Jump to content

Chiropractic: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
Converted "subluxation" into a wikipedia link "subluxation"
Add South Africa in first paragraph as well established
Line 2: Line 2:
'''Chiropractic''' (from [[Greek language|Greek]] ''chiro-'' χειρο- "hand-" + ''praktikós'' πρακτικός "concerned with action") is a [[complementary and alternative medicine]] [[health care profession]] that focuses on diagnosis, treatment and prevention of mechanical disorders of the [[musculoskeletal system]] and their effects on the [[nervous system]] and general health, with special emphasis on the spine.<ref name=Nelson/> It emphasizes [[manual therapy]] including [[spinal manipulation]] and other joint and [[soft-tissue]] manipulation, and includes exercises and health and lifestyle counseling.<ref name=ccestandards/> Traditionally, it assumes that a [[vertebral subluxation]] or [[Vertebral column|spinal joint]] dysfunction can interfere with the body's function and its innate ability to heal itself.<ref name=History-PPC/>
'''Chiropractic''' (from [[Greek language|Greek]] ''chiro-'' χειρο- "hand-" + ''praktikós'' πρακτικός "concerned with action") is a [[complementary and alternative medicine]] [[health care profession]] that focuses on diagnosis, treatment and prevention of mechanical disorders of the [[musculoskeletal system]] and their effects on the [[nervous system]] and general health, with special emphasis on the spine.<ref name=Nelson/> It emphasizes [[manual therapy]] including [[spinal manipulation]] and other joint and [[soft-tissue]] manipulation, and includes exercises and health and lifestyle counseling.<ref name=ccestandards/> Traditionally, it assumes that a [[vertebral subluxation]] or [[Vertebral column|spinal joint]] dysfunction can interfere with the body's function and its innate ability to heal itself.<ref name=History-PPC/>


[[Daniel David Palmer|D. D. Palmer]] founded chiropractic in the 1890s and his son [[Bartlett Joshua Palmer|B.J. Palmer]] helped to expand it in the early 20th century.<ref name=Martin/> It has two main groups: "straights", now the minority, emphasize [[vitalism]], [[innate intelligence]], [[spinal adjustment]]s, and subluxation as the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and [[acupuncture]].<ref name=Kaptchuk-Eisenberg/> Chiropractic is well established in the U.S., Canada and Australia.<ref name=global-strategy/>
[[Daniel David Palmer|D. D. Palmer]] founded chiropractic in the 1890s and his son [[Bartlett Joshua Palmer|B.J. Palmer]] helped to expand it in the early 20th century.<ref name=Martin/> It has two main groups: "straights", now the minority, emphasize [[vitalism]], [[innate intelligence]], [[spinal adjustment]]s, and subluxation as the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and [[acupuncture]].<ref name=Kaptchuk-Eisenberg/> Chiropractic is well established in the U.S., Canada, Australia and [[South Africa]].<ref name=global-strategy/>


For most of its existence chiropractic has battled with [[mainstream medicine]], sustained by ideas such as [[subluxation]] that are significant barriers to scientific progress within chiropractic.<ref name=History-Primer/> [[Vaccination]] remains controversial among chiropractors.<ref name=Busse/> In recent decades chiropractic has gained more legitimacy and greater acceptance among physicians and [[health plan]]s and has had a strong political base and sustained demand for services,<ref name=Cooper/> and [[evidence-based medicine]] has been used to review research studies and generate [[Medical guideline|practice guidelines]].<ref name=Villanueva-Russell/> Opinions differ as to the [[efficacy]] of chiropractic treatment<ref name=DeVocht/> and the efficacy and cost-effectiveness of maintenance chiropractic care are unknown.<ref name=Leboeuf-Yde-C/> Although spinal manipulation can have serious [[Complication (medicine)|complications]] in rare cases,<ref name=Ernst-adverse/> chiropractic care is generally safe when employed skillfully and appropriately.<ref name=WHO-guidelines/>
For most of its existence chiropractic has battled with [[mainstream medicine]], sustained by ideas such as [[subluxation]] that are significant barriers to scientific progress within chiropractic.<ref name=History-Primer/> [[Vaccination]] remains controversial among chiropractors.<ref name=Busse/> In recent decades chiropractic has gained more legitimacy and greater acceptance among physicians and [[health plan]]s and has had a strong political base and sustained demand for services,<ref name=Cooper/> and [[evidence-based medicine]] has been used to review research studies and generate [[Medical guideline|practice guidelines]].<ref name=Villanueva-Russell/> Opinions differ as to the [[efficacy]] of chiropractic treatment<ref name=DeVocht/> and the efficacy and cost-effectiveness of maintenance chiropractic care are unknown.<ref name=Leboeuf-Yde-C/> Although spinal manipulation can have serious [[Complication (medicine)|complications]] in rare cases,<ref name=Ernst-adverse/> chiropractic care is generally safe when employed skillfully and appropriately.<ref name=WHO-guidelines/>

