Chiropractic: Difference between revisions

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'''Editor-in-Chief:''' [[User:Drsjpdc  |Dr. Stephen J. Press]] [mailto:drsjp@drpress.com]
'''Editor-in-Chief:''' [[User:Drsjpdc  |Dr. Stephen J. Press]] [mailto:drsjp@drpress.com]
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Chiropractic is the largest alternative medical profession in the U.S.<ref name=Kaptchuk-Eisenberg/> and is the 3rd largest doctored profession behind [[medicine]] and [[dentistry]] in North America.<ref>{{cite web|url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html|title=Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.|coauthors=Smith M, Morschhauser S. |publisher=National Library of Medicine|accessdate=2008-05-06}}</ref> The percentage of population that utilize chiropractic care at any given time generally fall into a range from 6% to 12% in the U.S. and Canada,<ref name=Lawrence-Meeker/> with a global high of 20% in [[Alberta]].<ref name="Crownfield">{{cite journal |url=http://chiroweb.com/archives/25/06/02.html |title= Chiropractic in Alberta: a model of consumer utilization and satisfaction |journal= Dyn Chiropr |volume=25 |issue=6 |author= Crownfield PW |date=2007}}</ref> The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;<ref>{{cite journal |journal= BMC Health Serv Res |date=2006 |volume=6 |issue=49 |title= A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03 |author= Hurwitz EL, Chiang LM |doi=10.1186/1472-6963-6-49 |pmid=16600038 |url=http://www.biomedcentral.com/1472-6963/6/49}}</ref> most do so specifically for low back pain.<ref name=Lawrence-Meeker/> [[Complementary and alternative medicine]] (CAM) practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.<ref name=Lawrence-Meeker>{{cite journal |journal= Chiropr Osteopat |date=2007 |volume=15 |issue=2 |title= Chiropractic and CAM utilization: a descriptive review |author= Lawrence DJ, Meeker WC |doi=10.1186/1746-1340-15-2 |pmid=17241465 |url=http://www.chiroandosteo.com/content/15/1/2}}</ref> Satisfaction rates are typically higher for chiropractic care compared to medical care, with quality of communication seeming to be a consistent predictor of patient satisfaction with chiropractors.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=6 |pages=455–62 |title= Factors associated with patient satisfaction with chiropractic care: survey and review of the literature |author= Gaumer G |doi=10.1016/j.jmpt.2006.06.013 |pmid=16904491}}</ref> Despite high patient satisfaction scores, utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.<ref>{{cite book |author= Chapman-Smith DA, Cleveland CS III |chapter= International status, standards, and education of the chiropractic profession |pages=111–34 |title= Principles and Practice of Chiropractic |edition= 3rd ed. |editor= Haldeman S, Dagenais S, Budgell B ''et al.'' (eds.) |publisher=McGraw-Hill |date=2005 |isbn=0-07-137534-1}}</ref> The use of chiropractic is growing modestly; CAM as a whole is seeing wholesale increases.<ref name=Lawrence-Meeker/> Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.<ref name=BLS>{{cite web |url=http://stats.bls.gov/oco/ocos071.htm |author= Bureau of Labor Statistics |title= Occupational outlook handbook |date=2007 |accessdate=2008-02-14}}</ref> A 2008 survey stated that 69% of DC chiropractors disagree with the categorization of chiropractic as CAM, with 27% having some preference for the term "integrated medicine."<ref>{{cite journal |journal=J Altern Complement Med |date=2008 |volume=13 |issue=4 |pages=361-368 |title=Do Chiropractors Identify with Complementary and Alternative Medicine? Results of a Survey |doi=10.1089/acm.2007.0766 |pmid=18435599 |url=http://www.liebertonline.com/doi/abs/10.1089/acm.2007.0766}}</ref>
Chiropractic is the largest alternative medical profession in the U.S.<ref name=Kaptchuk-Eisenberg/> and is the 3rd largest doctored profession behind [[medicine]] and [[dentistry]] in North America.<ref>{{cite web|url=http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html|title=Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.|coauthors=Smith M, Morschhauser S. |publisher=National Library of Medicine|accessdate=2008-05-06}}</ref> The percentage of population that utilize chiropractic care at any given time generally fall into a range from 6% to 12% in the U.S. and Canada,<ref name=Lawrence-Meeker/> with a global high of 20% in [[Alberta]].<ref name="Crownfield">{{cite journal |url=http://chiroweb.com/archives/25/06/02.html |title= Chiropractic in Alberta: a model of consumer utilization and satisfaction |journal= Dyn Chiropr |volume=25 |issue=6 |author= Crownfield PW |date=2007}}</ref> The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;<ref>{{cite journal |journal= BMC Health Serv Res |date=2006 |volume=6 |issue=49 |title= A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03 |author= Hurwitz EL, Chiang LM |doi=10.1186/1472-6963-6-49 |pmid=16600038 |url=http://www.biomedcentral.com/1472-6963/6/49}}</ref> most do so specifically for low back pain.<ref name=Lawrence-Meeker/> [[Complementary and alternative medicine]] (CAM) practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.<ref name=Lawrence-Meeker>{{cite journal |journal= Chiropr Osteopat |date=2007 |volume=15 |issue=2 |title= Chiropractic and CAM utilization: a descriptive review |author= Lawrence DJ, Meeker WC |doi=10.1186/1746-1340-15-2 |pmid=17241465 |url=http://www.chiroandosteo.com/content/15/1/2}}</ref> Satisfaction rates are typically higher for chiropractic care compared to medical care, with quality of communication seeming to be a consistent predictor of patient satisfaction with chiropractors.