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Prognostic Significance of Subgroup Classification for Infant Patients with Crying Disorders

By |April 26, 2018|Colic|

Prognostic Significance of Subgroup Classification for Infant Patients with Crying Disorders: A Prospective Cohort Study

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2012 (Mar); 56 (1): 40–48

Joyce Miller, BS, DC and Dave Newell, BS, MSc, PhD

Anglo-European College of Chiropractic
(Bournemouth University),
3-15 Parkwood Road,
Bournemouth, Dorset BH5 2DF, UK


INTRODUCTION:   Few convincing treatment options have been identified for the excessively crying infant. One explanation may be a lack of identification of patient subgroups. This study used a clinically plausible categorization protocol to subgroup infants and compared changes in symptoms between these subgroups during treatment.

METHODS:   An observational cohort design was employed. All infants presenting with excessive infant crying between July 2007 and March 2008 were categorized into three subgroups,

(A)   infant colic,

(B)   irritable infant syndrome of musculoskeletal origin (IISMO) and

(C)   inefficient feeding crying infants with disordered sleep (IFCIDS) based on history and physical findings.

Mothers completed questionnaires which rated their own and their child’s characteristics prior to and at the end, of a course of manual therapy. Independent associations between infant subgroups and changes in continuous outcomes (crying, stress, sleep, and consolability) were assessed. Multivariable analysis of covariance was used to identify and control for potential confounders.

RESULTS:   A total of 158 infants were enrolled. There was no significant difference in demographic profile between groups or any significant difference in infant crying or level of maternal stress at the start. Only the putative subgroups were significantly associated with differences in outcomes. In general, colic babies improved the most in consolability and crying.

There are more articles like this @ our:

Infantile Colic and Chiropractic Page

(more…)

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

By |July 21, 2014|Chiropractic Care, Colic, Cost-Effectiveness|

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

The Chiro.Org Blog


J Clinical Chiropractic Peds 2013 (Jun);   14 (1):   1063–1069

Joyce Miller, DC, FAC O, FCC, FEAC (Paeds)

Anglo-European College of Chiropractic,
Lead Tutor in Advanced Professional Practice (Paediatrics),
Bournemouth University,
United Kingdom


Background:   There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65million [USD100 million] in 2001) with no alleviation of the condition.

Objectives:   The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomised controlled trial (RCT) showing effectiveness of treatment

Design:   Economic evaluation incorporating a RCT

Methods:   A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

Results:   100 infants completed the RCT and this resulted in treatment costs of £58/child ($93). An additional cost of GP care of £27.50 was added for initial evaluation of the general health of the child and suitability for chiropractic management, totaling £85.50 per child in the RCT. Clinical outcomes are published elsewhere, but care showed both statistically and clinically significant efficacy in reduced crying time by an average of 2.6 hours resulting in a crying time of less than two hours a day (reaching “normal” levels which could be classified as non-colic behavior). Cost per child’s care was £85.50 extrapolated to £14,278,500 for the full cohort of 167,000. If chiropractic care had been given privately, costs were calculated as £164/child per episode of care and this equalled £27,388,000 for the entire cohort. Medical costs through a normal stream of care amounted to £1089.91 per child or £182,014,970 for the cohort (including all costs of care, not just NHS). No benefits of effectiveness were accrued from any of those types of treatment. If the Morris NHS data were extrapolated to 2010, applying wage inflation, the cost would be £118 million (USD180 million) yearly. An episode of an average of four treatments of chiropractic manual therapy with documented efficacy of CMT cost from 8% to 24% of NHS care or routine care.

Conclusion:   chiropractic manual therapy was a cost-effective option in this study. A much larger randomized study of routine medical care versus routine chiropractic care is recommended to determine whether there is confirmation of these findings.


From the Full-Text Article:

Introduction

As effective treatment for children with infant colic remains elusive, the costs of managing the condition is gaining increasing attention. Although it is uncommon for clinicians to be quizzed about the cost-effectiveness of their treatments, [1] particularly where the clinicians’ services are covered by a national health plan, it is increasingly appropriate to ask this question, when prudence in health care expenditure is required.

There are more articles like this @ our:

Chiropractic Pediatrics Page and the:

Infantile Colic and Chiropractic Page

(more…)

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy

By |February 2, 2014|Chiropractic Care, Colic, Cost-Effectiveness, Randomized Controlled Trial|

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition

The Chiro.Org Blog


SOURCE:   J Clin Chiropr Pediatr 2013 (Jun);   14 (1):   1063–1069

Joyce E. Miller, BS, DC, DABCO

Anglo-European College of Chiropractic,
Bournemouth, UK.


This paper is a follow-up cost comparison of the medical and chiropractic care provided in Dr. Miller’s RTC study:

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial
J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

This RTC cast new and significant insight onto previous colic trials:

  1. In this study, it was found that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects. This was a major criticism of earlier colic studies, and thus may help support their conclusions.

  2. That study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

Background:   There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65 million [USD100 million] in 2001) with no alleviation of the condition.

Objectives:   The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomized controlled trial (RCT) showing effectiveness of treatment.

Design:   Economic evaluation incorporating a RCT.

Methods:   A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

(more…)

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

By |November 25, 2012|Chiropractic Care, Colic, Pediatrics|

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

Joyce E. Miller, BS, DC, David Newell, PhD, and
Jennifer E. Bolton, PhD

Associate Professor,
Anglo-European College of Chiropractic,
Bournemouth, UK.
jmiller@aecc.ac.uk.


Dr. Miller wrote a follow-up to this study, a cost comparison of the medical and chiropractic care provided in her earlier RTC study, titled:

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition


J Clinical Chiropractic Peds 2013 (Jun);   14 (1):   1063–1069

This RTC cast new and significant insights into previous colic trials:

  1. Chiropractic care lowered overall costs more than 400% compared with medical management
  2. The current study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

    OBJECTIVE:   The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias.

    METHODS:   Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups.

    RESULTS:   One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively).

    CONCLUSIONS:   In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.


    Introduction

    Excessive infant crying in otherwise healthy infants, traditionally called infant colic, continues to be an enigmatic condition with no known cause and no known cure. [1-3] Afflicting between 10% to 30% of all infants and consuming significant health care resources, [2] infant colic is a problem for parents and clinicians, both of whom try a wide range of therapies with often disappointing results.

    You may review the earlier Colic studies at:

    The Infantile Colic and Chiropractic Page

    and you may also enjoy our

    Chiropractic Pediatrics Page

    Despite decades of research, a clear pathogenesis has not been elucidated. Notwithstanding, what is clear is that underlying disease is rare in the excessively crying baby [4] and that half of those affected recover by 6 months of age, [5] with a small proportion at risk of injury [6] or long-term developmental problems. [7-9] In an effort to help their child with what appears to be a painful condition, some parents choose complementary and alternative medicine (CAM), including chiropractic manual therapy. [9-12] To date, several randomized trials have been reported, [13-19] and although these trials demonstrate some reduction in crying, weaknesses in study methodologies have compromised their contribution to the evidence base. [20-23]

    (more…)