Chiro.org - Chiropractic Resource Organization.     Support Chiropractic Research!

Evidence-based Medicine

Home/Evidence-based Medicine

Spinal Manipulation Compared with Back School and with Individually Delivered Physiotherapy

By |January 30, 2014|Chiropractic Care, Evidence-based Medicine, Low Back Pain, Outcome Assessment|

Spinal Manipulation Compared with Back School and with Individually Delivered Physiotherapy for the Treatment of Chronic Low Back Pain: A Randomized Trial with One-year Follow-up

The Chiro.Org Blog


SOURCE:   Clinical Rehabilitation 2010 (Jan);   24 (1):   26–36

Francesca Cecchi, Raffaello Molino-Lova, Massimiliano Chiti,
Guido Pasquini, Anita Paperini, Andrea A Conti, and Claudio Macchi

Fondazione Don Carlo Gnocchi,
Scientific Institute,
Florence, Italy.
francescacecchi2002@libero.it


FROM:   Health Insights Today

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week.

Outcome measures were the Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6), assessed at baseline, discharge, and at 3, 6, and 12 months. 205 patients completed the study.

At discharge, disability score decreased by:

3.7 +/- 4.1 for back school,

4.4 +/- 3.7 for individual physiotherapy, and

6.7 +/- 3.9 for manipulation.

The pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively.

Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups;

pain recurrences and drug intake were also reduced compared to back school or individual physiotherapy.


The difference in their improved scores is quite dramatic:

Intervention Disability Score Pain Rating
At Discharge
Spinal Manipulation 6.7 +/- 3.9 1.0 +/- 1.1
Individual Physiotherapy 4.4 +/- 3.7 1.1 +/- 1.0
Back School 3.7 +/- 4.1 0.9 +/- 1.1
After 12 months
Spinal Manipulation 5.9 +/- 4.6 1.5 +/- 1.1
Individual Physiotherapy 4.0 +/- 5.1 0.4 +/- 1.3
Back School 4.2 +/- 4.8 0.7 +/- 1.2

NOTE: These numbers indicate the reductions in scores on the Roland Morris Disability Questionnaire and the Pain Rating Scale.


The Abstract:

OBJECTIVE:   To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

By |January 26, 2014|Chiropractic Care, Evidence-based Medicine, Headache|

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

The Chiro.Org Blog


SOURCE:  Duke University Evidence-based Practice Center

Douglas C. McCrory, MD, MHSc, Donald B. Penzien, PhD,
Vic Hasselblad, PhD. Rebecca N. Gray, DPhil

Duke University Evidence-based Practice Center
Center for Clinical Health Policy Research
2200 W. Main Street, Suite 230
Durham, NC 27705


EXECUTIVE SUMMARY

Background

Tension-type headache and cervicogenic headache are two of the most common non-migraine headaches. Population-based studies suggest that a large proportion of adults experience mild and infrequent (once per month or less) tension-type headaches, and that the one-year prevalence of more frequent headaches (more than once per month) is 20%-30%; a smaller percentage of the population (roughly 3%) has been estimated to have chronic tension-type headache (180 days per year). Estimates of the prevalence of cervicogenic headache have varied considerably, due in large part to disagreements about the precise definition of the condition. A recent population-based study, which used the diagnostic criteria of the International Headache Society (IHS), found that 17.8% of subjects with frequent headache (5 days per month) fulfilled the criteria for cervicogenic headache; this was equivalent to a prevalence of 2.5% in the larger population. This agrees with an earlier clinic-based study which found that 14% of headache patients treated had cervicogenic headache.

The impact of tension-type headache on individuals and society appears to be significant. According to one population-based study, regular activities were limited during 38% of tension-type headache attacks, and 4% of respondents indicated that their headaches affected their attendance at work. Eighty-nine percent of tension-type headache sufferers reported that their headaches had negatively affected their relationships with friends, colleagues, and family. Little is known about the personal and societal impact of cervicogenic headache.

