From: Daniel Becker firstname.lastname@example.org>
To: email@example.com; firstname.lastname@example.org
Subject: Past comments on NEJM articles from V10 #11
Date: Monday, October 12, 1998 10:00 PM
I went back and reviewed commentary on the recently reported
by Cherkin et al. as noted in "The BackLetter" issue V10/11
The following are quotes:
Five hundred and six patients were identified as potential
candidates for the study after an initial visit with a primary
provider for back pain. A week later they were contacted to see
they still had back pain. (321 were choosen)
The educational booklet provided basic information about back
and exercise. In a previous study, Cherkin and colleagues had
proven this booklet to have no impact on back pain
The McKenzie therapists saw their patients for an average of 4.6
visits over one month, while the chiropractors had on average,
visits more per patient. In terms of total contact time,
the McKenzie spent more time with their patients than the
chiropractors. (The chiropractors and therapists were allowed to
set the exact number of visits up to 9).
The McKenzie patients received: "In addition to the therapy
sessions...'Treat Your Own Back' by Bob Mckenzie and a lumbar
Cherkin:...it is possible tht the positive results in the
and chiropractic groups could be a result of an attention placebo
In the next issue of the BackLetter V10/12 1995 is the following
concerning a new study on McKenzie protocol: A carefully designed
new study in Holland will compare the efficacy and costs of
McKenzie therapy, physical therapy, and treatment by a general
practitioner. The study was to get under way in 1996 and assess
3, 8,12, 26, and 52 weeks. 12 patient sessions up to an 8 week
period. It was performed by Bart W. Koes, PhD. 60 subjects.
I guess McKenzie does not consider his therapy to be PT. This
study if it has been published should help answer the question of
dosage vs MMI of the Cherkin study. Anyone have it?
BackLetter V11/12 1996 Qoutes on Cherkin study, one year
"We are going to report on costs and lon-term utilization of
services and health care," says Cherkin. We will provide the
that will allow policy makers to determine whether the treatment
benefits are worth the costs."
The key question is: "What price do managed care organizations
on symptom relief and patient satisfaction?"
I guess this last above qoute sums up the purpose of this
This Cherkin study was not a study to determine clinical
application/purpose/efficacy as much as it was to determine if 9
visits was enough treatment to cure/heal the patient. In other
words, could the HMO get away with 9 or less; or should they pay
for any treatment for the defined population.
It was an economic/business study. I say this because we still
don't know definitively what the proper dosage requirement is for
McKenzie, or for chiropractic for the defined research
to achieve improved function, less reoccurances and less
utilization of health care resources.
This question should have been answered before the study was
performed, just as the booklet was tested. So we now know that
an average of 6 visits in chiropractic care a defined population
can expect better satisfaction etc. than that which they would
receive from the book for a period of one month.
We don't know though, how much treatment it would take to achieve
the results which Cherkin was looking for: Improved function,
reoccurances, thus less utilization of health care resourses.
Daniel Becker, DC, DABCN