Quality of Life
Outcome studies measuring health related
quality of life (HRQL) are becoming increasingly sought as
tools to measure the value of a health intervention.
In outcome studies the overall wellness or well-being of
a person is explored to ask the question, “Is this
intervention truly benefiting the overall health of the patient
or are we just treating symptoms or having a minimal effect
on this patient’s life?”
Is the intervention worth
the risk?
That is very important because doctors can give a
patient a drug to lower their high blood pressure, but the
result may be impotence. Doctors may give a drug to lower high
cholesterol and the result may be suicide. Doctors may give
a child a measles-mumps-rubella shot and the result may be
autism.
Looking at it from a non-quality of life viewpoint the
doctor may say, “Well, his blood pressure is down, his cholesterol
is down and the child didn’t get the measles.” Of
course this begs the question, “Was the intervention
a net benefit to the patient?”
Quality of Life studies look at the big picture and they
are particularly valuable for subluxation research since
subluxation based chiropractic care is designed to affect
the entire person’s ability to relate to their environment
rather than the diagnosis and treatment of symptoms and diseases.
tk.
Maintenance care: health promotion services to US chiropractic
patients aged 65 and over, Part 11. Rupert, RL, Manuello
D, Sandefur R: Journal of Manipulative and Physiological
Therapeutics 2003;23(1):10.
73 chiropractic patients were interviewed
and asked, “How
important do you feel chiropractic treatment has been in
maintaining and promoting your health?” 95.8% said that
their chiropractic care was either “considerably” or “extremely” valuable.
Also, the longer people were in care, the less nonprescription
drugs they used.
The authors stated: “Chiropractors may
administer more prevention and health-promotion services than
any other health profession.”
Other findings from the
study:
The findings…significantly correlate reduced nervousness
with years of maintenance care (MC), as well as possible
reduced symptoms of depression…..
“Patients receiving MC had twice as many contacts
with a physician during the year than patients who receive
no chiropractic care at all. These doctor-patient contacts
are primarily for chiropractic MC care and result in a 50%
reduction in medical provider visits. Therefore for those
patients receiving MC, chiropractic management appeared to
replace medical management rather than be complementary to
medical treatment….
“The need for hospitalization
and the high costs associated with that service were markedly
reduced for the patient receiving MC. The total annual cost
of health care services for the patient receiving MC was conservatively
estimated at only a third of the expenses made by US citizens
of the same age. Patients also perceived MC services as highly
beneficial to prevention and health promotion.
Chiropractic
adjustments in asymptomatic subjects: measurable health benefits
following chiropractic care a review of literature
Sean Hannon,
DC Ninth Annual Vertebral Subluxation Research Conference.
October 13-14, 2001 Spartanburg, SC http://www.sherman.edu/research/subcon9.html#rob
This
review of literature explores the prevalence of data that describe
observable, or objectively measured "health
benefits" to individuals following chiropractic adjustments
despite the presence or absence of any symptom, condition,
or pathological presentation.
A "health benefit" for
this review was defined as any objectively measured improvement
in physiologic function.
The search revealed 20 peer-reviewed,
published studies that specifically involved "asymptomatic," "healthy," or "normal" subjects.
Health benefits of some kind were observed in all twenty
studies. Fourteen additional studies demonstrated measurable
health benefits in subjects to which no symptoms or pathology
were described.
Health benefits in these studies include but
are not limited to improvements in the respiratory system,
cardiovascular system, immune system, muscular strength, visual
acuity, cortical processing or mental functioning, the limbic
system, the endocrine system, as well as overall health and
wellness.
The notion that there is no evidence of chiropractic
care being of benefit to individuals without musculoskeletal
complaints is erroneous. Despite the opinions of some critics,
the data reviewed lend support to the contention that chiropractic
adjustments, often for the purpose of correcting vertebral
subluxations, confer health benefits to people regardless
of the presence or absence of symptoms.
Though limited, there
is an increasing body of evidence to support the contention
that individuals presenting without symptoms can benefit markedly
from chiropractic care.
A longitudinal assessment of chiropractic
care using a survey of self-rated health wellness & quality
of life: a preliminary study. Marino MJ and Phillippa ML. Journal
of Vertebral Subluxation Research, 3(2), 1999.
From the abstract:
This longitudinal study evaluated changes
in self-rated health status of patients receiving chiropractic
care at the training clinic of the New Zealand School of Chiropractic.
The study was designed to assess subluxation-based chiropractic
care in association with changes in patients’ perceived
health status. The Self-Rated Health/Wellness Survey (SRHW)
was used to evaluate the health status on two occasions, “initial” and “follow-up.” The
instrument assessed health across four domains, Physical
State, Emotional/Mental State, Stress and Life Enjoyment.
