Chiropractic Care

Costs of Routine Care For Infant Colic in the UK and Costs

By Frank M. Painter|February 2, 2014|Chiropractic Care, Colic, Cost-Effectiveness, Randomized Controlled Trial|

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

SOURCE: J Clin Chiropr Pediatr 2013 (Jun); 14 (1): 1063–1069

Joyce E. Miller, BS, DC, DABCO

Anglo-European College of Chiropractic,
Bournemouth, UK.

This paper is a follow-up cost comparison of the medical and chiropractic care provided in Dr. Miller’s RTC study:

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial
J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

This RTC cast new and significant insight onto previous colic trials:

In this study, it was found that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects. This was a major criticism of earlier colic studies, and thus may help support their conclusions.

That study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

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 (£65 million [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 randomized 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.

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The Collateral Benefits Of Having Chiropractic Available In A Public Central Hospital

By Frank M. Painter|February 1, 2014|Chiropractic Care, Complementary Medicine, Evidence-based Medicine, Integrative Care, Non-Musculoskeletal Conditions|

The Collateral Benefits Of Having Chiropractic Available In A Public Central Hospital

The Chiro.Org Blog

Journal of Hospital Administration 2013 (Aug 8); 2 (4): 138–143 ~ FULL TEXT

Jan Roar Orlin, Andrè Didriksen, Helge Hagen, Anders Sørfonden

Dept. of Orthopedics, Central Hospital (FSS), Førde, Norway, and
Dept. of Ear-Nose-Throat, Central Hospital (FSS), Førde, Norway

Thanks to Dana Lawrence, DC for drawing our attention to this article!

Following previous reports on the co-operation between a chiropractor and a central hospital, experiences from the past five years are presented. The objective of this paper is to show that improved management of muscular and skeletal problems within a hospital setting depends on the availability of chiropractic health care as a treatment option.

The following pain groups were sampled:

1) sacro-lumbar dysfunction and sciatic leg symptoms, with or without joint dysfunction and sciatica;

2) myo-fascial referred pain syndromes, frequently caused by peripheral nerve entrapment; and

3) tinnitus, dizziness/vertigo, facial pain, ear plug and swallowing difficulties, frequently caused by biomechanical components.

A majority of pain patients, after being subjected to traditional conservative treatment, usually over a period of several years, fail to return to work despite younger than average age. The only effective procedures seem to be those of chiropractors. In order to benefit from their particular knowledge, public hospitals need to open their doors to chiropractors. For that to happen, determined hospital administrators are needed.

1. Introduction

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Whiplash & Chiropractic

By Frank M. Painter|January 31, 2014|Chiropractic Care, Whiplash|

Whiplash & Chiropractic

The Chiro.Org Blog

SOURCE: ACA News

Whiplash is an enigmatic injury. We spend billions of dollars each year to treat it. Yet many lawyers, legislators, and medical doctors deny its existence. It affects millions of people around the world, yet research is severely under-funded. It is a largely preventable injury, yet we do little to prevent it. Fortunately, times are changing as whiplash enters a new phase of research and understanding.

“We now have a completely new model of whiplash,” says Dr. Arthur Croft, researcher and co-author of the well-respected textbook, Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome. “Back in 1982, when I started practice, we had an extremely simplistic view of whiplash-you got hit from the rear; your head snapped back, which may have caused damage to ligaments, muscles, and tendons; your head snapped forward, which may have caused some additional damage; and then you had symptoms. We weren’t very sophisticated in terms of what we knew, because there hadn’t been much research.”

