Chiropractic Management

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

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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Mechanisms of Chiropractic Spinal Manipulative Therapy for Patients with Chronic Primary Low Back Pain: Protocol for a Mechanistic Randomized Placebo-controlled Trial

By Frank M. Painter|February 25, 2023|Chiropractic Management, Low Back Pain, Spinal Joint Pain|

Mechanisms of Chiropractic Spinal Manipulative Therapy for Patients with Chronic Primary Low Back Pain: Protocol for a Mechanistic Randomized Placebo-controlled Trial

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SOURCE: BMJ Open 2023 (Feb 10); 13 (2): e065999

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Carlos Gevers-Montoro, Arantxa Ortega-De Mues, Mathieu Piché

Real Centro Universitario Escorial Maria Cristina,
San Lorenzo de El Escorial, Spain.

Introduction: Chronic low back pain (CLBP) is a highly prevalent and disabling condition. Identifying subgroups of patients afflicted with CLBP is a current research priority, for which a classification system based on pain mechanisms was proposed. Spinal manipulative therapy (SMT) is recommended for the management of CLBP. Yet, little data are available regarding its mechanisms of action, making it difficult to match this intervention to the patients who may benefit the most. It was suggested that SMT may influence mechanisms associated with central sensitisation. Therefore, classifying patients with CLBP according to central sensitisation mechanisms may help predict their response to SMT.

Methods and analysis: This protocol describes a randomised placebo-controlled trial aiming to examine which variables linked to central sensitisation may help predict the clinical response to SMT in a cohort of patients with CLBP. One hundred patients with chronic primary low back pain will be randomised to receive 12 sessions of SMT or placebo SMT over a 4–week period. Pain intensity and disability will be assessed as primary outcomes after completing the 4–week treatment (primary endpoint), and at 4–week and 12–week follow-ups. Baseline values of two pain questionnaires, lumbar pressure pain thresholds, concentrations of an inflammatory cytokine and expectations of pain relief will be entered as predictors of the response to SMT in a multiple regression model. Changes in these variables after treatment will be used in a second multiple regression model. The reference values of these predictors will be measured from 50 age and sex-matched healthy controls to allow interpretation of values in patients. Mixed analyses of variance will also be conducted to compare the primary outcomes and the predictors between groups (SMT vs placebo) over time (baseline vs post-treatment).

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Compliance with Clinical Practice Guidelines in Family Physicians Managing Worker’s Compensation Board Patients with Acute Lower Back Pain

By Frank M. Painter|November 23, 2022|Chiropractic Management, Workers' Compensation|

Compliance with Clinical Practice Guidelines in Family Physicians Managing Worker’s Compensation Board Patients with Acute Lower Back Pain

The Chiro.Org Blog

SOURCE: Spine J 2003 (Nov); 3 (6): 442–450

Paul B. Bishop, DC, MD, PhD, Peter C. Wing, MB, MSc, ChB, FRCS(C)

Combined Neurosurgical and Orthopaedic Spine Program,
Heather Pavilion, Vancouver General Hospital,
Vancouver, BC, Canada

Background context: Family physician compliance with acute lower back pain clinical practice guidelines remains uncertain.

Purpose: To determine the degree of guideline compliance of family physicians managing patients with workers’ compensation claims and acute mechanical lower back pain.

Study design: Observational study.

Patient sample: One hundred thirty-nine family physicians in British Columbia.

Outcome measures: Compliance with guideline recommendations for history, examination procedures, diagnostic testing and treatments.

Methods: Physician workers’ compensation board patient reports for acute lower back pain without leg symptoms and not greater than 2 to 3 weeks duration were scored for guideline adherence up until 12 weeks after onset.

Results: Physicians demonstrated a high degree of compliance with the guideline-recommended history, examination procedures and medications, but low compliance with recommended imaging and many treatment recommendations.

