Dr. Kirk Eriksen and Dr. Bo Rochester published a large prospective study looking at symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care.
What was the study?
Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and selflimiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.
Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included:
1) Neck pain disability index (100-point scale)
2) Oswestry back pain index (100-point scale)
3) 11-point numerical rating scale (NRS) for neck, headache, midback, & low back pain
4) Treatment satisfaction
5) Symptomatic Reactions (SR)
Data was collected at baseline, and after approximately two weeks of care, a patient reaching subclinical status for pain and disability was defined as a follow-up score <3 NRS and ><10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by ><3 NRS and 10% respectively. ASR is defined as a new complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.
What were the results?
A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty-eight (31.0%) patients had symptomatic reactions meeting the accepted definition. Intense symptomatic reactions (NRS ≥8) occurred in just 56 patients (5.1%).
Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p<0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.
Conclusions were that upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than three weeks of care with a high level of patient satisfaction greater than 90%.
Why is this important?
This study speaks to the safety and effectiveness of upper cervical care along with the high level of patient satisfaction with over 90% of patients saying they were satisfied. It also demonstrated that upper cervical specific chiropractic care is a safe approach and is not the same as upper cervical manipulation.