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Monthly Archives: January 2017


Clinical Effects of Spinal Manipulation in the Management of Children and Young Adults Diagnosed With Autism Spectrum Disorder

By |January 31, 2017|Autism|

Clinical Effects of Spinal Manipulation in the Management of Children and Young Adults Diagnosed With Autism Spectrum Disorder – A Systematic Review of the Literature

The Chiro.Org Blog

SOURCE:   J Clin Chiro Peds 2016 (Dec); 15 (3): 1280–1291

Sabine Kronau DO, MSc Paed Ost, Bettina Thiel Dipl.-Ing.,
Anne Jäkel DPhil, Torsten Liem DO, MSc Ost, MSc Paed Ost

Osteopathie Schule Deutschland,
Mexikoring 19, 22297
Hamburg, Germany

Background:   Autism spectrum disorders (ASD) are classified as pervasive developmental disorders that permanently affect essential mental functions. Symptoms include quality-related disorders in areas of social interaction, verbal and non-verbal communication, the variability of behaviours and specific learning disabilities. Abnormalities in development are already apparent in early childhood.

Aim:   To identify evidence for the clinical benefits of manual therapy of the musculoskeletal system in children diagnosed with ASD.

Methods:   The following databases and search interfaces were searched from Database start up until October 2015: Bio Med Central, Chiropractic Library Collaboration, Clinical Trials, Cochrane library, Dimdi, EBSCO host, Pubmed, Pubmed central, Medline Plus, Osteopathic research Digital repository, Osteopathic Research Web, and Physiotherapy Evidence Database. Further searches included journals provided by the University of Wales and the University of Duisburg-Essen. Studies were included if participants were children and young adults aged 0-21 years; studies published in English, German, or French; a diagnosis of autism or ASD, and study designs of randomized clinical trial, case-control studies, case series, case reports, and single subject studies (N of 1), which include manual therapeutic interventions of the musculoskeletal system. Two authors independently screened the studies for inclusion criteria, extracted the data and assessed for risk of bias. Methodological quality of randomized clinical trials was assessed by the Downs and Black tool. Quality of reporting for case series and case reports was assessed with the appropriate checklists provided by the QUAlity and Transparency Of health Research (EQUATOR) network.

Results:   Included in the review were one randomized clinical trial (uncontrolled), one case series, and 11 case reports. The methodological quality of the included randomised clinical trial was rated as being poor. Quality of reporting for the included case series and case reports was also insufficient. All included studies used spinal manipulation, and indicated an improvement in autistic symptoms after the manual therapeutic intervention.

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Autism and Chiropractic Page


Mild Traumatic Brain Injury After Motor Vehicle Collisions:
What Are the Symptoms and Who Treats Them?

By |January 29, 2017|Chronic Neck Pain, Whiplash|

Mild Traumatic Brain Injury After Motor Vehicle Collisions: What Are the Symptoms and Who Treats Them? A Population-Based 1-Year Inception Cohort Study

The Chiro.Org Blog

SOURCE:   Arch Phys Med Rehab 2014 (Mar); 95 (3 Sup): S286–294

Jan Hartvigsen, PhD, Eleanor Boyle, PhD,
J. David Cassidy, PhD, DrMedSc,
Linda J. Carroll, PhD

Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.

OBJECTIVE:   To describe the 1-year course of symptoms following mild traumatic brain injury (MTBI) sustained in a motor vehicle collision as well as patterns of care-seeking.

DESIGN:   One-year follow-up of a population-based inception cohort.

SETTING:   The province of Saskatchewan, Canada, with a population of about 1,000,000 inhabitants.

PARTICIPANTS:   Persons (N=1716) sustaining an MTBI during a car collision between November 1997 and December 1999.

INTERVENTIONS:   Not applicable.

MAIN OUTCOME MEASURES:   We report the prevalence of sleep disturbances, tiredness, dizziness, forgetfulness, vision problems, hearing problems, headache, neck pain, mid back pain, and low back pain at 6 weeks and 3, 6, 9, and 12 months postcollision. At the same time points, we report self-reported care-seeking from registered health care professionals.

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Chronic Neck Pain and Chiropractic Page


Dose-response of Spinal Manipulation for Cervicogenic Headache: Study Protocol for a Randomized Controlled Trial

By |January 25, 2017|Cervicogenic Headache|

Dose-response of Spinal Manipulation for Cervicogenic Headache: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog

Chiropractic & Manual Therapies 2016 (Jun 8); 24: 23 ~ FULL TEXT

Linda Hanson, Mitchell Haas, Gert Bronfort, Darcy Vavrek, Craig Schulz, Brent Leininger, Roni Evans, Leslie Takaki and Moni Neradilek

Center for Outcome Studies,
The University of Western States,
2900 NE 132nd Ave,
Portland, OR 97230 USA.

BACKGROUND:   Cervicogenic headache is a prevalent and costly pain condition commonly treated by chiropractors. There is evidence to support the effectiveness for spinal manipulation, but the dose of treatment required to achieve maximal relief remains unknown. The purpose of this paper is to describe the methodology for a randomized controlled trial evaluating the dose-response of spinal manipulation for chronic cervicogenic headache in an adult population.

METHODS/DESIGN:   This is a mixed-methods, two-site, prospective, parallel groups, observer-blind, randomized controlled trial conducted at university-affiliated research clinics in the Portland, OR and Minneapolis, MN areas. The primary outcome is patient reported headache frequency. Other outcomes include self-reported headache intensity, disability, quality of life, improvement, neck pain intensity and frequency, satisfaction, medication use, outside care, cervical motion, pain pressure thresholds, health care utilization, health care costs, and lost productivity. Qualitative interviews are also conducted to evaluate patients’ expectations of treatment.

