Chiropractic Management

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

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

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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

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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

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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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One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

By Frank M. Painter|October 6, 2022|Chiropractic Management, Whiplash|

One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

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SOURCE: J Rehabil Med 2016 (Jan); 48 (1): 56–64

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Maria Landén Ludvigsson, MSc, Gunnel Peterson MSc, Åsa Dedering, PhD and Anneli Peolsson, PhD

Department of Medical and Health Sciences,
Division of Physiotherapy,
Linköping University,
SE-581 83 Linköping, Sweden.

Objective: To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash.

Patients A total of 216 volunteers with chronic whiplash-associated disorders, grades 2 or 3.

Methods: Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years.

Results: Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p ≤ 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant.

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Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

By Frank M. Painter|October 3, 2022|Bell's Palsy, Chiropractic Management|

Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

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SOURCE: Am J Case Rep 2022 (Sep 19); 23: e937511

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Eric Chun-Pu Chu, Robert J Trager, Alan Te-Chang Chen

New Chiropractic and Physiotherapy Centre,
EC Healthcare,
Kowloon, Hong Kong.

BACKGROUND Bell’s palsy, also called facial nerve palsy, occasionally co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation.

CASE REPORT A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck.

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