Nearly all patients with tension-type headache have used medications at one time or another to treat their headaches. But pharmacological treatments are not suitable for all patients, nor are they universally effective. Drug treatments may also produce undesired side effects. Partly for these reasons, significant interest has developed among both patients and health care providers in alternative treatments for tension-type headache, including behavioral and physical interventions. Cervicogenic headache, when diagnosed as such, is commonly treated with non-pharmacological interventions, especially physical treatments.

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache

By |January 21, 2014|Chiropractic Care, Evidence-based Medicine, Headache, Migraine|

The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 1998 (Oct);   21 (8):   511–519

Nelson CF, Bronfort G, Evans R, Boline P,
Goldsmith C, Anderson AV

Center for Clinical Studies,
Northwestern College of Chiropractic,
Bloomington, MN 55431, USA.


BACKGROUND:   Migraine headache affects approximately 11 million adults in the United States. Spinal manipulation is a common alternative therapy for headaches, but its efficacy compared with standard medical therapies is unknown.

OBJECTIVE:   To measure the relative efficacy of amitriptyline, spinal manipulation and the combination of both therapies for the prophylaxis of migraine headache.

DESIGN:   A prospective, randomized, parallel-group comparison. After a 4-wk baseline period, patients were randomly assigned to 8 wk of treatment, after which there was a 4-wk follow-up period.

SETTING:   Chiropractic college outpatient clinic.

PARTICIPANTS:   A total of 218 patients with the diagnosis of migraine headache.

INTERVENTIONS:   An 8-wk course of therapy with spinal manipulation, amitriptyline or a combination of the two treatments.

MAIN OUTCOME MEASURES:   A headache index score derived from a daily headache pain diary during the last 4 wk of treatment and during the 4-wk follow-up period.

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Clinical Trial

By |January 20, 2014|Chiropractic Care, Evidence-based Medicine, Headache|

Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 1995 (Mar); 18 (3): 148–154

Patrick Boline, DC, Kassem Kassak, MPH, PhD,
Gert Bronfort, DC, PhD, Craig Nelson, DC,
A.V. Anderson, DC, MD

Funding was provided by:
Foundation for Chiropractic Education and Research (FCER)


This article is reprinted with the permission of National College of Chiropractic and JMPT.   Our special thanks to the Editor, Dr. Dana Lawrence, D.C. for permission to reproduce this article exclusively at Chiro.Org


This study compared the effects of spinal manipulation and pharmaceutical treatments for chronic tension headaches. Four weeks following the cessation of treatment, the pharmaceutical group demonstrated no improvement from the baseline. In the spinal manipulation group, headache intensity dropped 32 percent; frequency dropped 42 percent; and there was an overall improvement of 16 percent in functional health status.


Perhaps the best known clinical trial on chiropractic and Tension-type Headaches was the Boline et al study, which compared chiropractic care to the medication amitriptyline. These investigators found that one month of chiropractic care (approximately 2 visits per week) was more effective than amitriptyline for long-term relief of headache pain.

During the treatment phase of the trial, pain relief among those treated with medication was roughly comparable to the chiropractic group. But chiropractic patients maintained their levels of improvement after treatment was discontinued, while those taking medication returned to pretreatment status in an average of 4 weeks after its discontinuation.   (Thanks to Daniel Redwood, DC)

This study compared the effects of spinal manipulation and pharmaceutical treatments for chronic tension headaches. Four weeks following the cessation of treatment, the pharmaceutical group demonstrated no improvement from the baseline. In the spinal manipulation group, headache intensity dropped 32 percent;   frequency dropped 42 percent;   and there was an overall improvement of 16 percent in functional health status.

Background:   In the United States headaches are responsible for more than 18 million office visits annually, and are the most common reason for using over-the-counter medications. It is estimated that 156 million work days are lost each year because of headaches, translating to $25 billion in lost productivity. Of the categories of chronic headaches, tension-type headaches are most common.