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=6 |pages=455–62 |title= Factors associated with patient satisfaction with chiropractic care: survey and review of the literature |author= Gaumer G |doi=10.1016/j.jmpt.2006.06.013 |pmid=16904491}}</ref> Despite high patient satisfaction scores, utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.<ref>{{cite book |author= Chapman-Smith DA, Cleveland CS III |chapter= International status, standards, and education of the chiropractic profession |pages=111–34 |title= Principles and Practice of Chiropractic |edition= 3rd ed. |editor= Haldeman S, Dagenais S, Budgell B ''et al.'' (eds.) |publisher=McGraw-Hill |date=2005 |isbn=0-07-137534-1}}</ref> The use of chiropractic is growing modestly; CAM as a whole is seeing wholesale increases.<ref name=Lawrence-Meeker/> Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.<ref name=BLS>{{cite web |url=http://stats.bls.gov/oco/ocos071.htm |author= Bureau of Labor Statistics |title= Occupational outlook handbook |date=2007 |accessdate=2008-02-14}}</ref> A 2008 survey stated that 69% of DC chiropractors disagree with the categorization of chiropractic as CAM, with 27% having some preference for the term "integrated medicine."<ref>{{cite journal |journal=J Altern Complement Med |date=2008 |volume=13 |issue=4 |pages=361-368 |title=Do Chiropractors Identify with Complementary and Alternative Medicine? Results of a Survey |doi=10.1089/acm.2007.0766 |pmid=18435599 |url=http://www.liebertonline.com/doi/abs/10.1089/acm.2007.0766}}</ref>
== History ==
{{main|Chiropractic history}}
[[Image:ddpalmer3.jpg|thumb|left|D.D. Palmer]]
Chiropractic (also known as Chiropractic Medicine) was founded in the 1890s by Canadian-American [[Daniel David Palmer]] in [[Davenport, Iowa]], USA. Palmer and his son [[B.J. Palmer]] later wrote that the elder Palmer gave the first chiropractic adjustment to a deaf man, Harvey Lillard, on [[September 18]], [[1895]], restoring the man's hearing.<ref name=Palmer1906>{{cite book |author= Palmer DD, Palmer BJ |title= The science of chiropractic: its principles and adjustments |location= Davenport, IA |publisher= Palmer School of Chiropractic |date=1906 |oclc=36930079}}</ref> Lillard's daughter disputed the account, saying that Palmer had merely slapped Lillard on the back after hearing a joke.<ref>{{cite journal |author= Westbrooks B |date=1982 |title= The troubled legacy of Harvey Lillard: the black experience in chiropractic |journal= Chiropr Hist |volume=2 |issue=1 |pages=47–53 |pmid=11611211}}</ref> Investigator Cyrus Lerner found in 1952 that the Lillard story disagreed with other evidence published about the same time, speculated that B.J. had concocted the date of the first adjustment in order to establish priority for chiropractic, and compared the Lillard story to the [[Tales of the Arabian Nights]].<ref name=Lerner/> Palmer hypothesized that manual manipulation of the spine could result in improved neurological function and health. Friend and Rev. Samuel Weed suggested combining the words ''cheiros'' and ''praktikos'' (meaning "done by hand") and chiropractic was born.<ref>{{cite journal |journal=Technol Cult |author=Martin SC |date=1993 |volume=34 |issue=4 |pages=808–34 |title=Chiropractic and the social context of medical technology, 1895-1925 |pmid=11623404}}</ref>
=== Medical opposition ===
In [[1899]], a medical doctor in Davenport, USA, named Heinrich Matthey started a campaign against drugless practitioners.<ref name=Lerner>{{cite paper |author= Lerner C |title= Unpublished manuscript submitted to the Foundation for Health Research |date=1952 |url=http://philosophyofchiropractic.com/Lerner.pdf |format=PDF |accessdate=2008-05-12}}</ref><ref>{{cite journal |url=http://chiroweb.com/archives/19/06/07.html |title= Chiropractic at the turn of the century |author= Keating J Jr |journal= Dyn Chiropr |date=2001 |volume=18 |issue=6}}</ref> D.D. Palmer insisted that his techniques did not need the same courses or license as medical doctors, as his graduates did not prescribe drugs, perform surgery or evaluate laboratory diagnostics. However, in 1906, D.D. Palmer was convicted for practicing [[medicine]] without a license. In response, B.J. created the Universal Chiropractic Association (UCA) for the purpose of protecting its members by covering their legal expenses should they get arrested for practicing medicine.<ref>{{cite journal |author= Keating JC Jr |date=1999 |url=http://chiroweb.com/archives/17/25/09.html |title= Tom Moore, defender of chiropractic, part 1 |journal= Dyn Chiropr |volume=17 |issue=25}}</ref>
[[Image:BJPalmer2.jpg|thumb|left|130px|BJ Palmer, Developer of Chiropractic, 1882-1961]]
Its first case came in 1907, when Shegataro Morikubo, DC was charged with unlicensed practice of [[osteopathic medicine]] in Wisconsin. Morikubo was freed using the defense that chiropractic [[philosophy]] was different from osteopathic philosophy. The victory reshaped the development of the chiropractic profession, which then marketed itself as a science, an art and a philosophy.<ref name=Lerner/> This began a longstanding feud between chiropractors and medical doctors that would culminate in the mid 1980's in a landmark case, Wilk et al. vs [[American Medical Association]] (AMA). Until 1983, the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific [[cult]]."<ref>{{cite journal |journal=Am J Public Health |date=1989 |volume=79 |issue=11 |pages=1569–70 |title= AMA policy on chiropractic |author=Cherkin D |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=2817179 |pmid=2817179}}</ref> In 1984, Joseph Janse, DC, ND, attempted to describe the divide in chiropractic and medical philosophy regarding prevention and patient care:
<blockquote>
