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Patient Expectations of Benefit from Common Interventions for Low Back Pain and Effects on Outcome

Patient Expectations of Benefit from Common Interventions for Low Back Pain and Effects on Outcome: Secondary Analysis of a Clinical Trial of Manual Therapy Interventions

The Chiro.Org Blog


SOURCE:   J Man Manip Ther. 2011 (Feb);   19 (1):   20–25

Mark D Bishop, Joel E Bialosky & Josh A Cleland

Department of Physical Therapy,
University of Florida, USA.


OBJECTIVES:   The purpose of this secondary analysis was 1) to examine patient expectations related to a variety of common interventions for low back pain (LBP) and 2) to determine the influence that specific expectations about spinal manipulation might have had on self-report of disability.

METHODS:   We collected patients’ expectations about the benefit of specific interventions for low back pain. We also collected patients’ general expectations about treatment and tested the relationships among the expectation of benefit from an intervention, receiving that intervention and disability-related outcomes.

RESULTS:   Patients expected exercise and manual therapy interventions to provide more benefit than surgery and medication. There was a statistical association between expecting relief from thrust techniques and receiving thrust techniques, related to meeting the general expectation for treatment (chi-square: 15.5, P = 0.008). This was not the case for patients who expected relief from thrust techniques but did not receive it (chi-square: 6.9, P = 0.4). Logistic regression modeling was used to predict change in disability at treatment visit 5. When controlling for whether the general expectations for treatment were met, intervention assignment and the interaction between intervention assignment and expectations regarding thrust techniques, the parsimonious model only included intervention as the significant contributor to the model (P < 0.001). The adjusted odds ratio of success comparing thrust techniques to non-thrust in this study was 41.2 (11.0, 201.7).

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Patient Expectations of Relief

a subsection of our
Chiropractic and Spinal Pain Page

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Validity and Reliability of Clinical Prediction Rules used to Screen for Cervical Spine Injury in Alert Low-risk Patients with Blunt Trauma to the Neck

Validity and Reliability of Clinical Prediction Rules used to Screen for Cervical Spine Injury in Alert Low-risk Patients with Blunt Trauma to the Neck: Part 2. A Systematic Review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2017 (Sep 22) [Epub]

N. Moser, N. Lemeunier, D. Southerst,
H. Shearer, K. Murnaghan, D. Sutton, P. Cote

Division of Graduate Education and Research,
Canadian Memorial Chiropractic College (CMCC),
6100 Leslie Street,
Toronto, ON, Canada.


PURPOSE: &nbsp To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) on the validity and reliability of clinical prediction rules used to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck.

METHODS: &nbsp We searched four databases from 2005 to 2015. Pairs of independent reviewers critically appraised eligible studies using the modified QUADAS-2 and QAREL criteria. We synthesized low risk of bias studies following best evidence synthesis principles.

RESULTS: &nbsp We screened 679 citations; five had a low risk of bias and were included in our synthesis. The sensitivity of the Canadian C-spine rule ranged from 0.90 to 1.00 with negative predictive values ranging from 99 to 100%. Inter-rater reliability of the Canadian C-spine rule varied from k = 0.60 between nurses and physicians to k = 0.93 among paramedics. The inter-rater reliability of the Nexus Low-Risk Criteria was k = 0.53 between resident physicians and faculty physicians.

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What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain?

What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain? A Literature Review and Survey to Develop a Taxonomy

The Chiro.Org Blog


SOURCE:  

Felicity L Bishop, Beverly Coghlan, Adam WA Geraghty,
Hazel Everitt, Paul Little, Michelle M Holmes,
Dionysis Seretis, George Lewith

Department of Psychology,
Faculty of Social Human and Mathematical Sciences,
University of Southampton,
Southampton, UK.


OBJECTIVES:   Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice.

DESIGN:   Literature review and survey.

METHODS:   We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature.

RESULTS:   The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patient—practitioner interaction (7 procedures and 18 clinical applications).

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A Typical Week at the St. Louis VA Medical Center

A Typical Week at the St. Louis VA Medical Center

The Chiro.Org Blog


SOURCE:   ACA Blog ~ 9–19–2017

By Steven Huybrecht, DC

VA St. Louis Healthcare System


I’ve had more than a handful of family and friends ask me, “What’s it like working for the VA in St Louis?” and my response is always the same—“It’s great!” I usually then proceed to give them a rundown of what a typical week looks like as my activities vary from day to day and sometimes from month to month.

