• Brown S
• Cooperstein R

• Chiropractic / Connecticut
• Informed Consent
• Manipulation, Cervical / adverse effects
• Open Access Document
• Stroke
• Vertebral Artery Dissection

Objective: This paper reviews the evidence considered by the Connecticut Board of Chiropractic Examiners in their 2010 memorandum concluding (a) stroke or cervical artery dissection (CAD) is a not likely to be a risk or side effect of joint mobilization, manipulation, or adjustment of the cervical spine; and (b) chiropractors are not required to address stroke or CAD as a part of securing informed consent by patients for such treatment. The 2010 memorandum contains 5 Findings of Fact. An additional objective of this narrative review was to determine if there is sufficient evidence to support the Board’s third and fourth Findings of Fact.

Methods: We analyzed the 2010 memorandum to determine what evidence was considered by the Connecticut Board in arriving at their third and fourth Findings of Fact. Analysis revealed that the Connecticut Board reviewed 3 studies. All 3 studies were acquired and reviewed.

Results: Analysis of the Connecticut Board’s 2010 memorandum shows that they relied solely on the first conclusion of the 2008 Cassidy et al. study, Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a population-based Case-Control and Case-Crossover Study.

Conclusion: We conclude that the third and fourth Findings of Fact in the 2010 memorandum of the Connecticut Board of Chiropractic Examiners are not supported by the evidence. Patients have the right to consider whether the clinical benefits they seek are worth the inherent risks. The present authors therefore recommend that chiropractors include the risk of stroke and/or CAD in securing informed consent by patients to manipulation of the cervical spine. This practice would be both evidence-based and patient-centered, and constitute an important element of the chiropractic standard of care.

Author keywords: Chiropractic; Stroke; Dissection; Manipulation; Adjustment; Informed Consent; Adverse Consequences

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