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Federal Government Panel Endorses Spinal Manipulation For Acute Low Back Problems
Chiropractic Management of Low-Back Pain is More Cost-Effective Than Medical Management
Fewer Work Days Lost With Chiropractic Management
Chiropractic May be First Choice for Several Low-Back Conditions
Medical Society Recognizes Chiropractic Adjustment and Manipulation—”Accepted and Well-Established”
RAND Corporation Study—Chiropractic Care Appropriate for Low Back Pain
Journal of Occupational Medicine—Compensation Costs Ten Times Lower
A comprehensive federal government study performed by the Agency for Health Care Policy and Research (AHCPR) of the U.S. Department of Health and Human Services determined that spinal manipulation is a recommended and efficacious form of initial treatment for acute low back problems in adults.
In its clinical practice guideline, the 23-member panel consisting of medical doctors, nurses, doctors of chiropractic, osteopaths, physical therapists, an occupational therapist, experts in spine research, a psychologist and a consumer representative, concluded that expensive tests, prescription drugs and surgical procedures used to diagnose and treat acute low back pain are largely ineffective. Rather, experts recommend spinal manipulation, a procedure performed by doctors of chiropractic, as being an effective treatment for low back conditions
Bigos, et. al, Acute Low Back Problems in Adults, Clinical Practice Guidelines, AHCPR, U.S. Department of Health and Human Services, Rockville, MD, December 1994.
High-risk Surgery has Serious Implications
This study commissioned by the Ministry of Health in Ontario, Canada concluded that chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction. According to the study results “there would be highly significant cost savings if more management of low back pain as transferred from physicians to chiropractors.” There is also good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with physician management.
Manga, et al. The Effectiveness and cost Effectiveness of Chiropractic Management of Low-Back Pain. Ministry of Health, Government of Ontario, September 1993.
This workers’ compensation study published in the Chiropractic Journal of Australia compared chiropractic and medical management of 1,996 cases of work-related mechanical low back pain. The number of compensation days (paid days off from work) taken by claimants was found to be significantly lower an average of 6.26 days for chiropractic patients and 25.56 days for medical patients. The average cost of compensation for chiropractic management was $392 and for medical management, $1,569 or four times greater than chiropractic management.
- A significant reduction was seen in the number of claimants requiring compensation days when chiropractic care was chosen.
- Fewer compensation days were taken by claimants who chose chiropractic care.
- More patients progressed to chronic status when medical care was chosen.
- The average payment per claim was greater with medical management.
“Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian WorkCare Scheme,” Ebrall, P.S. Chiropractic Journal of Australia, June 1992, 22:2, 48-53.
The University of Richmond conducted an economic analysis in January of 1992 which concluded that chiropractic care is a lower cost option for prominent back-related ailments. One explanation for this is the lower insurance coverage of chiropractic care. If chiropractic care is insured to the extent other specialties are stipulated, it may emerge as a first option for patients with certain medical conditions. This could result in a decrease in overall treatment costs for these conditions.
“A Comparison of the costs of Chiropractors versus Alternative Medical Practitioners,” Dean, DH, Schmidt, R.M., University of Richmond, Richmond, Virginia, 13 January 1992.
The North American Spine Society’s Diagnostic and Therapeutic Committee has included chiropractic adjustment and manipulation in their general guide of common clinical procedures for doctors treating patients with lumbosacral spinal disorders. The North American Spine Society (NASS) is a prestigious medical organization that publishes the monthly professional journal, Spine.
The Committee’s recommended list of procedures appears in the October 1991 issue of Spine, and categorizes chiropractic adjustment and manipulation as a “Phase I…Non-Operative Therapeutic Procedure… generally accepted, well established and widely used” for lumbosacral conditions.
This medically oriented spine care organization’s formal recognition and acceptance of chiropractic procedures signals the final episode in the long history of mistrust and misunderstanding fostered by organized medicine.
“Common Diagnostic and Therapeutic Procedures of the Lumbosacral Spine,” The North American Spine Society – Ad Hoc Committee of Diagnostic and Therapeutic Procedures. Spine, October 1991; 16:10, 1161-1167.
A two-year multi-disciplinary study has issued reports that validate the assertion that spinal manipulation is an appropriate option for low back pain. The research was conducted by RAND, in Santa Monica, California, one of America’s most prestigious centers for research. The research panel includes medial, chiropractic and osteopathic doctors who are recognized experts in low back pain.
Significant conclusions reached in the first two reports issued in August 1991 are:
- Twenty one controlled research trials on low back pain have been identified in the medical literature that have found varying degrees of benefits from spinal manipulation.
- An expert panel of medical, chiropractic and osteopathic experts agree that spinal manipulation is appropriate treatment for acute, uncomplicated low back pain and for acute low back pain with minor neurological findings. (A great majority of low back conditions fall into the above categories.)
- The expert panel also concluded that in clinical practice, four weeks is a reasonable trial period for spinal manipulation. (The common prior medical position was that manipulation should be given only one to three times.)
Note: The California Chiropractic Foundation and the Consortium for chiropractic Research supported this research project. These groups asked RAND to conduct this series of studies to insure that all health care providers and policy makers have access to independent and unimpeachable information evaluating the appropriateness of chiropractic care.
“The Appropriateness of Spinal Manipulation for Low-Back Pain, Report 1: Project Overview and Literature Review, Report 2: Indications and Ratings by a Multi-Disciplinary Expert Panel,” Shekelle et al, RAND Reports R-4025/1 and R-4025/2, August 1991. Santa Monica, California.
In direct comparison, compensation costs for chiropractic patients were ten times lower than medical costs according to this published report. This study, found in the August 1991 Journal of Occupational Medicine, assessed the total cost for back injury claims from the 1986 Workers’ Compensation Fund of Utah. Researchers used standard matching diagnostic codes for patients with back injuries who were treated by either doctors of chiropractic or medical doctors.
- Compensation costs were ten times lower for chiropractic doctors’ patients ($68) than for medical doctors’ patients ($668).
- Treatment costs were “significantly higher” for medical doctors ($684) than for chiropractic doctors ($527).
- Medical patients received an average of 54.5 days of compensation while chiropractic patients needed and average of only 34.3 days of compensation.
- Patients under care see a DC three times more frequently (12.9 visits) than a medical doctor (4.9 visits) but at a less cost overall.
“Costs Per Case Comparison of Back Injury Claims of Chiropractic Versus Medical Management for Conditions with Identical Diagnostic Codes,” Jarvis et al. Journal of Occupational Medicine, August 1991; 33:8, 847-852.
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