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Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test

By Frank M. Painter|September 8, 2016|Headache|

Intertester Reliability and Diagnostic Validity of the Cervical Flexion-Rotation Test

SOURCE: J Manipulative Physiol Ther 2008; 31 (4): 293–300

Toby M. Hall, PT, MS, Kim W. Robinson, PT, BSc,
Osamu Fujinawa, PT, PhD, Kiyokazu Akasaka, PT, PhD,
Elizabeth A. Pyne, PT, MT

School of Physiotherapy,
Curtin University of Technology,
Australia.
halltm@netspace.net.au

OBJECTIVE: This article evaluates reliability and diagnostic validity of the cervical flexion-rotation test (FRT) to discriminate subjects with headache because of C1/2 dysfunction. In addition, this study evaluates agreement between experienced and inexperienced examiners.

METHODS: These were 2 single blind comparative measurement study designs. In study 1, 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls, 20 subjects with cervicogenic headache (CeH) where C1/2 was the primary dysfunctional level, and 10 subjects with CeH but without C1/2 as the primary dysfunctional level. In study 2, 2 inexperienced and 1 experienced blinded examiners evaluated the FRT in 12 subjects with CeH and 12 asymptomatic controls. Examiners were required to state whether the FRT was positive and also to determine range of rotation using a goniometer. An analysis of variance with planned orthogonal comparison, single measure intraclass correlation coefficient (2,1), and Bland-Altman plot were used to analyze FRT range of rotation between the examiners. Sensitivity, specificity, and examiner agreement for test interpretation were analyzed using cross tabulation and kappa.

RESULTS: In study 1, sensitivity and specificity of the FRT was 90% and 88% with 92% agreement for experienced examiners (P < .001). Overall diagnostic accuracy was 89% (P < .001) and kappa = 0.85. In study 2, for inexperienced examiners, FRT mobility was significantly greater than for experienced examiners, but sensitivity, specificity, agreement, and kappa values were all within clinically acceptable levels.

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Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students

By Frank M. Painter|September 6, 2016|Expanded Practice, Prescription Rights|

Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2015 (Feb 2); 23 (1): 4

Jordan A Gliedt, Cheryl Hawk, Michelle Anderson,
Kashif Ahmad, Dinah Bunn, Jerrilyn Cambron,
Brian Gleberzon, John Hart, Anupama Kizhakkeveettil,
Stephen M Perle, Michael Ramcharan,
Stephanie Sullivan, and Liang Zhang

Logan University College of Chiropractic,
1851 Schoettler Rd,
Chesterfield, MO 63017 USA.

BACKGROUND: The literature pertaining to chiropractic students’ opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America.

OBJECTIVE: The purpose of this study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.

METHODS: A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed.

RESULTS: A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.

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Prescription Rights and
Expanded Practice Debate Page

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Results of a National Survey and Examination of Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis

By Frank M. Painter|September 4, 2016|Complementary and Alternative Medicine|

Results of a National Survey and Examination of Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2016 (Aug 14) [Epub]

Patricia M. Herman, ND, PhD, Ian D. Coulter, PhD

RAND Health,
Santa Monica, CA.
pherman@rand.org

OBJECTIVES: The purpose of this project was to examine the policy implications of politically defining complementary and alternative medicine (CAM) professions by their treatment modalities rather than by their full professional scope.

METHODS: This study used a 2-stage exploratory grounded approach. In stage 1, we identified how CAM is represented (if considered as professions vs modalities) across a purposely sampled diverse set of policy topic domains using exemplars to describe and summarize each. In stage 2 we convened 2 stakeholder panels (12 CAM practitioners and 9 health policymaker representatives), and using the results of stage 1 as a starting point and framing mechanism, we engaged panelists in a discussion of how they each see the dichotomy and its impacts. Our discussion focused on 4 licensed CAM professions: acupuncture and Oriental medicine, chiropractic, naturopathic medicine, and massage.

RESULTS: Workforce policies affected where and how members of CAM professions could practice. Licensure affected whether a CAM profession was recognized in a state and which modalities were allowed. Complementary and alternative medicine research examined the effectiveness of procedures and modalities and only rarely the effectiveness of care from a particular profession. Treatment guidelines are based on research and also focus on procedures and modalities. Health plan reimbursement policies address which professions are covered and for which procedures/modalities and conditions.

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Alternative Medicine Articles Section

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Comparing 2 Whiplash Grading Systems To Predict Clinical Outcomes

By Frank M. Painter|September 2, 2016|Whiplash|

Comparing 2 Whiplash Grading Systems To Predict Clinical Outcomes

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2016 (Jun); 15 (2): 81–86

Arthur C. Croft, PhD, DC, MSc, MPH, Alireza Bagherian, DC, Patrick K. Mickelsen, DC, Stephen Wagner, DC

Spine Research Institute of San Diego,
San Diego, CA.

OBJECTIVE: Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum.

METHODS: This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics.

RESULTS: Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure.

