Chiropractic Care

Dose-response and Efficacy of Spinal Manipulation for Care of Chronic Low Back Pain: A Randomized Controlled Trial

By Frank M. Painter|October 29, 2013|Chiropractic Care, Low Back Pain|

Dose-response and Efficacy of Spinal Manipulation for Care of Chronic Low Back Pain: A Randomized Controlled Trial

SOURCE: Spine J. 2014 (Jul 1); 14 (7): 1106–1116

Mitchell Haas, DC, Darcy Vavrek, ND, David Peterson, DC,
Nayak Polissar, PhD, Moni B. Neradilek, MS

Center for Outcomes Studies,
University of Western States,
2700 NE 132nd Ave., Portland, OR 97230, USA.
haasmitch@comcast.net

BACKGROUND CONTEXT: There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation.

PURPOSE: To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control.

STUDY DESIGN/SETTING: Practice-based randomized controlled trial.

PATIENT SAMPLE: Four hundred participants with cLBP.

OUTCOME MEASURES: The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status.

METHODS: One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks.

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Chiropractic And Osteoarthritis

By Frank M. Painter|September 27, 2013|Chiropractic Care, Degenerative Joint Disease, Evidence-based Medicine, Osteoarthritis|

Chiropractic And Osteoarthritis

The Chiro.Org Blog

SOURCE: University of Maryland Medical Center

Although the vestiges of medical harassment against chiropractic still resonate, and are now supplanted by fringe web sites which continue to ignore the body of peer-reviewed research supporting chiropractic care, the ice is slowly melting.

Below you can read comments from the University of Maryland Medical Center website , which openly acknowledges the benefits of chiropractic care for patients suffering from the pain of osteoarthritis.

There are many more articles like this @ our:

Degenerative Joint Disease and Chiropractic Page

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Outcomes of Usual Chiropractic; Harm (OUCH) Randomised Controlled Trial of Adverse Events

By Frank M. Painter|September 24, 2013|Adverse Events, Chiropractic Care, Randomized Controlled Trial|

Outcomes of Usual Chiropractic; Harm (OUCH) Randomised Controlled Trial of Adverse Events

The Chiro.Org Blog

SOURCE: Spine 2013 (Sep 15); 38 (20): 1723-9 ~ FULL TEXT

Walker, Bruce F. DC, MPH, DrPH; Hebert, Jeffrey J. DC, PhD;
Stomski, Norman J. BHSc (hons), PhD; Clarke

Murdoch University School of Engineering and Information Technology,
Mathematics & Statistics,
Murdoch University Centre for Health,
Exercise and Sports Medicine,
University of Melbourne.

Study Design. Blinded parallel-group randomized controlled trial.

Objective. Establish the frequency and severity of adverse effects from short-term usual chiropractic treatment of the spine when compared with a sham treatment group.

Summary of Background Data. Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, as a result of design limitations in previous studies, particularly the lack of sham-controlled randomized trials, understanding of these adverse events and their relation with chiropractic treatment is suboptimal.

Methods. We conducted a trial to examine the occurrence of adverse events resulting from chiropractic treatment. It was conducted across 12 chiropractic clinics in Perth, Western Australia. The participants comprised 183 adults, aged 20 to 85 years, with spinal pain. Ninety-two participants received individualized care consistent with the chiropractors’ usual treatment approach; 91 participants received a sham intervention. Each participant received 2 treatments.

Results. Completed adverse questionnaires were returned by 94.5% of the participants after appointment 1 and 91.3% after appointment 2. Thirty-three percent of the sham group and 42% of the usual care group reported at least 1 adverse event. Common adverse events were:

increased pain (sham 29%; usual care 36%),
muscle stiffness (sham 29%; usual care 37%),
and headache (sham 17%; usual care 9%).

The relative risk (RR) was not significant for adverse event occurrence (RR = 1.24; 95% CI: 0.85–1.81),
occurrence of severe adverse events (RR = 1.9; 95% CI: 0.98–3.99),
adverse event onset (RR = 0.16; 95% CI: 0.02–1.34),
or adverse event duration (RR = 1.13; 95% CI: 0.59–2.18).
No serious adverse events were reported.

Conclusion. A substantial proportion of (previously reported) adverse events following chiropractic treatment appear to result from natural history variation and nonspecific effects.

From the FULL TEXT Article

Introduction

Chiropractic therapy is commonly used to manage musculoskeletal conditions in high-income countries. [1, 2] The occurrence of adverse events resulting from chiropractic treatment is of considerable interest to chiropractors and the general public. Most adverse events associated with chiropractic treatment are mild, short lasting, and typical of musculoskeletal condition symptoms. [3–11] However, due to a lack of appropriately designed studies, particularly sham-controlled trials, there are differences in views about what constitutes a chiropractic treatment–related adverse event.

