Evidence-based Medicine

Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain

By Frank M. Painter|November 28, 2013|Chiropractic Care, Chiropractic Research, Evidence-based Medicine, Neck Pain|

Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain

SOURCE: J Manipulative Physiol Ther 2014 (Jan); 37 (1): 42–63

Roland Bryans, DC, Philip Decina, DC, Martin Descarreaux, DC, PhD, Mireille Duranleau, DC, Henri Marcoux, DC, Brock Potter, BSc, DC, Richard P. Ruegg, PhD, DCs, Lynn Shaw, PhD, OT, Robert Watkin, BA, LLB, Eleanor White, MSc, DC

Guidelines Development Committee (GDC) Chairman; Chiropractor, Clarenville, Newfoundland, Canada.

OBJECTIVE: The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults.

METHODS: Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations.

RESULTS: Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain.

CONCLUSIONS: Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.

Thanks to Dynamic Chiropractic for these comments from their article:
The Science of Treating Neck Pain

Following a literature search of controlled clinical trials through December 2011, 560 studies were narrowed to 41 that met the authors’ inclusion criteria and served as the basis for their treatment recommendations, graded as strong, moderate or weak based on the number, quality and consistency of research results.

Treatment strategies given strong recommendations for chronic neck pain included manipulation, manual therapy and exercise in combination with other modalities; as well as stretching, strengthening and endurance exercises alone.

Mobilization, as well as massage in combination with other therapies, received moderate recommendations for chronic neck pain.

Manipulation and mobilization in combination with other modalities received moderate recommendations for treating acute neck pain.

Here are the recommendations:

Acute Neck Pain

Manipulation / Multimodal: “Spinal manipulative therapy is recommended for the treatment of acute neck pain for both short- and long-term benefit (pain and the number of days to recover) when used in combination with other treatment modalities (advice, exercise, and mobilization;
(grade of recommendation – moderate).”

Mobilization/ Multimodal: “Mobilization is recommended for the treatment of acute neck pain for short-term (up to 12 weeks) and long-term benefit (days to recovery, pain) in combination with advice and exercise
(grade of recommendation – moderate).”

Exercise: “Home exercise with advice or training is recommended in the treatment of acute neck pain for both long- and short-term benefits
(neck pain; grade of recommendation – weak).”

Chronic Neck Pain

Manipulation / Multimodal: “Spinal manipulative therapy is recommended in the treatment of chronic neck pain as part of a multimodal approach (including advice, upper thoracic high-velocity low-amplitude thrust, low-level laser therapy, soft-tissue therapy, mobilizations, pulsed short-wave diathermy, exercise, massage, and stretching) for both short- and long-term benefit
(pain, disability, cROMs; grade of recommendation – strong).”

Manual Therapy / Multimodal: “Manual therapy is recommended in the treatment of chronic neck pain for the short- and long-term benefit (pain, disability, cROM, strength) in combination with advice, stretching, and exercise
(grade of recommendation – strong).”

Exercise: “Regular home stretching (3-5 times per week) with advice / training is recommended in the treatment of chronic neck pain for long- and short-term benefits in reducing pain and analgesic intake
(grade of recommendation – strong).”

Exercise / Multimodal: “Exercise (including stretching, isometric, stabilization, and strengthening) is recommended for short- and long-term benefits (pain, disability, muscle strength, QoL, cROM) as part of a multimodal approach to the treatment of chronic neck pain when combined with infrared radiation, massage, or other physical therapies
(grade of recommendation – strong).”

Mobilization: “Mobilization is recommended for the treatment of chronic neck pain for short-term (immediate) benefit
(pain, cROM; grade of recommendation – moderate)”

Massage / Multimodal: “Massage is recommended for the treatment of chronic neck pain for short-term (up to 1 month) benefit (pain, disability, and cROM) when provided in combination with self-care, stretching, and/or exercise (grade of recommendation – moderate).”

Manipulation: “Spinal manipulative therapy is recommended in the treatment of chronic neck pain for short- and long-term benefit
(pain, disability; grade of recommendation – weak).”

In their conclusion, the authors note that their findings suggest “interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain” and that “increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.”

