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Cost-Effectiveness of Non-Invasive and
Non-Pharmacological Interventions for Low Back Pain

Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain:
A Systematic Literature Review

The Chiro.Org Blog


SOURCE:   Applied Health Econ & Health Policy 2016 (Aug 22)

Lazaros Andronis, Philip Kinghorn, Suyin Qiao,
David G. T. Whitehurst, Susie Durrell, Hugh McLeod

Health Economics Unit,
Public Health Building,
University of Birmingham,
Birmingham, B15 2TT, UK.
l.andronis@bham.ac.uk


BACKGROUND:   Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

OBJECTIVES:   To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.

METHODS:   Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), ‘similar article’ searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms.

RESULTS:   Thirty-three studies were identified. Study interventions were categorised as:

(1) combined physical exercise and psychological therapy,

(2) physical exercise therapy only,

(3) information and education, and

(4) manual therapy.

Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programmes as a whole, with yoga, but not group exercise, being cost effective.

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Non-Pharmacological Interventions for Low Back Pain

Diagnostic Testing Considerations in
Pediatric Cervicogenic Headache

Diagnostic Testing Considerations in
Pediatric Cervicogenic Headache

The Chiro.Org Blog


SOURCE:   ACA News ~ May 23, 2016

Robert Vining, DC and Janice Kane, DC

The Neurological Institute,
Taipei Veterans General Hospital,
Taipei, Taiwan.


We are all aware that children commonly complain of headaches, but determining a specific diagnosis can be challenging. That’s partly because pediatric patients may not describe their symptoms as well as adults. Therefore, we asked this question: “Is there a diagnostic test that helps classify headache in pediatric patients in the range of 6-12 years?” If an evidence-based diagnostic test is available, it may help providers diagnose and develop management strategies.

Cervicogenic headache is common in pediatric patients and is defined by the International Headache Society as a condition caused by cervical spine dysfunction that is usually accompanied by neck pain. We chose this type of headache because it is commonly seen in chiropractic offices. With these thoughts in mind, we performed a search for office-based tests to help substantiate a diagnosis of cervicogenic headache diagnosis in a pediatric patient.

An evidence-based consideration

A PubMed search using the terms pediatric AND headache AND posture produced only a few articles. Included in this list is an article authored by Budelmann et al. describing a cross-sectional study entitled:

Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?
Eur J Pediatr. 2013 (Oct);   172 (10):   1349-56

What happened in this study?

Investigators recruited 34 asymptomatic children from a high school and handball club in Germany and 30 symptomatic patients from physiotherapy departments in the Netherlands. Both groups had a mean age of 10 years (range of 6-12 years).

Criteria utilized for probable cervicogenic headaches were patient reports of:

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Pediatric Cervicogenic Headache

The Use of Spinal Manipulation to Treat
an Acute on Field Athletic Injury

The Use of Spinal Manipulation to Treat an Acute on Field Athletic Injury: A Case Report

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2016 (Jun); 60 (2): 158–163

Sean A. Duquette, BA, DC and
Mohsen Kazemi, RN, DC, MSc., FRCCSS(C), FCCPOR(C),
PhD (Candidate)

Canadian Memorial Chiropractic College.


This case describes the utilization of spinal manipulative therapy for an acute athletic injury during a Taekwondo competition. During the tournament, an athlete had a sudden, non-traumatic, ballistic movement of the cervical spine. This resulted in the patient having a locked cervical spine with limited active motion in all directions. The attending chiropractor assessed the athlete, and deemed manipulation was appropriate. After the manipulation, the athlete’s range of motion was returned and was able to finish the match. Spinal manipulation has multiple positive outcomes for an athlete with an acute injury including the increase of range of motion, decrease in pain and the relaxation of hypertonic muscles. However, there should be some caution when utilizing manipulation during an event.

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an Acute on Field Athletic Injury

Children and Adolescents Presenting to Chiropractors in Norway

Children and Adolescents Presenting to Chiropractors in Norway: National Health Insurance Data and a Detailed Survey

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2016 (Aug 1); 24: 29

Anna Allen-Unhammer, (1) Francis J. H. Wilson, (2)
and Lise Hestbaek (3)

1   Markveien Fysikalske Institutt,
Markveien 25, 0554 Oslo, Norway.

2   Anglo-European College of Chiropractic,
Bournemouth, Dorset BH5 2DF UK.

3   Nordic Institute of Chiropractic and Clinical Biomechanics
and Institute of Sports Science and Biomechanics,
University of Southern Denmark,
Campusvej 55, Odense M, DK-5230 Denmark.