"Unless pathology is demonstrable under the microscope, as in the laboratory or by roentgenograms, to them [medical doctors] it does not exist. For years the progressive minds in chiropractic have pointed out this deficiency. With emphasis they [chiropractors] have maintained the fact that prevention is so much more effective than attempts at a cure. They pioneered the all-important principle that effective eradication of disease is accomplished only when it is in its functional (beginning) phase rather than its organic (terminal) stage. It has been their contention that in general the doctor, the therapist and the clinician have failed to realize exactly what is meant by disease processes, and have been satisfied to consider damaged organs as disease, and to think in terms of sick organs and not in terms of sick people. In other words, we have failed to contrast disease with health, and to trace the gradual deteriorization along the downward path, believing almost that mild departures from the physiological normal were of little consequence, until they were replaced by pathological changes…"<ref>Janse J, quoted in: {{cite book |author= Strang VV |title= Essential Principles of Chiropractic |location= Davenport, IA |publisher= Palmer College of Chiropractic |oclc=12102972 |date=1984 |pages= p. 26}}</ref>
</blockquote>
In 1992, the AMA stated "It is ethical for a physician to associate professionally with chiropractors provided that the physician believes that such association is in the best interests of his or her patient. A physician may refer a patient for diagnostic or therapeutic services to a chiropractor permitted by law to furnish such services whenever the physician believes that this may benefit his or her patient. Physicians may also ethically teach in recognized schools of chiropractic."<ref name="E-3.041 Chiropractic">{{cite web |url=http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/E-3.041.HTM |title= E-3.041 Chiropractic |accessdate=2008-03-24 |publisher=American Medical Association}}</ref> In 1997, the following literature was adopted as policy of the AMA after a report on a number of alternative therapies. The report said (about chiropractic care): "[[joint manipulation|Manipulation]] has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints."<ref name="AMA Report 12">{{cite web |url=http://www.ama-assn.org/ama/pub/category/13638.html |title=Report 12 of the Council on Scientific Affairs (A-97) Full Text |accessdate=2008-03-24 |publisher=American Medical Association}}</ref>
The British Medical Association (BMA) notes that "There is also no problem with GPs referring patients to practitioners in osteopathy and chiropractic who are registered with the relevant statutory regulatory bodies, as a similar means of redress is available to the patient."<ref name=BMA-referrals>{{cite web |url=http://www.bma.org.uk/ap.nsf/Content/refcomtherap0406?OpenDocument&Highlight=2 |title=Referrals to complementary therapists |accessdate=2008-05-25 |publisher=British Medical Association}}</ref> In 1997, the BMA identified chiropractic health care as having "the potential for greatest use alongside orthodox medical care."<ref>{{cite journal |journal= Med Law |date=1997 |volume= 16 |issue=3 |pages=437–49 |title= Legislative approaches to the regulation of the chiropractic profession |author=Chapman-Smith DA |url= |pmid=9409129}}</ref>
=== Internal conflicts ===
Straights and mixers have had conflicts that continue to this day.<ref name=Ernst-2008/> ''Objective Straight'' chiropractors, who were an off-shoot of straights, only focused on the correction of chiropractic vertebral subluxations while traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases.<ref name=F.A.C.E.-position-paper1>{{cite web |url=http://www.f-a-c-e.com/positionpaper1.htm |title=Position Paper One — What is Objective Straight Chiropractic? |accessdate=2008-03-24 |publisher=Foundation for the Advancement of Chiropractic Education (F.A.C.E.)}}</ref> ''Reform'' chiropractors were an [[evidence-based]] off-shoot of mixers who rejected traditional Palmer philosophy and tended not to use [[alternative medicine]] methods.<ref name="JCMC"/> There is disagreement over what does innate and subluxation mean to chiropractic.<ref name=Kaptchuk-Eisenberg/> Some chiropractors believe in [[Innate intelligence]], an untestable faith-based belief, not of science, which has been a source of derision for chiropractors.<ref>{{cite journal |journal=J Can Chiropr Assoc |date=2002 |volume=46 |issue=1 |pages=10 |title=The Meanings of Innate |author=Joseph C. Keating, Jr |url=http://www.jcca-online.org/client/cca/JCCA.nsf/objects/Commentary+The+meanings+of+Innate/$file/3-Commentary%20Keating.pdf|format=PDF}}</ref> In Wisconsin, US, there was local chiropractic support to offset a chiropractic anti-fluoridation campaign.<ref>{{cite journal |journal=Am J Public Health |date=1989 |volume=79 |issue=10 |pages=1405–8 |title=Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success |author=Jones RB, Mormann DN, Durtsche TB |pmid=2782512 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=2782512}}</ref>
=== Wilk et al. vs. American Medical Association ===