Headaches are commonly treated by chiropractic doctors with spinal manipulation, and several studies have reported good outcomes. These trials however, suffered from either a lack of a control group or inadequate statistical power. The purpose of this randomized clinical trial was to evaluate the effectiveness of spinal manipulation and a common pharmaceutical treatment (amitriptyline) for chronic tension-type headache.

Methods:   One-hundred-fifty patients between the ages of 18 and 70 were randomly assigned to receive either six weeks of chiropractic or pharmaceutical treatment which was preceded by a two week baseline period and included a four week, post-treatment follow up period. Main outcome measures were change in patient-reported daily headache intensity, weekly headache frequency, over-the-counter medication usage, and functional health status using the SF-36 Health Survey.

Results:   During the treatment period both groups improved at very similar rates in all primary outcomes. Four weeks following the cessation of treatment patients who received spinal manipulative therapy showed a reduction of 32% in headache intensity, 42% in headache frequency, 30% in over-the-counter medication usage and 16% in functional health status. By comparison, patients that received amitriptyline showed no improvement or a slight worsening from baseline values in the same outcome measures. The group differences at four week post-treatment follow up were considered to be clinically important and statistically significant. There is further need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials.

Conclusion:   The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. Amitriptyline was slightly more effective in reducing pain by the end of the treatment period, but was associated with more side effects. Four weeks after cessation of treatment however, patients who received spinal manipulation experienced a sustained therapeutic benefit in all major outcomes in contrast to the amitriptyline group, who reverted to baseline values. The sustained theraputic benefit associated with spial manipulation seemed to result in a decreased need for over-the-counter medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare SMT to an appropriate placebo such as sham manipulation in future clinical trials.   (see the Problem with Placebo/Shams Page for other issues associated with sham treatments provided in previous studies.)

Key words:   clinical guidelines; low back pain; evidence based medicine; systematic reviews


From the Full-Text Article:

INTRODUCTION

There are more articles like this @ our:

Headache and Chiropractic Page

(more…)

A Theoretical Model For The Development Of A Diagnosis-based Clinical Decision Rule For The Management Of Patients With Spinal Pain

By |January 12, 2014|Chiropractic Care, Clinical Decision-making, Diagnosis, Evidence-based Medicine|

A Theoretical Model For The Development Of A Diagnosis-based Clinical Decision Rule For The Management Of Patients With Spinal Pain

The Chiro.Org Blog


BMC Musculoskelet Disord. 2007 (Aug 3); 8: 75 ~ FULL TEXT

Donald R Murphy and Eric L Hurwitz

Rhode Island Spine Center,
Pawtucket, RI, USA.
rispine@aol.com


BACKGROUND:   Spinal pain is a common problem, and disability related to spinal pain has great consequence in terms of human suffering, medical costs and costs to society. The traditional approach to the non-surgical management of patients with spinal pain, as well as to research in spinal pain, has been such that the type of treatment any given patient receives is determined more by what type of practitioner he or she sees, rather than by diagnosis. Furthermore, determination of treatment depends more on the type of practitioner than by the needs of the patient. Much needed is an approach to clinical management and research that allows clinicians to base treatment decisions on a reliable and valid diagnostic strategy leading to treatment choices that result in demonstrable outcomes in terms of pain relief and functional improvement. The challenges of diagnosis in patients with spinal pain, however, are that spinal pain is often multifactorial, the factors involved are wide ranging, and for most of these factors there exist no definitive objective tests.

DISCUSSION:   The theoretical model of a diagnosis-based clinical decision rule has been developed that may provide clinicians with an approach to non-surgical spine pain patients that allows for specific treatment decisions based on a specific diagnosis. This is not a classification scheme, but a thought process that attempts to identify most important features present in each individual patient. Presented here is a description of the proposed approach, in which reliable and valid assessment procedures are used to arrive at a working diagnosis which considers the disparate factors contributing to spinal pain. Treatment decisions are based on the diagnosis and the outcome of treatment can be measured.

