Frank M. Painter

Spinal Manipulation and Exercise for Low Back Pain in Adolescents

By Frank M. Painter|March 22, 2019|Exercise and Chiropractic|

Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial

SOURCE: Pain. 2018 (Jul); 159 (7): 1297–1307

Roni Evans, Mitchell Haas, Craig Schulz, Brent Leininger, Linda Hanson, and Gert Bronfort

Integrative Health & Wellbeing Research Program,
Earl E. Bakken Center for Spirituality and Healing,
University of Minnesota,
Minneapolis, MN, USA.

Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone.

Participants were 185 adolescents aged 12 to 18 years with chronic LBP.

The primary outcome was LBP severity at 12, 26, and 52 weeks. Secondary outcomes included disability, quality of life, medication use, patient- and caregiver-rated improvement, and satisfaction. Outcomes were analyzed using longitudinal linear mixed effect models. An omnibus test assessing differences in individual outcomes over the entire year controlled for multiplicity.

Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = 0.007). The group difference in LBP severity (0–10 scale) was small at the end of treatment (mean difference = 0.5; P = 0.08) but was larger at weeks 26 (mean difference = 1.1; P = 0.001) and 52 (mean difference = 0.8; P = 0.009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = 0.04) and improvement (P = 0.02). The SMT with ET group reported significantly greater satisfaction with care at all time points (P ≤ 0.02). There were no serious treatment-related adverse events.

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Manual Therapy for the Pediatric Population

By Frank M. Painter|March 21, 2019|Pediatrics|

Manual Therapy for the Pediatric Population: A Systematic Review

The Chiro.Org Blog

SOURCE: BMC Complement Altern Med. 2019 (Mar 13); 19 (1): 60

Carol Parnell Prevost, Brian Gleberzon, Beth Carleo, Kristian Anderson, Morgan Cark and Katherine A. Pohlman

Palmer College of Chiropractic,
4777 City Center Parkway,
Port Orange, FL, 32129, USA.

BACKGROUND: This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report.

METHODS: Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to:

(i) determine its suitability for inclusion,

(ii) extract data, and

(iii) aasess quality of study.

RESULTS: Of the 3,563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity.

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Prevalence of MRI Findings in the Cervical Spine

By Frank M. Painter|March 10, 2019|Degenerative Joint Disease, Radiology|

Prevalence of MRI Findings in the Cervical Spine in Patients with Persistent Neck Pain Based on Quantification of Narrative MRI Reports

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2019 (Mar 6); 27: 13

Rikke Krüger Jensen, Tue Secher Jensen, Søren Grøn, Erik Frafjord, Uffe Bundgaard, Anders Lynge Damsgaard, Jeppe Mølgaard Mathiasen and Per Kjaer

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark

BACKGROUND Previous studies of patients with neck pain have reported a high variability in prevalence of MRI findings of disc degeneration, disc herniation etc. This is most likely due to small and heterogenous study populations. Reasons for only including small study samples could be the high cost and time-consuming procedures of having radiologists coding the MRIs. Other methods for extracting reliable imaging data should therefore be explored.

The objectives of this study were

1) to examine inter-rater reliability among a group of chiropractic master students in extracting information
about cervical MRI-findings from radiologists´ narrative reports, and

2) to describe the prevalence of MRI findings in the cervical spine among different age groups in patients above
age 18 with neck pain.

METHOD Adult patients with neck pain (with or without arm pain) seen in a public hospital department between 2011 and 2014 who had an MRI of the cervical spine were identified in the patient registry ‘SpineData’. MRI-findings were extracted and quantified from radiologists’ narrative reports by second-year chiropractic master students based on a set of coding rules for the process.

The inter-rater reliability was quantified with Kappa statistics and the prevalence of the MRI findings were calculated.

RESULTS In total, narrative MRI reports from 611 patients were included. The patients had a mean age of 52 years (SD 13; range 19–87) and 63% were women. The inter-observer agreement in coding MRI findings ranged from substantial (κ = 0.78, CI: 0.33–1.00) to almost perfect (κ = 0.98, CI: 0.95–1.00).

The most prevalent MRI findings were foraminal stenosis (77%), uncovertebral arthrosis (74%) and disc degeneration (67%) while the least prevalent findings were nerve root compromise (2%) and Modic changes type 2 (6%). Modic type 1 was mentioned in 25% of the radiologists’ reports. The prevalence of all findings increased with age, except disc herniation which was most prevalent for patients in their forties.

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Cost-effectiveness of Spinal Manipulative Therapy

By Frank M. Painter|February 26, 2019|Chronic Spinal Pain|

Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

The Chiro.Org Blog

SOURCE: Spine J. 2016 (Nov); 16 (11): 1292–1304

Brent Leininger, DC, MS, Christine McDonough, PT, PhD, Roni Evans, DC, MS, PhD, Tor Tosteson, ScD, Anna N.A. Tosteson, ScD, Gert Bronfort, DC, PhD

Integrative Health & Wellbeing Research Program,
Center for Spirituality & Healing,
University of Minnesota,
B296 Mayo Memorial Building,
420 Delaware St SE, Minneapolis, MN 55455, USA.

BACKGROUND CONTEXT: Chronic neck pain is a prevalent and disabling condition among older adults. Despite the large burden of neck pain, little is known regarding the cost-effectiveness of commonly used treatments.

PURPOSE: This study aimed to estimate the cost-effectiveness of home exercise and advice (HEA), spinal manipulative therapy (SMT) plus HEA, and supervised rehabilitative exercise (SRE) plus HEA.

STUDY DESIGN/SETTING: Cost-effectiveness analysis conducted alongside a randomized clinical trial (RCT) was performed.

PATIENT SAMPLE: A total of 241 older adults (≥65 years) with chronic mechanical neck pain comprised the patient sample.