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Chronic Low-Back Pain: Is Infection a Common Cause?

By Frank M. Painter|September 6, 2013|Chiropractic Care, Low Back Pain|

Chronic Low-Back Pain: Is Infection a Common Cause?

The Chiro.Org Blog

SOURCE: ACA News ~ September 2013

By Daniel Redwood, DC

Background:

A 2013 randomized trial by Hanne Albert and colleagues at the University of Southern Denmark, published in the European Spine Journal, [1] found that 100 days of treatment with a disc-penetrating antibiotic was significantly more effective than a placebo for relief of chronic low-back pain (CLBP) in people whose MRI exam showed Modic Type 1 changes, which are associated with degeneration and inflammation. If confirmed by other studies, this would mean that disc infection is a far more common cause of CLBP than previously known.

Rare indeed is the publication of a Research paper with the potential to overturn long-standing, fundamental assumptions about the nature of a disease. Virtually all clinical research is incremental in its expansion of our knowledge — by evaluating the effectiveness of treatment methods, demonstrating the conditions under which they are most likely to be beneficial and exploring the physical mechanisms through which they work. But every now and then, a study like Marshall and Warren’s 1982 discovery [2] of the association between the heliobacter pylori bacterium and peptic ulcers appears out of left field to upend what previously passed for conventional wisdom.

In recent years, arguably the only publication to trigger a major reorientation of our understanding in an area critical to chiropractic practice was the 2008 Cassidy et al. paper in Spine, [3] in which the investigators examined nine years of medical records in the Canadian province of Ontario (covering 100 million patient years) and were able to definitively demonstrate that the likelihood of a stroke is no greater if one visits a doctor of chiropractic (DC) than if one visits a medical doctor. Overnight, this study shifted our understanding of stroke vis-à-vis chiropractic, with the authors concluding: “The increased risks of VBA (vertebrobasilar artery) stroke associated with chiropractic and PCP (primary care physician) visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated (with) chiropractic care compared to primary care.”

There’s a lot more material like this @:

Low Back Pain and Chiropractic Page

Is the Albert et al. study on antibiotics treatment of CLBP this kind of game-changer?

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New Chiropractic and Radicular Pain Study

By Frank M. Painter|August 31, 2013|Chiropractic Care, Disc Injury, Radiculopathy|

New Chiropractic and Radicular Pain Study

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2013 (Aug 12)

Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up

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

Professor, Department of Chiropractic Medicine,
Faculty of Medicine,
Orthopedic University Hospital Balgrist,
University of Zürich,
Zürich, Switzerland.
xraydcpeterson@yahoo.ca

This newly published prospective cohort study with 3-Month follow-up reports on the outcomes of 50 patients with MRI-confirmed cervical disc herniation who were also experiencing radiculopathy. Some of them were acute cases, but many of them also happened to be chronic pain patients.

A short, 3 month trial of chiropractic care led to significant improvements in all those individuals, and this improvement was sustained 3 months after care ceased.

OBJECTIVE: The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

METHODS: Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding “better” or “much better” on the patient’s global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

RESULTS: Fifty patients were included. At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.

There are many more articles like this at our:

Radiculopathy and Chiropractic Page

and our:

Chronic Neck Pain and Chiropractic Page

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A Framework For Chiropractic Training In Clinical Preventive Services

By Frank M. Painter|August 25, 2013|Chiropractic Care, Prevention|

A Framework For Chiropractic Training In Clinical Preventive Services

The Chiro.Org Blog

Chiropractic & Manual Therapies 2013 (Aug 20); 21: 28

Cheryl Hawk and Marion Willard Evans

Cheryl Hawk cheryl.hawk@logan.edu
Logan College of Chiropractic, 1851 Schoettler Rd, 63017 Chesterfield, MO, USA

The 2010 Patient Protection and Affordable Care Act provides incentives for both patients and providers to engage in evidence-based clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF). Depending upon the application of the new health care act, Doctors of Chiropractic (DC) may be considered to be covered providers of many of these services. It is therefore essential that DCs’ training prepare them to competently deliver them. The aim of this commentary is to describe a framework for training in clinical preventive services, based largely on the USPSTF recommendations, which could be readily integrated into existing DC educational programs.

From the Full-Text Article:

Background

The necessity for preventive care

The United States, despite spending more money on health care than any other country, has a population with shorter life expectancy and greater morbidity than any other wealthy nation [1]. The areas in which the U.S. lags behind its 16 peer nations are all lifestyle-related to a great degree [1]. Clearly this situation requires an approach that engages people in modifying their health behavior, as early as possible, rather than relying on heroic measures once conditions have become chronic and life-threatening. That approach is systematically addressed in the science of health promotion and disease prevention, often simply called “prevention” or “preventive care”. [2]

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