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Frank M. Painter

About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.
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What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

By |July 15, 2014|Chiropractic Research, Low Back Pain|

What Happened To The ‘Bio’ In The Bio-psycho-social Model of Low Back Pain?

The Chiro.Org Blog

SOURCE:   Eur Spine J. 2011 (Dec); 20 (12): 2105-2110

Mark J. Hancock, Chris G. Maher, Mark Laslett, Elaine Hay, and Bart Koes

Faculty of Health Sciences,
University of Sydney,
PO Box 170,
Lidcombe 1825, NSW, Australia.
mark.hancock@sydney.edu.au

Purpose   Over 20 years ago the term non-specific low back pain became popular to convey the limitations of our knowledge of the pathological source of most people’s low back pain. Knowledge of underlying pathology has advanced little since then, despite limited improvements in outcomes for patients with low back pain.

Methods   This paper discusses potential misunderstandings related to diagnostic studies in the field of low back pain and argues that future diagnostic studies should include and investigate pathological sources of low back pain.

Results   Six potential misunderstandings are discussed.

  1. Until diagnosis is shown to improve outcomes it is not worth investigating;
  2. without a gold standard it is not possible to investigate diagnosis of low back pain;
  3. the presence of pathology in some people without low back pain means it is not important;
  4. dismissal of the ability to diagnose low back pain in clinical guidelines is supported by the same level of evidence as recommendations for therapy;
  5. suggesting use of a diagnostic test in research is misinterpreted as endorsing its use in current clinical practice;
  6. we seem to have forgotten the ‘bio’ in biopsychosocial low back pain.

Conclusions   We believe the misunderstandings presented in this paper partly explain the lack of investigation into pathology as an important component of the low back pain experience. A better understanding of the biological component of low back pain in relation, and in addition, to psychosocial factors is important for a more rational approach to management of low back pain.

Keywords:   Low back pain, Diagnosis, Back pain

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Biopsychosocial Model Page

 

From the FULL TEXT Article

Introduction

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Joint Assessment – P.A.R.T.S.

By |July 15, 2014|Diagnosis, Medical Necessity, Medicare|

Joint Assessment – P.A.R.T.S.

The Chiro.Org Blog

SOURCE:   Topics in Clinical Chiropractic 2000; 7 (3): 1–10

Thomas F. Bergmann, DC,
Bradley A. Finer, DC, DACAN

Clinical Science Division
Northwestern Health Sciences University
College of Chiropractic
Bloomington, Minnesota

Purpose:   An approach to systematically perform clinical work-up for chiropractic subluxation is proposed. Literature on assessment approaches is reviewed and a discussion is presented.

Method:   A qualitative review of clinical and scientific literature related to assessment methodologies for subluxation was performed.

Summary:   Variation in assessment techniques exists for identification of spinal and other articular joint dysfunction. Useful scientific data also are limited to only a few approaches. and there is a need for a more systematic assessment approach profession wide.

Key words:   articular range oj motion, chiropractic, Medicare, palpation, physical examination, subluxation

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What is The Chiropractic Subluxation? Page

 

From the FULL TEXT Article

Background

Doctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. As such, they must maintain broad and thorough assessment/diagnostic skills. Before employing any therapy, a clinician must first determine if there is a need for treatment. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. Having gathered and interpreted this information, it must be processed in order to arrive at a sound clinical conclusion. The role of this assessment process in the chiropractic office is to determine whether the patient should receive chiropractic care only, chiropractic care in concert with other forms of health care, or a referral to another health care professional for some other form of stand-alone management such as acute, crisis care. This article suggests the need for, and possible form of, a standardized assessment procedure for use by chiropractic clinicians.

 

INTRODUCTION

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Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

By |July 13, 2014|Chiropractic Care, Spinal Manipulation|

Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2013 (Oct 21); 21 (1): 36

John J Triano, Brian Budgell, Angela Bagnulo,
Benjamin Roffey, Thomas Bergmann, Robert Cooperstein,
Brian Gleberzon, Christopher Good, Jacquelyn Perron
and Rodger Tepe

Canadian Memorial Chiropractic College,
6100 Leslie St,
Toronto, Ontario, Canada.
jtriano@cmcc.ca

BACKGROUND:   With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

METHODS:   Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

RESULTS:   A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.

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Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

By |July 9, 2014|Cost-Effectiveness|

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther. 2014 (Jul); 37 (6): 343–362

Alexander Tsertsvadze, MD, MSc,
Christine Clar, PhD, Rachel Court, MA,
Aileen Clarke, MD, Hema Mistry, PhD,
Paul Sutcliffe, DPhil

Senior Research Fellow,
Warwick Medical School,
University of Warwick, Coventry, UK.

OBJECTIVES:   The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

METHODS:   A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

RESULTS:   Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

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The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

By |July 7, 2014|Acute Facet Syndrome, Chiropractic Care|

The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

The Chiro.Org Blog

SOURCE:   Chiropractic & Osteopathy 2009 (Feb 5);   17:   2

Lise Hestbaek, Alice Kongsted, Tue Secher Jensen,
and Charlotte Leboeuf-Yde

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense M, Denmark.
l.hestbaek@nikkb.dk

Background   The term ‘acute facet syndrome’ is widely used and accepted amongst chiropractors, but poorly described in the literature, as most of the present literature relates to chronic facet joint pain. Therefore, research into the degree of consensus on the subject amongst a large group of chiropractic practitioners was seen to be a useful contribution.

