA, Brennan PC. ‘Manipulative therapy versus education programs in chronic low back pain.’ Spine. 1995 Apr 15;20(8):948-55. Conclusion: “ there appears to be clinical value to treatment according to a defined plan using manipulation even in low back pain exceeding 7 weeks' duration. ” “Greater improvement was noted in pain and activity tolerance in the manipulation group. Immediate benefit from pain relief continued to accrue after manipulation,”

59) Niemisto L, et al. “A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain.” Spine. 2003 Oct 1;28(19):2185-91. “ The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation alone (in a group of 204 chronic low back pain patients).” “ The present study showed that short, specific treatment programs with proper patient information may alter the course of chronic low back pain.”

60) Meade TW, et al. ‘Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment.’ BMJ. 1990 Jun 2;300(6737):1431-7. “CONCLUSIONS: 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. The benefit is seen mainly in those with chronic or severe pain.”

61) Meade TW, et al. ‘Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: results from extended follow-up.’ BMJ 1995; 311:349-51 “ At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.”

62) Aure OF, Nilsen JH, Vasseljen O. ‘Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up.” Spine 2003 28(6):525-31; discussion 531-2 Forty-nine patients were randomized into either an exercise group or a spinal manipulation group: “ CONCLUSIONS: …manual therapy (aka: manipulation or mobilization) showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up (1 year).” “Immediately after the 2-month treatment period, 67% in the manual therapy and 27% in the exercise therapy group had returned to work.”

63) Hawk C, Azad A, Phongphua C, Long CR. ‘Preliminary study of the effects of a placebo chiropractic treatment with sham adjustments.’ J Manipulative Physiol Ther. 1999 Sep;22(7):436-43. “ RESULTS: Although VAS and GWBS scores improved with both treatments, a somewhat greater improvement occurred in most cases with the active treatment.”

64) 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 Nov 1;27(21):2383-9. “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.”

65) Dabbs V, Lauretti WJ. ‘A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain.’ J Manipulative Physiol Ther. 1995 Oct;18(8):530-6. “ The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.”

66) Descarreaux M, et al. 'Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. 'J Manipulative Physiol Ther. 2004; 27(8):509-14. “ CONCLUSIONS: Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels.”

67) Haas M, et al. ‘Dose-response for chiropractic care of chronic low back pain.’ Spine J. 2004; 4(5):574-83. “ CONCLUSIONS: There was a positive, clinically important effect of the number of chiropractic treatments for chronic low back pain on pain intensity and disability at 4 weeks. Relief was substantial for patients receiving care 3 to 4 times per week for 3 weeks.”

68) Buchmann J, et al. 'Manual treatment effects to the upper cervical apophysial joints before, during, and after endotracheal anesthesia: a placebo-controlled comparison.' Am J Phys Med Rehabil. 2005; 84(4):251-7. “CONCLUSIONS: Both treatments (mobilization and manipulation) are superior to placebo.”

74) Page 125, Chapter 8 of the ‘Guidelines for Chiropractic Quality Assurance and Practice Parameters’ (aka: The Mercy Guidelines); Aspen publishers inc. 2005: Section VI, Subsection E.

75) Chapter 8: Page 125: Guidelines for Chiropractic Quality Assurance and Practice Parameters” (aka: The Mercy Guidelines): “…repeated use of passive care (chiropractic manipulation & PT) is generally acceptable in the management of cases undergoing prolonged recovery.”

76) Chapter 8: Page 120 – 121: Passive care - Guidelines for Chiropractic Quality Assurance and Practice Parameters” (aka: The Mercy Guidelines): “ Patients with chronic disorders may require more treatment/care to resolve symptomatic episodes than do other categories of complaint.”

77) Chapter 8: Page 125: Passive care - Guidelines for Chiropractic Quality Assurance and Practice Parameters (aka: The Mercy Guidelines): "Chronic Episode: Supportive care using passive therapy (spinal manipulation/modalities) may be necessary if repeated efforts to withdraw treatment/care result in significant deterioration of clinical status."

78) Hoving JL, Koes BW, de Vet HC, et al. “Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial.” Ann Intern Med. 2002;136(10):713-22 “CONCLUSION: In daily practice, manual therapy is a favorable treatment option for patients with neck pain compared with physical therapy or continued care by a general practitioner.”

79) Goldby L, et al. "A randomized controlled trial investigating the efficacy of manual therapy, exercises to rehabilitate spinal stabilization and an education booklet in the conservative treatment of chronic low back pain.’ In: Proceedings of International Federation of manipulative Therapists. Perth, Australia: 2000