In the recent release of the Asia Pacific Chiropractic Journal, a descriptive review of the literature funded and commissioned by the ASRF, collated all data featuring the terms “chiropractic” and “subluxation” emerging between 2019 and November 2022. While we could be forgiven for thinking Covid-19 would halt the course of chiropractic research, it seems the chiropractic research tribe have been hard at work.
Case report data proved a significant contributor to the evidence bank, with 130 papers. Observing the trend across journals like the Asia Pacific Chiropractic Journal, McCoy Press Journals and the Chiropractic Journal of Australia, it has become clear that that the clinical value of case reports is something of note for chiropractors and that it fits well with the chiropractic paradigm. Rather than trying to exclude all other factors that might influence a person’s health, chiropractic looks at the whole person and checks and adjusts the subluxation so the person under care may better express health and life.
It is perhaps an indication that chiropractic is embracing its “own lane” and not trying to compete in a research paradigm best suited for pharmacological interventions.
Case reports were not the only types of evidence to emerge, with three randomised controlled trials, one uncontrolled trial and a systematic review also emerging during that time. While the descriptive review focused on examining trends in the literature, the author made the observation that topics raised in the chiropractic and political space appeared to be reflected in the types of papers we saw emerge.
For example, previous discourse on whether or not chiropractic was a risk factor for stroke was followed by studies examining the role of chiropractic post stroke. Following a study finding no evidence for causation in cervical artery dissection, chiropractic researcher Kelly Holt served up two studies on the topic of chiropractic post stroke, with both finding improved outcomes in the groups receiving chiropractic care.
Unsurprisingly, following a controversial statement on chiropractic and immunity from the World Federation of Chiropractic, immunity emerged as a theme in chiropractic case reports. Focusing on presentations involving a range of symptomatology including Lupus, Rheumatological and autoimmune disorders down to more common issues like Sinusitis, case report data indicated that such conditions have improved concomitant with chiropractic care. This is likely to be unsurprising to chiropractors, however, as the issue gained visibility in chiropractic circles (especially during the pandemic), it may be the reason for immunity as a theme in case report data. It will be interesting to see whether larger studies and papers emerge in the following years, as we know such work takes more time to complete.
Paediatric chiropractic care also emerged as a theme. Being that the Safer Care Victoria review was a topical issue for chiropractors following the Victorian Health Minister launching an inquiry into paediatric chiropractic care, this may be a causal factor behind a large number of paediatric case reports. While the inquiry received overwhelmingly positive feedback and paediatric chiropractic care remained legal in Victoria, the advancement of case report data on our smallest practice members shows the lens hasn’t shifted for those of us delivering the care.
This is a good thing, as advancing our understanding of best practice, and of safety and efficacy always goes to the best interest of the person under care – no matter how old or how young they are.
Finally, another theme in the literature was emerging techniques. Chiropractic Biophysics continued to place more evidence for the efficacy of the relatively new technique. Additionally, the Averio Institute placed its first case reports into circulation under the ASRF Case Report Project. The Averio Functional Neurological Technique pioneered a condensed care regime which is continuing to reap results.
All in all, chiropractic research is still on the march. While it does cost money to fund and facilitate larger studies, it is clear that case report data is both contributing clinically relevant data for practitioners and leading the way to larger studies as our tribe responds both to the issues we see in practice and the issues we talk about more broadly.
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REFERENCES:
Australian Chiropractors Association (2019). COAG and the Safer Care Victoria Review. https://members.chiro.org.au/images/ stories/Files/COAG/COAG_and_the_Safer_Care_Victoria_Review_Online.pdf
McIvor C. Chiropractic Care for Subluxation: A descriptive review of the literature 2019 – 2022. Asia-Pac Chiropr J. 2023;3.3. URL apcj.net/Papers-Issue-3-3/#McIvorDescriptiveReview
