Research

Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study

By John Wiens DC|September 16, 2013|Research|

Kevin J Lyons, Stacie A Salsbury, Maria A Hondras, Mark E Jones, Andrew A Andresen and Christine M Goertz

BMC Complementary and Alternative Medicine 2013, 13:225

Provisional Abstract

Background

While older adults may seek care for low back pain (LBP) from both medical doctors (MDs) and doctors of chiropractic (DCs), co-management between these providers is uncommon. The purposes of this study were to describe the preferences of older adults for LBP co-management by MDs and DCs and to identify their concerns for receiving care under such a treatment model.

Methods

We conducted 10 focus groups with 48 older adults who received LBP care in the past year. Interviews explored participants’ care seeking experiences, co-management preferences, and perceived challenges to successful implementation of a MD-DC co-management model. We analyzed the qualitative data using thematic content analysis.

Results

Older adults considered LBP co-management by MDs and DCs a positive approach as the professions have complementary strengths. Participants wanted providers who worked in a co-management model to talk openly and honestly about LBP, offer clear and consistent recommendations about treatment, and provide individualized care. Facilitators of MD-DC co-management included collegial relationships between providers, arrangements between doctors to support interdisciplinary referral, computer systems that allowed exchange of health information between clinics, and practice settings where providers worked in one location. Perceived barriers to the co-management of LBP included the financial costs associated with receiving care from multiple providers concurrently, duplication of tests or imaging, scheduling and transportation problems, and potential side effects of medication and chiropractic care. A few participants expressed concern that some providers would not support a patient-preferred co-managed care model.

Conclusions

Older adults are interested in receiving LBP treatment co-managed by MDs and DCs. Older adults considered patient-centered communication, collegial interdisciplinary interactions between these providers, and administrative supports such as scheduling systems and health record sharing as key components for successful LBP co-management.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

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Havard’s School of Public Health and Medical School sponsoring their course in clinical trials for FREE.

By stevev|June 9, 2013|Education, Ethics, Medicine, Public Health, Randomized Controlled Trial, Research|

HSPH-HMS214X Fundamentals of Clinical Trials is just one of the courses offered at www.edx.org.

Ever wonder what it would be like to take a course offered at an Ivy League University? Wonder no more! Harvard is part of a consortium of the most prestigious Universities in the world that is offering MOOC‘s (Massive Open Online Courses). There are no costs involved in taking a MOOC and you get all the same information that you would in an on ground course. The only differences are that you don’t get the instructor (or even TA’s) grading your papers nor will you get college credit on a transcript from Harvard. They are however the same information used in the universities’ on ground for-credit courses that can cost thousands of dollars.

MOOC’s typically use open source materials (available at no charge for personal use) and a type of self grading system based off of discussion forums in the course (It is totally up to the professor how that is handled, so it will vary depending on the course and instructor). They are a combination of one answer to cutting high educational and making it available to everyone.

The course begins October 14, 2013, runs a total of 13 weeks and depending on your background will take between 4-6 hours of your time each week. A background in biostatistics and epidemiology equivalent to the content of PH207X Health in Numbers: Quantitative Methods in Clinical & Public Health Research.

From the course site;

“This course will provide an introduction to the scientific, statistical, and ethical aspects of clinical trials research. Topics include the design, implementation, and analysis of trials, including first-in-human studies (dose-finding, safety, proof of concept, and Phase I), Phase II, Phase III, and Phase IV studies. All aspects of the development of a study protocol will be addressed, including criteria for the selection of participants, treatments, and endpoints, randomization procedures, sample size determination, data analysis, and study interpretation. The ethical issues that arise at each phase of therapy development will be explored.”

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McMaster chiropractic working group aims to further health research and interdisciplinary care

By John Wiens DC|April 24, 2013|Research|

Source The Vancouver Sun

by Dr Don Nixdorf

Research is key to developing better treatments and care protocols to eliminate disease and stay healthy. The chiropractic profession is fortunate to have twelve Canadian Chiropractic Research Foundation (CCRF) research chairs in major universities across the country, each of which conducts and contributes to world class research. But the more significant benefits to weaving these research chairs into the fabric of academia are the interdisciplinary connections and collaborations that result. There is no other time in history where we have seen so many different health professions coming together with one common goal: improving healthcare.

When many different health professionals work together, patients routinely experience better care and are on average better prepared to care for themselves. There are several examples of this in practice already. St. Michael’s Hospital in Toronto uses a multi-disciplinary approach to treat and manage back pain. Community health clinics with nurse practitioners, dentists, nutritionists and several other health care providers are peppered throughout Canada and experience tremendous success in the amount of patients they can treat and the quality of the care that is delivered. Let’s also not forget our amazing Canadian athletes who benefit from a team healthcare approach. It makes perfect sense that patients benefit from having multiple perspectives of expertise that work together to treat the whole person, not just the corner of their body with a problem.