Chester A. Wilk, DC from Chicago initiated an [[United States antitrust law|antitrust]] suit against the AMA and other medical associations in 1976 - [[Wilk v. American Medical Association|Wilk ''et al.'' vs AMA ''et al.'']]<ref name="Sore Throat">{{cite web |url=http://www.findarticles.com/p/articles/mi_m0820/is_n230/ai_18696325/pg_3 |title=Medical monopoly: the game nobody wins - excerpt from 'Reclaiming Our Health: Exploding the Medical Myth and Embracing the Source of True Healing' |accessdate= |last=Robbins |first=John |coauthors= |date=1996 |work=CNET Networks |publisher=Vegetarian Times}}</ref> The landmark lawsuit ended in 1987 when the [[US District Court]] found the AMA guilty of conspiracy and restraint of trade; the Joint Council on Accreditation of Hospitals and the [[American College of Physicians]] were exonerated. The court recognized that the AMA had to show its concern for patients, but was not persuaded that this could not have been achieved in a manner less restrictive of competition, for instance by public education campaigns.<ref name=Wilk/> A summary of the court's opinion concluded:
<blockquote>
"''Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country.''"<ref name=Wilk/>
</blockquote>
On [[February 7]], [[1990]], the AMA lost its appeal,<ref>''[http://biotech.law.lsu.edu/cases/antitrust/wilk_v_AMA.htm Wilk v. AMA]'', 895 F.2d 352 (7th Cir. 1990).</ref> and could no longer prevent medical physicians from collaborating with chiropractors.<ref name=Wilk>{{cite web |url=http://chiro.org/abstracts/amavschiro.pdf |format=PDF |title= The Wilk case |publisher= The Chiropractic Resource Organization |accessdate=2008-05-12}}</ref>
=== Movement toward science ===
In the first 50 years of chiropractic, there was a lack of research. The terms science and research were often used as marketing tools. Several decades would pass before research and an interest in science became evident in chiropractic.<ref>{{cite journal |journal= J Manipulative Physiol Ther |date=1995 |volume=18 |issue=6 |pages=357–78 |title="Research" and "science" in the first half of the chiropractic century |author=Keating JC Jr, Green BN, Johnson CD |pmid=7595110}}</ref> In 1975, chiropractors joined medical and scientific attendees in a workshop sponsored by the [[National Institutes of Health]] on the research status of spinal manipulation. In 1978, the ''Journal of Manipulative & Physiological Therapeutics'' (''JMPT'') was launched.<ref name=Keating-1997>{{cite journal |author= Keating JC Jr |journal= Skept Inq |volume=21 |issue=4 |pages=37–43 |url=http://findarticles.com/p/articles/mi_m2843/is_n4_v21/ai_19727577 |title= Chiropractic: science and antiscience and pseudoscience side by side |date=1997 |accessdate=2008-05-10}}</ref> In 1983 the ''JMPT'' published an article advocating "a scientific institution with some capability for research" and was considered the beginning of the scientific chiropractic movement.<ref>{{cite journal |journal=J Manipulative Physiol Ther |date=1983 |volume=6 |issue=3 |pages=147–50 |title= Notes from the (chiropractic college's) underground |author= DeBoer KF |pmid=6655376}}</ref> Robert S. Francis, DC, states that "Spinal manipulative therapy gained recognition by mainstream medicine during the 1980s."<ref name=Francis>{{cite web |url=http://www.muaphysicians.com/historical.html |title=International MUA Academy of Physicians - Historical Considerations |accessdate=2008-03-24}}</ref> Various chiropractic groups distributed patient brochures with unsubstantiated claims.<ref name=Grod>{{cite journal |journal= J Manipulative Physiol Ther |date=2001 |volume=24|issue=8|pages=514–9|title= Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies |author= Grod JP, Sikorski D, Keating JC Jr |doi= 10.1067/mmt.2001.118205|pmid=11677551}}</ref> In the early 1990s there was little scientific research into chiropractic. In 1993, the Manga report funded by the Ministry of Health strongly supported chiropractic care for lower back pain.<ref name=Keating-1997/> At the time, the Manga report "caused ripples throughout the traditional medical community when it concluded that chiropractic management of low-back pain is both more effective and cost-effective than traditional medical treatment."<ref>{{cite web |url=http://www.chiroweb.com/archives/13/15/06.html|title=Canada Celebrates 100 Years of Chiropractic|accessdate=2008-05-01 |last= |first= |coauthors= |date=July 17, 1995 |volume=13|issue=15|publisher=Dynamic Chiropractic}}</ref> A 2001 study says "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established."<ref name=Grod/> In 1998, historian Joseph Keating Jr wrote that "substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline."<ref>{{cite journal |author= Keating J ''et al.'' |title= A descriptive analysis of the Journal of Manipulative and Physiological Therapeutics, 1989-1996 |journal= J Manip Physiol Ther |volume= 21 |pages= 539–52 |year= 1998 |pmid= PMID 9798183}}</ref> A 2002 study states "Chiropractic theory is still controversial, but recent expansion in federal support of chiropractic research bodes well for further scientific development. The medical establishment has not yet fully accepted chiropractic as a mainstream form of care. The next decade should determine whether chiropractic maintains the trappings of an alternative health care profession or becomes fully integrated into all health care systems."<ref name=Meeker-Haldeman/> Chiropractic began a century ago in simplistic terms but as the profession developed it is now well established with many chiropractic colleges worldwide.<ref name=DeVocht/> There are barriers between primary care physicians and chiropractors for having positive referral relationships.<ref>{{cite journal |journal= J Ambul Care Manage |year=2007 |volume=30 |issue=4 |pages=347–54 |title= Facilitators and barriers to improving interprofessional referral relationships between primary care physicians and chiropractors |author= Allareddy V, Greene BR, Smith M, Haas M, Liao J |doi=10.1097/01.JAC.0000290404.96907.e3 |pmid=17873667}}</ref> Despite internal debate and external opposition, its unified profession suggests it will endure as a relevant component of health care.<ref name=Kaptchuk-Eisenberg/>


