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Memorial Day (2016)
In Memory of Those Who Have Fallen

Memorial Day (2016)
In Memory of Those Who Have Fallen

The Chiro.Org Blog


The Bivouac of the Dead

The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;

On Fame’s eternal camping ground
Their silent tents are spread;
But Glory guards with solemn round
The bivouac of the dead.

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In Memory of Those Who Have Fallen

Trajectories of Low Back Pain

Trajectories of Low Back Pain

The Chiro.Org Blog


SOURCE:   Best Pract Res Clin Rheumatol. 2013 (Oct); 27 (5): 601–612

Iben Axén, Charlotte Leboeuf-Yde

Unit of Intervention & Implementation Research,
Institute of Environmental Medicine,
Karolinska Institutet,
Nobels väg 13, S-171 77 Stockholm, Sweden


Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories indicates that the low back pain ‘episode’ is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have low back pain, but most have it on and off or persistently. Thus, the low back pain ‘condition’ is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted to understand causality, treatment effect and prognostic factors and to study the possible association of trajectories with pathologies.



From the FULL TEXT Article:

Introduction

Until recently, low back pain (LBP) was believed to be a self-limiting condition, much like the common cold. The European guidelines for the management of acute LBP state that 90% of patients will recover within 6 weeks. [1]

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What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

What Have We Learned From Ten Years of Trajectory Research in Low Back Pain?

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2016 (May 21); 17 (1): 220

Alice Kongsted, Peter Kent, Iben Axen,
Aron S. Downie, and Kate M. Dunn

The Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.
a.kongsted@nikkb.dk


BACKGROUND:   Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management.

DISCUSSION:   LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients.

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Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog


SOURCE:   J Manip Physiol Ther. 2016 (May); 39 (4): 229–239

Eric L. Hurwitz, DC, PhD, Maria Vassilaki, MD, MPH, PhD,
Dongmei Li, PhD, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina.

METHODS:   Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns.

RESULTS:   The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care.

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Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (May); 39 (4): 240–251

Eric L. Hurwitz, DC, PhD, Dongmei Li, PhD, Jenni Guillen, MS,
Michael J. Schneider, DC, PhD, Joel M. Stevans, DC,
Reed B. Phillips, DC, PhD, Shawn P. Phelan, DC,
Eugene A. Lewis, DC, MPH, Richard C. Armstrong, MS, DC,
Maria Vassilaki, MD, MPH, PhD

Office of Public Health Studies,
University of Hawaii at Manoa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by provider patterns of care for the treatment of neck pain in North Carolina.

METHODS:   This was an analysis of neck-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees (NCSHP) from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the NCSHP using ICD-9 diagnostic codes for uncomplicated neck pain (UNP) and complicated neck pain (CNP).

RESULTS:   Care patterns with single-provider types and no referrals incurred the least average charges for both uncomplicated neck pain (UNP) and complicated neck pain (CNP). When care did not include referral providers or services, for either UNP or CNP, MD care with PT was generally less expensive than MD care with DC care. However, when care involved referral providers or services, MD and PT care was on average more expensive than MD and DC care for either UNP or CNP. Risk-adjusted charges for patients in the middle quintile of risk (available 2006-2009) were lower for chiropractic patients with or without medical care or referral care to other providers.

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Chronic Neck Pain and Chiropractic Page

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The Effect of Chiropractic Techniques on the Cobb Angle in Idiopathic Scoliosis Arising in Adolescence

The Effect of Chiropractic Techniques on the Cobb Angle in Idiopathic Scoliosis Arising in Adolescence

The Chiro.Org Blog


SOURCE:   J Phys Ther Sci. 2016 (Apr); 28 (4): 1106–1110

Sunghak Byun, PhD and Dongwook Han, PhD, PT

Department of Physical Therapy,
College of Health and Welfare,
Silla University, Republic of Korea.


Purpose   The purpose of this study was to examine whether chiropractic techniques would reduce the curvature of idiopathic scoliosis, which commonly occurs in elementary school children.

Subjects   The subjects of this study were 5 healthy elementary students who listened to an explanation of the study methods and purpose of the study and agreed to participate in the experiment.

Methods   The Cobb angle was measured by taking an X-ray (FCT-1, Dongmun, Goyangsi, Republic of Korea) taken from the rear, using X-ray film. The method of intervention this study used was application of chiropractic techniques. Spinal correction was carried out for 30 minutes per session, which included soft tissue massage, 3 times a week for 8 weeks.

Results   It was established that the Cobb angle was noticeably decreased after 4 weeks of the intervention. Post Hoc analysis revealed that the Cobb angle noticeably decreased after 4 weeks compared with the Cobb angle before the chiropractic techniques were applied. However, no significant difference in Cobb angle was evident after the fourth week.