BACKGROUND:   The idea of chiropractors treating children is controversial, yet many parents seek chiropractic care for their children. The reasons for this are not well documented. Part one of this study aimed to document the profile of all paediatric patients consulting Norwegian chiropractors in 2013 using National Health Insurance data (NHI) with regards to age, gender and primary complaints. Part two aimed to provide a more detailed description of these patients in the form of a descriptive, paper-based survey.

METHODS:   Part one involved Norwegian NHI data from 2013. Part two consisted of a year-long, paper-based survey. Chiropractors registered with the Norwegian chiropractic association (NKF) were invited to participate via email. Participating chiropractors were assigned one random month to collect data. All paediatric patients (or their parents) during that were asked to complete questionnaires containing information on presenting complaint, consequences of this complaint, age, and mode of referral.

RESULTS:   In general, there was good concordance between part one and two of the study in terms of age, gender and presenting complaint. The youngest children constituted the largest paediatric group in Norwegian chiropractic practice. Musculoskeletal problems were the most common reason for children visiting a chiropractor in all of the age categories, according to NHI data. Part two of the study found that one-third of young school children and adolescents reported pain lasting longer than 1-year. Eleven percent of children found that their complaint had severely affected their mood and 22 % felt their activities were very limited by their condition. Referrals from healthcare professionals were uncommon. The survey’s results were based on 161 completed questionnaires, received from 15 % of the Norwegian chiropractors.

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Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment

Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

The Chiro.Org Blog


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

Cynthia K Peterson, Daniel Mühlemann, Barry Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,

University of Zürich,
Forchstrasse 340,
Zürich, Switzerland


This study, from the chiropractic researchers at the University of Zurich in Switzerland, demonstrates that chiropractic care helps reduce low back pain during pregnancy, and another study by this same group demonstrates the long-term benefits from chiropractic adjustments for lumbar disc herniations.

BACKGROUND:   Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited.

The purposes of this study are

1) to report outcomes in pregnant patients receiving chiropractic treatment

2) to compare outcomes from subgroups

3) to assess predictors of outcome.

METHODS:   Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better or ‘much better’ were categorized as ‘improved’.The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.

RESULTS:   52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to 'improvement' when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).

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Chiropractic Management of Pregnancy-Related
Lumbopelvic Pain

Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Jun); 15 (2): 129–133

Maria Bernard, BSc, GradDipChiro, GradCertChiroPaediatrics,
Peter Tuchin, BSc, GredDipChiro, OHS, PhD

Private Practice,
Sydney, Australia.

Associate Professor,
Department of Chiropractic Faculty Science,
Macquarie University,
Sydney, NSW, Australia.


OBJECTIVE:   The purpose of this case report is to describe chiropractic management of a patient with pregnancy-related lumbopelvic pain.

CLINICAL FEATURES:   A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks’ gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain.

INTERVENTION AND OUTCOME:   A diagnosis of pregnancy-related low back pain and pregnancy-related pelvic girdle pain was made. The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved.

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Lumbopelvic Pain

Evidence-based Practice, Research Utilization, and Knowledge Translation in Chiropractic

Evidence-based Practice, Research Utilization, and Knowledge Translation in Chiropractic:
A Scoping Review

The Chiro.Org Blog


SOURCE:   BMC Complement Altern Med. 2016 (Jul 13); 16 (1): 216

André E. Bussières, Fadi Al Zoubi, Kent Stuber,
Simon D. French, Jill Boruff, John Corrigan,
and Aliki Thomas

School of Physical and Occupational Therapy,
Faculty of Medicine,
McGill University,
Montréal, Canada.


BACKGROUND:   Evidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic.

METHODS:   A scoping review using the Arksey and O’Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted.

RESULTS:   Nearly 85% (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely.

