Evidence-based Practice

Conservative Management of Cervicogenic Dizziness Associated With Upper Cervical Instability and Postural Orthostatic Tachycardia Syndrome: A Case Report

By Frank M. Painter|December 9, 2024|Cervicogenic Dizziness, Chiropractic Care, Evidence-based Practice|

Conservative Management of Cervicogenic Dizziness Associated With Upper Cervical Instability and Postural Orthostatic Tachycardia Syndrome: A Case Report

SOURCE: Cureus 2024 (Oct 31); 16 (10): e72765

Robert J Trager • Andres Schuster • Cliff Tao • Gina Zamary

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, USA.

OPEN ACCESS

Cervicogenic dizziness (CGD) is a disorder in which dizziness arises from cervical spine dysfunction and is diagnosed after excluding other conditions. We present a case of a 27–year-old woman with a six-year history of dizziness, neck and cervicothoracic pain, and occipital-temporal-orbital headaches. The patient also experienced occasional severe, incapacitating episodes of dizziness with vomiting. Previous evaluations, including advanced imaging, had helped rule out central, otolithic, and psychogenic causes of dizziness. Dynamic radiographs revealed signs of lateral instability of C1 while tilt table testing revealed postural orthostatic tachycardia syndrome (POTS). Over eight months, the patient underwent a regimen of gentle manual therapies and cervical stability exercises. The patient’s dizziness substantially improved, as measured by the Dizziness Handicap Inventory (DHI), with scores reducing from 50 (moderate handicap) to 10 (less than mild handicap). This case highlights the importance of considering cervical spine dysfunction and associated conditions like POTS in the differential diagnosis of chronic dizziness. While conservative management including manual therapy appeared effective in this case for CGD with underlying upper cervical instability and POTS, additional research is needed on this topic.

Keywords: case reports; cervical vertebrae; chiropractic; dizziness; headache; joint instability; neck pain; postural orthostatic tachycardia syndrome; rehabilitation.

From the FULL TEXT Article:

Introduction

Dizziness is a non-specific term used to describe various sensations, including lightheadedness, unsteadiness, or a spinning feeling. Its utility as a diagnostic term is limited due to its broad nature, necessitating a thorough assessment of the patient’s history and examination for an accurate diagnosis. [1] Dizziness is typically evaluated based on its timing, associated triggers, and symptom subtypes. For instance, benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, accounting for approximately 24% of cases, presents with brief episodes of rotatory dizziness triggered by head movements. [1, 2] Other subtypes of dizziness may arise from vestibular, vascular, or psychogenic sources, with less frequent causes including Meniere’s disease, vestibular neuritis, and others. [2]

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Chiropractic, One Big Unhappy Family?

By Frank M. Painter|September 10, 2019|Evidence-based Practice|

Chiropractic, One Big Unhappy Family: Better Together or Apart?

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2019 (Feb 21); 27: 4

Charlotte Leboeuf-Yde, Stanley I. Innes, Kenneth J. Young, Gregory Neil Kawchuk and Jan Hartvigsen

Institute for Regional Health Research,
University of Southern Denmark, DK-5000
Odense C, Denmark.

Editorial Comment:

It’s with heavy heart that I realize that it’s all come down to this: chiropractic depicted as a bad soap-opera marriage.

What is more upsetting is that this article is penned by some of the best, brightest and most-published of our chiropractic researchers. I love these folks!

That said, I’d like to challenge some of their assumptions. Chiropractic is not a marriage between chiropractors. At best, it’s a Family.

And families interact. I just might marry your sister, for example.

Now you may not like me, or you may not like our marriage. But that’s a personal problem.

The word Evidence has taken on a sacred-cow glow lately, and is only eclipsed by the adoption of the word skeptic by every Tom, Dick and Harry blog-opinionist/critic on the planet. So, let’s set the stage for the conversation.

This article dishes up several reasons why (as they call themselves) the ‘evidence-friendly’ faction are opposed to the ‘traditional’ group.