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Vertical Posture and Head Stability in Patients With Chronic Neck Pain

Vertical Posture and Head Stability in Patients With Chronic Neck Pain

The Chiro.Org Blog


SOURCE:   J Rehabil Med. 2003 (Sep); 35 (5): 229–235

P. Michaelson, M. Michaelson, S. Jaric,
M .L. Latash, P. Sjölander, M. Djupsjöbacka

Southern Lapland Research Department
Vilhelmina, Sweden.


OBJECTIVE:   To evaluate postural performance and head stabilization of patients with chronic neck pain.

DESIGN:   A single-blind comparative group study.

SUBJECTS:   Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16).

METHODS:   During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations.

RESULTS:   Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations.

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Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

The Chiro.Org Blog


SOURCE:   J Manip Physiol Ther. 2016 (May); 39 (4): 252–262

Eric L. Hurwitz, DC, PhD, Dongmei Li, PhD,
Jenni Guillen, MS, Michael J. Schneider, DC, PhD,
Joel M. Stevans, DC, Reed B. Phillips, DC, PhD,
Shawn P. Phelan, DC, Eugene A. Lewis, DC, MPH,
Richard C. Armstrong, MS, DC,
Maria Vassilaki, MD, MPH, PhD

Office of Public Health Studies,
University of Hawai`i at M?noa,
Honolulu, HI.


OBJECTIVES:   The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by patterns of care for the treatment of low back pain in North Carolina.

METHODS:   This was an analysis of low-back-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, 9th Revision diagnostic codes for:

uncomplicated low back pain   (ULBP) and
complicated low back pain   (CLBP).

RESULTS:   Care patterns with single-provider types and no referrals incurred the least charges on average for both ULBP and CLBP. When care did not include referral providers or services, for ULBP, MD and DC care was on average $465 less than MD and PT care. For CLBP, MD and DC care averaged $965 more than MD and PT care. However, when care involved referral providers or services, MD and DC care was on average $1600 less when compared to MD and PT care for ULBP and $1885 less for CLBP. Risk-adjusted charges (available 2006-2009) for patients in the middle quintile of risk were significantly less for DC care patterns.

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Prevalence and Tracking of Back Pain
From Childhood to Adolescence

Prevalence and Tracking of Back Pain
From Childhood to Adolescence

The Chiro.Org Blog


SOURCE:  

Per Kjaer, Niels Wedderkopp, Lars Korsholm
and Charlotte Leboeuf-Yde

Institute of Sports Science and Clinical Biomechanics,
Part of Clinical Locomotion Network,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense, Denmark.


BACKGROUND:   It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and 15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.

METHODS:   A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.

RESULTS:   Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for BP 33%, 28%, and 48%; for LBP 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for NP 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.

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From Childhood to Adolescence

Is Puberty a Risk Factor For Back Pain in the Young?

Is Puberty a Risk Factor For Back Pain in the Young? A Systematic Critical Literature Review

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2014 (Oct 15); 22 (1): 27

Arnaud Lardon, Charlotte Leboeuf-Yde,
Christine Le Scanff and
Niels Wedderkopp

EA 4532 CIAMS, Université Paris-Sud,
UFR STAPS, 91405 Orsay, France ;
Institut Franco-Européen de Chiropraxie,
24 Bld Paul Vaillant Couturier,
94200 Ivry sur Seine, France.


BACKGROUND:   Back pain is a common condition that starts early in life and seems to increase markedly during puberty. A systematic review was performed in order to investigate the link between puberty and back pain, using some Bradford Hill criteria for causality.

OBJECTIVES:   We sought to obtain answers to the following questions: 1) Is there an association between puberty and back pain? If so, how strong is this association? And do the results remain unchanged also when controlling for age and sex? 2) Are the results of the studies consistent? 3) Is there a dose-response, showing a link between the increasing stages of puberty and the subsequent prevalence of back pain? 4) Is there a temporal link between puberty and back pain?

DESIGN:   A systematic critical literature review.

METHODS:   Systematic searches were made in March 2014 in PubMed, Embase, CINAHL and PsycINFO including longitudinal or cross-sectional studies on back pain for subjects <19 years, written in French or English. The review process followed the AMSTAR recommendations. Interpretation was made using some of the Bradford-Hill criteria for causality.

RESULTS:   Four articles reporting five studies were included, two of which were longitudinal. 1) Some studies show a weak and others a strong positive association between puberty and back pain, which remains after controlling for age and sex; 2) Results were consistent across the studies; 3) There was a linear increase of back pain according to the stage of puberty 4) Temporality has not been sufficiently studied.

