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Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study [with consumer summary]
Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM
Spine 2005 Jul 1;30(13):1477-1484
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To document the types and frequencies of adverse reactions associated with the most common chiropractic treatments for neck pain, and to identify possible clinical predictors of adverse reactions to chiropractic treatment. SUMMARY OF BACKGROUND DATA: Chiropractic care is frequently sought by patients for relief from neck pain; however, adverse reactions related to its primary modes of treatment have not been well examined. METHODS: A total of 336 patients with neck pain presenting to 4 southern California health care clinics were randomized in a balanced 2x2x2 factorial design to manipulation with or without heat, and with or without electrical muscle stimulation (EMS); and mobilization with or without heat and with or without EMS. Discomfort or unpleasant reactions from chiropractic care were self-assessed at 2 weeks after the randomization/baseline visit. RESULTS: Of the 280 participants (83%) who responded, 85 (30.4%) had 212 adverse symptoms as a result of chiropractic care. Increased neck pain or stiffness was the most common symptom, reported by 25% of the participants. Less common were headache and radiating pain. Patients randomized to manipulation were more likely than those randomized to mobilization to have an adverse symptom occurring within 24 hours of treatment (adjusted odds ratio (OR) 1.44, 95% confidence interval (CI) 0.83 to 2.49). Heat and EMS were only weakly associated with adverse symptoms (heat OR 0.94, 95% CI 0.54 to 1.62; EMS OR 1.09, 95% CI 0.63 to 1.89). Moderate-to-severe neck disability at baseline was strongly associated with adverse neurologic symptoms (OR 5.70, 95% CI 1.49 to 21.80). CONCLUSIONS: Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.
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