Chiropractic Management

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

By Frank M. Painter|May 6, 2023|Chiropractic Care, Chiropractic Management, Veterans|

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

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SOURCE: J Chiropractic Medicine 2022 (Jun); 21 (2): 77–82

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Brian A. Davis DC, Andrew S. Dunn DC, MS, MEd, Derek J. Golley DC, MS, Dave R. Chicoine DC, MS

Chiropractic Department,
VA Western New York Healthcare System,
Buffalo, New York

FROM: Military.com 2019

Objective: The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care.

Methods: We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. We included those who received chiropractic management from January 1, 2010, to December 31, 2018. Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). The minimum clinically important difference (MCID) was set at 30% change from baseline.

Results: There were 217 individuals who met the inclusion criteria. The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction (t = 13.5, P < .001). The mean score change for BBQ was 14.7 points, representing a 35.9% reduction (t = 16.7, P < .001). The percentage of participants reaching the MCID for the NRS was 57% (n = 124) and for the BBQ was 59% (n = 126), with 41% (n = 90) of the sample reaching the MCID for both the NRS and BBQ.

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Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

By Frank M. Painter|April 29, 2023|Chiropractic Management, Initial Provider, Low Back Pain|

Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Nov); 44 (9): 683–689
Brian R. Anderson, DC, MPH, MS, PhD, Steve W. McClellan, MS

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA.

FROM:
Houweling, JMPT 2015 Liliedahl, JMPT 2010

Objective: The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims.

Methods: We performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. The 3 care patterns we analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. We considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery. Modified-Poisson regression modeling was used to determine relative risk of escalated care.

Results: There were 83,025 claims that were categorized into 10 372 unique patient first episodes. Spinal manipulative therapy was present in 2,943 episodes (28%). Initial spinal manipulation was present in 2,519 episodes (24%), delayed spinal manipulation was present in 424 episodes (4%), and 7,429 (72%) had no evidence of spinal manipulative therapy. The estimated relative risk, adjusted for age, sex, and risk score, for care escalation (eg, imaging, injections, or surgery) was 0.70 (95% confidence interval 0.65–0.75, P < .001) for initial spinal manipulation and 1.22 (95% confidence interval 1.10–1.35, P < .001) for delayed spinal manipulation with no spinal manipulation used as the reference group.

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The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

By Frank M. Painter|April 13, 2023|Chiropractic Management, Low Back Pain, Medicare|

The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

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SOURCE: PLoS One 2023 (Apr 12); 18 (4): e0283661

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Lobke P. De la Ruelle, Annemarie de Zoete, Cornelius Myburgh, Hella E. Brandt, Sidney M. Rubinstein

Department of Health Sciences,
Faculty of Science,
Amsterdam Movement Sciences,
Vrije Universiteit Amsterdam,
Amsterdam, The Netherlands.

Background: Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process.

Methods: Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim.

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Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

By Frank M. Painter|April 12, 2023|Chiropractic Management, Disc Derangement|

Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: A Case Report

The Chiro.Org Blog

SOURCE: Research Square (Apr 4, 2023)

Jessica F Billham, Erika Evans Roland, Matthew F. Gornet, Kelly Brinkman, Francine Schranck, Jim Cox, Norman W. Kettner

Logan University
Chesterfield, MO, US

The Vertebral Disc
FROM: Bioengineering 2022

INTRODUCTION: We report utility of magnetic resonance spectroscopy (MRS) in identifying the intervertebral disc (IVD) as a pain generator, describe the contemporary pathophysiology underlying biochemical and structural components of discogenic low back pain (DLBP), and exhibit therapeutic responses to spinal manipulation.

CLINICAL FEATURES: A 29-year old man presented with uncomplicated low back pain (LBP). The nonspecific presentation and clinical exam findings were consistent with non-specific LBP with the IVD as likely pain generator.

INTERVENTION AND OUTCOMES: Conventional magnetic resonance imaging showed findings of IVD degeneration including Modic Type 1 changes consistent with a diagnosis of DLBP. MRS was utilized for structural and biochemical analysis of the IVDs. Altered spectral features confirmed a DLBP diagnosis. The patient underwent 12 Cox Flexion Distraction treatments at a chiropractic teaching clinic. Follow-up MRS revealed improved IVD spectral features including decreased biochemical pain markers and increased glycoprotein biosynthesis suggesting improved IVD structural integrity.

