Frank M. Painter

Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

By Frank M. Painter|January 20, 2022|Initial Provider, Medicare|

Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

SOURCE: BMJ Open 2021 (Sep 17); 11 (9): e053229

Ørjan Nesse Vigdal, Kjersti Storheim, Rikke Munk Killingmo, Milada Cvancarova Småstuen, and Margreth Grotle

Department of Physiotherapy,
Oslo Metropolitan University,
Oslo, Norway

Objectives: To describe characteristics of older adults with back pain in primary care, and to assess associations between patient characteristics and type of first primary care provider (general practitioner (GP), physiotherapist (PT) or chiropractor).

Design: Cross-sectional analysis from the Back Complaints in the Elders-Norway cohort study.

Setting: Norwegian GP, PT and chiropractic primary care centres.

Participants: Patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain were invited to participate. Between April 2015 and February 2020, we included 452 patients: 127 first visited a GP, 130 first visited a PT and 195 first visited a chiropractor.

Primary and secondary outcome measures: For the first objective, the outcome measure was descriptive statistics of patient characteristics, covering the following domains: sociodemographic, general health, current and previous back pain, psychological and clinical factors. For the second objective, first primary care provider was the outcome measure. Associations between patient characteristics and visiting a GP or PT compared with a chiropractor were assessed with multiple multinomial regression analyses.

Results: Median (IQR) age was 66 (59-72) years. Levels of back-related disability was moderate to severe, with a median (IQR) Roland-Morris Disability Questionnaire (range 0-24) score of 9 (5-13). Recurring episodes were common, 301 (67%) patients had monthly or yearly recurrences. Patients with worse back-related disability, longer duration of symptoms, lower expectations for full recovery and worse physical performance measured with the Back Performance Scale had higher odds of visiting a GP or PT compared with a chiropractor (p<0.05).

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Attitudes Towards Chiropractic: A Repeated Cross-sectional Survey of Canadian Family Physicians

By Frank M. Painter|January 19, 2022|All About Chiropractic, Cost-Effectiveness of Chiropractic|

Attitudes Towards Chiropractic: A Repeated Cross-sectional Survey of Canadian Family Physicians

The Chiro.Org Blog

SOURCE: BMC Family Practice 2021 (Sep 15); 22 (1): 188

Jason W. Busse, DC, PhD; Sushmitha Pallapothu, BSc; Brian Vinh, BSc; Vivienne Lee, BSc; et. al.

Department of Health Research Methods,
Evidence, and Impact,
McMaster University,
Hamilton, ON, Canada.

Background: Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes.

Methods: A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores.

Results: Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (- 1.55 points for each 10-year increment from age 28; 95%CI – 2.67 to – 0.44), belief that adverse events are common with chiropractic care (- 1.41 points; 95% CI – 2.59 to – 0.23) and reported use of the research literature (- 6.04 points; 95% CI – 8.47 to – 3.61) or medical school (- 5.03 points; 95% CI – 7.89 to – 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic.

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Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

By Frank M. Painter|January 18, 2022|Chiropractic Management, Cost-Effectiveness, Veterans|

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

The Chiro.Org Blog

SOURCE: Pilot Feasibility Stud 2022 (Jan 14); 8 (1): 6

Stacie A. Salsbury, Elissa Twist, Robert B. Wallace, Robert D. Vining, Christine M. Goertz & Cynthia R. Long

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street,
Davenport, Iowa, 52803, USA.

Background: Low back pain (LBP) is common among military veterans seeking treatment in Department of Veterans Affairs (VA) healthcare facilities. As chiropractic services within VA expand, well-designed pragmatic trials and implementation studies are needed to assess clinical effectiveness and program uptake. This study evaluated veteran stakeholder perceptions of the feasibility and acceptability of care delivery and research processes in a pilot trial of multimodal chiropractic care for chronic LBP.

Methods: The qualitative study was completed within a mixed-method, single-arm, pragmatic, pilot clinical trial of chiropractic care for LBP conducted in VA chiropractic clinics. Study coordinators completed semi-structured, in person or telephone interviews with veterans near the end of the 10–week trial. Interviews were audiorecorded and transcribed verbatim. Qualitative content analysis using a directed approach explored salient themes related to trial implementation and delivery of chiropractic services.

Results: Of 40 participants, 24 completed interviews (60% response; 67% male gender; mean age 51.7 years). Overall, participants considered the trial protocol and procedures feasible and reported that the chiropractic care and recruitment methods were acceptable. Findings were organized into 4 domains, 10 themes, and 21 subthemes. Chiropractic service delivery domain encompassed 3 themes/8 subthemes: scheduling process (limited clinic hours, scheduling future appointments, attendance barriers); treatment frequency (treatment sufficient for LBP complaint, more/less frequent treatments); and chiropractic clinic considerations (hire more chiropractors, including female chiropractors; chiropractic clinic environment; patient-centered treatment visits). Outcome measures domain comprised 3 themes/4 subthemes: questionnaire burden (low burden vs. time-consuming or repetitive); relevance (items relevant for LBP study); and timing and individualization of measures (questionnaire timing relative to symptoms, personalized approach to outcomes measures). The online data collection domain included 2 themes/4 subthemes: user concerns (little difficulty vs. form challenges, required computer skills); and technology issues (computer/internet access, junk mail). Clinical trial planning domain included 2 themes/5 subthemes: participant recruitment (altruistic service by veterans, awareness of chiropractic availability, financial compensation); and communication methods (preferences, potential barriers).

