Chiropractic Care

Adherence to Clinical Practice Guidelines Among Three Primary Contact Professions

By Frank M. Painter|September 5, 2014|Chiropractic Care, Clinical Decision-making, Evidence-based Medicine, Guidelines|

Adherence to Clinical Practice Guidelines Among Three Primary Contact Professions: A Best Evidence Synthesis of the Literature for the Management of Acute and Subacute Low Back Pain

SOURCE: J Can Chiropr Assoc 2014 (Sept); 58(3): 220–237

Lyndon G. Amorin-Woods, B.App.Sci (Chiropractic)
Randy W. Beck, BSc (Hons), DC, PhD, DACNB, FAAFN, FACFN, Gregory F. Parkin-Smith, MTech(Chiro), MBBS, MSc, DrHC, James Lougheed, BA (Hons), Alexandra P. Bremner, BSc (Hons), DipEd, GradDipAppStats, PhD

Senior Clinical Supervisor, School of Health Professions
Murdoch University
Enrolled student, Master of Public Health
School of Population Health Faculty of Medicine, Dentistry and Health Sciences
The University of Western Australia

Aim: To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature.

Methods: A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors.

Results: The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%).

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Practice Guidelines Page and the:

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Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient’s Journey

By Frank M. Painter|July 31, 2014|Chiropractic Care, Cost-Effectiveness|

Tracking Low Back Problems in a Major Self-Insured Workforce:

Toward Improvement in the Patient’s Journey

The Chiro.Org Blog

SOURCE: J Occup Environ Med. 2014 (Jun); 56 (6): 604-620

Allen, Harris PhD; Wright, Marcia PharmD; Craig, Terri PharmD; Mardekian, Jack PhD; Cheung, Raymond PhD; Sanchez, Robert PhD; Bunn, William B. III MD, JD, MPH; Rogers, William PhD

From the Harris Allen Group, LLC (Dr Allen), Brookline, Mass; US Medical Affairs (Dr Wright), Pfizer Integrated Health, Overland Park, Kans; Pfizer Primary Care Medical Affairs (Dr Craig), Lincoln, Nebr; Pfizer Inc (Dr Mardekian), New York; Pfizer Integrated Health (Drs Cheung and Sanchez), New York; Health, Safety, Security & Productivity, Navistar, Inc (Dr Bunn)

This comprehensive new study from the Journal of Occupational and Environmental Medicine reveals that chiropractic care costs significantly less than other forms of low back care, and appears to comply with guideline recommendations more closely than than any of the other 4 comparison groups.The authors came to these conclusions after an exhaustive analysis of an integrated database belonging to a giant, self-insured Fortune 500 manufacturer covering nine years of claims They evaluated the direct and indirect costs of LBP for all employees, looking in-depth at personnel characteristics, and medical, behavioral health, pharmaceutical, Workers Comp costs, disability, absenteeism, and lost productivity during the 2001 to 2009 period.

Thanks to Dynamic Chiropractic for some of the following comments.

Make sure to read their full article!

The study had four objectives:

Identify all active employees reporting a back problem diagnosis during the study period.
Define and classify their initial patterns of medical care and use of Rx medication.
Track the effect of these patterns on direct and indirect cost outcomes.
Further stratify these treatment patterns by measures of congruence with the previously described guideline aspects for LBP care and determine the effect on cost outcomes.

Through their database review, the authors identified five specific care patterns that were typical of employee experiences

Information and Advice (“TalkInfo”):
information gathering, office visit consults, lab tests, imaging (X-ray, ultrasound, CT, or MRI)
but no other procedures.
(59 percent of employees).
Complex Medical Management (Complex MM):
physician visits for nerve blocks, surgeries, or comparable procedures
(2 percent of employees).
Chiropractic (Chiro):
more than one visit to a DC.
(11 percent of employees)
Physical therapy (PT):
more than one visit to a PT.
(11 percent of employees)
“Dabble”:
episodes with at most one visit for physician, chiropractic, or PT care,
or at most one visit to two or more of these categories.
(17 percent of employees)

The average overall costs for care were a real eye opener

Low Back/Neuro (three-year total)

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Costs of Routine Care for Infant Colic in the UK

By Frank M. Painter|July 21, 2014|Chiropractic Care, Colic, Cost-Effectiveness|

Costs of Routine Care for Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT for this Condition

