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Monthly Archives: September 2013

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Chiropractic And Osteoarthritis

By |September 27, 2013|Chiropractic Care, Degenerative Joint Disease, Evidence-based Medicine, Osteoarthritis|

Chiropractic And Osteoarthritis

The Chiro.Org Blog


SOURCE:   University of Maryland Medical Center


Although the vestiges of medical harassment against chiropractic still resonate, and are now supplanted by fringe web sites which continue to ignore the body of peer-reviewed research supporting chiropractic care, the ice is slowly melting.

Below you can read comments from the University of Maryland Medical Center website , which openly acknowledges the benefits of chiropractic care for patients suffering from the pain of osteoarthritis.

There are many more articles like this @ our:

Degenerative Joint Disease and Chiropractic Page


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Outcomes of Usual Chiropractic; Harm (OUCH) Randomised Controlled Trial of Adverse Events

By |September 24, 2013|Adverse Events, Chiropractic Care, Randomized Controlled Trial|

Outcomes of Usual Chiropractic;
Harm (OUCH) Randomised Controlled Trial of Adverse Events

The Chiro.Org Blog


SOURCE:   Spine 2013 (Sep 15); 38 (20): 1723-9 ~ FULL TEXT

Walker, Bruce F. DC, MPH, DrPH; Hebert, Jeffrey J. DC, PhD;
Stomski, Norman J. BHSc (hons), PhD; Clarke

Murdoch University School of Engineering and Information Technology,
Mathematics & Statistics,
Murdoch University Centre for Health,
Exercise and Sports Medicine,
University of Melbourne.


Study Design.   Blinded parallel-group randomized controlled trial.

Objective.   Establish the frequency and severity of adverse effects from short-term usual chiropractic treatment of the spine when compared with a sham treatment group.

Summary of Background Data.   Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, as a result of design limitations in previous studies, particularly the lack of sham-controlled randomized trials, understanding of these adverse events and their relation with chiropractic treatment is suboptimal.

Methods.   We conducted a trial to examine the occurrence of adverse events resulting from chiropractic treatment. It was conducted across 12 chiropractic clinics in Perth, Western Australia. The participants comprised 183 adults, aged 20 to 85 years, with spinal pain. Ninety-two participants received individualized care consistent with the chiropractors’ usual treatment approach; 91 participants received a sham intervention. Each participant received 2 treatments.

Results.   Completed adverse questionnaires were returned by 94.5% of the participants after appointment 1 and 91.3% after appointment 2. Thirty-three percent of the sham group and 42% of the usual care group reported at least 1 adverse event. Common adverse events were:

increased pain (sham 29%; usual care 36%),
muscle stiffness (sham 29%; usual care 37%),
and headache (sham 17%; usual care 9%).

The relative risk (RR) was not significant for adverse event occurrence (RR = 1.24; 95% CI: 0.85–1.81),
occurrence of severe adverse events (RR = 1.9; 95% CI: 0.98–3.99),
adverse event onset (RR = 0.16; 95% CI: 0.02–1.34),
or adverse event duration (RR = 1.13; 95% CI: 0.59–2.18).
No serious adverse events were reported.

Conclusion.   A substantial proportion of (previously reported) adverse events following chiropractic treatment appear to result from natural history variation and nonspecific effects.


From the FULL TEXT Article

Introduction

Chiropractic therapy is commonly used to manage musculoskeletal conditions in high-income countries. [1, 2] The occurrence of adverse events resulting from chiropractic treatment is of considerable interest to chiropractors and the general public. Most adverse events associated with chiropractic treatment are mild, short lasting, and typical of musculoskeletal condition symptoms. [3–11] However, due to a lack of appropriately designed studies, particularly sham-controlled trials, there are differences in views about what constitutes a chiropractic treatment–related adverse event.

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The sacroiliac joint is the most likely source of low back pain after lumbar fusion

By |September 18, 2013|Research|

Etiology of Chronic Low Back Pain in Patients Having Undergone Lumbar Fusion

Pain Medicine Volume 12, Issue 5, pages 732–739, May 2011

Michael J. DePalma MD , Jessica M. Ketchum PhD, Thomas R. Saullo MD

Abstract

Objective.  To estimate the prevalence of lumbar internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, and soft tissue irritation by fusion hardware in post-fusion low back pain patients compared with non-fused patients utilizing diagnostic spinal procedures.

Design.  Retrospective chart review.

Setting.  University spine center.

Patient Sample.  Patients presenting to a community-based, multidisciplinary, academic spine center (65.9% female, mean age 54.4 years, median pain duration 12 months).

Interventions.  Charts of consecutive low back pain cases completing diagnostic spinal procedures including provocation discography and zygapohyseal joint, sacroiliac joint, and fusion hardware blockade were retrospectively reviewed.