Methods   During the annual congress of The European Chiropractors Union (ECU) in 2008, the authors conducted a workshop involving volunteer chiropractors. Topics were decided upon in advance, and the participants were asked to form into groups of four or five. The groups were asked to reach consensus on several topics relating to a basic case of a forty-year old man, where an assumption was made that his pain originated from the facet joints. First, the participants were asked to agree on a maximum of three keywords on each of four topics relating to the presentation of pain: 1. location, 2. severity, 3. aggravating factors, and 4. relieving factors. Second, the groups were asked to agree on three orthopaedic and three chiropractic tests that would aid in diagnosing pain from the facet joints. Finally, they were asked to agree on the number, frequency and duration of chiropractic treatment.

Results   Thirty-four chiropractors from nine European countries participated. They described the characteristics of an acute, uncomplicated facet syndrome as follows: local, ipsilateral pain, occasionally extending into the thigh with pain and decreased range of motion in extension and rotation both standing and sitting. They thought that the pain could be relieved by walking, lying with knees bent, using ice packs and taking non-steroidal anti-inflammatory drugs, and aggravated by prolonged standing or resting. They also stated that there would be no signs of neurologic involvement or antalgic posture and no aggravation of pain from sitting, flexion or coughing/sneezing.

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Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

By |July 4, 2014|Cineradiography, Videofluoroscopy|

Does Inter-vertebral Range of Motion Increase After Spinal Manipulation? A Prospective Cohort Study

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2014 (Jul 1);   22:   24 ~ FULL TEXT

Jonathan Branney, Alan C Breen

Institute of Musculoskeletal Research & Clinical Implementation,
Anglo-European College of Chiropractic, 13-15 Parkwood Road,
Bournemouth BH5 2DF, UK

Background   Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes.

Objectives   This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments.

Method   Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated.

Results   QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06).

Conclusions   This study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM – providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this.

Keywords:   Neck pain; Manipulation; Spine kinematics; Fluoroscopy; Patient-reported outcomes

 

Background

Neck pain is a common condition which most people experience at some point in their lives, with self-reported incidence rates ranging from 15.5 to 213 per 1000 person years [1] and 12-month prevalence rates around 30-50%. The condition can also be a significant cause of work absence, [2, 3] decreased productivity [4] and increased healthcare costs. [5]

Spinal manipulation, mobilisation, exercise, analgesics, acupuncture and low level laser therapy have all been shown to provide at least some degree of short-term relief of neck pain in the absence of trauma. [6] Spinal manipulation or mobilisation, particularly combined with exercise, appears to confer marginal benefit over other interventions. [7, 8] However, trials investigating manipulation for neck pain have shown conflicting results [9, 10] and while some patients respond well, others derive little benefit. One step towards understanding this would be to further our knowledge of the mechanism of action of manipulation as an intervention.

There is evidence to suggest that manipulation can decrease pain and improve function and that this is probably associated with increased motion. Nansel et al. showed that a single manipulation could reduce asymmetry of passive regional cervical spine motion, [11] while Cassidy et al. and Martinez-Segura et al. independently found that manipulation was associated with both reduced neck pain and increased regional range of neck motion immediately after treatment. [12, 13] However, regional neck range of motion is also influenced by pain, disability and fear of movement, [14] leaving the role of manipulation ambiguous. Furthermore, spinal manipulation targets specific levels, often to improve intervertebral range of motion (IV-RoM), [15] but it is not known if this actually happens, or if reduced IV-RoM is even detectable by clinical examination (palpation). To begin to explain the therapeutic effects of neck manipulation therefore requires an accurate and reproducible means of measuring maximum IV-RoM wherever it occurs in the neck bending sequence, and relating it to symptomatic changes following a course of manipulative treatment. It is also necessary to know whether reduced motion at inter-vertebral levels as detected by palpation as the basis for a manipulation can be verified.

Cineradiography and videofluoroscopy have allowed the visualisation of complete intervertebral motion sequences and have been available for many yearr, [16, 17] but analysis of the motion has been largely qualitative. However, during the last decade considerable progress has been made with detailed measurement of inter-vertebral motion using quantitative fluoroscopy (QF). [18] It is now possible to track fluoroscopic images of lumbar vertebrae continuously throughout lumbar motion in living subjects [19] allowing the measurement of true IV-RoM, regardless of where it occurs during bending. QF has been found to have good reproducibility for this, [20] but has not yet been validated or extensively used in the cervical spine. This study aimed to explore the effects of neck manipulation on IV-RoM in the cervical spine as measured by QF.

The study had four main objectives:

 

  • To determine the accuracy, measurement precision and minimal detectable change (MDC) in IV-RoM over a period of treatment
  • To determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation for non-specific neck pain and if so, the dose–response associated with such change
  • To determine if there is any correlation between IV-RoM changes and patient reported outcomes
  • To compare the frequency of finding inter-vertebral motion hypomobility by palpation and QF measurement.

 

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