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.

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 endeavor to gain evidence related to her beliefs and preferr hypotheses of care for patients by means of chiropractic. This retrospective case series, however, resulting from a significant effort on a private practice clinician, stomachs extensively from over-reaching hypotheses, bias, and misrepresentation. The design and methodology of the studious mood are technically inadequate to answer the pos questions.The author's statement of follows is internally inconsistent with the arrangements used and at cross-purposes with any of the explicit comments made. Altogether, instead of fostering credibility for the profession and support for the clinical work she presents this work is more likely to raise belong tos based on the absence of appropriate rigor and objectivity.

Dr Elster writes that among her objects are I) "to examine the character of head and neck trauma as a contributing factor to the storming of Multiple Sclerosis (MS) and Parkinson's disease (PD)" and 2) "...to investigate the potential for improving and arresting M and PD between the walls of 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 command group.This work is technically a retrospective case series with no direct It is abundantly clear that this report could in no degree 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 command 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 relations reported by the author, we rest that the references have been misrepresented with honor to their actual content and the reported research observations. An excellent example of this is the difference between the models of trauma discussed in Bower et al.'s article (reference 1) and the representation of trauma discussed by Elster In their abstract, Bower and colleagues clearly state that "subject who experienced a mild head trauma with simply amnesia had no increased risk [of PD]; however, exposes who experienced a mild head trauma with los of consciousness or a more accurate 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 plain of severity or length of time between the purported trauma and/or the incident 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 curb group by stating,"This paper does not purport to be a controll research inquiry but rather serves to provide a foundation for what may occur hereafter research." It is somewhat of a contradiction, therefore, that in the conclusion the author states: "These ensues indicate a causal link between trauma, upper cervical injury, and disease attack for both MS and PD" Clearly, no of that kind causal link can be derived from these data and on the author's own admission that the appropriate controll research necessary for so a conclusion has not been mode of actioned 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 as it is an assumption. Such criteria, using valid and standard clinical assessment measures, would also allow an objective determination of issue of care. The measures chosen by the agency of Dr. Elster, on the other hand, not sole fail to be gold standards however are themselves controversial at best and irrelevant at worst.

With regard to the author's contention that her plan includes investigating "the potential for improving and arresting M and PD by the agency of the correction of trauma-induced upper cervical injury," the methodology of the effort is in like manner 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 opinion 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 onward the basis of their relationship with the doctor. They will report greater answer 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 pair disorders. Information regarding the duration of follow-up was not provided. Symptoms of as well-as; not only-but also; not only-but; not alone-but conditions, but especially MS, have a disposition to ebb and flow quite naturally.