An average week is broken down into four different segments:

outpatient clinic,
interdisciplinary pain rehabilitation (IPR) program,
scholarly activities, and
clinical rotations.

The majority of my time is spent in clinic helping veterans manage their pain and develop healthy habits for self-care. However, the time spent outside the clinic has also been beneficial for personal development and education.

On Mondays, Wednesdays and Fridays, I provide chiropractic care in the pain clinic during our normal hours of 8 a.m.- 4 p.m. along with the program director Dr. Pamela Wakefield and attending chiropractor Dr. Glenn Bub. I usually see anywhere from six to eight veterans on an average day, some more clinically complex than others. We have a (relatively) small workspace, but are very busy and have a full schedule on almost every clinic day.

This time is the “bread and butter” of my week where I’m working with veterans who not only have pain issues, but also often have multiple comorbidities. I spent over two years in private practice before starting at the St. Louis VA Healthcare System and have already seen more complexity in my patient population in the first two months of my residency than I saw in those previous two years.

On Tuesdays, in addition to treating veterans I have some scholarly time. One of the recent projects I participated in with two other residents, Nicholas Evertz from Canandaigua, N.Y. and Rachel Mooers from Los Angeles, Calif., was to create a presentation of evidence-based spinal examination procedures. After scouring the literature and cultivating sources, the best tests for diagnosing spinal-related complaints were established. This taught us not only how to critically appraise research, but also how to work together from different sites across the United States.

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Chiropractic Care For Veterans Page

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Chiropractic Spinal Manipulation and the Risk for Acute Lumbar Disc Herniation

Chiropractic Spinal Manipulation and the Risk for Acute Lumbar Disc Herniation: A Belief Elicitation Study

The Chiro.Org Blog


SOURCE:   European Spine Journal 2017 (Sep 18)

Cesar A. Hincapie, J. David Cassidy,
Pierre Côté, Raja Rampersaud
Alejandro R. Jadad, George A. Tomlinson

Injury Prevention Research Office, Division of Neurosurgery,
Li Ka Shing Knowledge Institute, St. Michael’s Hospital,
Toronto, Canada


Background   Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians’ beliefs regarding the risk for acute LDH associated with chiropractic SMT.

Methods   Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants’ elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT.

Results   Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39–1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64–1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95–1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29–0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11–1.59).

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Page
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Disc Herniation and Chiropractic Page

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Founder’s Day:   Chiropractic Turns 122 Today

Founder’s Day:   Chiropractic Turns 122 Today

The Chiro.Org Blog


     
Harvey Lillard (L)               D.D. Palmer (R)

The Story of Chiropractic

The year was 1895, the same year that x-rays were discovered. At that time, Health Care was provided by a diverse group of unregulated and unlicensed professions, including osteopaths, magnetic healers, and “medical” doctors.   In those days, most medical education consisted of working as an “apprentice” for a medical doctor, and learning the craft by observation.

D.D. Palmer, the Father of Chiropractic, was a magnetic healer,
with a huge practice in Davenport, Iowa.   He had doubts about the
“germ theory” as the complete explanation for the cause of all disease.

After all, if germs kill… shouldn’t we all be dead?   He asked himself:

how it was that 2 brothers could work in the same shop, eat the same food, sleep in the same bed, and that one would succumb to a disease while the other one would not”?

His theory evolved that it was not just the “seed” (or germ) which was the sole cause of dis-ease.   He felt that the “soil”, or the recuperative power of the body (which he later referred to as “innate intelligence”, and we now call homeostasis) was the missing component of the equation, which defines the continuum between health and “dis-ease”.

One day D.D. was talking with Harvey Lillard, the man who owned the janitor service in his building.   Harvey was deaf.   He mentioned to D.D. that years before, while lifting a heavy weight, he felt something “snap” at the base of his neck.   Shortly thereafter his hearing started to fade.

D.D. was intrigued, and asked Harvey if he could have permission examine his back.   What D.D. “felt” (we refer to this art as “palpation) was that one of the upper thoracic bones was sticking out much more than the one above or below it.   He explained to Harvey that he felt that this “bone out of place
could be causing pressure on his spinal cord, and that this could be the
reason that Harvey was now deaf.

