A CRITICAL APPRAISAL OF EVIDENCE AND ARGUMENTS USED BY AUSTRALIAN CHIROPRACTORS TO PROMOTE THERAPEUTIC INTERVENTIONS

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Published Sep 15, 2016
Ken Harvey

Abstract

The Australian Health Practitioner Regulation Agency is currently dealing with over 600 complaints about chiropractors. Common allegations in these complaints are that chiropractic adjustments are promoted for pregnant women, infants and children despite the lack of good evidence to justify many of these interventions. The majority of chiropractors complained about appear to be caring practitioners who genuinely believe that the interventions they promote are effective. However, belief based on disproven dogma, the selective use of poor-quality evidence, and personal experience subject to bias is no longer an appropriate basis on which to promote and practice therapeutic interventions. Nor should treatments be justified solely on the basis of possible placebo effect. This paper provides a critical analysis of some of the evidence and arguments used by chiropractors to justify treatments that have been the subject of complaints. This analysis amplifies the recent statement on advertising by the Chiropractic Board of Australia. It should assist practitioners to understand the difference between the high-level evidence required by the Board and the low-level evidence used by some practitioners to justify their promotion and practice. It supports efforts by the Chiropractors' Association of Australia to encourage more research. (Chiropr J Australia 2016;44:234-245)
Abstract 378 | PDF Downloads 311

##plugins.themes.bootstrap3.article.details##

Keywords

Chiropractic, Paediatrics, Evidence-Based Practice

References
1. Australian Health Practitioner Regulation Agency. Newsletter, June 2016. http://www.ahpra.gov.au/Publications/AHPRA-newsletter/June-2016.aspx#dealing (accessed Jun 2016)
2. New South Wales Consolidated Acts. Health Practitioner Regulation National Law (NSW) 2016, s.133. http://www.austlii.edu.au/au/legis/nsw/consol_act/hprnl460/s133.html (accessed Jun 2016)
3. Chiropractic Board of Australia. Code of Conduct, March 2014. http://www.chiropracticboard.gov.au/Codes-guidelines/Code-of-conduct.aspx (accessed Jun 2016)
4. Chiropractic Board of Australia. Statement on advertising, 07 Mar 2016. http://www.chiropracticboard.gov.au/News/2016-03-07-statement-on-advertising.aspx (accessed Jun 2016)
5. Spooner R. Strict conditions slapped on chiropractor Dr Ian Rossborough. The Age, June 9, 2016. http://www.theage.com.au/victoria/strict-conditions-slapped-on-chiropractor-dr-ian-rossborough-20160609-gpf299.html (accessed Jun 2016)
6. Morsels of evidence. Evidence-based medicine for general practitioners. Levels of evidence. http://evidencebasedmedicine.com.au/?page_id=30 (accessed Jun 2016)
7. Book extract: Surgery, The Ultimate Placebo by Ian Harris. Sydney Morning Herald, February 26, 2016. http://www.smh.com.au/national/surgery-the-ultimate-placebo-20160207-gmo484.html (accessed Jun 2016)
8. Keating JC, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF. Subluxation: dogma or science? Chiropr Osteop 2005;13: 7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1208927/ (accessed Jun 2016)
9. General Chiropractic Council. Guidance on claims made for the chiropractic vertebral subluxation complex, 18 August 2010. http://www.gcc-uk.org/UserFiles/Docs/What%20Can%20I%20Expect/Vertebral%20Subluxation%20Complex.pdf (accessed Jun 2016)
10. Chiropractic Australia. Policy statement by Chiropractic Australia regarding the Vertebral Subluxation Complex. http://chiropracticaustralia.org.au/wp-content/uploads/2015/05/Vertebral-Subluxation-Complex-Policy.pdf (accessed Jun 2016)
11. Klougart N, Nilsson N, Jacobsen Jl. Infantile colic treated by chiropractors: a prospective study of 316 cases. J Manipulative Physiol Ther 1989; 12(4):281-8. http://www.dcscience.net/Klougart%20et%20al_1989_JMPT_colic.pdf (accessed Jun 2016)
12. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteop 2010;18:3. http://chiromt.biomedcentral.com/articles/10.1186/1746-1340-18-3 (accessed Jun 2016)
13. Alcantara J, Alcantara J, Alcantara J. The chiropractic care of infants with colic: a systematic review of the literature. Explore (NY). 2011;7(3):168-74.
http://www.ncbi.nlm.nih.gov/pubmed/21571236 (accessed Jun 2016)
14. Dobson D, Lucassen PL, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database Syst Rev. 2012;12:CD004796. http://www.ncbi.nlm.nih.gov/pubmed/23235617 (accessed Jun 2016)
15. Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and nonmusculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Ther 2014,22:12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997823/
16. Miller J, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. J Manipulative Physiol Ther 2012;35(8):600-7. http://www.ncbi.nlm.nih.gov/pubmed/23158465
17. US National Library of Medicine National Institutes of Health. PubMed.gov. http://www.ncbi.nlm.nih.gov/pubmed (accessed Jun 2016)
18. Biedermann H. Manual Therapy in Newborn and Infants. Kongress der EWMM Kongress in Zusammenarbeit mit der ÄMM Puzzle Kindesentwicklung. FU Berlin 10.-12.03.2011. http://www.manmed.de/seiten/themen/manual/kinder/kiss-syndrom/kiss-kinder-en.html (accessed Jun 2016)
19. Band PL, Engelbert R, Helders PJM, Offringa M. Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain). Ned Tijdschr Geneeskd 2005;;149(13):703-7. http://www.ncbi.nlm.nih.gov/pubmed/15819137 (accessed Jun 2016)
20. Happle C, Wetzke M, Hermann EJ, Kriauss JK, Harmtann H, Lucke T. Cases against 'KiSS': a diagnostic algorithm for children with torticollis. Klin Padiatr 2009; 221(7): 430-435. http://www.ncbi.nlm.nih.gov/pubmed/20013566 (accessed Jun 2016).
21. Fallon J DC. Chiropractic and Pregnancy, a partnership of the future. ICA Review Nov/Dec 1990:39-42
22. Fallon J DC. The effect of chiropractic treatment on pregnancy and labour: a comprehensive study. Proceedings of the World Federation of Chiropractic, 1991:24-31
23. Frietag P. Expert testimony of P Frietag MD PhD., comparing the results of two neighbouring hospitals, US District Court Northern Illinois Eastern Division, No.76C 3777. May 1987
24. Wechsler M, Kelley JM, Boyd IO, et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med. 2011 Jul 14;365(2):119-26. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154208/
25. Mannix L et al. Camberwell GP Geoff Kemp fighting for his medical licence. The Age, March 2, 2016. http://www.theage.com.au/victoria/camberwell-gp-geoff-kemp-fighting-for-his-medical-licence-20160301-gn7lzk.html (accessed Jun 2016)
26. Therapeutic Goods Advertising Complaint Resolution Panel. Complaints Register. http://www.tgacrp.com.au/index.cfm?pageID=13 (accessed Jun 2016)
Section
Articles