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Short Term Treatment Versus Long Term Management of Neck and Back Disability in Older Adults Utilizing Spinal Manipulative Therapy and Supervised Exercise

By |August 30, 2017|Chronic Low Back Pain, Chronic Neck Pain, exercise|

Short Term Treatment Versus Long Term Management of Neck and Back Disability in Older Adults Utilizing Spinal Manipulative Therapy and Supervised Exercise: A Parallel-group Randomized Clinical Trial Evaluating Relative Effectiveness and Harms

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2014 (Jul 23); 22: 26

Corrie Vihstadt, Michele Maiers,
Kristine Westrom, Gert Bronfort,
Roni Evans, Jan Hartvigsen and
Craig Schulz

Northwestern Health Sciencs University,
Wolfe-Harris Center for Clinical Studies,
2501 W 84th Street,
Bloomington 55431, MN, USA.


BACKGROUND:   Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability.

METHODS/DESIGN:   Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area.

PARTICIPANTS:   Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200).

INTERVENTIONS:   12 weeks SMT + SRE or 36 weeks SMT + SRE.

RANDOMIZATION:   Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes.

BLINDING:   Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment.

PRIMARY ENDPOINT:   36 weeks post-randomization.

DATA COLLECTION:   Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected.

PRIMARY ANALYSIS:   Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Exercise and Chiropractic Care Page

and the:

Chronic Neck Pain and Chiropractic Page

(more…)

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-related Leg Pain

By |August 28, 2017|Low Back Pain, Sciatica|

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-related Leg Pain: A Trial With Adaptive Allocation

The Chiro.Org Blog


SOURCE:   Ann Intern Med. 2014 (Sep 16); 161 (6): 381—391

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

University of Minnesota,
Northwestern Health Sciences University, and
Berman Center for Outcomes and Clinical Research at
the Minneapolis Medical Research Foundation,
Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research,
Davenport, Iowa.


BACKGROUND:   Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management.

OBJECTIVE:   To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.

DESIGN:   Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011.
(ClinicalTrials.gov: NCT00494065).

SETTING:   2 research centers (Minnesota and Iowa).

PATIENTS:   Persons aged 21 years or older with BRLP for least 4 weeks.

INTERVENTION:   12 weeks of SMT plus HEA or HEA alone.

MEASUREMENTS:   The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.

RESULTS:   Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over home exercise and advice (HEA) (difference, 10 percentage points [95% CI, 2 to 19]; P=0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P=0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.

There are more articles like this @ our NEW:

Exercise and Chiropractic Care Page

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Exploring the Definition of «Acute» Neck Pain

By |August 20, 2017|Acute Neck Pain, Chronic Neck Pain|

Exploring the Definition of «Acute» Neck Pain:
A Prospective Cohort Observational Study Comparing the Outcomes of Chiropractic Patients with 0-2 Weeks, 2-4 Weeks and 4-12 Weeks of Symptoms

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2017 (Aug 16); 25: 24

Luana Nyiro, Cynthia K. Peterson and
B. Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,
Forchstrasse 340, 8008
Zürich, Switzerland


BACKGROUND:   Neck pain is a common complaint in chiropractic patients. Amongst other baseline variables, numerous studies identify duration of symptoms as a strong predictor of outcome in neck pain patients. The usual time frame used for ‘acute’ onset of pain is between 0 and 4 weeks. However, the appropriateness of this time frame has been challenged for chiropractic low back pain patients. Therefore, the purpose of this study was to compare outcomes in neck pain patients with 0–2 vs 2–4 and 4–12 weeks of symptoms undergoing chiropractic treatment.

METHODS:   This is a prospective cohort observational study with 1 year follow-up including 495 patients whose data was collected between October 2009 and March 2015. Patients were divided into high-acute (0–2 weeks), mid-acute (2–4 weeks) and subacute (4–12 weeks) corresponding to duration of their symptoms at initial treatment. Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire for neck pain (BQN) at baseline. At follow-up time points of 1 week, 1 month, 3 months, 6 months and 1 year the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. The PGIC responses were dichotomized into ‘improved’ and ‘not improved’ patients and compared between the 3 subgroups. The Chi-square test was used to compare improved patients between the 3 subgroups and the unpaired Student’s t-test was used for the NRS and BQN change scores.

