Chiropractic Care

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

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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Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging

By Frank M. Painter|May 6, 2014|Chiropractic Care, Disc Injury, Low Back Pain|

Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (3): 155-163

Serafin Leemann, DC, Cynthia K. Peterson, RN, Christof Schmid, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Chiropractic Medicine and Radiology departments, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. cynthia.peterson@balgrist.ch

Objective The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with high-velocity, low-amplitude spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year and to determine if outcomes differ between acute and chronic patients using a prospective, cohort design.

Methods This prospective cohort outcomes study includes 148 patients (between ages of 18 and 65 years) with LBP, leg pain, and physical examination abnormalities with concordant lumbar disc herniations. Baseline numerical rating scale (NRS) data for LBP, leg pain, and the Oswestry questionnaire were obtained. The specific lumbar spinal manipulation was dependent upon whether the disc herniation was intraforaminal or paramedian as seen on the magnetic resonance images and was performed by a doctor of chiropractic. Outcomes included the patient’s global impression of change scale for overall improvement, the NRS for LBP, leg pain, and the Oswestry questionnaire at 2 weeks, 1, 3, and 6 months, and 1 year after the first treatment. The proportion of patients reporting “improvement” on the patient’s global impression of change scale was calculated for all patients and acute vs chronic patients. Pretreatment and posttreatment NRS scores were compared using the paired t test. Baseline and follow-up Oswestry scores were compared using the Wilcoxon test. Numerical rating scale and Oswestry scores for acute vs chronic patients were compared using the unpaired t test for NRS scores and the Mann-Whitney U test for Oswestry scores. Logistic regression analysis compared baseline variables with “improvement.”

Results Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.

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A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

By Frank M. Painter|April 5, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

The Chiro.Org Blog

SOURCE: Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295. e1-7

James W. George, DC; Clayton D. Skaggs, DC;
Paul A. Thompson, PhD; D. Michael Nelson, MD, PhD;
Jeffrey A. Gavard, PhD; Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University, Chesterfield, MO, USA

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

CONCLUSION: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.

From the Full-Text Article:

Introduction

Musculoskeletal pain in pregnant women commonly is viewed as transient, physiologic, and self-limited. However, most women report either low back pain (LBP) or pelvic pain (PP) during pregnancy [1-6] and the morbidity that is associated with such complaints. [7, 8] Moreover, up to 40% of patients report musculoskeletal pain during the 18 months after delivery, [2, 7, 9, 10] and one-fifth of these women have severe LBP that leads to major personal, social, or economic problems. [7, 9, 11] Pregnancy-related LBP contributes substantially to health care costs. For example, one-fifth of pregnant women in Scandinavian countries experience back pain as an indication for up to 7 weeks of sick leave in the perinatal period. [7, 9] Ninety-four percent of women who experienced LBP in an index pregnancy have recurrent symptoms with subsequent pregnancy, and two-thirds of these patients experience disability and require sick leave during pregnancy. Notably, 19% of women with pain in an initial pregnancy report avoidance of a future pregnancy out of fear of recurrence of the musculoskeletal symptoms. [11]

Most past investigations that have evaluated interventions to reduce morbidity in women with LBP/PP during pregnancy have used modalities that have included prescription exercise, [12] manual manipulation, [13] education, [14] acupuncture, [15] or pelvic belts. [16] Recently, a multimodal randomized trial compared osteopathic manipulation to usual obstetric care and sham ultrasonic therapy on 144 participants. [13] Importantly, this trial did not include behavioral and exercise therapies. We conducted a prospective, randomized, masked clinical trial to test the hypothesis that a multimodal approach of manual therapy, exercise, and education for LBP/PP in pregnant women is superior to standard obstetric care (STOB) for the reduction of pain, impairment, and disability in the ante-partum period.

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