Here’s a short list of the infractions that are practiced by the ‘traditionalists’

They ‘believe’ in “subluxations”
Some of them ‘believe’ that you can find “subluxations” on x-rays
Some of them ‘believe’ that correcting “subluxations” leads to improved health

So let’s address these concerns, one at a time.

The Medicare and Medicaid definition of “subluxations” is:

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Evidence-informed Management of Chronic Low Back Pain

By Frank M. Painter|June 11, 2018|Evidence-based Practice|

Evidence-informed Management of Chronic Low Back Pain with Spinal Manipulation and Mobilization

The Chiro.Org Blog

SOURCE: Spine J. 2008 (Jan); 8 (1): 213–225

Gert Bronfort, DC, PhDa, Mitch Haas, DC, MA, Roni Evans, DC, MS, Greg Kawchuk, DC, PhD, Simon Dagenais, DC, PhD

Northwestern Health Sciences University,
2501 W 84th St,
Bloomington, MN 55431, USA.

The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence Informed Management of Chronic Low Back Pain Without Surgery.

Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

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International Web Survey of Chiropractic Students

By Frank M. Painter|August 6, 2017|Evidence-based Practice|

International Web Survey of Chiropractic Students About Evidence-based Practice: A Pilot Study

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2011 (Mar 3); 19 (1): 6

Ryunosuke Banzai, Dustin C Derby, Cynthia R Long
and Maria A Hondras

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street, Davenport, IA 52803-5209, USA.

BACKGROUND: Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles.

METHODS: We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis.

RESULTS: Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9).

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Knowledge Transfer within the Canadian Chiropractic Community

By Frank M. Painter|April 10, 2017|Chiropractic Care, Evidence-based Practice, Guidelines|

Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2014 (Sep); 58 (3): 206–214

Greg Kawchuk, DC, MSc, PhD, Genevieve Newton, DC, PhD,
John Srbely, DC, PhD, Steven Passmore, Hons BKin, DC, PhD,
André Bussières, DC, FCCS (C), Jason W. Busse, DC, PhD,
and Paul Bruno, BHK, DC, PhD

Associate Professor and Canada Research Chair
in Spinal Function,
Faculty of Rehabilitation Medicine,
University of Alberta

Introduction

This two-part commentary aims to provide clinicians with a basic understanding of knowledge translation (KT), a term that is often used interchangeably with phrases such as knowledge transfer, translational research, knowledge mobilization, and knowledge exchange. [1] Knowledge translation, also known as the science of implementation, is increasingly recognized as a critical element in improving healthcare delivery and aligning the use of research knowledge with clinical practice. [2] The focus of our commentary relates to how these KT processes link with evidence-based chiropractic care.

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Self-reported Attitudes, Skills and Use of Evidence-based Practice

By Frank M. Painter|March 25, 2017|Evidence-based Practice|

Self-reported Attitudes, Skills and Use of Evidence-based Practice Among Canadian Doctors of Chiropractic: A National Survey

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2015 (Dec); 59 (4): 332–348

André E. Bussières, DC, PhD, Lauren Terhorst, PhD,
Matthew Leach, RN, BN (Hons), ND, PhD,
Kent Stuber, DC, MSc, Roni Evans, DC, PhD, and
Michael J. Schneider, DC, PhD

Assistant Professor,
School of Physical and Occupational Therapy,
McGill University
Département Chiropratique,
Université du Québec à Trois-Rivières.

OBJECTIVES: To identify Canadian chiropractors’ attitudes, skills and use of evidence based practice (EBP), as well as their level of awareness of previously published chiropractic clinical practice guidelines (CPGs).

OBJECTIVES: 7,200 members of the Canadian Chiropractic Association were invited by e-mail to complete an online version of the Evidence Based practice Attitude & utilisation SurvEy (EBASE); a valid and reliable measure of participant attitudes, skills and use of EBP.

RESULTS: Questionnaires were completed by 554 respondents. (7.7% of those invited) Most respondents (>75%) held positive attitudes toward EBP. Over half indicated a high level of self-reported skills in EBP, and over 90% expressed an interest in improving these skills. A majority of respondents (65%) reported over half of their practice was based on evidence from clinical research, and only half (52%) agreed that chiropractic CPGs significantly impacted on their practice.

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