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Vertebral Artery Dissection as a Cause of Cervical Radiculopathy

Vertebral Artery Dissection as a Cause of Cervical Radiculopathy

The Chiro.Org Blog


SOURCE:   Asian Spine J. 2013 (Dec); 7 (4): 335–338

Benjamin Isaac Silbert, Mark Khangure, and
Peter Linton Silbert

Department of Neurology,
Royal Perth Hospital,
Perth, Australia.


The acute onset of neck pain and arm weakness is most commonly due to cervical radiculopathy or inflammatory brachial plexopathy. Rarely, extracranial vertebral artery dissection may cause radiculopathy in the absence of brainstem ischemia. We describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 43-year-old woman who presented with proximal left arm weakness and neck pain aggravated by movement. Cervical magnetic resonance imaging (MRI) and angiography revealed dissection of the left vertebral artery with an intramural hematoma compressing the left C5 and C6 nerve roots. Antiplatelet treatment was commenced, and full power returned after 2 months. Recognition of vertebral artery dissection on cervical MRI as a possible cause of cervical radiculopathy is important to avoid interventions within the intervertebral foramen such as surgery or nerve root sleeve injection. Treatment with antithrombotic agents is important to prevent secondary ischemic events.

KEYWORDS:   Cervical spine; Neck pain; Radiculopathy; Vertebral artery dissection


From the FULL TEXT Article:

Introduction

In patients presenting with neck pain and arm weakness a multitude of pathologies, ranging from the benign to those potentially fatal, must be considered in the differential diagnosis. On cervical magnetic resonance imaging (MRI), the absence of discogenic or other structural causes for compression provides clinical direction to consider other causes such as inflammatory brachial plexopathy or the more recently recognised entity of vertebral artery dissection (VAD)-associated cervical radiculopathy. The typical presentation of VAD is with neck pain and occipital headache, which is often misinterpreted as musculoskeletal in nature until focal neurological signs appear. [1] Occlusion of the vertebral artery commonly results in brainstem ischemia (e.g., lateral medullary syndrome), however in a small minority of patients perfusion is unaffected and in these patients there may be evidence of cervical radiculopathy if the dissecting vertebral artery compresses the adjacent spinal nerve roots. Predisposing incidents such as sudden neck movements may be a factor in VAD, but also in discogenic cervical radiculopathies and other entities from which they must be distinguished by imaging. Identification of VAD-associated radiculopathy is essential to avoid interventions such as surgery or nerve root sleeve injection.


Case Report

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Chiropractic Response to a Spontaneous Vertebral Artery Dissection

Chiropractic Response to a Spontaneous Vertebral Artery Dissection

The Chiro.Org Blog


SOURCE:   J Chiro Med 2015 (Sep); 14 (3): 183–190 ~ FULL TEXT

Gary Tarola, DC, and Reed B. Phillips, DC

Private Practice,
Lehigh Valley Medical Network,
Allentown, PA.


OBJECTIVE:   The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes.

CLINICAL FEATURES:   A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient’s pain in the most severe category.

INTERVENTION AND OUTCOME:   The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately.

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Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?

The Chiro.Org Blog


SOURCE:   Front Neurol. 2016 (Mar 21); 7: 40 ~ FULL TEXT

Jodan D. Garcia, Stephen Arnold, Kylie Tetley,
Kiel Voight, and Rachael Anne Frank

Department of Physical Therapy,
Georgia State University ,
Atlanta, GA , USA.


Cervical mobilization and manipulation are frequently used to treat patients diagnosed with cervicogenic headache (CEH); however, there is conflicting evidence on the efficacy of these manual therapy techniques. The purpose of this review is to investigate the effects of cervical mobilization and manipulation on pain intensity and headache frequency, compared to traditional physical therapy interventions in patients diagnosed with CEH. A total of 66 relevant studies were originally identified through a review of the literature, and the 25 most suitable articles were fully evaluated via a careful review of the text.

Ultimately, 10 studies met the inclusion criteria:

(1) randomized controlled trial (RCT) or open RCT; the study contained at least two separate groups of subjects that were randomly assigned either to a cervical spine mobilization or manipulation or a group that served as a comparison

(2) subjects must have had a diagnosis of CEH

(3) the treatment group received either spinal mobilization or spinal manipulation, while the control group received another physical therapy intervention or placebo control, and

(4) the study included headache pain and frequency as outcome measurements.

