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Failure to Define Low Back Pain as a Disease or an Episode

By Frank M. Painter|January 10, 2018|Clinical Prediction Rule|

Failure to Define Low Back Pain as a Disease or an Episode Renders Research on Causality Unsuitable: Results of a Systematic Review

SOURCE: Chiropractic & Manual Therapies 2017 (Jan 9)

Emad M. Ardakani, Charlotte Leboeuf-Yde and Bruce F. Walker

School of Health Professions,
Murdoch University,
90 South St,
Murdoch, WA 6150, Australia

Background Causative factors may be different for the very first onset of symptoms of the ‘disease’ of low back pain (LBP) than for ensuing episodes that occur after a pain-free period. This differentiation hinges on a life-time absence of low back pain at first onset and short-term absence for further episodes. In this systematic review, we explored whether researchers make these distinctions when investigating the causality of LBP.

Methods A literature search of PUBMED, CINAHL, and SCOPUS databases was performed from January 2010 until September 2016 using the search terms ‘low back pain’ or ‘back pain’ and ‘risk factor’ or ‘caus*’ or ‘predict*’ or ‘onset’ or ‘first-time’ or ‘inception’ or ‘incidence’. Two reviewers extracted information on study design, types of episodes of back pain to distinguish the disease of LBP and recurring episodes, and also to determine the definitions of disease- or pain-free periods.

Results Thirty-three articles purporting to study causes of LBP were included. Upon scrutiny, 31 of the 33 articles were unclear as to what type of causality they were studying, that of the ‘disease’ or the episode, or a mere association with LBP. Only 9 studies used a prospective study design. Five studies appeared to investigate the onset of the disease of LBP, however, only one study truly captured the first incidence of LBP, which was the result of sports injury. Six appeared to study episodes but only one clearly related to the concept of episodes. Therefore, among those 11 studies, nine included both first-time LBP and episodes of LBP. Consequently, 22 studies related to the prevalence of LBP, as they probably included a mixture of first-time, recurring and ongoing episodes without distinction.

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Low Back Pain and Chiropractic Page
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Clinical Prediction Rule Page

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Patient-centered Professional Practice Models for Managing Low Back

By Frank M. Painter|January 8, 2018|Patient Satisfaction|

Patient-centered Professional Practice Models for Managing Low Back Pain in Older Adults: A Pilot Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: BMC Geriatr. 2017 (Oct 13); 17 (1): 235

Christine M. Goertz, Stacie A. Salsbury, Cynthia R. Long, Robert D. Vining, Andrew A. Andresen, Maria A. Hondras, Kevin J. Lyons, Lisa Z. Killinger, Fredric D. Wolinsky, and Robert B. Wallace

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

BACKGROUND: Low back pain is a debilitating condition for older adults, who may seek healthcare from multiple providers. Few studies have evaluated impacts of different healthcare delivery models on back pain outcomes in this population. The purpose of this study was to compare clinical outcomes of older adults receiving back pain treatment under 3 professional practice models that included primary medical care with or without chiropractic care.

METHODS: We conducted a pilot randomized controlled trial with 131 community-dwelling, ambulatory older adults with subacute or chronic low back pain. Participants were randomly allocated to 12 weeks of individualized primary medical care (Medical Care), concurrent medical and chiropractic care (Dual Care), or medical and chiropractic care with enhanced interprofessional collaboration (Shared Care). Primary outcomes were low back pain intensity rated on the numerical rating scale and back-related disability measured with the Roland-Morris Disability Questionnaire. Secondary outcomes included clinical measures, adverse events, and patient satisfaction. Statistical analyses included mixed-effects regression models and general estimating equations.

RESULTS: At 12 weeks, participants in all three treatment groups reported improvements in mean average low back pain intensity [Shared Care: 1.8; 95% confidence interval (CI) 1.0 to 2.6; Dual Care: 3.0; 95% CI 2.3 to 3.8; Medical Care: 2.3; 95% CI 1.5 to 3.2)] and back-related disability (Shared Care: 2.8; 95% CI 1.6 to 4.0; Dual Care: 2.5; 95% CI 1.3 to 3.7; Medical Care: 1.5; 95% CI 0.2 to 2.8). No statistically significant differences were noted between the three groups on the primary measures. Participants in both models that included chiropractic reported significantly better perceived low back pain improvement, overall health and quality of life, and greater satisfaction with healthcare services than patients who received medical care alone.

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Low Back Pain and Chiropractic Page
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Patient Satisfaction With Chiropractic

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Management of Back Pain-related Disorders in a Community With Limited Access to Health Care Services

By Frank M. Painter|January 6, 2018|Integrative Care|

Management of Back Pain-related Disorders in a Community With Limited Access to Health Care Services: A Description of Integration of Chiropractors as Service Providers

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2017 (Nov); 40 (9): 635–642

Peter C. Emary, DC, MSc, Amy L. Brown, DC, Douglas F. Cameron, DC, Alexander F. Pessoa, DC, ICSSP, Jennifer E. Bolton, PhD, MA Ed

Private Practice,
Cambridge, Ontario, Canada.