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Chiropractic Identity:
A Neurological, Professional, and Political Assessment

Chiropractic Identity:
A Neurological, Professional, and Political Assessment

The Chiro.Org Blog


SOURCE:   J Chiropractic Humanities 2016 (Jul 20); 20: 1–11

Anthony L. Rosner, PhD, LLD (Hon)

Private Practice
Watertown, MA


Objective   The purpose of this article is to propose a focused assessment of the identity of chiropractic and its profession, triangulating multiple viewpoints converging upon various aspects and definitions of neurology, manual medicine, and alternative or mainstream medicine.

Discussion   Over 120 years since its inception, chiropractic has struggled to achieve an identity for which its foundations could provide optimal health care. Despite recognition of the benefits of spinal manipulation in various government guidelines, advances in US military and Veterans Administration, and persistently high levels of patient satisfaction, the chiropractic profession remains underrepresented in most discussions of health care delivery. Distinguishing characteristics of doctors of chiropractic include the following:

(1)   they embrace a model of holistic, preventive medicine (wellness);

(2)   they embrace a concept of neurological imbalance in which form follows function, disease follows disturbed biochemistry, and phenomenology follows physiology;

(3)   they diagnose, and their institutions of training are accredited by a body recognized by the US Department of Education;

(4)   they manage patients on a first-contact basis, often as primary care providers in geographical areas that are underserved;

(5)   the spine is their primary — but not exclusive — area of interaction;

(6)   they deliver high-velocity, low-amplitude adjustments with a superior safety record compared with other professions; and

(7)   they use a network of institutions worldwide that have shown increasing commitments to research.

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A Neurological, Professional, and Political Assessment

Effect of Two Consecutive Spinal Manipulations in a Single Session on Myofascial Pain Pressure Sensitivity

Effect of Two Consecutive Spinal Manipulations in a Single Session on Myofascial Pain Pressure Sensitivity: A Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2016 (Jun); 60 (2): 137–145

Michelle A. Laframboise, BKin (Hons), DC, FRCCSS(C),
Howard Vernon, BA, DC, PhD, and
John Srbely, BSc, DC, PhD

Canadian Memorial Chiropractic College,
6100 Leslie Street,
Toronto, Canada;
Division of Graduate Studies,
Sports Sciences,
Canadian Memorial Chiropractic College.


OBJECTIVE:   To investigate the summative effect of two consecutive spinal manipulative therapy (SMT) interventions within the same session on the pain pressure sensitivity of neurosegmentally linked myofascial tissues.

METHODS:   26 participants were recruited and assessed for the presence of a clinically identifiable myofascial trigger point in the right infraspinatus muscle. Participants were randomly assigned to test or control group. Test group received two consecutive real cervical SMT interventions to C5-C6 segment while controls received one real SMT followed by one validated sham SMT intervention to C5-C6 segment. Participants received the two consecutive SMT interventions 30 minutes apart. Pain pressure threshold (PPT) readings were recorded at pre-SMT1 and 5, 10, 15, 20 and 25 minutes post-SMT1 and post-SMT2. PPT readings were normalized to pre-SMT1 values and averaged.

RESULTS:   Repeated measures ANOVA demonstrated a significant main effect of SMT intervention [F(1,24)=8.60, p<0.05] but not group [F(1.24)=0.01] (p=0.91). Post-hoc comparisons demonstrated a statistically significant (p<0.05) increase in SMT2 versus SMT1 (18%) in the test group but not in controls (4%) (p=0.82).

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A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder

A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder

The Chiro.Org Blog


SOURCE:   Mil Med. 2009 (Jun); 174 (6): 578–583

Andrew S. Dunn; Steven R. Passmore;
Jeanmarie Burke; David Chicoine

Chiropractic Service,
VA of Western New York Healthcare System,
3495 Bailey Avenue,
Buffalo, NY 14215, USA.


This study was a cross-sectional analysis of clinical outcomes for 130 veteran patients with neck or low back complaints completing a course of care within the chiropractic clinic at the VA of Western New York in 2006. Multivariate analysis of variance (MANOVA) was utilized, comparing baseline and discharge scores for both the neck and low back regions and for those patients with and without post-traumatic stress disorder (PTSD). Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability. These findings, coupled with the theorized relationships between PTSD and chronic pain, suggest that the success of conservative forms of management for veteran patients with musculoskeletal disorders may be limited by the presence of PTSD. Further research is warranted to examine the potential contributions of PTSD on chiropractic clinical outcomes with this unique patient population.


