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Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient’s Journey

Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient’s Journey

The Chiro.Org Blog


SOURCE:   J Occup Environ Med. 2014 (Jun);   56 (6):   604-620

Allen, Harris PhD; Wright, Marcia PharmD; Craig, Terri PharmD; Mardekian, Jack PhD; Cheung, Raymond PhD; Sanchez, Robert PhD; Bunn, William B. III MD, JD, MPH; Rogers, William PhD

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; US Medical Affairs (Dr Wright), Pfizer Integrated Health, Overland Park, Kans; Pfizer Primary Care Medical Affairs (Dr Craig), Lincoln, Nebr; Pfizer Inc (Dr Mardekian), New York; Pfizer Integrated Health (Drs Cheung and Sanchez), New York; Health, Safety, Security & Productivity, Navistar, Inc (Dr Bunn)


This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.

The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Thanks to Dynamic Chiropractic for some of the following comments. Make sure to read their full article!

The study had four objectives:

  1. Identify all active employees reporting a back problem diagnosis during the study period.
  2. Define and classify their initial patterns of medical care and use of Rx medication.
  3. Track the effect of these patterns on direct and indirect cost outcomes.
  4. Further stratify these treatment patterns by measures of congruence with the previously described guideline aspects for LBP care and determine the effect on cost outcomes.

Through their database review, the authors identified five specific care patterns that were typical of employee experiences

  1. Information and Advice (“TalkInfo”):
           information gathering, office visit consults, lab tests, imaging (X-ray, ultrasound, CT, or MRI)
           but no other procedures.
           (59 percent of employees).

  2. Complex Medical Management (Complex MM):
           physician visits for nerve blocks, surgeries, or comparable procedures
           (2 percent of employees).

  3. Chiropractic (Chiro):
           more than one visit to a DC.
           (11 percent of employees)

  4. Physical therapy (PT):
           more than one visit to a PT.
           (11 percent of employees)

  5. “Dabble”:
           episodes with at most one visit for physician, chiropractic, or PT care,
           or at most one visit to two or more of these categories.
           (17 percent of employees)

The average overall costs for care were a real eye opener

Low Back/Neuro (three-year total)

Continue reading Tracking Low Back Problems in a Major Self-Insured Workforce:
Toward Improvement in the Patient’s Journey

Energy Drinks and Adolescents –
What Should Health Practitioners Know?

Energy Drinks and Adolescents –
What Should Health Practitioners Know?

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2012 (Dec);   13 (1): 1042-1044

Sharon Gordon, BAppSc(Chiro), DICCP

Private practice, Gippsland, Victoria, Australia.
Email: Sharon.gordon@rmit.edu.au


Energy Drinks are readily available in supermarkets throughout the world. There are currently no restrictions or guidelines on safe consumption by children. Energy drink consumption by adolescents is on the rise, as companies continue to aggressively market their product to this demographic. It has become socially acceptable for children to consume these drinks, as there is a perception that the products are safe. In addition, they have become a popular accessory in the youth extreme-sport culture. Overall, research on adolescent energy drink consumption is lacking, however side effects similar to that seen in adults, have been reported in the adolescent population. The chiropractor must be aware of these side effects, including how they may relate to presenting symptoms, and educate their patients on the dangers of energy drink consumption.

Key Words:   energy drink, caffeine, adolescent, chiropractic


Objective

To review the literature on energy drink consumption amongst adolescents, and discuss the physiological effects that may present to the chiropractic office.


Methods

Scientific journal databases were searched, including PubMed, Medline, Proquest, Cochrane, CINAHL, Medscape, and Index to Chiropractic Literature. An open internet search was also performed.


Discussion

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Chiropractic Pediatrics Page

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What Should Health Practitioners Know?

Low Back Pain – part of a whiteboard visual lecture series

Source DocMikeEvans

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2013 (Jun);   14 (1):   1063–1069

Joyce Miller, DC, FAC O, FCC, FEAC (Paeds)

Associate Professor, Anglo-European College of Chiropractic,
Lead Tutor in Advanced Professional Practice (Paediatrics),
Bournemouth University, United Kingdom
Email: jmiller@aecc.ac.uk


Background:   There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65million [USD100 million] in 2001) with no alleviation of the condition.

