Michael Lukas Meier, Andrea Vrana, Barry Kim Humphreys, Erich Seifritz, Philipp Stämpfli, and Petra Schweinhardt
Integrative Spinal Research,
Department of Chiropractic Medicine,
Balgrist University Hospital,
8008 Zurich, Switzerland.
Fear of pain demonstrates significant prognostic value regarding the development of persistent musculoskeletal pain and disability. Its assessment often relies on self-report measures of pain-related fear by a variety of questionnaires. However, based either on “fear of movement/(re)injury/kinesiophobia,” “fear avoidance beliefs,” or “pain anxiety,” pain-related fear constructs plausibly differ while it is unclear how specific the questionnaires are in assessing these different constructs. Furthermore, the relationship of pain-related fear to other anxiety measures such as state or trait anxiety remains ambiguous. Advances in neuroimaging such as machine learning on brain activity patterns recorded by functional magnetic resonance imaging might help to dissect commonalities or differences across pain-related fear constructs. We applied a pattern regression approach in 20 human patients with nonspecific chronic low back pain to reveal predictive relationships between fear-related neural pattern information and different pain-related fear questionnaires.
More specifically, the applied multiple kernel learning approach allowed the generation of models to predict the questionnaire scores based on a hierarchical ranking of fear-related neural patterns induced by viewing videos of activities potentially harmful for the back. We sought to find evidence for or against overlapping pain-related fear constructs by comparing the questionnaire prediction models according to their predictive abilities and associated neural contributors. By demonstrating evidence of nonoverlapping neural predictors within fear-processing regions, the results underpin the diversity of pain-related fear constructs. This neuroscientific approach might ultimately help to further understand and dissect psychological pain-related fear constructs.
Kelly Holt, PhD, David Russell, DC, Robert Cooperstein, MA, DC, Morgan Young, DC, Matthew Sherson, DC, Heidi Haavik, DC, PhD
Center for Chiropractic Research,
New Zealand College of Chiropractic,
Aukland, New Zealand.
OBJECTIVES: The purpose of this study was to assess the interexaminer reliability of palpation for stiffness in the cervical, thoracic, and lumbar spinal regions.
METHODS: In this secondary data analysis, data from 70 patients from a chiropractic college outpatient clinic were analyzed. Two doctors of chiropractic palpated for the stiffest site within each spinal region. Each were asked to select the stiffest segment and to rate their confidence in their palpation findings. Reliability between examiners was calculated as Median Absolute Examiner Differences (MedianAED) and data dispersion as Median Absolute Deviation (MAD). Interquartile analysis of the paired examiner differences was performed.
RESULTS: In total, 210 paired observations were analyzed. Nonparametric data precluded reliability determination using intraclass correlation. Findings included lumbar MedianAED = 0.5 vertebral equivalents (VE), thoracic = 1.7 VE, and cervical = 1.4 VE. For the combined dataset, the findings were MedianAED = 1.1 VE; MAD was lowest in the lumbar spine (0.3 VE) and highest in thoracic spine (1.4 VE), and for the combined dataset, MAD = 1.1 VE. Examiners agreed on the segment or the motion segment containing the stiffest site in 54% of the observations.
Robert Cooperstein, MA, DC, Morgan Young, DC, and Michael Haneline, DC, MPH
Palmer Center for Chiropractic Research,
San Jose, CA, USA.
INTRODUCTION: Motion palpators usually rate the movement of each spinal level palpated, and their reliability is assessed based upon discrete paired observations. We hypothesized that asking motion palpators to identify the most fixated cervical spinal level to allow calculating reliability at the group level might be a useful alternative approach.
METHODS: Three examiners palpated 29 asymptomatic supine participants for cervical joint hypomobility. The location of identified hypomobile sites was based on their distance from the T1 spinous process. Interexaminer concordance was estimated by calculating Intraclass Correlation Coefficient (ICC) and mean absolute differences (MAD) values, stratified by degree of examiner confidence.
RESULTS: For the entire participant pool, ICC [2,1] = 0.61, judged “good.” MAD=1.35 cm, corresponding to mean interexaminer differences of about 75% of one cervical vertebral level. Stratification by examiner confidence levels resulted in small subgroups with equivocal results.
Arlington, VA – The American Chiropractic Association (ACA) is pleased to announce that Congress yesterday introduced bipartisan legislation that would expand access to chiropractic services to military retirees as well as members of the National Guard and Reserve through the Department of Defense TRICARE health program.
The legislation — S. 30, introduced by Sen. Tammy Baldwin (D-Wis.) and Sen. Jerry Moran (R-Kan.), and H.R. 344, introduced by Rep. Mike Rogers (R-Ala.) and David Loebsack (D-Iowa) — would ensure that those who retire from military service can continue to receive the quality chiropractic care they accessed previously through the Department of Defense (DoD) healthcare system. Since painful musculoskeletal conditions are a common complaint among those who have served in the military, the legislation adds an important non-drug option for pain management in TRICARE for those who wish to avoid or reduce their need for prescription opioid pain medications.
“In the wake of the opioid epidemic, we are grateful that Congress recognizes the need for increased access to non-drug options for pain management,” said ACA President N. Ray Tuck, Jr., DC. “Chiropractors have become valued members of the military healthcare team. We are honored to help keep our service members battle-ready without the use of drugs or surgery and to help those who retire to continue to manage their pain conservatively with safe and effective chiropractic services.”
James W. DeVocht, Robert Vining, Dean L. Smith, Cynthia R. Long, Thomas M. Jones and Christine M. Goertz
Palmer Center for Chiropractic Research,
741 Brady St,
Davenport, IA, 52803, USA.
BACKGROUND: Chiropractic manipulative therapy (CMT) has been shown to improve reaction time in some clinical studies. Slight changes in reaction time can be critical for military personnel, such as special operation forces (SOF). This trial was conducted to test whether CMT could lead to improved reaction and response time in combat-ready SOF-qualified personnel reporting little or no pain.
METHODS: This prospective, randomized controlled trial was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY, USA. Active-duty US military participants over the age of 19 years carrying an SOF designation were eligible. Participants were randomly allocated to CMT or wait-list control. One group received four CMT treatments while the other received no treatment within the 2-week trial period. Assessment included simple hand/foot reaction time, choice reaction time, and Fitts’ Law and whole-body response time. On visits 1 and 5, the same five assessments were conducted immediately pre- and post-treatment for the CMT group and before and after a 10-min wait period for the wait-list group. Primary outcomes included between-group differences for the pre-CMT/wait-list period at visit 1 and visit 5 for each test. Secondary outcomes included between-group differences in immediate pre- and post-(within visit) changes. Analysis of covariance was used for all data analysis.
RESULTS: One hundred and seventy-five SOF-qualified personnel were screened for eligibility; 120 participants were enrolled, with 60 randomly allocated to each group. Due to technical problems resulting in inconsistent data collection, data from 77 participants were analyzed for simple hand/foot reaction time. The mean ± standard deviation (SD) age was 33.0 ± 5.6 years and all participants were male. No between-group statistically significant differences were found for any of the five biomechanical tests, except immediate pre- and post-changes in favor of the CMT group in whole-body response time at both assessment visits. There were four adverse events, none related to trial participation.