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Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

By Frank M. Painter|May 8, 2022|Acute Neck Pain, Chiropractic Care, Chronic Neck Pain|

Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

SOURCE: J Clinical Medicine 2021 (Oct 28); 10 (21): 5011

Aleksander Chaibi, Knut Stavem and Michael Bjørn Russell

Head and Neck Research Group,
Division for Research and Innovation,
Akershus University Hospital,
1478 Oslo, Norway

Background: Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs)

Method: To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. Data extraction was done in duplicate and formulated in tables. Quality and evidence were assessed using the Cochrane Back and

Results: Six studies were included. The overall pooled effect size for neck pain was very large –1.37 (95% CI, –2.41, –0.34), favouring treatments with SMT compared with controls. A single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment, ((–2.8 (46%) (95% CI, –2.1, –3.4) vs. –1.7 (30%) (95% CI, –1.1, –2.3), respectively; p = 0.02)). Minor transient AEs reported included increased pain and headache, while no serious AEs were reported.

There is more like this @ our:

CHRONIC NECK PAIN Page and the:

NON-PHARMACOLOGIC THERAPY Page

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The Passing of a Giant – Chester Wilk dies at 91

By John Wiens DC|April 23, 2022|History|

Shared from the World Federation of Chiropractic Facebook page

Dr Chester A. Wilk, the chiropractor famed for taking on the American Medical Association – and winning – passed away on Thursday, April, 21 at Advocate Lutheran Hospital, Park Ridge, Illinois.

The case of Wilk v AMA, an antitrust law suit, was a seminal moment in the profession’s history, at a time when chiropractors in the United States found themselves subjected to extreme prejudice and discrimination. The story of Chester Wilk’s epic battle is told in ‘Contain and Eliminate: the American Medical Association’s Conspiracy to Destroy Chiropractic’, written by Howard Wolinsky and published in 2021.

The persistence and fortitude of Wilk and his four co-plaintiffs, in the face of serious roadblocks to practicing as chiropractors, drove him to step up and take on the giant of healthcare. The David and Goliath story saw him consumed by his mission to expose the injustice and the covert Committee on Quackery that had been set up by the AMA to undermine and destroy chiropractic.

Starting in the 1970s, the legal battle continued for years, before a 1987 judgment by Judge Susan Getzendanner ruled that the AMA had illegally engaged in an unlawful conspiracy, a judgment subsequently upheld in 1990 in the Court of Appeals.

The impact of Wilk v AMA was huge. Doors that had previously been firmly shut opened up to allow interprofessional care and changes in the AMA’s ethical rules permitted referral by medical doctors to doctors of chiropractic.

We mourn the passing of Dr Wilk and recognize with gratitude the life of one of the legendary figures of the chiropractic profession.

Chiro.org has compiled a comprehensive page on the Wilk Anti-tust suit.

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Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries

By Frank M. Painter|April 10, 2022|Medicare|

Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2022 (Mar 26) [EPUB]

Anupama Kizhakkeveettil, PhD, Serena Bezdjian, PhD, Eric L. Hurwitz, PhD, Ian Coulter, PhD, Scott Haldeman, PhD, James M. Whedon, DC, MS et. al

Ayurveda Medicine Department,
Southern California University of Health Sciences,
Whittier, California.

Davis (J Am Board Fam Med 2015)

Objective: The objective of this study was to compare patients’ perspectives on the use of spinal manipulative therapy (SMT) compared to prescription drug therapy (PDT) with regard to health-related quality of life (HRQoL), patient beliefs, and satisfaction with treatment.

Methods: Four cohorts of Medicare beneficiaries were assembled according to previous treatment received as evidenced in claims data: SMT, PDT, and 2 crossover cohorts (where participants experienced both types of treatments). A total of 195 Medicare beneficiaries responded to the survey. Outcome measures used were a 0–to–10 numeric rating scale to measure satisfaction, the Low Back Pain Treatment Beliefs Questionnaire to measure patient beliefs, and the 12–item Short Form Health Survey to measure HRQoL.

Results: Recipients of SMT were more likely to be very satisfied with their care (84%) than recipients of PDT (50%; P = .002). The SMT cohort self-reported significantly higher HRQoL compared to the PDT cohort; mean differences in physical and mental health scores on the 12–item Short Form Health Survey were 12.85 and 9.92, respectively. The SMT cohort had a lower degree of concern regarding chiropractic care for their back pain compared to the PDT cohort’s reported concern about PDT (P = .03).

