February 2015
M T W T F S S
« Jan    
 1
2345678
9101112131415
16171819202122
232425262728  
Please support our Sponsors

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

The Chiro.Org Blog


SOURCE:   Am J Obstet Gynecol. 2013 (Apr);   208 (4):   295.e1-7

James W. George, DC, Clayton D. Skaggs, DC, Paul A. Thompson, PhD,
D. Michael Nelson, MD, PhD, Jeffrey A. Gavard, PhD, Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University,
Chesterfield, MO, USA.
james.george@logan.edu


OBJECTIVE:   Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN:   A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS:   The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

CONCLUSION:   A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.


From the Full-Text Article:

Introduction

Musculoskeletal pain in pregnant women commonly is viewed as transient, physiologic, and self-limited. However, most women report either low back pain (LBP) or pelvic pain (PP) during pregnancy [1-6] and the morbidity that is associated with such complaints. [7, 8] Moreover, up to 40% of patients report musculoskeletal pain during the 18 months after delivery, [2, 7, 9, 10] and one-fifth of these women have severe LBP that leads to major personal, social, or economic problems. [7, 9, 11] Pregnancy-related LBP contributes substantially to health care costs. For example, one-fifth of pregnant women in Scandinavian countries experience back pain as an indication for up to 7 weeks of sick leave in the perinatal period. [7, 9] Ninety-four percent of women who experienced LBP in an index pregnancy have recurrent symptoms with subsequent pregnancy, and two-thirds of these patients experience disability and require sick leave during pregnancy. Notably, 19% of women with pain in an initial pregnancy report avoidance of a future pregnancy out of fear of recurrence of the musculoskeletal symptoms. [11]

Continue reading A Randomized Controlled Trial Comparing a Multimodal Intervention and Standard Obstetrics Care for Low Back and Pelvic Pain in Pregnancy

Manual Therapy Followed by Specific Active Exercises

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises on the Improvement of Functional Disability in Patients with Chronic Non Specific Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2012 (Aug 28);   13:   162

Pierre Balthazard, Pierre de Goumoens, Gilles Rivier, Philippe Demeulenaere,
Pierluigi Ballabeni, and Olivier Dériaz

Physiotherapy Department,
HES-SO University of Applied Sciences Western Switzerland-HESAV,
Avenue de Beaumont,
Lausanne 1011, Switzerland.
pbalthaz@hecvsante.ch


BACKGROUND:   Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

METHODS:   Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.

RESULTS:   Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes.

CONCLUSIONS:   This study confirmed the immediate analgesic effect of manual therapy (MT) over sham therapy (ST). Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.


From the FULL TEXT Article:

Background

In developed countries, 60 to 80% of the active individuals suffer from low back pain (LBP) at least once in their life [1, 2]. Generally, patients with acute episode of non specific low back pain (ALBP) recover within 6 to 8 weeks, but the recurrence is frequent, and 7 to 10% of them will experience persistent pain and disabilities for more than 3 months [2-5]. Moreover, psycho-social, physical and behavioral components play an important role in the occurrence of chronic non specific low back pain (CNSLBP). Up to now, the treatment of CNSLBP is still complex and expensive and the outcome highly unpredictable [6-8].

There are many more articles like this @ our:

Low Back Pain and Chiropractic Page

Continue reading Manual Therapy Followed by Specific Active Exercises

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2015 (Jan 14) [Epub ahead of print]

James M. Whedon, DC, MS, Yunjie Song, PhD, Todd A. Mackenzie, PhD,
Reed B. Phillips, DC, PhD, Timothy G. Lukovits, MD, Jon D. Lurie, MD, MS

The Dartmouth Institute for Health Policy & Clinical Practice,
Dartmouth College,
Grantham, NH.
james.m.whedon@hitchcock.org


OBJECTIVE:   The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain.

METHODS:   This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts.

RESULTS:   The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19).