Objectives:   The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomised controlled trial (RCT) showing effectiveness of treatment

Design:   Economic evaluation incorporating a RCT

Methods:   A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

Results:   100 infants completed the RCT and this resulted in treatment costs of £58/child ($93). An additional cost of GP care of £27.50 was added for initial evaluation of the general health of the child and suitability for chiropractic management, totaling £85.50 per child in the RCT. Clinical outcomes are published elsewhere, but care showed both statistically and clinically significant efficacy in reduced crying time by an average of 2.6 hours resulting in a crying time of less than two hours a day (reaching “normal” levels which could be classified as non-colic behavior). Cost per child’s care was £85.50 extrapolated to £14,278,500 for the full cohort of 167,000. If chiropractic care had been given privately, costs were calculated as £164/child per episode of care and this equalled £27,388,000 for the entire cohort. Medical costs through a normal stream of care amounted to £1089.91 per child or £182,014,970 for the cohort (including all costs of care, not just NHS). No benefits of effectiveness were accrued from any of those types of treatment. If the Morris NHS data were extrapolated to 2010, applying wage inflation, the cost would be £118 million (USD180 million) yearly. An episode of an average of four treatments of chiropractic manual therapy with documented efficacy of CMT cost from 8% to 24% of NHS care or routine care.

Conclusion:   chiropractic manual therapy was a cost-effective option in this study. A much larger randomized study of routine medical care versus routine chiropractic care is recommended to determine whether there is confirmation of these findings.


From the Full-Text Article:

Introduction

As effective treatment for children with infant colic remains elusive, the costs of managing the condition is gaining increasing attention. Although it is uncommon for clinicians to be quizzed about the cost-effectiveness of their treatments, [1] particularly where the clinicians’ services are covered by a national health plan, it is increasingly appropriate to ask this question, when prudence in health care expenditure is required.

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Chiropractic Pediatrics Page and the:

Infantile Colic and Chiropractic Page

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Chiropractic and Breastfeeding Dysfunction:
A Literature Review

Chiropractic and Breastfeeding Dysfunction:
A Literature Review

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2)

Lauren M. Fry, BAppSc (CompMed-Chiro), MClinChiro

Lauren M. Fry, BAppSc(CompMed-Chiro), MClinChiro, private practice, Elwood, Victoria, Australia
Contact: laurenfry85@gmail.com


Objective:   Breastfeeding an infant has many long and short-term health benefits. Chiropractic care, as part of a multidisciplinary team, has the potential to assist with biomechanical causes of breastfeeding dysfunction. The purpose of this study was to review the literature and explore what evidence there is to support this theory.

Methods:   Database searches were performed (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health and Index to Chiropractic Literature) and hand searches to identify relevant studies. Inclusion criteria were: written in the English language in a peer-reviewed journal, involving infant human participants and a focus on chiropractic treatment for breastfeeding (dysfunction).

Results:   Ten articles were reviewed; 5 case studies, 3 case series, 1 clinical trial and 1 narrative.

Conclusions:   Limited evidence exists to support chiropractic treatment for infants with breastfeeding dysfunction. Of the 6 case studies, 3 case series and 1 clinical trial found in this report there was a trend towards resolution of breastfeeding issues with chiropractic treatment of biomechanical imbalances. More meticulous, higher evidence studies are needed to provide further evidence of this.

Key Words:   breastfeeding, chiropractic, infant, spinal manipulation.


From the Full-Text Article:

Introduction

Breastfeeding, particularly exclusively for the first 6 months, has been associated with numerous beneficial short and long term health outcomes for an infant. [1, 2] Breast milk has been shown to contain secretory IgA antibodies, lactoferrin, oligosaccharides, numerous cytokines and growth factors which all aid in an infant’s immune response. [3, 4] Purported short term benefits to the infant are a decreased risk of many childhood illnesses. [5] Incidence of gastro-intestinal infections, otitis media, other respiratory tract infections and asthma, even in those with a strong family history, may be decreased in infants who are breastfed. [6, 7]

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Chiropractic Pediatrics Page

Continue reading Chiropractic and Breastfeeding Dysfunction:
A Literature Review

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

The Chiro.Org Blog


SOURCE:   Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2)

Edward Holmes [1], DC and Joyce Miller, BSc, DC, DABCO, FCC [2]

1 – Edward Homes, DC, private practice, Bournemouth, United Kingdom

2 – Joyce Miller, BSc, DC, DABCO, FCC, Associate Professor,
Anglo-European College of Chiropractic, Bournemouth, United Kingdom.
Contact: jmiller@aecc.ac.uk


Summary:   This study demonstrates that adverse drug reactions do potentially pose a public health risk within the pediatric population and all healthcare providers need to be mindful of this risk. Adverse events to medication within this population are prevalent particularly in children under the age of two. Chiropractors must therefore be aware of adverse drug reactions and recognize symptoms within their patient population.

