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Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-year Update
J Manipulative Physiol Ther 2007 (May); 30 (4): 263–269
A new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.
Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain
J Manipulative Physiol Ther 2005 (Oct); 28 (8): 555–563
Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients.
Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain. There are more articles like this in the Low Back Pain Page.
Cost Effectiveness of Physical Treatments for Back Pain in Primary Care
British Medical Journal 2004 (Dec 11); 329 (7479): 1381 ~ FULL TEXT We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice. Indeed, as we trained practice teams in the best care of back pain, we may have underestimated the benefit of physical therapy (spinal manipulation) when compared with "usual care" in general practice. The detailed clinical outcomes reported in the accompanying paper reinforce these findings by showing that the improvements in health status reported here reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life, and beliefs about back pain.(1) Read more about this on the
UK BEAM Trial Page
Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
Arch Intern Med 2004 (Oct 11); 164 (18): 1985–1892
A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399).
The authors concluded:"Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care." You may also enjoy this recent press release and this glowing review on WebMD.
Cost Effectiveness of Physiotherapy, Manual Therapy, and General Practitioner Care for Neck Pain: Economic Evaluation Alongside a Randomised Controlled Trial
British Medical Journal 2003 (Apr 26); 326 (7395): 911 ~ FULL TEXT
A hands-on approach to treating neck pain by manual therapy may help people get better faster and at a lower cost than more traditional treatments, according to this study. After seven and 26 weeks, they found significant improvements in recovery rates in the manual therapy group compared to the other 2 groups. For example, at week seven, 68% of the manual therapy group had recovered from their neck pain vs. 51% in the physical therapy group and 36% in the medical care group. You may also enjoy this WebMD review titled: Manual Therapy Eases Neck Pain, Cheaply.
• Manipulation, with or without exercise, improved symptoms more than medical care did after both 3 and 12 months
• The authors concluded:
“We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost effective additions to care in general practice.”
An Evaluation of Medical and Chiropractic Provider Utilization and Costs: Treating Injured Workers in North Carolina
J Manipulative Physiol Ther 2004 (Sep); 27 (7): 442–448 These data, with the acknowledged limitations of an insurance database, indicate lower treatment costs, less workdays lost, lower compensation payments, and lower utilization of ancillary medical services for patients treated by DCs. Despite the lower cost of chiropractic management, the use of chiropractic services in North Carolina appears very low.
Clinical and Cost Outcomes of an Integrative Medicine IPA
J Manipulative Physiol Ther 2004 (Jun) ; 27 (5): 336–347
Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame.
Effects of Inclusion of a Chiropractic Benefit on the Utilization
of Health Care Resources in Managed Health Care Plan
Craig F Nelson, D.C., MS
A four-year longitudinal study using administrative claims data compared 700,000 health plan members with chiropractic coverage to 1 million health plan members without chiropractic coverage. This study demonstrates that the inclusion of a chiropractic benefit in a managed health care plan results in a reduction in the overall utilization of health care resources, and thereby, cost savings. There are four mechanism that produce this cost reduction: 1. A favorable selection process; 2. A substitution effect of chiropractic care for medical care; 3. Lower rates of use of high cost procedures; 4. Lower cost management of care episodes by chiropractors. You might also enjoy this sidebar article on this topic.
Chiropractic Care: Is It Substitution Care or Add-on Care in Corporate Medical Plans?
J Occup Environ Med 2004 (Aug); 46 (8): 847-855
An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. These results (of this file review) indicate that patients use chiropractic care as a direct substitution for medical care.
A Comparison of Health Care Costs for Chiropractic and Medical Patients
J Manipulative Physiol Ther 1993 (Jun); 16 (5): 291–299
Nearly one-fourth of patients were treated by chiropractors. Patients receiving chiropractic care experienced significantly lower health care costs as represented by third party payments in the fee-for-service sector. Total cost differences on the order of $1,000 over the 2-yr period were found in the total sample of patients as well as in subsamples of patients with specific disorders. The lower costs are attributable mainly to lower inpatient utilization. The cost differences remain statistically significant after controlling for patient demographics and insurance plan characteristics.
Further Analysis of Health Care Costs for Chiropractic and Medical Patients
J Manipulative Physiol Ther 1994 (Sep); 17 (7): 442–446
The analysis of well-insured patients in plans that do not restrict the chiropractic benefit strengthens results previously reported. In this study, therefore, the favorable cost patterns for chiropractic patients cannot be attributed to insurance restrictions limiting reimbursement for chiropractic services relative to other services. Because adjustments for patient characteristics systematically reduce the cost advantages of chiropractic patients as compared to mean differences derived from unadjusted data, the results also demonstrate that adjusted values should be used for meaningful comparisons between the two groups of patients.
Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian WorkCare Scheme
Chiropractic Journal of Australia 1992 (Jun); 22 (2): 47–53
Comparisons of costs and outcomes were made between the two samples with the results being:
(i) a significantly lower number of claimants requiring compensation days when chiropractic management was chosen, (ii) fewer compensation days taken by claimants who received chiropractic management,
(iii) a greater number of patients progressed to chronic status when medical management was chosen, and
(iv) a greater average payment per claim with medical management.
Economic Case for the Integration of Chiropractic Services into the Health Care System
J Manipulative Physiol Ther 2000 (Feb); 23 (2): 118-122
For much of its history, chiropractic care has been both an alternative therapeutic paradigm and separate from or marginal to the mainstream health care system. Over the past decade, the situation has changed somewhat in that chiropractic care is gradually being integrated within a variety of health care delivery organizations. According to Triano et al,1 by the application of evidence-based health care and good business, there is a surge in cooperation and integration among chiropractors, allopathic physicians, allied health care providers, ancillary therapists, and respective support staff. There is, however, no quantification of the level of integration. Integration may also be more true of the United States than elsewhere. The overall position of chiropractic care as alternative and separate still predominates. This situation does not serve the interests of the chiropractic profession nor the public well. There is a persuasive economic case for a radical shift in the role of chiropractic care to one that may succinctly be described as alternative and mainstream.
The chiropractic profession must preserve its identity and its unique therapeutic paradigm and continue to be seen as an alternative to other health care professions, especially medical doctors. However, it should also become mainstream and thus widely available and accessible to the public by being integrated into the wide variety of health care delivery organizations that collectively constitute the health care system.
The Cost-Effectiveness of Chiropractic
In the treatment of musculoskeletal disorders, despite the fact that most studies have not properly factored in such patient characteristics as severity and chronicity and lack the complete assessment of all direct costs and most indirect costs, the bulk of articles reviewed demonstrate lower costs for chiropractic.
9 This pattern is consistently observed from the perspectives of workers' compensation studies, 10-15 databases from insurers, 16-18 or the analysis of a health economist employed by the provincial government of Ontario. 19-20
Other studies have suggested the opposite [that chiropractic services are more expensive than medical], 5,21,22 but these contain significant flaws 21 which have been refuted. 23
The cost advantages for chiropractic for matched conditions appear to be so dramatic that Pran Manga, the aforementioned Canadian health economist, has concluded that doubling the utilization of chiropractic services from 10% to 20% may realize savings as much as $770 million in direct costs and $3.8 billion in indirect costs. 20 When iatrogenic effects [yet to be discussed] are factored in, the cost advantages of spinal manipulation as a treatment alternative become even more prominent. In one study, for instance, it was shown that for managing disc herniations, the cost of treatment failures following a medical course of treatment [chymopapain injections] averaged 300 British pounds per patient, while there were no such costs following spinal manipulation. 24 Imagine how failed back surgery might compare. Finally, in no cost studies to date have legal burdens been calculated, which one would expect should be heavily advantageous for chiropractic health management.
10
Cost Per Case Comparison of Back Injury Claims of Chiropractic Versus Medical Management for Conditions With Identical Diagnostic Codes
J Occup Med 1991 (Aug); 33 (8): 847–852
This workers’ compensation study conducted in Utah compared the cost of chiropractic care to the costs of medical care for conditions with identical diagnostic codes. The study indicated that costs were significantly higher for medical claims than for chiropractic claims. The sample consisted of 3062 claims or 40.6% of the 7551 estimated back injury claims from the 1986 Workers' Compensation Fund of Utah. For the total data set, cost for care was significantly more for medical claims, and compensation costs were 10-fold less for chiropractic claims.
11
Disabling Low Back Oregon Workers' Compensation Claims. Part I: Methodology and Clinical Categorization of Chiropractic and Medical Cases
J Manipulative Physiol Ther 1991 (Mar-Apr); 14 (3): 177–184
The two provider groups differed in the proportion of claimants who had physical factors contributing to low back compromise. DC claimants were less likely than MD claimants to have sought initial treatment in the emergency room, more likely to have a history of chronic, recurrent low back pain and more likely to have suffered exacerbation episodes. These differences suggest a greater level of chronicity among chiropractic claimants.