There are more articles like this @ our:

Stroke and Chiropractic Page

Continue reading Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B Beneficiaries Aged 66 to 99 Years With Neck Pain

Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects

Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects: A Preliminary Report of a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   Dis Markers. 2014; 2014 :815379

A. Achalandabaso, G. Plaza-Manzano, R. Lomas-Vega, A. Martínez-Amat,
M. V. Camacho, M. Gassó, F. Hita-Contreras, and F. Molina

Centro de Fisioterapia y Psicología Soluciona,
18002 Granada, Spain.


Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention.

Continue reading Tissue Damage Markers After a Spinal Manipulation in Healthy Subjects

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain:

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2013 (Apr 15);   38 (8):   627–634

Goertz, Christine M. DC, PhD; Long, Cynthia R. PhD;
Hondras, Maria A. DC, MPH; Petri, Richard MD;
Delgado, Roxana MS; Lawrence, Dana J. DC, MMedEd, MA;
Owens, Edward F. MS, DC; Meeker, William C. DC, MPH

Palmer Center for Chiropractic Research,
Davenport, IA 52803, USA.
christine.goertz@palmer.edu


STUDY DESIGN:   Randomized controlled trial.

OBJECTIVE:   To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel.

SUMMARY OF BACKGROUND DATA:   LBP is common, costly, and a significant cause of long-term sick leave and work loss. Many different interventions are available, but there exists no consensus on the best approach. One intervention often used is manipulative therapy. Current evidence from randomized controlled trials demonstrates that manipulative therapy may be as effective as other conservative treatments of LBP, but its appropriate role in the healthcare delivery system has not been established.

METHODS:   Prospective, 2-arm randomized controlled trial pilot study comparing SMC plus CMT with only SMC. The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).

RESULTS:   Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004). Mean numerical rating scale pain scores were also significantly better in the group that received CMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004).

Continue reading Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients with Acute Low Back Pain:

Life-Threatening Conditions That Walk:
A Clinician’s Review

Life-Threatening Conditions That Walk:
A Clinician’s Review

The Chiro.Org Blog


SOURCE:   J Amer Chiropr Assoc 2013 (Sept);   50 (5):   8-17

David J. Schimp, DC, DACNB, DAAPM

Clinician and Associate Professor
Texas Chiropractic College


Dr. Schimp describes the six most common undiagnosed life-threatening conditions encountered by chiropractors.

ABSTRACT

Chiropractors are hybrid physicians with a broad skill set. DCs need the diagnostic acumen of orthopedists and neurologists, a fine manual therapist’s hands, a psychologist’s insights, and the capacity to instantly respond to the unexpected. As front-line health care professionals, we may find ourselves serving as ER physicians. When a previously undiagnosed life- threatening condition shows up, we must recognize the problem and triage the patient appropriately. This article will review the six most common undiagnosed life-threatening conditions encountered by chiropractors.

Keywords:   cancer, abdominal aortic aneurysm, deep-vein thrombosis, pulmonary embolism, venous thromboembolism, stroke, cerebrovascular accident, subdural hematoma, myocardial infarction, red flag assessment, life- threatening conditions, chiropractor, chiropractic physician


INTRODUCTION

Daniel, et al., have identified the six most common life-threatening conditions that a chiropractic physician is likely to encounter in clinical practice. [1] The goal of this article is to translate the current evidence-based knowledge of these conditions into a quick-scan diagnostic and management reference for cancer, abdominal aortic aneurysm, venous thromboembolism, stroke, myocardial infarction, and subdural hematoma.



I. CANCER

Routine screening tests for the early detection of cancer save lives, but these tests are not without risk when applied indiscriminately. The potential for harm associated with routine screening includes:

a) false positives leading to unnecessary invasive testing,
b) stress and anxiety over test results,
c) financial issues, and
d) utilization costs [e.g., occupying an imaging device when someone else needs it more].