The Chiro.Org Blog

J Clinical Chiropractic Peds 2013 (Jun); 14 (1): 1063–1069

Joyce Miller, DC, FAC O, FCC, FEAC (Paeds)

Anglo-European College of Chiropractic,
Lead Tutor in Advanced Professional Practice (Paediatrics),
Bournemouth University,
United Kingdom

Background: There is a small body of published research (six research studies and a Cochrane review) suggesting that manual therapy is effective in the treatment of infant colic. Research from the UK has shown that the costs of NHS treatment are high (£65million [USD100 million] in 2001) with no alleviation of the condition.

Objectives: The objectives of this study were to: investigate the cost of the inconsolable nocturnal crying infant syndrome which is popularly known as infant colic in the first 20 weeks of life, estimate the costs of different types of treatment commonly chosen by parents for a colicky infant for a week of care or an episode of care, investigate the cost of chiropractic manual therapy intervention aimed at reducing the hours of infant crying alongside a randomised controlled trial (RCT) showing effectiveness of treatment

Design: Economic evaluation incorporating a RCT

Methods: A cost analysis was conducted using data from a RCT conducted in a three-armed single-blinded trial that randomized excessively crying infants into one of three groups: a) routine chiropractic manual therapy (CMT), b) CMT with parent blinded or c) no treatment control group with parent blinded. These costs were compared with costs of caring for infant colic from Unit Costs of Health and Social Care, UK, 2011. It has been widely estimated that 21% of infants in the UK present annually to primary care for excessive crying and this calculated to 167,000 infants (to the nearest 1,000) used in the cost analysis as there were 795,249 infants in the UK in mid-2010 according to the UK Office of National Statistics, 2011.

Results: 100 infants completed the RCT and this resulted in treatment costs of £58/child ($93). An additional cost of GP care of £27.50 was added for initial evaluation of the general health of the child and suitability for chiropractic management, totaling £85.50 per child in the RCT. Clinical outcomes are published elsewhere, but care showed both statistically and clinically significant efficacy in reduced crying time by an average of 2.6 hours resulting in a crying time of less than two hours a day (reaching “normal” levels which could be classified as non-colic behavior). Cost per child’s care was £85.50 extrapolated to £14,278,500 for the full cohort of 167,000. If chiropractic care had been given privately, costs were calculated as £164/child per episode of care and this equalled £27,388,000 for the entire cohort. Medical costs through a normal stream of care amounted to £1089.91 per child or £182,014,970 for the cohort (including all costs of care, not just NHS). No benefits of effectiveness were accrued from any of those types of treatment. If the Morris NHS data were extrapolated to 2010, applying wage inflation, the cost would be £118 million (USD180 million) yearly. An episode of an average of four treatments of chiropractic manual therapy with documented efficacy of CMT cost from 8% to 24% of NHS care or routine care.

Conclusion: chiropractic manual therapy was a cost-effective option in this study. A much larger randomized study of routine medical care versus routine chiropractic care is recommended to determine whether there is confirmation of these findings.

From the Full-Text Article:

Introduction

As effective treatment for children with infant colic remains elusive, the costs of managing the condition is gaining increasing attention. Although it is uncommon for clinicians to be quizzed about the cost-effectiveness of their treatments, [1] particularly where the clinicians’ services are covered by a national health plan, it is increasingly appropriate to ask this question, when prudence in health care expenditure is required.

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Chiropractic Pediatrics Page and the:

Infantile Colic and Chiropractic Page

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Chiropractic and Breastfeeding Dysfunction: A Literature Review

By Frank M. Painter|July 20, 2014|Breastfeeding Dysfunction, Chiropractic Care|

Chiropractic and Breastfeeding Dysfunction: A Literature Review

The Chiro.Org Blog

SOURCE: J Clin Chiro Pediatrics 2014 (Mar); 14 (2) ~ FULL TEXT

Lauren M. Fry, BAppSc (CompMed-Chiro), MClinChiro

private practice,
Elwood, Victoria, Australia
laurenfry85@gmail.com

Objective: Breastfeeding an infant has many long and short-term health benefits. Chiropractic care, as part of a multidisciplinary team, has the potential to assist with biomechanical causes of breastfeeding dysfunction. The purpose of this study was to review the literature and explore what evidence there is to support this theory.

