Extrapolating Beyond the Data

To the EditorWe represent the Southern California University of Health Sciences, incorporating the Los Angeles College of Chiropractic. We agree with the views and conclusions of the article by Goertz et al.1

Goertz CM, Hurwitz E, Murphy B, Coulter I. Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. J Manipulative Physiol Ther. https://doi.org/10.1016/j.jmpt.2021.02.003. Accessed April 17, 2021.

The overall paucity of high-quality evidence either for or against effectiveness, the threat to biological plausibility of collapsing 5 heterogeneous disorders into a single category, and careful consideration of best practices for use of evidence in policymaking suggests the need for their more accurate and cautious conclusion.We suggest that well-informed policy decisions, in addition to evidence of efficacy and effectiveness, should consider cost-effectiveness, safety, and other measures of quality and value. Readers and policymakers must be able to distinguish between spinal manipulative therapy, which is considered a procedure, and the profession of chiropractic. Doctors of chiropractic (DCs), who perform most spinal manipulative therapy procedures in the United States,2What role for chiropractic in health care?.,3

Whedon J, Haldean S, Petersen CL, Schoellkopf W, MacKenzie TA, Lurie JD. Temporal trends and geographic variations in the supply of clinicians who provide spinal manipulation to medicare beneficiaries: a serial cross-sectional study [e-pub ahead of print]. J Manipulative Physiol Ther. https://doi.org/10.1016/j.jmpt.2021.02.002. Accessed April 10, 2021.

frequently formulate management plans that include multiple interventions based on the needs of the patient.4The chiropractic scope of practice in the United States: a cross-sectional survey. Chiropractic scope of practice in many jurisdictions includes approaches such as dietary and lifestyle interventions that are supported by evidence for the treatment of nonmusculoskeletal (non-MSK) conditions. Premature policy decisions based on a lack of evidence can have unintended adverse impacts on the quality of clinical care.5Lucas CE Vlahos AL Ledgerwood AM Kindness kills: the negative impact of pain as the fifth vital sign. Prohibition against non-MSK treatment by DCs may inadvertently limit their ability to fully assess and diagnose patients with non-MSK conditions, regardless of the treatment approach that is ultimately chosen.6Whedon JM Goertz CM Lurie JD Stason WB Beyond spinal manipulation: should Medicare expand coverage for chiropractic services? A review and commentary on the challenges for policy makers.

At Southern California University of Health Sciences, we teach an integrative, biopsychosocial, and environmental approach to whole health that equips DC graduates to address patients with non-MSK health concerns, individually or in collaboration with other healthcare practitioners. Therefore, we agree that policies should not inhibit the ability of DCs to offer conservative care to patients with non-MSK conditions that are often comorbid with MSK conditions.

References

Goertz CM, Hurwitz E, Murphy B, Coulter I. Extrapolating beyond the data in a systematic review of spinal manipulation for nonmusculoskeletal disorders: a fall from the summit [e-pub ahead of print]. J Manipulative Physiol Ther. https://doi.org/10.1016/j.jmpt.2021.02.003. Accessed April 17, 2021.

What role for chiropractic in health care?.

N Engl J Med. 339: 1074-1075

Whedon J, Haldean S, Petersen CL, Schoellkopf W, MacKenzie TA, Lurie JD. Temporal trends and geographic variations in the supply of clinicians who provide spinal manipulation to medicare beneficiaries: a serial cross-sectional study [e-pub ahead of print]. J Manipulative Physiol Ther. https://doi.org/10.1016/j.jmpt.2021.02.002. Accessed April 10, 2021.

The chiropractic scope of practice in the United States: a cross-sectional survey.

J Manipulative Physiol Ther. 37: 363-376Lucas CE Vlahos AL Ledgerwood AM

Kindness kills: the negative impact of pain as the fifth vital sign.

J Am Coll Surg. 205: 101-107Whedon JM Goertz CM Lurie JD Stason WB

Beyond spinal manipulation: should Medicare expand coverage for chiropractic services? A review and commentary on the challenges for policy makers.

J Chiropr Humanit. 20: 9-18Article InfoPublication History

Published online: June 15, 2021

Accepted: April 19, 2021

Received: April 19, 2021

Publication stageIn Press Corrected ProofIdentification

DOI: https://doi.org/10.1016/j.jmpt.2021.04.004

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