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Informed Consent: What Does It Mean?

By Frank M. Painter|September 9, 2013|Informed Consent|

Informed Consent: What Does It Mean?

SOURCE: Health Insights Today ~ Sept 2013

Interview with Simon Dagenais, DC, PhD, MSc

Interviewed by Daniel Redwood, DC

Simon Dagenais, DC, PhD, MSc is uniquely qualified as an expert in a wide range of health and health policy areas. Since receiving his doctor of chiropractic degree from the Southern California University of Health Sciences in 2000, Dagenais received a PhD in Environmental Health, Science, and Policy (with emphasis in Epidemiology and Public Health) from the University of California, Irvine in 2005, followed by a Master of Science in Health Economics, Policy, and Management from the London School of Economics in 2011. He is also certified in Biomedical Regulatory Affairs by the University of California, San Diego, and certified as a Clinical Research Coordinator by the Association of Clinical Research Professionals.

Along with Scott Haldeman, DC, MD, PhD, Dr. Dagenais was an instrumental contributor to the widely-respected Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders, whose work was documented in eight papers in Spine in 2008. Currently, he is the program co-chair for nonoperative treatment of the North American Spine Society (NASS) and also serves on the NASS value committee. The list of his other accomplishments is extraordinarily impressive for a relatively young research and policy expert – perhaps best illustrated by the fact that his peer-reviewed articles, commentaries, technical reports, books and book chapters total 100 as of mid-2013.

In 2013, The Back Letter gave extensive coverage to an article by Dagenais et al in The Journal of Manipulative and Physiological Therapeutics on informed consent in the chiropractic profession, calling it, “perhaps the best article ever written on informed consent for low back pain.”

In this Health Insights Today interview, Dr. Dagenais discusses a wide range of issues related to informed consent, including the need for practitioners of all types to become well-informed about all alternative treatment approaches so that they may share these in an unbiased way with patients, thus enabling patients to make informed decisions about their health care choices.

There is more info like this in our:

Documentation Section

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Chronic Low-Back Pain: Is Infection a Common Cause?

By Frank M. Painter|September 6, 2013|Chiropractic Care, Low Back Pain|

Chronic Low-Back Pain: Is Infection a Common Cause?

The Chiro.Org Blog

SOURCE: ACA News ~ September 2013

By Daniel Redwood, DC

Background:

A 2013 randomized trial by Hanne Albert and colleagues at the University of Southern Denmark, published in the European Spine Journal, [1] found that 100 days of treatment with a disc-penetrating antibiotic was significantly more effective than a placebo for relief of chronic low-back pain (CLBP) in people whose MRI exam showed Modic Type 1 changes, which are associated with degeneration and inflammation. If confirmed by other studies, this would mean that disc infection is a far more common cause of CLBP than previously known.

Rare indeed is the publication of a Research paper with the potential to overturn long-standing, fundamental assumptions about the nature of a disease. Virtually all clinical research is incremental in its expansion of our knowledge — by evaluating the effectiveness of treatment methods, demonstrating the conditions under which they are most likely to be beneficial and exploring the physical mechanisms through which they work. But every now and then, a study like Marshall and Warren’s 1982 discovery [2] of the association between the heliobacter pylori bacterium and peptic ulcers appears out of left field to upend what previously passed for conventional wisdom.

In recent years, arguably the only publication to trigger a major reorientation of our understanding in an area critical to chiropractic practice was the 2008 Cassidy et al. paper in Spine, [3] in which the investigators examined nine years of medical records in the Canadian province of Ontario (covering 100 million patient years) and were able to definitively demonstrate that the likelihood of a stroke is no greater if one visits a doctor of chiropractic (DC) than if one visits a medical doctor. Overnight, this study shifted our understanding of stroke vis-à-vis chiropractic, with the authors concluding: “The increased risks of VBA (vertebrobasilar artery) stroke associated with chiropractic and PCP (primary care physician) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated (with) chiropractic care compared to primary care.”

There’s a lot more material like this @:

Low Back Pain and Chiropractic Page

Is the Albert et al. study on antibiotics treatment of CLBP this kind of game-changer?

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Comment glitch fixed

By John Wiens DC|September 4, 2013|News|

An apology to our readers.

After activating our new server, a switch for publishing comments inadvertently got pushed requiring a login to post. That switch has been turned off and posting comments should now return to normal.

