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Monthly Archives: February 2014


ICD-10 Follies: There’s a Code For That???

By |February 19, 2014|Humor|

ICD-10 Follies:
There’s a Code For That???

The Chiro.Org Blog

SOURCE:   MedPage Today ~ Feb 19, 2014

By David Pittman, Washington Correspondent,
MedPage Today

It is 224 days before the move to ICD-10 becomes a must-do. Lest the deadline slip your mind, MedPage Today is spotlighting some of those thousands of new codes that might just be getting a bit too granular.

Today’s code:

W61.92:   Struck by other birds   (There are already separate diagnostic codes for being struck by parrots, macaws, psittacines, chickens, geese, and ducks.   W61.92 is for all other types of birds.)

Here is a re-enactment for your viewing pleasure.

The First Research Agenda for the Chiropractic Profession in Europe

By |February 15, 2014|Chiropractic Research|

The First Research Agenda for the Chiropractic Profession in Europe

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2014 (Feb 10); 22 (1): 9

Sidney M Rubinstein, Jenni Bolton, Alexandra L Webb,
Jan Hartvigsen

Department of Health Sciences,
Faculty of Earth and Life Sciences,
VU University, Amsterdam,
1081 HV Amsterdam, The Netherlands

BACKGROUND:   Research involving chiropractors is evolving and expanding in Europe while resources are limited. Therefore, we considered it timely to initiate a research agenda for the chiropractic profession in Europe. The aim was to identify and suggest priorities for future research in order to best channel the available resources and facilitate advancement of the profession.

METHODS:   In total, 60 academics and clinicians working in a chiropractic setting, and who had attended any of the annual European Chiropractors’ Union/European Academy of Chiropractic (ECU/EAC) Researchers’ Day meetings since their inception in 2008, were invited to participate. Data collection consisted of the following phases: Phase 1 identification of themes; Phase 2 consensus, which employed a Delphi process and allowed us to distill the list of research priorities; and Phase 3 presentation of the results during both the Researchers’ Day and a plenary session of the annual ECU Convention in May 2013. In addition, results were also distributed to all ECU member countries.

RESULTS:   The response rate was 42% from Phase 1 and 68% from Phase 2. In general, participants were middle-aged, male and had been awarded a Doctor of Philosophy (PhD) as well as chiropractic degree. Approximately equal numbers of participants had obtained their chiropractic degree from the UK/Europe and North America. The majority of participants worked primarily in an academic/research environment and approximately half worked in an independent institution. In total, 58% of the participants were from the UK and Denmark, collectively representing 44% of the chiropractors working in Europe. In total, 70 research priorities were identified, of which 19 reached consensus as priorities for future research. The following three items were thought to be most important: 1) cost-effectiveness/economic evaluations, 2) identification of subgroups likely to respond to treatment, and 3) initiation and promotion of collaborative research activities.

CONCLUSIONS:   This is the first formal and systematic attempt to develop a research agenda for the chiropractic profession in Europe. Future discussion and study is necessary to determine whether the themes identified in this survey should be broadly implemented.

From the Full-Text Article:


Research involving chiropractors is evolving and expanding in several European countries while resources are limited. At the European Chiropractors’ Union/European Academy of Chiropractic (ECU/EAC) Researchers’ Day in Zurich, Switzerland (June 2011), it was decided amongst the members that we needed to establish a vision for chiropractic research in Europe for the forthcoming five to ten years. This is in line with the results from a recent survey of all ECU member nations by the EAC Research Council. [1] Various other initiatives have also been conducted within the chiropractic profession, which include a strategic planning conference whose goal was to better service the public and at the same time promote the profession. [2]

There are three primary reasons why the instigation of a research agenda is believed to be important. Firstly, it is thought that the process could facilitate unity within the European chiropractic research community and encourage collaboration on research items considered to be important. Secondly, no European chiropractic research agenda has ever been established, which is in contrast to North America where an agenda was first established in 1997 [3] with an update in 2006 [4, 5]. Finally, researchers with chiropractic backgrounds frequently work and publish with other professionals, so it is of interest to investigate whether priorities from a chiropractic research agenda differ from other published agendas. For example, recently, a set of research priorities was established in the UK for non-pharmacological therapies for common musculoskeletal problems through a consensus process. [6]

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Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey

By |February 13, 2014|Research|

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey

SOURCE:  BMC Complementary and Alternative Medicine 2014, 14:51 ~ FULL TEXT

Marion McGregor, Aaron A Puhl, Christine Reinhart, H Stephen Injeyan and David Soave


As health care has increased in complexity and health care teams have been offered as a solution, so too is there an increased need for stronger interprofessional collaboration. However the intraprofessional factions that exist within every profession challenge interprofessional communication through contrary paradigms. As a contender in the conservative spinal health care market, factions within chiropractic that result in unorthodox practice behaviours may compromise interprofessional relations and that profession’s progress toward institutionalization. The purpose of this investigation was to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions.


A stratified random sample of 740 Canadian chiropractors was surveyed to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guidelines. Stratification in practice behaviours is a stated concern of mainstream medicine when considering interprofessional referrals.



FDA’s NSAID Panel Nixes Naproxen Safety Claim

By |February 11, 2014|Iatrogenic Injury, NSAIDs, Safety|

FDA’s NSAID Panel Nixes Naproxen Safety Claim

The Chiro.Org Blog

SOURCE:   MedPage Today ~ 2-11-2014

By John Gever, Deputy Managing Editor, MedPage Today

In 16-9 vote, the FDA advisory committee assessing NSAID safety said the warning label on naproxen should not be changed to suggest it has a better cardiovascular risk profile than other drugs in this class.