SUMMARY:   In this paper, the theoretical model of a proposed diagnosis-based clinical decision rule is presented. In a subsequent manuscript, the current evidence for the approach will be systematically reviewed, and we will present a research strategy required to fill in the gaps in the current evidence, as well as to investigate the decision rule as a whole.


From the FULL TEXT Article:

Introduction

Chronic spinal pain is an increasingly common problem in Western Society [1]. Spinal disorders exact great costs, in terms of both direct medical costs and indirect costs related to disability and lost productivity [1-3]. A number of researchers have attempted to improve our ability to identify the causes of spinal pain as well as to diagnose and treat patients with this problem. In spite of this, accurate diagnosis, leading to specific, targeted treatments, of patients with spinal pain has been elusive.

It has been repeated over the years that only in 15% of patients with spinal pain can a definitive diagnosis be made [4-6]. However, if one surveys the spine literature, one finds a variety of methods for detecting many of the factors that are believed to be of importance, most of which have known reliability and validity, although there are some that do not. Each of these methods may only help the clinician to identify one particular potential contributing factor in the overall clinical picture of the spine pain patient. However, it may be possible that, by utilizing many of the various diagnostic procedures available to the spine clinician, one can develop a specific working diagnosis that encompasses all of the dimensions for which there may be contributing factors and from which a management strategy may be designed that addresses each of the most important factors in each individual patient.

There are more articles like this @ our:

Low Back Pain Page and the:

Chronic Neck Pain and Chiropractic Page and the:

Clinical Model for the Diagnosis and Management Page

(more…)

A Randomised Controlled Trial of Preventive Spinal Manipulation With and Without a Home Exercise Program For Patients With Chronic Neck Pain

By |December 25, 2013|Chiropractic Care, Chronic Pain, Evidence-based Medicine|

A Randomised Controlled Trial of Preventive Spinal Manipulation With and Without a Home Exercise Program For Patients With Chronic Neck Pain

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2011 (Feb 8);   12:   41

Johanne Martel, Claude Dugas, Jean-Daniel Dubois, and Martin Descarreaux

Département de Chiropratique,
Université du Québec à Trois-Rivières,
Trois-Rivières G9A 5H7, Canada.


Background:   Evidence indicates that supervised home exercises, combined or not with manual therapy, can be beneficial for patients with non-specific chronic neck pain (NCNP). The objective of the study is to investigate the efficacy of preventive spinal manipulative therapy (SMT) compared to a no treatment group in NCNP patients. Another objective is to assess the efficacy of SMT with and without a home exercise program.

Methods:   Ninety-eight patients underwent a short symptomatic phase of treatment before being randomly allocated to either an attention-group (n = 29), a SMT group (n = 36) or a SMT + exercise group (n = 33). The preventive phase of treatment, which lasted for 10 months, consisted of meeting with a chiropractor every two months to evaluate and discuss symptoms (attention-control group), 1 monthly SMT session (SMT group) or 1 monthly SMT session combined with a home exercise program (SMT + exercise group). The primary and secondary outcome measures were represented by scores on a 10-cm visual analog scale (VAS), active cervical ranges of motion (cROM), the neck disability index (NDI) and the Bournemouth questionnaire (BQ). Exploratory outcome measures were scored on the Fear-avoidance Behaviour Questionnaire (FABQ) and the SF-12 Questionnaire.

Results:   Our results show that, in the preventive phase of the trial, all 3 groups showed primary and secondary outcomes scores similar to those obtain following the non-randomised, symptomatic phase. No group difference was observed for the primary, secondary and exploratory variables. Significant improvements in FABQ scores were noted in all groups during the preventive phase of the trial. However, no significant change in health related quality of life (HRQL) was associated with the preventive phase.

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page and our

Maintenance Care, Wellness and Chiropractic Page

(more…)