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Yearly Archives: 2016

Comparing 2 Whiplash Grading Systems To Predict Clinical Outcomes

By |September 2, 2016|Whiplash|

Comparing 2 Whiplash Grading Systems To Predict Clinical Outcomes

The Chiro.Org Blog

SOURCE:   J Chiropractic Medicine 2016 (Jun); 15 (2): 81–86

Arthur C. Croft, PhD, DC, MSc, MPH, Alireza Bagherian, DC, Patrick K. Mickelsen, DC, Stephen Wagner, DC

Spine Research Institute of San Diego,
San Diego, CA.

OBJECTIVE:   Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum.

METHODS:   This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics.

RESULTS:   Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure.

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Whiplash Page

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PRESCRIPTION RIGHTS: The Timex Topic: It Takes A Licking But Keeps On Ticking

By |August 29, 2016|Expanded Practice, Prescription Rights|

PRESCRIPTION RIGHTS: The Timex Topic: It Takes A Licking But Keeps On Ticking

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2016 (Aug 24)

Peter C. Emary, Taco A. W. Houweling, Martin Wangler, Stephen J. Burnie, Katherine J. Hood and W. Mark Erwin

201C Preston Parkway,
Cambridge, ON
N3H 5E8 Canada.

The last I heard, all the significant National and International Associations, who comprise the “Chiropractic Summit” had all agreed (back in 2013) that chiropractic should maintain Drug-Free. However, I am also a member of a FaceBook group (Evidence-Informed Chiropractic Medicine) and the topic keeps popping up.

Our Blog has posted on medical resistance to chiropractic’s use of manipulation under anesthesia (MUA), and that one STILL has me scratching my head. After all, the DC isn’t knocking anyone out, a medical anesthesiologist does that, so this inter-professional service benefits both our professions, as well (in theory) the Patient.

We have also posted on the “expanded practice” movement in general, and we don’t need to revisit that here.

So, I have collected all our Blog postings on the prescription rights and “expanded practice” movements into one nice neat package in the new Prescription Rights and Expanded Practice Debate page.

The upper Background Materials section contains all our Blog postings, and the lower Recent Additions section contains this and earlier thoughtful articles on the expanded-practice and prescription rights movement,

The last section is titled Drug Evidence and it includes articles discussing the evidence base for various drugs for spinal pain.

I have no interest in rehashing all those conversations. I hope that if this is a hot topic for you, that you will read all these materials, and then let them percolate. It’s called informed decision. You have to get informed before you set your Profession on a different course. I hope you will take the time to absorb these materials.

 

A Commentary on the Implications of Medication Prescription Rights for the Chiropractic Profession
Chiropractic & Manual Therapies 2016 (Aug 24)

There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders.

However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.

KEYWORDS:   Attitudes; Behaviour; Chiropractic; Drug prescriptions; Evidence-based practice; Knowledge

 

From the FULL TEXT Article:

Background

Despite a growing number of surveys demonstrating a positive attitude among chiropractors and patients towards the limited use of medication within chiropractic practice, chiropractors remain unable to prescribe medication in most parts of the world [1–8]   (2007 and 2011 Ontario Chiropractic Association member surveys: B. Haig; personal communication, 3 November 2014).   In many countries, chiropractors also lack direct access to musculoskeletal (MSK) diagnostic imaging and laboratory testing – limitations that have real implications for the clinician in accurately diagnosing and managing their patient. Meanwhile, allied health care professions such as optometry, chiropody, and naturopathy have been steadily expanding their respective scopes’ of practice and gaining limited medication prescription rights relevant to their areas of training and expertise. [9–11]   Most notable for chiropractors is that physiotherapists are also interested in and have been granted prescriptive authority in some countries. [12, 13]   Moreover, there are increasing examples of physiotherapists with advanced training in medication prescription and diagnostic testing who now manage patients with MSK disorders at the primary care level. [14–16]

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The Prescription Rights and Expanded Practice Debate Page

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Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

By |August 27, 2016|Headache, Pediatrics|

Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

The Chiro.Org Blog

SOURCE:   Eur J Pediatr. 2013 (Oct); 172 (10): 1349–1356

Kim Budelmann, Harry von Piekartz, Toby Hall

University of Applied Science,
Osnabrück, Germany

Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT.

Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001).

In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.

