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Exploring the Definition of «Acute» Neck Pain

Exploring the Definition of «Acute» Neck Pain:
A Prospective Cohort Observational Study Comparing the Outcomes of Chiropractic Patients with 0-2 Weeks, 2-4 Weeks and 4-12 Weeks of Symptoms

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2017 (Aug 16); 25: 24

Luana Nyiro, Cynthia K. Peterson and
B. Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,
Forchstrasse 340, 8008
Zürich, Switzerland


BACKGROUND:   Neck pain is a common complaint in chiropractic patients. Amongst other baseline variables, numerous studies identify duration of symptoms as a strong predictor of outcome in neck pain patients. The usual time frame used for ‘acute’ onset of pain is between 0 and 4 weeks. However, the appropriateness of this time frame has been challenged for chiropractic low back pain patients. Therefore, the purpose of this study was to compare outcomes in neck pain patients with 0–2 vs 2–4 and 4–12 weeks of symptoms undergoing chiropractic treatment.

METHODS:   This is a prospective cohort observational study with 1 year follow-up including 495 patients whose data was collected between October 2009 and March 2015. Patients were divided into high-acute (0–2 weeks), mid-acute (2–4 weeks) and subacute (4–12 weeks) corresponding to duration of their symptoms at initial treatment. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire for neck pain (BQN) at baseline. At follow-up time points of 1 week, 1 month, 3 months, 6 months and 1 year the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. The PGIC responses were dichotomized into ‘improved’ and ‘not improved’ patients and compared between the 3 subgroups. The Chi-square test was used to compare improved patients between the 3 subgroups and the unpaired Student’s t-test was used for the NRS and BQN change scores.

RESULTS:   The proportion of patients ‘improved’ was only significantly higher for patients with symptoms of 0–2 weeks compared to 2–4 weeks at the 1 week outcome time point (p = 0.015). The NRS changes scores were significantly greater for patients with 2–4 weeks of symptoms compared to 4–12 weeks of symptoms only at 1 week (p = 0.035).

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Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

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SOURCE:   J Occupat Enviro Med 2011 (Apr); 53 (4): 396–404

Manuel Cifuentes, MD, PhD,
Joanna Willetts, MS, and
Radoslaw Wasiak, PhD, MA, MSc

Center for Disability Research
Liberty Mutual Research Institute for Safety
University of Massachusetts Lowell
Hopkinton, Mass


This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP).   They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio (HR) for disability recurrence between 3 types of providers:

Physical Therapists (PT),

Physicians (MD), or

Chiropractors (DC).

The results are quite interesting:

  • For PTs: HR = 2.0
  • For MDs: HR = 1.6
  • For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor.

You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.

The authors concluded:

In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services.”

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

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Prevention and Health Promotion by Chiropractors

Prevention and Health Promotion by Chiropractors

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SOURCE:   American J Lifestyle Medicine 2008;   2 (6):   537–545

Daniel Redwood, DC, and Gary Globe, MBA, DC, PhD

Cleveland Chiropractic College–Kansas City,
10850 Lowell Avenue,
Overland Park, KS 66210


Chiropractic care includes a variety of minimally invasive approaches, with both treatment and prevention as essential elements of clinical practice. Although chiropractic adjustment (manipulation) is the signature therapy and best-known identifier of the profession, the practice of chiropractic involves more than manual therapeutics. In general, chiropractors seek to bring a holistic worldview to the doctor–patient encounter, seeking not only to relieve pain and restore neuromusculoskeletal function but also to support the inherent self-healing and self-regulating powers of the body.

Aside from applying their diagnostic training to the evaluation of a variety of physical disorders and delivering manual adjustments and related therapeutic interventions, many chiropractors encourage patients to take an active role in restoring and maintaining health, with particular emphasis on doctor-guided self-care through exercise and nutrition. In this review, the authors summarize the peer-reviewed literature on chiropractic and prevention, describe health promotion and wellness approaches currently taught at chiropractic colleges and used in chiropractic clinical settings, discuss duration of care, emphasize the importance of interprofessional cooperation and collaboration, and address the hypothesis that chiropractic adjustments yield preventive effects.

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Do Participants with Low Back Pain who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

Do Participants with Low Back Pain who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2015 (Sep 1); 40 (17): 1329–1337

Arnold Y. L. Wong, PT, MPhil, PhD,
Eric C. Parent, PT, PhD,
Sukhvinder S. Dhillon, MB, ChB, CCST,
Narasimha Prasad, PhD,
and Gregory N. Kawchuk, DC, PhD

Department of Physical Therapy,
University of Alberta,
Alberta, Canada


STUDY DESIGN:   Nonrandomized controlled study.

OBJECTIVE:   To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls.

