Chiro.org - Chiropractic Resource Organization.     Support Chiropractic Research!

Monthly Archives: August 2013

Home/2013/August

New Chiropractic and Radicular Pain Study

By |August 31, 2013|Chiropractic Care, Disc Injury, Radiculopathy|

New Chiropractic and Radicular Pain Study

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2013 (Aug 12)


Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up

Cynthia K. Peterson, RN, DC, M.Med.Ed, Christof Schmid, DC,
Serafin Leemann, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Department of Chiropractic Medicine,
Faculty of Medicine,
Orthopedic University Hospital Balgrist,
University of Zürich,
Zürich, Switzerland.
xraydcpeterson@yahoo.ca


This newly published prospective cohort study with 3-Month follow-up reports on the outcomes of 50 patients with MRI-confirmed cervical disc herniation who were also experiencing radiculopathy. Some of them were acute cases, but many of them also happened to be chronic pain patients.

A short, 3 month trial of chiropractic care led to significant improvements in all those individuals, and this improvement was sustained 3 months after care ceased.


OBJECTIVE:   The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS:   Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS:   Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

There are many more articles like this at our:

Radiculopathy and Chiropractic Page

and our:

Chronic Neck Pain and Chiropractic Page

(more…)

Manual Treatment For Cervicogenic Headache And Active Trigger Point In The Sternocleidomastoid Muscle: A Pilot Randomized Clinical Trial

By |August 30, 2013|Cervicogenic, Headache, Myofascial Trigger Points|

Manual Treatment For Cervicogenic Headache And Active Trigger Point In The Sternocleidomastoid Muscle: A Pilot Randomized Clinical Trial

The Chiro.Org Blog


J Manipulative Physiol Ther. 2013 (Sep); 36 (7): 403—411

Gema Bodes-Pardo, PT, MSc, Daniel Pecos-Martín, PT, PhD, Tomás Gallego-Izquierdo, PT, PhD, Jaime Salom-Moreno, PT, MSc, César Fernández-de-las-Peñas, PT, PhD, Ricardo Ortega-Santiago, PT, PhD

Clínica Fisioterapia Santiago Vila,
San Fernando de Henares, Spain.


OBJECTIVE:   The purpose of this preliminary study was to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points (TrPs) in patients with cervicogenic headache (CeH).

METHODS:   Twenty patients, 7 males and 13 females (mean ± SD age, 39 ± 13 years), with a clinical diagnosis of CeH and active TrPs in the sternocleidomastoid muscle were randomly divided into 2 groups. One group received TrP therapy (manual pressure applied to taut bands and passive stretching), and the other group received simulated TrP therapy (after TrP localization no additional pressure was added, and inclusion of longitudinal stroking but no additional stretching). The primary outcome was headache intensity (numeric pain scale) based on the headaches experienced in the preceding week. Secondary outcomes included neck pain intensity, cervical range of motion (CROM), pressure pain thresholds (PPT) over the upper cervical spine joints and deep cervical flexors motor performance. Outcomes were captured at baseline and 1 week after the treatment.

There’s a lot more material like this @ our:

Headache and Chiropractic Page

(more…)

A Framework For Chiropractic Training In Clinical Preventive Services

By |August 25, 2013|Chiropractic Care, Prevention|

A Framework For Chiropractic Training In Clinical Preventive Services

The Chiro.Org Blog


Chiropractic & Manual Therapies 2013 (Aug 20); 21: 28

Cheryl Hawk and Marion Willard Evans

Cheryl Hawk cheryl.hawk@logan.edu
Logan College of Chiropractic, 1851 Schoettler Rd, 63017 Chesterfield, MO, USA


The 2010 Patient Protection and Affordable Care Act provides incentives for both patients and providers to engage in evidence-based clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF). Depending upon the application of the new health care act, Doctors of Chiropractic (DC) may be considered to be covered providers of many of these services. It is therefore essential that DCs’ training prepare them to competently deliver them. The aim of this commentary is to describe a framework for training in clinical preventive services, based largely on the USPSTF recommendations, which could be readily integrated into existing DC educational programs.

From the Full-Text Article:

Background

The necessity for preventive care

The United States, despite spending more money on health care than any other country, has a population with shorter life expectancy and greater morbidity than any other wealthy nation [1]. The areas in which the U.S. lags behind its 16 peer nations are all lifestyle-related to a great degree [1]. Clearly this situation requires an approach that engages people in modifying their health behavior, as early as possible, rather than relying on heroic measures once conditions have become chronic and life-threatening. That approach is systematically addressed in the science of health promotion and disease prevention, often simply called “prevention” or “preventive care”. [2]

(more…)

The Nordic Maintenance Care Program: What Is Maintenance Care? Interview Based Survey of Danish Chiropractors

By |August 21, 2013|Maintenance Care, Medical Necessity, Uncategorized|

The Nordic Maintenance Care Program:
What Is Maintenance Care? Interview Based Survey of Danish Chiropractors

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2013 (Aug 20);   21:   27

Corrie Myburgh, Dorthe Brandborg-Olsen, Hanne Albert and
Lise Hestbaek

Institute of Sports Science and Clinical Biomechanics,
Nordic Institute for Chiropractic and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark


Objective   To describe and interpret Danish Chiropractors’ perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.

