Evidence-based Medicine

Primary Spine Care Practitioners

By Frank M. Painter|July 22, 2011|Evidence-based Medicine|

Primary Spine Care Practitioners

SOURCE: Chiropractic & Manual Therapies 2011 (Jul 22); 19: 17 ~ FULL TEXT

The following is an interesting and well crafted article that posits yet another fanciful way to bring chiropractic “out of the closet”. I do have some issues with a few of Dr. Murphy’s recommendations, however:

1. In the Necessary Skill Set section of the article under point#2, he states that the “primary spine care practitioner” would employ those methods shown to be evidence-based, minimally invasive and cost-effective…one of them being the prescription of non-steroidal anti-inflammatory and non-opioid analgesics to their patients.

Our Iatrogenic Injury Page contains numerous articles detailing how NSAIDs and other analgesics are associated with the death of tens of thousands of people every year, for solely relying on them for pain relief. I just don’t see me EVER recommending them.

This is a genuine scientific conundrum:
how can anything that kills that many people still be referred to as “evidence-based”?

UPDATE: (2-14-17) The Annals of Internal Medicine pre-published a new article titled:

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain:
A Clinical Practice Guideline From the American College of Physicians

and in it the authors stated:

The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.

2. In the Obstacles To The Implementation section under point#5, Dr. Murphy states that “For whatever profession or professions that respond to the need for a primary spine care practitioner, this will be a significant disruption to the traditional practice patterns or self-image of these professions. As a result, the role that we are introducing here will be actively resisted”. Oh how true!

When you look closely at the “expanded practice” movement, the first thing I noticed was that this movement is being promoted by the chiropractic schools that have the lowest enrollment of students.

I suspect that they are hoping to (or already have) developed an “expanded practice” program that will attract more students, and that’s understandable, if expanding your income is your primary objective.

3. Finally, there is the subtle hint that becoming an “expanded practice chiropractor” (or “medi-practor”) will increase the doctor’s “market share”. That may even be true. But, if that also means embracing the kind of evidence-based care that kills thousands every year, I say “No thank you, sir”.

Please don’t get me wrong: I have tremendous respect for Dr. Murphy and the other authors of the following article.

This article is very well written and logical… up to a point. I am posting it on our blog because I agree that our profession needs to review this material and see if and how it can be tweaked. Most of their suggestions are valid. I just don’t see the need to grab for prescription rights….not when there’s such considerable scientific evidence for recommending Omega-3 fatty acids for pain relief.

I hope you will enjoy the following new article:

The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States (more…)

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A Systematic Review of Chiropractic Management of Adults With Whiplash Associated Disorders

By Frank M. Painter|June 1, 2011|Evidence-based Medicine, Whiplash|

A Systematic Review of Chiropractic Management of Adults with Whiplash Associated Disorders: Recommendations for Advancing Evidence-based Practice and Research

The Chiro.Org Blog

SOURCE: Journal of the Academy of Chiropractic Orthopedists 2011 (Mar); 8 (1)

By: Lynn Shaw, Martin Descarreaux, Roland Bryans, Mireille Duranleau, Henri Marcoux, Brock Potter, Rick Ruegg, Robert Watkin, Eleanor White

The literature relevant to the treatment of Whiplash Associated Disorders (WAD) is extensive and heterogeneous.

Methods: A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic Review to address a general question: ‘Does chiropractic management of WAD clients have an effect on improving health status?’ A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence.

Results: The initial search identified 1155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. For the review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: The WAD-Plus Model.

Conclusions: There is a baseline of evidence that suggests chiropractic care improves the cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, sub-acute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advanced evidenced-based care in the management of WAD.

There are more articles like this @ our:

Whiplash Page

The FULL TEXT Article:

Background

(more…)

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Chiropractic Goes To The Hospital

By Frank M. Painter|March 6, 2011|Evidence-based Medicine, Guidelines, Low Back Pain|

Chiropractic Goes To The Hospital

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2011 (Feb); 34 (2): 98–106

Paskowski I, Schneider M, Stevans J, Ventura JM, Justice BD.