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Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People

Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (Apr 2) [Epub]

Kelly R. Holt, BSc (Chiro), Heidi Haavik, BSc (Chiro), PhD,
Arier Chi Lun Lee, PhD, Bernadette Murphy, DC, PhD, C.
Raina Elley, MBChB, PhD

Research Fellow, Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Mt. Wellington, Auckland, New Zealand


OBJECTIVE:   This study assessed whether 12 weeks of chiropractic care was effective in improving sensorimotor function associated with fall risk, compared with no intervention, in community-dwelling older adults living in Auckland, New Zealand.

METHODS:   Sixty community-dwelling adults older than 65 years were enrolled in the study. Outcome measures were assessed at baseline, 4 weeks, and 12 weeks and included proprioception (ankle joint position sense), postural stability (static posturography), sensorimotor function (choice stepping reaction time), multisensory integration (sound-induced flash illusion), and health-related quality of life (SF-36).

RESULTS:   Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26-212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%-24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°-0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF-36 physical component of quality of life (2.4; 95% CI, 0.04-4.8; P = .04) compared with control.

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A Path Analysis of the Effects of the Doctor-patient Encounter and Expectancy in an Open-label Randomized Trial of Spinal Manipulation for the Care of Low Back Pain

A Path Analysis of the Effects of the Doctor-patient Encounter and Expectancy in an Open-label Randomized Trial of Spinal Manipulation for the Care of Low Back Pain

The Chiro.Org Blog


SOURCE:   BMC Complement Altern Med. 2014 (Jan 13); 14: 16

Mitchell Haas, Darcy Vavrek, Moni B Neradilek, and
Nayak Polissar

Center for Outcomes Studies,
University of Western States,
2900 NE 132nd Ave,
Portland, OR, USA.


BACKGROUND:   The doctor-patient encounter (DPE) and associated patient expectations are potential confounders in open-label randomized trials of treatment efficacy. It is therefore important to evaluate the effects of the DPE on study outcomes.

METHODS:   Four hundred participants with chronic low back pain (LBP) were randomized to four dose groups: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for six weeks. They received light massage control at visits when manipulation was not scheduled. Treating chiropractors were instructed to have equal enthusiasm for both interventions. A path analysis was conducted to determine the effects of dose, patient expectations of treatment success, and DPE on LBP intensity (100-point scale) at the end of care (6 weeks) and primary endpoint (12 weeks). Direct, indirect, and total standardized effects (βtotal) were computed. Expectations and DPE were evaluated on Likert scales. The DPE was assessed as patient-rated perception of chiropractor enthusiasm, confidence, comfort with care, and time spent.

RESULTS:   The DPE was successfully balanced across groups, as were baseline expectations. The principal finding was that the magnitude of the effects of DPE on LBP at 6 and 12 weeks (|β|total = 0.22 and 0.15, p < .05) were comparable to the effects of dose of manipulation at those times (|β|total = 0.11 and 0.12, p < .05). In addition, baseline expectations had no notable effect on follow-up LBP. Subsequent expectations were affected by LBP, DPE, and dose (p < .05).

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Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2015 (Feb 15); 40 (4): 209–217

Schneider, Michael DC, PhD, Haas, Mitchell DC, MA
Glick, Ronald MD, Stevans, Joel DC, Landsittel, Doug PhD

School of Health and Rehabilitation Sciences,
Clinical and Translational Science Institute,
University of Pittsburgh,
Pittsburgh, PA


STUDY DESIGN:   Randomized controlled trial with follow-up to 6 months.

OBJECTIVE:   This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).

SUMMARY OF BACKGROUND DATA:   Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.

METHODS:   A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

RESULTS:   Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = –8.1, P = 0.009; pain = –1.4, P = 0.002) and UMC (disability = –6.5, P = 0.032; pain = –1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.

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An Inspiring Story

This powerful video shows the story of a young man whose life was dramatically altered by a relatively short course of properly applied chiropractic treatment. In the spirit of sharing, this video appears to have been produced to demonstrate chiropractic technique rather than as a vehicle for self-promotion.

“Find it, fix it, and leave it alone”

Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection

Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection:
No Evidence for Causation

The Chiro.Org Blog


SOURCE:   Cureus 2016 (Feb 16);   8 (2):   e498

Ephraim W. Church, MD,   Emily P. Sieg, MD,
Omar Zalatimo, MD,   Namath S. Hussain, MD,
Michael Glantz, MD,   Robert E. Harbaugh, MD

Department of Neurosurgery,
Penn State Hershey Medical Center


BACKGROUND:   Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.

METHODS:   Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.

RESULTS:   Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was “very low.”

