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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.

The Research Crisis in American Institutions of CAM

By |June 18, 2019|Chiropractic Research|

The Research Crisis in American Institutions of Complementary and Integrative Health:
One Proposed Solution for the Chiropractic Profession

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2019 (Jun 17); 27: 32

Ian D. Coulter and Patricia M. Herman

RAND Corporation,
1776 Main Street, P.O. Box 2138,
Santa Monica, CA 90407-2138, USA


A crisis confronts the Complementary and Integrative Health (CIH) teaching institutions in the US. Research infrastructure is needed to build and sustain productive research programs and retain their own research faculty. In most health professions, this infrastructure is largely built through research grants. In CIH, most educational institutions are funded through student tuition, which has historically also had to be the source for building their research programs. Only a limited number of these institutions have emerged as National Institute of Health (NIH) grant-funded programs. As a result, the American chiropractic institutions have seen a retrenchment in the number of active research programs. In addition, although research training programs e.g., NIH’s K awards are available for CIH researchers, these programs generally result in these researchers leaving their institutions and depriving future CIH practitioners of the benefit of being trained in a culture of research.

One proposed solution is to leverage the substantial research infrastructure and long history of collaboration available at the RAND Corporation (https://www.rand.org) This article presents the proposed five components of the RAND Center for Collaborative CIH Research and the steps required to bring it to being:

1)   the CIH Research Network –   an online resource and collaborative site for CIH researchers;

2)   the CIH Research Advisory Board –   the governing body for the Center selected by its members;

3)   the RAND CIH Interest Group –   a group of RAND researchers with an interest in and who could provide support to CIH research;

There are more articles like this @ our:

Chiropractic Research Section

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A Narrative Review of Lumbar Fusion Surgery

By |June 6, 2019|Guidelines, Low Back Pain|

A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice

The Chiro.Org Blog


SOURCE:   J Chiropractic Medicine 2016 (Dec);   15 (4):   259–271

Clinton J. Daniels, DC, MS,
Pamela J. Wakefield, DC,
Glenn A. Bub, DC,
James D. Toombs, MD

Veteran Affairs Saint Louis Health Care System,
St. Louis, MO.


OBJECTIVE:   The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion.

METHODS:   The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed.

RESULTS:   The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain.

There are more articles like this @ our:

Low Back Pain Guidelines Page and the:

Low Back Pain and Chiropractic Page

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Who Will Have Sustainable Employment After a Back Injury?

By |June 1, 2019|Clinical Prediction Rule, Return To Work|

Who Will Have Sustainable Employment After a Back Injury? The Development of a Clinical Prediction Model in a Cohort of Injured Workers

The Chiro.Org Blog


SOURCE:   J Occup Rehabil. 2017 (Sep); 27 (3): 445–455

Heather M. Shearer, Pierre Cote, Eleanor Boyle, Jill A. Hayden, John Frank, William G. Johnson

UOIT-CMCC Center for the Study of Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology,
2000 Simcoe St. North,
Oshawa, ON, L1H 7K4, Canada.


Our objective was to develop a clinical prediction model to identify workers with sustainable employment following an episode of work-related low back pain (LBP).

Methods   We used data from a cohort study of injured workers with incident LBP claims in the USA to predict employment patterns 1 and 6 months following a workers’ compensation claim. We developed three sequential models to determine the contribution of three domains of variables:

(1)   basic demographic/clinical variables;

(2)   health-related variables; and

(3)   work-related factors.

Multivariable logistic regression was used to develop the predictive models. We constructed receiver operator curves and used the c-index to measure predictive accuracy.

Results   Seventy-nine percent and 77 % of workers had sustainable employment at 1 and 6 months, respectively. Sustainable employment at 1 month was predicted by initial back pain intensity, mental health-related quality of life, claim litigation and employer type (c-index = 0.77).

There are more articles like this @ our:

The RETURN TO WORK Section and the:

Clinical Prediction Rule Page

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Spinal Manipulation Therapy: Is It All About the Brain?

By |May 29, 2019|Neurology|

Spinal Manipulation Therapy: Is It All About the Brain? A Current Review of the Neurophysiological Effects of Manipulation

The Chiro.Org Blog


SOURCE:   Journal of Integrative Medicine 2019 (May 9) [Epub]

Giles Gyer, Jimmy Michael, James Inklebarger, Jaya Shanker Tedla

The London College of Osteopathic Medicine,
London NW1 6QH, United Kingdom.