Continue reading Founder’s Day:   Chiropractic Turns 122 Today

A Structured Protocol of Evidence-based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain

A Structured Protocol of Evidence-based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Arch Phys Med Rehabil. 2012 (Jan); 93 (1): 11–20

Gregory F. Parkin-Smith, MTech(Chiro), MSc, DrHC,
Ian J. Norman, BSc, MSc, PhD,
Emma Briggs, BSc, PhD, RN,
Elizabeth Angier, BSc, MSc(Chiro),
Timothy G. Wood, BSc, MTech(Chiro),
James W. Brantingham, DC, PhD

School of Chiropractic & Sports Science,
Murdoch University,
Perth, Australia.


OBJECTIVE:   To compare a protocol of evidence-based conservative care with usual care for acute nonspecific low back pain (LBP) of less than 6 weeks’ duration.

DESIGN:   Parallel-group randomized trial.

SETTING:   Three practices in the United Kingdom.

PARTICIPANTS:   Convenience sample of 149 eligible patients were invited to participate in the study, with 118 volunteers being consented and randomly allocated to a treatment group.

INTERVENTIONS:   The experimental group received evidence-based treatments for acute nonspecific LBP as prescribed in a structured protocol of care developed for this study. The control group received usual conservative care. Participants in both groups could receive up to 7 treatments over a 4-week period.

MAIN OUTCOME MEASURES:   Oswestry Low Back Disability Index (ODI), visual analog scale (VAS), and Patient Satisfaction Questionnaire, alongside estimation of clinically meaningful outcomes.

RESULTS:   Total dropout rate was 14% (n=16), with 13% of data missing. Missing data were replaced using a multiple imputation method. Participants in both groups received an average of 6 treatments. There was no statistically significant difference in disability (ODI) scores at the end of week 4 (P=.33), but there was for pain (VAS) scores (P< .001). Interestingly, there were statistically significant differences between the 2 groups for both disability and pain measures at the midpoint of the treatment period (P<.001). Patient satisfaction with care was equally high (85%) in both groups. Minimally clinically important differences in scores and number needed to treat scores (NNT<6) indicated that the experimental treatment (protocol of care) offered a clinically meaningful benefit over the control treatment (usual care), particularly at the midpoint of the treatment period.

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Recommendations to the Musculoskeletal Health Network

Recommendations to the Musculoskeletal Health Network, Health Department of Western Australia related to the Spinal Pain Model of Care made on behalf of the Chiropractors Association of Australia (Western Australian Branch)

The Chiro.Org Blog


SOURCE:   Topics in Integrative Health Care 2014 (Jun 30); 5 (2)

Lyndon G. Amorin-Woods, BAppSci(Chiropractic),
Gregory F. Parkin-Smith, MTech(Chiro), MBBS, MSc, DrHC,
Vern Saboe, DC, DACAN, FACO,
Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC


The 2009 Spinal Model of Care published by the Western Australian Health Department via the Musculoskeletal Health Network would benefit from an update. Best-evidence synthesis and cost-risks-benefits estimations suggest that such guidelines should provide:

(1)   the early assessment of patients with non-malignant spinal pain (particularly low back) by a musculoskeletal clinician, be it a chiropractor, musculoskeletal physician, osteopath or musculoskeletal physiotherapist with referral within the early stages of the disorder; and

(2)   the provision of manipulative therapy, where indicated, as a first-line treatment while also providing rehabilitation, health promotion, and contemporary wellness/wellbeing management with the intention of avoiding chronicity.

Emerging workforce capacity suggests that early assessment and evidence-based management of non-malignant spinal pain is feasible, leading to better patient outcomes. The authors and the association are hopeful that providing this submission in open access may prove useful for advocates of the chiropractic profession in other jurisdictions.


From the FULL TEXT Article:

Background

The importance of addressing spinal pain in the Australian community in a cost effective and clinically appropriate manner is illustrated in a series of studies emerging from the Global Burden of Disease 2010 Project. [1] It is well-known that musculoskeletal conditions, such as low back pain, neck pain and arthritis, affect more than 1.7 billion people worldwide and are set to become more prevalent with a growing, ageing, developed world population. [2] Australian chiropractors may occupy a pivotal role in the cost effective management of these clinical presentations.

