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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.

Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs

By |August 22, 2011|Medicare|

Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs

The Chiro.Org Blog


An older study of Medicare cost data completed in June (2001 or 2002) by the well-known Washington, DC-based firm Muse & Associates helps demonstrate the cost-saving impact that chiropractic care has on the current Federal Medicare program.

The study, titled “Utilization, Costs, and Effects of Chiropractic Care on Medicare Program Costs“, was commissioned by the ACA and is the first study of its type to compare the global, per capita Medicare expenditures of chiropractic patients to those of non-chiropractic patients receiving care in the federal Medicare program. The study utilizes data obtained from Medicare’s Standard Analytical Files for 1999 — the most recent year that cost data was available for analysis.

The study’s executive summary states:

“The results strongly suggest that chiropractic care significantly reduces per beneficiary costs to the Medicare program. The results also suggest that Chiropractic services could play a role in reducing costs of Medicare reform and/or a new prescription drug benefit.”

 

The study specifically found that:

  • Beneficiaries who received chiropractic care had lower average Medicare payments for all Medicare services than those who did not ($4,426 vs. $8,103);
  • Beneficiaries who received chiropractic care averaged fewer Medicare claims per capita than those who did not; and
  • Beneficiaries who received chiropractic care had lower average Medicare payments per claim than those who did not.

(more…)

Steroid Injections Offer Little Relief for Lower Back Pain

By |August 21, 2011|Low Back Pain|

Steroid Injections Offer Little Relief for Lower Back Pain

The Chiro.Org Blog


SOURCE:   Amer Acad Orthop Surgeons March 10-14 · San Francisco, CA


“Effects of Epidural Steroids in the Lumbar Spine: A Double Blind Randomized Control Trial”

Podium Presentation

By Andrew Skelly


SAN FRANCISCO – A randomized, controlled trial has shown an epidural or translaminar steroid injection is ineffective for the relief of lower back pain.

“I’m not saying that steroids don’t work. I’m just saying there’s definite reason to question whether they work or not,” Dr. Daniel Steinitz, an orthopedic surgeon at Belleville General Hospital in Ontario, said in an interview after his presentation at the American Academy of Orthopedic Surgeons meeting here.

Dr. Steinitz, who worked on the study during his residency at McGill University in Montreal, said steroid injections for lumbar pain are popular but research on their use over the past 40 years has produced conflicting results. Nor is the procedure benign, with dural puncture leading to headache being one of the more common complications. (more…)

The Evolution of Chiropractic — Science & Theory

By |August 20, 2011|Research|

The Evolution of Chiropractic — Science & Theory

The Chiro.Org Blog


By Scott Haldeman, D.C., M.D., Ph.D.

Keynote Presentation
International Conference on Spinal Manipulation


I have had the privilege of being associated with chiropractic and chiropractic ideas all of my life through my father and grandmother, both of whom were practicing chiropractors. I have also been lucky to have participated in one of the most exciting phases in the evolution of chiropractic over the past 35 years. I thought that it would be of interest to younger researchers and clinicians to present my views on how the profession has evolved to its current position in society and how this evolution has impacted our understanding of chiropractic. I plan to discuss how we can put the changes in the role of science over the past 100 years in perspective and how these changes are likely to impact our lives as researchers, chiropractors, and physicians studying and treating patients with spinal disorders. (more…)

Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability

By |August 18, 2011|Degenerative Joint Disease, Spinal Manipulation|

Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability: PART I and II

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic

By James Brantingham, DC, CCF , Randy Snyder, DC, CCFC, and David Biedebach, DC, CCFC


Has the hypomobile manipulable joint lesion been demonstrated to exist? Historically the manipulable joint lesion has, from the beginning of the chiropractic profession, been described as a painful stiff joint. [1, 2] Joint stiffness, commonly called hypomobility (also known in the chiropractic profession as “fixation”) has become by consensus one of the most important aspects of the manipulable joint lesion in the professions of chiropractic, osteopathy, and manual medicine. [3, 4] Nearly 100 years of clinical agreement between three separate professions supports the existence of such a lesion although research now supports its existence.

