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Monthly Archives: November 2016

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Genetic Risk, Adherence to a Healthy Lifestyle,
and Coronary Disease

By |November 29, 2016|Coronary Disease|

Genetic Risk, Adherence to a Healthy Lifestyle,
and Coronary Disease

The Chiro.Org Blog


N Engl J Med 2016 (Nov 13);   [Epub] ~ FULL TEXT

Amit V. Khera, M.D., Connor A. Emdin, D.Phil.,
Isabel Drake, Ph.D., et. al.

Center for Human Genetics Research,
Massachusetts General Hospital,
185 Cambridge St., CPZN 5.252,
Boston, MA 02114


BACKGROUND   Both genetic and lifestyle factors contribute to individual-level risk of coronary artery disease. The extent to which increased genetic risk can be offset by a healthy lifestyle is unknown.

METHODS   Using a polygenic score of DNA sequence polymorphisms, we quantified genetic risk for coronary artery disease in three prospective cohorts — 7,814 participants in the Atherosclerosis Risk in Communities (ARIC) study, 21,222 in the Women’s Genome Health Study (WGHS), and 22,389 in the Malmö Diet and Cancer Study (MDCS) — and in 4,260 participants in the cross-sectional BioImage Study for whom genotype and covariate data were available. We also determined adherence to a healthy lifestyle among the participants using a scoring system consisting of four factors: no current smoking, no obesity, regular physical activity, and a healthy diet.

RESULTS   The relative risk of incident coronary events was 91% higher among participants at high genetic risk (top quintile of polygenic scores) than among those at low genetic risk (bottom quintile of polygenic scores) (hazard ratio, 1.91; 95% confidence interval [CI], 1.75 to 2.09). A favorable lifestyle (defined as at least three of the four healthy lifestyle factors) was associated with a substantially lower risk of coronary events than an unfavorable lifestyle (defined as no or only one healthy lifestyle factor), regardless of the genetic risk category. Among participants at high genetic risk, a favorable lifestyle was associated with a 46% lower relative risk of coronary events than an unfavorable lifestyle (hazard ratio, 0.54; 95% CI, 0.47 to 0.63). This finding corresponded to a reduction in the standardized 10-year incidence of coronary events from 10.7% for an unfavorable lifestyle to 5.1% for a favorable lifestyle in ARIC, from 4.6% to 2.0% in WGHS, and from 8.2% to 5.3% in MDCS. In the BioImage Study, a favorable lifestyle was associated with significantly less coronary-artery calcification within each genetic risk category.

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Conservative Management of Uncomplicated
Mechanical Neck Pain in a Military Aviator

By |November 20, 2016|Conservative Management, Military Aviator|

Conservative Management of Uncomplicated Mechanical Neck Pain in a Military Aviator

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2010 (Jun); 54 (2): 92–99

Bart N. Green, DC, MSEd, Andrew S. Dunn, DC, MEd, MS,
LCDR Solomon M. Pearce, DO, and
Claire D. Johnson, DC, MSEd

Chiropractic Division,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego,
Marine Corps Air Station Miramar,
Branch Medical Clinic,
San Diego, CA 92145-2002


Non-radicular neck pain arising from local musculoskeletal structures, known as mechanical neck pain or somatic dysfunction, is highly prevalent in the fighter jet aviator population. The management of this problem includes both therapeutic and aeromedical decisions. In addition to non-steroidal anti-inflammatory medications, waiver guides recommend therapeutic exercise and manipulative therapy as treatments for somatic spine pain in aviators, and such treatments are employed in many military locations. However, there are currently no published studies that describe the use of manipulative therapy for fighter jet aviators. We report the case of an F/A-18 instructor pilot who experienced long-term relief of uncomplicated mechanical neck pain following interdisciplinary management that included manipulation and a home exercise program. Diagnostic considerations, conservative treatment options, and aeromedical concerns are discussed.

KEYWORDS:   aviation; exercise therapy; manipulation; manual therapy; neck pain; spinal


The Full-Text Article:

Introduction

Fighter jet aviators are exposed to large tensile, axial compression, and shear forces when flying, especially during aerial combat maneuvers (ACM). [1] Non-radicular neck pain arising from mechanical structures in the neck (somatic pain) is a common outcome of exposure to high gravitational (G) forces. [2] The weight of the helmet and oxygen mask and the various non-neutral head postures assumed when observing for enemy aircraft contribute to this problem. [1] Spinal disorders can result in disability [3] and conditions that may disqualify pilots from flight duties. [4] Thus, neck pain in the fighter jet aviator population has a negative impact on work performance, productivity, and is a threat to combat readiness. [5]