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Chiropractic and Spinal Pain Management

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Looking Ahead: Chronic Spinal Pain Management

Looking Ahead: Chronic Spinal Pain Management

The Chiro.Org Blog


SOURCE:   Journal of Pain Research 2017 (Aug 30); 10: 2089–2095

Gregory F Parkin-Smith, Stephanie J Davies,
Lyndon G Amorin-Woods

School of Health Professions,
Murdoch University,
Perth, WA, Australia


The other day, we oversaw a seminar on pain management for a local consumer pain group, where all consumers (patients) in attendance were experiencing chronic, persistent spinal pain. Each person had a unique story, and their experience and perceived cause of their pain differed. The quality of life in all these consumers was markedly reduced, which was the only clear similarity, confirming that there may be some similarities in the pain experience, but the pain experience was more often unique and individual. These consumers’ criticisms of care services were consistent, however, with dissatisfaction with their access to care and overall management of their pain. They described variable and often difficult access, limited continuity of care, they were often not taken seriously by health care providers, they received scant information about chronic pain and its prognosis and there were often noteworthy variations in the treatment they received. We agree that these criticisms are commonplace and a frequent gripe directed at health care practitioners about the “system.” [1] Moreover, the problems associated with care delivery are confounded by a number of patient/consumer factors, such as lifestyle habits, nutrition, body weight, depression, health literacy, geographical isolation and poor socioeconomic conditions, making the management of persistent pain even more complicated. [2] There is no doubt that, in the future, matching the care service and treatment with the individual patient will become an essential component of care services, as has been implied in published research. [3-6]

Health care practitioners involved in the triage and management of patients with persistent spinal pain will need to become more vigilant about individualizing and coordinating care for each patient, to achieve the best possible outcomes. For example, Cecchi et al concluded that patients with chronic (persistent) lower baseline pain (LBP)-related disability predicted “nonresponse” to standard physiotherapy, but not to spinal manipulation (an intervention commonly employed by chiropractors [7-9]), implying that spinal manipulation should be considered as a first-line conservative treatment. [9] We note that spinal manipulation is now suggested as the first-line intervention by Deyo, [10] since not a single study examined in a recent systematic review found that spinal manipulation was less effective than conventional care. [11]

Garcia et al, [12] conversely, showed that high pain intensity may be an important treatment effect modifier for patients with chronic low back pain receiving Mckenzie therapy (a treatment frequently used by physiotherapists). These examples demonstrate the importance of matching treatments with the characteristics of the patient.

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Chiropractic and Spinal Pain Management

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Chronic Neck Pain Patients With Traumatic or Non-traumatic Onset: Differences in Characteristics

Chronic Neck Pain Patients With Traumatic or Non-traumatic Onset: Differences in Characteristics.
A Cross-sectional Study

The Chiro.Org Blog


SOURCE:   Scand J Pain. 2017 (Jan); 14: 1-8

Inge Ris, Birgit Juul-Kristensen, Eleanor Boyle,
Alice Kongsted, Claus Manniche, Karen Søgaard

Research Unit for Musculoskeletal Function and Physiotherapy,
Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230 Odense M, Denmark;


BACKGROUND AND AIMS:   Patients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness.

METHODS:   This cross-sectional study included 200 participants with chronic neck pain: 120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p<0.01. Differences between groups for the continuous data were determined using either a Student’s t-test or Mann Whitney U test.

RESULTS:   In both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs. 138 months p=0.001). Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p=0.005, cranio-cervical flexion test p=0.007, cervical extensor test p=0.006) and cervical pressure pain threshold bilateral (p=0.002/0.004), as well on self-reported function (Neck Disability Index p=0.001 and Patient-Specific Functional Scale p=0.007), mental quality of life (mental component summary of the Short Form Health Survey p=0.004 and EuroQol-5D p=0.001) and depression (Beck Depression Inventory-II p=0.001).

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An Observational Study on Recurrences of Low Back Pain During the First 12 Months After Chiropractic Treatment

An Observational Study on Recurrences of Low Back Pain During the First 12 Months After Chiropractic Treatment

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2017 (Jul); 40 (6): 427–433

Christina Knecht, BMed,
Barry Kim Humphreys, DC, PhD,
Brigitte Wirth, PT, MSc, PhD

Chiropractic Medicine Department,
Faculty of Medicine,
University of Zürich and University Hospital Balgrist,
Zürich, Switzerland.


OBJECTIVES:   The purpose of this study was to investigate recurrence rate and prognostic factors in a large population of patients with low back pain (LBP) up to 1 year after chiropractic care using standardized definitions.