SUMMARY OF BACKGROUND DATA:   Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls.

METHODS:   Participants with LBP and asymptomatic controls attended 3 sessions for 7 days. On sessions 1 and 2, participants with LBP received SMT (+LBP/+SMT, n = 32) whereas asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from an LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/nonresponders on the basis of self-reported disability on day 7. A repeated measures analysis of covariance was used to compare apparent diffusion coefficients among responders, nonresponders, and +LBP/-SMT subjects, as well as spinal stiffness or multifidus thickness ratio among responders, nonresponders, and -LBP/-SMT subjects.

RESULTS:   After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups. Similarly, only SMT responders displayed significant post-SMT improvement in apparent diffusion coefficients.

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Effectiveness of Manual Therapy for Chronic Tension-type Headache

Effectiveness of Manual Therapy for Chronic Tension-type Headache: A Pragmatic, Randomised, Clinical Trial

The Chiro.Org Blog


SOURCE:   Cephalalgia. 2011 (Jan); 31 (2): 133–143

Rene F Castien, Danielle AWM van der Windt,
Anneke Grooten and Joost Dekker

Healthcare Centre Haarlemmermeer,
The Netherlands.


OBJECTIVE:   To evaluate the effectiveness of manual therapy (MT) in participants with chronic tension-type headache (CTTH).

SUBJECTS AND METHODS:   We conducted a multicentre, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with CTTH were randomly assigned to MT or to usual care by the general practitioner (GP). Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.

RESULTS:   After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the MT group (mean difference at 8 weeks, -6.4 days; 95% CI -8.3 to -4.5; effect size, 1.6). Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks.

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Essential Literature for the Chiropractic Profession

Essential Literature for the Chiropractic Profession: Results and Implementation Challenges from a Survey of International Chiropractic Faculty

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Education 2017 (Aug 2) [Epub]

Barbara A. Mansholt, DC, MS,
Stacie A. Salsbury, PhD, RN,
Lance G. Corber, MSITM,
and John S. Stites, DC

Palmer College of Chiropractic
1000 Brady Street,
Davenport, IA 52803


OBJECTIVE:   Scientific literature applicable to chiropractic practice proliferates in quantity, quality, and source. Chiropractic is a worldwide profession and varies in scope between states or provinces and from country to country. It is logical to consider that the focus and emphasis of chiropractic education varies between programs as well. This original research study endeavored to determine “essential literature” recommended by chiropractic faculty. The purpose of this article is (1) to share our results and (2) to promote discussion and explore means for future collaboration of chiropractic faculty through a worldwide platform.

METHODS:   A 2-phase recruitment occurred initially at the institutional level and subsequently at the faculty level. A Web-based survey used qualitative data collection methods to gather bibliographic citations. Descriptive statistics were calculated for demographics, and citation responses were ranked per number of recommendations, grouped into categories, and tabulated per journal source and publication date.

RESULTS:   Forty-one chiropractic programs were contacted, resulting in 30 participating chiropractic programs (16 US and 14 international). Forty-five faculty members completed the entire survey, submitting 126 peer-reviewed publications and 25 additional citations. Readings emphasized clinical management of spine pain, the science of spinal manipulation, effectiveness of manual therapies, teaching of chiropractic techniques, outcomes assessments, and professional issues.

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International Web Survey of Chiropractic Students About Evidence-based Practice

International Web Survey of Chiropractic Students About Evidence-based Practice: A Pilot Study

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SOURCE:   Chiropractic & Manual Therapies 2011 (Mar 3); 19 (1): 6

Ryunosuke Banzai, Dustin C Derby, Cynthia R Long
and Maria A Hondras

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street, Davenport, IA 52803-5209, USA.


BACKGROUND:   Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles.

METHODS:   We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis.

RESULTS:   Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9).

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Older Adults Who Use Vitamin/Mineral Supplements Differ from Nonusers in Nutrient Intake Adequacy and Dietary Attitudes

Older Adults Who Use Vitamin/Mineral Supplements Differ from Nonusers in Nutrient Intake Adequacy and Dietary Attitudes

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SOURCE:   J Am Diet Assoc. 2007 (Aug); 107 (8): 1322–1332

Rhonda S. Sebastian, MA, Linda E. Cleveland, MS, RD,
Joseph D. Goldman, MA, Alanna J. Moshfegh, MS, RD

US Department of Agriculture,
Agricultural Research Service,
Food Surveys Research Group,
Beltsville, MD 20705, USA.


OBJECTIVE:   To measure nutrient intake adequacy of vitamin/mineral supplement users and nonusers aged 51 years and older, determine the efficacy of supplement practices in compensating for dietary deficits, and identify predictors of supplement use.

DESIGN:   Analyses of two 24-hour recalls, demographic variables, and attitude questions collected during the Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey in 1994 to 1996. Data were weighted to be representative of older Americans.

