Two years ago, the Consortium for Chiropractic Research contracted with the RAND Corporation to assess the appropriateness of chiropractic care for low-back pain. Last Fall, the first two parts of the study were completed, a literature review, and ratings of a multidisciplinary panel for appropriateness of spinal manipulation.
Now the third part of the four part RAND study has been completed. A nine-member chiropractic panel has rated the same 1,500 low-back pain conditions that were previously rated by the multidisciplinary panel.
Dr. Paul Shekelle, primary investigator of the RAND study assessed the results of part three: "Both panels agree that spinal manipulation is appropriate for low-back pain without the indication of sciatica. They differ with regard to sciatica and chronic pain. It will remain to future studies to determine if these are appropriate to spinal manipulation or not."
The RAND study has garnered major media coverage, and for the first time, representatives of the medical community have gone on record saying that chiropractic is an appropriate treatment for certain low-back pain conditions.
Not surprisingly, Dr. Shekelle noted the all chiropractic panel rated "each indication as somewhat more appropriate for spinal manipulation" than the multidisciplinary panel. The chiropractic panel agreed that 63 percent of the indications warranted manipulation, while the multidisciplinary panel found agreement on only 36 percent. Further, the chiropractic panel agreed that 12 manipulations over a period of up to four weeks was an adequate trial period. If no documented improvement results during this period, the chiropractic panel agreed that spinal manipulation "is no longer indicated."
With the continued funding commitment of the Consortium for Chiropractic Research, and the Foundation for Chiropractic Education and Research, plus the additional support of the ACA, and the National Chiropractic Mutual Insurance Company, the next phase of the project is moving forward. The fourth part of the RAND study will be broad in scope: examination of clinical cases to determine how prevalent each condition is in practice; the types of health problems that bring patients to chiropractors; determining the rate and demographics of chiropractic patients and their health status; and outcomes of first-time chiropractic patients with low-back pain and their satisfaction rate.
FCER's Executive Director Stephen Seater anticipates that, because of the clinical nature of the fourth phase of the study, it will be more important to the chiropractic profession than the previous phases.
The RAND Corporation will continue to publish the results of the study in leading medical journals. For more information, you may contact:
RAND Corporation Distribution Services
1700 Main St.
Santa Monica, CA 90407
Tele: (213) 393-0411
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