Journal Club: The "Ouch" Trial- Outcomes of Usual Chiropractic Care

Reviewing the OUCH trialOutcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial. Spine 2013 June 17, Walker BF et al

http://www.ncbi.nlm.nih.gov/pubmed/23778372#

• This study was performed in 12 chiropractic clinics
• Compared 92 patients receiving normal chiropractic care to 91 patients received a sham intervention.  Sham interventions included:
  
  
  •  de-tuned ultrasound
  • an Activator instrument, a hand held device that delivers a low impulse, wound to lowest output and administered on the back randomly through a tongue depressor to disperse any remaining force
  • a randomly placed hand on the spine while ultrasound was administered to give a “hands on” experience
• Patients were assessed for adverse events using a questionnaire
• No severe adverse events were reported
• Relative risk (i.e., comparing the risk of chiropractic care vs sham intervention) was assessed for several criteria
  • adverse event occurrence
  • severe adverse events
  • adverse event onset
  • adverse event duration
• In all cases, there was no statistically significant difference in adverse events between chiropractic care and sham intervention

Bottom line: What does this mean for our patients? 

• Chiropractic care, like all interventions, has some risk of adverse events.  However, those risks may be overstated, and at least in this study, did not occur more frequently than sham interventions
• When considering treatment options, chiropractic care is not usually being compared to doing nothing, but rather is being compared to other treatment modalities that also have risk, including other manual therapies, medications, injections, or surgery
  • For perspective, the annual death toll from NSAIDs, the most common form of anti-inflammatory medication (e.g., ibuprofen), is estimated to be between 3,200 - 16,500 annually, far higher than from chiropractic care
• We believe that chiropractic care, in appropriately selected patients, is a helpful modality, and should be considered as a treatment option
• Our approach at Lake Washington Sports & Spine is to provide patients with a breadth of treatment options, inform them of risks and rewards, to help empower patients to make the right choice for them