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Outcomes of Usual Chiropractic. The OUCH Randomized Controlled Trial of Adverse Events

Walker, Bruce F., DC, MPH, DrPH*; Hebert, Jeffrey J., DC, PhD; Stomski, Norman J., BHSc (hons), PhD*; Clarke, Brenton R., PhD; Bowden, Ross S., M. Mathematics; Losco, Barrett, M. Chiropractic*; French, Simon D., MPH, BAppSc (Chiro), PhD*,§

doi: 10.1097/BRS.0b013e31829fefe4
Randomized Trial

Study Design. Blinded parallel-group randomized controlled trial.

Objective. Establish the frequency and severity of adverse effects from short-term usual chiropractic treatment of the spine when compared with a sham treatment group.

Summary of Background Data. Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, as a result of design limitations in previous studies, particularly the lack of sham-controlled randomized trials, understanding of these adverse events and their relation with chiropractic treatment is suboptimal.

Methods. We conducted a trial to examine the occurrence of adverse events resulting from chiropractic treatment. It was conducted across 12 chiropractic clinics in Perth, Western Australia. The participants comprised 183 adults, aged 20 to 85 years, with spinal pain. Ninety-two participants received individualized care consistent with the chiropractors’ usual treatment approach; 91 participants received a sham intervention. Each participant received 2 treatments.

Results. Completed adverse questionnaires were returned by 94.5% of the participants after appointment 1 and 91.3% after appointment 2. Thirty-three percent of the sham group and 42% of the usual care group reported at least 1 adverse event. Common adverse events were increased pain (sham 29%; usual care 36%), muscle stiffness (sham 29%; usual care 37%), and headache (sham 17%; usual care 9%). The relative risk (RR) was not significant for adverse event occurrence (RR = 1.24; 95% CI: 0.85–1.81), occurrence of severe adverse events (RR = 1.9; 95% CI: 0.98–3.99), adverse event onset (RR = 0.16; 95% CI: 0.02–1.34), or adverse event duration (RR = 1.13; 95% CI: 0.59–2.18). No serious adverse events were reported.

Conclusion. A substantial proportion of adverse events after chiropractic treatment may result from natural history variation and nonspecific effects.

Level of Evidence: 2

We examined the frequency and severity of adverse effects from short-term usual chiropractic treatment of the spine. The relative risk was not significant for adverse event occurrence, occurrence of severe adverse events, adverse event onset, or adverse event duration. A substantial proportion of these events result from nonspecific effects.

*School of Health Professions

School of Psychology and Exercise Science

Department of Mathematics & Statistics, School of Engineering and Information Technology, Murdoch University, Murdoch, Australia; and

§Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia.

Address correspondence and reprint requests to Bruce F. Walker, DC, MPH, DrPH, School of Health Professions, Murdoch University, 90 South St, Murdoch Australia; E-mail:

Acknowledgment date: March 20, 2013. Revision date: May 6, 2013. Acceptance date: June 7, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Chiropractors Registration Board of Victoria grant funds were received to support this work.

Relevant financial activities outside the submitted work: board membership, grants, travel/accommodations, meeting expenses, payment for development of education presentations, consultancy, grants.

© 2013 by Lippincott Williams & Wilkins