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A Giant in Chiropractic Radiology: Remembering Dr. Lindsay Rowe (1956-2016)

Source Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Lindsay Rowe, DC, MD, DACBR, was a giant in the field of chiropractic radiology who enjoyed careers as a chiropractor, medical doctor, radiologist and educator.

A distinguished international lecturer and author, he wrote more than 50 scientific papers and numerous book chapters; and together with Dr. Terry Yochum, co-authored the internationally respected text Essentials of Skeletal Radiology, now in its third edition. It is the standard text in most chiropractic colleges and has been enthusiastically reviewed in scientific journals such as The New England Journal of Medicine and Radiology.

Dr. Rowe earned his chiropractic degree (MAppSc – Chiropractic) with honors from the Royal Melbourne Institute of Technology in Melbourne, Australia. He subsequently practiced chiropractic and later earned board certification in chiropractic radiology at a time when few chiropractors entered into the specialty. He chaired the Department of Radiology at Canadian Memorial Chiropractic College in Toronto, Ontario. Later, he held the same position at Northwestern College of Chiropractic in Minneapolis, Minn.

Dr. Rowe received a medical degree from the University of Newcastle, Australia, followed by residencies in emergency medicine and diagnostic and interventional radiology at the same institution. He was associate professor at the University of Newcastle, an adjunct professor at Northwestern Health Sciences University and Murdoch University, staff radiologist at the Center for Diagnostic Imaging (a national medical imaging network) and John Hunter Hospital in Melbourne. He was also a prolific presenter at professional meetings in Australia and many countries around the world.

Dr. Rowe’s accomplishments in skeletal radiology have contributed much to the advancement of chiropractic’s acceptance in the medical community, especially chiropractic radiology. He was a leader and a trailblazer, bridging the gap between allopathic and chiropractic; creating respect for our profession within the modern health care community.

Management of Neck Pain and Associated Disorders

Management of Neck Pain and Associated Disorders: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2016 (Mar 16) [Epub]

Côté P, Wong JJ, Sutton D, Shearer HM, Mior S et. al.

Canada Research Chair in
Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT),
2000 Simcoe Street North,
Oshawa, ON, L1H 7L7, Canada.


PURPOSE:   To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD).

METHODS:   This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration.

RECOMMENDATION 1:   Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.

RECOMMENDATION 2:   Clinicians should assess prognostic factors for delayed recovery from NAD.

RECOMMENDATION 3:   Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.

RECOMMENDATION 4:   For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.

RECOMMENDATION 5:   For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.

RECOMMENDATION 6:   For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction.

RECOMMENDATION 7:   For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management.

RECOMMENDATION 8:   Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

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Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain

Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain –
A Longitudinal Observational Study

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2016 (Mar 16); 24: 9

Brigitte Wirth, B. Kim Humphreys and Cynthia Peterson

Chiropractic Medicine Department,
Faculty of Medicine,
University of Zurich and University Hospital Balgrist


It has been established that psychological factors (appear to play) an important role in chronic non-specific neck pain. Particularly anxiety, depression and catastrophizing appear to negatively affect pain intensity and disability in this patient group. [5]

To test whether these emotional elements are the natural side-effect of chronic pain as opposed to being causal, these researchers worked with 850 patients with acute non-specific neck pain with no history of previous neck or arm pain.

The results were quite fascinating:

  • They found that the psychological factors measured at baseline had no influence on the self-reported outcome at 1 week and 1 month
  • A high reduction in anxiety between 1 week and 1 month after the first consultation was linked to a significantly higher chance for self-reported improvement at 1 month in both models
  • Poor outcome at 1 and 3 months went along with high levels of anxiety. High baseline anxiety was not a risk factor for poor outcome, but its reduction during the first month was highly related to favorable recovery.
  • In contrast, high level of depression at baseline was fairly related to poor recovery at 3 months.

Thus, patients with acute non-specific neck pain might benefit from adequate information and communication that targets at reducing anxiety by encouraging self-management of the problem.

Background   The influence of psychological factors on acute neck pain is sparsely studied. In a secondary analysis of prospectively collected data, this study investigated how several psychological factors develop in the first three months of acute neck pain and how these factors influence self-perceived recovery.

Methods   Patients were recruited in various chiropractic practices throughout Switzerland between 2010 and 2014. The follow-up telephone interviews were conducted for all patients by research assistants in the coordinating university hospital following a standardized procedure. The population of this study consisted of 103 patients (68 female; mean age = 38.3 ± 13.8 years) with a first episode of acute (<4 weeks) neck pain. Prior to the first treatment, the patients filled in the Bournemouth Questionnaire (BQ). One week and 1 and 3 months later, they completed the BQ again along with the Patient Global Impression of Change (PGIC). The temporal development (repeated measure ANOVA) of the BQ questions 4 (anxiety), 5 (depression), 6 (fear-avoidance) and 7 (pain locus of control) as well as the influence of these scores on the PGIC were investigated (binary logistic regression analyses, receiver operating curves (ROC)).