Collectively, these four domains, assessed initially and
after a follow-up period, constituted Combined Wellness,
or a fifth domain. Quality of Life was evaluated as a sixth
domain of the questionnaire instrument.
The study population
included 89 subjects, evaluated over a five-month study period.
The average interval between initial and follow-up surveys
was 8.0+/- 3.2 weeks, with an average number of visits of
9.1 +/- 4.2. A bivariate analysis was conducted using a two
tailed, paired, sample t-test to assess the subjects’ survey
responses. Subjects reported significant positive perceived
changes in Physical State (p=0.000) Mental/Emotional State
(p=0.008), and Combined Wellness (p=0.001), with corresponding
effect sizes of 0.61, 0.24 and 0.31 respectively.
The improvement
in the Physical and Mental/Emotional State, and Combined
Wellness suggests that chiropractic care provided through
the NZ School of Chiropractic is associated with significant
benefits in these domains. Study data suggested that health/wellness
may accrue with time under care.
Thus, further study with a
larger sample size and longer duration of care is proposed
to more thoroughly investigate possible health benefits in
the areas studied, as well as to confirm present findings.
Changes
in general health status during upper cervical chiropractic
care: PBR report. Owens, Edward F., Hoiriis, Kathryn T.,
Burd, Deana. Chiropractic Research Journal, Vol. V, No. 1,
Spring 1998.
This is a practice-based research project (PBR):
doctors in their private offices collected and pooled data
on their patients.
From the abstract:
Data have been [so far] collected on 153
patients. Among the factors tested for are:
- physical functioning (PF) limitations in physical activities due to physical problems
- bodily pain (BP)
- general health (GH)
- vitality (V)
- social functioning (SF) – limitations in social activities due to physical or emotional problems
- mental health (MH)
The preliminary results show that patients enter into upper
cervical chiropractic care with a variety of mostly musculoskeletal
complaints. At the outset of care, those patients have significantly
lower health status, as measured by SF-36, than the general
population. There is a general trend for patients to experience
an upward trend in their perception of health as measured
by both the SF-36 and the GWBS (global well-being score).
Analysis
of SF-36 scores showed improvement in all categories compared
to the initial scores upon starting care. The average patient
improvement was 12.1% within the first four weeks, and
increased to 45.6% by maximum improvement.Overall, the chiropractic
patients on whom they had complete data improved on all subscales
and showed scores exceeding the national norms on four of
the eight scales (GH, V, SF, MH).
In addition, x-ray analysis
suggests that upper cervical chiropractic adjustment improves
misalignment of the occipito-atlanto-axial spine.
Although these
results are encouraging many of our original questions go unanswered
because of a lack of follow-up data. In addition, the sample
size is too small; additional upper cervical chiropractic offices
are needed as collection sites. Better tracking of patient
attrition is required to assess the length of chiropractic
care needed to reach maximum improvement for specific conditions.
Changes
in general health status during upper cervical chiropractic
care: a practice-based research project update. Hoiriis,
Kathryn T., Owens, Edward F. Chiropractic Research Journal,
Vol. Vl, No. 2, Fall 1999.
This is a continuation of the above
study with the number of patients now at 311. Again, the SF-36
Health Survey was used along with a global well being scale
(GWBS).
The findings are consistent with the previous studies’ findings: “All
subscales showed improvement.”
A study regarding measures
of general health status in patients using the Bio Energetic
Synchronization Technique: a follow-up study. Blanks R and
Dobson M.
Journal of Vertebral Subluxation Research, 3(2), 1999.
From
the Abstract:
The present study was conducted to investigate
the health benefits of Bio Energetic Synchronization Technique
(BEST) in a large patient sample. Participants were attendees
at one of ten consecutive, four day, in-residence health programs
(Health Weeks) held between July, 1997 and July, 1998. The
Health Week program consisted of a comprehensive four day
program of intensive BEST care which has been linked to restoring
autonomic nervous system balance, as well as reduction of
subluxation. The technique also includes lifestyle and nutritional
education. Patients were assessed with the Rand-36 health
survey and the Global Well-Being Scale (GWBS) just prior
to Health Week, and then eight weeks following the program.
Following a structured clinical interview, assessment forms
were administered by staff at the beginning or end of the
four day event. The eight-week follow-up questionnaires were
mailed to all study participants. Results indicate significant
(p<0.006) improvement in six of the eight subscales of
the Rand-36 health survey among the 205 participants completing
both the pre and post Health Week assessment in the Rand-36
scores through the eight week follow-up. The GWBS was higher
than the pre Health Week but lower than the post Health Week.