Although early detection may be desirable, it does not always mean that the patient will have a better clinical outcome. The following recommendations were adopted by the U.S. Preventive Services Task Force (USPSTF) and reflect best practices based on current knowledge. The guidelines can be viewed online, downloaded in a PDF format, or accessed through a mobile device using the Electronic Preventive Services Selector (ePSS) application. For a complete review of these guidelines, visit

http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Continue reading Life-Threatening Conditions That Walk:
A Clinician’s Review

WFC publishes suggested reading list of research papers

Source The World Federation of Chiropractic

The World Federation of Chiropractic (WFC) is pleased to announce the debut of an important, online, free service for the chiropractic profession and the public it serves – a Suggested Reading List of key research papers.

When you want an overview of research on a chiropractic topic, for yourself, for patients or to advocate for the profession, wouldn’t it be nice to have access to relevant papers collected in one location?

“That is the vision for this WFC project,” says WFC President Dr Greg Stewart of Canada. “The project is being led by Dr Greg Kawchuk of the University of Alberta, Chair of the WFC Research Council, who has brought together expert curators  from within the Research Council and abroad. We owe them a great debt for the expertise and hard work that has produced this exciting new service.”

The initial version of the Suggested Reading List goes live today at www.wfcsuggestedreadinglist.com  with 10 key papers curated in each of 21 subject areas.  These subject areas include cost-effectiveness of care, biomechanical and neurophysiological mechanisms of action, safety, pediatrics, wellness and many others. Each listed paper includes the published abstract and link to the original publication when available. Importantly, the site is searchable and visitors can leave suggestions for new topics and papers.

“This is just the beginning of this project,” explains Dr Kawchuk.  “We are already working on round two which will add new topic areas such as nutrition and public health.

This project has been possible because of generous sponsorship from NCMIC and Standard Process, two of the WFC’s long-standing and most supportive partners.

The WFC, whose members are 90 national associations of chiropractors worldwide including both the ACA and ICA in the USA, has been a non-governmental organization or NGO in official relations with the World Health Organization since 1997.  Its next major Congress is in Athens, Greece May 13-16, 2015. For more information visit www.wfc.org .

A Health Care System in Transformation:
Making the Case for Chiropractic

A Health Care System in Transformation:
Making the Case for Chiropractic

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2012 (Dec 6);20(1):37

Richard Brown

The Lansdown Clinic,
High Street,
Stroud, Gloucestershire, GL5 1AU, United Kingdom.
rbrown.bca@gmail.com


There are a number of factors that have conspired to create a crisis in healthcare. In part, the successes of medical science and technologies have been to blame, for they have led to survival where lives would previously have been cut short. An informed public, aware of these technological advances, is demanding access to the best that healthcare has to offer. At the same time the burden of chronic disease in an increasing elderly population has created a marked growth in the need for long term care. Current estimates for expenditure predict a rapid escalation of healthcare costs as a proportion of the GDP of developed nations, yet at the same time a global economic crisis has necessitated dramatic cuts in health budgets. This unsustainable position has led to calls for an urgent transformation in healthcare systems. This commentary explores the present day healthcare crisis and looks at the opportunities for chiropractors as pressure intensifies on politicians and leaders in healthcare to seek innovative solutions to a failing model. Amidst these opportunities, it questions whether the chiropractic profession is ready to accept the challenges that integration into mainstream healthcare will bring and identifies both pathways and potential obstacles to acceptance.

Keywords: Chiropractic, Healthcare transformation, Healthcare reform


From the Full-Text Article:

Background

A need for transformation in healthcare systems throughout the globe has long been recognised [1-3]. Social reform, improvements in living conditions and the positive impact of public health initiatives have all conspired to enhance quantity and quality of life [4]. As the baby boomers of the post World War Two era move into their twilight years enjoying a range of activities that would have left their ancestors aghast [5], western societies have experienced a steady increase in the size of the ageing population as communities dance, jog, cycle and gyrate their way into their eighties and nineties [6].

