History of Chiropractic Care The roots of chiropractic care can be traced all the way back to ... 2000: 11-17, 70-71. Chiropractic: State of Art. Arlington, Virginia, American Chiropractic Association, 1998: 2-3, ...
Charlton, Keith H
Background There is little homogeneity of opinion in the chiropractic profession about its essence and identity. Matters compromising the establishment of a coherent identity include the issue of vertebral subluxation, philosophy, mercantilism, poverty of qualifications in some chiropractic college faculty, and lack of intellectual productivity in some chiropractic college faculty. Discussion The Chiropractic profession has mislabeled rhetoric, supposition and cant as philosophy, whilst showing sparse evidence for the existence of more than a few chiropractors writing in philosophy as a discipline. There is no evidence for "Chiropractic Philosophy". I propose, however, that a better use of the discipline of philosophy can be of great use to the Chiropractic profession. Various thinkers throughout the ages have written about deduction, induction and falsificationism as methods to discover more reliably the nature of things in the world about us. Each method has strengths and frailties, but some of the latter are insurmountable for our purposes. Summary Using a contrivance of that method which seems most suited, sui generis, for the purpose, I propose a Chiropracticness Test as a tool to assist the search for essence and identity in Chiropractic. PMID:16307687
... 2015 Chiropractic Physicians Urge Conservative Approach to Pain Management See More » Classified Ads Seek positions or employees; search for or sell equipment and more Health Care Reform Video Update The ...
The use of x-ray is important to the chiropractic profession. The reasons for this significance are enumerated and discussed. The relevance of roentgenology to present and future chiropractic practice is set forth.
Weber II, Kenneth A.; He, Xiaohua
Purpose: To continue positive professional growth and boost research endeavors, chiropractic institutions need to develop a research-oriented foundation and produce a larger body of researchers. The purpose of this study was to provide a current analysis of the research culture among students at Palmer College of Chiropractic Florida. This study will gain insight toward the research contributions of the next generation of chiropractors and identify the difficulties toward participation. This will help modify current academic programs to better foster research and ensure a promising, credible future for the chiropractic profession. Methods: Participants were students at Palmer College of Chiropractic Florida enrolled in quarters 1 through 12 during the 2008 summer term. To evaluate the research culture, participants were asked to complete a 33-item web-based survey. Results: A total of 303 students completed the survey. Forty-four percent were female, and the mean age was 26 (SD = 4.2). Ninety-nine percent of respondents agreed that research was necessary for positive growth within the chiropractic profession. A majority of students reported having research experience, and 58% planned to participate in research activities prior to graduation. Technical writing was reported as the most challenging aspect of research, and heavy academic workload was reported as the greatest deterrent to participation. Conclusion: This study expresses possibilities for building a strong research culture at the college. Students were aware of the necessity for research and were openly interested in conducting research. Modification of current academic policies will allow for greater student research opportunities and the development of tomorrow's researchers. PMID:20480013
Dunn, Andrew S.
Objective: Department of Defense (DoD) chiropractic internships first began in July of 2001. At the time of this study, 30 New York Chiropractic College student interns had completed part of their clinical education within chiropractic clinics at either the National Naval Medical Center or Naval Hospital Camp Lejeune. The purpose of this study was to evaluate and compare the careers of DoD chiropractic internship participants with comparable nonparticipants in terms of demographics, professional activities, income, and satisfaction. Methods: Survey research was employed to gather data from DoD chiropractic internship participants and comparable nonparticipants. Statistical analysis was carried out to determine significant differences with a nominal significance level set as.05. Results: There were no statistically significant differences in demographics, professional activities, income, or career satisfaction between the 21 DoD chiropractic internship participants (70% response rate) and 35 internship nonparticipants (35% response rate). Conclusions: This study utilized practice parameters as a form of feedback for a comparative analysis of DoD chiropractic internship participants and nonparticipants and found no significant differences between these groups. Limitations of the study may have influenced the results. Opportunities for chiropractic students to train within these settings remains limited and should be further explored, as should additional research into this component of chiropractic clinical education. PMID:18483629
Verhoef, Marja J; Page, Stacey A
The objective of this study was to examine general practitioners’ opinions and behaviours concerning chiropractic. The study was a secondary analysis of the data collected in a cross-sectional survey of 400 general practitioners from Alberta and Ontario that assessed opinions and behaviours concerning several types of complementary medicine. The response rate was 52% Twenty-eight percent indicated they had considerable knowledge about chiropractic, overall 58% found chiropractic useful or very useful and 43% believed that chiropractic is efficacious for neck and back problems. Forty-four percent of the total sample stated they referred patients to chiropractors, primarily for back pain, musculoskeletal indications in general and chronic pain. Efforts need to be made to further improve the relationship between general practitioners and chiropractors and, thus, establish chiropractic as a viable treatment option.