CONCLUSION: We report the first utilization of MRS to quantify structural integrity and biochemical pain profile of the IVD in a conservatively managed DLBP patient. Findings of this case suggest spinal manipulative therapy in DLBP management may improve the structural integrity of IVDs and alter pain biochemistry.

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The Swiss Chiropractic Practice-based Research Network: A Population-based Cross-sectional Study to Inform Future Musculoskeletal Research

By Frank M. Painter|April 7, 2023|Chiropractic Management, Musculoskeletal Dysfunction, Musculoskeletal Pain|

The Swiss Chiropractic Practice-based Research Network: A Population-based Cross-sectional Study to Inform Future Musculoskeletal Research

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SOURCE: Scientific Reports 2023 (Apr 6); 13 (1): 5655

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Rahim Lalji, Léonie Hofstetter, Alice Kongsted, Viktor von Wyl, Milo A. Puhan & Cesar A. Hincapié

EBPI-UWZH Musculoskeletal Epidemiology Research Group,
University of Zurich and Balgrist University Hospital,
Forchstrasse 340, 8008,
Zurich, Switzerland.

FROM: BMJ Open 2022

The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance musculoskeletal epidemiologic research. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collaboration. A population-based cross-sectional study was performed. PBRN clinician characteristics were described and factors related to motivation (operationalised as VAS score ≥ 70) to participate in a subsequent patient cohort pilot study were assessed. Among 326 eligible chiropractors, 152 enrolled in the PBRN (47% participation). The PBRN was representative of the larger Swiss chiropractic population with regards to age, language, and geographic distribution. Of those enrolled, 39% were motivated to participate in a nested patient cohort pilot study. Motivation was associated with age 40 years or older versus 39 years or younger (OR 2.3, 95% CI 1.0–5.2), and with a moderate clinic size (OR 2.4, 95% CI 1.1–5.7) or large clinic size (OR 2.8, 95% CI 1.0–7.8) versus solo practice. The Swiss chiropractic PBRN has enrolled almost half of all Swiss chiropractors and has potential to facilitate collaborative practice-based research to improve musculoskeletal health care quality.

Trial registration: Swiss chiropractic PBRN
(ClinicalTrials.gov identifier: NCT05046249);
Swiss chiropractic cohort (Swiss ChiCo) pilot study
(ClinicalTrials.gov identifier: NCT05116020).

From the FULL TEXT Article:

Introduction

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Treatment Targets of Exercise for Persistent Non-specific Low Back Pain: A Consensus Study

By Frank M. Painter|March 24, 2023|Chiropractic Management, Exercise and Chiropractic, Low Back Pain|

Treatment Targets of Exercise for Persistent Non-specific Low Back Pain: A Consensus Study

The Chiro.Org Blog

SOURCE: Physiotherapy 2021 (Sep); 112: 78–86
Lianne Wood, Annette Bishop, Martyn Lewis, Rob J E M Smeets, Gert Bronfort, Jill A Hayden, Nadine E Foster

Primary Care Centre Versus Arthritis,
School of Primary, Community and Social Care,
Faculty of Medicine and Health Sciences,
Keele University,
Newcastle-under-Lyme ST5 5BG, UK

FROM: Br J Sports Med 2020

Objectives: Despite several hundred previous randomised controlled trials (RCTs), the key treatment targets of exercise for persistent non-specific low back pain (NSLBP) remain unclear. This study aimed to generate consensus about the key treatment targets of exercise interventions for patients with NSLBP.

Design: Consensus was generated using modified nominal group technique in two, sequential, workshops. The results of a previous systematic review informed the first, national, workshop idea generation and the results of this workshop informed the second, international, workshop. The authors generated a starting list of 30 treatment targets from the systematic review. A pre-specified consensus threshold of 75% was used in the voting stage.

Participants: Workshop participants included people with experience of using exercise to manage their persistent NSLBP, clinicians who prescribe exercise for persistent NSLBP, and researchers who design and evaluate exercise interventions in RCTs. All participants generated, voted and ranked the treatment targets in each workshop using an online platform.

Results: A total of 39 participants contributed to the consensus (15 in the national workshop and 24 in the international workshop), comprising two people with NSLBP, six clinicians and 31 researchers/clinicians. A total of 40 exercise treatment targets were generated, and 25 were retained after voting and ranking. The prioritised targets of exercise for persistent NSLBP were: improving function, improving quality of life, reducing pain, meeting patient-specific goals and reducing fear of movement.

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