Revision as of 17:14, 2 August 2008

Chiropractic (from Greek chiro- χειρο- "hand-" + praktikós πρακτικός "concerned with action") is a complementary and alternative medicine health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health, with special emphasis on the spine.[1] It emphasizes manual therapy including spinal manipulation and other joint and soft-tissue manipulation, and includes exercises and health and lifestyle counseling.[2] Traditionally, it assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate ability to heal itself.[3]

D. D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century.[4] It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence, spinal adjustments, and subluxation as the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture.[5] Chiropractic is well established in the U.S., Canada, Australia and South Africa.[6]

For most of its existence chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are significant barriers to scientific progress within chiropractic.[7] Vaccination remains controversial among chiropractors.[8] In recent decades chiropractic has gained more legitimacy and greater acceptance among physicians and health plans and has had a strong political base and sustained demand for services,[9] and evidence-based medicine has been used to review research studies and generate practice guidelines.[10] Opinions differ as to the efficacy of chiropractic treatment[11] and the efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[12] Although spinal manipulation can have serious complications in rare cases,[13] chiropractic care is generally safe when employed skillfully and appropriately.[14]

This article is part of a series on
Alternative medicine
General information
Fringe medicine and science
Controversies
Classifications
Traditional medicine
Alternative diagnoses

Philosophy

Although a wide diversity of belief exists among chiropractors,[15] they share the principle that the spine and health are related in a fundamental way, and this relationship is mediated through the nervous system.[16] Chiropractors pay attention to the biomechanics, structure and function of the spine, its effects on the nervous and musculoskeletal systems, and the role these systems play in preventing disease and restoring health.[17]

Two chiropractic belief system constructs
THE TESTABLE PRINCIPLE   THE UNTESTABLE METAPHOR
Chiropractic Adjustment Universal Intelligence
↓ ↓
Restoration of Structural Integrity Innate Intelligence
↓ ↓
Improvement of Health Status Body Physiology
 
MATERIALISTIC:     VITALISTIC:
— operational definitions possible — origin of holism in chiropractic
— lends itself to scientific inquiry — cannot be proven or disproven
taken from Mootz & Phillips 1997[18]

Chiropractic philosophy goes beyond manipulating the spine. Like naturopathy and several other forms of complementary and alternative medicine, chiropractic assumes that all aspects of a patient's health are interconnected, which leads to the following perspectives:[18]

  • Holism treats the patient as a whole, and appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system, recognizing dynamics between lifestyle, environment, and health.
  • Conservativism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.[17]
  • Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.[15]
  • A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health.[15]

Chiropractic's early philosophy was rooted in spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejected the inferential reasoning of the scientific method,[15] and relied on deductions from vitalistic principles rather than on the materialism of science.[18]

As chiropractic has matured, most practitioners accept the importance of scientific research into chiropractic.[15] Balancing the dualism between the metaphysics of their predecessors and the materialistic reductionism of science, their belief systems blend experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order. They emphasize the testable principle that structure affects function, and the untestable metaphor that life is self-sustaining. Their goal is to establish and maintain an organism-environment dynamic conducive to functional well-being of the whole person.[18]