Researchers now believe that during a rear-end collision, the lower neck goes into hyperextension, while the upper goes into flexion. “That means the bottom and top parts of the neck are going in opposite directions during the initial phase of a whiplash, which forms the letter ‘S,’” explains ACA member Dan Murphy, DC, who teaches whiplash throughout the world, including a 120-hour certification course on spine trauma. “This sequence of events has been captured with cineradiography, which lets us look at the movement of each joint of the spine with motion x-ray. It’s remarkable what it shows-especially in the lower neck where people seem to have the most complaints and most findings on examination. In a 6.5g impact, for example, the motion between C7 and T1 is supposed to be about two degrees, but researchers are finding that the joint is moving about 20 degrees – or 10 times more than it is supposed to.”

Researchers initially captured this information by using human cadavers in cars, but those who thought live humans would respond differently were skeptical. Researchers counter-argued that it made no difference because maximum injury occurs in less than one-tenth of a second. “The injuries happen so fast they beat the dynamic of the muscles that would normally protect the joints,” Dr. Murphy explains. “For the muscles to kick in to protect the joints, you need approximately two-tenths of a second.”

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Whiplash and Chiropractic Page

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Spinal Manipulation Compared with Back School and with Individually Delivered Physiotherapy

By Frank M. Painter|January 30, 2014|Chiropractic Care, Evidence-based Medicine, Low Back Pain, Outcome Assessment|

Spinal Manipulation Compared with Back School and with Individually Delivered Physiotherapy for the Treatment of Chronic Low Back Pain: A Randomized Trial with One-year Follow-up

The Chiro.Org Blog

SOURCE: Clinical Rehabilitation 2010 (Jan); 24 (1): 26–36

Francesca Cecchi, Raffaello Molino-Lova, Massimiliano Chiti,
Guido Pasquini, Anita Paperini, Andrea A Conti, and Claudio Macchi

Fondazione Don Carlo Gnocchi,
Scientific Institute,
Florence, Italy.
francescacecchi2002@libero.it

FROM: Health Insights Today

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week.

Outcome measures were the Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6), assessed at baseline, discharge, and at 3, 6, and 12 months. 205 patients completed the study.

At discharge, disability score decreased by:

3.7 +/- 4.1 for back school,4.4 +/- 3.7 for individual physiotherapy, and

6.7 +/- 3.9 for manipulation.

The pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively.

Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups;

pain recurrences and drug intake were also reduced compared to back school or individual physiotherapy.

The difference in their improved scores is quite dramatic:

After 12 months

Intervention	Disability Score	Pain Rating
At Discharge
Spinal Manipulation	6.7 +/- 3.9	1.0 +/- 1.1
Individual Physiotherapy	4.4 +/- 3.7	1.1 +/- 1.0
Back School	3.7 +/- 4.1	0.9 +/- 1.1
Spinal Manipulation	5.9 +/- 4.6	1.5 +/- 1.1
Individual Physiotherapy	4.0 +/- 5.1	0.4 +/- 1.3
Back School	4.2 +/- 4.8	0.7 +/- 1.2

NOTE: These numbers indicate the reductions in scores on the Roland Morris Disability Questionnaire and the Pain Rating Scale.

The Abstract:

OBJECTIVE: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain.

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Low Back Pain and Chiropractic Page

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Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

By Frank M. Painter|January 26, 2014|Chiropractic Care, Evidence-based Medicine, Headache|

Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache

The Chiro.Org Blog

SOURCE: Duke University Evidence-based Practice Center

Douglas C. McCrory, MD, MHSc, Donald B. Penzien, PhD,
Vic Hasselblad, PhD. Rebecca N. Gray, DPhil

Duke University Evidence-based Practice Center
Center for Clinical Health Policy Research
2200 W. Main Street, Suite 230
Durham, NC 27705

EXECUTIVE SUMMARY

Background

Tension-type headache and cervicogenic headache are two of the most common non-migraine headaches. Population-based studies suggest that a large proportion of adults experience mild and infrequent (once per month or less) tension-type headaches, and that the one-year prevalence of more frequent headaches (more than once per month) is 20%-30%; a smaller percentage of the population (roughly 3%) has been estimated to have chronic tension-type headache (180 days per year). Estimates of the prevalence of cervicogenic headache have varied considerably, due in large part to disagreements about the precise definition of the condition. A recent population-based study, which used the diagnostic criteria of the International Headache Society (IHS), found that 17.8% of subjects with frequent headache (5 days per month) fulfilled the criteria for cervicogenic headache; this was equivalent to a prevalence of 2.5% in the larger population. This agrees with an earlier clinic-based study which found that 14% of headache patients treated had cervicogenic headache.

