56 Cbmplementary Therapies in Medicine : Review section

ference, the evaluation of chiropractic can be viewed as a compression of the phases which medical and scientific evolution have followed over a much longer period. Chi- ropractic theory started primarily as avitalistic philosophy justifying its treatment while the medical scientific com- munity was rejecting vitalism Both chiropractic and medical spine specialists went through a period of specu- lative theory in the first half of this century based upon either perceived neurological or pathological observa- tions. This was a period of single-theory preoccupation by chiropractors (the subluxation) and medical specialists (disc hemiation) which brought these professions into conflict. The past decade has led to greater scientific exploration by both professions, with more national scien- tific discussions of the causes and treatment of spinal problems. The next decade. however, appears likely to require greater emphasis on social research into clinical effectiveness of treatments, prevention of back pain, pa- tient satisfaction and quality assurance. This evolution should be considered the normal maturation of a health care profession.

Hsieh C-YJ, Phillips RB, Adams AH, Pope MH. Functional outcomes of low back pain: comparison offour treatment groups in a randomized controlled trial. J Manip Physio Tberap 1992; 15: 4-9.

+ The revised Oswestry low back pain questionnaire (ROLBPQ) and Roland-Morris activity scale (RMAS) were compared in a randomized controlled trial of chiro- practic manipulation, stroking massage, corset and trans- cutaneous muscular stimulation (TMS). This trial employed specific inclusion and exclusion criteria, in- cluding non specific low back pain for a duration of 3 weeks to 6 months and ages between 18 and 55. We had the opportunity to ask 85 patients to answer the question- naires. 63 patients, who completed the initial and foal evaluations, were used for data analysis. Both ROLBPQ and RMAS showed good internal consistency and alpha coefficients ranging from 0.77 to 0.93. Both instruments showed a significant difference between the chiropractic manipulation and massage groups @ < 0.05). RMAS was able to further show significant differences between the chiropractic manipulation and TMS groups, and between the corset and massage groups, but the ROLBPQ failed to do so. RMAS also showed that chiropractic manipulation had a better but non significant result than corset, possibly due to insufficient sample size and/or duration of treat- ment. We conclude that both instruments are reliable for measuring low back pain disability, andchiropractic man- ipulation had a superior short-term benefit when com- pared to stroking massage and TMS in subacute low back pain patients. In addition, it appears that RMAS is prefer- able in a clinical trial situation for subacute low back pain because it is more sensitive than ROLBPQ to detect changes.

Koes BW, Bouter LM, van Mameren H et al. A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures. J Manip Phy sio Therap 1992; 15: 16-23 (20 refs). + In a blinded randomized clinical trial, we compared effectiveness of manual therapy, physiotherapy (conti- nued) treatment by the general practitioner, and a placebo therapy (detuned ultrasound and detuned short wave diathermy) for patients (n = 256) with chronic non specific back and neck complaints. The physical outcome measures (spinal mobility and physical functioning) are presented for 3.6 and 12 weeks follow-up. Manual ther- apy showed a faster and larger improvement in physical functioning compared to the other three therapies. The changes in spinal mobility among the four study groups appear to be small and show uo consistent pattern.

Waalen JK. Case study research designs: their place in chiropractic. J Can Chirop Assoc 1992; 36: 29-32.

Case studies involve utilizing a distinct research approach. They are often confused with case reports, case series, cases used in rounds, and cases without control groups or baseline measures. The case study approach can provide a way to investigate broad chiropractic issues, policies, or practices in their real settings. Case study research de- signs are appropriate in both clinical and non clinical settings. They require good conceptual skills not elabor- ate equipment; extensive ‘thinking’ time but not sophisti- cated statistical analysis; and a well-designed case study protocol but no control groups or randomized trials.

HERBAL MEDICINE

Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J Derrnatol 1992; 126: 179-184.

+ Severe and widespread atopic eczema often fails to respond,adequately to current available therapies. Fol- lowing the observation of substantial benefit in patients receiving oral treatment with daily decoctions of tradi- tional Chinese medicinal plants, we undertook a placebo- controlled double-bIind trial of a specific prescription formulated for widespread non-exudative atopic eczema. 47 children were given active treatment and placebo in random order, each for 8 weeks, with an intervening 4-week wash-out period. 37 children tolerated the treat- ment and completed the study. Response to active treat- ment was superior to response to placebo, and was clinically valuable. There was no evidence of haemato-