Schools of thought and practice styles

Range of belief perspectives in chiropractic
perspective attribute potential belief endpoints
scope of practice: narrow ("straight") ← → broad ("mixer")
diagnostic approach: intuitive ← → analytical
philosophic orientation: vitalistic ← → materialistic
scientific orientation: descriptive ← → experimental
process orientation: implicit ← → explicit
practice attitude: doctor/model-centered ← → patient/situation-centered
professional integration: separate and distinct ← → integrated into mainstream
taken from Mootz & Phillips 1997[18]

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy.[19] Still, significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.[20]

Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an "Innate Intelligence" within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies.[7] Their philosophy and explanations are metaphysical in nature and prefer to use traditional chiropractic lexicon (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care.

Mixer chiropractors "mix" diagnostic and treatment approaches from naturopathic, osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of the many causes of disease, and they incorporate mainstream medical diagnostics and employ myriad treatments including joint and soft tissue manipulation, electromodalities, physiotherapeutic modalities, exercise-rehabilitation and various complementary and alternative approaches such as acupuncture, homeopathy and applied kinesiology. Mixers tend to be open to mainstream medicine,[5] and are the majority group.[21]

Vertebral subluxation

Main article: Vertebral subluxation

Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself.[3] D.D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[22] This concept was later expanded upon by his son, B.J. Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled health:

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease."[23]

The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.[24] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.[24] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer College of Chiropractic[25]) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College[26]) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions.[27][28] A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of visceral ailments that subluxation significantly contributes to, the mean response was 62%.[29] In 2005, subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.… This definition is different from the current medical definition, in which subluxation is a significant structural displacement, and therefore visible on static imaging studies."[14]

Scope of practice

Chiropractors are primary-contact health care practitioners who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,[14] with special emphasis on the spine.[1] Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry.[30] The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests,[14] and specialized tests.[2] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[30] Common patient management involves:

  • spinal manipulation and other manual therapies to the joints and soft tissues
  • rehabilitative exercises
  • health promotion
  • electrical modalities
  • conservative and complementary procedures
  • lifestyle counseling.[31]

Chiropractors generally cannot write medical prescriptions; a 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[29] A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors to prescribe over-the-counter substances and perform minor surgery.[32] In some locations chiropractors (DCs) and veterinarians (DVMs) with additional training and certification can practice veterinary chiropractic which includes the diagnosis, treatment and rehabilitation of injured animals.[33][34] However, the official position of the American Chiropractic Association is that applying manipulative techniques to animals does not constitute chiropractic and that veterinary chiropractic is a misnomer.[35]

Chiropractic medicine is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[6] Similar to other primary contact health providers, chiropractors can specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2–3 additional years of additional post graduate study and passing competency examinations.[36]

Education, licensing, and regulation

Main articles: Chiropractic education and List of chiropractic schools

Chiropractors obtain a first professional degree in the field of chiropractic medicine.[37] The U.S. and Canada require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program.[2][38] The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.[14]

Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction.[39][40] Depending on the location, continuing education may be required to renew these licenses.[41][42]

In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK.[43][44] CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally.[45] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[46] 2 in Canada,[47] and 4 in Europe.[48] All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges.[11] Chiropractic education in the U.S. is divided into straight or mixer educational curricula depending on the philosophy of the institution.[37]

Regulatory colleges and chiropractic boards in the U.S., Canada, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[49][50] There are an estimated 53,000 chiropractors in the U.S. (2006),[51] 6526 in Canada (2006),[52] 2500 in Australia (2000),[53] and 1,500 in the UK (2000).[54]