Loss of full, or global, range of motion in the lumbar or cervical spines is an indirect proof that the segmental hypomobile manipulable vertebral joint lesion exists, because it is a fact that loss of full global range of motion occurs and such stiffness is considered an objective factor in chronic back pain. [5] therefore, even if this decreased range of motion is a mixture of hypermobile and hypomobile joints (i.e., a mixture of loose and stiff joints) there must be intervertebral hypomobility for global hypomobility to exist. Randomized controlled trials of manipulation documenting decreased global range of motion, and post-treatment global range of motion are growing. [6-12]

A meta-analysis of clinical trials of spinal manipulation performed by Anderson et al., clearly and strongly demonstrated that spinal manipulation is effective in restoring or increasing global, and therefore segmental lumbar mobility. Mead et al., documented post-manipulation treatment restored or increased lumbar mobility: data proving that the hypomobile manipulable joint lesion must have existed prior to treatment, and that manipulation restored to these hypomobile joints fuller mobility (Fig 1.). [6] Other studies have documented similar results. Nansel and his associates have demonstrated in three, multiply blinded, controlled studies, in which goniometer measurements confirmed cervical range of motion or global end range asymmetries or hypomobility, that after chiropractic high velocity low amplitude manipulation, statistically significant increased mobility was restored to the global and therefore segmental hypomobility areas: proof that global and therefore segmental hypomobility was returned to more normal mobility by manipulation. [14-16] (more…)

Bipartisan Group Urges Pentagon to Examine Chiropractic Provider Status

By |August 16, 2011|Announcement, News|

Bipartisan Group Urges Pentagon to Examine Chiropractic Provider Status

The Chiro.Org Blog


Fifteen Members of the House Defense Panel Advocate for Fair, and Equitable Treatment of DCs in the Military Health Care System

August 15, 2011 — In an effort strongly supported by the American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC), 15 members of the U.S. House of Representatives Armed Services Committee have requested that the Department of Defense (DoD) address disparities in its treatment of doctors of chiropractic.

In an Aug. 5 letter to Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs, the bipartisan group noted that pay and job classification disparities have resulted in doctors of chiropractic (DCs) who treat patients at military treatment facilities (MTFs) being compensated at much lower rates than providers with comparable, or even lesser, training, skill sets and responsibilities. They urged Woodson to examine the more equitable system used by the Department of Veteran Affairs health care system to integrate chiropractic and adopt a similar approach.

The group also pointed out that institutional bias against doctors of chiropractic among DoD health care officials has resulted in the active-duty military patient population having greater difficulty accessing chiropractic care and in unnecessary restrictions placed on DCs in performing their services. To address this, the legislators asked Woodson to evaluate the current supervisory procedures of DCs and to give serious consideration to having a DC as the chiropractic service leader for each branch of the military, as is the case with other specialty groups in TRICARE, the military’s health care system.

“I would like to thank congressmen Mike Rogers and Dave Loebsack for spearheading this effort,” said ACA President Dr. Rick A. McMichael. “The benefit provided by doctors of chiropractic to our brave men and women in uniform is integral to their recovery from injuries and their overall health and well-being. Impeding DCs from providing this care is a disservice to our troops.” (more…)

The Inherent Problems With Randomized Controlled Trials

By |August 15, 2011|Editorial, Research|

The Inherent Problems With Randomized Controlled Trials (RCTs)

The Chiro.Org Blog


SOURCE:   J Manip Physiol Ther 2003 (Sep); 26 (7): 460–467


Anthony Rosner, PhD

Foundation for Chiropractic Research and Education,
1330 Beacon Street, Suite 315,
Brookline, MA 02446, USA.


For 50 years, the accepted standard by which the usefulness of a therapeutic treatment is judged has been the randomized controlled trial (RCT), building from Hippocrates’ premise 2000 years ago that experience combined with reason was the therapy of choice for patients; that is, any treatment plan should both seem reasonable in theory and then be tested experimentally. Assuming that threats to both internal and external validity could be ruled out, the RCT became what is commonly regarded as the highest quality of clinical outcome study that could be mounted to allow inferences about cause and effect relationships to be drawn. The thinking was that the more rigorous and fastidious the design, the more credibility could be attached to the conclusions drawn from the outcomes of the study and the more likely the intervention was thought to have brought about those outcomes. [1] One of the strongest proponents of the RCT through the 1950s and 1960s was the British epidemiologist Archie Cochrane, who held that this type of experimental approach was essential for upgrading the quality of medical evidence. [2] In common hierarchical schemes of clinical experimental design, the RCT has been ranked the highest in rigor, as shown in Table 1.3 Even greater rigor has been presumed to occur with the statistical combination and weighting of the results of multiple RCTs in a meta-analysis to generate a more conclusive estimate of effect size. [4-5]

Table 1.   Hierarchy of Experimental Designs [3]

  1. Control group outcomes study (including RCTs).
  2. Single-subject experiment, replicated single-subject experiments.
  3. Single-group outcome study.
  4. Systematic case study.
  5. Anecdotal case report.

Designs are presented in descending order of rigor.

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