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Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

By Frank M. Painter|April 29, 2023|Chiropractic Management, Initial Provider, Low Back Pain|

Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

SOURCE: J Manipulative Physiol Ther 2021 (Nov); 44 (9): 683–689
Brian R. Anderson, DC, MPH, MS, PhD, Steve W. McClellan, MS

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA.

FROM:
Houweling, JMPT 2015 Liliedahl, JMPT 2010

Objective: The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims.

Methods: We performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. The 3 care patterns we analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. We considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery. Modified-Poisson regression modeling was used to determine relative risk of escalated care.

Results: There were 83,025 claims that were categorized into 10 372 unique patient first episodes. Spinal manipulative therapy was present in 2,943 episodes (28%). Initial spinal manipulation was present in 2,519 episodes (24%), delayed spinal manipulation was present in 424 episodes (4%), and 7,429 (72%) had no evidence of spinal manipulative therapy. The estimated relative risk, adjusted for age, sex, and risk score, for care escalation (eg, imaging, injections, or surgery) was 0.70 (95% confidence interval 0.65–0.75, P < .001) for initial spinal manipulation and 1.22 (95% confidence interval 1.10–1.35, P < .001) for delayed spinal manipulation with no spinal manipulation used as the reference group.

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Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey

By Frank M. Painter|April 16, 2023|Chronic Neck Pain, Chronic Spinal Pain, Low Back Pain|

Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey

The Chiro.Org Blog

SOURCE: Int J Environ Res Public Health 2023 (Apr 3); 20 (7): 5369

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Katie de Luca, Patricia Tavares, Haiou Yang, Eric L Hurwitz, Bart N Green, Hannah Dale, Scott Haldeman

Discipline of Chiropractic,
School of Health, Medical and Applied Science,
CQ University,
Brisbane, QLD 4701, Australia.

FROM: J Pain Res. 2021

Spinal pain and chronic health conditions are highly prevalent, burdensome, and costly conditions, both in the United States and globally. Using cross-sectional data from the 2016 through 2018 National Health Interview Survey (n = 26,926), we explored associations between spinal pain and chronic health conditions and investigated the influence that a set of confounders may have on the associations between spinal pain and chronic health conditions. Variance estimation method was used to compute weighted descriptive statistics and measures of associations with multinomial logistic regression models. All four chronic health conditions significantly increased the prevalence odds of spinal pain; cardiovascular conditions by 58%, hypertension by 40%, diabetes by 25% and obesity by 34%, controlling for all the confounders.

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LOW BACK PAIN Section and the:

CHRONIC NECK PAIN Section and the:

SPINAL PAIN MANAGEMENT Section

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The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

By Frank M. Painter|April 13, 2023|Chiropractic Management, Low Back Pain, Medicare|

The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

The Chiro.Org Blog

SOURCE: PLoS One 2023 (Apr 12); 18 (4): e0283661

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Lobke P. De la Ruelle, Annemarie de Zoete, Cornelius Myburgh, Hella E. Brandt, Sidney M. Rubinstein

Department of Health Sciences,
Faculty of Science,
Amsterdam Movement Sciences,
Vrije Universiteit Amsterdam,
Amsterdam, The Netherlands.

Background: Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process.

Methods: Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim.

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Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

By Frank M. Painter|April 12, 2023|Chiropractic Management, Disc Derangement|

Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

The Chiro.Org Blog

SOURCE: Research Square (Apr 4, 2023)

Jessica F Billham, Erika Evans Roland, Matthew F. Gornet, Kelly Brinkman, Francine Schranck, Jim Cox, Norman W. Kettner

Logan University
Chesterfield, MO, US

The Vertebral Disc
FROM: Bioengineering 2022

INTRODUCTION: We report utility of magnetic resonance spectroscopy (MRS) in identifying the intervertebral disc (IVD) as a pain generator, describe the contemporary pathophysiology underlying biochemical and structural components of discogenic low back pain (DLBP), and exhibit therapeutic responses to spinal manipulation.