Key terms:   off label use; non-prescription drugs, child, pediatrics, drug toxicity guidelines, adverse medication reactions in children


From the Full-Text Article:

Introduction

A 19-week-old premature infant presented to a chiropractic teaching clinic with a ‘poor feeding pattern, recent slowing in weight gain and increase in crying’ over a three week period. The mother stated that this had started following a respiratory infection which occurred two months ago, with an associated rash that spread from her abdomen to the back of her neck, face and head. At least six weeks previously her GP had prescribed a cold remedy for the day (Calcold®) and Calpol® Night for the evening for the respiratory infection, and cortisone cream when a rash developed two weeks later. The medications seemed to help the child sleep, in fact she seemed to sleep much more during the day and night, which was put down to illness. However this did not change in the ensuing weeks after the respiratory infection abated. The mother continued with the Calpol® Night at the recommendation of the GP along with a change to Calpol® (instead of Calcold®) in the day, since it seemed to have helped with sleep. We examined a lethargic infant with an erythematous rash covering the trunk, head and neck who had decreased almost two centiles on her growth chart in the previous several weeks, and although not losing weight, she was nevertheless not gaining weight. Without another obvious etiology, was there an association between the medication and the child’s signs and symptoms?

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Iatrogenic Injury Page and our:

Chiropractic Pediatrics Page

Continue reading Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2011 (Dec);   20 (12):   2105-2110

Mark J. Hancock, Chris G. Maher, Mark Laslett, Elaine Hay, and Bart Koes

Faculty of Health Sciences, University of Sydney, PO Box 170,
Lidcombe 1825, NSW, Australia. mark.hancock@sydney.edu.au


Purpose   Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people’s low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain.

Methods   This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain.

Results   Six potential misunderstandings are discussed.

  1. Until diagnosis is shown to improve outcomes it is not worth investigating;
  2. without a gold standard it is not possible to investigate diagnosis of low back pain;
  3. the presence of pathology in some people without low back pain means it is not important;
  4. dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy;
  5. suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice;
  6. we seem to have forgotten the ‘bio’ in biopsychosocial low back pain.

Conclusions   We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Keywords:   Low back pain, Diagnosis, Back pain

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Biopsychosocial Model Page


From the FULL TEXT Article

Introduction

Continue reading What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

Joint Assessment – P.A.R.T.S.

Joint Assessment – P.A.R.T.S.

The Chiro.Org Blog


SOURCE:   Topics in Clinical Chiropractic 2000;   7 (3):   1–10

Thomas F. Bergmann, DC, Bradley A. Finer, DC, DACAN

Professor, Clinical Science Division
Northwestern Health Sciences University
College of Chiropractic
Bloomington, Minnesota


Purpose:   An approach to systematically perform clinical work-up for chiropractic subluxation is proposed. Literature on assessment approaches is reviewed and a discussion is presented.

Method:   A qualitative review of clinical and scientific literature related to assessment methodologies for subluxation was performed.

Summary:   Variation in assessment techniques exists for identification of spinal and other articular joint dysfunction. Useful scientific data also are limited to only a few approaches. and there is a need for a more systematic assessment approach profession wide.

Key words:   articular range oj motion, chiropractic, Medicare, palpation, physical examination, subluxation

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What is The Chiropractic Subluxation? Page


From the FULL TEXT Article

Background

Doctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. As such, they must maintain broad and thorough assessment/diagnostic skills. Before employing any therapy, a clinician must first determine if there is a need for treatment. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. Having gathered and interpreted this information, it must be processed in order to arrive at a sound clinical conclusion. The role of this assessment process in the chiropractic office is to determine whether the patient should receive chiropractic care only, chiropractic care in concert with other forms of health care, or a referral to another health care professional for some other form of stand-alone management such as acute, crisis care. This article suggests the need for, and possible form of, a standardized assessment procedure for use by chiropractic clinicians.


INTRODUCTION

Continue reading Joint Assessment – P.A.R.T.S.

Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2013 (Oct 21);   21 (1):   36

John J Triano, Brian Budgell, Angela Bagnulo, Benjamin Roffey, Thomas Bergmann,
Robert Cooperstein, Brian Gleberzon, Christopher Good, Jacquelyn Perron and Rodger Tepe

Canadian Memorial Chiropractic College, 6100 Leslie St,, Toronto, Ontario, Canada. jtriano@cmcc.ca


BACKGROUND:   With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

METHODS:   Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

RESULTS:   A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.

