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Perspectives of Older Adults on Co-management of Low Back Pain by Doctors of Chiropractic and Family Medicine Physicians

By |January 26, 2018|Integrative Care|

Perspectives of Older Adults on Co-management of Low Back Pain by Doctors of Chiropractic and Family Medicine Physicians: A Focus Group Study

The Chiro.Org Blog

SOURCE:   BMC Complement Altern Med. 2013 (Sep 16); 13: 225

Kevin J Lyons, Stacie A Salsbury, Maria A Hondras, Mark E Jones, Andrew A Andresen and Christine M Goertz

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA, USA.

BACKGROUND:   While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.

METHODS:   We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants’ care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD–DC co-management model. We analyzed the qualitative data using thematic content analysis.

RESULTS:   Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD–DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.

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The Quality of Life of Children Under Chiropractic Care Using PROMIS-25

By |January 2, 2018|Pediatrics|

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network

The Chiro.Org Blog

SOURCE:   J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, DC, Andrea E. Lamont, PhD,
Jeanne Ohm, DC, and Junjoe Alcantara, DC

The International Chiropractic Pediatric Association,
327N Middletown Road
Media, PA 610-565-2360

OBJECTIVES:   To characterize pediatric chiropractic and assess pediatric quality of life (QoL).

DESIGN:   A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States.

SUBJECTS:   A convenience sample of children (8-17 years) under chiropractic care and their parents.

EXPOSURE:   Chiropractic spinal adjustments and adjunctive therapies.

OUTCOME MEASURES:   Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome.

RESULTS:   The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1, p < 0.05), anxiety (Wald = 20.603, df = 1, p < 0.05), fatigue (Wald = 22.191, df = 1, p < 0.05), and pain interference (Wald = 47.422, df = 1, p < 0.05) after a trial of chiropractic care.

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The Use of the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients

By |December 25, 2017|Pediatrics|

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique

The Chiro.Org Blog

SOURCE:   J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, Andrea Lamont Nazarenko,
Jeanne Ohm, and Junjoe Alcantara

The International Chiropractic Pediatric Association,
Media, PA.

OBJECTIVE:   To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women.

DESIGN:   A prospective cohort within a practice-based research network (PBRN). Setting/locations: Individual chiropractic offices.

SUBJECTS:   Pregnant women (age ≥18 years) attending chiropractic care.

INTERVENTION(S):   Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies).

MAIN OUTCOME MEASURES:   The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL.

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

By |October 12, 2017|Patient Expectations, Spinal Pain|

Patient Expectations of Benefit from Common Interventions for Low Back Pain and Effects on Outcome: Secondary Analysis of a Clinical Trial of Manual Therapy Interventions

The Chiro.Org Blog

SOURCE:   J Man Manip Ther. 2011 (Feb);   19 (1):   20–25

Mark D Bishop, Joel E Bialosky & Josh A Cleland

Department of Physical Therapy,
University of Florida, USA.

OBJECTIVES:   The purpose of this secondary analysis was 1) to examine patient expectations related to a variety of common interventions for low back pain (LBP) and 2) to determine the influence that specific expectations about spinal manipulation might have had on self-report of disability.

METHODS:   We collected patients’ expectations about the benefit of specific interventions for low back pain. We also collected patients’ general expectations about treatment and tested the relationships among the expectation of benefit from an intervention, receiving that intervention and disability-related outcomes.

RESULTS:   Patients expected exercise and manual therapy interventions to provide more benefit than surgery and medication. There was a statistical association between expecting relief from thrust techniques and receiving thrust techniques, related to meeting the general expectation for treatment (chi-square: 15.5, P = 0.008). This was not the case for patients who expected relief from thrust techniques but did not receive it (chi-square: 6.9, P = 0.4). Logistic regression modeling was used to predict change in disability at treatment visit 5. When controlling for whether the general expectations for treatment were met, intervention assignment and the interaction between intervention assignment and expectations regarding thrust techniques, the parsimonious model only included intervention as the significant contributor to the model (P < 0.001). The adjusted odds ratio of success comparing thrust techniques to non-thrust in this study was 41.2 (11.0, 201.7).

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Patient Expectations of Relief

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Chiropractic and Spinal Pain Page


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

By |September 30, 2017|Placebo|

What Techniques Might Be Used to Harness Placebo Effects in Non-malignant pain? A Literature Review and Survey to Develop a Taxonomy

The Chiro.Org Blog


Felicity L Bishop, Beverly Coghlan, Adam WA Geraghty,
Hazel Everitt, Paul Little, Michelle M Holmes,
Dionysis Seretis, George Lewith

Department of Psychology,
Faculty of Social Human and Mathematical Sciences,
University of Southampton,
Southampton, UK.

OBJECTIVES:   Placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice.

DESIGN:   Literature review and survey.

METHODS:   We systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from seven systematic reviews. In a validation exercise, we surveyed 33 leading placebo researchers (mean 12 years’ research experience, SD 9.8), who were asked to comment on and add to the draft taxonomy derived from the literature.

