Chiropractic Research

A Structured Protocol of Evidence-based Care

By Frank M. Painter|September 16, 2017|Chiropractic Research, Randomized Controlled Trial|

A Structured Protocol of Evidence-based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain: A Randomized Clinical Trial

SOURCE: Arch Phys Med Rehabil. 2012 (Jan); 93 (1): 11–20

Gregory F. Parkin-Smith, MTech(Chiro), MSc, DrHC,
Ian J. Norman, BSc, MSc, PhD,
Emma Briggs, BSc, PhD, RN,
Elizabeth Angier, BSc, MSc(Chiro),
Timothy G. Wood, BSc, MTech(Chiro),
James W. Brantingham, DC, PhD

School of Chiropractic & Sports Science,
Murdoch University,
Perth, Australia.

OBJECTIVE: To compare a protocol of evidence-based conservative care with usual care for acute nonspecific low back pain (LBP) of less than 6 weeks’ duration.

DESIGN: Parallel-group randomized trial.

SETTING: Three practices in the United Kingdom.

PARTICIPANTS: Convenience sample of 149 eligible patients were invited to participate in the study, with 118 volunteers being consented and randomly allocated to a treatment group.

INTERVENTIONS: The experimental group received evidence-based treatments for acute nonspecific LBP as prescribed in a structured protocol of care developed for this study. The control group received usual conservative care. Participants in both groups could receive up to 7 treatments over a 4-week period.

MAIN OUTCOME MEASURES: Oswestry Low Back Disability Index (ODI), visual analog scale (VAS), and Patient Satisfaction Questionnaire, alongside estimation of clinically meaningful outcomes.

RESULTS: Total dropout rate was 14% (n=16), with 13% of data missing. Missing data were replaced using a multiple imputation method. Participants in both groups received an average of 6 treatments. There was no statistically significant difference in disability (ODI) scores at the end of week 4 (P=.33), but there was for pain (VAS) scores (P<.001). Interestingly, there were statistically significant differences between the 2 groups for both disability and pain measures at the midpoint of the treatment period (P<.001). Patient satisfaction with care was equally high (85%) in both groups. Minimally clinically important differences in scores and number needed to treat scores (NNT<6) indicated that the experimental treatment (protocol of care) offered a clinically meaningful benefit over the control treatment (usual care), particularly at the midpoint of the treatment period.

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Essential Literature for the Chiropractic Profession

By Frank M. Painter|August 7, 2017|Chiropractic Research|

Essential Literature for the Chiropractic Profession: Results and Implementation Challenges from a Survey of International Chiropractic Faculty

The Chiro.Org Blog

SOURCE: Journal of Chiropractic Education 2017 (Aug 2) [Epub]

Barbara A. Mansholt, DC, MS,
Stacie A. Salsbury, PhD, RN,
Lance G. Corber, MSITM,
and John S. Stites, DC

Palmer College of Chiropractic
1000 Brady Street,
Davenport, IA 52803

OBJECTIVE: Scientific literature applicable to chiropractic practice proliferates in quantity, quality, and source. Chiropractic is a worldwide profession and varies in scope between states or provinces and from country to country. It is logical to consider that the focus and emphasis of chiropractic education varies between programs as well. This original research study endeavored to determine “essential literature” recommended by chiropractic faculty. The purpose of this article is (1) to share our results and (2) to promote discussion and explore means for future collaboration of chiropractic faculty through a worldwide platform.

METHODS: A 2-phase recruitment occurred initially at the institutional level and subsequently at the faculty level. A Web-based survey used qualitative data collection methods to gather bibliographic citations. Descriptive statistics were calculated for demographics, and citation responses were ranked per number of recommendations, grouped into categories, and tabulated per journal source and publication date.

RESULTS: Forty-one chiropractic programs were contacted, resulting in 30 participating chiropractic programs (16 US and 14 international). Forty-five faculty members completed the entire survey, submitting 126 peer-reviewed publications and 25 additional citations. Readings emphasized clinical management of spine pain, the science of spinal manipulation, effectiveness of manual therapies, teaching of chiropractic techniques, outcomes assessments, and professional issues.

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Make sure to review Table 2 which reports on the top 126 peer-reviewed submissions..

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Prevalence of Low Back Pain in Adolescents

By Frank M. Painter|April 24, 2017|Chiropractic Research, Scoliosis|

Prevalence of Low Back Pain in Adolescents with Idiopathic Scoliosis: A Systematic Review

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2017 (Apr 20); 25: 10

Jean Théroux, Norman Stomski, Christopher J. Hodgetts,
Ariane Ballard, Christelle Khadra, Sylvie Le May and
Hubert Labelle

Research Center,
Sainte-Justine University Hospital Center
School of Health Profession,
Murdoch University

Background Adolescent idiopathic scoliosis is the most common spinal deformity occurring in adolescents and its established prevalence varies from 2 to 3%. Adolescent idiopathic scoliosis has been identified as a potential risk factor for the development of low back pain in adolescents. The purpose of this study was to systematically review studies of the prevalence of low back pain in adolescents with idiopathic scoliosis in order to establish the quality of the evidence and determine whether the prevalence estimates could be statistically pooled.

Methods Systematic electronic searches were undertaken in PubMed, CINAHL, and CENTRAL without any restrictions. Studies were eligible for inclusion if they reported the prevalence of low back pain in adolescents with idiopathic scoliosis. Studies were excluded if they detailed the prevalence of pain in post-surgical subjects or were published in languages other than English or French. Data were reported qualitatively, since there was insufficient evidence for statistical pooling.

