Adverse Reactions to Chiropractic Treatment and their Effects on Satisfaction and Clinical Outcomes among Patients Enrolled in the UCLA Neck Pain Study

In Response: We thank Dr Grier for his letter regarding our article1.Hurwitz EL Morgenstern H Vassilaki M Chiang L-M Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA neck pain study.J Manipulative Physiol Ther. 2004; 27: 16-25Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar and welcome the opportunity to respond to each of his points. First, a “control” group was not chosen because the primary objective of the study was to compare the relative effectiveness of cervical spine manipulation and mobilization for neck pain. A no-treatment control group (or a group receiving neither manipulation nor mobilization) would be necessary if the objectives were to test the efficacy of manipulation and mobilization. Assessment of treatment efficacy was not our objective. However, because of the 2 × 2 × 2 factorial design, we were able to compare the frequencies of adverse reactions between subjects randomized to heat (vs. no heat) and to electrical muscle stimulation (EMS) (vs. no EMS). These findings are forthcoming. Second, the clinical outcomes at each follow-up time point are reported in a prior publication.2.Hurwitz EL Morgenstern H Harber P Kominski GF Yu F Adams AH A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study.Am J Public Health. 2002; 92: 1634-1641Crossref PubMed Scopus (147) Google Scholar Briefly, mean reductions in neck pain and related disability were similar in the manipulation and mobilization groups at each follow-up interval through 6 months. Little differences in clinical outcomes were detected between the heat and no heat groups and between the EMS and no EMS groups as well. The risks of achieving clinically meaningful levels of improvement from baseline to each follow-up point were also similar across treatment groups. There is no evidence that one group improved faster than another or that participants in one group versus another were more likely to have better clinical outcomes at 2 or 6 weeks or at 3 or 6 months. Dr Grier and other readers interested in more details on the clinical findings from the UCLA neck pain study should refer to the aforementioned clinical outcomes article.2.Hurwitz EL Morgenstern H Harber P Kominski GF Yu F Adams AH A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study.Am J Public Health. 2002; 92: 1634-1641Crossref PubMed Scopus (147) Google Scholar