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Possible Adverse Events in Children Treated By Manual Therapy: A Review

By Frank M. Painter|May 28, 2014|Adverse Events, Chiropractic Care, Pediatrics, Uncategorized|

Possible Adverse Events in Children Treated By Manual Therapy: A Review

SOURCE: Chiropractic & Osteopathy 2010 (Jun 2); ; 18: 12 ~ FULL TEXT

B Kim Humphreys

Professor Chiropractic Medicine, University of Zürich and
University Orthopedic Hospital Balgrist,
Forchstrasse 340, 8008 Zürich, Switzerland.
kim.humphreys@balgrist.ch

Background Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood.

Objective To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation.

Methods A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy.

Results Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available.

There are more articles like this @ our:

Chiropractic Pediatrics Page

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A Remberance of War on Veteran’s Day

By Frank M. Painter|November 11, 2013|Memorial, Uncategorized|

A Remberance of War on Veteran’s Day

The Chiro.Org Blog

SOURCE: Poetry of the Viet Nam War

By Pete “the Greek” Agriostathes & Paul Cameron

We Regret to Inform You

Dear parents of the deceased
We regret to inform you of this release
Your son was mortally wounded in combat
His valor in finest tradition and all that

Dear wife and children of this brave man
We regret to inform you of this telegram
Your husband and father killed by sniper fire
He was aiding the wounded until he expired

Dear America, home of our war dead,
We regret to inform you about all this bloodshed
For their gallantry under hostile action are sent
These silver stars and medals from the President

Dear combat comrades of these dear fallen men
We regret to inform you that your memories never end
The sights and sounds of their death keep pounding away
Their names carved on a wall as you kneel down to pray

– Paul Cameron –
1st Inf. Div.

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HIPAA GETS AN UPDATE: What You Need to Know Now

By Frank M. Painter|November 1, 2013|HIPAA, Uncategorized|

HIPAA GETS AN UPDATE: What You Need to Know Now

The Chiro.Org Blog

SOURCE: ACA News ~ November 2013

By Julie Lenhardt, Sr. Director, Insurance Advocacy

POP QUIZ: Do you know why Sept. 23, 2013, was significant for covered entities?

It’s because Sept. 23 was the date by which covered entities must be compliant with the new portions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that were added when the omnibus rule was finalized in January. What do you need to do in order to be compliant? ACA will help you answer that question and will provide you with the resources you need to be compliant.

The following steps are recommended, at a minimum. These suggestions do not take into consideration state provisions that may be more stringent than the federal regulations. Certainly, guidance should always be sought from your attorney, and your malpractice carrier may also offer some assistance as well.

(Note: If you are not sure you are a covered entity, you may check the Centers for Medicare and Medicaid Services website)

STEP 1: Update your clinic’s
Notice of Privacy Practices (NPP) –
The Omnibus Rule made several changes to how and when providers must get patient authorization to release Protected Health Information (PHI). The changes need to be reflected in a covered entity’s NPP.

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A Canadian Lawyer’s Rant

By Frank M. Painter|October 18, 2013|Editorial, Uncategorized|

A Canadian Lawyer’s Rant

The Chiro.Org Blog

SOURCE: A Chiro.Org Editorial about Canadian Family Physcian 2013(Oct); 59 (10): 1052

After reading the first 2 paragraphs of this… what… letter to the editor? … I had some thoughts…

As an attorney and advocate for patient safety, I believe the authors of the Motherisk article that appeared in the August 2013 issue of Canadian Family Physician give an insufficient account of the risks that might be associated with chiropractic treatment of pregnant patients. [1]

Many chiropractors continue to base their treatments on the “detection” and “correction” of “subluxations,” ill-defined and unproven spinal lesions unknown to the medical profession. Nevertheless, chiropractors “adjust” these subluxations with any number of treatments, including manual therapy. Thus, the physician whose patient is receiving manual therapy from a chiropractor might be wholly unaware that the chiropractor is actually adjusting these nonexistent subluxations. These adjustments cannot effectively treat back pain or any other condition or disease.

Have we been hoist on our own petard?