 

From the FULL TEXT Article:

Introduction

There are more articles like this @ our:

Chiropractic Pediatrics Section

and our:

Headache and Chiropractic Page

and our:

Forward Head Posture Page

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Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain

By |August 24, 2016|Cost-Effectiveness, Low Back Pain|

Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain:
A Systematic Literature Review

The Chiro.Org Blog

SOURCE:   Applied Health Econ & Health Policy 2016 (Aug 22)

Lazaros Andronis, Philip Kinghorn, Suyin Qiao,
David G. T. Whitehurst, Susie Durrell, Hugh McLeod

Health Economics Unit,
Public Health Building,
University of Birmingham,
Birmingham, B15 2TT, UK.
l.andronis@bham.ac.uk

BACKGROUND:   Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

OBJECTIVES:   To identify, document and appraise studies reporting on the cost effectiveness of non-invasive and non-pharmacological treatment options for LBP.

METHODS:   Relevant studies were identified through systematic searches in bibliographic databases (EMBASE, MEDLINE, PsycINFO, Cochrane Library, CINAHL and the National Health Service Economic Evaluation Database), ‘similar article’ searches and reference list scanning. Study selection was carried out by three assessors, independently. Study quality was assessed using the Consensus on Health Economic Criteria checklist. Data were extracted using customized extraction forms.

RESULTS:   Thirty-three studies were identified. Study interventions were categorised as:

(1) combined physical exercise and psychological therapy,

(2) physical exercise therapy only,

(3) information and education, and

(4) manual therapy.

Interventions assessed within each category varied in terms of their components and delivery. In general, combined physical and psychological treatments, information and education interventions, and manual therapies appeared to be cost effective when compared with the study-specific comparators. There is inconsistent evidence around the cost effectiveness of physical exercise programs as a whole, with yoga, but not group exercise, being cost effective.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Cost-Effectiveness of Chiropractic Page

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Diagnostic Testing Considerations in Pediatric Cervicogenic Headache

By |August 20, 2016|Cervicogenic, Headache|

Diagnostic Testing Considerations in Pediatric Cervicogenic Headache

The Chiro.Org Blog

SOURCE:   ACA News ~ May 23, 2016

Robert Vining, DC and Janice Kane, DC

The Neurological Institute,
Taipei Veterans General Hospital,
Taipei, Taiwan.

We are all aware that children commonly complain of headaches, but determining a specific diagnosis can be challenging. That’s partly because pediatric patients may not describe their symptoms as well as adults. Therefore, we asked this question: “Is there a diagnostic test that helps classify headache in pediatric patients in the range of 6-12 years?” If an evidence-based diagnostic test is available, it may help providers diagnose and develop management strategies.

Cervicogenic headache is common in pediatric patients and is defined by the International Headache Society as a condition caused by cervical spine dysfunction that is usually accompanied by neck pain. We chose this type of headache because it is commonly seen in chiropractic offices. With these thoughts in mind, we performed a search for office-based tests to help substantiate a diagnosis of cervicogenic headache diagnosis in a pediatric patient.

An evidence-based consideration

A PubMed search using the terms pediatric AND headache AND posture produced only a few articles. Included in this list is an article authored by Budelmann et al. describing a cross-sectional study entitled:

Is there a difference in head posture and cervical spine movement in children with and without pediatric headache?
Eur J Pediatr. 2013 (Oct);   172 (10):   1349-56

What happened in this study?

Investigators recruited 34 asymptomatic children from a high school and handball club in Germany and 30 symptomatic patients from physiotherapy departments in the Netherlands. Both groups had a mean age of 10 years (range of 6-12 years).

Criteria utilized for probable cervicogenic headaches were patient reports of:

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Headache and Chiropractic Page

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The Use of Spinal Manipulation to Treat an Acute on Field Athletic Injury

By |August 18, 2016|Sports Management|

The Use of Spinal Manipulation to Treat an Acute on Field Athletic Injury: A Case Report

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc. 2016 (Jun); 60 (2): 158–163

Sean A. Duquette, BA, DC and
Mohsen Kazemi, RN, DC, MSc., FRCCSS(C), FCCPOR(C),
PhD (Candidate)

Canadian Memorial Chiropractic College.

This case describes the utilization of spinal manipulative therapy for an acute athletic injury during a Taekwondo competition. During the tournament, an athlete had a sudden, non-traumatic, ballistic movement of the cervical spine. This resulted in the patient having a locked cervical spine with limited active motion in all directions. The attending chiropractor assessed the athlete, and deemed manipulation was appropriate. After the manipulation, the athlete’s range of motion was returned and was able to finish the match. Spinal manipulation has multiple positive outcomes for an athlete with an acute injury including the increase of range of motion, decrease in pain and the relaxation of hypertonic muscles. However, there should be some caution when utilizing manipulation during an event.

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