Results   All psychological parameters showed significant reduction within the first month. The parameter ‘anxiety’ was associated with outcome at 1 and 3 months (p = 0.013, R2 = 0.40 and p = 0.039, R2 = 0.63, respectively). Baseline depression (p = 0.037, R2 = 0.21), but not baseline anxiety, was a predictor for poor outcome. A high reduction in anxiety within the first month was a significant predictor for favorable outcome after 1 month (p < 0.001; R2 = 0.57).

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Happy St. Patty’s Day! (2016)



Is the WCA Trying to Create a New Profession?

Is the WCA Trying to Create a New Profession?

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic ~ March 15, 2016


The Wisconsin Chiropractic Association (WCA) is the driving force behind the introduction of a bill to create a new health care profession to be known as “primary spinal care practitioners.” [1] This is the apparent culmination of significant effort that began when “the WCA Board of Directors – at a special meeting on August 7, 2014 – voted unanimously to release a white paper outlining the Primary Spine Care Physician (PSCP) initiative to WCA members and the public.” [2]

According to the bill’s authors, Wisconsin Senator Frank Lasee and Representative Joe Sanfelippo, “[T]his bill creates a new type of health care provider in Wisconsin called the Primary Spine Care Practitioner (PSCP) designed to address the growing burden of spine related disorders and the overuse of prescription drugs in Wisconsin. The Primary Spine Care Practitioner would be a new practice act governed by the Medical Examining Board available to licensed chiropractors who meet the educational and clinical training requirements.” [3]

The bill includes rights and privileges for primary spinal care practitioners not currently enjoyed by doctors of chiropractic. In addition, the bill:

  • “[E]stablishes a licensure program for primary spinal care practitioners to be administered by the Spinal Medicine Affiliated Credentialing Board, which is created in the bill and attached to the Medical Examining Board.
  • “[D]efines ‘spinal medicine’ in relevant part as the integration and application of the practice of chiropractic and the practice of medicine and surgery, both as defined under current law, that is limited to conditions of the spine and the musculoskeletal, neuromuscular, and nervous systems.
  • Provides that “a licensed primary spinal care practitioner has authority to prescribe and administer prescription drugs.” [4]

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Best Practices Recommendations for Chiropractic Care for Older Adults

Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2010 (Jul); 33 (6): 464-473

Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD,
Paul Dougherty, DC, Brian J. Gleberzon, DC,
Lisa Z. Killinger, DC

Cleveland Chiropractic College,
Overland Park, KS 66210, USA.


OBJECTIVE:   At this time, the scientific evidence base supporting the effectiveness of chiropractic care for musculoskeletal conditions has not yet definitively addressed its appropriateness for older adults. Expert consensus, as a form of evidence, must be considered when higher levels of evidence are lacking. The purpose of this project was to develop a document with evidence-based recommendations on the best practices for chiropractic care of older adults.

METHODS:   A set of 50 seed statements was developed, based on the clinical experience of the multidisciplinary steering committee and the results of an extensive literature review. A formal Delphi process was conducted, following the rigorous RAND-UCLA (University of California, Los Angeles) methodology. The statements were circulated electronically to the Delphi panel until consensus was reached. Consensus was defined as agreement by at least 80% of the panelists. There were 28 panelists from 17 US states and Canada, including 24 doctors of chiropractic, 1 physical therapist, 1 nurse, 1 psychologist, and 1 acupuncturist.

RESULTS:   The Delphi process was conducted in January-February 2010; all 28 panelists completed the process. Consensus was reached on all statements in 2 rounds. The resulting best practice document defined the parameters of an appropriate approach to chiropractic care for older adults, and is presented in this article.

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Patients’ Experiences With Vehicle Collision

Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2016 (Feb 26) [EPub]

Gail M. Lindsay, RN, PhD, Silvano A. Mior, DC, PhD,
Pierre Côté, DC, PhD, Linda J. Carroll, PhD,
Heather M. Shearer, DC, MSc

Associate Professor,
Faculty of Health Sciences,
University of Ontario Institute of Technology,
Oshawa, ON


OBJECTIVE:   The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries.

METHODS:   Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs.

RESULTS:   Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language (“injured persons”) being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised.

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