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The Vast Majority of Patients With Fibromyalgia Have a Straight Neck Observed on a Lateral View Radiograph of the Cervical Spine: An Aid in the Diagnosis of Fibromyalgia and a Possible Clue to the Etiology

By Frank M. Painter|November 10, 2022|Chiropractic Management, Fibromyalgia, Hypolordosis|

The Vast Majority of Patients With Fibromyalgia Have a Straight Neck Observed on a Lateral View Radiograph of the Cervical Spine: An Aid in the Diagnosis of Fibromyalgia and a Possible Clue to the Etiology

The Chiro.Org Blog

SOURCE: J Clinical Rheumatology 2022 (Nov 3) [EPUB]

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Robert S Katz, MD, Frank Leavitt, PhD, Katya Cherny,MS , Alexandra Katz Small, MD, Ben J Small, MD

From the Rush Medical University.
Rheumatology Associates.
Northwestern University Medical Center,
Chicago, IL.

Objective: A straight cervical spine is an underappreciated and often overlooked finding in fibromyalgia. The aim of this medical records review study was to evaluate the cervical curvature on radiographs of patients with fibromyalgia.

Methods: A consecutive series of 270 cervical spine radiographs of patients with neck pain from 2015 to 2018 were retrospectively analyzed for cervical curvature using the Cobb angle measurement. One hundred fifty-five patients met full American College of Rheumatology criteria for fibromyalgia, whereas 115 subjects with other rheumatic diseases who were similar in age and education served as control subjects.

Results: Mean cervical curvature in fibromyalgia was 6.4 ± 5.2 degrees and 13.8 ± 7.4 degrees in control subjects. The more than 7-degree difference was significant (p < 0.001). Curvature in the magnitude of 21 degrees is at the low end of normal. At ≤10 degrees, where the cervical spine is essentially straight, there were 129 fibromyalgia patients (83.2%) and 37 control subjects (32.2%). The 51% difference was significant (p < 0.001).

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Providing Information at the Initial Consultation to Patients with Low Back Pain Across General Practice, Chiropractic and Physiotherapy – A Cross-sectorial Study of Danish Primary Care

By Frank M. Painter|November 2, 2022|Chiropractic Management, Low Back Pain|

Providing Information at the Initial Consultation to Patients with Low Back Pain Across General Practice, Chiropractic and Physiotherapy – A Cross-sectorial Study of Danish Primary Care

The Chiro.Org Blog

SOURCE: Scand J Prim Health Care 2022 (Oct 31); 1–9

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Lars Morsø, Jesper Lykkegaard, Merethe Kirstine Andersen, Anders Hansen, Mette Jensen Stochkendahl, Simon Dyrløv Madsen, Berit Schiøttz Christensen

Department of Clinical Research,
Research Unit OPEN,
University of Southern Denmark,
Odense, Denmark

Objective: Clinical guidelines for managing low back pain (LBP) emphasise patient information, patient education and physical activity as key components. Little is known about who actually receives information. This study investigates to what extent information at the first consultation with general practitioner (GP), chiropractor (DC) and physiotherapist (PT) in Danish primary care is provided to

Design and setting: This cross-sectorial study was conducted as a prospective survey registration of LBP consultations at the three primary health care professions in Denmark.

Intervention: Clinicians ticked off a paper survey chart during or after consultations with patients who visited the clinic for LBP (Approval number: ID # 11.220).

Subjects: 33 GPs, 43 DCs and 61 PTs registered first-time consultations.

Main outcome measures: The primary outcome was provision of information, overall and across care settings.

Results: The overall proportion of patients provided with information was 72%, but this varied among professions (GP, 44%; DC, 76%; and PT, 74%). Provision of information increased to 78% if patients had increased emotional distress or back-related leg pain below the knee. The strongest association with provision of information was having two or three signs of elevated distress (OR 2.58 and 5.05, respectively, p= 0.00) or physical disability (OR 2.55, p= 0.00).

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The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

By Frank M. Painter|October 10, 2022|Chiropractic Management, Low Back Pain, Return To Work, Whiplash|

The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

The Chiro.Org Blog

SOURCE: Disabil Rehabil 2015; 37 (20): 1808–1816

Amanda E Young, Elyssa Besen, YoonSun Choi

Liberty Mutual Research Institute for Safety,
Center for Disability Research,
Hopkinton, MA, USA.

Purpose: &nbsp Workers’ own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

Method: &nbsp A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

Results: &nbsp A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

Conclusions: &nbsp Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker’s movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker’s expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker’s concerns. Once underling issues are identified, work can be put into resolving these so that the worker’s return to the workplace is not impeded.

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