New CDAHK Study Finds Severe Adverse Events Associated with Chiropractic Treatment Are Very Rare
HONG KONG, CHINA, January 27, 2023 / — In one of the largest studies on the topic, Chiropractic Doctors Association of Hong Kong (CDAHK) researchers found that the incidence of severe adverse events associated with chiropractic spinal manipulation was 0.21 per 100,000 treatments.
•Severe adverse events associated with chiropractic treatment were found to be very rare.
•In nearly one million treatments, the researchers identified only two severe adverse events, both of which were rib fractures occurring in older women with osteoporosis.
•No adverse events were life-threatening or resulted in death.
The study, published in Nature Scientific Reports, looked at treatments involving chiropractic spinal manipulation across 30 chiropractic clinics spanning more than five years. Researchers from the Chiropractic Doctors Association of Hong Kong found that two patients experienced severe adverse events during or after their chiropractic spinal manipulation. The incidence of severe adverse events was 0.21 per 100,000 treatments, which suggested that such complications were reassuringly very rare.
“The incidence of severe adverse events was extremely low,” said Dr. Eric Chun-Pu Chu, lead author and Chairman of CDAHK. “Chiropractic treatment appears safe for most patients.”
Chiropractic is a health care profession that focuses on treatment of musculoskeletal conditions such as low back and neck pain. During treatment chiropractors often use spinal manipulation, a hands-on therapy aimed at the joints of the spine. While studies regarding safety of this treatment have been conducted previously, the current study represents one of the largest studies to date, including 54,846 unique patients and 960,140 treatment sessions.
“This was a unique study because it examined a large group of integrated clinics, and we had access to a rich dataset supported by patient surveys, phone calls, medical records, imaging test results, and more to support our analysis,” noted Dr. Robert Trager, the second author, a chiropractor at Connor Whole Health, University Hospitals Cleveland Medical center.
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The two severe adverse events were both rib fractures occurring in women over the age of 60 with underlying osteoporosis. Considering these findings, the authors suggest that chiropractors should be cautious when treating elderly patients or those with poor bone density. In addition, they note that forceful spinal manipulation should be avoided in these patients due to its risk for injury and potential for causing complications such as rib fracture. The authors also noted that no adverse events were life-threatening or resulted in death.
The study included examined data spanning from January 2017 through August 2022. The author team used a rigorous approach to grade adverse events, using the Common Terminology Criteria for Adverse Events (CTCAE), and completed the study adhering to a registered protocol. The authors obtained data from a variety of sources, including patient surveys and phone calls, complaints, clinician reports, medical records, imaging reports, and others, from Hong Kong’s largest non-hospital medical service provider, EC Healthcare.
The lead author, Eric Chun-Pu Chu, is the chairman of Chiropractic Doctors Association of Hong Kong and investigator at New York Chiropractic and Physiotherapy Centre, where his team treats patients with spinal manipulative therapy. Through collaboration with a chiropractic physician of Connor Whole Health at University Hospitals (USA), Robert J. Trager; associate dean of School of Nursing and Health Studies at Metropolitan University (Hong Kong), Linda Lee; and research director of New Zealand Chiropractic College (New Zealand), Imran Khan Niazi, the team benefited from a diversity of professional backgrounds in chiropractic, nursing, and engineering. The team aims to continue their collaboration on other projects.
Read “A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy” by clicking here.
The original study reference is noted below:
Chu EC-P, Trager RJ, Lee LY-K, Niazi IK. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep 2023;13:1254. https://doi.org/10.1038/s41598-023-28520-4.
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