12
Disabling Low Back Oregon Workers' Compensation Claims Part II: Time Loss
J Manipulative Physiol Ther 1991 (May); 14 (4): 231–239
for claimants with a history of chronic low back problems, the median time loss days for MD cases was 34.5 days, compared to 9 days for DC cases. It is suggested that chiropractors are better able to manage injured workers with a history of chronic low back problems and to return them more quickly to productive employment.
14
A Comparison of Chiropractic, Medical and Osteopathic Care for Work-related Sprains and Strains
J Manipulative Physiol Ther 1989 (Oct); 12 (5): 335–344
For those who received care from DCs (n = 266), the mean number of compensated days lost from work was at least 2.3 days less than for those who were treated by MDs (n = 494; p less than 0.025) and at least 3.8 days less than for those who were treated by DOs (n = 102; p less than 0.025). Consequently, much less money in employment compensation was paid, on the average, to those who saw DCs.
15
An Analysis of Florida Workers' Compensation Medical Claims for Back-related Injuries
Journal of the American Chiro Association 1988; 25 (7): 50–59
This study of 10,652 Florida Workers’ Compensation cases was conducted by Steve Wolk, Ph.D. , and reported by the Foundation for Chiropractic Education and Research. It was concluded that “a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors.”
The analysis focused on the cost of treatment, frequency of compensable injuries (an injury which disables an individual for more than seven days, resulting in wage compensation benefits), and frequency of hospitalization for workers' compensation claim patient (end of reference).
17
Chiropractic and Medical Costs of Low Back Care
Med Care 1996 (Mar); 34 (3): 191–204
This study compares health insurance payments and patient utilization patterns for episodes of care for common lumbar and low back conditions treated by chiropractic and medical providers. Using 2 years of insurance claims data, this study examines 6,183 patients who had episodes with medical or chiropractic first-contact providers. Multiple regression analysis, to control for differences in patient, clinical, and insurance characteristics, indicates that total insurance payments were substantially greater for episodes with a medical first-contact provider.
18
Costs and Recurrences of Chiropractic and Medical Episodes of Low-back Care
J Manipulative Physiol Ther 1997 (Jan); 20 (1): 5–12 Total insurance payments within and across episodes were substantially greater for medically initiated episodes. Analysis of recurrent episodes as measures of patient outcomes indicated that chiropractic providers retain more patients for subsequent episodes, but that there is no significant difference in lapse time between episodes for chiropractic vs. medical providers. Chiropractic and medical patients were comparable on measures of severity; however, the chiropractic cohort included a greater proportion of chronic cases.
19
The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain
Richmond Hill, Ontario: Kenilworth Publishing, 1993
A major study to assess the most appropriate use of available health care resources was reported in 1993. This was an outcomes study funded by the Ontario Ministry of Health. The study was conducted by three health economists led by University of Ottawa Professor Pran Manga, Ph.D. The report of the study is commonly called the Manga Report. The Manga Report overwhelmingly supported the efficacy, safety, scientific validity, and cost-effectiveness of chiropractic for low-back pain. Additionally, it found that higher patient satisfaction levels were associated with chiropractic care than with medical treatment alternatives. On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. It also found that many medical therapies are of questionable validity, or are clearly inadequate.
20
Enhanced Chiropractic Coverage Under OHIP as a Means for Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services
Report to the Ontario Ministry of Health, 1998
Expenditure to improve access to chiropractic services, and the changed utilization patterns it produces, will lead to very substantial net savings in direct and indirect costs. Direct savings to Ontario's health care system may be as much as $770 million, will very likely be $548 million, and will be at least $380 million.
The corresponding savings in indirect costs - made up of the short and long term costs of disability - are $3.775 billion, $1.849 billion and $1.255 billion.
21
Comparing the Costs Between Provider Types of Episodes of Back Pain Care
Spine 1995 (Jan 15); 20 (2): 221–227
There were 1020 episodes of back pain care made by 686 different persons and encompassing 8825 visits. Chiropractors and general practitioners were the primary providers for 40% and 26% of episodes, respectively. Chiropractors had a significantly greater mean number of visits per episode (10.4) than did other practitioners.
Orthopedic physicians and "other" physicians were significantly more costly on a per visit basis. Orthopedists had the highest mean total cost per episode, and general practitioners the lowest.
23
[Letter to the editor regarding] Comparing the Costs Between Provider Types of Episodes of Back Pain Care
Spine 1995 (Dec); 20 (23): 2595–2596
Based on the proliferation of more recent studies that have selected (by means of provider codes) a patient population that is narrower, yet more homogeneous, I conclude that the burden of proof for the higher cost of chiropractic healthcare without hospital services remains on the authors of this article. There appears to be too many questions raised by this study that, if they remain unanswered, prevent it from becoming a major addition to the chiropractic literature.
The National Board of Chiropractic Examiners
published reports based on a four-year study of chiropractic. These
reports focused on three surveys including full-time,
licensed U.S., Canadian and registered Australian and New Zealand chiropractic
practitioners. The surveys and their resulting reports are titled
Job Analysis of Chiropractic.
Following publication of the Job Analysis of Chiropractic,
the NBCE began to receive requests for permission to reproduce certain
portions of the reports. In response to those requests, the NBCE
has condensed relevant portions and reprinted them in this brochure.
In recent years, numerous independent researchers
and various government agencies have conducted studies which focus
on the efficacy, appropriateness and cost-effectiveness of chiropractic
treatment. Several of these important studies are listed below.
U.S. GOVERNMENT AGENCY REPORT
A 1994 study published by the U.S. Agency for Health Care Policy and
Research (AHCPR) and the U.S. Department of Health and Human Services
endorses spinal manipulation for acute low back pain in adults in its Clinical
Practice Guideline # 14. An independent multidisciplinary panel of
private-sector clinicians and other experts convened and developed specific
statements on appropriate health care of acute low back problems in adults.
One statement cited, relief of discomfort (low back pain) can be
accomplished most safely with spinal manipulation, and/or nonprescription
medication.
THE MANGA REPORT
A major study to assess the most appropriate use of available health
care resources was reported in 1993. This was an outcomes study funded
by the Ontario Ministry of Health and conducted in hopes of sharing information
about ways to reduce the incidence of work-related injuries and to address
cost-effective ways to rehabilitate disabled and injured workers. The study
was conducted by three health economists led by University of Ottawa Professor
Pran Manga, Ph.D. The report of the study is commonly called the
Manga Report. The Manga Report overwhelmingly supported the efficacy,
safety, scientific validity, and cost-effectiveness of chiropractic for
low-back pain. Additionally, it found that higher patient satisfaction
levels were associated with chiropractic care than with medical treatment
alternatives. “Evidence from Canada and other countries suggests
potential savings of hundreds of millions annually,” the Manga Report
states. “The literature clearly and consistently shows that the major savings
from chiropractic management come from fewer and lower costs of auxiliary
services, fewer hospitalizations, and a highly significant reduction in
chronic problems, as well as in levels and duration of disability.”
RAND STUDY ON LOW-BACK PAIN
A four-phase study conducted in the early 1990s by RAND, one of America’s
most prestigious centers for research in public policy, science and technology,
explored many indications of low-back pain. In the RAND studies,
an expert panel of researchers, including medical doctors and doctors of
chiropractic, found that:
chiropractors deliver a substantial amount of health care to the U.S. population.
spinal manipulation is of benefit to some patients with acute low-back pain.
The RAND reports marked the first time that representatives of the medical community went on record stating that spinal manipulation is an appropriate treatment for certain low-back pain conditions.
THE NEW ZEALAND COMMISSION REPORT
A particularly significant study of chiropractic was conducted between
1978-1980 by the New Zealand Commission of Inquiry. In its 377-page
report to the House of Representatives, the Commission called its study
“probably the most comprehensive and detailed independent examination of
chiropractic ever undertaken in any country.” The Commission entered
the inquiry with “the general impression ... shared by many in the community:
that chiropractic was an unscientific cult, not to be compared with orthodox
medical or paramedical services.” By the end of the inquiry,
the commission reported itself “irresistibly and with complete unanimity
drawn to the conclusion that modern chiropractic is a soundly-based and
valuable branch of health care in a specialized area...” Conclusions
of the Commission’s report, based on investigations in New Zealand,
the U.S., Canada, the United Kingdom, and Australia, stated:
Spinal manual therapy in the hands of a registered chiropractor is safe.
Spinal manual therapy can be effective in relieving musculo-skeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine.
Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy.
In the public interest and in the interests of patients, there must be no impediment to full professional cooperation between chiropractors and medical practitioners.
