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Daily Archives: July 13, 2014

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

By |July 13, 2014|Chiropractic Care, Spinal Manipulation|

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

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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.

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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