Results The electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.

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The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

By Frank M. Painter|February 23, 2017|Chiropractic Research, Pain Relief|

The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2015 (Sep 7); 23: 25

Søren O’Neill, Øystein Ødegaard-Olsen and Beate Søvde

Institute of Regional Health Research,
University of Southern Denmark,
Campusvej 55, Odense, 5230 DK Denmark ;

Spine Centre of Southern Denmark,
Lillebælt Hospital, Østre Hougvej 55,
Middelfart, 5500 DK Denmark

BACKGROUND: High-velocity low-amplitude (HVLA) spinal manipulation is commonly used in the treatment of spinal pain syndromes. The mechanisms by which HVLA-manipulation might reduce spinal pain are not well understood, but often assumed to relate to the reduction of biomechanical dysfunction. It is also possible however, that HVLA-manipulation involves a segmental or generalized inhibitory effect on nociception, irrespective of biomechanical function. In the current study it was investigated whether a local analgesic effect of HVLA-manipulation on deep muscle pain could be detected, in healthy individuals.

METHODS AND MATERIALS: Local, para-spinal muscle pain was induced by injection of 0.5 ml sterile, hyper-tonic saline on two separate occasions 1 week apart. Immediately following the injection, treatment was administered as either a) HVLA-manipulation or b) placebo treatment, in a randomized cross-over design. Both interventions were conducted by an experienced chiropractor with minimum 6 years of clinical experience. Participants and the researcher collecting data were blinded to the treatment allocation. Pain scores following saline injection were measured by computerized visual analogue pain scale (VAS) (0-100 VAS, 1 Hz) and summarized as a) Pain duration, b) Maximum VAS, c) Time to maximum VAS and d) Summarized VAS (area under the curve). Data analysis was performed as two-way analysis of variance with treatment allocation and session number as explanatory variables.

RESULTS: Twenty-nine healthy adults (mean age 24.5 years) participated, 13 women and 16 men. Complete data was available for 28 participants. Analysis of variance revealed no statistically significant difference between active and placebo manipulation on any of the four pain measures.

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Interprofessional Collaboration in Research, Education, and Clinical Practice

By Frank M. Painter|December 21, 2016|Chiropractic Research, Interprofessional Collaboration|

Interprofessional Collaboration in Research, Education, and Clinical Practice: Working Together for a Better Future

The Chiro.Org Blog

Journal of Chiropractic Education 2015 (Mar); 29 (1): 1–10 ~ FULL TEXT

Bart N. Green, DC, MSEd and
Claire D. Johnson, DC, MSEd

Department of Physical and Occupational Therapy,
Chiropractic Services, and Sports Medicine
at the Naval Medical Center San Diego

Interprofessional collaboration occurs when 2 or more professions work together to achieve common goals and is often used as a means for solving a variety of problems and complex issues. The benefits of collaboration allow participants to achieve together more than they can individually, serve larger groups of people, and grow on individual and organizational levels. This editorial provides an overview of interprofessional collaboration in the areas of clinical practice, education, and research; discusses barriers to collaboration; and suggests potential means to overcome them.

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Sophisticated Research Design in Chiropractic and Manipulative Therapy: Part 3

By Frank M. Painter|July 17, 2016|Chiropractic Research|

Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”
Part C: Mixed Methods: “Why Can’t Science And Chiropractic Just Be Friends?”

The Chiro.Org Blog

SOURCE: Chiropractic Journal of Australia 2016; 44 (2): 1–21

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150

Enjoy Part 1: Quantitative Research: Size Does Matter Enjoy Part 2: Qualitative Research: Quality vs. Quantity

Many commentators have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, observing the way Evidence-based Practice [EBP] is sometimes implemented is controversial, not only within the chiropractic profession, but in all other healthcare disciplines, including medicine itself. A phased approach to the development and evaluation of complex interventions can help researchers define the research process and complex interventions may require use of both qualitative and quantitative methods. The chiropractic profession has little to fear from evidence-based practice; in fact it should be used productively to improve patient care, clinical outcomes and the standing of the profession in the eyes of the public, other health professions and legislators.

Keywords Evidence-Based Practice; Mixed Methods; Research Design

INTRODUCTION

Many scientists have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, including chiropractic. Over the last decade some authors have suggested refinements of the model, for instance; in the place of an evidence hierarchy, Jonas [1] suggested the construction of an “evidence house” with “rooms” for different types of information and purposes and later presented a refined circular model. [1]

Jonas [1] observed:

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Chiropractic Research

A Structured Protocol of Evidence-based Care

A Structured Protocol of Evidence-based Conservative Care Compared with Usual Care for Acute Nonspecific Low Back Pain: A Randomized Clinical Trial

Essential Literature for the Chiropractic Profession

Essential Literature for the Chiropractic Profession: Results and Implementation Challenges from a Survey of International Chiropractic Faculty

Prevalence of Low Back Pain in Adolescents

Prevalence of Low Back Pain in Adolescents with Idiopathic Scoliosis: A Systematic Review

The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

Interprofessional Collaboration in Research, Education, and Clinical Practice

Interprofessional Collaboration in Research, Education, and Clinical Practice: Working Together for a Better Future

Sophisticated Research Design in Chiropractic and Manipulative Therapy: Part 3

Sophisticated Research Design in Chiropractic and Manipulative Therapy; “What You Learn Depends on How You Ask.” Part C: Mixed Methods: “Why Can’t Science And Chiropractic Just Be Friends?”

Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”
Part C: Mixed Methods: “Why Can’t Science And Chiropractic Just Be Friends?”