== Scientific research ==
== Scientific research ==

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Template:Alternative medical systems Chiropractic (from Greek chiro- χειρο- "hand-" + praktikós πρακτικός "concerned with action") is a complementary and alternative medicine health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the functions of the nervous system and general health. It emphasizes manual therapy including spinal adjustment and other joint and soft-tissue manipulation.[1] Today, according to the mainstream of the profession, it is based on the premise that spinal joint dysfunction can interfere with the nervous system and result in many different conditions of diminished health. The concept of what was called vertebral subluxation is now adhered to by a small minority and generally relegated to history. The term was defined quite differently by the chiropractic vs the medical professions, and thus incited much misunderstanding. Thus, this alternative form of therapy examines the relationship between structure and function and its impact on neurological mechanisms in both health and disease.
Doctors of Chiropractic usually obtain one of the following equivalent first professional degrees in chiropractic medicine: D.C., D.C.M., B.Chiro or M.Chiro.[2][3][4]

In treating patients, chiropractors may develop a comprehensive treatment plan based on the patient's individual needs. Such a plan may include spinal adjustments, soft tissue therapy, prescription of exercises, and health and lifestyle counseling.[5]

Chiropractic was founded in 1895 by D. D. Palmer in the USA, and is practiced in more than 100 countries.[6] Since its inception, chiropractic has been controversial, both within the profession and in the medical and scientific community, particularly regarding the metaphysical approach espoused by its founders and advocated by "straight" chiropractors today.[7][8] This same criticism may have been the catalyst that allowed some within the profession to emphasize primarily a neuromusculoskeletal approach in their educational curriculum, leading them away from the original metaphysical explanations of their predecessors towards more scientific ones.[9][10]

Chiropractors have historically fallen into two main groups, "straights" and "mixers," although both groups have had off-shoots. Internal conflicts still exist within the field.[11][11][12][13] Significant differences regarding scope of practice, claims made about spinal manipulation, and beliefs regarding professional integration, differentiate the various schools of thought and practice styles held within the profession.[14] Traditional and evidence-based chiropractic beliefs range from vitalism to materialism.[15]

The utilization of chiropractic has increased in popularity.[16] The profession has remained unified with a continuous commitment to clinical care. Chiropractic's greatest contribution to health care may be its patient-physician relationship and hands-on treatment. Patients are usually satisfied with the treatment they received.[12]

The principles of evidence-based medicine has grown in prominence and have been used to review research studies and generate practice guidelines.[17] The efficacy of chiropractic treatment has not been rigorously proven.[18] Chiropractic care is generally safe when employed skillfully and appropriately.[19] The cost-effectiveness of maintenance chiropractic care is unknown.[20] Vaccination remains controversial within the chiropractic community.[21]

Scope of practice

Chiropractors are primary-contact health care practitioners who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery.[19] Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry.[22] The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests,[19] and specialized tests.[1] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.[22] Common patient management involves:

  • spinal manipulation and other manual therapies to the joints and soft tissues
  • rehabilitative exercises
  • health promotion
  • electrical modalities
  • conservative and complementary procedures
  • lifestyle counseling.[23]

Chiropractors generally cannot write medical prescriptions; a 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs.[24] A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors to prescribe over-the-counter substances and perform minor surgery.[25] In some locations chiropractors (DCs) and veterinarians (DVMs) with additional training and certification can practice veterinary chiropractic which includes the diagnosis, treatment and rehabilitation of injured animals.[26][27] However, the official position of the American Chiropractic Association is that applying manipulative techniques to animals does not constitute chiropractic and that veterinary chiropractic is a misnomer.[28]

Chiropractic medicine is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[29] Similar to other primary contact health providers, chiropractors can specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2–3 additional years of additional post graduate study and passing competency examinations.[30] Chiropractors may further specialize in fields such as Chiropractic Orthopedics (DABCO), Chiropractic Radiology (DABCR), and Chiropractic Sports Physician (DABCSP) by completing additional study and passing the specified boards that are separate and distinctly different than medical boards.[31]

Education, licensing, and regulation

Main articles: Chiropractic education and List of chiropractic schools

Chiropractors obtain a first-professional degree in the field of Chiropractic medicine.[32] Canada and the U.S. require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school. Matriculation through an accredited chiropractic program includes no less than 4200 instructional hours (or the equivalent) of full‐time chiropractic education.[33] Internationally, the World Health Organization (WHO) suggests 3 major educational paths involving full‐time chiropractic education:

  • "A four‐year full‐time program within specifically designated colleges or universities, with a 1 - 4 year pre-requisite training in basic sciences at university level;
  • " A five‐year bachelor integrated chiropractic degree programme offered within a public or private university;
  • " A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree."[19]

The WHO also suggests that health care professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours that includes a minimum of 1000 hours of supervised clinical training.[19] Once graduated, the chiropractor may then be required to pass national, state or provincial boards before being licensed to practice in a particular location. Depending on the location, continuing education may be required to renew these licenses.

In the United States, chiropractic schools are accredited through the Council on Chiropractic Education (CCE). The CCE-USA has joined with CCEs in Australia, Canada, and Europe forming CCE - International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally.[34] Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe and the UK.[35][36][37] All but one of the chiropractic colleges in the United States are privately funded, but in several other countries they are in government-sponsored universities and colleges.[18]

Regulatory colleges and chiropractic boards in the U.S., Canada, Australia, Mexico and U.S. territories are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[38][39] In 2006, there were approximately 53,000 chiropractors in the United States[40] and over 6500 chiropractors licensed in Canada.[41]

Treatment procedures

Main article: Chiropractic treatment techniques
Procedures received by more than 1/3 of patients of licensed U.S. chiropractors (2003 survey)[42]
procedure % of DCs
using
it 		% of patients
receiving
it
Diversified (full-spine manipulation) 96.2 71.5
Physical fitness/exercise promotion 98.3 64.9
Corrective or therapeutic exercise 98.3 63.2
Ergonomic/postural advice 97.3 61.9
Self-care strategies 96.6 60.6
Activities of daily living 96.6 57.9
Changing risky/unhealthy behaviors 96.6 54.9
Nutritional/dietary recommendations 97.7 51.8
Relaxation/stress reduction recommendations 96.4 50.1
Ice pack/cryotherapy 94.5 48.5
Extremity adjusting 95.4 46.8
Trigger point therapy 91.0 45.3
Disease prevention/early screening advice 90.8 39.7

Spinal manipulation, the most common modality in chiropractic care,[42] is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit.[43] The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques,[44] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[45] Spinal manipulation gained mainstream recognition during the 1980s (see History). In the U.S., chiropractors perform over 90% of all manipulative treatments[46] and consider themselves to be expertly qualified providers of spinal adjustment, manipulation and other manual treatments.[47]

Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[48] Typically, it is performed on patients who have failed to respond to other forms of treatment.[49]

Utilization and satisfaction rates

Chiropractic is the largest alternative medical profession in the U.S.[12] and is the 3rd largest doctored profession behind medicine and dentistry in North America.[50] The percentage of population that utilize chiropractic care at any given time generally fall into a range from 6% to 12% in the U.S. and Canada,[16] with a global high of 20% in Alberta.[51] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[52] most do so specifically for low back pain.[16] Complementary and alternative medicine (CAM) practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.[16] Satisfaction rates are typically higher for chiropractic care compared to medical care, with quality of communication seeming to be a consistent predictor of patient satisfaction with chiropractors.[53] Despite high patient satisfaction scores, utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient.[54] The use of chiropractic is growing modestly; CAM as a whole is seeing wholesale increases.[16] Employment of U.S. chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations.[55] A 2008 survey stated that 69% of DC chiropractors disagree with the categorization of chiropractic as CAM, with 27% having some preference for the term "integrated medicine."[56]

Scientific research

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care.[17] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims.[57] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice which may have resulted from a lack of research education and skills.[58] Evidence-based chiropractors possess the ability to apply research in practice. Continued education enhances the scientific knowledge of the practitioner.[59]