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Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jun 27);   [Epub ahead of print]

Alexander Tsertsvadze, MD, MSc, Christine Clar, PhD, Rachel Court, MA, Aileen Clarke, MD, Hema Mistry, PhD, Paul Sutcliffe, DPhil

Senior Research Fellow, Warwick Medical School, University of Warwick, Coventry, UK.


OBJECTIVES:   The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

METHODS:   A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

RESULTS:   Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

Continue reading Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

NCAA suggests contact limits for football practice

Source YAHOO News

The NCAA is suggesting that football teams hold no more than two contact practices per week during the season in guidelines that grew out of a safety and concussion summit early this year.

Practice limits were among several recommendations released Monday by the NCAA, which called them guidelines that could change “in real time” rather than rules passed through legislation.

The practice guidelines also recommend four contact practices per week during the preseason and no more than eight of the 15 sessions during spring football.

The NCAA is also suggesting that schools have independent doctors to evaluate injuries and a “return to learn” process for integrating athletes back into their academic work after they have been diagnosed with a concussion.

The Safety in College Football Summit was in Atlanta in January.

More articles on concussion at Chiro.org

 

The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

The Chiro.Org Blog


SOURCE:   Chiropractic & Osteopathy 2009 (Feb 5);   17:   2

Lise Hestbaek, Alice Kongsted, Tue Secher Jensen, and Charlotte Leboeuf-Yde

Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark. l.hestbaek@nikkb.dk


Background   The term ‘acute facet syndrome’ is widely used and accepted amongst chiropractors, but poorly described in the literature, as most of the present literature relates to chronic facet joint pain. Therefore, research into the degree of consensus on the subject amongst a large group of chiropractic practitioners was seen to be a useful contribution.

Methods   During the annual congress of The European Chiropractors Union (ECU) in 2008, the authors conducted a workshop involving volunteer chiropractors. Topics were decided upon in advance, and the participants were asked to form into groups of four or five. The groups were asked to reach consensus on several topics relating to a basic case of a forty-year old man, where an assumption was made that his pain originated from the facet joints. First, the participants were asked to agree on a maximum of three keywords on each of four topics relating to the presentation of pain: 1. location, 2. severity, 3. aggravating factors, and 4. relieving factors. Second, the groups were asked to agree on three orthopaedic and three chiropractic tests that would aid in diagnosing pain from the facet joints. Finally, they were asked to agree on the number, frequency and duration of chiropractic treatment.

Results   Thirty-four chiropractors from nine European countries participated. They described the characteristics of an acute, uncomplicated facet syndrome as follows: local, ipsilateral pain, occasionally extending into the thigh with pain and decreased range of motion in extension and rotation both standing and sitting. They thought that the pain could be relieved by walking, lying with knees bent, using ice packs and taking non-steroidal anti-inflammatory drugs, and aggravated by prolonged standing or resting. They also stated that there would be no signs of neurologic involvement or antalgic posture and no aggravation of pain from sitting, flexion or coughing/sneezing.

Continue reading The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2014 (Jul 1);   22:   24 ~ FULL TEXT

Jonathan Branney, Alan C Breen

Institute of Musculoskeletal Research & Clinical Implementation,
Anglo-European College of Chiropractic, 13-15 Parkwood Road,
Bournemouth BH5 2DF, UK


Background

Neck pain is a common condition which most people experience at some point in their lives, with self-reported incidence rates ranging from 15.5 to 213 per 1000 person years [1] and 12-month prevalence rates around 30-50%. The condition can also be a significant cause of work absence, [2, 3] decreased productivity [4] and increased healthcare costs. [5]

Spinal manipulation, mobilisation, exercise, analgesics, acupuncture and low level laser therapy have all been shown to provide at least some degree of short-term relief of neck pain in the absence of trauma. [6] Spinal manipulation or mobilisation, particularly combined with exercise, appears to confer marginal benefit over other interventions. [7, 8] However, trials investigating manipulation for neck pain have shown conflicting results [9, 10] and while some patients respond well, others derive little benefit. One step towards understanding this would be to further our knowledge of the mechanism of action of manipulation as an intervention.

