Frank M. Painter

A Scoping Review of Biopsychosocial Risk Factors

By Frank M. Painter|June 8, 2018|Biopsychosocial Model|

A Scoping Review of Biopsychosocial Risk Factors and Co-morbidities for Common Spinal Disorders

SOURCE: PLoS One. 2018 (Jun 1); 13 (6):e0197987

Bart N. Green, Claire D. Johnson, Scott Haldeman, Erin Griffith, Michael B. Clay, Edward J. Kane, Juan M. Castellote, Shanmuganathan Rajasekaran, Matthew Smuck, Eric L. Hurwitz, Kristi Randhawa, Hainan Yu, Margareta Nordin

Qualcomm Health Center,
Stanford Health Care,
San Diego, California

OBJECTIVE: The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders.

METHODS: A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities.

RESULTS: Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers’ compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders.

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Association Between Utilization of Chiropractic Services

By Frank M. Painter|June 7, 2018|Spinal Pain|

Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2018 (May 26) [Epub]

James M. Whedon, DC, MS, Andrew W.J. Toler, MS, Justin M. Goehl, DC, MS, Louis A. Kazal, MD

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

OBJECTIVES: Mortality rates due to adverse drug events (ADEs) are escalating in the United States. Analgesics are among the drug classes most often associated with occurrence of an ADE. Utilization of nonpharmacologic chiropractic services for treatment of low back pain could lead to reduced risk of an ADE. The objective of this investigation was to evaluate the association between utilization of chiropractic services and likelihood of an ADE.

METHODS: We employed a retrospective cohort design to analyze health insurance claims data from the state of New Hampshire. After inversely weighting each participant by their propensity to be in their cohort, we employed logistic regression to compare recipients of chiropractic services to nonrecipients with regard to likelihood of occurrence of an ADE in an outpatient setting.

RESULTS: The risk of an ADE was significantly lower among recipients of chiropractic services as compared with nonrecipients. The adjusted likelihood of an ADE occurring in an outpatient setting within 12 months was 51% lower among recipients of chiropractic services as compared to nonrecipients (OR 0.49; P = .0002). The reported ADEs were nonspecific with regard to drug category in the majority of incidents that occurred in both cohorts.

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Agents of Change: How Do CAM Providers Play a Role

By Frank M. Painter|June 4, 2018|Alternative Medicine|

Agents of Change: How Do Complementary and Alternative Medicine Providers Play a Role in Health Behavior Change?

The Chiro.Org Blog

SOURCE: Altern Ther Health Med. 2011 (Jan); 17 (1): 22–30

Pamela A. Williams-Piehota, PhD; Fuschia M. Sirois, PhD; Carla M. Bann, PhD; Karen B. Isenberg, MPH; Edith G. Walsh, PhD

RTI International,
Research Triangle Park,
North Carolina, USA.

BACKGROUND: Recent investigations indicate that complementary and alternative medicine (CAM) use may be conducive to health behavior change.

OBJECTIVE: The goal of this study was to investigate how this change occurs.

METHODS: Using Social Cognitive Theory (SCT) and Self-determination Theory (SDT) as guiding frameworks, we surveyed a convenience sample of 216 CAM consumers abouttheir CAM therapy and iors and conducted focus groups with 36 CAM consumers.

RESULTS: Consumers reported encouragement from providers and improved energy resulting from treatments as reasons for making health behavior changes. Multivariate analysis showed that increased odds of self-reported dietary change were significantly associated with increasing body awareness as a result of therapy, endorsing the statement that sustained improvement for their health conditions required self-care, using an acupuncturist, and being 44 years or younger. Comparable results were found for exercise change, except using an acupuncturist was a significant negative predictor and age was not significant. Focus group findings echoed these themes.

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Association Between Centralization and Directional Preference

By Frank M. Painter|June 3, 2018|Chronic Neck Pain, McKenzie|

Association Between Centralization and Directional Preference and Functional and Pain Outcomes in Patients With Neck Pain

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SOURCE: J Orthop Sports Phys Ther. 2014 (Feb); 44 (2): 68–75

Susan L. Edmond, PT, DSc, OCS, Guillermo Cutrone, PT, DSc, OCS, Cert MDT, FAAOMPT, Mark Werneke, PT, MS, Dip MDT et. al.

Rutgers,
The State University of New Jersey,
Newark, NJ.

STUDY DESIGN: Retrospective cohort.

OBJECTIVES: In subjects with neck pain, the present study aimed (1) to describe the prevalence of centralization (CEN), noncentralization (non-CEN), directional preference (DP), and no directional preference (no DP); (2) to determine if age, sex, fear-avoidance beliefs about physical activity, number of comorbid conditions, or symptom duration varies among subjects who demonstrate CEN versus non-CEN and DP versus no DP; and (3) to determine if CEN and/or DP are associated with changes in function and pain.

BACKGROUND: CEN and DP are prevalent among patients with low back pain and should be considered when determining treatment strategies and predicting outcomes; however, these findings are not well investigated in patients with neck pain.

