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Outcomes Indicators and a Risk Classification System

By Frank M. Painter|March 24, 2018|Spinal Pain Management|

Outcomes Indicators and a Risk Classification System for Spinal Manipulation Under Anesthesia: A Narrative Review and Proposal

SOURCE: Chiropractic & Manual Therapies 2018 (Mar 8); 26: 9

Dennis DiGiorgi, John L. Cerf, and Daniel S. Bowerman

Consultant Practice
Whitestone, NY, USA.

Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice.

With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia.

A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.

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Congress Passes Legislation Expanding Veteran Access

By Frank M. Painter|March 23, 2018|Announcement|

Congress Passes Legislation Expanding Veteran Access to Nondrug Chiropractic Services

The Chiro.Org Blog

SOURCE: American Chiropractic Association

Arlington, Va. — The American Chiropractic Association (ACA) announced today that Congress, with the passage of the Consolidated Appropriations Act of 2018, has approved a plan to expand access to chiropractic’s nondrug approach to pain relief to veterans, many of whom suffer from back pain and other musculoskeletal conditions resulting from their service.

The Senate voted 65-32 to approve the $1.3 trillion omnibus spending package early Friday, less than 24 hours ahead of what would have been a government shutdown. The vote follows House passage, and the bill now heads to the president’s desk for his signature.

Supported by several veterans groups and championed in Congress by Sens. Jerry Moran (R-Kansas), Jon Tester (D-Mont.), Johnny Isakson (R-Ga.) and Richard Blumenthal (D-Conn.), the approved language calls for the U.S. Department of Veterans Affairs (VA) to expand the availability of chiropractic services at no fewer than two medical centers or clinics in each Veterans Integrated Service Network (VISN) by no later than Dec. 31, 2019, and at no fewer than 50 percent of all medical centers in each VISN by no later than Dec. 31, 2021.

The measure also, for the first time, codifies and broadens chiropractic services in the VA to include services provided by doctors of chiropractic under the Preventive Health Services and Medical categories — in addition to existing coverage under Rehabilitative Services — placing chiropractors in service categories previously closed to them.

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Chiropractic Management of Postoperative Spine Pain

By Frank M. Painter|March 21, 2018|Spinal Pain Management|

Chiropractic Management of Postoperative Spine Pain: A Report of 3 Cases

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2013 (Sep); 12 (3): 168–175

Christopher M. Coulisa, and Anthony J. Lisi

VA Connecticut Healthcare System,
West Haven, CT;
University of Bridgeport College of Chiropractic,
Bridgeport, CT.

OBJECTIVE: The purpose of this case series is to describe chiropractic care including spinal manipulation for 3 patients with postsurgical spine pain.

CLINICAL FEATURES: Three patients with postsurgical spine pain (1 cervical fusion, 1 lumbar discectomy, and 1 lumbar laminectomy) presented for chiropractic treatment at a major US medical center. Treatment included spinal manipulation and/or flexion-distraction mobilization based on patient response to joint loading strategies.

INTERVENTION AND OUTCOMES: Two patients were treated with high-velocity, low-amplitude spinal manipulation; and 1 patient was treated with flexion-distraction mobilization. Treatment frequency and duration were 4 treatments over 4 weeks for case 1, 17 treatments over 7 years for case 2, and 5 treatments over 5 weeks for case 3. Subjective improvement was noted using numeric pain scores and functional changes; and upon completion, the patients reported being “satisfied” with their overall outcome. One episode of transient benign soreness was noted by 1 patient. No additional adverse events or effects were noted.

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A Systematic Review on the Effectiveness of Physical and Rehabilitation

By Frank M. Painter|March 18, 2018|Low Back Pain|

A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions for Chronic Non-specific Low Back Pain

The Chiro.Org Blog

SOURCE: European Spine Journal 2011 (Jan); 20 (1): 19–39

Marienke van Middelkoop • Sidney M. Rubinstein • Ton Kuijpers • Arianne P. Verhagen • Raymond Ostelo •
Bart W. Koes • Maurits W. van Tulder

Department of General Practice,
Erasmus MC, University Medical Center,
Rotterdam, The Netherlands.

This study has been included for completeness sake. It provides a broad assessment of many of the treatments available in the Supermarket Approach to the Management of Chronic Low Back Pain

Strangely, it only mentions spinal manipulation in the Exercise therapy versus manual therapy/ manipulation section, and none of those studies included chiropractic (CMT) trials.

Perhaps they missed the numerous studies conducted by researchers at the Wolfe-Harris Center @ Northwestern Health Sciences University. They are certainly worth reviewing.

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008.

Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥ 18 years) population with chronic (≥ 12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence.

In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6).

Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function.

Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls.

Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls.

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Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis

By Frank M. Painter|March 16, 2018|Forward Head Posture|

Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2017 (Sep); 16 (3): 220–229

Deepika Singla, MPT Sports, BPT and Zubia Veqar, PhD, MPT Ortho, BPT

Centre for Physiotherapy and Rehabilitation Sciences,
Jamia Millia Islamia,
Jamia Nagar, Okhla, Delhi, India

OBJECTIVE: The purpose of this review was to explore the association between forward head posture, rounded shoulders, and increased thoracic kyphosis.

METHODS: The PubMed, ERIC, and Cochrane databases were searched using the key words posture, head, shoulder, forward scapular posture, and thoracic kyphosis through December 2016.

RESULTS: Our initial search yielded 6,840 research studies, 6,769 of which were excluded because they either were duplicates or did not satisfy the inclusion criteria. After the abstracts of the remaining studies were read, 15 were assessed for eligibility, and only 4 papers were included in the present review. Cervical lordosis values were found to be significantly associated with thoracic kyphosis values. Also, there were significant correlations between rounded shoulders and increased thoracic kyphosis.

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Manual Therapy and Exercise for Neck Pain

By Frank M. Painter|March 14, 2018|Exercise and Chiropractic, Pain Management|

Manual Therapy and Exercise for Neck Pain: A Systematic Review

The Chiro.Org Blog

SOURCE: Man Ther. 2010 (Aug); 15 (4): 334–354

Jordan Miller, Anita Gross, Jonathan D’Sylva, Stephen J. Burnie, Charles H. Goldsmith, Nadine Graham, Ted Haines, Gert Brønfort, Jan L. Hoving

School of Rehabilitation Science,
McMaster University,
Hamilton, Canada

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy.

Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias.

Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: -1.69, -0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment.

High quality evidence suggests greater short-term pain relief [pSMD-0.50(95% CI: -0.76, -0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache.

Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash.

Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

From the Database of Abstracts of Reviews of Effects (DARE) review

CRD summary

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