RESULTS:   The proportion of patients ‘improved’ was only significantly higher for patients with symptoms of 0–2 weeks compared to 2–4 weeks at the 1 week outcome time point (p = 0.015). The NRS changes scores were significantly greater for patients with 2–4 weeks of symptoms compared to 4–12 weeks of symptoms only at 1 week (p = 0.035).

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page

(more…)

Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

By |August 18, 2017|Cost-Effectiveness, Low Back Pain|

Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability Recurrence

The Chiro.Org Blog


SOURCE:   J Occupat Enviro Med 2011 (Apr); 53 (4): 396–404

Manuel Cifuentes, MD, PhD,
Joanna Willetts, MS, and
Radoslaw Wasiak, PhD, MA, MSc

Center for Disability Research
Liberty Mutual Research Institute for Safety
University of Massachusetts Lowell
Hopkinton, Mass


This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP).   They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio (HR) for disability recurrence between 3 types of providers:

Physical Therapists (PT),
Physicians (MD), or
Chiropractors (DC)
.

The results are quite interesting:

  • For PTs: HR = 2.0
  • For MDs: HR = 1.6
  • For DCs: HR = 1.0

Statistically, this means you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor.

You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.

The authors concluded:

In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services.”

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

There are more articles like this @ our:

Low Back Pain and Chiropractic Page
and the:

Cost-Effectiveness of Chiropractic Page

(more…)

Prevention and Health Promotion by Chiropractors

By |August 15, 2017|Health Promotion|

Prevention and Health Promotion by Chiropractors

The Chiro.Org Blog


SOURCE:   American J Lifestyle Medicine 2008;   2 (6):   537–545

Daniel Redwood, DC, and Gary Globe, MBA, DC, PhD

Cleveland Chiropractic College–Kansas City,
10850 Lowell Avenue,
Overland Park, KS 66210


Chiropractic care includes a variety of minimally invasive approaches, with both treatment and prevention as essential elements of clinical practice. Although chiropractic adjustment (manipulation) is the signature therapy and best-known identifier of the profession, the practice of chiropractic involves more than manual therapeutics. In general, chiropractors seek to bring a holistic worldview to the doctor–patient encounter, seeking not only to relieve pain and restore neuromusculoskeletal function but also to support the inherent self-healing and self-regulating powers of the body.

Aside from applying their diagnostic training to the evaluation of a variety of physical disorders and delivering manual adjustments and related therapeutic interventions, many chiropractors encourage patients to take an active role in restoring and maintaining health, with particular emphasis on doctor-guided self-care through exercise and nutrition. In this review, the authors summarize the peer-reviewed literature on chiropractic and prevention, describe health promotion and wellness approaches currently taught at chiropractic colleges and used in chiropractic clinical settings, discuss duration of care, emphasize the importance of interprofessional cooperation and collaboration, and address the hypothesis that chiropractic adjustments yield preventive effects.

There are more articles like this @ our:

Health Promotion, Wellness and Chiropractic Page

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Do Participants with Low Back Pain who Respond to Spinal Manipulative Therapy Differ Biomechanically?

By |August 13, 2017|Clinical Prediction Rule, Low Back Pain|

Do Participants with Low Back Pain who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

The Chiro.Org Blog


SOURCE:   Spine 2015 (Sep 1); 40 (17): 1329–1337

Arnold Y. L. Wong, PT, MPhil, PhD,
Eric C. Parent, PT, PhD,
Sukhvinder S. Dhillon, MB, ChB, CCST,
Narasimha Prasad, PhD,
and Gregory N. Kawchuk, DC, PhD

Department of Physical Therapy,
University of Alberta,
Alberta, Canada


STUDY DESIGN:   Nonrandomized controlled study.

OBJECTIVE:   To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls.

SUMMARY OF BACKGROUND DATA:   Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls.

METHODS:   Participants with LBP and asymptomatic controls attended 3 sessions for 7 days. On sessions 1 and 2, participants with LBP received SMT (+LBP/+SMT, n = 32) whereas asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from an LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/nonresponders on the basis of self-reported disability on day 7. A repeated measures analysis of covariance was used to compare apparent diffusion coefficients among responders, nonresponders, and +LBP/-SMT subjects, as well as spinal stiffness or multifidus thickness ratio among responders, nonresponders, and -LBP/-SMT subjects.

RESULTS:   After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups. Similarly, only SMT responders displayed significant post-SMT improvement in apparent diffusion coefficients.

There are more articles like this @ our:

Clinical Prediction Rule and the:

Low Back Pain and Chiropractic Page

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