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Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report

By Frank M. Painter|January 17, 2022|Adjacent Segment Disease, Case Studies, McKenzie, Myofascial Disorder, Myofascial Trigger Points|

Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2020 (Dec); 19 (4): 249–259

Emsal Salik, MD PhD; Ali Donat, DC; Mustafa Hulisi Ağaoğlu, DC

Chiropractic Program,
Health Sciences Institute,
Bahcesehir University,
Besiktas, Istanbul, Turkey

Objective: The objective of the present study objective was to describe adjacent segment disease (ASD) from a chiropractic management prospective and subsequently to stimulate further research into the chiropractic therapeutic effects on such cases and to contribute to chiropractic literature.

Clinical features: A 44–year-old woman had a history of lumbar stabilization revision operation by pedicle screw fixation for spondylolisthesis. Her intractable back pain episodes, which were diagnosed as ASD, began shortly after this surgery. At presentation, she was taking pregabalin 75 mg 2 times a day for postoperative neuropathic pain without any pain relief. Clinical testing revealed myofascial tender points reproducing the pain.

Intervention and outcome: After taking the case history and performing a physical examination, the patient was managed with chiropractic Nimmo receptor-tonus technique in combination with McKenzie exercises. Nimmo was applied by manually pressing on clinically relevant points for 5 to 15 seconds in 11 visits over 3 weeks. The patient by herself did McKenzie exercises 5 to 10 times a day for 10 to 12 repetitions over 2 months. After 3 weeks of therapy, visual analog scale and Oswestry Disability Index scores were improved. Furthermore, because of the amelioration of the patient’s symptoms, her neurosurgeon successfully discontinued pregabalin 75 mg 2 times a day without negative consequences to care.

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Chiropractic Management of a Symptomatic Patient Who Previously Had Surgery for Cauda Equina Syndrome

By Frank M. Painter|January 15, 2022|Uncategorized|

Chiropractic Management of a Symptomatic Patient Who Previously Had Surgery for Cauda Equina Syndrome

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2021 (Jun); 20 (2): 85–89

Jonathan R. Cook, MChiro

24 Manor Gardens,
Millbrook, Cornwall,
PL10 1PR, United Kingdom

Objective: The purpose of this report is to describe the outcomes of chiropractic care for a patient after surgery for cauda equina syndrome.

Clinical features: Following surgery for cauda equina syndrome caused by a herniated lumbar disc at L5/S1, a 28-year old woman presented for chiropractic care with an 18-month history of lower back pain. She had bilateral L5 and S1 dermatome pain and paraesthesia; saddle

Intervention and outcome: The patient received a variety of chiropractic manipulative techniques including cervical and thoracic spine manipulation, instrumented adjustments to the lumbar spine, and drop technique to the sacroiliac joints. Trigger point therapy was performed on the gluteus medius, quadratus lumborum, and piriformis muscles bilaterally. After 12 months, the patient reported a reduction in lower back and radicular leg pain, was able to reduce her use of opioid medications, and experienced improved lower limb function following chiropractic care.

Conclusion: The patient responded favorably to a course of chiropractic care for symptoms remaining after surgery for cauda equina syndrome.

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Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

By Frank M. Painter|January 14, 2022|Chronic Low Back Pain, Chronic Neck Pain, Spinal Pain Management|

Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

The Chiro.Org Blog

SOURCE: J Alternative and Complementary Medicine 2019 (Oct 1); 25 (10): 1015–1025

Patricia M. Herman, ND, PhD, Sarah E. Edgington, MA, Gery W. Ryan, PhD, and Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA.

Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain

Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with

Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions.

Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP).

Interventions: All were receiving ongoing chiropractic care.

Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables.

Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer.

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About Frank M. Painter

Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

Attitudes Towards Chiropractic: A Repeated Cross-sectional Survey of Canadian Family Physicians

Attitudes Towards Chiropractic: A Repeated Cross-sectional Survey of Canadian Family Physicians

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report

Chiropractic Nimmo Receptor-Tonus Technique and McKenzie Self-Therapy Program in the Management of Adjacent Segment Disease: A Case Report

Chiropractic Management of a Symptomatic Patient Who Previously Had Surgery for Cauda Equina Syndrome

Chiropractic Management of a Symptomatic Patient Who Previously Had Surgery for Cauda Equina Syndrome

Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care

Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care