There are more articles like this @ our:

Clinical Model for the Diagnosis and Management Page and the:

Chronic Neck Pain and Chiropractic Page

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Chiropractic And Osteoarthritis

By Frank M. Painter|September 27, 2013|Chiropractic Care, Degenerative Joint Disease, Evidence-based Medicine, Osteoarthritis|

Chiropractic And Osteoarthritis

The Chiro.Org Blog

SOURCE: University of Maryland Medical Center

Although the vestiges of medical harassment against chiropractic still resonate, and are now supplanted by fringe web sites which continue to ignore the body of peer-reviewed research supporting chiropractic care, the ice is slowly melting.

Below you can read comments from the University of Maryland Medical Center website , which openly acknowledges the benefits of chiropractic care for patients suffering from the pain of osteoarthritis.

There are many more articles like this @ our:

Degenerative Joint Disease and Chiropractic Page

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An Evidence-based Diagnostic Classification System For Low Back Pain

By Frank M. Painter|September 14, 2013|Evidence-based Medicine, Low Back Pain|

An Evidence-based Diagnostic Classification System For Low Back Pain

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2013 (Sep); 57 (3): 189–204

Robert Vining, DC, Eric Potocki, DC, MS, Michael Seidman, MSW, DC, A. Paige Morgenthal, DC, MS

Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 5433 Bryant Ave, South Minneapolis, MS 55419; dr.potocki@yahoo.com

INTRODUCTION: While clinicians generally accept that musculoskeletal low back pain (LBP) can arise from specific tissues, it remains difficult to confirm specific sources.

METHODS: Based on evidence supported by diagnostic utility studies, doctors of chiropractic functioning as members of a research clinic created a diagnostic classification system, corresponding exam and checklist based on strength of evidence, and in-office efficiency.

RESULTS: THE DIAGNOSTIC CLASSIFICATION SYSTEM CONTAINS ONE SCREENING CATEGORY, TWO PAIN CATEGORIES: Nociceptive, Neuropathic, one functional evaluation category, and one category for unknown or poorly defined diagnoses. Nociceptive and neuropathic pain categories are each divided into 4 subcategories.

CONCLUSION: This article describes and discusses the strength of evidence surrounding diagnostic categories for an in-office, clinical exam and checklist tool for LBP diagnosis. The use of a standardized tool for diagnosing low back pain in clinical and research settings is encouraged.

There’s a lot more material like this @:

Low Back Pain and Chiropractic Page and the

Clinical Model for Diagnosis and Management Page

From the FULL TEXT Article:

Introduction

Health professionals across such disciplines as orthopedics, physical therapy, and chiropractic have shared the goal of categorizing patients with musculoskeletal low back pain (LBP) according to evidence-based classification systems. [1, 2] To this end, several investigators have generated classification systems for LBP diagnosis and treatment. [3–8] Identifying specific pathophysiology causing LBP has the potential to positively impact clinical research and practice by providing opportunities to test, validate or reject treatments targeted at specific diagnoses. [1,2] Clinical prediction rules [4,6] and symptom or treatment-based classification systems [7,8] lack the pathophysiological component(s) clinicians sometimes use to better understand a condition and make clinical decisions. Patho-anatomic diagnoses address pain arising from more specific anatomic structures or pathological processes. However, definitively confirming pain sources for LBP continues to be a challenge.

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Evidence-Based Practice and Chiropractic Care

By Frank M. Painter|August 5, 2013|Chiropractic Education, Evidence-based Medicine|

Evidence-Based Practice and Chiropractic Care

The Chiro.Org Blog

SOURCE: J Evid Based Comp Altern Med. 2012 (Dec 28); 18 (1): 75-79

Ron LeFebvre, MA, DC, David Peterson, DC, and Mitchell Haas, MA, DC

University of Western States,
Portland, OR, USA.

Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.

Introduction

The use of complementary and alternative medicine has increased dramatically during the past several decades. [1, 2] Estimates based on the 2002 National Health Interview Survey reveal that 62.1% of US adults used complementary and alternative medicine therapies during the previous year. [3] Chiropractic is the largest complementary and alternative medicine profession in the United States, with approximately 70 000 members, [4] and chiropractic services account for the greatest number of complementary and alternative medicine visits. [1] In 2002, approximately 7.4% of Americans consulted a chiropractor for treatment. [2] Chiropractic is a well-established part of the health care delivery system, included under Medicare and Medicaid laws, with worker’s compensation coverage in all 50 states. Insurance coverage for chiropractic is also quite extensive. Approximately 50% of health maintenance organizations and 75% of private health insurance plans cover chiropractic care.