There are more articles like this @ our new:

Health Care Reform Page

Continue reading A Health Care System in Transformation:
Making the Case for Chiropractic

Immediate Effect of Spinal Manipulative Protocols on Kicking Speed Performance in Soccer Players

A Non-randomised Experimental Feasibility Study Into the Immediate Effect of Three Different Spinal Manipulative Protocols on Kicking Speed Performance in Soccer Players

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2015 (Jan 13)

Kyle Colin Deutschmann, Andrew Douglas Jones, Charmaine Maria Korporaal

Department of Chiropractic and Somatology,
Chiropractic Programme,
Durban University of Technology,
Durban, South Africa

Background   The most utilized soccer kicking method is the instep kicking technique. Decreased motion in spinal joint segments results in adverse biomechanical changes within in the kinematic chain. These changes may be linked to a negative impact on soccer performance. This study tested the immediate effect of lumbar spine and sacroiliac manipulation alone and in combination on the kicking speed of uninjured soccer players.

Methods   This 2010 prospective, pre-post experimental, single-blinded (subject) required forty asymptomatic soccer players, from regional premier league teams, who were purposively allocated to one of four groups (based on the evaluation of the players by two blinded motion palpators). Segment dysfunction was either localized to the lumbar spine (Group 1), sacroiliac joint (Group 2), the lumbar spine and sacroiliac joint (Group 3) or not present in the sham laser group (Group 4). All players underwent a standardized warm-up before the pre-measurements. Manipulative intervention followed after which post-measurements were completed. Measurement outcomes included range of motion changes (digital inclinometer); kicking speed (Speed Trac™ Speed Sport Radar) and the subjects’ perception of a change in kicking speed. SPSS version 15.0 was used to analyse the data, with repeated measures ANOVA and a p-value <0.05 (CI 95%).

Results   Lumbar spine manipulation resulted in significant range of motion increases in left and right rotation. Sacroiliac manipulation resulted in no significant changes in the lumbar range of motion. Combination manipulative interventions resulted in significant range of motion increases in lumbar extension, right rotation and right SI joint flexion. There was a significant increase in kicking speed post intervention for all three manipulative intervention groups (when compared to sham). A significant correlation was seen between Likert based-scale subjects’ perception of change in kicking speed post intervention and the objective results obtained.

Conclusions   This pilot study showed that lumbar spine manipulation combined with SI joint manipulation, resulted in an effective intervention for short-term increases in kicking speed / performance. However, the lack of an a priori analysis, a larger sample size and an unblinded outcome measures assessor requires that this study be repeated, addressing these concerns and for these outcomes to be validated.


From the FULL TEXT Article:

Introduction

The instep kicking technique is the most commonly used kicking technique in soccer, which allows the development of an optimum kicking speed [1-3]. This kicking technique requires that the power is generated through the co-ordinated effort of the muscles and the motion of all the joints involved (viz. lumbar spine, sacroiliac joint, hip, knee and foot and ankle) [4, 5]. Thus, this kicking technique’s biomechanics are seen as a segmented motion pattern sequence which initiates from the at the spine and moves distally down the open biomechanical chain [4-7]. As, the lumbar spine and sacroiliac joint are both proximal parts of this biomechanical chain, they form the basis for motion which follows the open chain movement pattern, and thus initiate the forward motion during kicking [2, 5]. Thus musculoskeletal co-ordination forms the basis for the kicking action and closely controls the compression forces being transferred towards the spine, stabilising and keeping the upper body balanced and upright, whilst transmitting the requires forces down the kinematic chain [8].

Continue reading Immediate Effect of Spinal Manipulative Protocols on Kicking Speed Performance in Soccer Players

Should Medicare Expand Coverage for Chiropractic Services?

Beyond Spinal Manipulation: Should Medicare Expand Coverage for Chiropractic Services? A Review and Commentary on the Challenges for Policy Makers

The Chiro.Org Blog


SOURCE:   Journal of Chiropractic Humanities 2013 (Aug 28);   20 (1):   9–18

James M. Whedon, DC, MS, Christine M. Goertz, DC, PhD,
Jon D. Lurie, MD, MS, and William B. Stason, MD, MSc

The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College, 30 Lafayette St, Lebanon, NH 03756, USA.
james.m.whedon@dartmouth.edu


OBJECTIVES:   Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, and occupational therapists; however, it does not reimburse the same services provided by chiropractic physicians. Advocates for expanded coverage of chiropractic services under Medicare cite clinical effectiveness and patient satisfaction, whereas critics point to unnecessary services, inadequate clinical documentation, and projected cost increases. To further inform this debate, the purpose of this commentary is to address the following questions:

(1) What are the barriers to expand coverage for chiropractic services?
(2) What could potentially be done to address these issues?
(3) Is there a rationale for Centers for Medicare and Medicaid Services to expand coverage for chiropractic services?