However, the server may have reset to where you will get a message that says:

Your comment is awaiting moderation.

even though you have successfully posted before. Once approved you will again be able to post as normal.

Again, sorry for the inconvenience.

If anyone has any further problems please contact the manager. (manager@chiro.org)

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Evidence-based Classification Of Low Back Pain In The General Population: One-year Data Collected With SMS Track

By Frank M. Painter|September 3, 2013|Low Back Pain|

Evidence-based Classification Of Low Back Pain In The General Population: One-year Data Collected With SMS Track

The Chiro.Org Blog

Chiropractic & Manual Therapies 2013 (Sep 2); 21: 30

Charlotte Leboeuf-Yde, Nadège Lemeunier, Niels Wedderkopp and Per Kjaer

Research Department, The Spine Center of Southern Denmark, Hospital Lillebælt and Institute of Regional Health Research, University of Southern Denmark, Østre Hougvej 55, DK5500 Middelfart, Denmark

Background It was previously assumed that low back pain (LBP) is a disorder that can be classified as acute, subacute and chronic. Lately, the opinion seems to have veered towards a concept of it being a more recurrent or cyclic condition. Interestingly, a recent review of the literature indicated that LBP in the general population is a rather stable condition, characterized as either being present or absent. However, only one of the reviewed studies had used frequent data collection, which would be necessary when studying detailed course patterns over time. It was the purpose of this study to see, if it was possible to identify whether LBP, when present, is rather episodic or chronic/persistent. Further, we wanted to see if it was possible to describe any specific course profiles of LBP in the general population.

Methods In all, 293 49/50-yr old Danes, who previously participated in a population-based study on LBP were invited to respond to 26 fortnightly text-messages over one year, each time asking them the number of days they had been bothered by LBP in the past two weeks. The course patterns for these individuals were identified through manual analysis, by observing the interplay between non-episodes and episodes of LBP. A non-episode of LBP was defined as a period of at least one month without LBP as proposed by de Vet et al. A fortnight with at least one day of pain was defined as a pain fortnight (FN). At least one pain FN surrounded by a non-episode on each side was defined as an episode of LBP. After some preliminary observations of the spread of data, episodes were further classified as brief (consisting of only one pain FN) or longer (if there were at least 2 pain FNs in a row). An episode of at least 6 pain FNs in a row (i.e. 3 months) was defined as a long-lasting episode.

Results In all, 261 study subjects were included in the analyses, for which 7 distinct LBP subsets could be identified. These could be grouped into three major clusters; those mainly without LBP (35%), those with episodic LBP (30%) and those with persistent LBP (35%). There was a positive association between number of episodes and their duration.

There’s a lot more material like this @:

Low Back Pain and Chiropractic Page and the

Clinical Model for Diagnosis and Management Page

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New Beginnings and Happy Endings

By Frank M. Painter|September 1, 2013|Announcement|

New Beginnings and Happy Endings

The Chiro.Org Blog

I just have to share this story:

I recently called for insurance verification for a new patient, and the person droned on:

For medical care, deductible = 500, co-insurance 70%

I said, yeah fine, but I am a Chiropractor.

And then she said…”Oh, you’re a chiropractor!”
(all breathless, like I was a Rock Star!)

for chiropractic deductible = 250, co-insurance 80%

so this is the FIRST company I’ve run across that preferentially prices things to ENCOURAGE patients to seek chiropractic care FIRST (to the extent that they can).

ASTOUNDING!!!

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New Chiropractic and Radicular Pain Study

By Frank M. Painter|August 31, 2013|Chiropractic Care, Disc Injury, Radiculopathy|

New Chiropractic and Radicular Pain Study

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Aug 12)

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

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.
xraydcpeterson@yahoo.ca

This newly published prospective cohort study with 3-Month follow-up reports on the outcomes of 50 patients with MRI-confirmed cervical disc herniation who were also experiencing radiculopathy. Some of them were acute cases, but many of them also happened to be chronic pain patients.

A short, 3 month trial of chiropractic care led to significant improvements in all those individuals, and this improvement was sustained 3 months after care ceased.

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.

There are many more articles like this at our:

Radiculopathy and Chiropractic Page

and our:

Chronic Neck Pain and Chiropractic Page

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