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MEDICARE Section

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Development and Evaluation of the MAINTAIN Instrument, Selecting Patients Suitable for Secondary or Tertiary Preventive Manual Care: The Nordic Maintenance Care Program

By Frank M. Painter|March 24, 2022|Chiropractic Management, Maintenance Care|

Development and Evaluation of the MAINTAIN Instrument, Selecting Patients Suitable for Secondary or Tertiary Preventive Manual Care: The Nordic Maintenance Care Program

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2022 (Mar 17)

Andreas Eklund, Per J Palmgren, Ulf Jakobsson, Iben Axén

Unit of Intervention and Implementation Research for Worker Health,
The Institute of Environmental Medicine (IMM),
Karolinska Institutet,
Stockholm, Sweden

Background: Chiropractic maintenance care (MC) has been found to be effective for patients classified as dysfunctional by the West Haven-Yale Multidimensional Pain Inventory (MPI). Although displaying good psychometric properties, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. The aim was to develop a brief clinical instrument with the intent of identifying dysfunctional patients with acceptable diagnostic accuracy.

Methods: Data from 249 patients with a complete MPI dataset from a randomized clinical trial that investigated the effect and cost-effectiveness of MC with a 12-month follow-up was used in this cross-sectional analysis. A brief screening instrument was developed to identify dysfunctional patients, with a summary measure. Different cut-offs were considered with regards to diagnostic accuracy using the original instrument’s classification of dysfunctional patients as a reference. Very good diagnostic accuracy was defined as an area under the curve (AUC) metric between 0.8 and 0.9. The instrument was then externally validated in 3 other existing datasets to assess model transportability across populations and medical settings.

Results: Using an explorative approach, the MAINTAIN instrument with 10 questions (0-6 Likert responses) capturing 5 dimensions (pain severity, interference, life control, affective distress, and support) was developed, generating an algorithm-based score ranging from – 12 to 48. Reporting a MAINTAIN score of 18 or higher, 146 out of the 249 patients were classified as dysfunctional with 95.8% sensitivity and 64.3% specificity. At a score of 22 or higher, 109/249 were classified as dysfunctional with 81.1% sensitivity and 79.2% specificity. AUC was estimated to 0.87 (95% CI 0.83, 0.92) and Youden’s index was highest (0.70) at a score of 20. The diagnostic accuracy was similar and high across populations with minor differences in optimal thresholds for identifying dysfunctional individuals.

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MAINTENANCE CARE page

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Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Single-arm, Pragmatic, Pilot Trial of Multimodal Chiropractic Care for U.S. Veterans with Chronic Low Back Pain

By Frank M. Painter|March 11, 2022|Chiropractic Management, Chronic Low Back Pain|

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Single-arm, Pragmatic, Pilot Trial of Multimodal Chiropractic Care for U.S. Veterans with Chronic Low Back Pain

The Chiro.Org Blog

SOURCE: Pilot and Feasibility Studies 2022 (Mar 7); 8 (1): 54

Cynthia R. Long, PhD, Stacie A. Salsbury, PhD, RN, Robert D. Vining, DC, Anthony J. Lisi, DC, et al.

Palmer Center for Chiropractic Research, Davenport,
Palmer College of Chiropractic,
741 Brady St, Davenport, IA, 52803

Background: Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial.

Methods: This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10–week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables.

Results: We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial.

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CHIROPRACTIC CARE FOR VETERANS Section

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Multidisciplinary Integrative Care Versus Chiropractic Care for Low Back Pain: A Randomized Clinical Trial

By Frank M. Painter|March 9, 2022|Chiropractic Management, Low Back Pain|

Multidisciplinary Integrative Care Versus Chiropractic Care for Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2022 (Mar 1); 30: 10

Gert Bronfort, Michele Maiers, Craig Schulz, Brent Leininger, Kristine Westrom, Greg Angstman & Roni Evans

University of Minnesota,
Mayo Building C504,
420 Delaware Street SE,
Minneapolis, MN, 55455, USA.

Read the 2 previous papers associated with this study:

Maiers et. al.; BMC Health Serv Res. 2010 (Oct 29) and

Westrom et al.; Trials. 2010 (Mar 8)

Background: Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients’ needs more comprehensively.

Methods: This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes.

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LOW BACK PAIN Section

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