Treatment procedures

Procedures received by more than 1/3 of patients of licensed U.S. chiropractors (2003 survey)[55]
procedure % of
DCs
using
it 		% of
patients
getting
it
Diversified
(full-spine manipulation) 		96.2 71.5
Physical fitness/exercise
promotion 		98.3 64.9
Corrective or therapeutic
exercise 		98.3 63.2
Ergonomic/postural advice 97.3 61.9
Self-care strategies 96.6 60.6
Activities of daily living 96.6 57.9
Changing risky/unhealthy
behaviors 		96.6 54.9
Nutritional/dietary
recommendations 		97.7 51.8
Relaxation/stress reduction
recommendations 		96.4 50.1
Ice pack/cryotherapy 94.5 48.5
Extremity adjusting 95.4 46.8
Trigger point therapy 91.0 45.3
Disease prevention/
early screening advice 		90.8 39.7
Main articles: Chiropractic treatment techniques and Spinal adjustment

Spinal manipulation, which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care;[55] in the U.S., chiropractors perform over 90% of all manipulative treatments.[56] Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit; its defining factor is a dynamic thrust, a sudden force that causes an audible release and attempts to increase a joint's range of motion. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues; in chiropractic care SMT most commonly takes the form of spinal manipulation.[57] The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques,[58] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[59] SMT gained mainstream recognition during the 1980s.[60] Chiropractors consider themselves to be expertly qualified providers of spinal adjustment, manipulation and other manual treatments.[61]

Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[62] Typically, it is performed on patients who have failed to respond to other forms of treatment.[63]

Utilization and satisfaction rates

In the U.S., chiropractic is the largest alternative medical profession,[5] and is the third largest doctored profession, behind medicine and dentistry.[64] The percentage of population that utilize chiropractic care at any given time generally fall into a range from 6% to 12% in the U.S. and Canada,[65] with a global high of 20% in Alberta.[66] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[67] most do so specifically for low back pain. Complementary and alternative medicine (CAM) practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.[65] Satisfaction rates are typically higher for chiropractic care compared to medical care, with quality of communication seeming to be a consistent predictor of patient satisfaction with chiropractors.[68] Despite high patient satisfaction scores, utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[69] The use of chiropractic is growing modestly; CAM as a whole is seeing wholesale increases.[65] Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[51] A 2008 survey stated that 69% of DC chiropractors disagree with the categorization of chiropractic as CAM, with 27% having some preference for the term "integrated medicine."[70]

History

Main article: Chiropractic history
File:Ddpalmer3.jpg
D.D. Palmer

Chiropractic was founded in the 1890s by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. Although initially keeping the theory a family secret, in 1898 he began teaching it to a few students at his new Palmer School of Chiropractic. One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment.[4] Prosecutions and incarcerations of chiropractors for practicing medicine without a license grew common, and to defend against medical statutes B.J. argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxation rather than "treated" disease.[7] Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vital nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions. D.D. and B.J. both seriously considered declaring chiropractic a religion, which might have provided legal protection under the U.S. constitution, but decided against it partly to avoid confusion with Christian Science.[4][71] Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).[4]

File:BJPalmer2.jpg
B.J. Palmer

Although D.D. and B.J. were "straight" and disdained the use of instruments, some early chiropractors, whom B.J. scornfully called "mixers", advocated use of instruments. In 1910 B.J. changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. The mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J.'s promotion of the neurocalometer, a new temperature-sensing device, was another sign of chiropractic's gradual acceptance of medical technology, although it was highly controversial among B.J.'s fellow straights. Despite heavy opposition by organized medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S.[4] The longstanding feud between chiropractors and medical doctors continued for decades. Until 1983, the AMA labeled chiropractic "an unscientific cult" and held that it was unethical for medical doctors to associate with an "unscientific practitioner".[72] This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.[9]

Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by the chiropractic philosophy that sustained the profession in its long battle with organized medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain.[7] In recent decades chiropractic gained legitimacy and greater acceptance by physicians and health plans, and enjoyed a strong political base and sustained demand for services. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.[9]

Evidence basis

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care.[10] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what chiropractic historian Joseph C. Keating, Jr. calls "antiscientific" reasoning and unsubstantiated claims,[24][73][74] stratagems that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.[1] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.[75] Evidence-based chiropractors possess the ability to apply research in practice. Continued education enhances the scientific knowledge of the practitioner.[76]