Effectiveness

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.[18] Chiropractic care, like all medical treatment, benefits from the placebo response.[60] The efficacy of maintenance care in chiropractic is unknown.[20]

Research has focused on spinal manipulation therapy (SMT) in general,[61] rather than specifically on chiropractic SMT.[17] There is little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.[17] Many controlled clinical studies of SMT are available, but their results disagree,[62] and they are typically of low quality.[63] It is hard to construct a trustworthy placebo for clinical trials of SMT, as experts often disagree whether a proposed placebo actually has no effect.[64] Although a 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference,[11] a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.[65]

Available evidence covers the following conditions:

  • Low back pain. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.[66] A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail,[67] whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level.[66] A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care.[65] A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain.[68] Of four systematic reviews published between 2000 and May 2005, only one recommended SMT, and a 2004 Cochrane review ([69]) stated that SMT or mobilization is no more or less effective than other standard interventions for back pain.[62]
  • Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain.[70] A 2008 review found evidence that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis.[71] A 2007 review found that SMT and mobilization are effective for neck pain.[70] Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, and a 2004 Cochrane review ([72]) found that SMT and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder.[62] A 2005 review found limited evidence supporting SMT for whiplash.[73]
  • Headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache.[74] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[75] A 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache.[76] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SMT.[62]
  • Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,[77] and a lack of higher-quality publications supporting chiropractic management of leg conditions.[78] A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.[68] There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine)[79] and no scientific data for idiopathic adolescent scoliosis.[80] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions.[81] Other reviews have found no evidence of benefit for baby colic,[82] bedwetting,[83] fibromyalgia,[84] or menstrual cramps.[85]

Safety

Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.[19] Absolute contraindications to spinal manipulation are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[19] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[86]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,[86][87] including new or worsening pain or stiffness in the affected region.[88] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.[86] Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[87] and children.[89] The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[87] Several case reports show temporal associations between interventions and potentially serious complications.[71] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[71] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[90]

Cost-effectiveness

A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings.[91] A 2006 UK systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation compares favorably with other treatments for back pain, but that reports are based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[92] A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[93] The cost-effectiveness of maintenance chiropractic care is unknown.[20]

Vaccination

Although vaccination is one of the most cost-effective forms of prevention against infectious disease, it remains controversial within the chiropractic community.[21] Most chiropractic writings on vaccination focus on its negative aspects,[21] claiming that it is hazardous or ineffective.[94] Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines.[95] The American Chiropractic Association and the International Chiropractic Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.[95] The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.[21]