SUBJECTS:   Four thousand three hundred eighty-four adults aged 51 years and older (1,777 daily supplement users, 428 infrequent users, and 2,179 nonusers) residing in households in the United States.

STATISTICAL ANALYSES:   Usual nutrient intake distributions were estimated using the Iowa State University method. The Estimated Average Requirement (EAR) cutpoint method was applied to determine the proportion of older adults not meeting requirements before and after accounting for nutrient intake from supplements. Student t tests were used to assess differences between users and nonusers. Logistic regression was used to determine sociodemographic and attitudinal predictors of supplement use.

RESULTS:   For one or more of the sex-age groups studied, a significantly smaller proportion of supplement users than nonusers had intakes from food alone below the EAR for vitamins A, B-6, and C; folate; zinc; and magnesium. Even so, less than 50% of both users and nonusers met the EAR for folate, vitamin E, and magnesium from food sources alone. Overall, supplements improved the nutrient intake of older adults. After accounting for the contribution of supplements, 80% or more of users met the EAR for vitamins A, B-6, B-12, C, and E; folate; iron; and zinc, but not magnesium. However, some supplement users, particularly men, exceeded Tolerable Upper Intake Levels for iron and zinc and a small percentage of women exceeded the Tolerable Upper Intake Level for vitamin A. Significant sociodemographic factors related to supplement use for older men were age group, metropolitan area, and educational status. Race, region, smoking status, and vegetarian status were significant factors for women. Attitude about the importance of following a healthful diet was a consistent predictor of supplement use for both men and women.

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The Role of Chiropractic Care in Older Adults

The Role of Chiropractic Care in Older Adults

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SOURCE:   Chiropractic & Manual Therapies 2012 (Feb 21); 20 (1): 3

Paul E Dougherty, Cheryl Hawk,
Debra K Weiner, Brian Gleberzon,
Kari Andrew and Lisa Killinger

Research Department,
New York Chiropractic College,
2360 State Route 89,
Seneca Falls, NY 13148, USA.


There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.


From the Full-Text Article:

Introduction

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National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy

National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy

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SOURCE:   Eur Spine J. 2017 (Apr 20)[Epub] 1451–1460

Mette Jensen Stochkendahl, Per Kjaer,
Jan Hartvigsen, Alice Kongsted1,
Jens Aaboe, Margrethe Andersen, et al.

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230, Odense M, Denmark.


PURPOSE:   To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.

METHODS:   Two multidisciplinary working groups formulated recommendations based on the GRADE approach.

RESULTS:   Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.

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Amount of Health Care and Self-care Following a Randomized Clinical Trial Comparing Flexion-distraction with Exercise Program for Chronic Low Back Pain

Amount of Health Care and Self-care Following a Randomized Clinical Trial Comparing Flexion-distraction with Exercise Program for Chronic Low Back Pain

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SOURCE:   Chiropractic & Osteopathy 2006 (Aug 24); 14: 19

Jerrilyn A Cambron, M Ram Gudavalli,
Marion McGregor, James Jedlicka,
Michael Keenum, Alexander J Ghanayem,
Avinash G Patwardhan and Sylvia E Furner

Department of Research,
National University of Health Sciences,
Lombard, IL, USA.


BACKGROUND:   Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program) or a form of chiropractic care (Flexion Distraction) for chronic low back pain.

METHODS:   In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD) or a form of physical therapy (EP). Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain.

RESULTS:   Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p < 0.05). No group differences were noted in the number of visits to a chiropractor or physical therapist. Self-care was initiated by nearly every participant in both groups.

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Whiplash-associated Disorders: Who Gets Depressed? Who Stays Depressed?

Whiplash-associated Disorders:
Who Gets Depressed? Who Stays Depressed?

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SOURCE:   Eur Spine J. 2010 (Jun); 19 (6): 945–956

Leah A. Phillips, Linda J. Carroll,
J. David Cassidy, and Pierre Côté

Department of Public Health Sciences,
Alberta Centre for Injury Control and Research,
School of Public Health, University of Alberta,
4075 RTF, 8308 114 St, Edmonton, AB, T6G 2E1, Canada.


Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, and initial post-crash pain and symptoms. Depressive symptomatology was assessed at baseline and at each follow-up using the Centre for Epidemiological Studies Depression Scale   (CES-D).   We included only those who participated at all follow-ups (n = 3,452; 59% of eligible participants). Using logistic regression, we identified factors associated with initial (post-crash) depression. Using multinomial regression, we identified baseline factors predicting course of depression. Courses of depression were no depression; initial depression that resolves, recurs or persists, and later onset depression. Factors associated with initial depression included greater neck and low back pain severity, greater percentage of body in pain, numbness/tingling in arms/hand, dizziness, vision problems, post-crash anxiety, fracture, prior mental health problems, and poorer general health. Predictors of persistent depression included older age, greater initial neck and low back pain, post-crash dizziness, vision and hearing problems, numbness/tingling in arms/hands, anxiety, prior mental health problems, and poorer general health. Recognition of these underlying risk factors may assist health care providers to predict the course of psychological reactions and to provide effective interventions.


