This report resulted in inconsistent findings with regard to whether spinal manipulation therapy was helpful for acute and chronic pain in the short term and long term. Evidence on adverse events was minimal, but the literature consistently reported that patients commonly experienced mild adverse events, and rarely experienced serious adverse events. Given the low level of evidence and contradictory or lack of effect on health outcomes, it is difficult to make any positive statements regarding the clinical effectiveness of spinal manipulation. ECRI reported minimally on costing information from two American articles. Both studies stated that chiropractic care alone was more expensive than medical care alone, when assessing outpatient costs or office costs. However, when combined with other treatments, one paper reported chiropractic care was less expensive, and the second study stated that costs were lower only for patients with chronic low back pain. Despite years of published evidence on spinal manipulation and chiropractic care, it is difficult to draw any conclusions regarding the clinical and cost-effectiveness of chiropractic care or spinal manipulation therapy performed by a chiropractor.