Effectiveness

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.[11] Chiropractic care, like all medical treatment, benefits from the placebo response.[77] The efficacy of maintenance care in chiropractic is unknown.[12]

Research has focused on spinal manipulation (SM) in general,[78] rather than specifically on chiropractic SM.[10] There is little consensus as to who should administer the SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors; the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.[10] Many controlled clinical studies of SM are available, but their results disagree,[79] and they are typically of low quality.[80] It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree whether a proposed placebo actually has no effect.[81] Although a 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference,[82] a 2008 supportive review found serious flaws in the critical approach, and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.[83]

Available evidence covers the following conditions:

  • Low back pain. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.[84] A 2007 U.S. guideline weakly recommended SM as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail,[85] whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level.[84] A 2008 review found strong evidence that SM is similar in effect to medical care with exercise, and moderate evidence that SM is similar to physical therapy and other forms of conventional care.[83] A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain.[86] Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review[87] stated that SM or mobilization is no more or less effective than other standard interventions for back pain.[79] A 2005 systematic review found that exercise appears to be slightly effective for chronic low back pain, and that it is no more effective than no treatment or other conservative treatments for acute low back pain.[88]
  • Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain.[89] A 2008 review found evidence that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SM, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis.[90] A 2007 review found that SM and mobilization are effective for neck pain.[89] Of three systematic reviews of SM published between 2000 and May 2005, one reached a positive conclusion, and a 2004 Cochrane review ([91]) found that SM and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder.[79] A 2005 review found consistent evidence supporting mobilization for acute whiplash, and limited evidence supporting SM for whiplash.[92]
  • Headache. A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.[93] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[94] A 2004 review found that SM may be effective for migraine and tension headache, and SM and neck exercises may be effective for cervicogenic headache.[95] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SM.[79]
  • Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,[96] and a lack of higher-quality publications supporting chiropractic management of leg conditions.[97] A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.[86] There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine)[98] and no scientific data for idiopathic adolescent scoliosis.[99] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions.[100] Other reviews have found no evidence of benefit for baby colic,[101] bedwetting,[102] fibromyalgia,[103] or menstrual cramps.[104]

Safety

Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[14] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[105]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,[13][105] including new or worsening pain or stiffness in the affected region.[106] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.[105] Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[13] and children.[107] The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[13] Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[90] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[108]

Cost-effectiveness

A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings.[109] A 2006 UK systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation compares favorably with other treatments for back pain, but that reports are based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[110] A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[111] The cost-effectiveness of maintenance chiropractic care is unknown.[12]

Vaccination

Although vaccination is one of the most cost-effective forms of prevention against infectious disease, it remains controversial within the chiropractic community. Most chiropractic writings on vaccination focus on its negative aspects,[8] claiming that it is hazardous or ineffective.[112] Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractic Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.[53] The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.[8]

