Cochrane Review of Chiropractic Interventions for LBP Misses the Mark

By Anthony Rosner, PhD, LLD [Hon.], LLC

As systematic as Walker, et al.'s recent Cochrane review of combined chiropractic interventions for low back pain1 may seem, it cannot be disputed that it remains only a single and possibly myopic lens through which the most appropriate clinical interventions for chronic low-back pain may actually be viewed.
The prevailing operative that one carries away from the Walker, et al., study is that the authors have assiduously turned the crank of a formulaic literature review and ground through a vast body of retrieved material, collecting only a few and sometimes fatally flawed pieces of literature on which to base their conclusions. From many points of view, Walker's exercise appears to have strayed far from what is truly a clinical perspective, one in which the most clinically relevant evidence base has been argued to be no less than a tripartite construct of the best available external evidence, individual clinical expertise29 and empowerment of the patient in the decision-making process.30 For this reason, as well as those discussed above, the authors in their attention to certain details appear to have missed the forest for the trees and left us with a regrettably incomplete portrayal of clinical evidence in support of the chiropractic management of back pain.