Stacie A. Salsbury, PhD, RN, Christine M. Goertz, DC, PhD,
Robert D. Vining, DC, Maria A. Hondras, DC, MPH, PhD,
Andrew A. Andresen, MD, Cynthia R. Long, PhD,
Kevin J. Lyons, PhD, Lisa Z. Killinger, DC and
Robert B. Wallace, MD, MS
Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
PURPOSE: Older adults seek health care for low back pain from multiple providers who may not coordinate their treatments. This study evaluated the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family medicine physicians and doctors of chiropractic.
DESIGN AND METHODS: This qualitative evaluation was a component of a randomized controlled trial of 3 interdisciplinary models for back pain management: usual medical care; concurrent medical and chiropractic care; and collaborative medical and chiropractic care with interprofessional education, clinical record exchange, and team-based case management. Data collection included clinician interviews, chart abstractions, and fieldnotes analyzed with qualitative content analysis. An organizational-level framework for dissemination of health care interventions identified norms/attitudes, organizational structures and processes, resources, networks-linkages, and change agents that supported model implementation.
RESULTS: Clinicians interviewed included 13 family medicine residents and 6 chiropractors. Clinicians were receptive to interprofessional education, noting the experience introduced them to new colleagues and the treatment approaches of the cooperating profession. Clinicians exchanged high volumes of clinical records, but found the logistics cumbersome. Team-based case management enhanced information flow, social support, and interaction between individual patients and the collaborating providers. Older patients were viewed positively as change agents for interprofessional collaboration between these provider groups.
Dina Lelic, Imran Khan Niazi, Kelly Holt,
Mads Jochumsen, Kim Dremstrup,
Paul Yielder, Bernadette Murphy,
Asbjørn Mohr Drewes, and Heidi Haavik
Department of Gastroenterology and Hepatology,
Aalborg University Hospital,
9000 Aalborg, Denmark
Objectives. Studies have shown decreases in N30 somatosensory evoked potential (SEP) peak amplitudes following spinal manipulation (SM) of dysfunctional segments in subclinical pain (SCP) populations. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes.
Methods. Nineteen subclinical pain volunteers attended two experimental sessions, SM and control in random order. SEPs from 62-channel EEG cap were recorded following median nerve stimulation (1000 stimuli at 2.3 Hz) before and after either intervention. Peak-to-peak amplitude and latency analysis was completed for different SEPs peak. Dipolar models of underlying brain sources were built by using the brain electrical source analysis. Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes, dipole locations, and dipole strengths.
Results. SM decreased the N30 amplitude by 16.9 ± 31.3% (P = 0.02), while no differences were seen following the control intervention (P = 0.4). Brain source modeling revealed a 4-source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2% (P = 0.03) following SM.
Masatoshi Teraguchi, Noriko Yoshimura,
Hiroshi Hashizume, Shigeyuki Muraki, et al
Department of Orthopaedic surgery,
Wakayama Medical University,
Wakayama, 641-8509, Japan.
OBJECTIVE: The objective of the present study was to examine the associations between metabolic syndrome (MS) components, such as overweight (OW), hypertension (HT), dyslipidemia (DL), and impaired glucose tolerance (IGT), and intervertebral disc degeneration (DD).
DESIGN: The present study included 928 participants (308 men, 620 women) of the 1,011 participants in the Wakayama Spine Study. DD on magnetic resonance imaging was classified according to the Pfirrmann system. OW, HT, DL, and IGT were assessed using the criteria of the Examination Committee of Criteria for MS in Japan.
RESULTS: Multivariable logistic regression analysis revealed that OW was significantly associated with cervical, thoracic, and lumbar DD (cervical: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; thoracic: OR, 1.75; 95% CI, 1.24-2.51; lumbar: OR, 1.87; 95% CI, 1.06-3.48). HT and IGT were significantly associated with thoracic DD (HT: OR, 1.54; 95% CI, 1.09-2.18; IGT: OR, 1.65; 95% CI, 1.12-2.48). Furthermore, subjects with 1 or more MS components had a higher OR for thoracic DD compared with those without MS components (vs. no component; 1 component: OR, 1.58; 95% CI, 1.03-2.42; 2 components: OR, 2.60; 95% CI, 1.62-4.20; ≥3 components: OR, 2.62; 95% CI, 1.42-5.00).
Southern Cross University, Australia;
International Medical University, Malaysia;
Tokyo College of Chiropractic, Japan.
