The Chiropractic Doctors' Association of Hong Kong

Effectiveness & Cost-Effectiveness of Chiropractic

Few (if any) other health care interventions have been assessed as extensively as chiropractic spinal manipulation, both in terms of safety and effectiveness. Furthermore, few other health care professions have been as thoroughly researched as chiropractic.

There have been at least six formal government inquiries into chiropractic worldwide over the last 25 years (including Canada, Australia, New Zealand and Sweden). All have concluded that contemporary chiropractic care is safe, effective, cost-effective and have recommended public funding for chiropractic services.

In addition to government inquiries, there have been many scientific clinical studies (randomized controlled trials included) assessing the appropriateness, effectiveness and/or cost-effectiveness of spinal manipulation or chiropractic manipulation (most notably for back pain).

Meade, T.W., Dyer, S., Browne, W., Townsend, J., Fran, A.O. (1990 & 1995) Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain, British Medical Journal.

In 1990, this widely reported randomized controlled trial conducted by the British Medical Research Council compared chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. The investigators concluded that chiropractic treatment almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. They also related that consideration should be given to providing chiropractic coverage within the National Health System and in hospitals. BMJ, Vol 300, pp. 1431-37.

A follow-up study was published in the British Medical Journal in 1995, which presents the full results and concludes that "at three years, the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain, as they would in day to day practice, those treated by chiropractic derive more benefit and long-term satisfaction than those treated by hospitals". BMJ, Vol 311, pp. 349-51.

Shekelle, P.G., Adams, A.H., Chassin, M.R., Hurwitz, E.I., Phillips, R.B., Brook, R.H. (1991) "The Appropriateness of Spinal Maniplation for Low Back Pain. Project Overview and Literature Review", Rand, Santa Monica, California.

Rand, a prestigious research organization in the US, released a report on the appropriateness of spinal manipulation for low back pain. On the efficacy of spinal manipulation for low back pain, although the investigators found that the literature on this subject is of uneven quality, they concluded that "support is consistent for the use of spinal manipulation as a treatment for patients with acute low back pain and an absence of other signs or symptoms of lower limb nerve root involvement".

Ebrall, P.S. (1992) "Mechanical Low Back Pain: A comparison of Medical and Chiropractic Management Within the Victorian WorkCare Scheme", Chiropractic Journal of Australia, Vol. 22 (2), pp. 47-53.

This was a retrospective study of all work-related low back pain claimants within a twelve-month period in Victoria, Australia, drawing on the database of the Victoria Accident Compensation Commission and comparing costs of outcomes between chiropractic and medical care. The study found that: 1) there was a significantly lower number of claimants requiring compensation days when chiropractic management was chosen; 2) there were fewer compensation days taken by claimants who received chiropractic management; 3) a greater number of patients progressed to chronic status when medical management was chosen and; 4)there was a greater average payment per claim with medical management ($2308.10) versus chiropractic management ($963.47).

The investigator concluded that if the Victorian chiropractors managed up to 40% of low back pain cases (substituting medical care) then the direct savings within the Victorian WorkCare scheme for the study period would have been $10 million over 7,482 claims.

Manga, P, Angus D., Papadopoulos, C., Swan, W. (1993) The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain, Kenilworth Publishing, Ottawa.

In 1993, the Ontario Ministry of Health commissioned and funded a study to examine the effectiveness and cost-effectiveness of chiropractic management of low back pain. The report concluded that there is an overwhelming body of evidence indicating that chiropractic management of low back pain is the most cost-effective, and that there would be highly significant cost savings if more management of low back pain was transferred to chiropractors. This report also recommended that there should be a shift in policy to encourage chiropractic services for most patients with low back pain and that chiropractic services should be fully insured under the Ontario Health Insurance Plan.

Stano, M., Smith, M. (1996) "Chiropractic and Medical Costs of Low Back Pain", Medical Care, Vol. 34(3), pp. 191-204

This study compared health insurance payments and utilization for episodes of care for common low back conditions treated by chiropractic and medical providers, using 2 years of insurance claims data. The mean total payments were lower for chiropractic care ($518) versus medical care ($1020) as were the mean total outpatient payments ($477 versus $598). The authors concluded that the lower costs for episodes in which chiropractors serve as initial contact providers along with the favourable satisfaction and quality indicators suggests that chiropractic deserves careful consideration in gate keeper strategies adopted by employers and third-party payers to control health care spending.

Mosley, C.D., Ilana, G.C., Arnold, R.M. (1996) "Cost-Effectiveness of Chiropractic in a Managed Care Setting", The American Journal of Managed Care, Vol. 2, pp. 280-282.

The authors of this study retrospectively evaluated the cost of health care for back and neck pain (using ICD-9 codes) for members of a health maintenance organization who sought chiropractic care in 1994-1995. In addition, differences between the groups in surgical rate, the use of diagnostic imaging and patient satisfaction were compared. The cost of healthcare for back and neck pain was substantially lower for chiropractic patients ($539 versus $774)). The authors concluded that properly managed chiropractic care can yield outcomes, in terms of surgical requirements and patient satisfaction, that are equal to those of non-chiropractic care at a substantially lower cost per patient.