The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61039

Eric L. Hurwitz, DC, PhD, Hal Morgenstern, PhD, Maria Vassilaki, MD, MPH, and Lu-May Chiang, MS. Department of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, 310-206-4074, ehurwitz@ucla.edu

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. The objectives of this presentation 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. Neck-pain patients were randomized to receive cervical spine manipulation or mobilization. At 2 weeks, subjects were queried about possible treatment-related adverse reactions and followed for 6 months with assessments for pain and disability at 2, 6, 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 4 weeks. Of 960 eligible patients, 336 were enrolled and 280 responded to the adverse-event questionnaire. 30% of respondents reported at least 1 adverse symptom, most commonly increased pain and headache within 24 hours of treatment. Patients randomized to manipulation were more likely than those randomized to mobilization to report an adverse reaction (adjusted odds ratio = 1.44, 95% 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. Adverse reactions are more likely to be reported following cervical spine manipulation than mobilization. Chiropractors may be able to reduce iatrogenesis and increase satisfaction and clinical outcomes by mobilizing rather than manipulating their neck-pain patients.

Learning Objectives:

• Participants will acquire knowledge about the research design and methods of the UCLA Neck Pain Study, including the source population, interventions, and measures used to assess adverse reactions and clinical outcomes, as well as the statistical models used to estimate the effects of adverse reactions on subsequent pain, disability, and patient satisfaction. Participants will be able to describe the study design and population, discuss pertinent results, identify the study’s strengths and limitations, and place the study in the context of existing literature on the side effects of chiropractic care.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.