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Headache and Chiropractic Page


GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

By |January 23, 2017|Guidelines|

GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

The Chiro.Org Blog

Brit Med J 2008 (Apr 26); 336 (7650): 924–926 ~ FULL TEXT

Gordon H Guyatt, Andrew D Oxman, Gunn E Vist,
Regina Kunz, Yngve Falck-Ytter

G H Guyatt
CLARITY Research Group,
Department of Clinical Epidemiology and Biostatistics,
Room 2C12, 1200 Main Street,
West Hamilton, ON, Canada L8N 3Z5

Guidelines are inconsistent in how they rate the quality of evidence and the strength of recommendations. This article explores the advantages of the GRADE system, which is increasingly being adopted by organisations worldwide.

From the FULL TEXT Article

Summary points

  • Failure to consider the quality of evidence can lead to misguided recommendations; hormone replacement therapy for post-menopausal women provides an instructive example
  • High quality evidence that an intervention’s desirable effects are clearly greater than its undesirable effects, or are clearly not, warrants a strong recommendation
  • Uncertainty about the trade-offs (because of low quality evidence or because the desirable and undesirable effects are closely balanced) warrants a weak recommendation
  • Guidelines should inform clinicians what the quality of the underlying evidence is and whether recommendations are strong or weak
  • The Grading of Recommendations Assessment, Development and Evaluation (GRADE ) approach provides a system for rating quality of evidence and strength of recommendations that is explicit, comprehensive, transparent, and pragmatic and is increasingly being adopted by organisations worldwide


Guideline developers around the world are inconsistent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face challenges in understanding the messages that grading systems try to communicate. Since 2006 the BMJ has requested in its “Instructions to Authors” on that authors should preferably use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for grading evidence when submitting a clinical guidelines article. What was behind this decision?

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Practice Guidelines Page


Interdisciplinary Practice Models for Older Adults With Back Pain

By |January 15, 2017|Interdisciplinary Practice, Interprofessional Collaboration|

Interdisciplinary Practice Models for Older Adults With Back Pain: A Qualitative Evaluation

The Chiro.Org Blog

SOURCE:   Gerontologist. 2017 (Jan 11) [Epub]

Stacie A. Salsbury, PhD, RN, Christine M. Goertz, DC, PhD,
Robert D. Vining, DC, Maria A. Hondras, DC, MPH, PhD,
Andrew A. Andresen, MD, Cynthia R. Long, PhD,
Kevin J. Lyons, PhD, Lisa Z. Killinger, DC and
Robert B. Wallace, MD, MS

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, Iowa.

PURPOSE:   Older adults seek health care for low back pain from multiple providers who may not coordinate their treatments. This study evaluated the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family medicine physicians and doctors of chiropractic.

DESIGN AND METHODS:   This qualitative evaluation was a component of a randomized controlled trial of 3 interdisciplinary models for back pain management: usual medical care; concurrent medical and chiropractic care; and collaborative medical and chiropractic care with interprofessional education, clinical record exchange, and team-based case management. Data collection included clinician interviews, chart abstractions, and fieldnotes analyzed with qualitative content analysis. An organizational-level framework for dissemination of health care interventions identified norms/attitudes, organizational structures and processes, resources, networks-linkages, and change agents that supported model implementation.

RESULTS:   Clinicians interviewed included 13 family medicine residents and 6 chiropractors. Clinicians were receptive to interprofessional education, noting the experience introduced them to new colleagues and the treatment approaches of the cooperating profession. Clinicians exchanged high volumes of clinical records, but found the logistics cumbersome. Team-based case management enhanced information flow, social support, and interaction between individual patients and the collaborating providers. Older patients were viewed positively as change agents for interprofessional collaboration between these provider groups.

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Low Back Pain and Chiropractic Page


Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex

By |January 11, 2017|Chiropractic Care, Neurology|

Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study

The Chiro.Org Blog

SOURCE:   Neural Plast. 2016 (Mar 7); 2016: 3704964 ~ FULL TEXT

Dina Lelic, Imran Khan Niazi, Kelly Holt,
Mads Jochumsen, Kim Dremstrup,
Paul Yielder, Bernadette Murphy,
Asbjørn Mohr Drewes, and Heidi Haavik

Department of Gastroenterology and Hepatology,
Aalborg University Hospital,
9000 Aalborg, Denmark

Objectives.   Studies have shown decreases in N30 somatosensory evoked potential (SEP) peak amplitudes following spinal manipulation (SM) of dysfunctional segments in subclinical pain (SCP) populations. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes.

Methods.   Nineteen subclinical pain volunteers attended two experimental sessions, SM and control in random order. SEPs from 62-channel EEG cap were recorded following median nerve stimulation (1000 stimuli at 2.3 Hz) before and after either intervention. Peak-to-peak amplitude and latency analysis was completed for different SEPs peak. Dipolar models of underlying brain sources were built by using the brain electrical source analysis. Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes, dipole locations, and dipole strengths.

Results.   SM decreased the N30 amplitude by 16.9 ± 31.3% (P = 0.02), while no differences were seen following the control intervention (P = 0.4). Brain source modeling revealed a 4-source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2% (P = 0.03) following SM.

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Neurology subsection