References

  1. ^ a b c Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13: 9. doi:10.1186/1746-1340-13-9. PMID 16000175. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  2. ^ a b c "Standards for Doctor of Chiropractic programs and requirements for institutional status" (PDF). The Council on Chiropractic Education. 2007. Retrieved 2008-02-14.
  3. ^ a b Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 23–64. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  4. ^ a b c d e Martin SC (1993). "Chiropractic and the social context of medical technology, 1895-1925". Technol Cult. 34 (4): 808–34. doi:10.2307/3106416. PMID 11623404.
  5. ^ a b c Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. doi:10.1001/archinte.158.20.2215. PMID 9818801.
  6. ^ a b Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps. Retrieved 2008-04-18.
  7. ^ a b c d Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16.{{cite web}}: CS1 maint: multiple names: authors list (link)
  8. ^ a b c Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther. 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ a b c Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Q. 81 (1): 107–38. doi:10.1111/1468-0009.00040. PMID 12669653.
  10. ^ a b c d Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303.
  11. ^ a b c DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
  12. ^ a b c Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic - what do we know?" (PDF). Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ^ a b c d Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMID 17606755.
  14. ^ a b c d e f World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). ISBN 92 4 159371 7. Retrieved 2008-02-29. {{cite journal}}: Cite journal requires |journal= (help)
  15. ^ a b c d e Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  16. ^ Gay RE, Nelson CF (2003). "Chiropractic philosophy". In Wainapel SF, Fast A (eds.) (ed.). Alternative Medicine and Rehabilitation: a Guide for Practitioners. New York: Demos Medical Publishing. ISBN 1-888799-66-8. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  17. ^ a b American Chiropractic Association. "History of chiropractic care". Retrieved 2008-02-21.
  18. ^ a b c d e Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  19. ^ Keating J Jr. (2003). "Surveys now and then". Dyn Chiropr. 21 (19).
  20. ^ Healey JW (1990). "It's where you put the period". Dyn Chiropr. 8 (21).
  21. ^ Coulehan JL (1985). "Adjustment, the hands and healing". Cult Med Psychiatry. 9 (4): 353–82. PMID 2934224.
  22. ^ Keating JC Jr (1995). "D.D. Palmer's forgotten theories of chiropractic" (PDF). Association for the History of Chiropractic. Retrieved 2008-05-14.
  23. ^ Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House Co. OCLC 17205743.
  24. ^ a b c Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17. PMID 16092955.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  25. ^ "Palmer College of Chiropractic, General Information". Retrieved 2008-03-24.
  26. ^ "Undergraduate and graduate programs 2006–2007" (PDF). Canadian Memorial Chiropractic College. 2006. Retrieved 2008-07-05.
  27. ^ Kevin A. Rose, Alan Adams (2000). "A Survey of the Use of Evidence-Based Health Care in Chiropractic College Clinics" (PDF). The Journal of Chiropractic Education. 14 (2): 71–7.
  28. ^ Homola S (2006). "Can chiropractors and evidence-based manual therapists work together? an opinion from a veteran chiropractor" (PDF). J Man Manip Ther. 14 (2): E14–8.
  29. ^ a b McDonald WP, Durkin KF, Pfefer M; et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0972805559. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med. 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)
  30. ^ a b Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498.
  31. ^ Haldeman, Scott (2004). Guidelines for Chiropractic Quality and Practice Parameters. Sudbury, MA: Jones and Bartlett. pp. 111–3. ISBN 0-7637-2921-3. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  32. ^ "Chapter 684 — Chiropractors". Oregon State Legislature. Retrieved 2008-05-08.
  33. ^ "Canadian Animal Chiropractic Certification Program frequently asked questions". Retrieved 2008-05-08.
  34. ^ "RMIT - Animal Chiropractic – Master of Chiropractic Science incorporating Graduate Diploma". RMIT University. Retrieved 2008-05-09.
  35. ^ ACA House of Delegates (1994). "'Veterinary' chiropractic". American Chiropractic Association. Retrieved 2008-07-05.
  36. ^ Chiropractic training:
  37. ^ a b "First-professional studies". U.S. Network for Education Information, U.S. Dept. of Education. Retrieved 2008-07-05.
  38. ^ "Standards for Doctor of Chiropractic Programmes" (PDF). Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. 2006-10-21. Retrieved 2008-06-13.
  39. ^ "State chiropractic licensure". Life University. 2007. Retrieved 2008-07-05.
  40. ^ "CFCREAB - Becoming a Chiropractor". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. 2008. Retrieved 2008-06-13.
  41. ^ Grod JP (2006). "Continuing health education in Canada". J Can Chiropr Assoc. 50 (1): 14–7. PMC 1839972. PMID 17549163.