Keating, Joseph C
Chiropractic education in the northwestern United States has its origins in the Marsh School & Cure in 1904. Most of the early schools were located in Portland, Oregon, including the D.D. Palmer College of Chiropractic (1908-1910), and several of these had merged by 1912 or 1913 to form the Pacific Chiropractic College, forerunner of today's Western States College. The latter was organized as a non-profit institution during the Great Depression, and struggled not only to survive but to create a higher standard. The early broad-scope of chiropractic training in the state probably encouraged the liberal scope of practice enjoyed in Oregon to this day. ImagesFigure 2Figure 3Figure 4Figure 6Figure 7Figure 8Figure 9Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16Figure 18Figure 19Figure 20Figure 21Figure 22Figure 24
Ohm, Jeanne; Kunz, Derek
Abstract Objective The objective of this study was to characterize the practice of pediatric chiropractic. Design The study design was a cross-sectional descriptive survey. Settings/location The settings were private practices throughout the United States, Canada, and Europe. Participants The participants were 548 chiropractors, the majority of whom are practicing in the United States, Canada, and Europe. Main outcome measures Practitioner demographics (i.e., gender, years in practice, and chiropractic alma mater), practice characteristics (i.e., patient visits per week, practice income reimbursement), and chiropractic technique were surveyed. The practitioners were also asked to indicate common indicators for pediatric presentation, their practice activities (i.e., use of herbal remedies, exercise and rehabilitation, prayer healing, etc.), and referral patterns. Results A majority of the responders were female with an average practice experience of 8 years. They attended an average of 133 patient visits per week, with 21% devoted to the care of children (<18 years of age). Practice income was derived primarily from out-of-pocket reimbursement with charges of an average of $127 and $42 for the first and subsequent visits, respectively. These visits were reimbursed to address common conditions of childhood (i.e., asthma, ear infections, etc.). Approach to patient care was spinal manipulative therapy (SMT) augmented with herbal remedies, exercises, rehabilitation, and so on. Wellness care also figured prominently as a motivator for chiropractic care. Fifty-eight percent (58%) indicated an established relationship with an osteopathic or medical physician. Eighty percent (80%) of the responders indicated referring patients to medical practitioners while only 29% indicated receiving a referral from a medical/osteopathic physician. Conclusions The chiropractic care of children is a significant aspect of the practice of chiropractic. Further research is warranted to examine the safety and effectiveness of this popular nonallopathic approach to children's health. PMID:20569028
Jamison, Jennifer R
The chiropractic profession is increasingly expressing the sentiment that chiropractic clinical intervention should rest upon a scientific foundation. Before ‘scientific research’ can become meaningful in chiropractic clinical practice, it is necessary that field practitioners be conversant with research terminology. If chiropractic clinical practice is to achieve credibility as a scientific mode of health care and if the benefits of a ‘scientific’ practice model are to enhance patient care, then future chiropractic practitioners must be familiar with a currently accredited scientific frame of reference. A survey of final year chiropractic students at Phillip Institute of Technology found that respondents appreciation of the strength of diverse clinical research methodologies and their ranking of criteria for ascertaining a cause-effect association bears some similarity (RHO = 0.97 and 0.98 respectively, p < 0.05) to that of the ‘scientific’ clinical community.
Woodfield, H. Charles; York, Craig; Rochester, Roderic P.; Bales, Scott; Beebe, Mychal; Salminen, Bryan; Scholten, Jeffrey N.