Methods   Semi-structured interviews were conducted with 10 chiropractors identified using a stratified, theoretical sampling framework. Interviews covered four domains relating to MC, namely: purpose, patient characteristics, content, and course and development. Data was analysed thematically.

Results   Practitioners regard MC primarily as a means of providing secondary or tertiary care and they primarily recommend it to patients with a history of recurrence. Initiating MC is often a shared decision between clinician and patient. The core elements of MC are examination and manipulation, but exercise and general lifestyle advice are often included. Typically, treatment intervals lie between 2 and 4 months. Clinician MC practices seem to evolve over time and are informed by individual practice experiences.

Chiropractors are more likely to offer MC to patients whose complaints include a significant muscular component. Furthermore, a successful transition to MC appears dependent on correctly matching complaint with management. A positive relationship between chiropractor and patient facilitates the initiation of MC. Finally; MC appears grounded in a patient-oriented approach to care rather than a market-oriented one.

Conclusions   MC is perceived as both a secondary and tertiary preventative measure and its practice appears grounded in the tenet of patient-oriented care. A positive personal relationship between chiropractor and patient facilitates the initiation of MC. The results from this and previous studies should be considered in the design of studies of efficacy.

There are many similar studies in our new

Maintenance Care, Wellness and Chiropractic Page


From the Full-Text Article:

Background

Maintenance care (MC) is used by chiropractors to treat patients who are no longer in an acute state of pain; the purpose being to prevent recurrence of episodic conditions (secondary prevention) and/or maintain a desired level of function (tertiary prevention). The concept is frequently used among chiropractors [1,2] and limited evidence suggests that, among workers with work-related back pain, MC in chiropractic practice appears to decrease the recurrence rate [3]. However, according to two literature reviews, very limited evidence regarding the definitions, purpose and content of MC is currently available [4,5].

(more…)

Chiropractic Cost-Effectiveness Supplement

By |August 17, 2013|Chiropractic Care, Chronic Pain, Cost-Effectiveness, Low Back Pain|

Chiropractic Cost-Effectiveness Supplement

The Chiro.Org Blog


SOURCE:   Virginia Chiropractic Association

Download the complete 29-Page Acrobat File


The following studies detail the cost effectiveness and overall efficacy of chiropractic care, and the procedures that doctors of chiropractic provide their patients.

This presentation is divided into several parts:

  • Background studies, detailing that LBP is much more complex than the literature leads us to believe;
  • Cost-Effectiveness Studies;
  • Worker’s Compensation Studies (National studies) and
  • Worker’s Compensation Studies (State specific studies)



GENERAL BACKGROUND STUDIES:


Prognosis in Patients with Recent Onset Low Back Pain in Australian Primary Care: Inception Cohort Study
British Medical Journal 2008 (Jul 7); 337: a171 ~ FULL TEXT

This study contradicts the Clinical Practice Guidelines that maintain that recovery from acute low back pain is usually rapid and complete.   Their findings with 973 consecutive primary care patients was that recovery was slow for most patients, and almost 1/3 of patients did not recover within one year (when following standard medical recommendations).

This study was designed to determine the one year prognosis of patients with low back pain. 973 patients with low back pain that had lasted less than 2 weeks completed a baseline questionnaire. Patients were reassessed through a phone interview at six weeks, three months and 12 months. The study found that the prognosis claimed in clinical guidelines was more favorable than the actual prognosis for the patients in the study. Recovery was slow for most patients and almost 1/3 of patients did not recover within one year.

          

Low Back Pain In A General Population. Natural Course And Influence Of Physical Exercise–A 5-Year Follow-Up
Spine. 2006 (Dec 15); 31 (26): 3045-51

This study contradicts the common belief that low back pain will extinguish with simple core exercises. This study provided significant benefits for only 1 out of 5 LPB sufferers.   Researchers followed 790 patients who initially sought care for low back pain from 70 different caregivers. After 5 years, only 21% of patients studied reported no continued pain while only 37% reported no disability. Pain and disability scores dropped significantly at 6 months, then remained flat at 2 yrs and 5 yrs. Nonspecific regular exercise did not affect recovery. Between 27% and 66% of the study population experienced a recurrence of low back pain.

          
(more…)

“Unnecessary” Spinal Surgery:
A Review With Commentary

By |August 15, 2013|Uncategorized|

“Unnecessary” Spinal Surgery:
A Review With Commentary

The Chiro.Org Blog


SOURCE:   Surgical Neurology Internat 2011; 2: 83

Nancy E Epstein, Donald C Hood

Department of Neurological Surgery,
The Albert Einstein College of Medicine,
Bronx, NY, USA


INTRODUCTION:   Although one spine surgeon may decide that a patient needs surgery, another surgeon [e.g. a second opinion] might decide that surgery is “unnecessary”. Here we define “unnecessary surgery” as spinal surgery based upon “pain alone”. That is, the patient has no neurological deficit and no significant abnormal radiographic findings on dynamic X-rays, MR, and/or CT. Surgeons can, and do, debate whether it is appropriate to operate on patients with pain alone. To put this debate in context, however, we need to better understand the number of patients involved and the type of procedures recommended. In this prospective study performed over a one-year period, a single neurosurgeon documented the “unnecessary” lumbar and cervical surgeries planned by other spinal surgeons.

BACKGROUND:   There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.

METHODS:   During a one-year period [November 2009-October 2010], the senior author, a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations. A patient was assigned to the “unnecessary surgery” group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits, and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans].

(more…)