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Whiplash Page

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PRESCRIPTION RIGHTS: The Timex Topic: It Takes A Licking But Keeps On Ticking

By Frank M. Painter|August 29, 2016|Expanded Practice, Prescription Rights|

PRESCRIPTION RIGHTS: The Timex Topic: It Takes A Licking But Keeps On Ticking

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2016 (Aug 24)

Peter C. Emary, Taco A. W. Houweling, Martin Wangler, Stephen J. Burnie, Katherine J. Hood and W. Mark Erwin

201C Preston Parkway,
Cambridge, ON
N3H 5E8 Canada.

The last I heard, all the significant National and International Associations, who comprise the “Chiropractic Summit” had all agreed (back in 2013) that chiropractic should maintain Drug-Free. However, I am also a member of a FaceBook group (Evidence-Informed Chiropractic Medicine) and the topic keeps popping up.

Our Blog has posted on medical resistance to chiropractic’s use of manipulation under anesthesia (MUA), and that one STILL has me scratching my head. After all, the DC isn’t knocking anyone out, a medical anesthesiologist does that, so this inter-professional service benefits both our professions, as well (in theory) the Patient.

We have also posted on the “expanded practice” movement in general, and we don’t need to revisit that here.

So, I have collected all our Blog postings on the prescription rights and “expanded practice” movements into one nice neat package in the new Prescription Rights and Expanded Practice Debate page.

The upper Background Materials section contains all our Blog postings, and the lower Recent Additions section contains this and earlier thoughtful articles on the expanded-practice and prescription rights movement,

The last section is titled Drug Evidence and it includes articles discussing the evidence base for various drugs for spinal pain.

I have no interest in rehashing all those conversations. I hope that if this is a hot topic for you, that you will read all these materials, and then let them percolate. It’s called informed decision. You have to get informed before you set your Profession on a different course. I hope you will take the time to absorb these materials.

A Commentary on the Implications of Medication Prescription Rights for the Chiropractic Profession
Chiropractic & Manual Therapies 2016 (Aug 24)

There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders.

However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.

KEYWORDS: Attitudes; Behaviour; Chiropractic; Drug prescriptions; Evidence-based practice; Knowledge

From the FULL TEXT Article:

Background

Despite a growing number of surveys demonstrating a positive attitude among chiropractors and patients towards the limited use of medication within chiropractic practice, chiropractors remain unable to prescribe medication in most parts of the world [1–8] (2007 and 2011 Ontario Chiropractic Association member surveys: B. Haig; personal communication, 3 November 2014). In many countries, chiropractors also lack direct access to musculoskeletal (MSK) diagnostic imaging and laboratory testing – limitations that have real implications for the clinician in accurately diagnosing and managing their patient. Meanwhile, allied health care professions such as optometry, chiropody, and naturopathy have been steadily expanding their respective scopes’ of practice and gaining limited medication prescription rights relevant to their areas of training and expertise. [9–11] Most notable for chiropractors is that physiotherapists are also interested in and have been granted prescriptive authority in some countries. [12, 13] Moreover, there are increasing examples of physiotherapists with advanced training in medication prescription and diagnostic testing who now manage patients with MSK disorders at the primary care level. [14–16]

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Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

By Frank M. Painter|August 27, 2016|Headache, Pediatrics|

Is There a Difference in Head Posture and Cervical Spine Movement in Children With and Without Pediatric Headache?

The Chiro.Org Blog

SOURCE: Eur J Pediatr. 2013 (Oct); 172 (10): 1349–1356

Kim Budelmann, Harry von Piekartz, Toby Hall

University of Applied Science,
Osnabrück, Germany

Pediatric headache is an increasingly reported phenomenon. Cervicogenic headache (CGH) is a subgroup of headache, but there is limited information about cervical spine physical examination signs in children with CGH. Therefore, a cross-sectional study was designed to investigate cervical spine physical examination signs including active range of motion (ROM), posture determined by the craniovertebral angle (CVA), and upper cervical ROM determined by the flexion-rotation test (FRT) in children aged between 6 and 12 years. An additional purpose was to determine the degree of pain provoked by the FRT.

Thirty children (mean age 120.70 months [SD 15.14]) with features of CGH and 34 (mean age 125.38 months [13.14]) age-matched asymptomatic controls participated in the study. When compared to asymptomatic controls, symptomatic children had a significantly smaller CVA (p < 0.001), significantly less active ROM in all cardinal planes (p < 0.001), and significantly less ROM during the FRT (p < 0.001), especially towards the dominant headache side (p < 0.001).

In addition, symptomatic subjects reported more pain during the FRT (p < 0.001) and there was a significant negative correlation (r = -0.758, p < 0.001) between the range recorded during the FRT towards the dominant headache side and FRT pain intensity score. This study found evidence of impaired function of the upper cervical spine in children with CGH and provides evidence of the clinical utility of the FRT when examining children with CGH.

From the FULL TEXT Article:

Introduction

There are more articles like this @ our:

Chiropractic Pediatrics Section

and our:

Headache and Chiropractic Page

and our:

Forward Head Posture Page

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