two weeks of care elicits further im-provement. If more improvement has been seen and yet the patients are not fully resolved, then it would be easy to add another two weeks of care on an ongoing basis until symptoms are re-solved and function is restored. With properly controlled studies with a placebo or sham manipulation group this would provide very impor-tant data. Any comparators should be for the same duration. If we are going to compare chiropractic SMT to drugs or any other comparator, then the dose of care and timing of data collection must be standardized and made equal between the groups. It would not be difficult to standard-ize frequency and duration of care for studies, and to make mandatory inclu-sion of a control or sham SMT group and standardized duration of any comparators. This is research method-ology 101; I cannot understand why we have not done this. Every systematic review on SMT laments that few pub-lished studies meet selection criteria with respect to validity, yet we keep funding and conducting low quality studies. This is a waste of valuable limited resources and leads to more heterogeneity of results, which leads to invalid downgrading of the level of evidence for SMT. There is so much more to discuss but space will not allow. Instead I will con-clude with a plea for the standardization of SMT studies with respect to dose of care, timing of data collection, and thrust SMT vs non-thrust mobilizations and, in the meantime, for systematic reviews to address these issues of validity in their selection criteria and data analysis. It is clinically and scientifically absurd to continue to conduct and/or pool to-gether in systematic reviews, data from studies that have, “The number of SMT treatments varied from 1 to 24 and fol-low-up from immediate posttreatment to three years,” or that include mobilizations instead of thrust manipu-lations but are classified as SMT studies. REFRENCES 1. Bronfort et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal 2008 (8): 213-225. 2. Paige et al. (2017) Association of Spinal Manipulative Therapy with Clinical Benefit and Harm for Acute Low Back Pain. System-atic Review and Meta-analysis. JAMA;317(14):1451-1460 3. Hancock, M.J. et al. (2007) Assessment of diclofenac [Voltaren] or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomized controlled trial. Lancet. 2007;370:1638-1643 4. Hidalgo, et al. (2014). The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews. Journal of Manual and Manipula-tive Therapy 22(2): 59-74 5. Castro-Sanchez, A.M. et al. (2016) Short-term effectiveness of spinal manipulation therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial. The Spine Journal 16: 302-312. 6. Fritz, J.M. et al. (2015) Early physical therapy vs usual care in patients with recent-onset low back pain: A randomized clinical trial. JAMA 314 (14): 1459-1467. 7. Haas, M. et al. (2014) Dose-Response and Efficacy of Spinal Manipulation for Care of Chronic Low Back Pain: A Randomized Controlled Trial Spine J. 2014 July 1; 14(7): 1106–1116. www.Cndoctor.ca CND_Hammerberg Lawyers-Helpforme_JulyAug20_CSA.indd 1 July/August 2020 Chiropractic and Naturopathic Doctor 19 2020-07-16 10:22 AM
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