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.

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