Objective: To present an objective interpretation of the literature reporting evidence based medicine or practice and to raise discussion points based on those findings which, if explored, may advance the chiropractic profession in both its academic and clinical activities.
Data Sources and Synthesis: The indexed literature and URLs identified by on-line searching. A contextual narrative identifies specific points that may be worthy of formal discussion, either by individual authors preparing papers for publication, or by symposia.
Conclusion: Evidence based medicine is thought by some to have had its day. The concept of best practice seems embedded within chiropractic education. Whether they appreciate it or not, most chiropractors practice a rich form of evidence based practice into which they inject their experience as a chiropractor and the characteristics including preferences of the patient.
Department of Physical and Rehabilitation Medicine,
Campus Bio-Medico University,
Subjective tinnitus and cervical spine disorders (CSD) are among the most common complaints encountered by physicians. Although the relationship between tinnitus and CSD has attracted great interest during the past several years, the pathogenesis of tinnitus induced by CSD remains unclear.
Conceivably, cervical spine disorders could trigger a somatosensory pathway-induced disinhibition of dorsal cochlear nucleus (DCN) activity in the auditory pathway; furthermore, CSD can cause inner ear blood impairment induced by vertebral arteries hemodynamic alterations and trigeminal irritation.
Heidi Haavik, Imran Khan Niazi, Mads Jochumsen,
Diane Sherwin, Stanley Flavel, and Kemal S. Türker
Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland 1060, New Zealand.
This study investigates whether spinal manipulation leads to changes in motor control by measuring the recruitment pattern of motor units in both an upper and lower limb muscle and to see whether such changes may at least in part occur at the cortical level by recording movement related cortical potential (MRCP) amplitudes.
In experiment one, transcranial magnetic stimulation input-output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves before and after either spinal manipulation or a control intervention for the same subjects on two different days. During two separate days, lower limb TMS I/O curves and MRCPs were recorded from tibialis anterior muscle (TA) pre and post spinal manipulation. Dependent measures were compared with repeated measures analysis of variance, with p set at 0.05.
Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. For the MRCP data following spinal manipulation there were significant difference for amplitude of early bereitschafts-potential (EBP), late bereitschafts potential (LBP) and also for peak negativity (PN).
The results of this study show that spinal manipulation leads to changes in cortical excitability, as measured by significantly larger MEPmax for TMS induced input-output curves for both an upper and lower limb muscle, and with larger amplitudes of MRCP component post manipulation. No changes in spinal measures (i.e., F wave amplitudes or persistence) were observed, and no changes were shown following the control condition. These results are consistent with previous findings that have suggested increases in strength following spinal manipulation were due to descending cortical drive and could not be explained by changes at the level of the spinal cord.
Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations and/or may also be of interest to sports performers.
Pain Therapy Service,
Fondazione IRCCS Policlinico San Matteo,
Recently, attention to the lifestyle of patients has been rapidly increasing in the field of pain therapy, particularly with regard to the role of nutrition in pain development and its management. In this review, we summarize the latest findings on the role of nutrition and nutraceuticals, microbiome, obesity, soy, omega-3 fatty acids, and curcumin supplementation as key elements in modulating the efficacy of analgesic treatments, including opioids. These main topics were addressed during the first edition of the Study In Multidisciplinary Pain Research workshop: “FYD (Feed Your Destiny): Fighting Pain”, held on April 7, 2016, in Rome, Italy, which was sponsored by a grant from the Italian Ministry of Instruction on “Nutraceuticals and Innovative Pharmacology”.
The take-home message of this workshop was the recognition that patients with chronic pain should undergo nutritional assessment and counseling, which should be initiated at the onset of treatment. Some foods and supplements used in personalized treatment will likely improve clinical outcomes of analgesic therapy and result in considerable improvement of patient compliance and quality of life. From our current perspective, the potential benefit of including nutrition in personalizing pain medicine is formidable and highly promising.
Bart N. Green, DC, MSEd and
Claire D. Johnson, DC, MSEd
Department of Physical and Occupational Therapy,
Chiropractic Services, and Sports Medicine
at the Naval Medical Center San Diego
Interprofessional collaboration occurs when 2 or more professions work together to achieve common goals and is often used as a means for solving a variety of problems and complex issues. The benefits of collaboration allow participants to achieve together more than they can individually, serve larger groups of people, and grow on individual and organizational levels. This editorial provides an overview of interprofessional collaboration in the areas of clinical practice, education, and research; discusses barriers to collaboration; and suggests potential means to overcome them.
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