RESULTS:   The final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications and classifies procedures into five domains: the patient’s characteristics and belief (5 procedures and 11 clinical applications), the practitioner’s characteristics and beliefs (2 procedures and 4 clinical applications), the healthcare setting (8 procedures and 13 clinical applications), treatment characteristics (8 procedures and 14 clinical applications) and the patient—practitioner interaction (7 procedures and 18 clinical applications).

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Looking Ahead: Chronic Spinal Pain Management

By |September 13, 2017|Low Back Pain|

Looking Ahead: Chronic Spinal Pain Management

The Chiro.Org Blog

SOURCE:   Journal of Pain Research 2017 (Aug 30); 10: 2089–2095

Gregory F Parkin-Smith, Stephanie J Davies,
Lyndon G Amorin-Woods

School of Health Professions,
Murdoch University,
Perth, WA, Australia

The other day, we oversaw a seminar on pain management for a local consumer pain group, where all consumers (patients) in attendance were experiencing chronic, persistent spinal pain. Each person had a unique story, and their experience and perceived cause of their pain differed. The quality of life in all these consumers was markedly reduced, which was the only clear similarity, confirming that there may be some similarities in the pain experience, but the pain experience was more often unique and individual. These consumers’ criticisms of care services were consistent, however, with dissatisfaction with their access to care and overall management of their pain. They described variable and often difficult access, limited continuity of care, they were often not taken seriously by health care providers, they received scant information about chronic pain and its prognosis and there were often noteworthy variations in the treatment they received. We agree that these criticisms are commonplace and a frequent gripe directed at health care practitioners about the “system.” [1] Moreover, the problems associated with care delivery are confounded by a number of patient/consumer factors, such as lifestyle habits, nutrition, body weight, depression, health literacy, geographical isolation and poor socioeconomic conditions, making the management of persistent pain even more complicated. [2] There is no doubt that, in the future, matching the care service and treatment with the individual patient will become an essential component of care services, as has been implied in published research. [3-6]

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. [11]

Garcia et al, [12] conversely, showed that high pain intensity may be an important treatment effect modifier for patients with chronic low back pain receiving Mckenzie therapy (a treatment frequently used by physiotherapists). These examples demonstrate the importance of matching treatments with the characteristics of the patient.

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Chiropractic and Spinal Pain Management


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

By |September 8, 2017|Chronic Neck Pain|

Chronic Neck Pain Patients With Traumatic or Non-traumatic Onset: Differences in Characteristics.
A Cross-sectional Study

The Chiro.Org Blog

SOURCE:   Scand J Pain. 2017 (Jan); 14: 1-8

Inge Ris, Birgit Juul-Kristensen, Eleanor Boyle,
Alice Kongsted, Claus Manniche, Karen Søgaard

Research Unit for Musculoskeletal Function and Physiotherapy,
Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230 Odense M, Denmark;

BACKGROUND AND AIMS:   Patients with chronic neck pain can present with disability, low quality of life, psychological factors and clinical symptoms. It is unclear whether patients with a traumatic onset differ from those with a non-traumatic onset, by having more complex and severe symptoms. The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics: quality of life, neck pain and function, kinesiophobia, depression, and pain bothersomeness.

METHODS:   This cross-sectional study included 200 participants with chronic neck pain: 120 with traumatic onset and 80 with non-traumatic onset. Participants were recruited from physiotherapy clinics in primary and secondary health care. For participants to be included, they were required to be at least 18 years of age, have had neck pain for at least 6 months, and experienced neck-related activity limitation as determined by a score of at least 10 on the Neck Disability Index. We conducted the following clinical tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index, Patient-Specific Functional Scale, Pain Bothersomeness, Beck Depression Inventory-II, and TAMPA scale of kinesiophobia. The level of significance for all analyses was defined as p<0.01. Differences between groups for the continuous data were determined using either a Student’s t-test or Mann Whitney U test.

RESULTS:   In both groups, the majority of the participants were female (approximately 75%). Age, educational level, working situation and sleeping patterns were similar in both groups. The traumatic group had symptoms for a shorter duration (88 vs. 138 months p=0.001). Participants in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p=0.005, cranio-cervical flexion test p=0.007, cervical extensor test p=0.006) and cervical pressure pain threshold bilateral (p=0.002/0.004), as well on self-reported function (Neck Disability Index p=0.001 and Patient-Specific Functional Scale p=0.007), mental quality of life (mental component summary of the Short Form Health Survey p=0.004 and EuroQol-5D p=0.001) and depression (Beck Depression Inventory-II p=0.001).

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Chronic Neck Pain and Chiropractic Page


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

By |July 24, 2017|Depression, Whiplash|

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

The Chiro.Org Blog

SOURCE:   Eur Spine J. 2010 (Jun); 19 (6): 945–956

Leah A. Phillips, Linda J. Carroll,
J. David Cassidy, and Pierre Côté

Department of Public Health Sciences,
Alberta Centre for Injury Control and Research,
School of Public Health, University of Alberta,
4075 RTF, 8308 114 St, Edmonton, AB, T6G 2E1, Canada.

Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, and initial post-crash pain and symptoms. Depressive symptomatology was assessed at baseline and at each follow-up using the Centre for Epidemiological Studies Depression Scale   (CES-D).   We included only those who participated at all follow-ups (n = 3,452; 59% of eligible participants). Using logistic regression, we identified factors associated with initial (post-crash) depression. Using multinomial regression, we identified baseline factors predicting course of depression. Courses of depression were no depression; initial depression that resolves, recurs or persists, and later onset depression. Factors associated with initial depression included greater neck and low back pain severity, greater percentage of body in pain, numbness/tingling in arms/hand, dizziness, vision problems, post-crash anxiety, fracture, prior mental health problems, and poorer general health. Predictors of persistent depression included older age, greater initial neck and low back pain, post-crash dizziness, vision and hearing problems, numbness/tingling in arms/hands, anxiety, prior mental health problems, and poorer general health. Recognition of these underlying risk factors may assist health care providers to predict the course of psychological reactions and to provide effective interventions.

From the FULL TEXT Article:


The biopsychosocial model of health posits that in addition to biomedical factors, psychological, and sociological factors play important roles in the diagnosis, treatment, and recovery from illness and disease. [11] According to the Quebec Task Force on whiplash-associated disorders, whiplash is defined as an acceleration–deceleration mechanism of energy transferred to the neck as a result of a motor vehicle collision, and the resulting injury or cluster of symptoms is referred to as whiplash-associated disorders (WAD). [20] WAD is a disorder where the interplay between biological and psychosocial factors appears to have an important effect on recovery. [8]

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

By |July 21, 2017|Chiropractic Management, Mild Traumatic Brain Injury|

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

The Chiro.Org Blog

Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S132–151

J. David Cassidy, PhD, DrMedSc, Carol Cancelliere, DC, MPH,
Linda J. Carroll, PhD, Pierre Côté, DC, PhD,
Cesar A. Hincapié, DC, MHSc, Lena W. Holm, et al.

Institute of Sports Science and Clinical Biomechanics,
Faculty of Health, University of Southern Denmark,
Odense, Denmark

OBJECTIVE:   To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004.

DATA SOURCES:   MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than 30 adult cases.

STUDY SELECTION:   Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess subjective, self-reported outcomes. After 77,914 titles and abstracts were screened, 299 articles were eligible and reviewed for scientific quality. This includes 3 original International Collaboration on MTBI Prognosis (ICoMP) research studies.

DATA EXTRACTION:   Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed each study and tabled data from accepted articles. A third reviewer was consulted for disagreements.

DATA SYNTHESIS:   Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress.

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Mild Traumatic Brain Injury Page


Cortical Changes in Chronic Low Back Pain

By |July 3, 2017|Cortical Changes, Low Back Pain|

Cortical Changes in Chronic Low Back Pain: Current State of the Art and Implications for Clinical Practice

The Chiro.Org Blog

SOURCE:   Man Ther. 2011 (Feb); 16 (1): 15-20

Benedict Martin Wand, Luke Parkitny,
Neil Edward O’Connell, Hannu Luomajoki,
James Henry McAuley, Michael Thacker,
G. Lorimer Moseley

School of Health Sciences,
The University of Notre Dame Australia,
Fremantle, WA, Australia

There is increasing evidence that chronic pain problems are characterised by alterations in brain structure and function. Chronic back pain is no exception. There is a growing sentiment, with accompanying theory, that these brain changes contribute to chronic back pain, although empirical support is lacking. This paper reviews the structural and functional changes of the brain that have been observed in people with chronic back pain. We cast light on the clinical implications of these changes and the possibilities for new treatments but we also advise caution against concluding their efficacy in the absence of solid evidence to this effect.

From the Full-Text Article:


Chronic musculoskeletal pain is almost by definition a problem for which previous treatment has been unsuccessful. The clinical stories of patients with problems such as chronic low back pain (CLBP), fibromyalgia, and late whiplash associated disorder are usually ones of confusing and conflicting diagnoses and multiple treatment failures. Diagnosis and treatment has traditionally focused on what Robinson and Apkarian (2009) have called ‘end organ dysfunction’. That is, clinicians and researchers have looked to structural and functional abnormalities within the musculoskeletal system for a driver of the clinical condition and treatment has sought to normalise peripheral pathology and mechanics (stretch it, splint it, remove it, anaesthetise or denervate it). In general terms the ‘end organ dysfunction’ approach might be considered to have proven unsuccessful for these conditions (see for e.g. van Tulder et al., 2006a; van Tulder et al., 2006b). Neuroimaging studies have revealed numerous structural and functional changes within the brains of people with chronic musculoskeletal pain and there is growing opinion that these changes may contribute to the development and maintenance of the chronic pain state (Apkarian et al., 2009; Tracey and Bushnell, 2009). In this model of chronic pain the brain is seen as an explicit target for treatment and several treatment strategies have been developed and modified to fit this aim. Although there are data available on a range of chronic painful disorders, we will focus here on the cortical changes observed in patients with CLBP and the possible clinical implications for this population.

Brain changes in people with CLBP

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