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

Chiro.Org Blog: The findings of this secondary analysis indicate that patients seeking intervention for LBP expect active interventions and manual therapy to significantly help improve their pain more than interventions like traction, rest, surgery, or medication. Additionally, in patients who meet the clinical prediction rule for good prognosis when managed with thrust techniques, treating with thrust techniques is more important than matching treatment to patient expectation. […]

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

Chiro.Org Blog: Our review adds new evidence to the Neck Pain Task Force and supports the use of clinical prediction rules in emergency care settings to screen for cervical spine injury in alert low-risk adult patients with blunt trauma to the neck. The Canadian C-spine rule consistently demonstrated excellent sensitivity and negative predictive values. Our review, however, suggests that the reproducibility of the clinical predictions rules varies depending on the examiners level of training and experience. […]

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

Chiro.Org Blog: Placebo recipients in clinical trials and experiments are exposed to a large number and variety of procedures, many of which might contribute to placebo effects. Researchers seeking to develop a translational science of placebo effects are thus faced with myriad possibilities. We have systematically identified and defined these procedures, classified them into five domains and suggested possible clinical applications. […]

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 […]

Chiropractic Spinal Manipulation and the Risk for Acute Lumbar Disc Herniation

Chiro.Org Blog: 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). […]

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 […]

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

Chiro.Org Blog: Overall, the 2 treatment groups were similar based on primary or secondary outcome measure scores for the full treatment period (4 weeks, with up to 7 treatments). However, there were statistically significant and clinically meaningful differences in both disability and pain scores at week 2 (midpoint) with 4 treatments, suggesting that the protocol of care had a more rapid effect than usual care. The results of this study offer guidance to musculoskeletal practitioners, who regularly use manual and manipulative therapy (MMT) for acute LBP, that an evidence-based, structured protocol of care may yield comparable results to usual care in a shorter period with less treatment. […]

Recommendations to the Musculoskeletal Health Network

Chiro.Org Blog: The preparedness of the musculoskeletal professions for providing appropriate care is demonstrated by the development of care algorithms based on the current best-available research evidence. [51] Such algorithms would help healthcare gate-keepers, such as GPs, to steer suitable patients towards early access and appropriate treatment for their back pain, with a view to reduce morbidity and prevent chronicity. An algorithm, such as the one proposed by Baker et al (2012) requires little modification to conform to Western Australian requirements and can be used in various professional contexts. The chiropractic profession, for example, has also developed a consensus-led definition and approach to wellness/wellbeing care that would act as a model to facilitate to correct management and treatment of non-malignant back pain within a multidisciplinary context. In fact, musculoskeletal clinicians, such as chiropractors, already implement the majority of the health promotion and wellness/wellbeing strategies recommended in both the SPMoC (2009) and the Western Australian Health Promotion Strategic Framework 2012–2016 with their private patients. [52] The same would easily translate to the public healthcare system and be used by other musculoskeletal clinicians. […]

Looking Ahead: Chronic Spinal Pain Management

Chiro.Org Blog: 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. […]

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

Chiro.Org Blog: This study found that patients with chronic neck pain with atraumatic onset in general were worse than those with pain from a non-traumatic origin on both the physical tests and self-reported health characteristics. There were no exclusive characteristics foreither group, and both groups presented a large variety of signs and symptoms. […]

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

Chiro.Org Blog: The recurrence rate of LBP using a stringent definition of recurrence was found to be low in this chiropractic LBP patient population. Nevertheless, the vast majority of patients were not pain free after 1 year. The recurrent course could be distinguished from the fast recovering and chronic patterns, but the differences with respect to the others subgroups were minor. The duration of complaint before treatment was the main predictor for recurrence. Of importance, a subacute duration, defined in the present study as longer than 14 days, significantly increased the odds for an unfavorable course of LBP, which is of clinical relevance. […]

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

Chiro.Org Blog: Two groups of idiopathic scoliosis patients received the same chiropractic rehabilitation treatment, including a baseline neurotransmitter panel. However, one group received treatment for abnormal neurotransmitter status while the other did not. The group that complied with supplement recommendations for their specific neurotransmitter imbalances demonstrated better Cobb angle correction at 6 months post-treatment as compared to the second group, who declined to follow the supplement recommendations. The results of this study suggest that neurotransmitter status needs to be more thoroughly explored in its potential relation to changes in the magnitude of scoliosis. Follow-up studies that substantiate our clinical observations during and after intervention are warranted. […]

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

Chiro.Org Blog: The 2014 SOSORT and SRS Non-Operative Committee consensus paper details the format and types of outcomes they collectively believe are the most important and relevant to the patient. Among the chiropractic studies located in this review, 2 described outcomes consistent with how SOSORT recommends they be reported. Given that these consensus papers form the basis for nonoperative treatment recommendations and outcome reporting, future chiropractic studies should seek to report their outcomes as recommended by these papers. This will allow for better interprofessional collaboration and methodologic comparison. […]

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

Chiro.Org Blog: 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. […]

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

Chiro.Org Blog: 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.   For patients with back-related leg pain (BRLP), SMT plus home exercise and advice (HEA) was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. […]