OUTCOME MEASURES: The outcome measures were direct and indirect costs, neck pain, neck disability, SF–6D-derived quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over a 1–year time horizon.

METHODS: This work was supported by grants from the National Center for Complementary and Integrative Health (#F32AT007507), National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60AR062799), and Health Resources and Services Administration (#R18HP01425).
The RCT is registered at ClinicalTrials.gov (NCT00269308 ).

A societal perspective was adopted for the primary analysis. A healthcare perspective was adopted as a sensitivity analysis. Cost-effectiveness was a secondary aim of the RCT which was not powered for differences in costs or QALYs. Differences in costs and clinical outcomes were estimated using generalized estimating equations and linear mixed models, respectively. Cost-effectiveness acceptability curves were calculated to assess the uncertainty surrounding cost-effectiveness estimates.

RESULTS: Total costs for spinal manipulative therapy (SMT) + home exercise and advice (HEA) were 5% lower than HEA (mean difference: –$111; 95% confidence interval [CI] –$1,354 to $899) and 47% lower than supervised rehabilitative exercise (SRE) + HEA (mean difference: –$1,932; 95% CI –$2,796 to –$1,097).

SMT+HEA also resulted in a greater reduction of neck pain over the year relative to HEA (0.57; 95% CI 0.23 to 0.92) and SRE+HEA (0.41; 95% CI 0.05 to 0.76). Differences in disability and quality-adjusted life years (QALYs) favored SMT+HEA. The probability that adding SMT to HEA is cost-effective at willingness to pay thresholds of $50,000 to $200,000 per QALY gained ranges from 0.75 to 0.81. If adopting a health-care perspective, costs for SMT+HEA were 66% higher than HEA (mean difference: $515; 95% CI $225 to $1,094), resulting in an ICER of $55,975 per QALY gained.

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Diagnostic and Treatment Methods Used by Chiropractors

By Frank M. Painter|February 14, 2019|Diagnosis|

Diagnostic and Treatment Methods Used by Chiropractors: A Random Sample Survey of Canada’s English-speaking Provinces

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2015 (Sep); 59 (3): 279–287

Aaron A. Puhl, MSc, DC, Christine J Reinhart, PhD, DC, and H. Stephen Injeyan, PhD, DC

Department of Pathology and Microbiology,
Canadian Memorial Chiropractic College,
Toronto, ON, M2H 3J1

OBJECTIVE: It is important to understand how chiropractors practice beyond their formal education. The objective of this analysis was to assess the diagnostic and treatment methods used by chiropractors in English-speaking Canadian provinces.

METHODS: A questionnaire was created that examined practice patterns amongst chiropractors. This was sent by mail to 749 chiropractors, randomly selected and stratified proportionally across the nine English-speaking Canadian provinces. Participation was voluntary and anonymous. Data were entered into an Excel spreadsheet, and descriptive statistics were calculated.

RESULTS: The response rate was 68.0%. Almost all (95.1%) of respondents reported performing differential diagnosis procedures with their new patients; most commonly orthopaedic testing, palpation, history taking, range of motion testing and neurological examination. Palpation and painful joint findings were the most commonly used methods to determine the appropriate joint to apply manipulation. The most common treatment methods were manual joint manipulation/mobilization, stretching and exercise, posture/ergonomic advice and soft-tissue therapies.

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Instrument-assisted Delivery and the Prevalence

By Frank M. Painter|February 11, 2019|Pediatrics|

Instrument-assisted Delivery and the Prevalence of Reduced Cervical Spine Range of Motion in Infants

The Chiro.Org Blog

SOURCE: Chiropractic J Australia 2018 (Jun); 46 (2): 162–171

Christian Fludder, B.Chiro.Sc, M.Chiro, DACCP,
Braden G. Keil, B.App.Sc. (Chiropractic), M.C.Sc. (Paediatrics), FICC, FACCP

Chiropractic Children’s Healthcare,
9 Lower Plenty Road,
Rosanna, VIC, 3084

Introduction: Instrument-assisted delivery occurs regularly in Australia. This study aims to determine if there is a higher prevalence of restricted cervical spine range of motion (ROM) in infants born via instrumental delivery or Caesarean section compared to vaginal delivery without instrument assistance.

Methods: Data was collated from all 176 infants under 112 days of age in a paediatric chiropractic clinic. Details regarding method of delivery and instrumental assistance were obtained. Passive ROM assessment was recorded as either “Full” or “Reduced”.

Results: Reduced cervical spine ROM was apparent in 76.1% of infants born vaginally without intervention (n=88), 75.0% with forceps assistance (n=16), 88.9% with vacuum-assistance (n = 18), 100% born with vacuum and forceps (n=3), and 82.3% born via Caesarean section (n = 51).

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About Frank M. Painter

Spinal Manipulation and Exercise for Low Back Pain in Adolescents

Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial

Manual Therapy for the Pediatric Population

Manual Therapy for the Pediatric Population: A Systematic Review

Prevalence of MRI Findings in the Cervical Spine

Prevalence of MRI Findings in the Cervical Spine in Patients with Persistent Neck Pain Based on Quantification of Narrative MRI Reports

Cost-effectiveness of Spinal Manipulative Therapy

Cost-effectiveness of Spinal Manipulative Therapy, Supervised Exercise, and Home Exercise for Older Adults with Chronic Neck Pain

Diagnostic and Treatment Methods Used by Chiropractors

Diagnostic and Treatment Methods Used by Chiropractors: A Random Sample Survey of Canada’s English-speaking Provinces

Instrument-assisted Delivery and the Prevalence

Instrument-assisted Delivery and the Prevalence of Reduced Cervical Spine Range of Motion in Infants