METHODS:   A literature search was conducted of Google and PubMed for peer-reviewed articles and US government reports relevant to the provision of chiropractic care under Medicare. We reviewed relevant articles and reports to identify key issues concerning the expansion of coverage for chiropractic under Medicare, including identification of barriers and rationale for expanded coverage.

RESULTS:   The literature search yielded 29 peer-reviewed articles and 7 federal government reports. Our review of these documents revealed 3 key barriers to full coverage of chiropractic services under Medicare: inadequate documentation of chiropractic claims, possible provision of unnecessary preventive care services, and the uncertain costs of expanded coverage. Our recommendations to address these barriers include the following: individual chiropractic physicians, as well as state and national chiropractic organizations, should continue to strengthen efforts to improve claims and documentation practices; and additional rigorous efficacy/effectiveness research and clinical studies for chiropractic services need to be performed. Research of chiropractic services should target the triple aim of high-quality care, affordability, and improved health.

There are more articles like this @ our:

Medicare Information Page

Continue reading Should Medicare Expand Coverage for Chiropractic Services?

Anatomy Curriculum For Chiropractic Training

Emphasis On Various Subtopics in the Anatomy Curriculum For Chiropractic Training: An International Survey of Chiropractors and Anatomists

The Chiro.Org Blog


SOURCE:   J Chiropr Educ. 2014 Dec 17. [Epub ahead of print]

Peter D. Chapman, MChiro, Amanda Meyer, PhD,
Kenneth Young, DC, MAppSc, Daniel Wibowo, MD,
and Bruce Walker, DrPH


Objective:   The aim of this study was to conduct an international survey of the perceived optimal level of anatomy teaching from anatomy academics and practicing chiropractors. We hypothesized that the optimum level of anatomical understanding for chiropractic students does not differ between the anatomists teaching the students and practicing chiropractors.

Methods:   The opinion of anatomists teaching in a chiropractic course (n = 16) was compared to practicing chiropractors (n = 589). The students’ level of understanding was based on the revised Bloom’s taxonomy for 16 different curriculum areas. Anatomists were recruited by contacting the accredited chiropractic courses worldwide. Snowball sampling was used for the practicing chiropractors. Independent-samples Mann-Whitney U tests were used to compare the results of anatomists and chiropractors.

Results:   Opinions differed between anatomists and chiropractors on 9 out of the 16 questions. Where opinions differed, chiropractors recommended a higher standard of anatomical knowledge. The level suggested by chiropractors for these curriculum areas is equal to the “evaluating” level where chiropractic students can remember, understand, apply, and analyze anatomical knowledge to be able to justify a clinical decision.

Conclusion:   Compared to anatomists working in chiropractic programs, chiropractors suggest a higher standard of anatomy be taught to undergraduates. Collaboration between chiropractors and anatomists would likely be beneficial in creating or modifying anatomy curricula for chiropractic students.


From the FULL TEXT Article:

INTRODUCTION

A sufficient knowledge or mastery of human anatomy is required by those working in the health professions. The level of knowledge differs among the different professions, with some requiring an in-depth knowledge of specific parts of the body rather than general anatomical knowledge. For example, dental students require emphasis on the oral cavity and podiatrists on the feet. For chiropractors, there is little research on the depth and breadth of research required for safe and effective practice. In Australia this situation is not unique to chiropractic; studies at medical schools have found that there is no consensus on exactly what students need to know. [1] Excerpts from accreditation requirements of several chiropractic bodies are shown in the Appendix (available online as supplemental material at www.journalchiroed.com).