  42. ^ Stuber KJ, Grod JP, Smith DL, Powers P (2005). "An online survey of chiropractors' opinions of Continuing Education". Chiropr Osteopat. 13: 22. doi:10.1186/1746-1340-13-22. PMID 16242035.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  43. ^ "The Council on Chiropractic Education (CCE)". The Council on Chiropractic Education. Retrieved 2008-07-05.
  44. ^ "The General Chiropractic Council". Retrieved 2008-07-26.
  45. ^ "History and Purpose of The Councils on Chiropractic Education International". Councils on Chiropractic Education International. 2005. Retrieved 2008-06-13.
  46. ^ "Accredited Doctor of Chiropractic programs". The Council on Chiropractic Education. Retrieved 2008-02-22.
  47. ^ "CFCREAB - Accreditation of Educational Programmes". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. 2008. Retrieved 2008-05-28.
  48. ^ "Institutions holding Accredited Status with the Council". European Council On Chiropractic Education. 2008-06-11. Retrieved 2008-06-28.
  49. ^ "Facts & FAQs". Canadian Chiropractic Association. 2008. Retrieved 2008-05-08.
  50. ^ "Chiropractic regulatory boards". Greeley, CO: Federation of Chiropractic Licensing Boards. Retrieved 2008-06-30.
  51. ^ a b "Chiropractors". U.S. Bureau of Labor Statistics. 2007. Retrieved 2008-07-05.
  52. ^ "Number of Licensed Chiropractors in Canada". Canadian Chiropractic Association. 2006. Retrieved 2008-05-28.
  53. ^ a b Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics. 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  54. ^ Chapman-Smith D (2000). "Current status of the profession". The Chiropractic Profession: Its Education, Practice, Research and Future Directions. West Des Moines, IA: NCMIC. ISBN 1-892734-02-8.
  55. ^ a b Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures". Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners. pp. 121–38. ISBN 1-884457-05-3. {{cite book}}: |access-date= requires |url= (help); |format= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  56. ^ "About chiropractic and its use in treating low-back pain" (PDF). NCCAM. 2005. Retrieved 2008-03-24.
  57. ^ Winkler K, Hegetschweiler-Goertz C, Jackson PS; et al. (2003). "Spinal manipulation policy statement" (PDF). American Chiropractic Association. Retrieved 2008-05-24. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  58. ^ Swedlo DC (2002). "The historical development of chiropractic" (PDF). In Whitelaw WA (ed.) (ed.). Proc 11th Annual History of Medicine Days. Faculty of Medicine, The University of Calgary. pp. 55–58. Retrieved 2008-05-14. {{cite conference}}: |editor= has generic name (help); Unknown parameter |booktitle= ignored (|book-title= suggested) (help)
  59. ^ Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.
  60. ^ Francis RS (2005). "Manipulation under anesthesia: historical considerations". International MUA Academy of Physicians. Retrieved 2008-07-06.
  61. ^ World Federation of Chiropractic (2005). "WFC consultation on the identity of the chiropractic profession". Retrieved 2008-02-14.
  62. ^ Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES (2005). "Manipulation under anesthesia: a report of four cases". J Manipulative Physiol Ther. 28 (7): 526–33. doi:10.1016/j.jmpt.2005.07.011. PMID 16182028.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  63. ^ Michaelsen MR (2000). "Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin". J Manipulative Physiol Ther. 23 (2): 127–9. doi:10.1016/S0161-4754(00)90082-4. PMID 10714542.
  64. ^ "Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure". National Library of Medicine. Retrieved 2008-05-06. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  65. ^ a b c Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat. 15: 2. doi:10.1186/1746-1340-15-2. PMID 17241465.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  66. ^ Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction". Dyn Chiropr. 25 (6).
  67. ^ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03". BMC Health Serv Res. 6 (49): 49. doi:10.1186/1472-6963-6-49. PMID 16600038.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  68. ^ Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review of the literature". J Manipulative Physiol Ther. 29 (6): 455–62. doi:10.1016/j.jmpt.2006.06.013. PMID 16904491.
  69. ^ Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  70. ^ Redwood D, Hawk C, Cambron J, Vinjamury SP, Bedard J (2008). "Do chiropractors identify with complementary and alternative medicine? results of a survey". J Altern Complement Med. 14 (4): 361–8. doi:10.1089/acm.2007.0766. PMID 18435599.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  71. ^ Palmer DD (1911-05-04). "Letter to P.W. Johnson, D.C." (PDF). Retrieved 2008-06-29.
  72. ^ Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health. 79 (11): 1569–70. PMC 1349822. PMID 2817179.
  73. ^ Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq. 21 (4): 37–43. Retrieved 2008-05-10.