You may also enjoy our:

Evidence-based Practice Page

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A Comprehensive Review of Chiropractic Research

By Frank M. Painter|May 14, 2013|Chiropractic Care, Evidence-based Medicine, Spinal Manipulation|

A Comprehensive Review of Chiropractic Research

The Chiro.Org Blog

You will love this Comprehensive Review of Chiropractic Research, by Anthony L. Rosner, Ph.D., Director of Research and Education for the Foundation for Chiropractic Education and Research (FCER) until its demise (1992-2007), and current Director of Research for the International College of Applied Kinesiology (USA).

I. Introduction

A. Perspectives:

In the space of just 115 years from its inception, chiropractic has emerged as the third largest healthcare profession in the United States offering diagnostic as well as therapeutic services to patients. It has reached this lofty height driven by research which has made particularly dramatic strides over the past 30 years, supported by a budget which represents merely an infinitesimal fraction of that applied to medical and pharmaceutical research.

Like all health professions, chiropractic regularly tests the effectiveness, safety, and costs of its approaching health care. Studies continue to show that chiropractors offer the public a viable alternative to invasive healthcare (drugs, surgery) especially in the treatment of musculoskeletal problems such as back, neck, and headache pain. But chiropractic treatments are likewise effective in the treatment of non-musculoskeletal health issues, including infantile colic, enuresis, asthma, dysmenorrheal, otitis media, hypertension, and heart rate variability. And few medical professions outside of chiropractic can offer such healthcare solutions with equal safety and cost records.

Having been historically been placed in the category of “alternative and complementary” medicine, chiropractic because of its rapid growth in its research has now been deemed to have reached the crossroads of mainstream and alternative medicine. [1] As a hybrid, it appears to have successfully incorporated many of the research methodologies of orthodox medicine while striving to maintain its distinct healthcare paradigm. Indeed, when the practitioner’s primary means of patient care and published randomized clinical trials supporting that intervention are matched, chiropractic can be shown to enjoy a higher percentage of interventions thus supported when compared to such other medical disciplines as general practice, inpatient general surgery, dermatology, or hematology-oncology. [2] In other words, chiropractic can now claim to have attained at least as much of a scientific grounding as other medical interventions based upon its research.

So what is it that one means by chiropractic research? The research related to the practice of chiropractic, to be reviewed in this chapter, has been presented in multiple dimensions, including:

Published clinical articles;
Literature reviews;
Surveys and public opinion research;
Analyses of insurance claims [actuarial research]; and
Guidelines

B. First major interdisciplinary cohort study:

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For CAs: The Language of the Health-Care Professions

By Frank M. Painter|March 31, 2013|Chiropractic Care, Chiropractic Education, Education, Evidence-based Medicine|

For CAs: The Language of the Health-Care Professions

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 4 from RC’s best-selling book:
“The Chiropractic Assistant”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 4: The Language of the Health-Care Professions

When more than one person is involved in any task, good communication is basic for success. Thus, a sound foundation in chiropractic terminology is an important functional skill to be possessed by any chiropractic assistant. It is a requisite to becoming an important asset to the office.

If a CA’s duties include taking dictation of case histories, examination findings, or narrative reports, she must know how to record scientific terms in shorthand and know how to spell them accurately. A good medical dictionary will be an important reference. Even if dictation is not required, she still must know what the doctor means when certain terms are used. He will expect his assistants to have a fundamental grasp of commonly used medical terms, abbreviations, and acronyms.

Do not enter this study lightly. On the other hand, do not let yourself be appalled by the formidable and specialized vocabulary used in health care. The learning of professional terms will not come overnight. It will extend the entire length of your career as new and unfamiliar words are confronted.

THE UNIVERSAL LANGUAGE OF HEALTH CARE: WHY IT IS NECESSARY

It would not be unusual if you found many words used in the first three chapters of this program strange or at least unknown. When you undertake the transposition from lay person to chiropractic assistant, you are faced with an entirely new language that must be mastered so the transition be successful. The most efficient method to accomplish this is by securing an understanding of basic word roots, prefixes, and suffixes used in the formation of technical words and gaining an understanding of the meaning of commonly used abbreviations and acronyms. Study and repetitive use is the way to mastery.

A fundamental knowledge of anatomy (structure) and physiology (function) will be of great assistance in learning terminology. A basic understanding of human anatomy and physiology is offered in the following chapter. This chapter will prepare you for the terminology of those and other clinical subjects. While professional terms may at first seem strange, you will see their purpose in this and following chapters.

PHONETICS: THE QUICK WAY TO GRASP MEANINGS (more…)

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