Methods: Database searches were performed (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health and Index to Chiropractic Literature) and hand searches to identify relevant studies. Inclusion criteria were: written in the English language in a peer-reviewed journal, involving infant human participants and a focus on chiropractic treatment for breastfeeding (dysfunction).

Results: Ten articles were reviewed; 5 case studies, 3 case series, 1 clinical trial and 1 narrative.

Conclusions: Limited evidence exists to support chiropractic treatment for infants with breastfeeding dysfunction. Of the 6 case studies, 3 case series and 1 clinical trial found in this report there was a trend towards resolution of breastfeeding issues with chiropractic treatment of biomechanical imbalances. More meticulous, higher evidence studies are needed to provide further evidence of this.

Key Words: breastfeeding, chiropractic, infant, spinal manipulation.

From the Full-Text Article:

Introduction

Breastfeeding, particularly exclusively for the first 6 months, has been associated with numerous beneficial short and long term health outcomes for an infant. [1, 2] Breast milk has been shown to contain secretory IgA antibodies, lactoferrin, oligosaccharides, numerous cytokines and growth factors which all aid in an infant’s immune response. [3, 4] Purported short term benefits to the infant are a decreased risk of many childhood illnesses. [5] Incidence of gastro-intestinal infections, otitis media, other respiratory tract infections and asthma, even in those with a strong family history, may be decreased in infants who are breastfed. [6, 7]

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Chiropractic Pediatrics Page

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Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

By Frank M. Painter|July 13, 2014|Chiropractic Care, Spinal Manipulation|

Review Of Methods Used By Chiropractors To Determine The Site For Applying Manipulation

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2013 (Oct 21); 21 (1): 36

John J Triano, Brian Budgell, Angela Bagnulo,
Benjamin Roffey, Thomas Bergmann, Robert Cooperstein,
Brian Gleberzon, Christopher Good, Jacquelyn Perron
and Rodger Tepe

Canadian Memorial Chiropractic College,
6100 Leslie St,
Toronto, Ontario, Canada.
jtriano@cmcc.ca

BACKGROUND: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

METHODS: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation.

RESULTS: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement.

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What is The Chiropractic Subluxation? Page

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The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

By Frank M. Painter|July 7, 2014|Acute Facet Syndrome, Chiropractic Care|

The Clinical Aspects Of The Acute Facet Syndrome: Results From A Structured Discussion Among European Chiropractors

The Chiro.Org Blog

SOURCE: Chiropractic & Osteopathy 2009 (Feb 5); 17: 2

Lise Hestbaek, Alice Kongsted, Tue Secher Jensen,
and Charlotte Leboeuf-Yde

Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense M, Denmark.
l.hestbaek@nikkb.dk

Background The term ‘acute facet syndrome’ is widely used and accepted amongst chiropractors, but poorly described in the literature, as most of the present literature relates to chronic facet joint pain. Therefore, research into the degree of consensus on the subject amongst a large group of chiropractic practitioners was seen to be a useful contribution.

Methods During the annual congress of The European Chiropractors Union (ECU) in 2008, the authors conducted a workshop involving volunteer chiropractors. Topics were decided upon in advance, and the participants were asked to form into groups of four or five. The groups were asked to reach consensus on several topics relating to a basic case of a forty-year old man, where an assumption was made that his pain originated from the facet joints. First, the participants were asked to agree on a maximum of three keywords on each of four topics relating to the presentation of pain: 1. location, 2. severity, 3. aggravating factors, and 4. relieving factors. Second, the groups were asked to agree on three orthopaedic and three chiropractic tests that would aid in diagnosing pain from the facet joints. Finally, they were asked to agree on the number, frequency and duration of chiropractic treatment.

Results Thirty-four chiropractors from nine European countries participated. They described the characteristics of an acute, uncomplicated facet syndrome as follows: local, ipsilateral pain, occasionally extending into the thigh with pain and decreased range of motion in extension and rotation both standing and sitting. They thought that the pain could be relieved by walking, lying with knees bent, using ice packs and taking non-steroidal anti-inflammatory drugs, and aggravated by prolonged standing or resting. They also stated that there would be no signs of neurologic involvement or antalgic posture and no aggravation of pain from sitting, flexion or coughing/sneezing.

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