At each office, the team randomly selected the records of 10 patients who had sought care for low back pain. The researchers developed an abstraction system to collect data on more than 70 clinical variables in the records. Senior chiropractic students or recent graduates collected the data. Although the results provide some reassurance to those concerned about chiropractic care, the researchers say the results probably underestimate the number of inappropriate spinal manipulations. The judgment of appropriateness applies only to the decision to initiate treatment and says nothing about its frequency or duration.
Most patients receive several manipulations for low back pain.
It is likely that all subsequent manipulations given to a patient whose initial treatment is inappropriate are also inappropriate. And even when the initial treatment is appropriate, it is difficult to determine when treatment should cease. Moreover, the research team had no information about the actual outcomes of the patients whose care was rated. This study did not measure the efficacy of spinal manipulation. Finally, the study assumes that office records are valid sources of information upon which to judge the appropriateness of care.