Clinical Rheumatology

, Volume 30, Issue 5, pp 593–600 | Cite as

An independent review of NCCAM-funded studies of chiropractic

  • Edzard Ernst
  • Paul Posadzki
Review Article


To promote an independent and critical evaluation of 11 randomised clinical trials (RCTs) of chiropractic funded by the National Centre for Complementary and Alternative Medicine (NCCAM). Electronic searches were conducted to identify all relevant RCTs. Key data were extracted and the risk of bias of each study was determined. Ten RCTs were included, mostly related to chiropractic spinal manipulation for musculoskeletal problems. Their quality was frequently questionable. Several RCTs failed to report adverse effects and the majority was not described in sufficient detail to allow replication. The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile.


Alternative medicine Bias Chiropractic Research Spinal manipulation 





  1. 1.
    Marcus DM, Grollman AP (2006) Review for NCCAM is overdue. Science 313:301–302PubMedCrossRefGoogle Scholar
  2. 2.
    Couzin J (1998) Beefed-up NIH center probes unconventional therapies. Science 282(2175):2176Google Scholar
  3. 3.
    Marwick C (1992) Congress wants alternative therapies studies; NIH responds with programs. JAMA 268(8):957–958PubMedCrossRefGoogle Scholar
  4. 4.
    National Center for Complementary and Alternative Medicine (NCCAM) (2005) Expanding horizons of health care: strategic plan 2005–2009. National Institutes of Health, Bethesda, MD, USA. Available at:
  5. 5.
    Salzberg S (2010) Save Taxpayer $$$: eliminate alternative medicine research. Available at: Accessed 16 June 2010
  6. 6.
    Homola S (2006) Chiropractic: history and overview of theories and methods. Clin Orthop Relat Res 444:236–242PubMedCrossRefGoogle Scholar
  7. 7.
    Kaptchuk TJ, Eisenberg DM (1998) Chiropractic origins, controversies, and contributions. Arch Intern Med 158:2215–2224PubMedCrossRefGoogle Scholar
  8. 8.
    Ernst E (2008) Chiropractic: a critical evaluation. J Pain Sympt Man 35(5):544–562CrossRefGoogle Scholar
  9. 9.
    Mirtz TA, Morgan L, Wyatt LH, Greene L (2009) An epidemiological examination of the subluxation construct using Hill’s criteria of causation. Chiropr Osteopat 17:13PubMedCrossRefGoogle Scholar
  10. 10.
    Marcus DD, Grollman AP (2006) Debating the worth of NCCAM research. Science 314:1083–1084CrossRefGoogle Scholar
  11. 11.
    Folkman S, Berman B, Bondurant S, Eisenberg D, Haramati A, Kreitzer MJ (2006) Debating the Worth of NCCAM Research. Science 314(5802):1083–1084PubMedCrossRefGoogle Scholar
  12. 12.
    Bialosky JE, Bishop MD, Robinson ME, Zeppieri G Jr, George SZ (2009) Spinal manipulative therapy has an immediate effect on thermal pain sensitivity in people with low back pain: a randomized controlled trial. Phys Ther 89(12):1292–1303PubMedCrossRefGoogle Scholar
  13. 13.
    Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH (2002a) A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study. Am J Public Health 92(10):1634–1641PubMedCrossRefGoogle Scholar
  14. 14.
    Hawk C, Long CR, Reiter R, Davis CS, Cambron JA, Evans R (2002) Issues in planning a placebo-controlled trial of manual methods: results of a pilot study. J Altern Complement Med 8:21–32PubMedCrossRefGoogle Scholar
  15. 15.
    Cramer GD, Gregerson DM, Knudsen JT, Hubbard BB, Ustas LM, Cantu JA (2002) The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Spine 27(22):2459–2466PubMedCrossRefGoogle Scholar
  16. 16.
    Hurwitz EL, Morgenstern H, Harber P et al (2002b) A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine 27(20):2193–2204PubMedCrossRefGoogle Scholar
  17. 17.
    Haas M, Groupp E, Panzer D, Partna L, Lumsden S, Aicken M (2003) Efficacy of cervical endplay assessment as an indicator for spinal manipulation. Spine 28(11):1091–1096, discussion 1096PubMedGoogle Scholar
  18. 18.
    Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM (2004) Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study. J Manip Physiol Ther 27:16–25CrossRefGoogle Scholar
  19. 19.
    Haas M, Groupp E, Kraemer DF (2004a) Dose-response for chiropractic care of chronic low back pain. Spine J 4(5):574–583PubMedCrossRefGoogle Scholar
  20. 20.
    Haas M, Groupp E, Aickin M et al (2004b) Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther 27(9):547–553PubMedCrossRefGoogle Scholar
  21. 21.
    Hurwitz EL, Morgenstern H, Kominski GF, Chiang LM (2006a) A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study. Spine 31:611–621PubMedCrossRefGoogle Scholar
  22. 22.
    Hurwitz EL, Goldstein MS, Morgenstern H, Chiang LM (2006b) The impact of psychosocial factors on neck pain and disability outcomes among primary care patients: results from the UCLA Neck Pain Study. Disabil Rehabil 28(21):1319–1329PubMedCrossRefGoogle Scholar
  23. 23.
    Eisenberg DM, Post DE, Davis RB et al (2007) Addition of choice of complementary therapies to usual care for acute low back pain. Spine 32:151–158PubMedCrossRefGoogle Scholar
  24. 24.
    Dishman JD, Greco DS, Burke JR (2008) Motor-evoked potentials recorded from lumbar erector spinae muscles: a study of corticospinal excitability changes associated with spinal manipulation. J Manipulative Physiol Ther 31(4):258–270PubMedCrossRefGoogle Scholar
  25. 25.
    Haas M, Spegman A, Peterson D, Aicken M, Vavrek D (2010) Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J 10(2):117–128PubMedCrossRefGoogle Scholar
  26. 26.
    The Cochrane Collaboration (2010). Available at:
  27. 27.
    Ernst E, Canter PH (2006) A systematic review of systematic reviews of spinal manipulation. J R Soc Med 99:192–196PubMedCrossRefGoogle Scholar
  28. 28.
    Cassidy JD, Boyle E, Côté P et al (2008) Risk of verebrobasilar stroke and chiropractic care. Spine 33(45):S176–S183PubMedCrossRefGoogle Scholar
  29. 29.
    Ernst E (2010) Vascular accidents after chiropractic spinal manipulation: myth or reality? Perfusion 23(2):73–24Google Scholar
  30. 30.
    Hurwitz EL, Morgenstern H, Harber P et al (2002c) A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study. Spine (Phila Pa 1976) 27(20):2193–2204Google Scholar

Copyright information

© Clinical Rheumatology 2010

Authors and Affiliations

  1. 1.Complementary Medicine, Peninsula Medical SchoolUniversity of ExeterExeterUK

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