Frank M. Painter

Best Practices Recommendations for Chiropractic Care for Older Adults

By Frank M. Painter|March 12, 2016|Medicare|

Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process

SOURCE: J Manipulative Physiol Ther 2010 (Jul); 33 (6): 464-473

Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD,
Paul Dougherty, DC, Brian J. Gleberzon, DC,
Lisa Z. Killinger, DC

Cleveland Chiropractic College,
Overland Park, KS 66210, USA.

OBJECTIVE: At this time, the scientific evidence base supporting the effectiveness of chiropractic care for musculoskeletal conditions has not yet definitively addressed its appropriateness for older adults. Expert consensus, as a form of evidence, must be considered when higher levels of evidence are lacking. The purpose of this project was to develop a document with evidence-based recommendations on the best practices for chiropractic care of older adults.

METHODS: A set of 50 seed statements was developed, based on the clinical experience of the multidisciplinary steering committee and the results of an extensive literature review. A formal Delphi process was conducted, following the rigorous RAND-UCLA (University of California, Los Angeles) methodology. The statements were circulated electronically to the Delphi panel until consensus was reached. Consensus was defined as agreement by at least 80% of the panelists. There were 28 panelists from 17 US states and Canada, including 24 doctors of chiropractic, 1 physical therapist, 1 nurse, 1 psychologist, and 1 acupuncturist.

RESULTS: The Delphi process was conducted in January-February 2010; all 28 panelists completed the process. Consensus was reached on all statements in 2 rounds. The resulting best practice document defined the parameters of an appropriate approach to chiropractic care for older adults, and is presented in this article.

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Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines

By Frank M. Painter|March 8, 2016|Evidence-based Practice, Whiplash|

Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2016 (Feb 26) [EPub]

Gail M. Lindsay, RN, PhD, Silvano A. Mior, DC, PhD,
Pierre Côté, DC, PhD, Linda J. Carroll, PhD,
Heather M. Shearer, DC, MSc

Associate Professor,
Faculty of Health Sciences,
University of Ontario Institute of Technology,
Oshawa, ON

OBJECTIVE: The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries.

METHODS: Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs.

RESULTS: Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language (“injured persons”) being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised.

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Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome

By Frank M. Painter|March 6, 2016|Hypermobility Syndrome|

Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome: A Case Report

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Mar); 13 (1): 35–42 ~ FULL TEXT

Richard G. Strunk, DC, MS, Mark T. Pfefer, RN, DC, MS, Derrick Dube

Research Clinician Cleveland Chiropractic College,
Overland Park, KS.

OBJECTIVE: The purpose of this case report is to describe multimodal chiropractic care of a female patient diagnosed with benign joint hypermobility syndrome (BJHS) and a history of chronic spine pain.

CLINICAL FEATURES: A 23-year-old white female presented for chiropractic care with chronic low back pain, neck pain, and headaches. The patient was diagnosed with BJHS, including joint hypermobility of her thumbs, elbows, right knee, and lumbopelvic region. A 6-year history of low back pain and varicose veins in her posterior thighs and knees were additional significant diagnostic findings of BJHS.

INTERVENTIONS AND OUTCOMES: The treatment consisted of spinal and extremity manipulation, Graston technique, and postisometric relaxation combined with sensory motor stimulation and scapular stabilization exercises. The patient was seen 15 times over an 18-week period. After 18 weeks of care, the Revised Oswestry Low Back Questionnaire and Headache Disability Index demonstrated clinically important improvements with her low back pain and headache; but little change was noted in her neck pain as measured by the Neck Disability Index.

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Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache?

By Frank M. Painter|March 2, 2016|Headache|

Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache? A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: Eur J Phys Rehabil Med. 2016 (Feb 29) [Epub]

Gemma V. Espí-López , Cleofas Rodríguez-Blanco, Angel Oliva-Pascual-Vaca, Francisco J. Molina-Martínez, Deborah Falla

Department of Physiotherapy,
University of Valencia,
Valencia, Spain

BACKGROUND: Controversy exists regarding the effectiveness of manual therapy for the relief of tension-type headache (TTH). However most studies have addressed the impact of therapy on the frequency and intensity of pain. No studies have evaluated the potentially significant effect on the patient’s quality of life.

