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Is EBM Damaging the Social Conscience of Chiropractic?

By |December 7, 2016|Chiropractic Management, Evidence-based Medicine|

Commentary: Is EBM Damaging the Social Conscience of Chiropractic?

The Chiro.Org Blog


Chiropractic J Australia 2016 (Dec); 44 (3): 203–213 ~ FULL TEXT

Phillip Stuart Ebrall, BAppSc(Chiropr), GradCert (Learn&Teach), PhD

Senior Education Advisor,
Tokyo College of Chiropractic;
Faculty of Medicine,
International Medical University,
Kuala Lumpur


Introduction:   One expression of the social conscience of chiropractic is the provision by chiropractic educational institutions of low-cost or free chiropractic care to disadvantaged communities. It is expected that institutions offer to all patients the same full standard of care that is the hallmark of traditional chiropractic.

Objective:   To explore whether an observed schism occurring within chiropractic education, where a minority of institutions are minimising the major premise of the discipline and replacing it with an emphasis on only the science or literature component of the evidence-based triad, has any potential impact on the quality of care provided particularly within the charitable context.

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Overtreating Chronic Back Pain: Time to Back Off?

By |January 16, 2016|Evidence-based Medicine, Low Back Pain|

Overtreating Chronic Back Pain:
Time to Back Off?

The Chiro.Org Blog


SOURCE:   J Am Board Fam Med. 2009 (Jan); 22 (1): 62–68

Richard A. Deyo, M.D., M.P.H., Sohail K. Mirza, M.D., M.P.H.,
Judith A. Turner, Ph.D., and Brook I. Martin, M.P.H.

Department of Medicine,
Oregon Health and Science University,
Portland, OR, USA.
deyor@ohsu.edu


Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses.

Recent studies document a

629% increase in Medicare expenditures for epidural steroid injections;

a 423% increase in expenditures for opioids for back pain;

a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;

and a 220% increase in spinal fusion surgery rates.

The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.


From the FULL TEXT Article:

Introduction

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Low Back Pain and Chiropractic Page

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The Chiropractic Hospital-Based Interventions Research Outcomes Study

By |July 10, 2015|Evidence-based Medicine, Low Back Pain|

The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2015 (Jun 24) ~ FULL TEXT

Jeffrey A. Quon, DC, MHSc, PhD, FCCS(C), Paul B. Bishop, DC, MD, PhD,
Brian Arthur, DC, MSc

Clinical Associate Professor,
Faculty of Medicine,
School of Population and Public Health,
University of British Columbia


Introduction

Within mainstream health care, the customary management of low back pain (LBP) by primary care medical physicians is often not evidence based. Interestingly, clinical practice guidelines (CPG) for the treatment of acute mechanical LBP, for example, have been developed independently by multidisciplinary expert panels in 12 countries. [1-12]

The recommendations from those guidelines have been further accompanied by rigorous systematic reviews of the evidence [13-15] rather than expert consensus alone, [1] and, to date, they have generally endorsed the use of the following conservative modalities:

(1) reassurance about the favorable natural history of acute LBP,

(2) early activation,

(3) time-limited nonsteroidal anti-inflammatory medication
(barring contraindications
), and

(4) spinal manipulative therapy (SMT).

Despite widespread dissemination of CPG for LBP, compliance with this knowledge in general and with the SMT component in particular has been limited among mainstream health care providers. This is particularly true among family medical physicians, [16-18] whose personal beliefs about effective LBP care are often discordant with what is known from external research evidence. [19, 20] Yet, ironically, family medical physicians account for most office visits for LBP in many North American jurisdictions. [21]

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Adherence to Clinical Practice Guidelines Among Three Primary Contact Professions

By |September 5, 2014|Chiropractic Care, Clinical Decision-making, Evidence-based Medicine, Guidelines|

Adherence to Clinical Practice Guidelines Among Three Primary Contact Professions: A Best Evidence Synthesis of the Literature for the Management of Acute and Subacute Low Back Pain

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc 2014 (Sept);   58(3):   220–237

Lyndon G. Amorin-Woods, B.App.Sci (Chiropractic)
Randy W. Beck, BSc (Hons), DC, PhD, DACNB, FAAFN, FACFN, Gregory F. Parkin-Smith, MTech(Chiro), MBBS, MSc, DrHC, James Lougheed, BA (Hons), Alexandra P. Bremner, BSc (Hons), DipEd, GradDipAppStats, PhD

Senior Clinical Supervisor, School of Health Professions
Murdoch University
Enrolled student, Master of Public Health
School of Population Health Faculty of Medicine, Dentistry and Health Sciences
The University of Western Australia


Aim:   To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature.

Methods:   A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors.

Results:   The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%).

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The Evidence House: How to Build an Inclusive Base for Complementary Medicine

By |June 3, 2014|Evidence-based Medicine|

The Evidence House: How to Build an Inclusive Base for Complementary Medicine

The Chiro.Org Blog


SOURCE:   West J Med 2001 (Aug);   175 (2):   79–80

Wayne B Jonas

Department of Family Medicine Uniformed Services
University of the Health Sciences
Bethesda, MD 20814


We all want good evidence available when making medical decisions. Evidence, however, comes in a variety of forms and purposes, and what may be good for one purpose may not be good for another. The term “evidence-based medicine” (EBM) has become almost a cliché in recent years, being used as a synonym for “good” or “scientific,” both to support and refute the value of complementary medicine practices. [1] But EBM takes a narrow view of what constitutes “good” evidence, and it excludes important qualitative and observational information about the use and benefits of complementary medicine.

The key idea of EBM is a “hierarchy of evidence” (figure 1). In this hierarchy, information from systematic reviews of randomized controlled trials is the “best” evidence, followed by individual randomized controlled trials, then by nonrandomized trials, observational studies, and finally case-series. [2] When the evidence of what type of medicine works and what type does not is synthesized, the type of emphasis is at the top of the pyramid, and the evidence that is considered inferior is at the lower levels. Clinical experiments that isolate a causal and additive link between a specific intervention and a specific clinical outcome are seen as the “gold standard” in this evidence model.


Figure 1:   The traditional hierarchy of evidence is narrow


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The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

By |April 10, 2014|Chiropractic Care, Cost-Effectiveness, Evidence-based Medicine|

The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2014 (Mar); 37 (3): 143–154

Paula A Weigel, MS, Jason Hockenberry, PhD,
Suzanne E. Bentler, PhD, Fredric D. Wolinsky, PhD

Department of Health Management and Policy,
College of Public Health,
The University of Iowa,
Iowa City, IA.


OBJECTIVES:   The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS:   Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants’ Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS:   Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

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Medicare and Chiropractic Page

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