Spinal manipulation has been an effective intervention for the management of various musculoskeletal disorders. However, the mechanisms underlying the pain modulatory effects of spinal manipulation remain elusive. Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin.

In this article, we reviewed the relevance of various neurophysiological theories with respect to the findings of mechanistic studies that demonstrated neural responses following spinal manipulation. This article also discussed whether these neural responses are associated with the possible neurophysiological mechanisms of spinal manipulation. The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more. However, the clinical relevance of these changes in relation to the mechanisms that underlie the effectiveness of spinal manipulation is still unclear. In addition, there were some major methodological flaws in many of the reviewed studies. Future mechanistic studies should have an appropriate study design and methodology and should plan for a long-term follow-up in order to determine the clinical significance of the neural responses evoked following spinal manipulation.

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A Risk-benefit Assessment Strategy

By |May 25, 2019|Stroke|

A Risk-benefit Assessment Strategy to Exclude Cervical Artery Dissection in Spinal Manual-therapy: A Comprehensive Review

The Chiro.Org Blog


SOURCE:   Annals of Medicine 2019 (Mar 19): 1–10 [Epub]

Aleksander Chaibi & Michael Bjørn Russell

Head and Neck Research Group,
Research Centre, Akershus University Hospital,
Oslo, Norway.


Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural haematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger. Headache and/or neck pain is the most common initial symptom of cervical artery dissection. Other symptoms include Horner’s syndrome and lower cranial nerve palsy. Both headache and/or neck pain are common symptoms and leading causes of disability, while cervical artery dissection is rare. Patients often consult their general practitioner for headache and/or neck pain, and because manual-therapy interventions can alleviate headache and/or neck pain, many patients seek manual therapists, such as chiropractors and physiotherapists. Cervical mobilization and manipulation are two interventions that manual therapists use. Both interventions have been suspected of being able to trigger cervical artery dissection as an adverse event. The aim of this review is to provide an updated step-by-step risk-benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection.

Key messages

 

  • Cervical mobilization and/or manipulation have been suspected to be able to trigger cervical artery dissection (CAD). However, these assumptions are based on case studies which are unable to established direct causality.

    There are more articles like this @ our:

    STROKE AND CHIROPRACTIC Page

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Relationship Between Early Prescription Dispensing Patterns

By |May 22, 2019|Workers' Compensation|

Relationship Between Early Prescription Dispensing Patterns and Work Disability in a Cohort of Low Back Pain Workers’ Compensation Claimants: A Historical Cohort Study

The Chiro.Org Blog


SOURCE:   Occup Environ Med. 2019 (May 15) [Epub]

Nancy Carnide, Sheilah Hogg-Johnson, Mieke Koehoorn, Andrea D Furlan1, Pierre Côté

Institute for Work and Health,
Toronto, Ontario, Canada.


OBJECTIVES:   To examine and compare whether dispensing of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) within 8 weeks after a work-related low back pain (LBP) injury is associated with work disability.

METHODS:   A historical cohort study of 55 571 workers’ compensation claimants with LBP claims in British Columbia from 1998 to 2009 was conducted using linked compensation, dispensing and healthcare data. Four exposures were constructed to estimate the effect on receipt of benefits and days on benefits 1 year after injury: drug class(es) dispensed, days’ supply, strength of opioids dispensed and average daily morphine-equivalent dose.

RESULTS:   Compared with claimants receiving NSAIDs and/or SMRs, the incidence rate ratio (IRR) of days on benefits was 1.09 (95% CI 1.04 to 1.14) for claimants dispensed opioids only and 1.26 (95% CI 1.22 to 1.30) for claimants dispensed opioids with NSAIDs and/or SMRs. Compared with weak opioids only, the IRR for claimants dispensed strong opioids only or strong and weak opioids combined was 1.21 (95% CI 1.12 to 1.30) and 1.29 (95% CI 1.20 to 1.39), respectively. The incident rate of days on benefits associated with each 7-day increase in days supplied of opioids, NSAIDs and SMRs was 10%, 4% and 3%, respectively. Similar results were seen for receipt of benefits, though effect sizes were larger.

There are more articles like this @ our:

WORKERS’ COMPENSATION Page

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