Continue reading Anatomy Curriculum For Chiropractic Training

A Culture of Collaboration at an Integrative Health Center

A Culture of Collaboration
at an Integrative Health Center –
An Interview with David Fogel, MD –
Interviewed by Daniel Redwood, DC

The Chiro.Org Blog


SOURCE:   Topics in Integrative Health Care 2014, Vol. 5(3)

Daniel Redwood, DC



David Fogel, MD, is the cofounder (with his wife, Ilana Bar-Levav, MD), of the Casey Health Institute (CHI) in Gaithersburg, Maryland, a nonprofit integrative primary care practice that includes Internal Medicine, Family Practice, Chiropractic, Acupuncture, Massage Therapy, Yoga Therapy, Naturopathic Medicine and more. He is board certified in Internal Medicine with additional specialty training in mind/body focused individual and group psychotherapy.

As an internist, he served in the National Health Service Corps and on the staff at Johns Hopkins University School of Medicine, providing primary care to medically underserved inner city Baltimore residents. He has held positions as Medical Director of Employee Health at NASA Headquarters and as Medical Director of Integrative Medicine Associates in Washington, DC. Dr. Fogel holds a B.A. from Hampshire College and is a graduate of the George Washington University School of Medicine. He completed his residency at Washington Hospital Center.

In this interview, Dr. Fogel describes his journey from conventional to integrative medicine, the unique circumstances surrounding CHI’s founding, the collaborative relationships that comprise its core, and the ways he hopes it can serve as a model for new methods of healthcare delivery that are both effective and cost-effective.


Tell us how you first branched out from the conventional approaches you were taught in medical school.

I was first exposed to the concept of chi as a teenager. It’s kind of the classic story — I was beaten up, and as a result I got into the martial arts. There, I learned this incredible concept, that there was energy running through your body. That you can channel it, that it can be used for healing. So that opened me up at a young age to exploring other things. Then, I went to a kind of hippie college, Hampshire College, which opened me up to non-conventional alternatives of all kinds. This included mind-body approaches. I concentrated in humanistic psychology.

I went on to medical school. This was the era when Nixon went to China, and suddenly there were acupuncturists in the DC area. I said to myself, I need to go to an acupuncturist just to experience what it is. The Traditional Acupuncture Institute in Columbia, Maryland was just opening up (now Maryland University of Integrative Health). I kept reading and exploring these sorts of things throughout medical school. Then, in the 1990s, when David Eisenberg published his landmark article in the New England Journal of Medicine, about how many people were using complementary and alternative approaches, that gave a lot of people permission to start experimenting with different models, in a more mainstream or public way.

There are more articles like this @ our:

Alternative Medicine Articles Section

Continue reading A Culture of Collaboration at an Integrative Health Center

An interview with Dr Greg Stewart, president of the WFC

Greg Stewart

Dr Greg Stewart

Source Canadian Chiropractor

Mari-Len De Guzman of Canadian Chiropractor magazine talked with the president of the World Federation of Chiropractic Dr Greg Stewart about global opportunities, collaboration and the chiropractic values.

What Dr Stewart is most excited about is the opportunity to help advance the chiropractic profession as an equal player in the global health care arena, helping solve some of the world’s most pressing health issues.

“The opportunities have never been better. It’s a matter of whether we have the courage to walk through the doors that are open”, says Stewart. The World Health Organization has acknowledged the need for leadership in the area of spinal disorders, which are now a greater contributor to the burden of disease than HIV/AIDS, malaria, stroke, lung and breast cancer, and diabetes.

Says Stewart, “We have the ability to change the way the world is dealing with their health care. It’s cost-effective, it’s drugless, it has unlimited possibilities to help improve the health of the world and decrease the burden of disability world-wide.”

There are many reasons to be encouraged. “We have situations like in Denmark and Switzerland, where the curriculum for chiropractic and medicine is the same for the first three years, with chiropractic and medical students in the same classes until they branch off to their different streams in later years, “ Stewart notes. This early exposure to one another is enabling a new generation of health care practitioners that is much more inclined to collaboration.

