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Dose-response of Spinal Manipulation for Cervicogenic Headache: Study Protocol for a Randomized Controlled Trial

By Frank M. Painter|January 25, 2017|Cervicogenic Headache|

Dose-response of Spinal Manipulation for Cervicogenic Headache: Study Protocol for a Randomized Controlled Trial

Chiropractic & Manual Therapies 2016 (Jun 8); 24: 23 ~ FULL TEXT

Linda Hanson, Mitchell Haas, Gert Bronfort, Darcy Vavrek, Craig Schulz, Brent Leininger, Roni Evans, Leslie Takaki and Moni Neradilek

Center for Outcome Studies,
The University of Western States,
2900 NE 132nd Ave,
Portland, OR 97230 USA.

BACKGROUND: Cervicogenic headache is a prevalent and costly pain condition commonly treated by chiropractors. There is evidence to support the effectiveness for spinal manipulation, but the dose of treatment required to achieve maximal relief remains unknown. The purpose of this paper is to describe the methodology for a randomized controlled trial evaluating the dose-response of spinal manipulation for chronic cervicogenic headache in an adult population.

METHODS/DESIGN: This is a mixed-methods, two-site, prospective, parallel groups, observer-blind, randomized controlled trial conducted at university-affiliated research clinics in the Portland, OR and Minneapolis, MN areas. The primary outcome is patient reported headache frequency. Other outcomes include self-reported headache intensity, disability, quality of life, improvement, neck pain intensity and frequency, satisfaction, medication use, outside care, cervical motion, pain pressure thresholds, health care utilization, health care costs, and lost productivity. Qualitative interviews are also conducted to evaluate patients’ expectations of treatment.

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Headache and Chiropractic Page

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GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

By Frank M. Painter|January 23, 2017|Guidelines|

GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations

The Chiro.Org Blog

Brit Med J 2008 (Apr 26); 336 (7650): 924–926 ~ FULL TEXT

Gordon H Guyatt, Andrew D Oxman, Gunn E Vist, Regina Kunz, Yngve Falck-Ytter

CLARITY Research Group,
Department of Clinical Epidemiology and Biostatistics,
Room 2C12, 1200 Main Street,
West Hamilton, ON, Canada L8N 3Z5

Guidelines are inconsistent in how they rate the quality of evidence and the strength of recommendations. This article explores the advantages of the GRADE system, which is increasingly being adopted by organisations worldwide.

From the FULL TEXT Article

Summary points

Failure to consider the quality of evidence can lead to misguided recommendations; hormone replacement therapy for post-menopausal women provides an instructive example
High quality evidence that an intervention’s desirable effects are clearly greater than its undesirable effects, or are clearly not, warrants a strong recommendation
Uncertainty about the trade-offs (because of low quality evidence or because the desirable and undesirable effects are closely balanced) warrants a weak recommendation
Guidelines should inform clinicians what the quality of the underlying evidence is and whether recommendations are strong or weak
The Grading of Recommendations Assessment, Development and Evaluation (GRADE ) approach provides a system for rating quality of evidence and strength of recommendations that is explicit, comprehensive, transparent, and pragmatic and is increasingly being adopted by organisations worldwide

Introduction:

Guideline developers around the world are inconsistent in how they rate quality of evidence and grade strength of recommendations. As a result, guideline users face challenges in understanding the messages that grading systems try to communicate. Since 2006 the BMJ has requested in its “Instructions to Authors” on bmj.com that authors should preferably use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for grading evidence when submitting a clinical guidelines article. What was behind this decision?

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Interdisciplinary Practice Models for Older Adults With Back Pain

By Frank M. Painter|January 15, 2017|Interdisciplinary Practice, Interprofessional Collaboration|

Interdisciplinary Practice Models for Older Adults With Back Pain: A Qualitative Evaluation

The Chiro.Org Blog

SOURCE: Gerontologist. 2017 (Jan 11) [Epub]

Stacie A. Salsbury, PhD, RN, Christine M. Goertz, DC, PhD,
Robert D. Vining, DC, Maria A. Hondras, DC, MPH, PhD,
Andrew A. Andresen, MD, Cynthia R. Long, PhD,
Kevin J. Lyons, PhD, Lisa Z. Killinger, DC and
Robert B. Wallace, MD, MS

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

PURPOSE: Older adults seek health care for low back pain from multiple providers who may not coordinate their treatments. This study evaluated the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family medicine physicians and doctors of chiropractic.

DESIGN AND METHODS: This qualitative evaluation was a component of a randomized controlled trial of 3 interdisciplinary models for back pain management: usual medical care; concurrent medical and chiropractic care; and collaborative medical and chiropractic care with interprofessional education, clinical record exchange, and team-based case management. Data collection included clinician interviews, chart abstractions, and fieldnotes analyzed with qualitative content analysis. An organizational-level framework for dissemination of health care interventions identified norms/attitudes, organizational structures and processes, resources, networks-linkages, and change agents that supported model implementation.