CLINICAL FEATURES: A 29-year old man presented with uncomplicated low back pain (LBP). The nonspecific presentation and clinical exam findings were consistent with non-specific LBP with the IVD as likely pain generator.

INTERVENTION AND OUTCOMES: Conventional magnetic resonance imaging showed findings of IVD degeneration including Modic Type 1 changes consistent with a diagnosis of DLBP. MRS was utilized for structural and biochemical analysis of the IVDs. Altered spectral features confirmed a DLBP diagnosis. The patient underwent 12 Cox Flexion Distraction treatments at a chiropractic teaching clinic. Follow-up MRS revealed improved IVD spectral features including decreased biochemical pain markers and increased glycoprotein biosynthesis suggesting improved IVD structural integrity.

CONCLUSION: We report the first utilization of MRS to quantify structural integrity and biochemical pain profile of the IVD in a conservatively managed DLBP patient. Findings of this case suggest spinal manipulative therapy in DLBP management may improve the structural integrity of IVDs and alter pain biochemistry.

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LOW BACK PAIN Section and the:

DISC HERNIATION & CHIROPRACTIC Section

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The Swiss Chiropractic Practice-based Research Network: A Population-based Cross-sectional Study to Inform Future Musculoskeletal Research

By Frank M. Painter|April 7, 2023|Chiropractic Management, Musculoskeletal Dysfunction, Musculoskeletal Pain|

The Swiss Chiropractic Practice-based Research Network: A Population-based Cross-sectional Study to Inform Future Musculoskeletal Research

The Chiro.Org Blog

SOURCE: Scientific Reports 2023 (Apr 6); 13 (1): 5655

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Rahim Lalji, Léonie Hofstetter, Alice Kongsted, Viktor von Wyl, Milo A. Puhan & Cesar A. Hincapié

EBPI-UWZH Musculoskeletal Epidemiology Research Group,
University of Zurich and Balgrist University Hospital,
Forchstrasse 340, 8008,
Zurich, Switzerland.

FROM: BMJ Open 2022

The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance musculoskeletal epidemiologic research. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collaboration. A population-based cross-sectional study was performed. PBRN clinician characteristics were described and factors related to motivation (operationalised as VAS score ≥ 70) to participate in a subsequent patient cohort pilot study were assessed. Among 326 eligible chiropractors, 152 enrolled in the PBRN (47% participation). The PBRN was representative of the larger Swiss chiropractic population with regards to age, language, and geographic distribution. Of those enrolled, 39% were motivated to participate in a nested patient cohort pilot study. Motivation was associated with age 40 years or older versus 39 years or younger (OR 2.3, 95% CI 1.0–5.2), and with a moderate clinic size (OR 2.4, 95% CI 1.1–5.7) or large clinic size (OR 2.8, 95% CI 1.0–7.8) versus solo practice. The Swiss chiropractic PBRN has enrolled almost half of all Swiss chiropractors and has potential to facilitate collaborative practice-based research to improve musculoskeletal health care quality.

Trial registration: Swiss chiropractic PBRN
(ClinicalTrials.gov identifier: NCT05046249);
Swiss chiropractic cohort (Swiss ChiCo) pilot study
(ClinicalTrials.gov identifier: NCT05116020).

From the FULL TEXT Article:

Introduction

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Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

By Frank M. Painter|March 29, 2023|Chiropractic Care, Radiology|

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

The Chiro.Org Blog

SOURCE: J Clinical Medicine 2023 (Mar 10); 12 (6): 2169

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Philip A Arnone, Steven J Kraus, Derek Farmen, Douglas F Lightstone, Jason Jaeger, Christine Theodossis

Community Based Internship Program, Associate Faculty,
Southern California University of Health Sciences,
Whittier, CA 90604, USA.

FROM: Umeå University, Sweden 2008

Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4,301 surveys were completed, of which 3,641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model.

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