Medical Back Pain Program,
Jordan Hospital,
Plymouth, Mass

This hospital-based study is interesting for several reasons:

First, they utilized an evidence-based program for treating low back pain (LBP)
Based on that evidence, they assigned 83% of those who sought care to chiropractic management.
Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, and
95% of those patients rated their care as “excellent.”

OBJECTIVE: A health care facility (Jordan Hospital) implemented a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. The purpose of this report is to describe the implementation and results of a multidisciplinary, evidence-based, standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.

METHODS: A standardized SCP was developed to improve the quality of back pain care. The NCQA BPRP provided the framework for the SCP to determine the standard of quality care delivered. Patients were triaged, and suitable patients were categorized into 1 of 5 classifications based upon history and examination, directional exercise flexion or “extension biases,” spinal manipulation, traction, or spinal stabilization exercises.

RESULTS: The findings for 518 consecutive patients were included. One hundred sixteen patients (10%) were seen once and triaged to specialty care; 7% of patients received magnetic resonance imagings. Four hundred thirty-two patients (83%) were classified and treated by doctors of chiropractic and/or physical therapists. Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, mean intake pain rating score of 6.2 of 10, and mean discharge score of 1.9 of 10; 95% of patients rated their care as “excellent.” (more…)

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The Mythology Of Evidence-Based Medicine

By Frank M. Painter|February 25, 2011|Evidence-based Medicine, News|

The Mythology Of Evidence-Based Medicine

The Chiro.Org Blog

SOURCE: The Huffington Post ~ 2-25-2011

Dr. Larry Dossey, Deepak Chopra and Dr. Rustum Roy

The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

One side, mainstream medicine, promotes the notion that it alone should be considered “real” medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it’s dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.

If a pill or surgery won’t do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.

The British Medical Journal recently undertook an general analysis of common medical treatments to determine which are supported by sufficient reliable evidence. They evaluated around 2,500 treatments, and the results were as follows:

* 13 percent were found to be beneficial (more…)

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Chiropractic Care Plans for Common Low Back Conditions

By Frank M. Painter|February 3, 2011|Care Plans, Evidence-based Medicine, Low Back Pain, Research|

Chiropractic Care Plans for Common Low Back Conditions

The Chiro.Org Blog

SOURCE: Chiropractic Technique 1993 (Aug); 5 (3): 119-125

by Robert D. Mootz, D.C. and V. Thomas Waldorf, D.C.

Our thanks to Robert D. Mootz, D.C. and to Dana Lawrence, D.C., the editor of Chiropractic Technique, for permission to reprint this FULL-TEXT article article, and its extensive collection of Care Plans, exclusively at Chiro.Org

A detailed description of chiropractic care parameters used at a large occupational medicine center is presented. The algorithms were derived from clinical needs of the facility, expert opinion, and reviews of several contemporary written protocols. Twelve of the most common industrially related low back conditions are included. The algorithms are grouped according to nondiscogenic and discogenic conditions. The guidelines are consistent with many third party chiropractic review policies, as well as the recently published Chiropractic Quality Assurance Guidelines and Practice Parameters. The first algorithm is based on uncomplicated joint dysfunction, and is considered the base algorithm. Other, more complicated conditions follow, and a preface is included for each describing specific issues relevant to each condition. The purpose of these algorithms was to help standardize care in the clinic, to foster interdisciplinary communication, and to provide consistency in administration for research purposes.

Occupational Low back injuries make up a major component of industrial expenditures in the United States. [1] A number of retrospective studies have suggested that conservative chiropractic management may be more cost effective than other approaches. [2-3] Although a number of general practice guidelines have been developed [4-6], none have (yet) provided “condition specific” guidelines. (more…)

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