There is evidence to suggest that manipulation can decrease pain and improve function and that this is probably associated with increased motion. Nansel et al. showed that a single manipulation could reduce asymmetry of passive regional cervical spine motion, [11] while Cassidy et al. and Martinez-Segura et al. independently found that manipulation was associated with both reduced neck pain and increased regional range of neck motion immediately after treatment. [12, 13] However, regional neck range of motion is also influenced by pain, disability and fear of movement, [14] leaving the role of manipulation ambiguous. Furthermore, spinal manipulation targets specific levels, often to improve intervertebral range of motion (IV-RoM), [15] but it is not known if this actually happens, or if reduced IV-RoM is even detectable by clinical examination (palpation). To begin to explain the therapeutic effects of neck manipulation therefore requires an accurate and reproducible means of measuring maximum IV-RoM wherever it occurs in the neck bending sequence, and relating it to symptomatic changes following a course of manipulative treatment. It is also necessary to know whether reduced motion at inter-vertebral levels as detected by palpation as the basis for a manipulation can be verified.

Cineradiography and videofluoroscopy have allowed the visualisation of complete intervertebral motion sequences and have been available for many yearr, [16, 17] but analysis of the motion has been largely qualitative. However, during the last decade considerable progress has been made with detailed measurement of inter-vertebral motion using quantitative fluoroscopy (QF). [18] It is now possible to track fluoroscopic images of lumbar vertebrae continuously throughout lumbar motion in living subjects [19] allowing the measurement of true IV-RoM, regardless of where it occurs during bending. QF has been found to have good reproducibility for this, [20] but has not yet been validated or extensively used in the cervical spine. This study aimed to explore the effects of neck manipulation on IV-RoM in the cervical spine as measured by QF.

The study had four main objectives:

  1. To determine the accuracy, measurement precision and minimal detectable change (MDC) in IV-RoM over a period of treatment
  2. To determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation for non-specific neck pain and if so, the dose–response associated with such change
  3. To determine if there is any correlation between IV-RoM changes and patient reported outcomes
  4. To compare the frequency of finding inter-vertebral motion hypomobility by palpation and QF measurement.

Continue reading Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

Dr Greg Stewart Elected WFC President

Source The World Federation of Chiropractic

Greg Stewart

Dr Greg Stewart

June 10, 2014

The World Federation of Chiropractic (WFC) is pleased to announce that Dr Gregory B Stewart of Winnipeg, Manitoba, Canada was elected President for a 2-year term at the WFC Executive Council Meeting held last month in San Juan, Puerto Rico. He succeeds Dr Dennis Richards of Australia, now Past President.
Dr Stewart, who received a Bachelor of Physical Education from the University of Manitoba (1982), graduated as a Doctor of Chiropractic (cum laude) from the Canadian Memorial Chiropractic College in Toronto in 1986. He has been in fulltime private practice in Winnipeg, Manitoba since that time, and has served on many provincial and national chiropractic committees since 1990. These include committees on the identity of the profession, government relations, ethics, communications, interprofessional collaboration, chiropractic legislation, third party and government service negotiations, clinical practice guidelines and research.

Continue reading Dr Greg Stewart Elected WFC President

An International Survey of Pain in Adolescents

An International Survey of Pain in Adolescents

The Chiro.Org Blog


SOURCE:   BMC Public Health. 2014 (May 13);   14 (1):   447

Michael Swain, Nicholas Henschke, Steven Kamper, Inese Gobina, Veronika Ottová-Jordan, Christopher Maher

Department of Chiropractic, Faculty of Science,
Macquarie University, Sydney 2109, Australia. michael.swain@mq.edu.au


BACKGROUND:   A common belief is that pain is uncommon and short lived in adolescents. However, the burden of pain in adolescents is unclear because of limitations in previous research. The aim of this study is to estimate the prevalence of headache, stomach-ache and backache in adolescents and to explore the extent to which these three forms of pain coexist based upon a representative sample of adolescents from 28 countries.

METHODS:   Data were analysed from three consecutive waves (1997/98, 2001/02 and 2005/06) of the Health Behavior in School-aged Children: WHO Collaborative Cross-National survey (HBSC). Prevalence estimates are based upon adolescents who reported experiencing headache, stomach-ache or backache at least monthly for the last 6 months.

RESULTS:   There were a total of 404,206 participants with a mean (±SD) age of 13.6 (±1.7) years (range 9.8 to 17.3 years). The prevalence of headache was 54.1%, stomach-ache 49.8%, backache 37%, and at least one of the three pains 74.4%. Girls had a higher prevalence of the three pains than boys and the prevalence of pain increased with age. Headache, stomach-ache and backache frequently coexist, for example, of those with headache: 21.2% had headache alone, 31% suffered from both headache and stomach-ache, 12.1% suffered from backache and headache, and 35.7% had all three pains.

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Chiropractic Pediatrics Page

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