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Yearly Archives: 2016

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain

By |April 7, 2016|Low Back Pain|

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog

SOURCE:   Spine (Phila Pa 1976). 2015 (Feb 15); 40 (4): 209–217

Schneider, Michael DC, PhD, Haas, Mitchell DC, MA
Glick, Ronald MD, Stevans, Joel DC, Landsittel, Doug PhD

School of Health and Rehabilitation Sciences,
Clinical and Translational Science Institute,
University of Pittsburgh,
Pittsburgh, PA

STUDY DESIGN:   Randomized controlled trial with follow-up to 6 months.

OBJECTIVE:   This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).

SUMMARY OF BACKGROUND DATA:   Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.

METHODS:   A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

RESULTS:   Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = –8.1, P = 0.009; pain = –1.4, P = 0.002) and UMC (disability = –6.5, P = 0.032; pain = –1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.

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Low Back Pain and Chiropractic Page

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Systematic Review and Meta-analysis of Chiropractic Care

By |March 26, 2016|Stroke|

Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection:
No Evidence for Causation

The Chiro.Org Blog

SOURCE:   Cureus 2016 (Feb 16);   8 (2):   e498

Ephraim W. Church, MD,   Emily P. Sieg, MD,
Omar Zalatimo, MD,   Namath S. Hussain, MD,
Michael Glantz, MD,   Robert E. Harbaugh, MD

Department of Neurosurgery,
Penn State Hershey Medical Center

BACKGROUND:   Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.

METHODS:   Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.

RESULTS:   Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was “very low.”

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Stroke and Chiropractic Page

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A Giant in Chiropractic Radiology: Remembering Dr. Lindsay Rowe (1956-2016)

By |March 23, 2016|News|

Source Dynamic Chiropractic

By Deborah Pate, DC, DACBR

Lindsay Rowe, DC, MD, DACBR, was a giant in the field of chiropractic radiology who enjoyed careers as a chiropractor, medical doctor, radiologist and educator.

A distinguished international lecturer and author, he wrote more than 50 scientific papers and numerous book chapters; and together with Dr. Terry Yochum, co-authored the internationally respected text Essentials of Skeletal Radiology, now in its third edition. It is the standard text in most chiropractic colleges and has been enthusiastically reviewed in scientific journals such as The New England Journal of Medicine and Radiology.

Dr. Rowe earned his chiropractic degree (MAppSc – Chiropractic) with honors from the Royal Melbourne Institute of Technology in Melbourne, Australia. He subsequently practiced chiropractic and later earned board certification in chiropractic radiology at a time when few chiropractors entered into the specialty. He chaired the Department of Radiology at Canadian Memorial Chiropractic College in Toronto, Ontario. Later, he held the same position at Northwestern College of Chiropractic in Minneapolis, Minn.

Dr. Rowe received a medical degree from the University of Newcastle, Australia, followed by residencies in emergency medicine and diagnostic and interventional radiology at the same institution. He was associate professor at the University of Newcastle, an adjunct professor at Northwestern Health Sciences University and Murdoch University, staff radiologist at the Center for Diagnostic Imaging (a national medical imaging network) and John Hunter Hospital in Melbourne. He was also a prolific presenter at professional meetings in Australia and many countries around the world.

Dr. Rowe’s accomplishments in skeletal radiology have contributed much to the advancement of chiropractic’s acceptance in the medical community, especially chiropractic radiology. He was a leader and a trailblazer, bridging the gap between allopathic and chiropractic; creating respect for our profession within the modern health care community.

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Management of Neck Pain and Associated Disorders

By |March 23, 2016|Guidelines, Neck Pain, Whiplash|

Management of Neck Pain and Associated Disorders: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

The Chiro.Org Blog

SOURCE:   Eur Spine J. 2016 (Mar 16) [Epub]

Côté P, Wong JJ, Sutton D, Shearer HM, Mior S et. al.

Canada Research Chair in
Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT),
2000 Simcoe Street North,
Oshawa, ON, L1H 7L7, Canada.

PURPOSE:   To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD).

METHODS:   This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD <6 months duration.

RECOMMENDATION 1:   Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.

RECOMMENDATION 2:   Clinicians should assess prognostic factors for delayed recovery from NAD.

RECOMMENDATION 3:   Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.

RECOMMENDATION 4:   For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.

RECOMMENDATION 5:   For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.

RECOMMENDATION 6:   For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction.

RECOMMENDATION 7:   For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management.

RECOMMENDATION 8:   Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

There are more articles like this @ our:

Practice Guidelines Page and the:

Chronic Neck Pain and Chiropractic Page

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Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain

By |March 18, 2016|Chronic Pain|

Importance of Psychological Factors for the Recovery From a First Episode of Acute Non-specific Neck Pain – A Longitudinal Observational Study

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2016 (Mar 16); 24: 9

Brigitte Wirth, B. Kim Humphreys and Cynthia Peterson

Chiropractic Medicine Department,
Faculty of Medicine,
University of Zurich and University Hospital Balgrist

It has been established that psychological factors (appear to play) an important role in chronic non-specific neck pain. Particularly anxiety, depression and catastrophizing appear to negatively affect pain intensity and disability in this patient group. [5]To test whether these emotional elements are the natural side-effect of chronic pain as opposed to being causal, these researchers worked with 850 patients with acute non-specific neck pain with no history of previous neck or arm pain.

The results were quite fascinating:

  • They found that the psychological factors measured at baseline had no influence on the self-reported outcome at 1 week and 1 month
  • A high reduction in anxiety between 1 week and 1 month after the first consultation was linked to a significantly higher chance for self-reported improvement at 1 month in both models
  • Poor outcome at 1 and 3 months went along with high levels of anxiety. High baseline anxiety was not a risk factor for poor outcome, but its reduction during the first month was highly related to favorable recovery.
  • In contrast, high level of depression at baseline was fairly related to poor recovery at 3 months.

Thus, patients with acute non-specific neck pain might benefit from adequate information and communication that targets at reducing anxiety by encouraging self-management of the problem.

Background   The influence of psychological factors on acute neck pain is sparsely studied. In a secondary analysis of prospectively collected data, this study investigated how several psychological factors develop in the first three months of acute neck pain and how these factors influence self-perceived recovery.

Methods   Patients were recruited in various chiropractic practices throughout Switzerland between 2010 and 2014. The follow-up telephone interviews were conducted for all patients by research assistants in the coordinating university hospital following a standardized procedure. The population of this study consisted of 103 patients (68 female; mean age = 38.3 ± 13.8 years) with a first episode of acute (<4 weeks) neck pain. Prior to the first treatment, the patients filled in the Bournemouth Questionnaire (BQ). One week and 1 and 3 months later, they completed the BQ again along with the Patient Global Impression of Change (PGIC). The temporal development (repeated measure ANOVA) of the BQ questions 4 (anxiety), 5 (depression), 6 (fear-avoidance) and 7 (pain locus of control) as well as the influence of these scores on the PGIC were investigated (binary logistic regression analyses, receiver operating curves (ROC)).

Results   All psychological parameters showed significant reduction within the first month. The parameter ‘anxiety’ was associated with outcome at 1 and 3 months (p = 0.013, R2 = 0.40 and p = 0.039, R2 = 0.63, respectively). Baseline depression (p = 0.037, R2 = 0.21), but not baseline anxiety, was a predictor for poor outcome. A high reduction in anxiety within the first month was a significant predictor for favorable outcome after 1 month (p < 0.001; R2 = 0.57).

There are more articles like this @ our:

Chronic Neck Pain and Chiropractic Page and the:

The Biopsychosocial Model Page

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