Chiropractic Care

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

By Frank M. Painter|June 6, 2014|Chiropractic Care, Low Back Pain, Randomized Controlled Trial|

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

SOURCE: J Altern Complement Med. 2014 (May); 20 (5): A22–23

Michael Schneider, Mitchell Haas, Joel Stevans, Ronald Glick, Doug Landsittel

Michael Schneider, mjs5@pitt.edu
University of Pittsburgh, Pittsburgh, PA, USA

Purpose: The primary aim of this study was to compare manual and mechanical methods of spinal manipulation (Activator) for patients with acute and sub-acute low back pain. These are the two most common methods of spinal manipulation used by chiropractors, but there is insufficient evidence regarding their comparative effectiveness against each other. Our secondary aim was to compare both methods with usual medical care.

Methods: In a randomized comparative effectiveness trial, we randomized 107 participants with acute and sub-acute low back pain to: 1) usual medical care; 2) manual side-posture manipulation; and 3) mechanical manipulation (Activator). The primary outcome was self-reported disability (Oswestry) at four weeks. Pain was rated on a 0 to 10 numerical rating scale. Pain and disability scores were regressed on grouping variables adjusted for baseline covariates.

Results: Manual manipulation demonstrated a clinically important and statistically significant reduction of disability and pain compared to Activator (adjusted mean difference=7.9 and 1.3 points respectively, P<.05) and compared to usual medical care (7.0 and 1.8 points respectively, P<.05). There were no significant adjusted mean differences between Activator and usual medical care in disability and pain (0.9 and 0.5 points respectively, P>.05).

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Spinal Manipulation and Exercise for Low Back Painin Adolescents: Study Protocol for a Randomized Controlled Trial

By Frank M. Painter|June 1, 2014|Chiropractic Care, Low Back Pain, Pediatrics|

Spinal Manipulation and Exercise for Low Back Pain in Adolescents: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2014 (May 23); 22: 21 ~ FULL TEXT

Craig Schulz, Brent Leininger, Roni Evans, Darcy Vavrek, Dave Peterson, Mitchell Haas

and Gert Bronfort

Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences
University, 2501 W 84th St, Bloomington, MN 55431, USA

Background Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.

Methods This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment.

Discussion This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

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Chiropractic Care for Pediatric and Adolescent Attention-Deficit/Hyperactivity Disorder: A Systematic Review

By Frank M. Painter|May 30, 2014|Attention Deficit, Chiropractic Care|

Chiropractic Care for Pediatric and Adolescent Attention-Deficit/Hyperactivity Disorder: A Systematic Review

The Chiro.Org Blog

SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); 18: 13 ~ FULL TEXT

Fay Karpouzis, Rod Bonello, and Henry Pollard

Department of Chiropractic,
Faculty of Science,
Macquarie University, Sydney, NSW 2109, Australia.
faykchiro@optusnet.com.au

Background Psychostimulants are first line of therapy for pediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors.

Objective The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for pediatric and adolescent AD/HD.

Methods Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines.

Results The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for pediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria.

Conclusions To date there is insufficient evidence to evaluate the efficacy of chiropractic care for pediatric and adolescent AD/HD. The claim that chiropractic care improves pediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of pediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for pediatric and adolescent AD/HD.

From the FULL TEXT Article:

Background

Attention-Deficit/Hyperactivity Disorder (AD/HD) is considered to be one of the most frequently diagnosed disruptive behaviour disorders in childhood [1-5], with world wide prevalence rates of 8-12%. [6] The American prevalence rates range between 3-7% [1], and 4-12%. [7] The Australian prevalence rates show 11% of 6-17 year olds are diagnosed with this disorder [8], where as the English and Welsh AD/HD prevalence rates find 5% of 6-16 year olds have the disorder. [9] The Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision (DSM-IV-TR) [1], is the most widely used classification system for mental disorders. [10, 11] The DSM-IV-TR characterises AD/HD as inappropriate, chronic levels of inattention, hyperactivity and impulsivity. [1] These children continually experience difficulties in academic achievement, and behavioural control, and as a consequence, they have difficulty in establishing positive relationships with family, authority figures and their peers. [12-14] As a result, much attention has been devoted to the development and evaluation of assessment and treatment for this disorder over the last fifty years. [2, 15-17] The majority of the AD/HD literature is dedicated to the treatment of this disorder. [2, 15-18] Most of this research can be found in the area of pharmacological therapies [12, 16, 17], with less emphasis in psychotherapy and other psychosocial interventions. [19] There is even less research in the area of AD/HD and complementary and alternative medicine (CAM) therapies. [20, 21]

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Chiropractic and Children: Is More Research Enough?

By Frank M. Painter|May 29, 2014|Chiropractic Care, Pediatrics|

Chiropractic and Children: Is More Research Enough?

The Chiro.Org Blog

SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); 18: 11 ~ FULL TEXT

Charlotte Leboeuf-Yde, and Lise Hestbæk

Nordic Institute of Chiropractic and Clinical Biomechanics,
Forskerparken 10, DK-5230 Odense M, Denmark. l.hestbaek@nikkb.dk

Many health science research and review articles end with the words: “More research is needed”. However, when it comes to research, it is not as much a question of quantity as of quality. There are a number of important prerequisites before research should be initiated. The three pillars, relevance, quality and ethics should be respected but for a project to be meaningful, it must also be based on plausible rationale.

In evidence-based (informed) practice, one takes into account not only research-based evidence but also clinical expertise and the patients’ perspectives. In this paper, we briefly discuss how this should be handled in clinical practice is briefly discussed, using the concept of “traffic lights” (red, yellow, green). We explain how the combination of evidence and plausibility can be used to reach a decision as to whether a treatment or diagnostic procedure is suitable, possible, or unsuitable.

In this thematic series of Chiropractic & Osteopathy a number of reviews are presented, in which the research status of pediatric chiropractic is scrutinized and found wanting. Two important aspects were studied in these reviews: the effect of treatment and safety issues. Two types of problems were identified: the lack of research in general and the lack of research using the appropriate study designs and methodology in particular. Therefore, we discuss the meager research noted in the areas of chiropractic care in children and the clinical consequences this should have. The prerequisites for “more research” are scrutinized and an example given of suitable research programs.

Finally, the important issue of implementation of research findings is covered, emphasizing the responsibility of all stakeholders involved at both the undergraduate and the postgraduate level, within professional associations, and on an individual level.

Introduction

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Possible Adverse Events in Children Treated By Manual Therapy: A Review

By Frank M. Painter|May 28, 2014|Adverse Events, Chiropractic Care, Pediatrics, Uncategorized|

Possible Adverse Events in Children Treated By Manual Therapy: A Review

The Chiro.Org Blog

SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); ; 18: 12 ~ FULL TEXT

B Kim Humphreys

Professor Chiropractic Medicine, University of Zürich and
University Orthopedic Hospital Balgrist,
Forchstrasse 340, 8008 Zürich, Switzerland.
kim.humphreys@balgrist.ch

Background Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood.

Objective To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation.

Methods A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy.

Results Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available.

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Chiropractic Approach to the Management of Children

By Frank M. Painter|May 18, 2014|Chiropractic Care, Education, Pediatrics|

Chiropractic Approach to the Management of Children

The Chiro.Org Blog

SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); 18: 16 ~ FULL TEXT

Sharon A Vallone, Joyce Miller, Annica Larsdotter, and Jennifer Barham-Floreani

Private Practice,
Connecticut, USA.
svallonedc@aol.com

Background Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor’s role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families.

Objective To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient.

Discussion The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines.

Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees.

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