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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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Comparative Effectiveness of Usual Care With or Without

By |July 9, 2018|Cost-Effectiveness of Chiropractic|

Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain

The Chiro.Org Blog

SOURCE:   J Gen Intern Med. 2018 (Jun 25) [Epub]

Charles Elder, MD MPH, Lynn DeBar, PhD MPH, Cheryl Ritenbaugh, PhD MPH, John Dickerson, PhD, William M. Vollmer, PhD, Richard A. Deyo, MD MPH, Eric S. Johnson, PhD, and Mitchell Haas, DC MA

Kaiser Permanente Center for Health Research,
Portland, OR, USA.

BACKGROUND:   Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored.

OBJECTIVE:   To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain.

STUDY DESIGN:   Prospective cohort study using propensity score-matched controls.

PARTICIPANTS:   Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months.

MAIN MEASURES:   Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care.

KEY RESULTS:   Both groups’ (N = 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed. (severity – 0.10 (95% CI – 0.30, 0.10), interference – 0.07 (– 0.31, 0.16), bothersomeness – 0.1 (– 0.39, 0.19)). After controlling for variances in baseline costs, total costs during the 6–month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group ($1,996 [SD = 3874] vs $1,086 [SD = 1212], p = .034). Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p = .072).

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A Hypothesis of Chronic Back Pain

By |July 8, 2018|Neurology, Subluxation|

A Hypothesis of Chronic Back Pain: Ligament Subfailure Injuries Lead to Muscle Control Dysfunction

The Chiro.Org Blog

SOURCE:   European Spine Journal 2006 (May); 15 (5): 668–676

Manohar M. Panjabi

Biomechanics Research Laboratory,
Department of Orthopaedics and Rehabilitation,
Yale University School of Medicine,
New Haven, CT 06520-8071, USA.

Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit.

Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.

From the Full-Text Article:

Introduction

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The Role of Vitamins and Minerals in Energy Metabolism and Well-being

By |July 6, 2018|Multivitamins|

The Role of Vitamins and Minerals in Energy Metabolism and Well-being

The Chiro.Org Blog

SOURCE:   J Int Med Res. 2007 (May); 35 (3):   277–289

Huskisson E, Maggini S, Ruf M.

King Edward VII Hospital,
London, UK.

Physicians are frequently confronted with patients complaining of fatigue, tiredness and low energy levels. In the absence of underlying disease, these symptoms could be caused by a lack of vitamins and minerals. Certain risk groups like the elderly and pregnant women are well-recognized. Our aim was, therefore, to find out if other, less well-established groups might also be at risk.

Thus, the objectives of this review are: to describe the inter-relationship between micronutrients, energy metabolism and well-being; identify risk groups for inadequate micronutrient intake; and explore the role of micronutrient supplementation in these groups. A review of the literature identified an important group at risk of inadequate micronutrient intake: young adults, often women, with a demanding lifestyle who are physically active and whose dietary behaviour is characterized by poor choices and/or regular dieting. Micronutrient supplementation can alleviate deficiencies, but supplements must be taken for an adequate period of time.

From the FULL TEXT Article:

Introduction

Every doctor is familior wi1b the patient who presents complaining of a lack of energy. tiredness and exhaustion, and for whom thorough examination and even routine laboratory tests do not provide a satisfactory explanation for their symptoms. Without any underlying diseases, might these symptoms be caused by a lack of vitamins and minerals?

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Nutrition Section

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A Prospective Cohort Study of the Impact of Return-to-Work

By |June 29, 2018|Return To Work|

A Prospective Cohort Study of the Impact of Return-to-Work Coordinators in Getting Injured Workers Back on the Job

The Chiro.Org Blog

SOURCE:   J Occup Rehabil. 2018 (Jun); 28 (2): 298–306

Tyler J. Lane, Rebbecca Lilley, Sheilah Hogg-Johnson, Anthony D. LaMontagne, Malcolm R. Sim, Peter M. Smith

Department of Epidemiology and Preventive Medicine,
School of Public Health and Preventive Medicine,
Monash University, Level 2,
553 St Kilda Road,
Melbourne, VIC, 3004, Australia.

Purpose   To assess the impact of workplace-based return-to-work (RTW) Coordinators’ interpersonal and functional activities on RTW outcomes.

Methods   Multivariable logistic regression analyses of cross-sectional and longitudinal survey responses of 632 injured workers with at least 10 days of work absence in Victoria, Australia, adjusting for demographic and other workplace factors. Outcome was being back at work for at least 1 month, measured at both baseline and 6 month follow-up survey. Participant responses to stressfulness of Coordinator interactions were dichotomised into good and poor and evaluated as a proxy for Coordinators’ interpersonal activities, while having a RTW plan was evaluated as a proxy for functional activities.

Results   At baseline, RTW plans doubled the odds of RTW (OR 2.02; 95% CI 1.40-2.90) and attenuated the impact of good Coordinator interactions (1.14; 0.77-1.70). At 6-month follow-up, the opposite was observed: good interactions nearly doubled odds of RTW (1.90; 1.22-2.95) while RTW plans were non-significant (1.02; 0.68-1.54).

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Low Back Pain: A Major Global Problem For Which

By |June 26, 2018|Low Back Pain|

Low Back Pain: A Major Global Problem For Which the Chiropractic Profession Needs to Take More Care

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2018 (Jun 25); 26: 28

Simon D. French, Aron S. Downie and Bruce F. Walker

Department of Chiropractic,
Faculty of Science and Engineering,
Macquarie University,
Sydney, Australia

An important series of papers have been published in the Lancet. These papers provide a comprehensive update for the major global problem of low back pain, and the challenges that low back pain presents to healthcare practitioners and policy makers. Chiropractors are well placed to reduce the burden of low back pain, but not all that chiropractors do is supported by robust, contemporary evidence. This commentary summarises the Lancet articles. We also make suggestions for how the chiropractic profession should most effectively help people with low back pain by implementing practices supported by high quality evidence.

This is just one article from a series of 4:

The Lancet 2018 Series on Low Back Pain

From the Full-Text Article

Background

Low back pain is a major global problem and it is getting worse. [1] An important series of articles in the journal Lancet, authored by world leading authorities on low back pain evidence, has drawn international attention to how enormous the problem is. The Lancet authors also discussed how low back pain is being poorly managed by healthcare systems around the globe, including emerging issues in low and middle-income countries. [2–4] This commentary will summarise the main findings of these Lancet papers, and provide some suggestions for how the chiropractic profession should respond to the global challenge that is low back pain.

The Lancet papers

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Low Back Pain and Chiropractic Page

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Be Good, Communicate, and Collaborate: A Qualitative Analysis

By |June 24, 2018|Integrative Care|

Be Good, Communicate, and Collaborate: A Qualitative Analysis of Stakeholder Perspectives on Adding a Chiropractor to the Multidisciplinary Rehabilitation Team

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2018 (Jun 22); 26: 29

Stacie A. Salsbury, Robert D. Vining, Donna Gosselin and Christine M. Goertz

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, USA

Background   While chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting.

Methods   This qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62–bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains.

Results   Sixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient’s values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.

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