RESULTS: Clinicians interviewed included 13 family medicine residents and 6 chiropractors. Clinicians were receptive to interprofessional education, noting the experience introduced them to new colleagues and the treatment approaches of the cooperating profession. Clinicians exchanged high volumes of clinical records, but found the logistics cumbersome. Team-based case management enhanced information flow, social support, and interaction between individual patients and the collaborating providers. Older patients were viewed positively as change agents for interprofessional collaboration between these provider groups.

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Low Back Pain and Chiropractic Page

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Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex

By Frank M. Painter|January 11, 2017|Chiropractic Care, Neurology|

Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study

The Chiro.Org Blog

SOURCE: Neural Plast. 2016 (Mar 7); 2016: 3704964 ~ FULL TEXT

Dina Lelic, Imran Khan Niazi, Kelly Holt, Mads Jochumsen, Kim Dremstrup, Paul Yielder, Bernadette Murphy, Asbjørn Mohr Drewes, and Heidi Haavik

Mech-Sense,
Department of Gastroenterology and Hepatology,
Aalborg University Hospital,
9000 Aalborg, Denmark

Objectives. Studies have shown decreases in N30 somatosensory evoked potential (SEP) peak amplitudes following spinal manipulation (SM) of dysfunctional segments in subclinical pain (SCP) populations. This study sought to verify these findings and to investigate underlying brain sources that may be responsible for such changes.

Methods. Nineteen subclinical pain volunteers attended two experimental sessions, SM and control in random order. SEPs from 62-channel EEG cap were recorded following median nerve stimulation (1000 stimuli at 2.3 Hz) before and after either intervention. Peak-to-peak amplitude and latency analysis was completed for different SEPs peak. Dipolar models of underlying brain sources were built by using the brain electrical source analysis. Two-way repeated measures ANOVA was used to assessed differences in N30 amplitudes, dipole locations, and dipole strengths.

Results. SM decreased the N30 amplitude by 16.9 ± 31.3% (P = 0.02), while no differences were seen following the control intervention (P = 0.4). Brain source modeling revealed a 4-source model but only the prefrontal source showed reduced activity by 20.2 ± 12.2% (P = 0.03) following SM.

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Metabolic Syndrome Components Are Associated with Intervertebral Disc Degeneration

By Frank M. Painter|January 8, 2017|Somato-visceral, Spinal Manipulation|

Metabolic Syndrome Components Are Associated with Intervertebral Disc Degeneration: The Wakayama Spine Study

The Chiro.Org Blog

SOURCE: PLoS One. 2016 (Feb 3); 11 (2): e0147565 ~ FULL TEXT

Masatoshi Teraguchi, Noriko Yoshimura,
Hiroshi Hashizume, Shigeyuki Muraki, et al

Department of Orthopaedic surgery,
Wakayama Medical University,
811-1 Kimiidera,
Wakayama, 641-8509, Japan.

OBJECTIVE: The objective of the present study was to examine the associations between metabolic syndrome (MS) components, such as overweight (OW), hypertension (HT), dyslipidemia (DL), and impaired glucose tolerance (IGT), and intervertebral disc degeneration (DD).

DESIGN: The present study included 928 participants (308 men, 620 women) of the 1,011 participants in the Wakayama Spine Study. DD on magnetic resonance imaging was classified according to the Pfirrmann system. OW, HT, DL, and IGT were assessed using the criteria of the Examination Committee of Criteria for MS in Japan.

RESULTS: Multivariable logistic regression analysis revealed that OW was significantly associated with cervical, thoracic, and lumbar DD (cervical: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; thoracic: OR, 1.75; 95% CI, 1.24-2.51; lumbar: OR, 1.87; 95% CI, 1.06-3.48). HT and IGT were significantly associated with thoracic DD (HT: OR, 1.54; 95% CI, 1.09-2.18; IGT: OR, 1.65; 95% CI, 1.12-2.48). Furthermore, subjects with 1 or more MS components had a higher OR for thoracic DD compared with those without MS components (vs. no component; 1 component: OR, 1.58; 95% CI, 1.03-2.42; 2 components: OR, 2.60; 95% CI, 1.62-4.20; ≥3 components: OR, 2.62; 95% CI, 1.42-5.00).

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Non-musculoskeletal Disorders and Chiropractic

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Discussion Paper: Evidence-Based Practice and Chiropractic

By Frank M. Painter|January 7, 2017|Evidence-based Practice|

Discussion Paper: Evidence-Based Practice and Chiropractic

The Chiro.Org Blog

Chiropractic Journal of Australia 2016; 44: 308–319 ~ FULL TEXT

Phillip Ebrall

Southern Cross University, Australia;
International Medical University, Malaysia;
Tokyo College of Chiropractic, Japan.

Objective: To present an objective interpretation of the literature reporting evidence based medicine or practice and to raise discussion points based on those findings which, if explored, may advance the chiropractic profession in both its academic and clinical activities.

Data Sources and Synthesis: The indexed literature and URLs identified by on-line searching. A contextual narrative identifies specific points that may be worthy of formal discussion, either by individual authors preparing papers for publication, or by symposia.

Conclusion: Evidence based medicine is thought by some to have had its day. The concept of best practice seems embedded within chiropractic education. Whether they appreciate it or not, most chiropractors practice a rich form of evidence based practice into which they inject their experience as a chiropractor and the characteristics including preferences of the patient.

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