From the FULL TEXT Article:

Introduction

The biopsychosocial model of health posits that in addition to biomedical factors, psychological, and sociological factors play important roles in the diagnosis, treatment, and recovery from illness and disease. [11] According to the Quebec Task Force on whiplash-associated disorders, whiplash is defined as an acceleration–deceleration mechanism of energy transferred to the neck as a result of a motor vehicle collision, and the resulting injury or cluster of symptoms is referred to as whiplash-associated disorders (WAD). [20] WAD is a disorder where the interplay between biological and psychosocial factors appears to have an important effect on recovery. [8]

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Expectations for Recovery Important in the Prognosis of Whiplash Injuries

Expectations for Recovery Important in the Prognosis of Whiplash Injuries

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SOURCE:   PLoS Med. 2008 (May 13); 5 (5): e105 ~ FULL TEXT

Lena W Holm , Linda J Carroll,
J. David Cassidy, Eva Skillgate, Anders Ahlbom

Division of Epidemiology,
Institute of Environmental Medicine,
Karolinska Institutet, Stockholm, Sweden.


BACKGROUND:   Individuals’ expectations on returning to work after an injury have been shown to predict the duration of time that a person with work-related low back pain will remain on benefits; individuals with lower recovery expectations received benefits for a longer time than those with higher expectations. The role of expectations in recovery from traumatic neck pain, in particular whiplash-associated disorders (WAD), has not been assessed to date to our knowledge. The aim of this study was to investigate if expectations for recovery are a prognostic factor after experiencing a WAD.

METHODS AND FINDINGS:   We used a prospective cohort study composed of insurance claimants in Sweden. The participants were car occupants who filed a neck injury claim (i.e., for WAD) to one of two insurance companies between 15 January 2004 and 12 January 2005 (n = 1,032). Postal questionnaires were completed shortly (average 23 d) after the collision and then again 6 mo later.

Expectations for recovery were measured with a numerical rating scale (NRS) at baseline, where 0 corresponds to “unlikely to make a full recovery” and 10 to “very likely to make a full recovery.” The scale was reverse coded and trichotomised into NRS 0, 1-4, and 5-10. The main outcome measure was self-perceived disability at 6 mo postinjury, measured with the Pain Disability Index, and categorised into no/low, moderate, and high disability. Multivariable polytomous logistic regression was used for the analysis.

There was a dose response relationship between recovery expectations and disability. After controlling for severity of physical and mental symptoms, individuals who stated that they were less likely to make a full recovery (NRS 5-10), were more likely to have a high disability compared to individuals who stated that they were very likely to make a full recovery (odds ratio [OR] 4.2 [95% confidence interval (CI) 2.1 to 8.5]. For the intermediate category (NRS 1-4), the OR was 2.1 (95% CI 1.2 to 3.2). Associations between expectations and disability were also found among individuals with moderate disability.

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Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

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Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S132–151

J. David Cassidy, PhD, DrMedSc, Carol Cancelliere, DC, MPH,
Linda J. Carroll, PhD, Pierre Côté, DC, PhD,
Cesar A. Hincapié, DC, MHSc, Lena W. Holm, et al.

Institute of Sports Science and Clinical Biomechanics,
Faculty of Health, University of Southern Denmark,
Odense, Denmark


OBJECTIVE:   To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004.

DATA SOURCES:   MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than 30 adult cases.

STUDY SELECTION:   Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess subjective, self-reported outcomes. After 77,914 titles and abstracts were screened, 299 articles were eligible and reviewed for scientific quality. This includes 3 original International Collaboration on MTBI Prognosis (ICoMP) research studies.

DATA EXTRACTION:   Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed each study and tabled data from accepted articles. A third reviewer was consulted for disagreements.

DATA SYNTHESIS:   Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress.

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Sport Concussion Knowledge and Clinical Practices

Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification

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SOURCE:   J Chiropractic Medicine 2015 (Sep);   14 (3):   169–175

William J. Moreau, DC, DACBSP, CSCS,
Dustin C. Nabhan, DC, DACBSP, CSCS, RMSK,
Taylor Walden, BA

Managing Director,
United States Olympic Committee,
Colorado Springs, CO


OBJECTIVE:   The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic.

METHODS:   A 21–item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors.

RESULTS:   Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool–3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%).

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