  74. ^ Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  75. ^ Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  76. ^ Feise RJ, Grod JP, Taylor-Vaisey A (2006). "Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care". Chiropr Osteopat. 14: 18. doi:10.1186/1746-1340-14-18. PMID 16930482.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  77. ^ Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  78. ^ Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  79. ^ a b c d Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972.
  80. ^ Quality of SM studies:
    • Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther. 36 (3): 160–9. PMID 16596892.{{cite journal}}: CS1 maint: multiple names: authors list (link)
    • Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine. 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  81. ^ Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother. 52 (2): 135–8. PMID 16764551.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  82. ^ Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
  83. ^ a b Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  84. ^ a b Murphy AYMT, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  85. ^ Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  86. ^ a b Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-03-13. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  87. ^ Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  88. ^ Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005). "Exercise therapy for treatment of non-specific low back pain". Cochrane Database Syst Rev (3): CD000335. doi:10.1002/14651858.CD000335.pub2. PMID 16034851.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  89. ^ a b Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.
  90. ^ a b Hurwitz EL, Carragee EJ, van der Velde G; et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |doi_brokendate= ignored (|doi-broken-date= suggested) (help)CS1 maint: multiple names: authors list (link)
  91. ^ Gross AR, Hoving JL, Haines TA; et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  92. ^ Conlin A, Bhogal S, Sequeira K, Teasell R (2005). "Treatment of whiplash-associated disorders—part I: non-invasive interventions". Pain Res Manag. 10 (1): 21–32. PMID 15782244.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  93. ^ Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  94. ^ Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
  95. ^ Bronfort G, Nilsson N, Haas M; et al. (2004). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  96. ^ McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  97. ^ Hoskins W, McHardy A, Pollard H, Windsham R, Onley R (2006). "Chiropractic treatment of lower extremity conditions: a literature review". J Manipulative Physiol Ther. 29 (8): 658–71. doi:10.1016/j.jmpt.2006.08.004. PMID 17045100.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  98. ^ Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.
  99. ^ Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis. 3: 2. doi:10.1186/1748-7161-3-2. PMID 18211702.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  100. ^ Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med. 13 (5): 491–512. doi:10.1089/acm.2007.7088. PMID 17604553.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  101. ^ Kingston H (2007). "Effectiveness of chiropractic treatment for infantile colic". Paediatr Nurs. 19 (8): 26. PMID 17970361.
  102. ^ Glazener CM, Evans JH, Cheuk DK (2005). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  103. ^ Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Curr Pharm Des. 12 (1): 47–57. doi:10.2174/138161206775193262. PMID 16454724.
  104. ^ Proctor ML, Hing W, Johnson TC, Murphy PA (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  105. ^ a b c Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
     • Anderson-Peacock E, Bryans B, Descarreaux M; et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc. 52 (1): 7–8. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  106. ^ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. PMID 17906581.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  107. ^ Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  108. ^ Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  109. ^ Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C (2006). "Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession". J Manipulative Physiol Ther. 29 (9): 707–25. doi:10.1016/j.jmpt.2006.09.001. PMID 17142165.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  110. ^ Canter PH, Coon JT, Ernst E (2006). "Cost-effectiveness of complementary therapies in the United kingdom—a systematic review". Evid Based Complement Alternat Med. 3 (4): 425–32. doi:10.1093/ecam/nel044. PMID 17173105.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  111. ^ van der Roer N, Goossens MEJB, Evers SMAA, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? a systematic review". Best Pract Res Clin Rheumatol. 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  112. ^ Ernst E (2001). "Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination". Vaccine. 20 (Suppl 1): S89–93. doi:10.1016/S0264-410X(01)00290-0. PMID 11587822.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=229432642"