The British Chiropractic Association has a Research page on their website. It contains references to “a selection of research papers and reports of relevance and interest”. Let’s take a closer look.
Here’s a rough guide to the make-up of their research page:
|Report||Clinical Standards Advisory Group|
|Report||Wiltshire and Bath Health Commission|
|Guidelines||Faculty of Occupational Medicine|
|Trial||Journal of the Neuromusculoskeletal System*****|
|Guidelines||Department of Health|
|Guidelines||EC Research Directorate Council|
*Here are Edzard Ernst’s comments on the BEAM trial:
“Three brief comments on the excellent BEAM Trial. My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se. It would be relevant to know which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question. It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation. If that is the case, such adverse events might also influence GP’s referrals.” [Link.]
**There is some criticism of this trial here: pubmed/1833493.
***The follow-up trial by Meade et al is discussed here: BMJ and the author of the letter states that:
Unfortunately, their report is far from convincing. The “headline” advantage of chiropractic over hospital management at three years (29%) sounds impressive but refers to an improvement of three points on the 100 point Oswestry scale, or one and a half responses on the questionnaire. This difference may be statistically significant but is clinically trivial.
****The RCGP withdrew those guidelines in 2005 – pdf – it remains to be seen whether these guidelines will be reinstated.
*****I failed to find this journal on Pubmed. According to worldcat.org, it is a journal of the American Chiropractic Association. [Link.]
So, the research page of the British Association of Chiropractors seems to have (as far as I can tell) references to: three randomised trials, one other trial (randomisation not specified), some clinical guidelines (at least one set of which has been withdrawn in 2005 and may or may not reappear), and some reports. This is fine – there’s nothing wrong with making reference to guidelines from bodies such as NICE or the Department of Health. Neither is there anything wrong with referring to randomised trials. The thing is, though, there don’t seem to be any links to systematic reviews.
A systematic review is undertaken in order to “identify, appraise, select and synthesize all high quality research evidence relevant to that question”. The Cochrane Collaboration is a group that aims to improve “healthcare decision-making globally, through systematic reviews of the effects of healthcare interventions”, and their library contains several of these reviews relating to chiropractic.
I have looked at some Cochrane reviews in previous posts on chiropractic and I’ll reproduce that here: This review of 33 trials did not favour manipulation or mobilisation done alone or in combination with various other physical medicine agents. It was unclear if manipulation and mobilisation performed in combination were beneficial, but when compared to one another, neither was superior. [For mechanical neck disorders]
There was weak evidence to support the use of hypnosis, psychotherapy, acupuncture and chiropractic but it was provided in each case by single small trials, some of dubious methodological rigour. Robust randomised trials are required with efficacy, cost-effectiveness and adverse effects carefully monitored.
[For nocturnal enuresis in children. It says there was ‘weak evidence to support the use of chiropractic’ and this was the absolute best I could find on Cochrane for chiropractic – doesn’t exactly fill you with confidence does it?]
Apart from the Cochrane reviews, there are also some reviews on Pubmed. I had a look at a couple. A recent paper, Chiropractic treatment of upper extremity conditions: a systematic review, concluded that:
There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence). Most treatments are multimodal in nature, which address both spinal and peripheral structures, with joint and soft tissue methods. There is a need for future research to be directed at higher-level evidence, in particular, randomized controlled trials for the chiropractic treatment of upper limb conditions. [PMID: 18328941]
Another review, The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review, had the following in the results and conclusions sections:
Of 12 eligible trials, none made use of an expertise-based randomized trial design […] Investigators designing acupuncture or spinal manipulation trials in which 2 or more active therapies are compared should consider expertise-based randomization to increase the validity and feasibility of their efforts. [PMID:18404113]
There are systematic reviews available. You can read some of them in the form of full-text PDFs for free. I’ve linked to some of these reviews in this blog post. It was easy for me to do so, and it didn’t cost me a penny. This is thanks to the Cochrane Collaboration’s commitment to improve “healthcare decision-making globally, through systematic reviews of the effects of healthcare interventions” – and their decision to make the reviews I have linked to available without charge. Bless ’em. The British Chiropractic Association can add links to these reviews to their research page if they so wish. I won’t even charge them a finder’s fee.
[Thanks are also due to Blue Wode, who pointed out the criticisms of BEAM study and the two Meade et al papers.]
Chiropractic and the BCA Research Page by jdc is licensed under a Creative Commons Attribution-Non-Commercial-No Derivative Works 2.0 UK: England & Wales License.