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Spinal Manipulation and Home Exercise With Advice

By |August 28, 2017|Low Back Pain, Sciatica|

Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic
Back-related Leg Pain: A Trial With Adaptive Allocation

The Chiro.Org Blog

SOURCE:   Annals of Internal Medicine 2014 (Sep 16); 161 (6): 381—391

Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH;
Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD;
Cynthia R. Long, PhD; and Richard Grimm, MD, PhD

University of Minnesota,
Northwestern Health Sciences University, and
Berman Center for Outcomes and Clinical Research at
the Minneapolis Medical Research Foundation,
Minneapolis, Minnesota, and
Palmer Center for Chiropractic Research,
Davenport, Iowa.

BACKGROUND:   Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management.

OBJECTIVE:   To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.

DESIGN:   Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011.
(ClinicalTrials.gov: NCT00494065).

SETTING:   2 research centers (Minnesota and Iowa).

PATIENTS:   Persons aged 21 years or older with BRLP for least 4 weeks.

INTERVENTION:   12 weeks of SMT plus HEA or HEA alone.

MEASUREMENTS:   The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.

RESULTS:   Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over home exercise and advice (HEA) (difference, 10 percentage points [95% CI, 2 to 19]; P=0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P=0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.

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Health Maintenance Care in Work-Related Low Back Pain

By |August 18, 2017|Cost-Effectiveness, Low Back Pain|

Health Maintenance Care in Work-Related Low Back Pain
and Its Association With Disability Recurrence

The Chiro.Org Blog

SOURCE:   J Occupat Enviro Med 2011 (Apr); 53 (4): 396–404

Manuel Cifuentes, MD, PhD,
Joanna Willetts, MS, and
Radoslaw Wasiak, PhD, MA, MSc

Center for Disability Research
Liberty Mutual Research Institute for Safety
University of Massachusetts Lowell
Hopkinton, Mass

This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety AND the University of Massachusetts Lowell, Hopkinton, Mass

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP).   They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio</i? (HR) for disability recurrence between 3 types of providers:

Physical Therapists (PT),
Physicians (MD), or
Chiropractors (DC).

The results are quite interesting:

  • For PTs: HR = 2.0
  • For MDs: HR = 1.6
  • For DCs: HR = 1.0

  • Statistically, this means you are twice as likely to end up disabled if you got your care from a Physical Therapists (PT), rather than from a chiropractor.

    You’re also 60% more likely to be disabled if you choose a Physicians (MD) to manage your care, rather than a chiropractor.

    The authors concluded:

    “In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services.”

 

OBJECTIVES:   To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).

METHOD:   A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.

RESULTS:   Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).

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Prevention and Health Promotion by Chiropractors

By |August 15, 2017|Health Promotion|

Prevention and Health Promotion by Chiropractors

The Chiro.Org Blog

SOURCE:   American J Lifestyle Medicine 2008;   2 (6):   537–545

Daniel Redwood, DC, and Gary Globe, MBA, DC, PhD

Cleveland Chiropractic College–Kansas City,
10850 Lowell Avenue,
Overland Park, KS 66210

Chiropractic care includes a variety of minimally invasive approaches, with both treatment and prevention as essential elements of clinical practice. Although chiropractic adjustment (manipulation) is the signature therapy and best-known identifier of the profession, the practice of chiropractic involves more than manual therapeutics. In general, chiropractors seek to bring a holistic worldview to the doctor–patient encounter, seeking not only to relieve pain and restore neuromusculoskeletal function but also to support the inherent self-healing and self-regulating powers of the body.

Aside from applying their diagnostic training to the evaluation of a variety of physical disorders and delivering manual adjustments and related therapeutic interventions, many chiropractors encourage patients to take an active role in restoring and maintaining health, with particular emphasis on doctor-guided self-care through exercise and nutrition. In this review, the authors summarize the peer-reviewed literature on chiropractic and prevention, describe health promotion and wellness approaches currently taught at chiropractic colleges and used in chiropractic clinical settings, discuss duration of care, emphasize the importance of interprofessional cooperation and collaboration, and address the hypothesis that chiropractic adjustments yield preventive effects.

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Do Participants with Low Back Pain who Respond

By |August 13, 2017|Clinical Prediction Rule, Low Back Pain|

Do Participants with Low Back Pain who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls?

