Chiropractic Care

Clinical Practice Guidelines for the Noninvasive Management of Low Back Pain

By Frank M. Painter|December 2, 2016|Chiropractic Care, Guidelines, Low Back Pain|

Clinical Practice Guidelines for the Noninvasive Management of Low Back Pain: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

Eur J Pain. 2016 (Oct 6) ~ FULL TEXT

J.J. Wong, P. Côté, D.A. Sutton, K. Randhawa, H. Yu, S. Varatharajan, R. Goldgrub, M. Nordin, D.P.

UOIT-CMCC Centre for the Study of
Disability Prevention and Rehabilitation,
University of Ontario Institute of Technology (UOIT)
Canadian Memorial Chiropractic College (CMCC),
Oshawa, ON, Canada.

BACKGROUND: &nbsp Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on healthcare systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost effectiveness is unclear.

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias.

According to high-quality guidelines:

(1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options;

(2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation;

(3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and

(4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Low Back Pain Guidelines Section

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Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain

By Frank M. Painter|November 12, 2016|Chiropractic Care, Chronic Low Back Pain, Cost-Effectiveness|

Cost Analysis Related to Dose-response of Spinal Manipulative Therapy for Chronic Low Back Pain: Outcomes from a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2014 (Jun); 37 (5): 300–311

Darcy A. Vavrek, ND, MS, Rajiv Sharma, PhD,
Mitchell Haas, DC, MA

University of Western States,
Portland, OR.

OBJECTIVE: The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).

METHODS: We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

and the:

Cost-Effectiveness of Chiropractic Page

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Integration of Chiropractic Services in Military and Veteran Health Care Facilities

By Frank M. Painter|December 20, 2015|Chiropractic Care|

Integration of Chiropractic Services in Military and Veteran Health Care Facilities: A Systematic Review of the Literature

The Chiro.Org Blog

SOURCE: J Evid Based Complementary Altern Med. 2015 (Dec 16)

Green BN, Johnson CD, Daniels CJ, Napuli JG, Gliedt JA, Paris DJ

Naval Medical Center San Diego,
San Diego, CA, USA
National University of Health Sciences,
Lombard, IL, USA

This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria. Studies reporting utilization and policy show that chiropractic services are successfully implemented in various military and veteran health care settings and that integration varies by facility.

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Wellness-related Use of Common Complementary Health Approaches Among Adults

By Frank M. Painter|November 16, 2015|Chiropractic Care, Complementary Medicine|

Wellness-related Use of Common Complementary Health Approaches Among Adults: United States, 2012

The Chiro.Org Blog

SOURCE: Natl Health Stat Report. 2015 (Nov 4); (85): 1–12 ~ FULL TEXT

Barbara J. Stussman, B.A., Lindsey I. Black, M.P.H.,
Patricia M. Barnes, M.A., and Tainya C. Clarke, Ph.D., M.P.H.,
and Richard L. Nahin, Ph.D., M.P.H.

National Institutes of Health
National Center for Health Statistics

Objective This 12 page National Institutes of Health report presents national estimates of selected wellness-related reasons for the use of natural product supplements, yoga, and spinal manipulation among U.S. adults in 2012. Self-reported perceived health outcomes were also examined.

Methods Data from 34,525 adults aged 18 and over collected as part of the 2012 National Health Interview Survey were analyzed for this report. In particular, whether adults who used selected complementary health approaches did so to treat a specific health condition or for any of five wellness-related reasons was examined, as well as whether these adults perceived that this use led to any of nine health-related outcomes. Sampling weights were used to produce national estimates that are representative of the civilian noninstitutionalized U.S. adult population.

Results Users of natural product supplements and yoga were more likely to have reported using the approach for a wellness reason than for treatment of a specific health condition, whereas more spinal manipulation users reported using it for treatment rather than for wellness. The most common wellness-related reason reported by users of each of the three approaches was for ‘‘general wellness or disease prevention.’’ The majority of users of all three health approaches reported that they perceived this use improved their overall health and made them feel better. Yoga users perceived higher rates of all of the self-reported wellness-related health outcomes than users of natural product supplements or spinal manipulation.