STATE OF TEXAS WORKERS' COMPENSATION STUDY OF 2003
In 2002, the Texas Chiropractic Association (TCA) commissioned an independent study to determine the use and effectiveness of chiropractic with regard to workers' compensation, the results of which were published in February. According to the report, Chiropractic Treatment of Workers' Compensation Claimants in the State of Texas, chiropractic care was associated with significantly lower costs and more rapid recovery in treating workers with low-back injuries. They found:
Lower back and neck injuries accounted for 38 percent of all claims costs. Chiropractors treated about 30 percent of workers with lower back injuries, but were responsible for only 17.5 percent of the medical costs and 9.1 percent of the total costs. These findings were even more intertesting: The average claim for a worker with a low-back injury was $15,884. However, if a worker received at least 75 percent of his or her care from a chiropractor, the total cost per claimant decreased by nearly one-fourth to $12,202. If the chiropractor provided at least 90 percent of the care, the average cost declined by more than 50 percent, to $7,632.
FLORIDA WORKERS’ COMPENSATION STUDY
A 1988 study of 10,652 Florida workers’ compensation cases was conducted
by Steve Wolk, Ph.D. , and reported by the Foundation for Chiropractic
Education and Research. It was concluded that “a claimant with a back-related
injury, when initially treated by a chiropractor versus a medical doctor,
is less likely to become temporarily disabled, or if disabled, remains
disabled for a shorter period of time; and claimants treated by medical
doctors were hospitalized at a much higher rate than claimants treated
by chiropractors.”
WASHINGTON HMO STUDY
In 1989, a survey administered by Daniel C. Cherkin, Ph.D., and Frederick A. MacCornack, Ph.D., concluded that
patients receiving care from health maintenance organizations (HMOs) within the state of Washington were three times as likely to report satisfaction with care from chiropractors as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.
UTAH WORKERS’ COMPENSATION STUDY
A workers’ compensation study conducted in Utah by Kelly B. Jarvis,
D.C., Reed B. Phillips, D.C., Ph.D., and Elliot K. Morris, JD, MBA, compared the cost of chiropractic care to the costs of medical care for conditions with identical diagnostic codes. Results were reported in the August
1991 Journal of Occupational Medicine. The study indicated that costs were significantly higher for medical claims than for chiropractic claims; in addition, the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.
PATIENT DISABILITY COMPARISON
A 1992 article in the Journal of Family Practice reported a study by DC Cherkin, Ph.D., which compared patients of family physicians and of chiropractors. The article stated “the number of days of disability for patients seen by family physicians was significantly higher (mean 39.7) than for patients managed by chiropractors (mean 10.8).” A related editorial in the same issue referred to risks of complications from lumbar manipulation as being “very low.”
OREGON WORKERS’ COMPENSATION STUDY
A 1991 report on a workers’ compensation study conducted in Oregon
by Joanne Nyiendo, Ph.D., concluded that the median time loss days (per
case) for comparable injuries was 9.0 for patients receiving treatment
by a doctor of chiropractic and 11.5 for treatment by a medical doctor.
STANO COST COMPARISON STUDY
Miron Stano, PhD, Oakland University, conducted a study comparing the health-care costs for chiropractic and medical patients with neuromusculoskeletal conditions. The database he used came from the records of MEDSTAT Systems, Inc., a health benefits management consulting firm which processes insurance claims for many of the country's largest corporations.
This June 1993 Journal of Manipulative and Physiological Therapeutics study involved 395,641 patients.
Results over a two-year period showed that patients who received chiropractic care incurred significantly lower health care costs than did patients treated solely by medical or osteopathic physicians.
SASKATCHEWAN CLINICAL RESEARCH
Following a 1993 study, researchers J. David Cassidy, D.C., Haymo Thiel,
D.C., M.S., and W. Kirkaldy-Willis, M.D., of the Back Pain Clinic at the
Royal University Hospital in Saskatchewan concluded that “the treatment
of lumbar intervertebral disk herniation by side posture manipulation is
both safe and effective.”
UNIVERSITY OF SASKATCHEWAN STUDY OF 1985
In 1985 the University of Saskatchewan conducted a study of 283 patients “who had not responded to previous conservative or operative treatment” and who were initially classified as totally disabled. The study revealed that
“81% ... became symptom free or achieved a state of mild intermittent pain with no work restrictions” after daily spinal manipulations were administered.
WIGHT STUDY ON RECURRING HEADACHES
A 1978 study conducted by J.S. Wight, D.C. , and reported in the ACA
Journal of Chiropractic, indicated that 74.6% of patients with recurring
headaches, including migraines, were either cured or experienced reduced
headache symptomatology after receiving chiropractic manipulation.
