Low Back Pain

New LBP Study Reveals Chiropractic Is Superior to PT and MD Care

By Frank M. Painter|March 17, 2011|Low Back Pain, Physical Therapy, Research|

New LBP Study Reveals Chiropractic Is Superior to PT and MD Care

SOURCE: J Occupational and Enviro Medicine 2011 (Mar 14)

Cifuentes M, Willetts J, Wasiak R.

The Center for Disability Research at the Liberty Mutual Research Institute for Safety

This study is unique in that it was conducted by the Center for Disability Research at the Liberty Mutual Research Institute for Safety and the University of Massachusetts Lowell, Hopkinton, Mass; and the Center for Health Economics & Science Policy at United BioSource Corporation, London, United Kingdom.

Their objective was to compare the occurrences of repeated disability episodes between types of health care providers, who treat claimants with new episodes of work-related low back pain (LBP). They followed 894 patients over 1-year, using workers’ compensation claims data.

By controlling for demographics and severity, they determined the hazard ratio (HR) for disability recurrence between 3 types of providers:
Physical Therapists (PT),
Physicians (MD), and
Chiropractors (DC).

The results are quite interesting: (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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Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas

By Frank M. Painter|February 24, 2011|Cost-Effectiveness, Low Back Pain, Research|

Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas

The Chiro.Org Blog

SOURCE: MGT of America, Austin, Texas ~ February 2003

In 2002, the Texas Chiropractic Association (TCA) commissioned an independent study to determine the use and effectiveness of chiropractic with regard to workers’ compensation, the results of which were published in February 2003. According to the report, chiropractic care was associated with significantly lower costs and more rapid recovery in treating workers with low-back injuries.

They found:

Lower back and neck injuries accounted for 38 percent of all claims costs.

Chiropractors treated about 30 percent of workers with lower back injuries, but were responsible for only 17.5 percent of the medical costs and 9.1 percent of the total costs.

These findings were even more intertesting:

The average claim for a worker with a low-back injury was $15,884. However, if a worker received at least 75 percent of his or her care from a chiropractor, the total cost per claimant decreased by nearly one-fourth to $12,202.

If the chiropractor provided at least 90 percent of the care, the average cost declined by more than 50 percent, to $7,632.

Doctors of chiropractic have been licensed to practice in Texas since 1949 and have been a fundamental part of the state’s workers’ compensation system since 1953. Each year, Texas DCs treat tens of thousands of injured workers, but until recently, little data were available comparing the cost-effectiveness and efficacy of chiropractic versus other forms of care available through the workers’ compensation program.

(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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Newly Published Study Confirms That “Maintenance Care” Delivers!

By Frank M. Painter|January 26, 2011|Cost-Effectiveness, Low Back Pain, Research|

Newly Published Study Confirms
That “Maintenance Care” Delivers!

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976) 2011 (Aug 15); 36 (18): 1427-37

Senna, Mohammed K. MD; Machaly, Shereen A. MD

Shereen A. Machaly, MD,
Rheumatology and Rehabilitation Department,
Mansoura Faculty of Medicine,
Mansoura University, Mansoura, Egypt;
shmach_237@hotmail.com

This new, single blinded placebo controlled study, conducted by the Faculty of Medicine at Mansoura University, conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain. [1]

The authors concluded that spinal manipulation is effective for the treatment of chronic nonspecific LBP and that to obtain long-term benefit for the patient, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy can provide that additional benefit.

BACKGROUND: Spinal manipulation (SMT) is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP previously, but the efficacy of maintenance SMT in chronic non-specific LBP has never been studied. (more…)

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SPECT/CT Imaging of the Lumbar Spine in Chronic Low Back Pain

By Frank M. Painter|January 11, 2011|Low Back Pain, SPECT/CT Imaging|

SPECT/CT Imaging of the Lumbar Spine in Chronic Low Back Pain

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2011 (Jan 11) ~ FULL TEXT

Michael H. Carstensen, Mashael Al-Harbi,
Jean-Luc Urbain, Tarik-Zine Belhocine

Department of Medical Imaging, St Joseph´s Hospital,
268 Grosvenor Street, N6A 4V2, London, Ontario, Canada

Abstract

Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localization to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.

Background

The concept of lumbar facet joints causing or contributing to mechanical low back pain syndromes has been debated in the health care literature for decades [1]. Practitioners of the various manual therapies commonly treat patients presenting with low back pain but are faced with the diagnostic challenge of trying to identify a tissue source of low back pain. While this complaint may be the result of any of a number of pathologies, the vast majority of low back pain falls under the diagnostic umbrella of ‘‘ mechanical low back pain ’’ [2]. We present here the case of a patient with radiological signs of marked lumbosacral junction facet joint osteoarthrosis and clinical symptoms supportive of pathology in this region but with SPECT/CT findings suggestive of an active bony lesion at a more remote spinal segment.

There are more articles like this @ our:

Chiropractic Radiology Section

(more…)

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