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Monthly Archives: July 2014


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

By |July 31, 2014|Chiropractic Care, Cost-Effectiveness|

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)


Energy Drinks and Adolescents – What Should Health Practitioners Know?

By |July 24, 2014|Pediatrics|

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.

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


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


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


There are more articles like this @ our:

Chiropractic Pediatrics Page


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

By |July 21, 2014|Chiropractic Care, Colic, Cost-Effectiveness|

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

J Clinical Chiropractic Peds 2013 (Jun);   14 (1):   1063–1069

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

Anglo-European College of Chiropractic,
Lead Tutor in Advanced Professional Practice (Paediatrics),
Bournemouth University,
United Kingdom

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:


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.

There are more articles like this @ our:

Chiropractic Pediatrics Page and the:

Infantile Colic and Chiropractic Page


Chiropractic and Breastfeeding Dysfunction: A Literature Review

By |July 20, 2014|Breastfeeding Dysfunction, Chiropractic Care|

Chiropractic and Breastfeeding Dysfunction:
A Literature Review

The Chiro.Org Blog

SOURCE:   J Clin Chiro Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT

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

private practice,
Elwood, Victoria, Australia

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:


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]

There are more articles like this @ our:

Chiropractic Pediatrics Page


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

By |July 19, 2014|Adverse Drug Reactions, Pediatrics|

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

The Chiro.Org Blog

SOURCE:   J Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT

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.

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:


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?

There are more articles like this @ our:

Iatrogenic Injury Page and our:

Chiropractic Pediatrics Page