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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. […]

Exploring the Definition of «Acute» Neck Pain

Chiro.Org Blog: The time period with 0–4 weeks of symptoms as the definition of “acute” neck pain should be maintained. Patients with a shorter period (0–2 weeks) of symptoms recover faster than patients with a longer period of symptoms (2–4 weeks) but this difference is only statistically significant at the 1 week and 1 month time periods. These results for neck pain patients are different from those obtained in the similar study investigating acute low back pain patients where the 0–2 weeks time period as the definition of ‘acute’ was recommended. Medium-term and long-term outcome is favourable for acute as well as subacute neck pain patients, independent of the exact duration of symptoms. […]

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

Chiro.Org Blog: After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type. Even without an improvement in days until recurrent disability, our findings seem to support the use of chiropractor services, as chiropractor services generally cost less than services from other providers. […]

Prevention and Health Promotion by Chiropractors

Chiro.Org Blog: Chiropractic is currently in transition, steadily moving toward a more mainstream status. Chiropractors can play a meaningful role in both treatment and prevention, complementing the efforts of other healing arts. Recent changes in the public health curricula of chiropractic colleges, with strong support from the Council on Chiropractic Education, demonstrate a dramatic upgrading of evidence-based prevention approaches in chiropractic educational settings. As students with greatly enhanced prevention training graduate and begin their careers, this should ripple across the mainstream of chiropractic. […]

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

Chiro.Org Blog: Our results demonstrate that those reporting post-SMT improvement in disability have coherent changes in multiple, objective measures of spinal biomechanics. This same coherence does not exist for asymptomatic controls or no-treatment symptomatic controls. Our data further support a differential effect of SMT on a specific constellation of biomechanical outcomes that are not responsive in all patients with LBP. This work provides a foundation from which to investigate the heterogeneous nature of LBP, the mechanisms underlying differential therapeutic response, and the biomechanical characteristics defining the responders at baseline. […]

Effectiveness of Manual Therapy for Chronic Tension-type Headache

Chiro.Org Blog: We performed a pragmatic, randomised clinical trial to evaluate the effect of manual therapy compared to usual care by the general practitioner. Based on this trial, we conclude that manual therapy provides an effective intervention for patients with chronic tension-type headache (CTTH) and, thereby, an effective option for referral for the general practitioner. […]

Essential Literature for the Chiropractic Profession

Chiro.Org Blog: A systematic approach to surveying educators in all international chiropractic institutions was accomplished. The results of this survey provide a cursory list of essential literature for the chiropractic profession. An interesting follow-up or related study would be an examination of the scientific literature used in chiropractic program syllabi. We recommend establishment of a chiropractic faculty registry for ease of communication and collaboration. This could be done under a current established organization, such as the WFC, or alternatively as an international entity affiliated with the ACC. […]

International Web Survey of Chiropractic Students About Evidence-based Practice

Chiro.Org Blog: The results of this survey indicate that although it appears feasible to conduct a web-based survey with chiropractic students, significant stakeholder participation is crucial to improve response rates. Students had relatively positive attitudes toward EBP. However, they felt they needed more training in EBP and based on the knowledge questions they may need further training about basic research concepts. […]

Older Adults Who Use Vitamin/Mineral Supplements Differ from Nonusers in Nutrient Intake Adequacy and Dietary Attitudes

Chiro.Org Blog: Supplements had a positive influence on nutrient adequacy for men and women aged 51 years and older. Whereas dietary modifications to improve intake are paramount, the use of supplements by older adults appears beneficial to attain nutrient adequacy. To avoid exceeding the UL, this population should avoid the routine supplemental intake of certain nutrients including vitamin A in the form of retinol and iron. […]

The Role of Chiropractic Care in Older Adults

Chiro.Org Blog: While there is already substantial published research to assist the evidence-based DC in his/her care plan for the older adult, there is a need for well designed clinical trials and large observational studies to identify the most beneficial treatments, particularly for complementary and alternative interventions such as manual therapy including, but not limited to, spinal manipulative therapy and acupuncture. […]

National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy

Chiro.Org Blog: Two multidisciplinary working groups developed two national clinical guidelines for non-surgical treatment in adult patients with non-specific low back pain (LBP) and lumbar radiculopathy (LR) of less than 12 weeks’ duration under the Danish Health Authority. The recommendations are based on limited evidence or on consensus, but are well aligned with recommendations from similar international guidelines. The guideline working groups strongly recommend that research efforts in relation to all aspects of the management of LBP and, in particular, LR be intensified. […]

Amount of Health Care and Self-care Following a Randomized Clinical Trial Comparing Flexion-distraction with Exercise Program for Chronic Low Back Pain

Chiro.Org Blog: Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p < 0.05). No group differences were noted in the number of visits to a chiropractor or physical therapist. Self-care was initiated by nearly every participant in both groups.   During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care. […]

Whiplash-associated Disorders: Who Gets Depressed? Who Stays Depressed?

Chiro.Org Blog: In a prior study we reported that post crash depression is common following crash related WAD. As a follow-up to that, we now report the characteristics that can assist clinicians to identify not only which patients are more likely to experience post-crash depression, but also identify which are at risk for a more severe course of depression. This is important because depressed mood in those with WAD is not only an additional health burden in itself, but is also associated with slower recovery. The most important characteristics in identifying those with WAD who are likely to experience depression were higher post crash pain, other post-crash symptoms, sustaining a fractured bone, the presence of post-crash anxiety, and the presence of prior mental health problems. […]

Expectations for Recovery Important in the Prognosis of Whiplash Injuries

Chiro.Org Blog: In conclusion, we suggest early assessment of expectations for recovery to be made, in order to identify people at risk for poor prognosis after WAD. Furthermore, controlled studies on interventions aimed at modifying expectations are warranted. Such studies could be conducted on the population level, similar to the successful media campaign on back pain beliefs, which decreased disability claims, both in terms of incidence and time on benefits. [31, 32] Alternatively interventions targeting persons in the acute phase of an injury should be evaluated. Finally, it is not inconceivable that our findings can be extended to persons with pain conditions other than WAD. […]

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury

Chiro.Org Blog: Since the prognosis review of the WHO Collaborating Centre Task Force, there has been some progress in understanding MTBI prognosis. Our results add to the growing evidence that postconcussion symptoms are not specific to MTBI and occur commonly in the general population and after other nonhead injuries. Our results also confirm the importance of psychosocial determinants of recovery. We conclude that self-reported symptoms can be persistent after MTBI, and there is a need for more intervention research targeting modifiable prognostic factors. Finally, we found only 1 study of a clinical prediction rule, and we recommend more focus on this issue because it holds the potential of identifying those at risk of a poor recovery who might benefit from more focused clinical attention. […]