From the FULL TEXT Article:

INTRODUCTION

A diagnosis of post-traumatic stress disorder (PTSD) can be conveyed when a person has been exposed to a traumatic event that could be perceived as threatening or that actually threatened the physical integrity of the individual or others, and his or her response involved fear, helplessness, or horror. [1] The person must also persistently re-experience the perception of the trauma and avoid reminders of the event while displaying symptoms of increased arousal (sleeplessness, irritability, outbursts) for at least 1 month, which disrupts their social, occupational, or other levels of functioning. [1]

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Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel With Low Back Pain

Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel With Low Back Pain: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   Trials. 2016 (Feb 9);   17:   70

Christine M. Goertz, Cynthia R. Long, Robert D. Vining,
Katherine A. Pohlman, Bridget Kane, Lance Corber,
Joan Walter and Ian Coulter

Palmer College of Chiropractic,
Palmer Center for Chiropractic Research,
741 Brady Street, Davenport, IA, 52803, USA.
christine.goertz@palmer.edu


BACKGROUND:   Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone.

METHODS/DESIGN:   This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation.

DISCUSSION:   Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability.

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Sophisticated Research Design in
Chiropractic and Manipulative Therapy: Part 3

Sophisticated Research Design in
Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”

Part C:  Mixed Methods:   “Why Can’t Science
And Chiropractic Just Be Friends?”

The Chiro.Org Blog


SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–21

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150


Many commentators have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, observing the way Evidence-based Practice [EBP] is sometimes implemented is controversial, not only within the chiropractic profession, but in all other healthcare disciplines, including medicine itself.   A phased approach to the development and evaluation of complex interventions can help researchers define the research process and complex interventions may require use of both qualitative and quantitative methods.   The chiropractic profession has little to fear from evidence-based practice; in fact it should be used productively to improve patient care, clinical outcomes and the standing of the profession in the eyes of the public, other health professions and legislators.

Keywords Evidence-Based Practice; Mixed Methods; Research Design


INTRODUCTION

Many scientists have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, including chiropractic. Over the last decade some authors have suggested refinements of the model, for instance;   in the place of an evidence hierarchy, Jonas [1] suggested the construction of an “evidence house” with “rooms” for different types of information and purposes and later presented a refined circular model. [1]

Jonas [1] observed:

Continue reading Sophisticated Research Design in
Chiropractic and Manipulative Therapy: Part 3

Sophisticated Research Design in
Chiropractic and Manipulative Therapy: Part 2

Sophisticated Research Design in
Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”
 
Part B.   Qualitative Research;   Quality vs. Quantity

The Chiro.Org Blog


SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–14

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150


The plethora of quantitative evidence in chiropractic science stands in contrast to the relative dearth of qualitative studies. This phenomenon exists in spite of the intuitive impression that chiropractic is indeed suitable for investigation with a variety of qualitative methodologies. There is a long tradition of qualitative investigation in the social sciences, which focuses on gathering rich experiential data, recognising both that health research deals with ‘real’ people, and that people are not predictable or pre-determined. Qualitative chiropractic research can examine various aspects of a “package” of care and the participants “care journey” and the interplay between verbal and nonverbal, including tactile interactions, which may be diagnostic or therapeutic. Research in chiropractic ideally integrates experience, neurobiology and nonlinear dynamic thinking. Many chiropractic scientists are used to only working with linear models, consequently they may be reluctant to adopt the nonlinear framework of complexity theory and recognise that the analysis of lived experience including subjective phenomena can be an integral part of studies in the chiropractic space.

Keywords Evidence-Based Practice; Qualitative Research; Research Design


INTRODUCTION

This paper examines the application of qualitative methodology in the chiropractic sector. Philosophers of science have long observed that the positivist paradigm that underpins quantitative research can itself easily become a dogma, they recognise that science can never ‘prove itself’ and many would no doubt agree with Dupre that it may indeed become a form of ‘scientific imperialism’. [1-3] There is thus an increasing recognition that devotion to a purely quantitative methodology in the health sciences is at best, ‘unbalanced’. [1] This paper will lead the reader through a preliminary description of qualitative research methodologies while providing an overview of the major paradigms on which qualitative research is based, along with selected chiropractic examples.

