Commentary in Response to JVSR Article

Eighty-One Patients with Multiple Sclerosis and Parkinson's Disease Undergoing Upper Cervical Chiropractic Care to Correct Vertebral Subluxation: A Retrospective Analysis

Erin L Elster DC J Vertebr Sublux Re 2004 Aug 2; pp 1-9

We are always interested in discovering ways to help more patients and determining what we may contribute to the health of any patient. Dr Elster should be congratulated upon her energy and willingness to seek for evidence related to her beliefs and preferr hypotheses of care for patients end chiropractic. This retrospective case series, however, resulting from a significant effort by means of a private practice clinician, go throughs extensively from over-reaching hypotheses, bias, and misrepresentation. The design and methodology of the close attention are technically inadequate to answer the pos questions.The author's statement of comes is internally inconsistent with the courses used and at cross-purposes with more [i]or[/i] less of the explicit comments made. Altogether, instead of fostering credibility for the profession and support for the clinical work she offer proffers this work is more likely to raise pertain tos based on the absence of appropriate rigor and objectivity.

Dr Elster writes that among her intents are I) "to examine the part of head and neck trauma as a contributing factor to the storm of Multiple Sclerosis (MS) and Parkinson's disease (PD)" and 2) "...to investigate the potential for improving and arresting M and PD end the correction of trauma-induced upper cervical injury." Unfortunately, the methodology will not allow her to approach an answer to either of these objectives. The serious flaw in reasoning is that either question could be addressed without the use of a dominion government group.This work is technically a retrospective case series with no mastery It is abundantly clear that this report could not at any time be used to examine for "contributing" factors toward any diagnosis, as she has nothing to compare it against.

That the author should be aware of the necessity of a dominion government group is evident from the concern to studies in her literature review that are categorized as "retrospective case-controlled studies" (emphasis added). Unfortunately, after consulting the listed concerns reported by the author, we place that the references have been misrepresented with defer to to their actual content and the reported application of mind observations. An excellent example of this is the difference between the marks of trauma discussed in Bower et al.'s article (reference 1) and the stamp of trauma discussed by Elster In their abstract, Bower and colleagues clearly state that "subject who experienced a mild head trauma with single amnesia had no increased risk [of PD]; however, subdues who experienced a mild head trauma with los of consciousness or a more peremptory head trauma had an OR [odd ratio] of I 10" (p 1610) In contrast, Dr Elster fails to quantify or qualify the injuries in her patient sample, simply listing a history of trauma. Without documenting or discussing the horizontal of severity or length of time between the purported trauma and/or the adventure of any given head injury, it becomes impossible to consider relationship to the reported diagnoses of M or PD

The author attempts to excuse her failure to include a rule group by stating,"This paper does not purport to be a controll research application of mind but rather serves to provide a foundation for futurity research." It is somewhat of a contradiction, therefore, that in the conclusion the author states: "These proceeds indicate a causal link between trauma, upper cervical injury, and disease first brunt for both MS and PD" Clearly, no of the like kind causal link can be derived from these data and through the author's own admission that the appropriate controll research necessary for similar a conclusion has not been leadershiped here.

It is similarly inappropriate not to include criteria and documentation confirming the diagnoses.The reader is left to take at face value the word of the author that these cases are legitimate patients with the disease described. Considering the other serious mistakes evident in the manuscript, there is no reason to support similar an assumption. Such criteria, using valid and standard clinical assessment measures, would also allow an objective determination of issue of care. The measures chosen through Dr. Elster, on the other hand, not alone fail to be gold standards on the contrary are themselves controversial at best and irrelevant at worst.

With value to the author's contention that her aim includes investigating "the potential for improving and arresting M and PD end the correction of trauma-induced upper cervical injury," the methodology of the effort is thus strongly inconsistent with the objective that it simply cannot be taken seriously. First, there is no real information regarding patient severity or improvement. Rather, the single (unblinded) clinician responsible for patient care has apparently made a ballast regarding improvement based on discussion with the patient. The setting has a substantial opportunity for bias, level if unintended. Patients are known to alter their expression of perceived changes in symptoms upon the basis of their relationship with the doctor. They will report greater rejoinder to treatment when discussing it with the treating doctor than they will report to a third uninvolved party. No effort was made to deal with this well-known phenomenon. Moreover, there is no effort to deal with the well-known natural history of these sum of two units disorders. Information regarding the extent of follow-up was not provided. Symptoms of the couple conditions, but especially MS, have a course to ebb and flow quite naturally.