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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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Cost-effectiveness of Spinal Manipulative Therapy

By |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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Cost-Effectiveness of Chiropractic Page and the

Chronic Neck Pain and Chiropractic Page

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Diagnostic and Treatment Methods Used by Chiropractors

By |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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CHIROPRACTIC SUBLUXATION Page

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Instrument-assisted Delivery and the Prevalence

By |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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PEDIATRICS Section

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An Observational Study on Trajectories and Outcomes of Chronic Low Back Pain Patients Referred From a Spine Surgery Division for Chiropractic Treatment

By |February 7, 2019|Trajectories of Back Pain|

An Observational Study on Trajectories and Outcomes of Chronic Low Back Pain Patients Referred From a Spine Surgery Division for Chiropractic Treatment

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2019 (Feb 5); 27: 6

Brigitte Wirth, Fabienne Riner, Cynthia Peterson, Barry Kim Humphreys, Mazda Farshad, Susanne Becker and
Petra Schweinhardt

1Integrative Spinal Research Group,
Department of Chiropractic Medicine,
Balgrist University Hospital,
Forchstr. 340, 8008 Zurich, Switzerland

Background:   A close collaboration between surgeons and non-surgical spine experts is crucial for optimal care of low back pain (LBP) patients. The affiliation of a chiropractic teaching clinic to a university hospital with a large
spine division in Zurich, Switzerland, enables such collaboration. The aim of this study was to describe the trajectories and outcomes of patients with chronic LBP referred from the spine surgery division to the chiropractic teaching clinic.

Methods:   The patients filled in an 11-point numeric rating scale (NRS) for pain intensity and the Bournemouth Questionnaire (BQ) (bio-psycho-social measure) at baseline and after 1 week, 1, 3, 6 and 12 months. Additionally, the Patient’s Global Impression of Change (PGIC) scale was recorded at all time points apart from baseline. The courses of NRS and BQ were analyzed using linear mixed model analysis and repeated measures ANOVA. The proportion of patients reporting clinically relevant overall improvement (PGIC) was calculated and the underlying factors were determined using logistic regression analyses.

Results:   Between June 2014 and October 2016, 67 participants (31 male, mean age = 46.8 ± 17.6 years) were recruited, of whom 46 had suffered from LBP for > 1 year, the rest for > 3 months, but < 1 year. At baseline, mean NRS was 5.43 (SD 2.37) and mean BQ was 39.80 (SD 15.16) points. NRS significantly decreased [F(5, 106.77) = 3.15, p = 0.011] to 4.05 (SD 2.88) after 12 months. A significant reduction was not observed before 6 months after treatment start (p = 0.04). BQ significantly diminished [F(5, 106.47) = 6.55, p < 0.001] to 29.00 (SD 17.96) after 12 months and showed a significant reduction within the first month (p < 0.01). The proportion of patients reporting overall improvement significantly increased from 23% after 1 week to 47% after 1 month (p = 0.004), when it stabilized [56% after 3 and 6 months, 44% after 12 months]. Reduction in bio-psycho-social impairment (BQ) was of higher importance for overall improvement than pain reduction.

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The Influence of Neck Pain on Sensorimotor Function in the Elderly

By |January 28, 2019|Neurology, Subluxation|

The Influence of Neck Pain on Sensorimotor Function in the Elderly

The Chiro.Org Blog

SOURCE:   Arch Gerontol Geriatr. 2012 (Nov); 55 (3): 667–672

Sureeporn Uthaikhup, Gwendolen Jull, Somporn Sungkarat, Julia Treleaven

Department of Physical Therapy,
Faculty of Associated Medical Sciences,
Chiang Mai University,
Thailand.

Greater disturbances in sensorimotor control have been demonstrated in younger to middle aged groups. However, it is unknown whether or not the impairments documented in these populations can be extrapolated to elders with neck pain. The aim of this study was to investigate the influence of neck pain on sensorimotor function in elders. Twenty elders with neck pain (12 women and 8 men) and 20 healthy elder controls (14 women and 6 men) aged 65 years and over were recruited from the general community. Tests for sensorimotor function included; cervical joint position sense (JPS); computerised rod-and-frame test (RFT); smooth pursuit neck torsion test (SPNT); standing balance (under conditions of eyes open, eyes closed on firm and soft surfaces in comfortable stance); step test and ten-meter walk test with and without head movement.

Elders with neck pain had greater deficits in the majority of sensorimotor function tests after controlling for effects of age and comorbidities. Significant differences were found in the SPNT (p<0.01), error in the RFT (frame angled at 10° and 15° anticlockwise) (p<0.05), standing balance (amplitude of sway) – eyes open on a firm surface in the medio-lateral (ML) direction (p=0.03), and total number of steps on the step test, both left and right sides (p<0.01).

Elders with neck pain have greater sensorimotor disturbances than elders without neck pain, supporting a contribution of altered afferent information originating from the cervical spine to such disturbances. The findings may inform falls prevention and management programs.

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SENIOR CARE Page

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Joint Position Sense Error in People With Neck Pain

By |January 25, 2019|Neurology|

Joint Position Sense Error in People With Neck Pain: A Systematic Review

The Chiro.Org Blog

SOURCE:   Man Ther. 2015 (Dec); 20 (6): 736–744

J. de Vries, B.K. Ischebeck, L.P. Voogt, J.N. van der Geest, M. Janssen, M.A. Frens, G.J. Kleinrensink

Department of Neuroscience,
Erasmus MC, P.O. Box 2040,
3000 CA Rotterdam,
The Netherlands

BACKGROUND:   Several studies in recent decades have examined the relationship between proprioceptive deficits and neck pain. However, there is no uniform conclusion on the relationship between the two. Clinically, proprioception is evaluated using the Joint Position Sense Error (JPSE), which reflects a person’s ability to accurately return his head to a predefined target after a cervical movement.

OBJECTIVES:   We focused to differentiate between JPSE in people with neck pain compared to healthy controls.

STUDY DESIGN:   Systematic review according to the PRISMA guidelines.

METHOD:   Our data sources were Embase, Medline OvidSP, Web of Science, Cochrane Central, CINAHL and Pubmed Publisher. To be included, studies had to compare JPSE of the neck (O) in people with neck pain (P) with JPSE of the neck in healthy controls (C).

RESULTS/FINDINGS:   Fourteen studies were included. Four studies reported that participants with traumatic neck pain had a significantly higher JPSE than healthy controls. Of the eight studies involving people with non-traumatic neck pain, four reported significant differences between the groups. The JPSE did not vary between neck-pain groups.

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