The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study.
OBJECTIVE
This study describes both positive clinical outcomes and adverse events in patients treated for neck pain by a chiropractor.


METHODS
This study was a prospective, multicenter, observational cohort study. Patients with neck pain of any duration who fulfilled the inclusion criteria were recruited in a practice-based study. Data were collected on the patients and from the chiropractors at baseline, the first 3 visits, and at 3 and 12 months. Clinical outcome measures included (1) neck pain in the 24 hours preceding the visit, (2) neck disability, (3) treatment satisfaction, (4) global assessment, and (5) adverse events. Recovery was defined as "completely improved" or "much better" using the global assessment scale. An adverse event was defined as either a new related complaint or a worsening of the presenting or existing complaint by >30% based upon an 11-point numerical rating scale.


RESULTS
In all, 79 chiropractors participated, recruiting 529 subjects, representing 4891 treatment consultations. Follow-up was possible for 90% and 92%, respectively, at 3 and 12 months. Most patients had chronic, recurrent complaints; mild to moderate disability of the neck; and a mild amount of pain at baseline; and two thirds had sought previous care for the presenting complaint in the preceding 6 months. Adverse events after any of the first 3 treatments were reported by 56%, and 13% of the study population reported these events to be severe in intensity. The most common adverse events affected the musculoskeletal system or were pain related, whereas symptoms such as tiredness, dizziness, nausea, or ringing in the ears were uncommon (<8%). Only 5 subjects (1%) reported to be much worse at 12 months. No serious adverse events were recorded during the study period. Of the patients who returned for a fourth visit, approximately half reported to be recovered, whereas approximately two thirds of the cohort were recovered at 3 and 12 months.


CONCLUSIONS
Adverse events may be common, but are rarely severe in intensity. Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks.
Rubinstein
Sidney M
SM
Institute for Research in Extramural Medicine (EMGO-Institute), VU University Medical Center, Amsterdam, The Netherlands. sm.rubinstein@vumc.nl <sm.rubinstein@vumc.nl>
Leboeuf-Yde
Charlotte
C
Knol
Dirk L
DL
de Koekkoek
Tammy E
TE
Pfeifle
Charles E
CE
van Tulder
Maurits W
MW
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000503:physiopathology; D019547:Neck Pain / Q000150:complications / Q000628:therapy*; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012074:Remission Induction; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome