Faced with great increases in the costs of health care, the government agencies responsible for funding are taking a much more active role in the decision making process regarding the expenditure of health care dollars. This paper reviews how a government analysis of the type of care rendered by chiropractors can result in assumptions about the quality of care which may be erroneous. Although data from Saskatchewan is presented, the issues and arguments are relevant in all areas where chiropractic care is insured.
BACKGROUND: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. METHODS: Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping. RESULTS: Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit. CONCLUSIONS: We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.
BACKGROUND: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. MAIN BODY: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. CONCLUSION: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.
In: Côté , P , Bussières , A , Cassidy , J D , Hartvigsen , J , Kawchuk , G N , Leboeuf-Yde , C , Mior , S , Schneider , M & 140 signatories# call for an end to pseudoscientific claims on the effect of chiropractic care on immune function 2020 , ' A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity ' , Chiropractic and Manual Therapies , vol. 28 , no. 1 , 21 . https://doi.org/10.1186/s12998-020-00312-x
Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.
In: van der Velde , G , Côté , P , Bayoumi , A M , Cassidy , J D , Boyle , E , Shearer , H M , Stupar , M , Jacobs , C , Ammendolia , C , Carette , S & van Tulder , M 2011 , ' Protocol for an economic evaluation alongside the University Health Network Whiplash Intervention Trial: cost-effectiveness of education and activation, a rehabilitation program, and the legislated standard of care for acute whiplash injury in Ontario ' , B M C Public Health , vol. 11 , pp. 594 . https://doi.org/10.1186/1471-2458-11-594
Whiplash injury affects 83% of persons in a traffic collision and leads to whiplash-associated disorders (WAD). A major challenge facing health care decision makers is identifying cost-effective interventions due to lack of economic evidence. Our objective is to compare the cost-effectiveness of: 1) physician-based education and activation, 2) a rehabilitation program developed by Aviva Canada (a group of property and casualty insurance providers), and 3) the legislated standard of care in the Canadian province of Ontario: the Pre-approved Framework Guideline for Whiplash developed by the Financial Services Commission of Ontario.
In: Côté , P , Bussières , A , Cassidy , J D , Hartvigsen , J , Kawchuk , G N , Leboeuf-Yde , C , Mior , S , Schneider , M , Aillet , L , Ammendolia , C , Arnbak , B , Axen , I , Baechler , M , Barbier-Cazorla , F , Barbier , G , Bergstrøm , C , Beynon , A , Blanchette , M A , Bolton , P S , Breen , A , Brinch , J , Bronfort , G , Brown , B , Bruno , P , Konner , M B , Burrell , C , Busse , J W , Byfield , D , Campello , M , Cancelliere , C , Carroll , L , Cedraschi , C , Chéron , C , Chow , N , Christensen , H W , Claussen , S , Corso , M , Davis , M A , Demortier , M , De Carvalho , D , De Luca , K , De Zoete , A , Doktor , K , Downie , A , Du Rose , A , Eklund , A , Engel , R , Erwin , M , Eubanks , J E , Evans , R , Evans , W , Fernandez , M , Field , J , Fournier , G , French , S , Fuglkjaer , S , Gagey , O , Giuriato , R , Gliedt , J A , Goertz , C , Goncalves , G , Grondin , D , Gurden , M , Haas , M , Haldeman , S , Harsted , S , Hartvigsen , L , Hayden , J , Hincapié , C , Hébert , J J , Hesby , B , Hestbæk , L , Hogg-Johnson , S , Hondras , M A , Honoré , M , Howarth , S , Injeyan , H S , Innes , S , Irgens , P M , Jacobs , C , Jenkins , H , Jenks , A , Jensen , T S , Johhansson , M , Kongsted , A , Kopansky-Giles , D , Kryger , R , Lardon , A , Lauridsen , H H , Leininger , B , Lemeunier , N , Le Scanff , C , Lewis , E A , Linaker , K , Lothe , L , Marchand , A A , McNaughton , D , Meyer , A L , Miller , P , Mølgaard , A , Moore , C , Murphy , D R , Myburgh , C , Myhrvold , B , Newell , D , Newton , G , Nim , C , Nordin , M , Nyiro , L , O'Neill , S , Øverås , C , Pagé , I , Pasquier , M , Penza , C W , Perle , S M , Picchiottino , M , Piché , M , Poulsen , E , Quon , J , Raven , T , Rezai , M , Roseen , E J , Rubinstein , S , Salmi , L R , Schweinhardt , P , Shearer , H M , Sirucek , L , Sorondo , D , Stern , P J , Stevans , J , Stochkendahl , M J , Stuber , K , Stupar , M , Srbely , J , Swain , M , Teodorczyk-Injeyan , J , Théroux , J , Thiel , H , Uhrenholt , L , Verbeek , A , Verville , L , Vincent , K , Dan Wang , A L , Weber , K A , Whedon , J M , Wong , J , Wuytack , F , Young , J , Yu , H & Ziegler , D 2020 , ' A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity ' , Chiropractic and Manual Therapies , vol. 28 , no. 1 , 21 . https://doi.org/10.1186/s12998-020-00312-x
Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. Main body: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. Conclusion: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system.
