The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial

Abstract

Chiropractic spinal adjustments have been shown to result in short-term increases in muscle strength in chronic stroke patients, however, the effect of longer-term chiropractic spinal adjustments on people with chronic stroke is unknown. This exploratory study assessed whether 4 weeks of chiropractic spinal adjustments, combined with physical therapy (chiro + PT), had a greater impact than sham chiropractic with physical therapy (sham + PT) did on motor function (Fugl Meyer Assessment, FMA) in 63 subacute or chronic stroke patients. Secondary outcomes included health-related quality of life and other measures of functional mobility and disability. Outcomes were assessed at baseline, 4 weeks (post-intervention), and 8 weeks (follow-up). Data were analyzed using linear mixed-effects models or generalized linear mixed models. A post-hoc responder analysis was performed to investigate the clinical significance of findings. At 4 weeks, there was a larger effect of chiro + PT, compared with sham + PT, on the FMA (difference = 6.1, p = 0.04). The responder analysis suggested the improvements in motor function seen following chiropractic spinal adjustments may have been clinically significant. There was also a robust improvement in both groups in most measures from baseline to the 4- and 8-week assessments, but between-group differences were no longer significant at the 8-week assessment. Four weeks of chiro + PT resulted in statistically significant improvements in motor function, compared with sham + PT, in people with subacute or chronic stroke. These improvements appear to be clinically important. Further trials, involving larger group sizes and longer follow-up and intervention periods, are required to corroborate these findings and further investigate the impacts of chiropractic spinal adjustments on motor function in post-stroke survivors. ClinicalTrials.gov Identifier NCT03849794.

Keywords: chiropractic spinal adjustment; health-related quality of life; motor function; physical therapy; recovery of function; stroke.

Figure 1

CONSORT study flow diagram.

Figure 2

Participant-wise FMA scores, along with group-wise means and standard errors for the two interventions at pre-randomization baseline, at the end of the interventions (4 weeks), and the follow-up (8 weeks). Note: FMA stands for Fugl-Meyer Assessment and PT stands for physical therapy. The baseline means and standard errors are calculated from the raw data, whereas the remaining statistics are from the fitted model, which computes means and standard errors after adjusting for the baseline scores. Similar illustrations of remaining outcomes are available in the supplementary file.