OBJECTIVE: The purpose of this study was to evaluate a chiropractic service for back pain patients integrated within a publicly funded, multidisciplinary, primary care community health center in Cambridge, Ontario, Canada.

METHODS: Patients consulting for back pain of any duration were referred by their medical doctor or nurse practitioner for chiropractic treatment at the community health center. Patients completed questionnaires at baseline and at discharge from the service. Data were collected prospectively on consecutive patients between January 2014 and January 2016.

RESULTS: Questionnaire data were obtained from 93 patients. The mean age of the sample was 49.0 ± 16.27 years, and 66% were unemployed. More than three-quarters (77%) had had their back pain for more than a month, and 68% described it as constant. According to the Bournemouth Questionnaire, Bothersomeness, and global improvement scales, a majority (63%, 74%, and 93%, respectively) reported improvement at discharge, and most (82%) reported a significant reduction in pain medication. More than three-quarters (77%) did not visit their primary care provider while under chiropractic care, and almost all (93%) were satisfied with the service. According to the EuroQol 5 Domain questionnaire, more than one-third of patients (39%) also reported improvement in their general health state at discharge.

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Integrated Health Care Page and the:

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The Quality of Life of Children Under Chiropractic Care Using PROMIS-25

By Frank M. Painter|January 2, 2018|Pediatrics|

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, DC, Andrea E. Lamont, PhD,
Jeanne Ohm, DC, and Junjoe Alcantara, DC

The International Chiropractic Pediatric Association,
327N Middletown Road
Media, PA 610-565-2360

OBJECTIVES: To characterize pediatric chiropractic and assess pediatric quality of life (QoL).

DESIGN: A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States.

SUBJECTS: A convenience sample of children (8-17 years) under chiropractic care and their parents.

EXPOSURE: Chiropractic spinal adjustments and adjunctive therapies.

OUTCOME MEASURES: Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome.

RESULTS: The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1, p < 0.05), anxiety (Wald = 20.603, df = 1, p < 0.05), fatigue (Wald = 22.191, df = 1, p < 0.05), and pain interference (Wald = 47.422, df = 1, p < 0.05) after a trial of chiropractic care.

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Chiropractic Pediatrics Section and the:

Outcome Assessment Page

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Impact of Musculoskeletal Pain on Balance

By Frank M. Painter|December 28, 2017|Low Back Pain|

Impact of Musculoskeletal Pain on Balance and Concerns of Falling in Mobility-limited, Community-dwelling Danes over 75 Years of Age: A Cross-sectional Study

The Chiro.Org Blog

SOURCE: Aging Clin Exp Res. 2018 (Aug); 30 (8): 969–975

Julie C. Kendall, Lars G. Hvid, Jan Hartvigsen,
Azharuddin Fazalbhoy, Michael F. Azari,
Mathias Skjødt, Stephen R. Robinson, Paolo Caserotti

School of Health and Biomedical Sciences,
RMIT University,
PO Box 71,
Bundoora, Melbourne, 3083, VIC, Australia.

BACKGROUND: In older adults, musculoskeletal pain is associated with increased concerns of falling, reduced balance and increased occurrence of falls. In younger adults, the intensity of neck pain and low back pain is associated with increased postural sway. It is not known if pain further impairs balance and concerns of falling in mobility-limited older adults, and if so, whether this is associated with different intensities of pain.

OBJECTIVE: This study examined whether mobility-limited older adults with mild or intense neck pain and/or low back pain have significantly increased postural sway as measured by centre of pressure (COP) changes and concerns of falling compared to those without pain.

METHODS: 48 older adults with a gait speed of < 0.9 m/s from Odense, Denmark were recruited through the public health service. Self-reported neck pain, low back pain, and concerns of falling were recorded on questionnaires. Sway range, velocity and area were recorded on a force plate in a comfortable standing stance. Pain intensity was rated on an 11 point numerical rating scale (0-10). Participants were sub-grouped into mild (0-4) and intense (> 5) neck pain or low back pain.

RESULTS: Intense neck pain was associated with increased anterior-posterior sway range and area of sway. Intense low back pain was associated with increased concerns of falling.

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Chiropractic and Senior Care Page

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Low Back Pain and Chiropractic Page

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The Use of the RAND VSQ9 to Measure the Quality of Life

By Frank M. Painter|December 25, 2017|Pediatrics|

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, Andrea Lamont Nazarenko,
Jeanne Ohm, and Junjoe Alcantara

The International Chiropractic Pediatric Association,
Media, PA.

OBJECTIVE: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women.

DESIGN: A prospective cohort within a practice-based research network (PBRN). Setting/locations: Individual chiropractic offices.

SUBJECTS: Pregnant women (age ≥18 years) attending chiropractic care.

INTERVENTION(S): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies).

MAIN OUTCOME MEASURES: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL.

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Chiropractic Pediatrics Section and the:

Outcome Assessment Page

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