BLOG – Page 21 – Chiropractic Resource Organization

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

By Frank M. Painter|December 23, 2021|Cost-Effectiveness, Low Back Pain, Medicare|

Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults

SOURCE: J Manipulative Physiol Ther 2021 (Dec 5)

James M. Whedon, DC, MSm Anupama Kizhakkeveettil, PhD, Andrew Toler, MS, Todd A. MacKenzie, PhD, Jon D. Lurie, MD, MS, Serena Bezdjian, PhD, Scott Haldeman, DC, MD, PhD, Eric Hurwitz, DC, PhD, Ian Coulter, PhD

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

FROM: The Facts on Medicare Spending (2019)

Objectives: The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT).

Methods: We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias.

Results: The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001).

There is more like this @ our:

MEDICARE Section and our:

COST-EFFECTIVENESS Section

(more…)

0

Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

By Frank M. Painter|December 22, 2021|Chiropractic Management, Pregnancy|

Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

The Chiro.Org Blog

SOURCE: Obstet Gynecol Surv 2009 (Jun); 64 (6): 416–427

Raheleh Khorsan, MA, Cheryl Hawk, DC, PhD, Anthony J. Lisi, DC, and Anupama Kizhakkeveettil, BAMS, MAOM

Military Medical Research and Integrative Medicine,
Samueli Institute,
Corona del Mar,
California 92625, USA

Objective: The objective of this review is to evaluate the evidence on the effects of Spinal Manipulative Therapy (SMT) on back pain and other related symptoms during pregnancy.

Data sources: A literature search was conducted using Pubmed, Manual, Alternative and Natural Therapy Index System, Cumulated Index to Nursing and Allied Health, Index to Chiropractic Literature, the Cochrane Library, and Google Scholar. In addition hand searches and reference tracking were also performed, and the citation list was assessed for comprehensiveness by content experts.

Methods of study selection : This review was limited to peer-reviewed manuscripts published in English from 1966 until September 2008. The initial search strategy yielded 140 citations of which 12 studies were reviewed for quality.

Tabulation, integration, and results: The methodological quality of the included studies was assessed independently using quality checklists of the Scottish Intercollegiate Guidelines Network and Council on Chiropractic Guidelines and Practice Parameters. The review indicates that the use of SMT during pregnancy to reduce back pain and other related symptoms is supported by limited evidence.

Conclusion: Overall, this body of evidence is best described as emergent. However, since effective treatments for pregnancy-related back pain are limited, clinicians may want to consider SMT as a treatment option, if no contraindications are present.

There are more articles like this @ our:

PREGNANCY AND CHIROPRACTIC page

(more…)

0

The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-velocity, Low-amplitude Controlled Vertebral Thrusts on Neuromuscular Function

By Frank M. Painter|December 17, 2021|Neurology, Subluxation|

The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-velocity, Low-amplitude Controlled Vertebral Thrusts on Neuromuscular Function

The Chiro.Org Blog

SOURCE: European J Applied Physiology 2021 (Oct); 121 (10): 2675–2720

Heidi Haavik, Nitika Kumari, Kelly Holt, Imran Khan Niazi, Imran Amjad, Amit N Pujari, Kemal Sitki Türker, Bernadette Murphy

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland, New Zealand.

Purpose: There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This invited review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments (high-velocity, low-amplitude or HVLA thrusts directed at a CSMC problem) and spinal manipulation (HVLA thrusts directed at segments of the vertebral column that may not have clinical indicators of a CSMC problem) alters neuromuscular function.

Methods: The current review elucidates the peripheral mechanisms by which CSMC problems, the spinal adjustment or spinal manipulation alter the afferent input from the paravertebral tissues. It summarises the contemporary model that provides a biologically plausible explanation for CSMC problems, the manipulable spinal lesion. This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force. The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centres will be covered in a second invited review.

Results: Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration. The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a CSMC problem. The many gaps in the literature have been identified, along with suggestions for future studies.

There are more articles like this @ our:

CHIROPRACTIC SUBLUXATION Page

(more…)

0

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

By Frank M. Painter|December 16, 2021|Chiropractic Management, Pregnancy|

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Nov 23)

Carol Ann Weis, MSc, DC, Katherine Pohlman, DC, PhD, Jon Barrett, MBBch, MD, Maeve O’Beirne, MD, PhD, Kent Stuber, DC, MSc, Cheryl Hawk, DC, PhD

Department of Research,
Canadian Memorial Chiropractic College,
Toronto, ON, Canada.

Objective: The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.

Methods: A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.

Results: Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.

There are more articles like this @ our:

PREGNANCY AND CHIROPRACTIC page

(more…)

0

The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

By Frank M. Painter|December 15, 2021|Cost-Effectiveness, Cost-Effectiveness of Chiropractic|

The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Aug 7)

Matthew Davis, Olga Yakusheva, Haiyin Liu, Brian Anderson, Julie Bynum

University of Michigan,
400 North Ingalls, Room 4347,
Ann Arbor, MI 48109

Objective: The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

Methods: We used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation. Using a difference-in-difference analysis (before versus after relocation), we compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

Results: Among those who experienced a reduction in access to chiropractic care (versus those who did not), we observed an increase in the rate of visits to primary care physicians for spine conditions (an annual increase of 32.3 visits, 95% CI: 1.4-63.1 per 1,000) and rate of spine surgeries (an annual increase of 5.5 surgeries, 95% CI: 1.3-9.8 per 1,000). Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 beneficiaries on medical services ($391 million nationally).

There are more articles like this @ our:

COST-EFFECTIVENESS Section

(more…)

0

Diagnosis of Sacroiliac Joint Pain: Validity of Individual Provocation Tests and Composites of Tests

By Frank M. Painter|December 14, 2021|Palpation|

Diagnosis of Sacroiliac Joint Pain: Validity of Individual Provocation Tests and Composites of Tests

The Chiro.Org Blog

SOURCE: Manual Therapy 2005 (Aug); 10 (3): 207–218

Mark Laslett, Charles N. Aprill, Barry McDonald, Sharon B. Young

Department of Health and Society,
Linköpings Universitet,
Linköping, Sweden.

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard.

In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842.

In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

There is more like this @ our:

CHIROPRACTIC SUBLUXATION Page and the:

SPINAL PALPATION page

(more…)

0