In an effort to gain further momentum to this type of approach and increase collaboration in the academic community, several chiropractic doctors out of McMaster University came together to form the McMaster Chiropractic Working Group in 2009. Dr. Steven Passmore DC, PhD, a researcher from the University of Manitoba is one of the founding members of this group that aims to raise the profile of chiropractic in the university setting through credible research and collaborative efforts. With the exception of the CCRF researchers in universities, chiropractic education and advancement is primarily through chiropractic schools and funded almost entirely by chiropractic doctors. Even after earning his PhD from McMaster in 2012, Dr. Passmore continues to be a part of this initiative that is setting an example for others across the country. BC is already investigating the potential of a local working group based on the McMaster model. (more…)

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Is sunlight good for our heart?

By John Wiens DC|February 18, 2013|Research|

Source European Heart Journal

Humans evolved being exposed for about half of the day to the light of the sun. Nowadays, exposure to sunlight is actively discouraged for fear of skin cancer, and contemporary lifestyles are associated with long hours spent under artificial light indoors. Besides an increasing appreciation for the adverse effects of these life-style-related behavioural changes on our chronobiology, the balance between the beneficial and harmful effects of sunlight on human health is the subject of considerable debate, in both the scientific and popular press, and the latter is of major public health significance. While there is incontrovertible evidence that ultraviolet radiation (UVR) in the form of sunlight is a significant predisposing factor for non-melanoma and melanoma skin cancers in pale skinned people, a growing body of data suggest general health benefits brought about by sunlight.

The researchers propose that many of the beneficial effects of sunlight, particularly those related to cardiovascular health, are mediated by mechanisms that are independent of melatonin, vitamin D, and exposure to UVB alone. Specifically, they suggest that the skin is a significant store of nitric oxide (NO)-related species that can be mobilized by sunlight and delivered to the systemic circulation to exert coronary vasodilator and cardioprotective as well as antihypertensive effects. They further hypothesize that this dermal NO reservoir is a product of local production and dietary supply with nitrate-rich foods.

The full article (pdf) is available on the European Heart Journal website.

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Vertebral artery strains during high-speed, low amplitude cervical spinal manipulation.

By John Wiens DC|November 23, 2012|Research|

J Electromyogr Kinesiol . 2012 Oct;22(5):740-6. doi: 10.1016/j.jelekin.2012.03.005. Epub 2012 Apr 5.

Herzog W, Leonard TR, Symons B, Tang C, Wuest S.

Abstract

Spinal manipulative therapy (SMT) has been recognized as an effective treatment modality for many back, neck and musculoskeletal problems. One of the major issues of the use of SMT is its safety, especially with regards to neck manipulation and the risk of stroke. The vast majority of these accidents involve the vertebro-basilar system, specifically the vertebral artery (VA) between C2/C1. However, the mechanics of this region of the VA during SMT are unexplored. Here, we present first ever data on the mechanics of this region during cervical SMT performed by clinicians. VA strains obtained during SMT are significantly smaller than those obtained during diagnostic and range of motion testing, and are much smaller than failure strains. We conclude from this work that cervical SMT performed by trained clinicians does not appear to place undue strain on VA, and thus does not seem to be a factor in vertebro-basilar injuries.

The October 2012 issue is devoted to the study of spinal manipulation.

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Chiropractic May Reduce Deaths And Injuries From Falls Among Older People

By John Wiens DC|July 20, 2012|Research|

Chiropractic care for older people may reduce deaths and injuries from falls according to researchers taking part in a study by Auckland University and the Chiropractic Research Centre (CRC) at the New Zealand College of Chiropractic on the neurophysiological effects of chiropractic on the brain.

According to chiropractor, PhD candidate and principal investigator of the study Dr Kelly Holt, falls often occur due to a decline in nervous system function with advancing age. This can lead to a loss of balance, or poor control of the limbs, which dramatically increases the risk of falling.

Dr Holt says: `Already it is estimated that in New Zealand slips, trips and falls cost almost $300 million per year in treatment and rehabilitation costs and as the population ages this will likely get worse.’ He says that ‘falls result in approximately 450 deaths per year in New Zealand and for older adults in particular, a fall can lead to a downward spiral that involves a loss of confidence, a cessation of day to day activities and eventually increased frailty and even death.’

ABSTRACT: The Effects of Manual Therapy on Balance and Falls: A Systematic Review
Journal of Manipulative and Physiological Therapeutics March/April 2012, Holt et al

Objective

The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.

Methods

This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.

Results

Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.

Conclusion

A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.

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