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Chiropractic Care For Veterans Page

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The Effect of Chiropractic Treatment on the Reaction and Response Times of Special Operation Forces Military Personnel

By |November 19, 2016|Veterans|

The Effect of Chiropractic Treatment on the Reaction and Response Times of Special Operation Forces Military Personnel: Study Protocol for a Randomized Controlled Trial

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SOURCE:   Trials. 2016 (Sep 20); 17 (1): 457

James W. DeVocht, Dean L. Smith, Cynthia R. Long,
Lance Corber, Bridget Kane, Thomas M. Jones and
Christine M. Goertz

Palmer Center for Chiropractic Research,
741 Brady St,
Davenport, IA, 52803, USA.


BACKGROUND:   Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment. However, it is unknown whether or not chiropractic treatment is able to improve reaction and response times in specific populations of interest. One such population is the U.S. military special operation forces’ (SOF) personnel.

METHODS:   This study is a randomized controlled trial of 120 asymptomatic volunteer SOF personnel. All participants are examined by a study doctor of chiropractic (DC) for eligibility prior to randomization. The participants are randomly allocated to either a treatment group receiving four treatments of chiropractic manipulative therapy (CMT) over 2 weeks or to a wait-list control group. The wait-list group does not receive any treatment but has assessments at the same time interval as the treatment group. The outcome measures are simple reaction times for dominant hand and dominant foot, choice reaction time with prompts calling for either hand or either foot, response time using Fitts’ law tasks for small movements involving eye-hand coordination, and brief whole body movements using the t-wall, a commercially available product. At the first visit, all five tests are completed so that participants can familiarize themselves with the equipment and protocol. Assessments at the second and the final visits are used for data analysis.

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Does Cervical Spine Manipulation Reduce Pain
in People with Degenerative Cervical Radiculopathy?

By |November 16, 2016|Radiculopathy|

Does Cervical Spine Manipulation Reduce Pain in People with Degenerative Cervical Radiculopathy? A Systematic Review of the Evidence, and a Meta-analysis

The Chiro.Org Blog


SOURCE:   Clin Rehabil. 2016 (Feb); 30 (2): 145-155

Liguo Zhu, Xu Wei and Shangquan Wang

Department of Spine,
Wangjing Hospital,
Beijing, People’s Republic of China.


OBJECTIVE:   To access the effectiveness and safety of cervical spine manipulation for cervical radiculopathy.

DATA SOURCES:   PubMed, the Cochrane Central Registry of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), Wanfang data, the website of Chinese clinical trial registry and international clinical trial registry by US National Institutes of Health.

REVIEW METHODS:   Randomized controlled trials that investigated the effects of cervical manipulation compared with no treatment, placebo or conventional therapies on pain measurement in patients with degenerative cervical radiculopathy were searched. Two authors independently evaluated the quality of the trials according to the risk of bias assessment provided by the PEDro (physiotherapy evidence database) scale. RevMan V.5.2.0 software was employed for data analysis. The GRADE approach was used to evaluate the overall quality of the evidence.

RESULTS:   Three trials with 502 participants were included. Meta-analysis suggested that cervical spine manipulation (mean difference 1.28, 95% confidence interval 0.80 to 1.75; P < 0.00001; heterogeneity: Chi2 = 8.57, P = 0.01, I2 = 77%) improving visual analogue scale for pain showed superior immediate effects compared with cervical computer traction. The overall strength of evidence was judged to be moderate quality. One out of three trials reported the adverse events and none with a small sample size.

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Radiculopathy and Chiropractic Page

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The Chiropractic Scope of Practice in the United States

By |November 14, 2016|Scope of Practice|

The Chiropractic Scope of Practice in the United States: A Cross-sectional Survey

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jul); 37 (6): 363–376

Mabel Chang, DC, MPH

National University of Health Sciences-Florida,
Pinellas Park, FL.


OBJECTIVE:   The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998.

METHODS:   A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability.

RESULTS:   Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30).

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Chiropractors Are Spinal Health Care Experts Page

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Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain

By |November 12, 2016|Chiropractic Care, Chronic Low Back Pain, Cost-Effectiveness|

Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes from a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Jun); 37 (5): 300–311

Darcy A. Vavrek, ND, MS, Rajiv Sharma, PhD,
Mitchell Haas, DC, MA

University of Western States,
Portland, OR.


OBJECTIVE:   The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

METHODS:   We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

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Low Back Pain and Chiropractic Page

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Cost-Effectiveness of Chiropractic Page

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