AIM: To assess the quality of life of patients suffering from TTH treated for 4 weeks with different manual therapy techniques.

DESIGN: Factorial, randomized, single-blinded, controlled clinical trial.

SETTING: Specialized center for the treatment of headache.

POPULATION: Seventy-six (62 women) patients aged between 18 and 65 years (age: 39.9 ± 10.9) with either episodic or chronic TTH.

METHODS: Patients were divided into four groups: suboccipital inhibitory pressure; suboccipital spinal manipulation; a combination of the two treatments; control. Quality of life was assessed using the SF-12 questionnaire (considering both the overall score and the different dimensions) at the beginning and end of treatment, and after a one month follow-up.

RESULTS: Compared to baseline, the suboccipital inhibition treatment group showed a significant improvement in their overall quality of life at the one month follow-up and also showed specific improvement in the dimensions related to moderate physical activities, and in their emotional role. All the treatment groups, but not the control group, showed improvements in their physical role, bodily pain, and social functioning at the one month follow-up. Post treatment and at the one month follow-up, the combined treatment group (suboccipital inhibitory pressure and suboccipital spinal manipulation) showed improved vitality and the two treatment groups that involved manipulation showed improved mental health.

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Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

By Frank M. Painter|February 29, 2016|Medicare|

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (8): 542-551

Paula A.M. Weigel, PhD, Jason M. Hockenberry, PhD, Fredric D. Wolinsky, PhD

Research Associate,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa, Iowa City, IA

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

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The OUCH Randomized Controlled Trial of Adverse Events

By Frank M. Painter|February 25, 2016|Adverse Events, Spinal Manipulation|

Outcomes of Usual Chiropractic. The OUCH Randomized Controlled Trial of Adverse Events

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2013 (Sep 15); 38 (20): 1723–1729

Bruce F Walker, Jeffrey J Hebert, Norman J Stomski,
Brenton R Clarke, Ross S Bowden,
Barrett Losco, Simon D French

School of Health Professions
Murdoch University,
Murdoch, Australia

STUDY DESIGN: Blinded parallel-group randomized controlled trial.

OBJECTIVE: Establish the frequency and severity of adverse effects from short-term usual chiropractic treatment of the spine when compared with a sham treatment group.

SUMMARY OF BACKGROUND DATA: Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, as a result of design limitations in previous studies, particularly the lack of sham-controlled randomized trials, understanding of these adverse events and their relation with chiropractic treatment is suboptimal.

METHODS: We conducted a trial to examine the occurrence of adverse events resulting from chiropractic treatment. It was conducted across 12 chiropractic clinics in Perth, Western Australia. The participants comprised 183 adults, aged 20 to 85 years, with spinal pain. Ninety-two participants received individualized care consistent with the chiropractors’ usual treatment approach; 91 participants received a sham intervention. Each participant received 2 treatments.

RESULTS: Completed adverse questionnaires were returned by 94.5% of the participants after appointment 1 and 91.3% after appointment 2. Thirty-three percent of the sham group and 42% of the usual care group reported at least 1 adverse event.

Common adverse events were

increased pain	sham 29%	usual care 36%
muscle stiffness	sham 29%	usual care 37%
headache	sham 17%	usual care 9%

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About Frank M. Painter

Best Practices Recommendations for Chiropractic Care for Older Adults

Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process

Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines

Patients’ Experiences With Vehicle Collision to Inform the Development of Clinical Practice Guidelines: A Narrative Inquiry

Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome

Multimodal Chiropractic Care of Pain and Disability for a Patient Diagnosed With Benign Joint Hypermobility Syndrome: A Case Report

Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache?

Do Manual Therapy Techniques Have a Positive Effect on Quality of Life in People With Tension-type Headache? A Randomized Controlled Trial

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

The OUCH Randomized Controlled Trial of Adverse Events

Outcomes of Usual Chiropractic. The OUCH Randomized Controlled Trial of Adverse Events