METHODS:   In Switzerland, 722 patients with LBP (375 male; mean age = 44.5 ± 13.8 years) completed the Numeric Rating Scale for pain (NRS) and the Oswestry Disability Index (ODI) before treatment and 1, 3, 6, and 12 months later (ODI up to 3 months). Based on NRS values, patients were categorized as “fast recovery,” “slow recovery,” “recurrent,” “chronic,” and “others.” In multivariable logistic regression models, age, sex, work status, duration of complaint (subacute: ≥14 days to <3 months; chronic: ≥3 months), previous episodes, baseline NRS, and baseline ODI were investigated as predictors.

RESULTS:   Based on NRS values, 13.4% of the patients were categorized as recurrent. The recurrent pattern significantly differed from fast recovery in duration of complaint (subacute: odds ratio [OR] = 3.3; chronic: OR = 10.1). The recurrent and chronic pattern significantly differed in duration of complaint (chronic: OR = 0.14) and baseline NRS (OR = 0.75).

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Can Neurotransmitter Status Affect the Results of Exercise-Based Scoliosis Treatment?

Can Neurotransmitter Status Affect the Results of Exercise-Based Scoliosis Treatment? Results of a Controlled Comparative Chart Review

The Chiro.Org Blog


SOURCE:   Alternative & Integrative Medicine 2014 (Nov 20); 3: 177

Mark W Morningstar, Aatif Siddiqui,
Brian Dovorany and Clayton J Stitzel

Natural Wellness & Pain Relief Center
8293 Office Park Dr.,
Grand Blanc, MI 48439, USA


Idiopathic scoliosis has long been held as a purely orthopedic spinal deformity without a known origin. Hence all treatment of scoliosis has involved physical methods exclusively to treat the condition, whether by bracing, surgery, or exercise-based methods. Over the last several years many authors have introduced etiological concepts of scoliosis involving multiple biochemical central nervous system pathways, such as neurotransmitter imbalances. The purpose of this study is to evaluate how these neurotransmitter imbalances affect patients’ ability to participate in a scoliosis therapy program and the ability of the resultant radiographic changes to be maintained. Two groups of patients performed baseline neurotransmitter testing, and completed a short-term chiropractic rehabilitation program for scoliosis. One group additionally participated in a nutrient program designed to rebalance their neurotransmitter levels, while the second group declined. Both groups were evaluated 6 months after the completion of their rehabilitation program to evaluate Cobb angle changes

Keywords   Chiropractic; Nutrition; Scoliosis; Spine; Rehabilitation


From the Full-Text Article:

Introduction:

Scoliosis is historically thought of as a purely biomechanical or orthopedic disorder of the spine wherein the spine curves greater than 10 degrees on radiographic assessment. [1] Conventional treatments of scoliosis have been entirely based upon this model of scoliosis, whether it be bracing or surgery. Both of these treatments entirely focus upon the spine curvature, and attempt to straighten or stabilize the spine throughout the human growing years.

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Chiropractic Treatments for Idiopathic Scoliosis: A Narrative Review Based on SOSORT Outcome Criteria

Chiropractic Treatments for Idiopathic Scoliosis: A Narrative Review Based on SOSORT Outcome Criteria

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2017 (Mar); 16 (1): 64–71

Mark W. Morningstar, DC, PhD, Clayton J. Stitzel, DC,
Aatif Siddiqui, DC, Brian Dovorany, DC

Natural Wellness & Pain Relief Center,
Grand Blanc, MI.


OBJECTIVE:   The purpose of this review was to evaluate the current body of literature on chiropractic treatment of idiopathic scoliosis against the 2014 consensus paper of the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) and the Scoliosis Research Society (SRS) Non-Operative Management Committee for outcome reporting in nonoperative treatments.

METHODS:   A search of the PubMed and Index to Chiropractic Literature databases for studies published from January 2000 through February 2016 detailing specific treatments and outcomes for idiopathic scoliosis was conducted.

RESULTS:   A total of 27 studies that discussed chiropractic scoliosis treatments were identified. Of these, there were 15 case reports, 10 case series, 1 prospective cohort, and 1 randomized clinical trial. Of the 27 studies, only 2 described their outcomes as recommended in the 2014 SOSORT and SRS Non-Operative Management Committee consensus paper.

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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

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.

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Exercise and Chiropractic Care Page and the:

Chronic Neck Pain and Chiropractic Page

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

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

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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.

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