      Importance of Qualitative Research to
     Chiropractic Health Research

Continue reading Sophisticated Research Design in
Chiropractic and Manipulative Therapy: Part 2

Sophisticated Research Design in
Chiropractic and Manipulative Therapy: Part I

Sophisticated Research Design in
Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”

Part A. Quantitative Research: Size Does Matter

The Chiro.Org Blog


SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–21

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150


Many chiropractors remain skeptical of evidence-based practice (EBP) and some may view it as an attack on the profession which they feel must be resisted. A counter-argument is centred on the primacy afforded quantitative methodology as epitomised by the randomised controlled trial (RCT). This defensive posture may be mitigated by recognising the role complex research has played in the legitimisation of the profession. The pre-eminence of the randomised controlled trial (RCT), considered by many as the gold-standard of evidence, has led some authors to go so far as to functionally disregard all evidence that is not an RCT. However, it is readily apparent the RCT is not always the most appropriate study design to gather evidence, especially in the CAM health sector. This paper discusses the role of sophisticated design in quantitative chiropractic research, presenting examples sequentially through the traditional quantitative hierarchy and concludes that optimal methodology depends on the research question. Research design must allow for the various dimensions of the (chiropractic) clinical encounter, and may be sophisticated at all levels, but must above all, be contextual. The ‘best available’ or most relevant evidence depends on what one needs for a specific purpose. A critical caution is the proviso that care must be exercised not to draw inappropriate conclusions such as causation from descriptive studies.

INDEX TERMS: Chiropractic; Evidence-Based Practice; Quantitative Evaluation; Research Design


INTRODUCTION

Proponents and detractors of evidence-based practice (EBP) in chiropractic, in common with the rest of healthcare, generally adopt antithetical positions characterised more by dogmatic convictions than by genuine debate. Some consider RCT evidence as the gold standard of sophisticated evidence, while others are highly critical. [1] The principal proposition of this paper will be that sophisticated research designs have an important role in generating new knowledge at all ‘levels’ of the hierarchy and should not be avoided because of the challenge presented by complexity. It is my view that a sequential analysis of the various study designs in clinical and health system research demonstrates that different designs have each added a unique dimension to the corpus of knowledge concerning chiropractic, manual therapy, spinal pain complementary medicine and human well-being. A study may reside ‘lower’ on the evidentiary hierarchy, but this certainly does not preclude it from being complex, sophisticated or valuable.

Continue reading Sophisticated Research Design in
Chiropractic and Manipulative Therapy: Part I

Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant and Nonpregnant Women

Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant and Nonpregnant Women:
A Preliminary Study

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2016 (Jun); 39 (5): 339–347

Heidi Haavik, BSc (Chiro), PhDip (Science), PhD,
Bernadette A. Murphy, DC, MSc, PhD,
Jennifer Kruger, BSc (Nursing), MSc, PhD

Director of Research,
Centre for Chiropractic Research,
New Zealand College of Chiropractic


OBJECTIVE:   The aim of this study was to investigate whether a single session of spinal manipulation of pregnant women can alter pelvic floor muscle function as measured using ultrasonographic imaging.

METHODS:   In this preliminary, prospective, comparative study, transperineal ultrasonographic imaging was used to assess pelvic floor anatomy and function in 11 primigravid women in their second trimester recruited via notice boards at obstetric caregivers, pregnancy keep-fit classes, and word of mouth and 15 nulliparous women recruited from a convenience sample of female students at the New Zealand College of Chiropractic. Following bladder voiding, 3-/4-dimensional transperineal ultrasonography was performed on all participants in the supine position. Levator hiatal area measurements at rest, on maximal pelvic floor contraction, and during maximum Valsalva maneuver were collected before and after either spinal manipulation or a control intervention.

RESULTS:   Levator hiatal area at rest increased significantly (P < .05) after spinal manipulation in the pregnant women, with no change postmanipulation in the nonpregnant women at rest or in any of the other measured parameters.

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