"Patients suffering from back pain gain greater benefit from chiropractors than from conventional treatment in National Health Service hospitals, an independent study of the two methods says today." -- David Fletcher, Health Services Correspondent, Daily Telegraph
"The Medical Research Council yesterday urged Mr. Kenneth Clarke, Secretary of State for Health, to ease the distress of Britain's back pain sufferers by making an alternative treatment (chiropractic) available on the National Health Service." -- The London Times
"Patients with back pain who go to a chiropractor do better than those treated in hospital, says a report. They suffer less pain and need fewer days off work. Wider use of the treatment could save the country millions of pounds in lost output and social security payments, it is claimed." -- Clare Dover, Medical Reporter, Daily Express
Not fiction or fantasy, these are headlines in three major British newspapers announcing the results of an independent study reported in the British Medical Journal, June 2, 1990, entitled, "Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment." This study is filled with information that is very positive for the chiropractic profession.
In this study made by the Medical Research Council, chiropractic treatment was shown to be more effective than hospital outpatient management. The results were especially significant for patients with chronic or severe back pain. The benefits of chiropractic care became more evident throughout the two year follow-up period. According to the study's results, even the secondary outcome measures showed chiropractic to be more beneficial. This is one of the only studies that demonstrates the effectiveness of chiropractic care on a long-term basis. As the abstract states: "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. Introducing chiropractic into National Health Services should be considered." -- Meade, et. al.
In the past few years, chiropractic research has become more and more important in the establishment of chiropractic as a scientifically supported discipline. There are some in the chiropractic profession who have questioned the need for "scientific proof" and who have criticized both the researchers themselves as well as the amounts of money spent on research. This study alone, clearly demonstrates the need for and benefits of chiropractic research.
This particular study has made a very strong case for the inclusion of chiropractic care in the National Health Service of Great Britain. This is a tremendously important statement in light of the fact that the United States is considering a national health plan. This research illustrates the cost effectiveness of the inclusion of chiropractic treatment in national health care as well supporting the effectiveness of chiropractic treatment.
Though the average cost of chiropractic investigation and treatment was £165 in 1988-89 compared to £111 for hospital treatment, the overall cost was dramatically less in terms of frequency and duration of absence from work. This study showed significant reduction of work days lost when patients received chiropractic treatment in comparison with those patients treated as hospital outpatients. According to Meade et. al., there could be a reduction in sickness absence of some 290,000 days over a two year period. This would lead to a savings of "about £13 million in out-put and £2.9 million in social security payments," (These payments correspond to our workers' compensation payments.) according to the study's results.
To quote: "The economic, resource, and policy implications of our results are extensive... There is, therefore, economic support for use of chiropractic in low back pain, though the obvious clinical improvement in pain and disability attributable to chiropractic treatment is in itself an adequate reason for considering the use of chiropractic."
It should be noted that chiropractors participating in these trials were limited to a maximum of ten treatments, intended to be concentrated in the first three months but which could be spread out over a year's time if necessary. This fact may prove significant in later studies. It should also be considered by those practitioners who have a tendency to schedule their patients for 30 visits or more upon the initial examination.
Another point of great interest to chiropractors is the statement that the effects of chiropractic treatment seem to be long-term, as the study showed no return to pre-treatment pain levels during the two years of follow-up. This is in comparison to hospital treatment where patients began to deteriorate after six months to a year. "This pragmatic comparison of two types of treatment used in day to day practice shows that patients treated by chiropractors were not only no worse off than those treated in hospital but almost certainly fared considerably better and that they maintained their improvement for at least two years." -- Meade et. al.
The benefits of this research have not been limited to exposure in medical and scientific circles. The public image of the chiropractic profession in Great Britain has been considerably strengthened by the results of this study and the widespread publicity of these results in the press. Three major British papers, including the front page of the Daily Telegraph reported these incredibly positive research results to the general public. Again, research-based support of chiropractic treatment provided the means to inform the public about the benefits of chiropractic. The chiropractic profession could not ask for any better PR than this.
It is time for chiropractic in the United States, as national health care looms on the horizon, to look to chiropractic research as the means to ensuring chiropractic's place in the nation's health care systems. We have the opportunity and the obligation to support chiropractic research now so that chiropractic care and treatment will be assured worldwide in the future. This study by Meade et. al. concluded with a call for further research. Trials are needed which will identify the specific component(s) responsible for the effectiveness of chiropractic.