References

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  2. ↑ National Center for Complementary and Alternative Medicine (2007). "An introduction to chiropractic". Retrieved 2008-02-14.
  3. ↑ American Chiropractic Association. "A history of chiropractic care". Retrieved 2008-02-14.
  4. ↑ "Chiropractic Care and Back Pain". WebMD. WebMD LLC. 2008-02-24. Retrieved 2008-02-25.
  5. ↑ "What is chiropractic?". Ontario Chiropractic Association. Retrieved 2008-05-12.
  6. ↑ Tetrault M (2005). "Country support groups". Chiropractic Diplomatic Corps. Retrieved 2008-05-06.
  7. ↑
  8. ↑ Jaroff, Leon (February 27, 2002). "Back Off, Chiropractors!". CNN. Time magazine. Retrieved 2008-02-10.
  9. ↑
  10. ↑ Mirtz TA, Long P, Dinehart A; et al. (2002). "NACM and its argument with mainstream chiropractic health care". J Controv Med Claims. 9 (1): 11–8.
  11. ↑ 11.0 11.1 11.2 Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
  12. ↑ 12.0 12.1 12.2
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  16. ↑ 16.0 16.1 16.2 16.3 16.4 Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat. 15 (2). doi:10.1186/1746-1340-15-2. PMID 17241465.
  17. ↑ 17.0 17.1 17.2 17.3 Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303.
  18. ↑ 18.0 18.1 18.2 DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
  19. ↑ 19.0 19.1 19.2 19.3 19.4 19.5 19.6 Template:Cite paper
  20. ↑ 20.0 20.1 20.2 Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic - what do we know?" (PDF). Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMID 18466623.
  21. ↑ 21.0 21.1 21.2 21.3 Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther. 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414.
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  26. ↑ "Canadian Animal Chiropractic Certification Program frequently asked questions". Retrieved 2008-05-08.
  27. ↑ "RMIT - Animal Chiropractic – Master of Chiropractic Science incorporating Graduate Diploma". RMIT University. Retrieved 2008-05-09.
  28. ↑ ACA House of Delegates (1994). "'Veterinary' chiropractic". American Chiropractic Association.
  29. ↑ Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps. Retrieved 2008-04-18.
  30. ↑ Chiropractic training:
    • Pybus, Beverly, E. A Guide to AHP Credentialing. C. hcPro. pp. 241–3. ISBN 1-57839-478-3. Unknown parameter |coauthors= ignored (help); |access-date= requires |url= (help)
    • Coulter ID, Adams AH, Sandefur R (1997). "Chiropractic training". In Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11.
    • Mestan MA, Taylor JA, Blackshaw GL, McDonald JC (2006). "Commentary: establishing an accredited Master of Science in Diagnostic Imaging degree at a chiropractic college". J Manipulative Physiol Ther. 29 (5): 410–3.
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  32. ↑ "First-professional studies". U.S. Network for Education Information. Retrieved 2008-05-27.
  33. ↑ CCE standardsCFCRB standards
  34. ↑ [1]
  35. ↑ "Accredited Doctor of Chiropractic programs". The Council on Chiropractic Education. Retrieved 2008-02-22.
  36. ↑ "CFCREAB - Accreditation of Educational Programmes". Retrieved 2008-05-28.
  37. ↑ "Institutions holding Accredited Status with the Council". Retrieved 2008-05-28.
  38. ↑ "Facts & FAQs". Canadian Chiropractic Association. Retrieved 2008-05-08.
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  40. ↑ "Chiropractors". U.S. Department of Labor Bureau of Labor Statistics.
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  42. ↑ 42.0 42.1 Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures" (PDF). Job Analysis of Chiropractic (PDF)|format= requires |url= (help). Greeley, CO: National Board of Chiropractic Examiners. pp. 121–38. ISBN 1-884457-05-3. Retrieved 2008-03-14.
  43. ↑ Winkler K, Hegetschweiler-Goertz C, Jackson PS; et al. (2003). "Spinal manipulation policy statement" (PDF). American Chiropractic Association. Retrieved 2008-05-24.
  44. ↑ Swedlo DC (2002). "The historical development of chiropractic" (PDF). In Whitelaw WA (ed.). Proc 11th Annual History of Medicine Days. Faculty of Medicine, The University of Calgary. pp. 55–58. Retrieved 2008-05-14.
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  47. ↑ World Federation of Chiropractic (2005). "WFC consultation on the identity of the chiropractic profession". Retrieved 2008-02-14.
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  51. ↑ Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction". Dyn Chiropr. 25 (6).
  52. ↑ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03". BMC Health Serv Res. 6 (49). doi:10.1186/1472-6963-6-49. PMID 16600038.
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  54. ↑ Chapman-Smith DA, Cleveland CS III (2005). "International status, standards, and education of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 111–34. ISBN 0-07-137534-1.
  55. ↑ Bureau of Labor Statistics (2007). "Occupational outlook handbook". Retrieved 2008-02-14.
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  57. ↑
  58. ↑ Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731.
  59. ↑ Feise RJ, Grod JP, Taylor-Vaisey A (2006). "Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care". Chiropr Osteopat. 24 (14): 14:18. PMID 16930482.
  60. ↑ Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  61. ↑ Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  62. ↑ 62.0 62.1 62.2 62.3 Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972.
  63. ↑ Quality of SMT studies:
    • Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther. 36 (3): 160–9. PMID 16596892.
    • Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine. 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113.
  64. ↑ Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother. 52 (2): 135–8. PMID 16764551.
  65. ↑ 65.0 65.1 Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469.
  66. ↑ 66.0 66.1 Murphy AYMT, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.
  67. ↑ Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.
  68. ↑ 68.0 68.1 Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-03-13.
  69. ↑ Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.
  70. ↑ 70.0 70.1 Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.
  71. ↑ 71.0 71.1 71.2 Hurwitz EL, Carragee EJ, van der Velde G; et al. (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386.
  72. ↑ Gross AR, Hoving JL, Haines TA; et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063.
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  77. ↑ McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.
  78. ↑ Hoskins W, McHardy A, Pollard H, Windsham R, Onley R (2006). "Chiropractic treatment of lower extremity conditions: a literature review". J Manipulative Physiol Ther. 29 (8): 658–71. doi:10.1016/j.jmpt.2006.08.004. PMID 17045100.
  79. ↑ Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.
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  81. ↑ Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med. 13 (5): 491–512. doi:10.1089/acm.2007.7088. PMID 17604553.
  82. ↑ Kingston H (2007). "Effectiveness of chiropractic treatment for infantile colic". Paediatr Nurs. 19 (8): 26. PMID 17970361.
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  86. ↑ 86.0 86.1 86.2 Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209.
     • Anderson-Peacock E, Bryans B, Descarreaux M; et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc. 52 (1): 7–8.
  87. ↑ 87.0 87.1 87.2 Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. PMID 17606755.
  88. ↑ Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. PMID 17906581.
  89. ↑ Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922.
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  92. ↑ Canter PH, Coon JT, Ernst E (2006). "Cost-effectiveness of complementary therapies in the United kingdom—a systematic review". Evid Based Complement Alternat Med. 3 (4): 425–32. doi:10.1093/ecam/nel044. PMID 17173105.
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  94. ↑ Ernst E (2001). "Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination". Vaccine. 20 (Suppl 1): S89–93. doi:10.1016/S0264-410X(01)00290-0. PMID 11587822.
  95. ↑ 95.0 95.1 Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics. 105 (4): e43. PMID 10742364.

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