Those voting “No” on the question indicated that the current evidence on naproxen’s safety — much of which was indirect, coming from studies in which it served as a comparator to a coxib drug — did not meet the standards necessary to support label statements.

The panel — comprising members of FDA’s arthritis and risk management committees — split more closely on a question about label information on the duration of NSAID treatment that raises cardiovascular safety risks.

Currently, labels for these drugs say that short-term treatment is relatively safe; however, some recent studies have sown doubt. A total of 14 panel members said the current statement should be reconsidered, while 11 voted No.

However, most of those in the latter camp indicated in post-vote discussion that they believed there is no completely safe dosing period.

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Cost Effectiveness of Spinal Manipulation

By |February 7, 2014|Cost-Effectiveness, Epidemiology, Spinal Manipulation|

Spinal Manipulation Epidemiology: Systematic Review of Cost Effectiveness Studies

The Chiro.Org Blog

SOURCE:   J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 655–662 ~ FULL TEXT

Michaleff ZA, Lin CW, Maher CG, van Tulder MW.

The George Institute for Global Health, The University of Sydney, Missenden Road, Sydney, NSW 2050, Australia.

BACKGROUND:   Spinal manipulative therapy (SMT) is frequently used by health professionals to manage spinal pain. With many treatments having comparable outcomes to SMT, determining the cost-effectiveness of these treatments has been identified as a high research priority.

OBJECTIVE:   To investigate the cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration.

METHODS:   We searched eight clinical and economic databases and the reference lists of relevant systematic reviews. Full economic evaluations conducted alongside randomised controlled trials with at least one SMT arm were eligible for inclusion. Two authors independently screened search results, extracted data and assessed risk of bias using the CHEC-list.

RESULTS:   Six cost-effectiveness and cost-utility analysis were included. All included studies had a low risk of bias scoring =16/19 on the CHEC-List. SMT was found to be a cost-effective treatment to manage neck and back pain when used alone or in combination with other techniques compared to general practitioner (GP = MD) care, exercise and physiotherapy.

CONCLUSIONS:   This review supports the use of SMT in clinical practice as a cost-effective treatment when used alone or in combination with other treatment approaches. However, as this conclusion is primarily based on single studies more high quality research is needed to identify whether these findings are applicable in other settings.

From the Full-Text Article:


Spinal pain, including neck pain and back pain, is a common condition in modern society (Woolf and Pfleger, 2003;   Côté et al., 2003 ). It presents major social and economic burdens due to the high levels of chronicity and resultant long term disability which are associated with high costs in health care and losses of productivity (e.g. sick leave) (Woolf and Pfleger, 2003). While existing practice guidelines inform the individual, clinicians and policy makers on the effectiveness of a range of interventions, few provide information on the cost-effectiveness of treatments. It is arguable that cost-effectiveness of treatment is an equally important consideration as effectiveness, as all health administrators need to make decisions about how they allocate scarce health resources.

Economic evaluations are frequently conducted alongside randomised controlled trials of treatment effectiveness and involve the identification, measurement, valuation and then comparison of the costs and consequences (benefits) of two or more alternatives (Drummond et al., 2005). Economic evaluations are most useful when the treatments under question have been evaluated in terms of efficacy (can the treatment work in those who comply with the recommendations), effectiveness (is the treatment acceptable and does the treatment work in those who the treatment is offered) and availability (is the treatment accessible to all who would benefit from it). The result of an economic evaluation supplements the evidence base on treatment effectiveness by providing information on the efficiency or “value for money ” of treatment alternatives (Drummond et al., 2005). This information can be used to inform consumers, insurers, governments and policy makers where the health budget should be spent.

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Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy

By |February 4, 2014|Cervical Disk Herniation, Chiropractic Care|

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

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2013 (Oct); 36 (8): 461–467

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.

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.

CONCLUSIONS: Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging-confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.


Symptomatic compression of a cervical nerve root occurs in approximately 83.2 of every 100000 persons and is caused by disk herniations, degenerative spondylosis, or a combination of the [2] . Degenerative stenosis leading to narrowing of the intervertebral foramen is reported to be the most common cause of nerve root compression. [1]The C6 and C7 nerve roots are most frequently involved, often resulting in severe pain and disability. [1, 2] Symptoms can arise from the nerve root compression, inflammation, or both and include pain in a radicular distribution, paresthesias in a dermatomal pattern, decreased relevant reflex, and weakness of the muscles innervated by the nerve root. [3]

Patients with radiculopathy from cervical disk herniations (CDHs), the second most common cause of cervical nerve root compression, typically have acute neck pain with associated arm pain following the distribution of the involved nerve root, although the arm pain may be the predominant symptom. [3, 4]However, it is important to recognize that disk protrusions are also a common finding on magnetic resonance imaging (MRI) scans of asymptomatic people. [5-7]One study found that 63% of asymptomatic athletic males older than 40 years had protruding disks in the cervical spine. [5]In another study, disk protrusion with demonstrable spinal cord compression was noted in 7.6% of asymptomatic subjects over the age of 50 years. [6]However, extruded disk herniations and cord compression are unusual findings in asymptomatic individuals. [7]

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