I love how this author ramps up his misinformation campaign, stating that the subluxation is: first

ill-defined…then

unproven, and their final death stroke:

nonexistent.

Then, emboldened, he crows that:

“These adjustments cannot effectively treat back pain”

At this point, I am rolling in the aisles!

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The Nordic Maintenance Care Program: What Is Maintenance Care? Interview Based Survey of Danish Chiropractors

By Frank M. Painter|August 21, 2013|Maintenance Care, Medical Necessity, Uncategorized|

The Nordic Maintenance Care Program: What Is Maintenance Care? Interview Based Survey of Danish Chiropractors

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2013 (Aug 20); 21: 27

Corrie Myburgh, Dorthe Brandborg-Olsen, Hanne Albert and
Lise Hestbaek

Institute of Sports Science and Clinical Biomechanics,
Nordic Institute for Chiropractic and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark

Objective To describe and interpret Danish Chiropractors’ perspectives regarding the purpose and rationale for using MC (maintenance care), its content, course and patient characteristics.

Methods Semi-structured interviews were conducted with 10 chiropractors identified using a stratified, theoretical sampling framework. Interviews covered four domains relating to MC, namely: purpose, patient characteristics, content, and course and development. Data was analysed thematically.

Results Practitioners regard MC primarily as a means of providing secondary or tertiary care and they primarily recommend it to patients with a history of recurrence. Initiating MC is often a shared decision between clinician and patient. The core elements of MC are examination and manipulation, but exercise and general lifestyle advice are often included. Typically, treatment intervals lie between 2 and 4 months. Clinician MC practices seem to evolve over time and are informed by individual practice experiences.

Chiropractors are more likely to offer MC to patients whose complaints include a significant muscular component. Furthermore, a successful transition to MC appears dependent on correctly matching complaint with management. A positive relationship between chiropractor and patient facilitates the initiation of MC. Finally; MC appears grounded in a patient-oriented approach to care rather than a market-oriented one.

Conclusions MC is perceived as both a secondary and tertiary preventative measure and its practice appears grounded in the tenet of patient-oriented care. A positive personal relationship between chiropractor and patient facilitates the initiation of MC. The results from this and previous studies should be considered in the design of studies of efficacy.

There are many similar studies in our new

Maintenance Care, Wellness and Chiropractic Page

From the Full-Text Article:

Background

Maintenance care (MC) is used by chiropractors to treat patients who are no longer in an acute state of pain; the purpose being to prevent recurrence of episodic conditions (secondary prevention) and/or maintain a desired level of function (tertiary prevention). The concept is frequently used among chiropractors [1,2] and limited evidence suggests that, among workers with work-related back pain, MC in chiropractic practice appears to decrease the recurrence rate [3]. However, according to two literature reviews, very limited evidence regarding the definitions, purpose and content of MC is currently available [4,5].

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“Unnecessary” Spinal Surgery: A Review With Commentary

By Frank M. Painter|August 15, 2013|Uncategorized|

“Unnecessary” Spinal Surgery: A Review With Commentary

The Chiro.Org Blog

SOURCE: Surgical Neurology Internat 2011; 2: 83

Nancy E Epstein, Donald C Hood

Department of Neurological Surgery,
The Albert Einstein College of Medicine,
Bronx, NY, USA

INTRODUCTION: Although one spine surgeon may decide that a patient needs surgery, another surgeon [e.g. a second opinion] might decide that surgery is “unnecessary”. Here we define “unnecessary surgery” as spinal surgery based upon “pain alone”. That is, the patient has no neurological deficit and no significant abnormal radiographic findings on dynamic X-rays, MR, and/or CT. Surgeons can, and do, debate whether it is appropriate to operate on patients with pain alone. To put this debate in context, however, we need to better understand the number of patients involved and the type of procedures recommended. In this prospective study performed over a one-year period, a single neurosurgeon documented the “unnecessary” lumbar and cervical surgeries planned by other spinal surgeons.

BACKGROUND: There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.

METHODS: During a one-year period [November 2009-October 2010], the senior author, a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations. A patient was assigned to the “unnecessary surgery” group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits, and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans].

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