A pragmatic multi-site clinical trial of chiropractic treatment for asthma

The World Health Organisation (WHO) estimates that 300 million people suffer from asthma. The prevalence of asthma in Australia is one of the highest in the world, according to population studies. -- It is a fact that health consumers consult chiropractors for treatment of asthma; and report beneficial outcomes. It is also the fact that research studies into the potential benefits of chiropractic in the treatment of asthma have been inconclusive. The thesis reports on a clinical trial, the research methodology of which was designed by the Macquarie University multidisciplinary team of researchers with specific regard for those seemingly contradictory facts. -- The focus of this thesis is to review particular evidence of efficacy in chiropractic as a treatment for improving the health of the individual asthma sufferer and to consider the applicability of research methods that may be adopted to evidence any such benefits from chiropractic treatments. The nature of chiropractic treatment is reviewed through research to date and with identification of current topics of research significance in chiropractic healthcare. -- The complex condition of asthma as a chronic multi-factorial condition is reviewed, as is the pathophysiological nature of asthma as a potential factor of influence itself. Chiropractic healthcare is discussed in its context as a Complementary and Alternative Medicine (CAM) healthcare service. -- The thesis identifies strengths and weaknesses in research methods of chiropractic and CAM healthcare approaches that are non-pharmaceutical by nature. It is recognised that in CAM there are therapeutic mechanisms of health change that are yet to be understood. A pragmatic research trial within an asthma management plan offered a patient-centric model for examining the health of the individual asthma sufferer, with the inclusion of a nonpharmaceutical treatment program. The thesis acknowledges the importance of emerging trends in issues such as consumer health demand and clinical co-management, and offers observations on the place of a patient outcome-centric model of health delivery in particular in the context of CAM. -- There is background to the research design of the clinical trial. The research design was informed by preliminary studies and constructed by the multi-disciplinary team. The clinical trial then proceeded. -- The clinical trial was undertaken to examine whether there are any therapeutic benefits for the individual with asthma from chiropractic treatment; the trial is discussed in terms of its findings and also in terms of its implications on the question of research design in the context of medical and alternative healthcare.