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Monthly Archives: February 2016


Chiropractic Use in the Medicare Population

By |February 29, 2016|Medicare|

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2014 (Mar); 37 (8): 542-551

Paula A.M. Weigel, PhD, Jason M. Hockenberry, PhD,
Fredric D. Wolinsky, PhD

Research Associate,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa, Iowa City, IA

OBJECTIVE:   The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS:   Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS:   The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

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The OUCH Randomized Controlled Trial of Adverse Events

By |February 25, 2016|Adverse Events, Spinal Manipulation|

Outcomes of Usual Chiropractic. The OUCH Randomized Controlled Trial of Adverse Events

The Chiro.Org Blog

SOURCE:   Spine (Phila Pa 1976). 2013 (Sep 15); 38 (20): 1723–1729

Bruce F Walker, Jeffrey J Hebert, Norman J Stomski,
Brenton R Clarke, Ross S Bowden,
Barrett Losco, Simon D French

School of Health Professions
Murdoch University,
Murdoch, Australia

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%
headache sham 17% usual care 9%


Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction Associated with Upper Cervical Chiropractic Care

By |February 24, 2016|Adverse Events, Patient Satisfaction, Upper Cervical Adjusting|

Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction Associated with
Upper Cervical Chiropractic Care: A Prospective, Multicenter, Cohort Study

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2011 (Oct 5); 12: 219

Kirk Eriksen, Roderic P Rochester, and Eric L Hurwitz

Chiropractic Health Institute, PC
2500 Flowers Chapel Road
Dothan, AL 36305, USA.

BACKGROUND:   Observational studies have previously shown that adverse events following manipulation to the neck and/or back are relatively common, although these reactions tend to be mild in intensity and self-limiting. However, no prospective study has examined the incidence of adverse reactions following spinal adjustments using upper cervical techniques, and the impact of this care on clinical outcomes.

METHODS:   Consecutive new patients from the offices of 83 chiropractors were recruited for this practice-based study. Clinical outcome measures included

1) Neck pain disability index (100-point scale),
2) Oswestry back pain index (100-point scale),
3) 11-point numerical rating scale (NRS) for neck, headache, midback, and low back pain,
4) treatment satisfaction, and
5) Symptomatic Reactions (SR).

Data were collected at baseline, and after approximately 2 weeks of care. A patient reaching sub-clinical status for pain and disability was defined as a follow-up score <3 NRS and <10%, respectively. A SR is defined as a new complaint not present at baseline or a worsening of the presenting complaint by >30% based on an 11-point numeric rating scale occurring <24 hours after any upper cervical procedure.

RESULTS:   A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had symptomatic reactions (SRs) meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.

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Chiropractic Research Review 2015

By |February 23, 2016|Chiropractic Research|

Chiropractic Research Review 2015

The Chiro.Org Blog

SOURCE:   Practice Analysis of Chiropractic 2015 (Chapter 2)

National Board of Chiropractic Examiners (NBCE)


Healthcare services are provided by a practitioner in response to each patient’s expressed health concerns. Critical in this process are: the knowledge and experience of the practitioner, the preferences and values of the patient, and the empirical evidence concerning the appropriate care for the patient’s health condition. [1] This chapter focuses on the current state of scientific evidence regarding chiropractic care. The use of empirical evidence to guide practice is frequently called “evidence-based practice,” or “evidence-informed care.” Evidence-based practice was defined by one of the leading pioneers of the evidence-based movement, David Sackett, as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”. [2]

Because the types of chiropractic research investigations have expanded, this chapter addresses not only clinical and basic science research, but also cost analysis, patient safety, and patient satisfaction. To effectively organize this research evidence, this chapter is primarily focused on findings from systematic reviews and meta-analyses, which combine results from many investigations to provide summaries of evidence in a specific area of healthcare.

Through the application of evidence-based practice principles, chiropractors rely, in part, upon research when making decisions about the care of their individual patients. Likewise, policymakers require evidence on which they can base decisions regarding policies to facilitate improved health outcomes. Additionally, patients depend on their doctors to have knowledge of the best available evidence within their discipline. Therefore, it is important to understand the depth and breadth of the chiropractic evidence base, while also noting the limitations and challenges of the state of evidence. Thus, this chapter is designed to provide evidence which may enhance decision-making by doctors of chiropractic and other health professionals, patients, educators, policymakers, and payors.

Evidence that informs chiropractic practice ranges from systematic reviews/meta-analyses and randomized clinical trials to observational and case-control studies, as well as mechanical force investigations and animal studies. This chapter provides an overview of the most recent and highest quality research evidence, but is not an exhaustive listing of all studies. Additional information and discussions of other research efforts are available in Chapter 2 of the Practice Analysis of Chiropractic 2010, as well as the Job Analysis of Chiropractic 2005, 2000, and 1993. [3-6]

Clinical Effectiveness

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Back Pain


Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel with Low Back Pain

By |February 20, 2016|Low Back Pain|

Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel with Low Back Pain: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Trials. 2016 (Feb 9);   17 (1):   70 ~ FULL TEXT

Christine M. Goertz, Cynthia R. Long, Robert D. Vining,
Katherine A. Pohlman, Bridget Kane, Lance Corber,
Joan Walter, and Ian Coulter

Palmer College of Chiropractic,
Palmer Center for Chiropractic Research,
741 Brady Street,
Davenport, IA, 52803, USA.

BACKGROUND:   Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone.

METHODS/DESIGN:   This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation.

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Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache

By |February 10, 2016|Headache|

Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache: A Multi-center Randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   BMC Musculoskel Disord. 2016 (Feb 6); 17 (1): 64

James R. Dunning, Raymond Butts, Firas Mourad,
Ian Young, Cesar Fernandez-de-las Peñas st. al.

Alabama Physical Therapy & Acupuncture,
Montgomery, AL, USA

BACKGROUND:   Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH.

METHODS:   One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable.

RESULTS:   The 2X4 ANOVA demonstrated that individuals with cervicogenic headache (CH) who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001).

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