These follow-up data demonstrate long term benefits derived
during the Health Week program, and confirm a previous pilot
study involving Health Week attendees. Further investigation
relative to sociodemographic factors, which may influence
the health and wellness outcomes associated with this form
of care will be evaluated in future studies.
Changes in salivary
pH and General Health Status following the clinical application
of bio-energetic synchronization. Morter T, Schuster T. J
Vertebral Subluxation Research 2(2), Jan. 1998.
From the abstract:
The present preliminary study investigated
the relationship between autonomic nervous system imbalance,
fasting salivary pH, and general health status following the
clinical application of Bio-energetic Synchronization (BEST)….Twenty-four
patients attending a four day program were separated into
two groups of 12 each.
Following the administration of BEST
pH values increased significantly in the (subject) S-Group,
and decreased significantly in the (placebo) P-group. Moreover,
the G-group expressed lower total scores (lowered perceived
health status) than the P-Group…
Based on these preliminary findings it is suggested that
measurement of fasting salivary pH may be a reliable non-invasive
means of substantiating pre/post intervention changes in
autonomic imbalance…both groups (report) self-reported
overall improvement in general health status concomitant
with pH changes following the application of BEST. The preliminary
findings support clinical observations suggesting that this
approach is associated with restoration of autonomic balance.
The relevance of this process to the etiology and correction
of vertebral subluxation is discussed.
A retrospective assessment
of network care using a survey of self-rated health, wellness
and quality of life. Blanks, RHI, Schuster, TL. J Vertebral
Subluxation Research Vol. 1 No. 4, 1997.
From the abstract:
The present study represents a retrospective
characterization of Network Care, a health care discipline
within the subluxation-based chiropractic model. Data were
obtained from 156 Network offices (49% practitioners participation
rate) in the United States, Canada, Australia and Puerto Rico.
This
was a survey of 2818 patients of 156 Network chiropractic offices.
Results
indicated that patients reported significant positive perceived
change in all four domains of health, as well as overall quality
of life.
The evidence of improved health in the four domains
(physical state, mental/emotional state, stress evaluation,
life enjoyment), overall quality of life from a standardized
index and the “wellness
coefficient” suggests that Network Care is associated
with significant benefits. These benefits are evident from
as early as 1-3 months under care, and appear to show continuing
clinical improvements in the duration of care …with
no indication of a maximum clinical benefit.
Comment by Dr.
Koren: Network chiropractic is a combination of chiropractic
techniques tailored to the specific needs of the patient.
It capitalizes on the best that many traditional chiropractic
techniques have to offer. This study is unique in its size,
scale and scientific rigor.
Study Associates chiropractic with
better health in the elderly. Today’s Chiropractic November/December
1996 originally published by the Foundation for Chiropractic
Education and Research.
The results of a three year randomized
trial of people 75 years of age and over revealed better overall
health and a higher quality of life among those who use chiropractic
care. Elderly chiropractic patients report better overall
health, have fewer chronic conditions, spend less days in
nursing homes and hospitals, are more mobile in their communities
and are less likely to use prescription drugs than non-chiropractic
patients according to a study conducted by the Foundation
for Chiropractic Education and Research through the Los Angeles
College of Chiropractic.
In addition, 87% of chiropractic patients
described their health as excellent compared to just 67.8%
of non- chiropractic patients.
Follow-up to Meade Study Mead
TW, British Medical Journal August 5, 1995
Chiropractic patients
not only reported less pain than hospital patients at six weeks,
but three years later chiropractic patients reported a 29%
greater improvement with chiropractic compared to hospital
treatment.
The most dramatic improvements were associated with
pain reduction, but many of the factors that contribute to
the quality of life were affected by chiropractic care.
Sitting
for more than a short period of time and sleeping showed the
most significant improvement, but scores such as personal care,
lifting, walking, standing, sex life, social life, and ability
to travel also improved.
Chiropractic-Therapeutical effectiveness-Social
importance. Incidence of Absence from work and Hospitalization.
Survey on a Sample of 17,142 patients, Italy, 1987, Professor
F. Splendori
This 1987 study of 17,142 patients from 22 clinics
in Italy by medical physicians and chiropractors concluded:
The
results of our survey presented herein, are clear and incontrovertible:
our sample population of over seventeen thousand patients treated
with chiropractic for at least two years showed that this treatment
could lead to a 75-55% reduction in the number of daily absences
from work and could cut down the number of hospitalized patients
by 87.60% vis-à-vis
other currently used forms of treatment (pharmacological,
psysiokinesitherapic, surgical, etc.)
A most meaningful indicator
of the effectiveness of chiropractic is the improvement it
produces in the quality of life, not only because of its curative
effect but also thanks to its preventative and rehabilitative
functions.
Copyright 2004 Koren Publications, Inc. & Tedd
Koren, D.C.