1991 GALLUP POLL
A 1991 demographic poll conducted by the Gallup Organization revealed that 90% of chiropractic patients felt their treatment was effective; more than 80% were satisfied with that treatment; and nearly 75% felt most of their expectations had been met during their chiropractic visits.
A study conducted by T.W. Meade, a medical doctor, and reported in the
June 2, 1990, British Medical Journal concluded after two years of patient monitoring, “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.” More importantly, this article contradicts other articles which maintained that spinal adjusting (manipulation) was only effective for "acute" low back pain
. This article found:The benefit is seen mainly in those with chronic or severe pain . It also suggested that “introducing chiropractic into NHS practice should be considered.”
VIRGINIA COMPARATIVE STUDY
A 1992 study conducted by L.G. Schifrin, Ph.D., provided an economic
assessment of mandated health insurance coverage for chiropractic treatment
within the Commonwealth of Virginia. As reported by the College of
William and Mary, and the Medical College of Virginia, the study indicated
that chiropractic provides therapeutic benefits at economical costs. The
report also recommended that chiropractic be a widely available form of
health care.
1992 AMERICA HEALTH POLICY REPORT
A 1992 review of data from over 2,000,000 users of chiropractic care in the U.S., reported in the Journal of American Health Policy, stated that
“chiropractic users tend to have substantially lower total health care costs,”
and that
“chiropractic care reduces the use of both physician and hospital care.”
1985 UNIVERSITY OF SASKATCHEWAN STUDY
In 1985 the University of Saskatchewan conducted a study of 283 patients
“who had not responded to previous conservative or operative treatment”
and who were initially classified as totally disabled. The study revealed
that “81% ... became symptom free or achieved a state of mild intermittent
pain with no work restrictions” after daily spinal manipulations were administered.
Further validation of chiropractic care evolved from an antitrust suit
which was filed by four members of the chiropractic profession against
the American Medical Association (AMA) and a number of other health care
organizations in the U.S. (Wilk et al v. AMA et al, 1990). Following
11 years of litigation, a federal appellate court judge upheld a ruling
by U.S. District Court Judge Susan Getzendanner that the AMA had engaged
in a “lengthy, systematic, successful and unlawful boycott” designed to
restrict cooperation between MDs and chiropractors in order to eliminate
the profession of chiropractic as a competitor in the U.S. health care
system. Judge Getzendanner rejected the AMA’s patient care defense,
and cited scientific studies which implied that “chiropractic care was
twice as effective as medical care in relieving many painful conditions
of the neck and back as well as related musculo-skeletal problems."
Since the court’s findings and conclusions were released, an increasing
number of medical doctors, hospitals, and health care organizations in
the U.S. have begun to include the services of chiropractors.
In order to become a licensed doctor of chiropractic, an individual
must meet stringent testing, academic and professional requirements.
Currently, an individual must complete the four major steps shown below
in order to become a chiropractic practitioner:
CHIROPRACTIC TRAINING
Government inquiries (some of which are described in this brochure),
as well as independent investigations by medical practitioners, have affirmed
that today’s chiropractic academic training is of equivalent standard to
medical training in all pre-clinical subjects. High standards in
chiropractic education are maintained by the Council on Chiropractic Education
(CCE) and its Commission on Accreditation, as recognized by the U.S.
Department of Education. Some Chiropractic colleges require a Bachelor's
degree before enrollment. A doctor of chiropractic’s training generally
requires a minimum of six years of college study (two years of which are
undergraduate course work) and an internship prior to entering practice.
Postdoctoral training in a variety of clinical disciplines and specialties
is also available through accredited colleges and specialty councils.
CHIROPRACTIC LICENSING
Chiropractic is one of many occupations which are regulated by state
licensing agencies. The requirements for chiropractic licensure vary from
state to state (and country to country). Some states require a Bachelor's
degree as a prerequisite for licensure. To assist the various regulatory
agencies in assessing candidates for licensure, the National Board administers
examinations to individuals currently in the chiropractic educational system
or who have completed a chiropractic educational program. The National
Board also offers an examination designed for previously licensed individuals.
A candidate for chiropractic licensure may request that transcripts
of scores from National Board examinations be forwarded to licensing agencies
which assess eligibility for licensure. Scores from National Board
examinations are made available to licensing agencies throughout the U.S.
and in some foreign countries including Canada, the United Kingdom, France
and Australia.
For additional information, or to order a Job Analysis
of Chiropractic conducted in the U.S., Canada, Australia
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