Evaluating primary practice: proposals for a modified model suited to chiropractic care.

Although chiropractic care is not yet considered to have achieved scientific validity, it enjoys widespread public acceptance. It is hypothesised that one of the barriers to chiropractic establishing scientific validity is the propensity of researchers to frame their randomized controlled clinical trials according to a biomedical rather than a biopsychosocial model. It is proposed that while chiropractic care should be required to establish a cause--effect relationship between spinal manipulation and clinical response, subjective patient--valued outcomes should also be monitored. For chiropractic care to be adequately assessed recognition needs to be given to the usefulness of qualitative measurements in health care. Interventions selected solely upon the basis of statistical significance run the risk of overlooking clinically meaningful outcomes.