Chiropractic Care

Post-Poliomyelitis Syndrome

The Chiro.Org Blog

SOURCE:   International Medical Case Reports 2019 (Aug 8); 12: 261–264

Eric Chun Pu Chu, Kary Ka Wai Lam

New York Chiropractic and Physiotherapy Center,
New York Medical Group

Most developed countries eliminated paralytic poliomyelitis (polio) in the 1970s to 1980s. It was believed that after recovery from acute paralytic poliomyelitis, the physical condition of survivors would remain stable for the rest of their lives. However, the elimination of polio does not equate the end of medical management of polio. Hundreds of thousands of polio survivors worldwide are still at risk of developing the late effects of the disease. Here, we report a case of post-polio syndrome who attended our clinic for the presence of new weakness and neuromuscular problems six decades after recovery from paralytic polio. It is essential that health professionals be aware of these conditions and have an understanding of the underlying pathophysiology of the symptoms.

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The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey

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SOURCE:   Spine (Phila Pa 1976). 2017 (Dec 1); 42 (23): 1810–1816

Jon Adams, PhD, Wenbo Peng, PhD, Holger Cramer, PhD, Tobias Sundberg, PhD, Craig Moore, Masters of Clinical Trials Research, Lyndon Amorin-Woods, MPH, David Sibbritt, PhD, Romy Lauche, PhD

Australian Research Centre in Complementary and Integrative Medicine (ARCCIM),
Faculty of Health, University of Technology Sydney,
Sydney, New South Wales, Australia.

STUDY DESIGN:   Secondary analysis of a national survey.

OBJECTIVE:   The aim of this study was to investigate the prevalence, patterns, and predictors of chiropractic utilization in the US general population.

SUMMARY OF BACKGROUND DATA:   Chiropractic is one of the largest manual therapy professions in the United States and internationally. Very few details have been reported about the use of chiropractic care in the United States in recent years.

METHODS:   Cross-sectional data from the 2012 National Health Interview Survey (n = 34,525) were analyzed to examine the lifetime and 12–month prevalence and utilization patterns of chiropractic use, profile of chiropractic users, and health-related predictors of chiropractic consultations.

RESULTS:   Lifetime and 12–month prevalence of chiropractic use were 24.0% and 8.4%, respectively. There is a growing trend of chiropractic use among US adults from 2002 to 2012. Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought and 63.8% reported chiropractic care combined with medical treatment as helpful. Both adults older than 30 years (compared to younger adults), and those diagnosed with spinal pain (compared to those without spinal pain) were more likely to have consulted a chiropractor in the past 12 months.

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Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers

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SOURCE:   JAMA Netw Open. 2018 (Oct 5); 1 (6): e183044

James Heyward, MPH; Christopher M. Jones, PharmD, MPH; Wilson M. Compton, MD, MPE; et al

Center for Drug Safety and Effectiveness,
Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland.

IMPORTANCE:   Despite epidemic rates of addiction and death from prescription opioids in the United States, suggesting the importance of providing alternatives to opioids in the treatment of pain, little is known regarding how payers’ coverage policies may facilitate or impede access to such treatments.

OBJECTIVE:   To examine coverage policies for 5 nonpharmacologic approaches commonly used to treat acute or chronic low back pain among commercial and Medicare Advantage insurance plans, plus an additional 6 treatments among Medicaid plans.

DESIGN, SETTING, AND PARTICIPANTS:   Cross-sectional study of 15 commercial, 15 Medicaid, and 15 Medicare Advantage health plans for the 2017 calendar year in 16 states representing more than half of the US population. Interviews were conducted with 43 senior medical and pharmacy health plan executives from representative plans.

MAIN OUTCOMES AND MEASURES:   Medical necessity and coverage status for the treatments examined, as well as the use of utilization management tools and cost-sharing magnitude and structure.

RESULTS:   Commercial and Medicare insurers consistently regarded physical and occupational therapy as medically necessary, but policies varied for other therapies examined.

Payers most commonly covered

physical therapy (98% [44 of 45 plans]),

occupational therapy (96% [43 of 45 plans]), and

chiropractic care (89% [40 of 45 plans]),

while transcutaneous electrical nerve stimulation (67% [10 of 15 plans]) and steroid injections (60% [9 of 15 plans]) were the most commonly covered among the therapies examined for Medicaid plans only.

Despite evidence in the literature to support use of acupuncture and psychological interventions, these therapies were either not covered by plans examined (67% of all plans [30 of 45] did not cover acupuncture) or lacked information about coverage (80% of Medicaid plans [12 of 15] lacked information about coverage of psychological interventions). Utilization management tools, such as prior authorization, were common, but criteria varied greatly with respect to which conditions and what quantity and duration of services were covered. Interviewees represented 6 Medicaid managed care organizations, 2 Medicare Advantage or Part D plans, 9 commercial plans, and 3 trade organizations (eg, Blue Cross Blue Shield Association). Interviews with plan executives indicated a low level of integration between the coverage decision-making processes for pharmacologic and nonpharmacologic therapies for chronic pain.

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Epidemiology: Spinal Manipulation Utilization

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SOURCE:   J Electromyogr Kinesiol. 2012 (Oct); 22 (5): 648–654

Eric L. Hurwitz

Department of Public Health Sciences,
John A. Burns School of Medicine,
University of Hawaii,
M?noa, Honolulu, HI 96822, USA.

The objectives of this article are to

        (1)   describe spinal manipulation use by time, place, and person, and

        (2)   identify predictors of the use of spinal manipulation.

We conducted a systematic review of the English-language literature published from January 1, 1980 through June 30, 2011. Of 822 citations identified, 213 were deemed potentially relevant; 75 were included after further consideration. Twenty-one additional articles were identified from reference lists. The literature is heavily weighted toward North America, Europe, and Australia and thus largely precludes inferences about spinal manipulation use in other parts of the world. In the regions covered by the literature, chiropractors, osteopaths, and physical therapists are most likely to deliver spinal manipulation, often in conjunction with other conservative therapies.

Back and neck pain are the most frequent indications for receiving spinal manipulation; non-musculoskeletal conditions comprise a very small percentage of indications. Although spinal manipulation is more commonly used in adults than children, evidence suggests that spinal manipulation may be more likely used for non-musculoskeletal ailments in children than in adults. Patient satisfaction with spinal manipulation is very high.

From the Full-Text Article:

Introduction

Although spinal manipulation has been practiced for thousands of years in several cultures spanning the globe, it is most commonly associated with chiropractic and osteopathy, which originated in the late 1800s in the United States (Pettman, 2007). The purpose of this article is to review the literature on the use of spinal manipulation. Specifically, our objectives are twofold: (1) To describe spinal manipulation use by time (temporal trends), place (geographic distribution), and person (practitioner and patient), and (2) to identify predictors of the use of spinal manipulation.

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