Outcome Measures.  Based on the results of discography and/or diagnostic blockades, subjects were classified with internal disc disruption, zygapohyseal joint pain, sacroiliac joint pain, or fusion hardware related pain.

Results.  The diagnoses of 28 fusion cases identified from 170 low back pain patients undergoing diagnostic procedures included 12 with sacroiliac joint pain, seven with internal disc disruption, five with zygapohyseal joint pain, and four due to soft tissue irritation from fusion hardware. No significant differences were noted in zygapohyseal joint mediated pain with and without fusion history. Mean ages of patients were similar with and without fusion history for cases diagnosed as internal disc disruption.

Conclusion.  In patients’ recalcitrant to non-interventional care, the sacroiliac joint is the most likely source of low back pain after lumbar fusion followed by internal disc disruption, zygapohyseal joint pain, and soft tissue irritation due to fusion hardware. Sacroiliac joint pain is more common after fusion, while internal disc disruption is more common in non-fusion patients.

 

 

Prognosis in Patients with Recent Onset Of Low Back Pain

By |September 17, 2013|Low Back Pain, Prognosis|

Prognosis in Patients with Recent Onset Low Back Pain in Australian Primary Care: Inception Cohort Study

The Chiro.Org Blog


British Medical Journal 2008 (Jul 7); 337: a171

Henschke N, Maher CG, Refshauge KM, Herbert RD,
Cumming RG, Bleasel J, York J, Das A, McAuley JH.

Musculoskeletal Division,
The George Institute for International Health,
Sydney, Australia.


This BMJ study contradicts Clinical Practice Guidelines that suggest that recovery from an episode of recent onset 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).

OBJECTIVE:   To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.

DESIGN:   Cohort study with one year follow-up.

SETTING:   Primary care clinics in Sydney, Australia.

PARTICIPANTS:   An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks’ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.

MAIN OUTCOME MEASURES:   Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.

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Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study

By |September 16, 2013|Research|

Kevin J Lyons, Stacie A Salsbury, Maria A Hondras, Mark E Jones, Andrew A Andresen and Christine M Goertz

BMC Complementary and Alternative Medicine 2013, 13:225

Provisional Abstract

Background

While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.

Methods

We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants’ care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis.

Results

Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD-DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.

Conclusions

Older adults are interested in receiving LBP treatment co-managed by MDs and DCs. Older adults considered patient-centered communication, collegial interdisciplinary interactions between these providers, and administrative supports such as scheduling systems and health record sharing as key components for successful LBP co-management.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

An Evidence-based Diagnostic Classification System For Low Back Pain

By |September 14, 2013|Evidence-based Medicine, Low Back Pain|

An Evidence-based Diagnostic Classification System For Low Back Pain

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2013 (Sep); 57 (3): 189–204

Robert Vining, DC, Eric Potocki, DC, MS, Michael Seidman, MSW, DC, A. Paige Morgenthal, DC, MS

Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 5433 Bryant Ave, South Minneapolis, MS 55419; dr.potocki@yahoo.com


INTRODUCTION:   While clinicians generally accept that musculoskeletal low back pain (LBP) can arise from specific tissues, it remains difficult to confirm specific sources.

METHODS:   Based on evidence supported by diagnostic utility studies, doctors of chiropractic functioning as members of a research clinic created a diagnostic classification system, corresponding exam and checklist based on strength of evidence, and in-office efficiency.

RESULTS:   THE DIAGNOSTIC CLASSIFICATION SYSTEM CONTAINS ONE SCREENING CATEGORY, TWO PAIN CATEGORIES: Nociceptive, Neuropathic, one functional evaluation category, and one category for unknown or poorly defined diagnoses. Nociceptive and neuropathic pain categories are each divided into 4 subcategories.

CONCLUSION:   This article describes and discusses the strength of evidence surrounding diagnostic categories for an in-office, clinical exam and checklist tool for LBP diagnosis. The use of a standardized tool for diagnosing low back pain in clinical and research settings is encouraged.

There’s a lot more material like this @:

Low Back Pain and Chiropractic Page and the

Clinical Model for Diagnosis and Management Page


From the FULL TEXT Article:

Introduction

Health professionals across such disciplines as orthopedics, physical therapy, and chiropractic have shared the goal of categorizing patients with musculoskeletal low back pain (LBP) according to evidence-based classification systems. [1, 2] To this end, several investigators have generated classification systems for LBP diagnosis and treatment. [3–8] Identifying specific pathophysiology causing LBP has the potential to positively impact clinical research and practice by providing opportunities to test, validate or reject treatments targeted at specific diagnoses. [1,2] Clinical prediction rules [4,6] and symptom or treatment-based classification systems [7,8] lack the pathophysiological component(s) clinicians sometimes use to better understand a condition and make clinical decisions. Patho-anatomic diagnoses address pain arising from more specific anatomic structures or pathological processes. However, definitively confirming pain sources for LBP continues to be a challenge.

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