Abstract
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 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.
Results
Of 960 eligible patients, 336 enrolled and 280 responded to the adverse event questionnaire.
Thirty percent of respondents reported at least 1 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% 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 and increase satisfaction
and perhaps clinical outcomes by mobilizing rather than manipulating their neck pain
patients.
Keywords
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Article info
Publication history
Received:
September 5,
2003
Identification
Copyright
© 2004 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