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Maintenance Care, Wellness and Chiropractic Page

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Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults

By Frank M. Painter|November 14, 2015|Chiropractic Care, Myofascial Disorder|

Immediate Effects of Spinal Manipulative Therapy on Regional Antinociceptive Effects in Myofascial Tissues in Healthy Young Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Jul); 36 (6): 333–341 ~ FULL TEXT

John Z. Srbely, DC PhD, Howard Vernon, DC, PhD,
David Lee, DC, Miranda Polgar, BSc

Department of Human Health and Nutritional Science,
University of Guelph, Guelph,
Ontario, Canada

OBJECTIVE: The purpose of this study was to investigate if spinal manipulative therapy (SMT) can evoke immediate regional antinociceptive effects in myofascial tissues by increasing pressure pain thresholds (PPTs) over myofascial trigger points in healthy young adults.

METHODS: A total of 36 participants (19 men, 17 women; age, 28.0 [5.3] years; body mass index, 26.5 [5.7] kg/m(2)) with clinically identifiable myofascial trigger points in the infraspinatus and gluteus medius muscles were recruited from the University of Guelph, Ontario, Canada. Participants were randomly allocated to 2 groups. Participants in the test group received chiropractic SMT targeted to the C5-C6 spinal segment. Participants in the control group received sham SMT. The PPT was recorded from the right infraspinatus and gluteus medius muscles at baseline (preintervention) and 1, 5, 10, and 15 minutes postintervention.

RESULTS: Three participants were disqualified, resulting in a total of 33 participants analyzed. Significant increases in the pressure pain thresholds (PPT) [decreased pain sensitivity] were observed in the test infraspinatus group when compared with test gluteus medius, control infraspinatus, and control gluteus medius groups (P < .05). No significant differences in PPT were observed at any time point when comparing test gluteus medius, control infraspinatus, and control gluteus medius groups (P > .05).

CONCLUSIONS: This study showed that SMT evokes short-term regional increases in PPT within myofascial tissues in healthy young adults.

Key Indexing Terms: Manipulation, Myofascial Pain Syndrome, Myofascial Trigger Point, Pain Threshold, Chiropractic

From the Full-Text Article:

Introduction

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Myofascial Trigger Point Page

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Acupuncture and Chiropractic Care Utilization

By Frank M. Painter|November 9, 2015|Acupuncture, Chiropractic Care|

Acupuncture and Chiropractic Care: Utilization and Electronic Medical Record Capture

The Chiro.Org Blog

SOURCE: Am J Manag Care. 2015 (Jul 1); 21 (7): e414-21 ~ FULL TEXT

Charles Elder, MD, MPH; Lynn DeBar, PhD, MPH;
Cheryl Ritenbaugh, PhD, MPH; et. al

Kaiser Permanente Northwest,
Center for Health Research,
3800 N Interstate Ave,
Portland, OR 97227
Charles.Elder@kpchr.org

This recent study, published in the American Journal of Managed Care, underscores why so many chiropractic patients have to go “out of network” in order to get the care they need: Managed care appears to be be effectively locking them out. This study reviews chiropractic and acupuncture utilization by adults with chronic musculoskeletal pain at Kaiser Permanente Northwest, an HMO.

Evidently, physician referral for acupuncture is strictly limited to chronic pain complaints, while referral for chiropractic benefits is limited to acute pain. This is why 43-54% of those individuals who sought chiropractic care had to seek “out-of-plan” (aka out-of-pocket) care.

Physician referrals within this Kaiser program was tipped in favor of acupuncture, with 55% of them being referred for care, versus only 9% of the chiropractic patients.

Thanks to Dynamic Chiropractic for their brief review of this study!

OBJECTIVES: To describe acupuncture and chiropractic use among patients with chronic musculoskeletal pain (CMP) at a health maintenance organization, and explore issues of benefit design and electronic medical record (EMR) capture.

STUDY DESIGN: Cross-sectional survey.

METHODS: Kaiser Permanente members meeting EMR diagnostic criteria for CMP were invited to participate. The survey included questions about self-identified presence of chronic musculoskeletal pain, use of acupuncture and chiropractic care, use of ancillary self-care modalities, and communication with conventional medicine practitioners. Analysis of survey data was supplemented with a retrospective review of EMR utilization data.

RESULTS: Of 6068 survey respondents, 32% reported acupuncture use, 47% reported chiropractic use, 21% used both, and 42% used neither. For 25% of patients using acupuncture and 43% of those using chiropractic care, utilization was undetected by the EMR. Thirty-five percent of acupuncture users and 42% of chiropractic users did not discuss this care with their health maintenance organization (HMO) clinicians. Among chiropractic users, those accessing care out of plan were older (P < .01), were more likely to use long-term opioids (P = .03), and had more pain diagnoses (P = .01) than those accessing care via clinician referral or self-referral. For acupuncture, those using the clinician referral mechanism exhibited these same characteristics.

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