When researchers randomized 272 neck pain patients to receive either spinal manipulation, medication, or instructions on home exercises, they found some differences that were statistically significant. But the big picture is that all the patients tended to get better and those who got manipulation or home exercise instructions fared about the same. And that the bottom line message that readers get from the news story. The story didn’t mention costs and it could have provided more details about potential harms, but overall it gives readers a fair overview of the research and the broader background of neck pain treatment.
News reports should always distinguish between study results that really mean something to people dealing with illnesses and those that are merely statistically significant, but clinically underwhelming. This story reports key findings about measured differences, but also helps readers to see the main message; that those differences didn’t make a dramatic difference to how patients felt… and that important questions remain.
The study raises some interesting questions. It’s difficult to know if similar results would be seen for patients coming for care in usual practice settings, rather than in response to newspaper and radio ads recruiting subjects. It’s also worth looking at effective care versus efficient care. If two group instructional sessions are as good as 15 individual chiropractic sessions on average, one could surmise that home exercise might provide more bank for the buck. The story could have done a better job driving this point home. AS
It’s too bad this story didn’t mention costs. Considering that the trial found only small differences in the effectiveness of the treatments, it seems that cost might be a key deciding factor for many people with neck pain. It’s notable that two educational sessions about home exercise were as effective as 15 chiropractic sessions.
The story includes both some of the specific results reported by researchers as well as more conversational descriptions of the overall experiences of people in this trial. Readers get the message that people with neck pain tend to feel better as time passes no matter which treatment option they used and that none of the treatments is clearly superior or can deliver sure-fire pain relief.
This rating is a close call. The story does warn readers that spinal manipulation can pose “rare, but serious risks.” Also, none of the trial participants reported a serious adverse event. But the story could have been more specific and reported that, as the editorial accompanying the research article pointed out, “neck manipulation has a rare but potentially catastrophic risk for vertebral artery stroke.” Also, the story should have at least briefly mentioned some of the harms that can be caused by the pain medications (including acetaminophen, narcotics and muscle relaxants) that were prescribed to some participants.
This story gives readers the important highlights of the study design and how the researchers measured effectiveness. It also includes a comment from an independent source that the trial would have been better if it had included a no-treatment group (in order to look for improvements that were due simply to the passage of time or a placebo effect).
The story could have pointed out that unlike major drug trials that use placebo pills there was no way to prevent patients from knowing which treatment they received, which means the researchers can’t be sure that the reports from patients weren’t partially influenced by their beliefs about how effective a treatment might be. For instance, it could be that people who got spinal manipulation from a professional (and paid for it) might tend to believe that the treatment was more effective than a set of exercises that they did themselves at home.
The story accurately reports that neck pain is common. It also includes cautionary statements about the uncertainty that exists about what sort of treatment works best, thus helping readers keep expectations in line with reality.
The story includes quotes from multiple independent sources. It reports that funding for this trial was provided by “U.S. National Center for Complementary and Alternative Medicine.” It might have been helpful to point out that the center is part of the National Institutes of Health, so that it would be clear to readers that it is a public institution. Although the story does not report on any potential conflicts of interest on the part of the researchers, the article authors did not disclose any conflicts in their journal article.
The trial was set up as a direct comparison of popular treatments for neck pain, and that is just how the story presents it. It even includes a comment from an independent source that this sort of neck pain tends to improve on its own. As mentioned above, the story could have provided more details about the potential harms of the various treatment options.
It is clear that all of the treatments included in this trial are widely available.
The story points out that this trial was designed to address the lack of solid evidence comparing common treatments for back pain, while also noting that this trial doesn’t answer all of the questions.
The story does not appear to rely on a news release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
Comments (1)
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Jann Bellamy
January 9, 2012 at 11:09 pmNews reports about spinal manipulation performed by chiropractors would do well to point out the differing uses of the term “spinal manipulation” within chiropractic. Spinal manipulation is a legitimate physical therapy performed, as the story points out, by chiropractors, physical therapists and other health care providers. However, chiropractors alone use the term “manipulation” as a synonym for “adjustment.” A chiropractic adjustment is done to “correct” what chiropractors call a “subluxation” (which they define differently than other health care professionals). There is no scientific evidence that the chiropractic subluxation exists, which is a fact admitted in their own literature. Without this knowledge, a patient may seek out a chiropractor for neck pain, not realizing that he may be subjected to a diagnosis of “subluxations” and subsequent manipulations/adjustments to correct them, instead of the legitimate spinal manipulation performed by several types of health care providers.
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