The Chiro.Org Blog

SOURCE:   Spine 2015 (Sep 1); 40 (17): 1329–1337

Arnold Y. L. Wong, PT, MPhil, PhD,
Eric C. Parent, PT, PhD,
Sukhvinder S. Dhillon, MB, ChB, CCST,
Narasimha Prasad, PhD,
and Gregory N. Kawchuk, DC, PhD

Department of Physical Therapy,
University of Alberta,
Alberta, Canada

STUDY DESIGN:   Nonrandomized controlled study.

OBJECTIVE:   To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls.

SUMMARY OF BACKGROUND DATA:   Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls.

METHODS:   Participants with LBP and asymptomatic controls attended 3 sessions for 7 days. On sessions 1 and 2, participants with LBP received SMT (+LBP/+SMT, n = 32) whereas asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from an LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/nonresponders on the basis of self-reported disability on day 7. A repeated measures analysis of covariance was used to compare apparent diffusion coefficients among responders, nonresponders, and +LBP/-SMT subjects, as well as spinal stiffness or multifidus thickness ratio among responders, nonresponders, and -LBP/-SMT subjects.

RESULTS:   After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups. Similarly, only SMT responders displayed significant post-SMT improvement in apparent diffusion coefficients.

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Effectiveness of Manual Therapy

By |August 9, 2017|Chiropractic Care, Chronic Tension-type Headache, Uncategorized|

Effectiveness of Manual Therapy for Chronic Tension-type Headache: A Pragmatic, Randomised, Clinical Trial

The Chiro.Org Blog

SOURCE:   Cephalalgia. 2011 (Jan); 31 (2): 133–143

Rene F Castien, Danielle AWM van der Windt,
Anneke Grooten and Joost Dekker

Healthcare Centre Haarlemmermeer,
The Netherlands.

OBJECTIVE:   To evaluate the effectiveness of manual therapy (MT) in participants with chronic tension-type headache (CTTH).

SUBJECTS AND METHODS:   We conducted a multicentre, pragmatic, randomised, clinical trial with partly blinded outcome assessment. Eighty-two participants with CTTH were randomly assigned to MT or to usual care by the general practitioner (GP). Primary outcome measures were frequency of headache and use of medication. Secondary outcome measures were severity of headache, disability and cervical function.

RESULTS:   After 8 weeks (n = 80) and 26 weeks (n = 75), a significantly larger reduction of headache frequency was found for the MT group (mean difference at 8 weeks, -6.4 days; 95% CI -8.3 to -4.5; effect size, 1.6). Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks.

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Essential Literature for the Chiropractic Profession

By |August 7, 2017|Chiropractic Research|

Essential Literature for the Chiropractic Profession: Results and Implementation Challenges from a Survey of International Chiropractic Faculty

The Chiro.Org Blog

SOURCE:   Journal of Chiropractic Education 2017 (Aug 2) [Epub]

Barbara A. Mansholt, DC, MS,
Stacie A. Salsbury, PhD, RN,
Lance G. Corber, MSITM,
and John S. Stites, DC

Palmer College of Chiropractic
1000 Brady Street,
Davenport, IA 52803

OBJECTIVE:   Scientific literature applicable to chiropractic practice proliferates in quantity, quality, and source. Chiropractic is a worldwide profession and varies in scope between states or provinces and from country to country. It is logical to consider that the focus and emphasis of chiropractic education varies between programs as well. This original research study endeavored to determine “essential literature” recommended by chiropractic faculty. The purpose of this article is (1) to share our results and (2) to promote discussion and explore means for future collaboration of chiropractic faculty through a worldwide platform.

METHODS:   A 2-phase recruitment occurred initially at the institutional level and subsequently at the faculty level. A Web-based survey used qualitative data collection methods to gather bibliographic citations. Descriptive statistics were calculated for demographics, and citation responses were ranked per number of recommendations, grouped into categories, and tabulated per journal source and publication date.

RESULTS:   Forty-one chiropractic programs were contacted, resulting in 30 participating chiropractic programs (16 US and 14 international). Forty-five faculty members completed the entire survey, submitting 126 peer-reviewed publications and 25 additional citations. Readings emphasized clinical management of spine pain, the science of spinal manipulation, effectiveness of manual therapies, teaching of chiropractic techniques, outcomes assessments, and professional issues.

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Make sure to review Table 2   which reports on the top 126 peer-reviewed submissions..

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