METHODS: Three hundred four subjects contributed data. CEN and DP prevalence were calculated, as was the association between CEN and DP, and age, sex, number of comorbid conditions, fear-avoidance beliefs, and symptom duration. Multivariate models assessed whether CEN and DP predicted change in function and pain.

RESULTS: CEN and DP prevalence were 0.4 and 0.7, respectively. Younger subjects and those with fewer comorbid conditions were more likely to centralize; however, subjects who demonstrated DP were more likely to have acute symptoms. Subjects who centralized experienced, on average, a 3.6-point (95% confidence interval: -0.3, 7.4) improvement in function scores, whereas subjects with a DP averaged a 5.4-point (95% confidence interval: 0.8, 10.0) improvement. Neither CEN nor DP was associated with pain outcomes.

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Centralization and Directional Preference

By Frank M. Painter|May 31, 2018|Centralization, Directional Preference|

Centralization and Directional Preference: A Systematic Review

The Chiro.Org Blog

SOURCE: Man Ther. 2012 (Dec); 17 (6): 497–506

Stephen May, Alessandro Aina

Faculty of Health and Wellbeing,
Collegiate Cresent Campus,
Sheffield Hallam University,
Sheffield S10 2BP, UK.

Centralization is a symptom response to repeated movements that can be used to classify patients into sub-groups, determine appropriate management strategies, and prognosis. The aim of this study was to systematically review the literature relating to centralization and directional preference, and specifically report on prevalence, prognostic validity, reliability, loading strategies, and diagnostic implications. Search was conducted to June 2011; multiple study designs were considered. 62 studies were included in the review; 54 related to centralization and 8 to directional preference. The prevalence of centralization was 44.4% (range 11%-89%) in 4,745 patients with back and neck pain in 29 studies; it was more prevalent in acute (74%) than sub-acute or chronic (42%) symptoms.

The prevalence of directional preference was 70% (range 60%-78%) in 2,368 patients with back or neck pain in 5 studies. Twenty-one of 23 studies supported the prognostic validity of centralization, including 3 high quality studies and 4 of moderate quality; whereas 2 moderate quality studies showed evidence that did not support the prognostic validity of centralization. Data on the prognostic validity of directional preference was limited to one study. Centralization and directional preference appear to be useful treatment effect modifiers in 7 out of 8 studies. Levels of reliability were very variable (kappa 0.15-0.9) in 5 studies. Findings of centralization or directional preference at baseline would appear to be useful indicators of management strategies and prognosis, and therefore warrant further investigation.

From the FULL TEXT Article:

Introduction

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The Comparative Prognostic Value of Directional Preference

By Frank M. Painter|May 30, 2018|Centralization, Directional Preference|

The Comparative Prognostic Value of Directional Preference and Centralization: A Useful Yool for Front-line Clinicians?

The Chiro.Org Blog

SOURCE: J Man Manip Ther. 2008; 16 (4): 248–254

Audrey Long, BSc, PT, Stephen May, MSc, and Tak Fung, PhD

Senior Statistical Consultant,
University of Calgary,
Calgary AB, Canada.

A large number of prognostic factors have been associated with recovery from an episode of back pain, and much emphasis has been placed on psychosocial prognostic factors. The large number of prognostic factors and the lack of comparative analysis of different factors make use of these difficult in clinical practice. The aim of this study was to evaluate the comparative usefulness of a range of factors to predict outcome using data from a randomized controlled trial (RCT) in which 312 patients with sub-acute to chronic back pain received a mechanical evaluation and were sub-grouped based on the presence or absence of directional preference (DP). Patients were then randomized to treatment that was matched or unmatched to that DP.

Patients with a minimal reduction of 30% in Roland-Morris Disability Questionnaire (RMDQ) score were defined as the good outcome group. Seventeen baseline variables were entered into a step-wise logistic regression analysis for the ability to predict a good outcome. Of the patients, 84 met the good outcome criteria and had a mean RMDQ decrease of 58.2% (9.8 points) in 4 visits. Leg pain, work status, depression, pain location, chronicity, and treatment assignment were significant predictors of outcome in univariate analysis. Only leg bothersomeness rating and treatment assignment survived multivariate analysis. Subjects with DP/centralization who received matched treatment had a 7.8 times greater likelihood of a good outcome. Matching patients to their DP is a stronger predictor of outcome than a range of other biopsychosocial factors.

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About Frank M. Painter

A Scoping Review of Biopsychosocial Risk Factors

A Scoping Review of Biopsychosocial Risk Factors and Co-morbidities for Common Spinal Disorders

Association Between Utilization of Chiropractic Services

Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events

Agents of Change: How Do CAM Providers Play a Role

Agents of Change: How Do Complementary and Alternative Medicine Providers Play a Role in Health Behavior Change?

Association Between Centralization and Directional Preference

Association Between Centralization and Directional Preference and Functional and Pain Outcomes in Patients With Neck Pain

Centralization and Directional Preference

Centralization and Directional Preference: A Systematic Review

The Comparative Prognostic Value of Directional Preference

The Comparative Prognostic Value of Directional Preference and Centralization: A Useful Yool for Front-line Clinicians?