The impact of tension-type headache on individuals and society appears to be significant. According to one population-based study, regular activities were limited during 38% of tension-type headache attacks, and 4% of respondents indicated that their headaches affected their attendance at work. Eighty-nine percent of tension-type headache sufferers reported that their headaches had negatively affected their relationships with friends, colleagues, and family. Little is known about the personal and societal impact of cervicogenic headache.

Nearly all patients with tension-type headache have used medications at one time or another to treat their headaches. But pharmacological treatments are not suitable for all patients, nor are they universally effective. Drug treatments may also produce undesired side effects. Partly for these reasons, significant interest has developed among both patients and health care providers in alternative treatments for tension-type headache, including behavioral and physical interventions. Cervicogenic headache, when diagnosed as such, is commonly treated with non-pharmacological interventions, especially physical treatments.

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Headache and Chiropractic Page

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Medical Management of Pediatric and Non-Musculoskeletal Conditions by Spinal Manipulation

By Frank M. Painter|January 23, 2014|Chiropractic Care, Non-Musculoskeletal Conditions, Pediatrics, Visceral Disease|

Medical Management of Pediatric and Non-Musculoskeletal Conditions by Spinal Manipulation

The Chiro.Org Blog

Chiropractic Journal of Australia 2013 (Dec); 43 (4): 131–136 ~ FULL TEXT

Peter L. Rome, D.C.

Melbourne, Australia

Thanks to Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Considering the unpleasant fallout from the Simon Singh Case, this article sheds a unique, new perspective on manipulative care for non-musculoskeletal conditions.

The Abstract: There is a well established precedent by medical doctors, particularly in Europe, of managing infant, paediatric and other patients for so-called organic conditions by spinal manipulation. There are also claims that chiropractic should not be involved with this form of management for so-called visceral disorders because it does not quite meet the current orthodox theories. This seems contradictory if not hypocritical when there is noted evidence in the medical literature itself of not only the rationale supporting these concepts, but evidence of medical doctors carrying out the same procedures for the same purpose on the same conditions.

Index terms: (MeSH): chiropractic; manipulation, chiropractic; manipulation, orthopedic; manipulation, musculoskeletal; manipulation, spinal; pediatrics; evidence based medicine. (other): medical manipulative therapy.

From the Full-Text Article:

Introduction

Some have questioned the hypotheses justifying chiropractic involvement in the management of paediatric patients, as well as those with so-called visceral conditions. [1-4] This topic was raised recently in a television program by Demasi. [5]

It is acknowledged that chiropractic constructs have been outside the traditional or orthodox models of understanding. However, there is a major contradiction regarding manipulative management of visceral and paediatric care due to the adoption of those very concepts by other areas of medicine – namely manipulative medicine. [6-9]

In particular, European medical doctors have published refereed papers on these very topics involving spinal manipulation in medical journals and medical textbooks for some decades. [10] (see Table 1) In an apparent contradictory development, it is primarily English language medical authors and other sources that seem to have attracted critics who direct their reservations at the principles espoused by chiropractors, but not to their European medical colleagues who are proponents of spinal manipulation. [11] It is also curious that osteopathic manipulative therapy does not appear to attract the same degree of debate and reservations despite the similarities.

There are at least three medical textbooks which include the topics of paediatric manipulative care and the manipulative management of visceral disorders. [6-8] One such medical text is totally devoted to paediatric manual therapy. [6]

INFANTS

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