“We have to leave our little comfortable areas and actually go into areas that are challenging, and sometimes confrontational, in order to get ahead,” he says.

Stewart acknowledges there are still ongoing issues that may have to be ironed out within the profession, but cautions against letting these internal disagreements get in the way of progress for the profession.

Stewart is confident the profession can effect big changes in health care, nationally and globally. “It’s my personal goal to really move away from chiropractic just trying to survive, into a world where we flourish.”

Read the full interview at Canadian Chiropractor.

Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

The Chiro.Org Blog


SOURCE:   Spine (Phila Pa 1976). 2014 (Dec 9) [Epub ahead of print]

James M Whedon, DC, MS; Todd A Mackenzie, PhD;
Reed B Phillips, DC, PhD; Jon D Lurie, MD, MS

The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH

Southern California University of Health Sciences,
Whittier, CA


Study Design.   Retrospective cohort study

Objective.   In older adults with a neuromusculoskeletal complaint, to evaluate risk of injury to the head, neck or trunk following an office visit for chiropractic spinal manipulation, as compared to office visit for evaluation by primary care physician

Summary of Background Data.   The risk of physical injury due to spinal manipulation has not been rigorously evaluated for older adults, a population particularly vulnerable to traumatic injury in general.

Methods.   We analyzed Medicare administrative data on Medicare B beneficiaries aged 66-99 with an office visit in 2007 for a neuromusculoskeletal complaint. Using a Cox proportional hazards model, we evaluated for adjusted risk of injury within 7 days, comparing two cohorts: those treated by chiropractic spinal manipulation vs. those evaluated by a primary care physician. We used direct adjusted survival curves to estimate the cumulative probability of injury. In the chiropractic cohort only, we used logistic regression to evaluate the effect of specific chronic conditions on likelihood of injury.

Results.   The adjusted risk of injury in the chiropractic cohort was lower as compared to the primary care cohort (hazard ratio 0.24; 95% CI 0.23-0.25). The cumulative probability of injury in the chiropractic cohort was 40 injury incidents per 100,000 subjects, as compared to 153 incidents per 100,000 subjects in the primary care cohort. Among subjects who saw a chiropractic physician, the likelihood of injury was increased in those with a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term use of anticoagulant therapy.

There are more articles like this @ our:

Stroke and Chiropractic Page

Continue reading Risk of Traumatic Injury Associated with Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66-99

The Medical Monopoly:
Protecting Consumers Or Limiting Competition?

The Medical Monopoly:
Protecting Consumers Or Limiting Competition?

The Chiro.Org Blog


SOURCE:   The Cato Institute Policy Analysis No. 246

by Sue A. Blevins

Sue A. Blevins is a writer and health policy consultant based in Boston.


Executive Summary

Nonphysician providers of medical care are in high demand in the United States. But licensure laws and federal regulations limit their scope of practice and restrict access to their services. The result has almost inevitably been less choice and higher prices for consumers.

Safety and consumer protection issues are often cited as reasons for restricting nonphysician services. But the restrictions appear not to be based on empirical findings. Studies have repeatedly shown that qualified nonphysician providers–such as midwives, nurses, and chiropractors — can perform many health and medical services traditionally performed by physicians — with comparable health outcomes, lower costs, and high patient satisfaction.

Licensure laws appear to be designed to limit the supply of health care providers and restrict competition to physicians from nonphysician practitioners. The primary result is an increase in physician fees and income that drives up health care costs.

At a time government is trying to cut health spending and improve access to health care, it is imperative to examine critically the extent to which government policies are responsible for rising health costs and the unavailability of health services. Eliminating the roadblocks to competition among health care providers could improve access to health services, lower health costs, and reduce government spending.

Introduction

There are more articles like this @ our:

Alternative Medicine Articles Collection

Continue reading The Medical Monopoly:
Protecting Consumers Or Limiting Competition?