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Musculoskeletal Pain in Children and Adolescents

Musculoskeletal Pain in Children and Adolescents

The Chiro.Org Blog


SOURCE:   Braz J Phys Ther. 2016 (Feb 16) [Epub]

Steve J. Kamper, Nicholas Henschke, Lise Hestbaek,
Kate M. Dunn, Christopher M. Williams

The George Institute,
University of Sydney, Australia.


Introduction   Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research.

Results   Rates of self-reported MSK pain in adolescents are similar to those in adult populations and they are typically higher in teenage girls than boys. Epidemiological research has identified conditions such as back and neck pain as major causes of disability in adolescents, and in up to a quarter of cases there are impacts on school or physical activities. A range of physical, psychological and social factors have been shown to be associated with MSK pain report, but the strength and direction of these relationships are unclear. There are few validated instruments available to quantify the nature and severity of MSK pain in children, but some show promise. Several national surveys have shown that adolescents with MSK pain commonly seek care and use medications for their condition. Some studies have revealed a link between MSK pain in adolescents and chronic pain in adults.

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Bladder Metastasis Presenting as Neck, Arm and Thorax Pain

Bladder Metastasis Presenting as Neck, Arm and Thorax Pain: A Case Report

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2016 (May 4); 24: 14

Clinton J. Daniels, Pamela J. Wakefield
and Glenn A. Bub

Chiropractic Clinic,
VA St. Louis Healthcare System


Background   A case of metastatic carcinoma secondary to urothelial carcinoma presenting as musculoskeletal pain is reported. A brief review of urothelial and metastatic carcinoma including clinical presentation, diagnostic testing, treatment and chiropractic considerations is discussed.

Case presentation   This patient presented in November 2014 with progressive neck, thorax and upper extremity pain. Computed tomography revealed a destructive soft tissue mass in the cervical spine and additional lytic lesion of the 1st rib. Prompt referral was made for surgical consultation and medical management.

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Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

The Chiro.Org Blog


SOURCE:   J Am Board Fam Med. 2015 (Jul); 28 (4): 481–490

Matthew A. Davis, MPH, DC, PhD, Olga Yakusheva, PhD,
Daniel J. Gottlieb, MS and Julie P.W. Bynum, MD, MPH

Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College,
Geisel School of Medicine,
Hanover, NH


BACKGROUND:   Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown.

METHODS:   We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain.

RESULTS:   We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P < .001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91-0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million.

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Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use

Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (Mar 28) [Epub]

William B Weeks, MD, PhD, MBA,
Christine M Goertz, DC, PhD

The Dartmouth Institute for
Health Policy and Clinical Practice,
Lebanon, NH


OBJECTIVE:   The purpose of this study was to determine whether the per-capita supply of doctors of chiropractic (DCs) or Medicare spending on chiropractic care was associated with opioid use among younger, disabled Medicare beneficiaries.

METHODS:   Using 2011 data, at the hospital referral region level, we correlated the per-capita supply of DCs and spending on chiropractic manipulative therapy (CMT) with several measures of per-capita opioid use by younger, disabled Medicare beneficiaries.

RESULTS:   Per-capita supply of DCs and spending on CMT were strongly inversely correlated with the percentage of younger Medicare beneficiaries who had at least 1, as well as with 6 or more, opioid prescription fills. Neither measure was correlated with mean daily morphine equivalents per opioid user or per chronic opioid user.

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The Influence of Curricular and Extracurricular Learning Activities on Students’ Choice of Chiropractic Technique

The Influence of Curricular and Extracurricular Learning Activities on Students’ Choice of Chiropractic Technique

The Chiro.Org Blog


SOURCE:   J Chiropractic Education 2016 (Mar); 30 (1): 30-36

David M. Sikorski , DC,
Anupama KizhakkeVeettil , MAOM and
Gene S. Tobias , PhD, DC

Professor
Southern California University of Health Sciences
16200 E. Amber Valley Dr.
Whittier, CA 90604


Objective:   Surveys for the National Board of Chiropractic Examiners indicate that diversified chiropractic technique is the most commonly used chiropractic manipulation method. The study objective was to investigate the influences of our diversified core technique curriculum, a technique survey course, and extracurricular technique activities on students’ future practice technique preferences.

Methods:   We conducted an anonymous, voluntary survey of 1st, 2nd, and 3rd year chiropractic students at our institution. Surveys were pretested for face validity, and data were analyzed using descriptive and inferential statistics.

Results:   We had 164 students (78% response rate) participate in the survey. Diversified was the most preferred technique for future practice by students, and more than half who completed the chiropractic technique survey course reported changing their future practice technique choice as a result. The students surveyed agreed that the chiropractic technique curriculum and their experiences with chiropractic practitioners were the two greatest bases for their current practice technique preference, and that their participation in extracurricular technique clubs and seminars was less influential.

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