Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study

Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study

Hurwitz, Eric

Background: Minor side-effects associated with chiropractic are common. However, little is known about their predictors or the effects of reactions on satisfaction and clinical outcomes.

Objective: The objectives of this study are to compare the relative effects of cervical spine manipulation and mobilization on adverse reactions and to estimate the effects of adverse reactions on satisfaction and clinical outcomes among patients with neck pain.

Methods: Neck-pain patients were randomized to receive cervical spine manipulation or mobilization. At two weeks, subjects were queried about possible treatment-related adverse reactions and followed for six months with assessments for pain and disability at two, six, 13, and 26 weeks. Numerical rating scales and the Neck Disability Index were used to measure pain and disability. Perceived improvement and satisfaction with care were assessed at four weeks.

Results: Of 960 eligible patients, 336 enrolled and 280 responded to the adverse-event questionnaire. Thirty percent of respondents reported at least one adverse symptom, most commonly increased pain and headache. Patients randomized to manipulation were more likely than those randomized to mobilization to report an adverse reaction (adjusted odds ratio = 1.44, 95 percent confidence interval = 0.85, 2.43). Subjects reporting adverse reactions were less satisfied with care and less likely to have clinically meaningful improvements in pain and disability.

Conclusions: Adverse reactions are more likely to be reported following cervical spine manipulation than mobilization. Chiropractors may reduce iatrogenesis, increase satisfaction and clinical outcomes by mobilizing, rather than manipulating their neck-pain patients.

Key Indexing Terms: Chiropractic; spinal manipulation; neck pain; adverse reactions; side-effects; iatrogenesis; patient satisfaction.

Eric Hurwitz, DC, PhD; Hal Morgenstern, PhD; Maria Vassilaki, MD, MPH; Lu-May Chiang, MS

World Federation of Chiropractic

2nd Prize Winner

Copyright Dynamic Chiropractic Mar 11, 2004

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