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Outcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial

Walker, B.F., Hebert, J.J., Stomski, N.J., Clarke, B.R., Bowden, R.S., Losco, B. and French, S.D. (2013) Outcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial. Spine, 38 (20). pp. 1723-1729.

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Study Design: Blinded parallel group randomised controlled

Objective: Establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group.

Summary of Background Data: Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, as a result of design limitations in previous studies, particularly the lack of sham-controlled randomised trials, understanding of these adverse events and their relation with chiropractic treatment, is suboptimal.

Methods: We conducted a trial to examine the occurrence of adverse events resulting from chiropractic treatment. It was conducted across 12 chiropractic clinics in Perth, Western Australia. The participants comprised 183 adults, aged 20-85, with spinal pain. Ninety two participants received individualized care consistent with the chiropractors' usual treatment approach; 91 participants received a sham intervention. Each participant received two treatments.

Results: Completed adverse questionnaires were returned by 94.5% of the participants after appointment one and 91.3% after appointment two. Thirty three per cent of the sham group and 42% of the usual care group reported at least one adverse event. Common adverse events were increased pain (sham 29%; usual care 36%), muscle stiffness (sham 29%; usual care 37%), headache (sham 17%; usual care 9%). The relative risk was not significant for either adverse event occurrence (RR = 1.24 95% CI 0.85 to 1.81); occurrence of severe adverse events (RR = 1.9; 95% CI 0.98 to 3.99); adverse event onset (RR = 0.16; 95% CI 0.02 to 1.34); or adverse event duration (RR = 1.13; 95% CI 0.59 to 2.18). No serious adverse events were reported.

Conclusions: A substantial proportion of adverse events following chiropractic treatment may result from natural history variation and non-specific effects.

Publication Type: Journal Article
Murdoch Affiliation: School of Psychology and Exercise Science
Publisher: Lippincott Williams & Wilkins
Copyright: (C) 2013 Lippincott Williams & Wilkins, Inc.
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