Letters to the Editor

Re: Clinical effectiveness of the activator adjusting instrument in the management of musculoskeletal disorders: a systematic review of the literature. JCCA 2012; 56(1):49–57.

To the Editor:

We read with great interest, the systematic review by Huggins et al.¹ in the previous issue of the JCCA. In their review, the authors conclude that there is benefit to the use of the Activator Adjusting Instrument (AAI) for patients with spinal pain and trigger points. Unfortunately, we feel that this conclusion holds little value to the reader, as the authors do not provide the context within which use of the AAI is beneficial. We assert that a clinical tool, such as the AAI, may not be of much benefit unless its action is directed with the correct clinical intent. As such, clinical outcomes could differ greatly depending on whether or not the AAI was used purely for instrument-assisted adjusting (i.e., the use of an activator to impart a chiropractic adjustment), or used as part of Activator Methods Chiropractic Technique (AMCT), a technique system that involves a group of specialized diagnostic procedures while assessing patient leg length in the prone position. The lack of context provided in their conclusion is surprising, as in their introduction, the authors do an excellent job of differentiating these notably different approaches to use of the AAI.

The authors correctly note in their introduction that it is difficult to make a distinction in the existing social-science literature between instrument-assisted adjusting and AMCT. In fact, they cite the 2005 National Board of Chiropractic Examiner’s Job Analysis, which reported that 51% of American chiropractors have used ‘activator’, but which failed to distinguish the approach with which the ‘activator’ was used.² Furthermore, it has often been reported in peer-reviewed studies that over 1/3 of North American chiropractors use ‘activator’ on a regular basis^3,4, however, none of these studies made a distinction between use of an ‘activator’ for instrument-assisted adjusting vs. the use of AMCT. Although the authors of this review¹ have uncovered this flaw in the existing social-science literature, they too have neglected to adequately make this distinction in the conclusions of their own clinical-outcome-based systematic review. The authors mention both AAI and AMCT in their statement of objectives, but then seem to present a discussion with regard only to instrument-assisted adjusting and a conclusion that presumably blends the outcomes from studies using these two diverse approaches. Eight clinical studies that used the AAI are included in their review, but the authors neglect to differentiate which investigated instrument-assisted adjusting vs. those that investigated AMCT. In fact, the authors do not differentiate in any way, their findings with respect to the clinical efficacy of AAI for AMCT vs. AAI for instrument-assisted adjusting. Thus, we ask, was any clinical research found that investigated the use of AAI with AMCT for the treatment of any condition? Or, does the existing research only support the use of the AAI as a tool for instrument-assisted adjusting, in the absence of AMCT protocols?