نبذة مختصرة : Objective: To determine the effectiveness of chiropractic treatment on patients with back or neck pain as compared to traditional allopathic treatments, a systematic review of the literature. Reporting Sources: A search for randomized clinical trials (RCT's) on chiropractic therapy was conducted using a Medline search (1980-2001), citation tracking and directed reference acquisition from relevant publications. Data Extraction: Studies examined for this review specifically compared chiropractic manipulative therapy with traditional "mainstream" medical treatment (i.e. physiotherapy, mobilization, massage, deep heat, bed rest, prescriptive drugs, back school, corset, T. E. N. S., traction and/or placebo). Exclusion criteria covered a wide range of diseases and conditions such as spondylolysis, root compression, osteoarthritus, psychological disturbances, pregnancy and vertebral collapse. Data Synthesis: Three meta-analysis studies examining 35 RCT's met the inclusion criteria for this review. They were Assendelft, et al. (1996); Abenheim, et al. (1992); Koes, et al. (1991). Additionally, twelve individual studies comparing the effectiveness of chiropractic manipulation to medical interventions in the treatment of musculoskeletal pain, not examined in the abovementioned meta-analysis, were included. Methods: A study was ascertained to be positive, if the RCT determined that chiropractic was more effective than allopathic methodologies and/or placebos (i.e., the difference being statistically significant at a level of P<0.05). A study was deemed negative, if the RCT reported favorable results for the non-chiropractic treatment, and neutral, if there was no discernable difference between the treatment outcomes. Both objective and subjective outcome measures were used in the RCT's reviewed. The following represent the most prevalent outcome measures: recovery rate; the amount of time required for the patient to return to work or normal activities; reductive change in the threshold of pain; and the patients' efficacy of treatment rating. Conclusions: There is an obvious research need for direct attention focused upon the methodologies of design, execution, reporting, randomization (to eliminate bias), control and manipulation in future RCT's for chiropractic. This also should entail the development of standardized uniform guidelines for varying types of chiropractic clinical studies. Accomplishing the above will afford subsequent statistical pooling, which is not wholly viable now. The above notwithstanding, this review presents 47 clinical trials and studies that have been analyzed from the standpoint of their empiric outcomes. These data strongly suggest that chiropractic manipulation offers superior results when compared to traditional allopathic treatments for musculoskeletal pain.
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