A 2014 study published in the Journal of Manipulative and Physiological Therapeutics posed an interesting question: how does chiropractic compare to medical treatments on 1-year changes in self-reported function, health and satisfaction with care measures? It was a representative sample of American Medicare beneficiaries, but it’s a study worth a second look as it examines a common comparison – chiropractic versus medical care.
At first look, it’s an “apples and oranges” comparison. Chiropractic has been said to be a ‘care’ not a ‘treatment.’ We check for subluxations and adjust them, thus removing interference from the central nervous system. The body does the rest. We do not treat symptoms per se. Still, research is currency and until the rest of the world understands the differences between chiropractic and medical care as coherently as we do, the questions are bound to repeat.
That’s where this study came in: the authors used regression analysis based on generalized estimate equations to “model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations [1].” Six measures assessing satisfaction with discrete aspects of care were also included, taking the number of outcomes measured in the study to a total of 13.
The sample looked specifically at those older than 65 years, who were living in the community (i.e. not in care) and who did not have end-stage renal failure (as this would skew their functional health trajectory).
The participants did two interviews, one year apart. To be rated as a decline, the person would have to either:
- Rate their general health lower at the second interview (according to the 2 self-reported health measures), or;
- Report extra difficulty in at least one of their activities of daily living.
The satisfactions outcomes assessed were “quality of care received over the past year, doctors concern for overall health, out-of-pocket costs for services, ease of getting to the doctor, satisfaction with follow-up care, and satisfaction with information about what was wrong [1].”
The study found “evidence of a protective effect of chiropractic against 1-year declines in functional and SRH [self-reported health] among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided [1].”
Some of the more poignant takeaways from the study are the following[1]:
- “The average annual population prevalence in community-dwelling and age-eligible Medicare beneficiaries using chiropractic was 7.4% (range, 6.3%-8.9%). Among persons with spine conditions, the average annual prevalence was 34.5% (range, 32.4%-35.7%)” [1]. This offers up insight into the main draw-card for this group, and perhaps an impetus for future efforts among chiropractic communicators when it comes to non-musculoskeletal impacts of care.
- Chiropractic users were “relatively healthier than the medical-only group based on presence of disease conditions and having significantly lower proportions of arthritis and rheumatoid arthritis; heart disease, heart attacks, and stroke; and diabetes, hypertension, and osteoporosis, although among these last 3 conditions, the prevalence among users of chiropractic increased over time.”
- Chiropractic users also had “significantly less functional limitation as reflected by fewer ADLs [activities of daily life] and less self-reported difficulty lifting, reaching, stooping, and walking several blocks.”
- Vision was better and self-reported health higher among those using chiropractic.”
- “The proportion of chiropractic users worried about their health was significantly lower than those using medical-only care, which could be a reflection of the relative disease burden for each group.”
- Chiropractic users had proportionately fewer hospitalizations in the year prior to their first interview and were less prevalent in the highest category of office visits (N6 per year) compared with medical-only users.
Admittedly the study did focus on an American sample, and we know that the American health system differs greatly in terms of cost and access to Australian, Canadian or other socialized health-care systems. That said, the challenges faced in similar samples in other countries could be quite comparable.
All in all, it is a poignant and encouraging view of chiropractic care in comparison to medical-only care. While we still have work to do in terms of communicating the non-musculoskeletal aspects of our offering, it is nice to see chiropractic usage in older adults hitting the spot.
REFERENCES:
- Weigel P, Hockenberry J, Wolinsky F (2014), “Chiropractic use in the medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care,” Journal of Manipulative and Physiological Therapeutics,
