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Spinal Manipulation Epidemiology: Systematic Review of Cost Effectiveness Studies

By Frank M. Painter|February 7, 2014|Cost-Effectiveness, Epidemiology, Spinal Manipulation|

Spinal Manipulation Epidemiology: Systematic Review of Cost Effectiveness Studies

SOURCE: J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 655–662 ~ FULL TEXT

Michaleff ZA, Lin CW, Maher CG, van Tulder MW.

The George Institute for Global Health, The University of Sydney, Missenden Road, Sydney, NSW 2050, Australia. zmichaleff@georgeinstitute.org.au

BACKGROUND: Spinal manipulative therapy (SMT) is frequently used by health professionals to manage spinal pain. With many treatments having comparable outcomes to SMT, determining the cost-effectiveness of these treatments has been identified as a high research priority.

OBJECTIVE: To investigate the cost-effectiveness of SMT compared to other treatment options for people with spinal pain of any duration.

METHODS: We searched eight clinical and economic databases and the reference lists of relevant systematic reviews. Full economic evaluations conducted alongside randomised controlled trials with at least one SMT arm were eligible for inclusion. Two authors independently screened search results, extracted data and assessed risk of bias using the CHEC-list.

RESULTS: Six cost-effectiveness and cost-utility analysis were included. All included studies had a low risk of bias scoring =16/19 on the CHEC-List. SMT was found to be a cost-effective treatment to manage neck and back pain when used alone or in combination with other techniques compared to general practitioner (GP = MD) care, exercise and physiotherapy.

CONCLUSIONS: This review supports the use of SMT in clinical practice as a cost-effective treatment when used alone or in combination with other treatment approaches. However, as this conclusion is primarily based on single studies more high quality research is needed to identify whether these findings are applicable in other settings.

From the Full-Text Article:

Introduction

Spinal pain, including neck pain and back pain, is a common condition in modern society (Woolf and Pfleger, 2003; Côté et al., 2003 ). It presents major social and economic burdens due to the high levels of chronicity and resultant long term disability which are associated with high costs in health care and losses of productivity (e.g. sick leave) (Woolf and Pfleger, 2003). While existing practice guidelines inform the individual, clinicians and policy makers on the effectiveness of a range of interventions, few provide information on the cost-effectiveness of treatments. It is arguable that cost-effectiveness of treatment is an equally important consideration as effectiveness, as all health administrators need to make decisions about how they allocate scarce health resources.

Economic evaluations are frequently conducted alongside randomised controlled trials of treatment effectiveness and involve the identification, measurement, valuation and then comparison of the costs and consequences (benefits) of two or more alternatives (Drummond et al., 2005). Economic evaluations are most useful when the treatments under question have been evaluated in terms of efficacy (can the treatment work in those who comply with the recommendations), effectiveness (is the treatment acceptable and does the treatment work in those who the treatment is offered) and availability (is the treatment accessible to all who would benefit from it). The result of an economic evaluation supplements the evidence base on treatment effectiveness by providing information on the efficiency or “value for money ” of treatment alternatives (Drummond et al., 2005). This information can be used to inform consumers, insurers, governments and policy makers where the health budget should be spent.

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Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy

By Frank M. Painter|February 4, 2014|Cervical Disk Herniation, Chiropractic Care|

Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2013 (Oct); 36 (8): 461–467

Cynthia K. Peterson, RN, DC, M.Med.Ed,
Christof Schmid, DC, Serafin Leemann, DC,
Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Department of Chiropractic Medicine,
Faculty of Medicine, Orthopedic University Hospital Balgrist,
University of Zürich, Zürich, Switzerland.

OBJECTIVE: The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS: Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS: Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

CONCLUSIONS: Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging-confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Introduction

Symptomatic compression of a cervical nerve root occurs in approximately 83.2 of every 100000 persons and is caused by disk herniations, degenerative spondylosis, or a combination of the [2] . Degenerative stenosis leading to narrowing of the intervertebral foramen is reported to be the most common cause of nerve root compression. [1]The C6 and C7 nerve roots are most frequently involved, often resulting in severe pain and disability. [1, 2] Symptoms can arise from the nerve root compression, inflammation, or both and include pain in a radicular distribution, paresthesias in a dermatomal pattern, decreased relevant reflex, and weakness of the muscles innervated by the nerve root. [3]

Patients with radiculopathy from cervical disk herniations (CDHs), the second most common cause of cervical nerve root compression, typically have acute neck pain with associated arm pain following the distribution of the involved nerve root, although the arm pain may be the predominant symptom. [3, 4]However, it is important to recognize that disk protrusions are also a common finding on magnetic resonance imaging (MRI) scans of asymptomatic people. [5-7]One study found that 63% of asymptomatic athletic males older than 40 years had protruding disks in the cervical spine. [5]In another study, disk protrusion with demonstrable spinal cord compression was noted in 7.6% of asymptomatic subjects over the age of 50 years. [6]However, extruded disk herniations and cord compression are unusual findings in asymptomatic individuals. [7]

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Radiculopathy and Chiropractic Page and the:

Disc Herniation and Chiropractic Page and the:

Chronic Neck Pain and Chiropractic Page

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Costs of Routine Care For Infant Colic in the UK and Costs

By Frank M. Painter|February 2, 2014|Chiropractic Care, Colic, Cost-Effectiveness, Randomized Controlled Trial|

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition

The Chiro.Org Blog

SOURCE: J Clin Chiropr Pediatr 2013 (Jun); 14 (1): 1063–1069

Joyce E. Miller, BS, DC, DABCO

Anglo-European College of Chiropractic,
Bournemouth, UK.

This paper is a follow-up cost comparison of the medical and chiropractic care provided in Dr. Miller’s RTC study:

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial
J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

This RTC cast new and significant insight onto previous colic trials:

In this study, it was found that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects. This was a major criticism of earlier colic studies, and thus may help support their conclusions.

That study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

Background: There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65 million [USD100 million] in 2001) with no alleviation of the condition.

Objectives: The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomized controlled trial (RCT) showing effectiveness of treatment.

Design: Economic evaluation incorporating a RCT.

Methods: A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

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The Collateral Benefits Of Having Chiropractic Available In A Public Central Hospital

By Frank M. Painter|February 1, 2014|Chiropractic Care, Complementary Medicine, Evidence-based Medicine, Integrative Care, Non-Musculoskeletal Conditions|

The Collateral Benefits Of Having Chiropractic Available In A Public Central Hospital

The Chiro.Org Blog

Journal of Hospital Administration 2013 (Aug 8); 2 (4): 138–143 ~ FULL TEXT

Jan Roar Orlin, Andrè Didriksen, Helge Hagen, Anders Sørfonden

Dept. of Orthopedics, Central Hospital (FSS), Førde, Norway, and
Dept. of Ear-Nose-Throat, Central Hospital (FSS), Førde, Norway

Thanks to Dana Lawrence, DC for drawing our attention to this article!

Following previous reports on the co-operation between a chiropractor and a central hospital, experiences from the past five years are presented. The objective of this paper is to show that improved management of muscular and skeletal problems within a hospital setting depends on the availability of chiropractic health care as a treatment option.

The following pain groups were sampled:

1) sacro-lumbar dysfunction and sciatic leg symptoms, with or without joint dysfunction and sciatica;

2) myo-fascial referred pain syndromes, frequently caused by peripheral nerve entrapment; and

3) tinnitus, dizziness/vertigo, facial pain, ear plug and swallowing difficulties, frequently caused by biomechanical components.

A majority of pain patients, after being subjected to traditional conservative treatment, usually over a period of several years, fail to return to work despite younger than average age. The only effective procedures seem to be those of chiropractors. In order to benefit from their particular knowledge, public hospitals need to open their doors to chiropractors. For that to happen, determined hospital administrators are needed.

