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"People familiar with clinical tests of spinal manipulative therapy (SMT) for back pain were puzzled by the outcome of the British study by Meade, et al, (Brit Med J, 300:1431-37, 1990) which found chiropractic care to be more effective in the long term than hospital management (for chronic back pain sufferers only). Studies designed to test SMT against other modalities have consistently found that although SMT may produce more rapid relief there are no differences over the long term (for a review see Clinical Orthopaedics & Related Research, 179:62-70, 1983).

The Meade study did not test SMT against other modalities but merely compared hospital with chiropractic care in which a flock of modalities were employed. It did not even equalize the number of treatment sessions nor length of time under care. The most likely answer to this anomalous finding lies in patient satisfaction.

The Ostwestry Disability Questionnaire employed by Meade is a 10-item patient self-report on the relief of symptoms during specified activities. Although the test has high reliability (.99), this matter involves its validity. Cherkin reports "there is mounting evidence that patient satisfaction is associated with desirable outcomes including self-assessed relief of symptoms" (Chiropractic Technique, 2:138-142, 1990). Parker & Tupling (Med J Aust, 2:373-376, 1976) also reported: "satisfaction at follow-up was associated with reported improvement in the condition, greater approval of chiropractic treatment, and less reporting of pain at follow-up." DCs generally score better than MDs on patient satisfaction because of such factors as:

"making the patient feel welcome"

"ability to explain problem & treatment"(1)

"amount of time spent listening to my description of pain"

 "seemed to believe that my pain was real"

 "seemed confident that the diagnosis s/he gave was correct"

 "seemed confident that the treatment s/he recommended would work"

 "seemed comfortable dealing with my back pain"

 "concern about my pain after the office visit" (2)

The explanation that patient satisfaction rather than real differences was responsible for better long term Ostwestry scores is supported by the fact that a significantly greater portion of chiropractic patients reported being "satisfied or very satisfied" in the Meade Study."

National Council Against Health Fraud News, Volume 14, Issue1 (Jan/Feb 1991) [Citations: (1.) Lancet, 1974, June, 29, 1333-36. (2.) West J Med, 150:351-355, 1989]