1. Introduction

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Whiplash & Chiropractic

By Frank M. Painter|January 31, 2014|Chiropractic Care, Whiplash|

Whiplash & Chiropractic

The Chiro.Org Blog

SOURCE: ACA News

Whiplash is an enigmatic injury. We spend billions of dollars each year to treat it. Yet many lawyers, legislators, and medical doctors deny its existence. It affects millions of people around the world, yet research is severely under-funded. It is a largely preventable injury, yet we do little to prevent it. Fortunately, times are changing as whiplash enters a new phase of research and understanding.

“We now have a completely new model of whiplash,” says Dr. Arthur Croft, researcher and co-author of the well-respected textbook, Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome. “Back in 1982, when I started practice, we had an extremely simplistic view of whiplash-you got hit from the rear; your head snapped back, which may have caused damage to ligaments, muscles, and tendons; your head snapped forward, which may have caused some additional damage; and then you had symptoms. We weren’t very sophisticated in terms of what we knew, because there hadn’t been much research.”

Researchers now believe that during a rear-end collision, the lower neck goes into hyperextension, while the upper goes into flexion. “That means the bottom and top parts of the neck are going in opposite directions during the initial phase of a whiplash, which forms the letter ‘S,’” explains ACA member Dan Murphy, DC, who teaches whiplash throughout the world, including a 120-hour certification course on spine trauma. “This sequence of events has been captured with cineradiography, which lets us look at the movement of each joint of the spine with motion x-ray. It’s remarkable what it shows-especially in the lower neck where people seem to have the most complaints and most findings on examination. In a 6.5g impact, for example, the motion between C7 and T1 is supposed to be about two degrees, but researchers are finding that the joint is moving about 20 degrees – or 10 times more than it is supposed to.”

Researchers initially captured this information by using human cadavers in cars, but those who thought live humans would respond differently were skeptical. Researchers counter-argued that it made no difference because maximum injury occurs in less than one-tenth of a second. “The injuries happen so fast they beat the dynamic of the muscles that would normally protect the joints,” Dr. Murphy explains. “For the muscles to kick in to protect the joints, you need approximately two-tenths of a second.”

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Spinal Manipulation Compared with Back School and with Individually Delivered Physiotherapy

By Frank M. Painter|January 30, 2014|Chiropractic Care, Evidence-based Medicine, Low Back Pain, Outcome Assessment|

Spinal Manipulation Compared with Back School and with Individually Delivered Physiotherapy for the Treatment of Chronic Low Back Pain: A Randomized Trial with One-year Follow-up

The Chiro.Org Blog

SOURCE: Clinical Rehabilitation 2010 (Jan); 24 (1): 26–36

Francesca Cecchi, Raffaello Molino-Lova, Massimiliano Chiti,
Guido Pasquini, Anita Paperini, Andrea A Conti, and Claudio Macchi

Fondazione Don Carlo Gnocchi,
Scientific Institute,
Florence, Italy.
francescacecchi2002@libero.it

FROM: Health Insights Today

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week.

Outcome measures were the Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6), assessed at baseline, discharge, and at 3, 6, and 12 months. 205 patients completed the study.

At discharge, disability score decreased by:

3.7 +/- 4.1 for back school,4.4 +/- 3.7 for individual physiotherapy, and

6.7 +/- 3.9 for manipulation.

The pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively.

Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups;

pain recurrences and drug intake were also reduced compared to back school or individual physiotherapy.

The difference in their improved scores is quite dramatic:

After 12 months

Intervention	Disability Score	Pain Rating
At Discharge
Spinal Manipulation	6.7 +/- 3.9	1.0 +/- 1.1
Individual Physiotherapy	4.4 +/- 3.7	1.1 +/- 1.0
Back School	3.7 +/- 4.1	0.9 +/- 1.1
Spinal Manipulation	5.9 +/- 4.6	1.5 +/- 1.1
Individual Physiotherapy	4.0 +/- 5.1	0.4 +/- 1.3
Back School	4.2 +/- 4.8	0.7 +/- 1.2

NOTE: These numbers indicate the reductions in scores on the Roland Morris Disability Questionnaire and the Pain Rating Scale.

The Abstract:

OBJECTIVE: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain.

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