Presented here is a narrative review of upper cervical procedures intended to facilitate understanding and to increase knowledge of upper cervical chiropractic care. Safety, efficacy, common misconceptions, and research are discussed, allowing practitioners, chiropractic students, and the general public to make informed decisions regarding utilization and referrals for this distinctive type of chiropractic care. Upper cervical techniques share the same theoretical paradigm in that the primary subluxation exists in the upper cervical spine. These procedures use similar assessments to determine if spinal intervention is necessary and successful once delivered. The major difference involves their use of either an articular or orthogonal radiograph analysis model when determining the presence of a misalignment. Adverse events following an upper cervical adjustment consist of mild symptomatic reactions of short-duration (< 24-hours). Due to a lack of quality and indexed references, information contained herein is limited by the significance of literature cited, which included non-indexed and/or non-peer reviewed sources. PMID:26136610
Lawrence, Dana J; Meeker, William C
Objective To conduct a descriptive review of the scientific literature examining use rates of modalities and procedures used by CAM clinicians to manage chronic LBP and other conditions Data Sources A literature of PubMed and MANTIS was performed using the key terms Chiropractic; Low Back Pain; Utilization Rate; Use Rate; Complementary and Alternative Medicine; and Health Services in various combinations. Data Selection A total of 137 papers were selected, based upon including information about chiropractic utilization, CAM utilization and low back pain and other conditions. Data Synthesis Information was extracted from each paper addressing use of chiropractic and CAM, and is summarized in tabular form. Results Thematic analysis of the paper topics indicated that there were 5 functional areas covered by the literature: back pain papers, general chiropractic papers, insurance-related papers, general CAM-related papers; and worker's compensation papers. Conclusion Studies looking at chiropractic utilization demonstrate that the rates vary, but generally fall into a range from around 6% to 12% of the population, most of whom seek chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine. PMID:17241465
LeFebvre, Ron; Peterson, David; Haas, Mitchell
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies. PMID:23875117
From January 2013, The UK College of Chiropractors joins the partnership between the Chiropractic and Osteopathic College of Australasia (COCA) and the European Academy of Chiropractic (EAC) to publish Chiropractic & Manual Therapies. This new partnership will enable the journal to grow and flourish and further improve access to high quality research publications for interested researchers and clinicians worldwide. PMID:23289610
Background Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor's role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families. Objective To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient. Discussion The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines. Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees. Conclusion Studies in the United States show that over the last several decades, chiropractors are the most common complementary and alternative medicine providers visited by children and adolescents. Chiropractors continue to seek integration with other healthcare providers to provide the most appropriate care for their paediatric patients. In the interest of what is best for the paediatric population in the future, collaborative efforts for research into the effectiveness and safety of chiropractic care as an alternative healthcare approach for children should be negotiated and are welcomed. PMID:20525200
Nelson, Craig F; Lawrence, Dana J; Triano, John J; Bronfort, Gert; Perle, Stephen M; Metz, R Douglas; Hegetschweiler, Kurt; LaBrot, Thomas
Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession. PMID:16000175
Dana J Lawrence; William C Meeker
OBJECTIVE: To conduct a descriptive review of the scientific literature examining use rates of modalities and procedures used by CAM clinicians to manage chronic LBP and other conditions DATA SOURCES: A literature of PubMed and MANTIS was performed using the key terms Chiropractic; Low Back Pain; Utilization Rate; Use Rate; Complementary and Alternative Medicine; and Health Services in various combinations.
Many of the nation's chiropractic colleges, like other small colleges that rely heavily on tuition, are struggling to stay in business. At the same time that they are working to improve their stature in higher education and broadening their missions to increase their appeal, a number of the colleges are seeing enrollments plummet--and revenues are…
West, Jason; Phillips, Reed B.
Objective The purpose of this case report is to describe chiropractic care of a patient with persistent headache treated using chiropractic manipulative therapy and adjunct treatments. Clinical features A 54-year-old multiparous woman had chronic debilitating headaches for 11 months. Previous care from a variety of specialties had brought no appreciable relief. Intervention and outcome The patient was managed with chiropractic manipulative therapy, injections, and electromagnetic therapy. Five treatments over 6 weeks brought resolution of the headaches. Conclusion This patient with persistent headache responded favorably to a course of chiropractic and adjunctive care. PMID:24396331
Borggren, Cara L.
Abstract Objective The purpose of this article is to review the literature on the topic of chiropractic care during pregnancy. Methods A PubMed search was performed using the terms pregnancy and chiropractic. Sources were cross-referenced to obtain further articles and research information after reviewing the articles obtained through the search. Results Thirty-three references were used for this review. The current literature reports favorable results on the use of chiropractic care throughout pregnancy. Conclusions Chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research. PMID:19674697
Walker, Bruce F; French, Simon D; Cameron, Melanie; Perle, Stephen M; Lebouef-Yde, Charlotte; Rubinstein, Sidney M
Chiropractic & Osteopathy changes its title to Chiropractic & Manual Therapies in January 2011. This change reflects the expanding base of submissions from clinical scientists interested in the discipline of manual therapy. It is also in accord with the findings of a review of the journal content and a joint venture between the original parent organisation the Chiropractic and Osteopathic College of Australasia and a new partner the European Academy of Chiropractic, which is a subsidiary body of the European Chiropractors' Union. The title change should encourage submissions from all professionals interested in manual therapy including chiropractors, osteopaths, physiotherapists, medical doctors and scientists interested in this field. PMID:21247414
Lind, Bonnie K.; Diehr, Paula K.; Grembowski, David E.; Lafferty, William E.
Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use…
Many health science research and review articles end with the words: "More research is needed". However, when it comes to research, it is not as much a question of quantity as of quality. There are a number of important prerequisites before research should be initiated. The three pillars, relevance, quality and ethics should be respected but for a project to be meaningful, it must also be based on plausible rationale. In evidence-based (informed) practice, one takes into account not only research-based evidence but also clinical expertise and the patients' perspectives. In this paper, we briefly discuss how this should be handled in clinical practice is briefly discussed, using the concept of "traffic lights" (red, yellow, green). We explain how the combination of evidence and plausibility can be used to reach a decision as to whether a treatment or diagnostic procedure is suitable, possible, or unsuitable. In this thematic series of Chiropractic & Osteopathy a number of reviews are presented, in which the research status of pediatric chiropractic is scrutinized and found wanting. Two important aspects were studied in these reviews: the effect of treatment and safety issues. Two types of problems were identified: the lack of research in general and the lack of research using the appropriate study designs and methodology in particular. Therefore, we discuss the meager research noted in the areas of chiropractic care in children and the clinical consequences this should have. The prerequisites for "more research" are scrutinized and an example given of suitable research programs. Finally, the important issue of implementation of research findings is covered, emphasizing the responsibility of all stakeholders involved at both the undergraduate and the postgraduate level, within professional associations, and on an individual level. PMID:20525193
Holleman, Annique C.; Nee, John; Knaap, Simone F.C.
Objective The purpose of this study is to discuss a chiropractic case of management and resolution of breast-feeding difficulties. Clinical Features The case involves an 8-day-old baby unable to breast-feed since 4 days old. Initial examination revealed cervical, cranial, and sacral restrictions. She was diagnosed with craniocervical syndrome by a doctor of chiropractic. Intervention and Outcome Following history and examination, the infant received gentle chiropractic manipulation based on clinical findings. Immediate improvement and complete resolution of the nursing problems were observed after 3 treatments over 14 days. Conclusion The results of this case suggest that neuromusculoskeletal dysfunction may influence the ability of an infant to suckle successfully and that intervention via chiropractic adjustments may result in improving the infant's ability to suckle efficiently. PMID:22014911
Sawyer, C; Haas, M; Nelson, C; Elkington, W
In the current climate of accountability, health care financing reform and the demand on all health professions for evidence, there is an urgent need to expand clinical research activity within the profession. Those randomized clinical trials that have been reported in the literature have focused primarily on low back and headache pain. Only recently have studies been initiated to investigate the effectiveness of chiropractic interventions for conditions other than back pain. The ability of chiropractic colleges to develop research infrastructures and productive clinical research programs depends on removing or minimizing a number of impediments. A shortage of chiropractic clinicians who have the experience and training to conduct clinical research is compounded by a dependency on tuition revenue, limited external funding and a lack of institutional emphasis on research. The profession generally, and chiropractic colleges specifically, must address the impediments that limit the growth of research capacity. We present several recommendations and the action steps required to achieve specific outcomes. PMID:9127255
to the body's muscular, nervous, and skeletal system, particularly the spine. They view their patients of Chiropractic degree (DC). Most D.C. programs operate on the trimester system and are 3 1/3 years long. Students
Jason W. Busse; Abhaya V. Kulkarni; James B. Campbell; H. Stephen Injeyan
Background: Although the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiro- practic students. Methods: An 11-item questionnaire about attitudes toward vaccination was distrib- uted to students enrolled at CMCC during the 1999\\/2000 academic year. The
Edzard Ernst; Paul Posadzki
To promote an independent and critical evaluation of 11 randomised clinical trials (RCTs) of chiropractic funded by the National\\u000a Centre for Complementary and Alternative Medicine (NCCAM). Electronic searches were conducted to identify all relevant RCTs.\\u000a Key data were extracted and the risk of bias of each study was determined. Ten RCTs were included, mostly related to chiropractic\\u000a spinal manipulation for
Sutherland, Donald C
This paper presents some of the significant milestones that were reached in the long struggle from rejection to acceptance. While it does not attempt to include all of the historical events which contributed to this evolutionary process, it does identify some of the key elements in the laying of a sound foundation upon which the profession could continue to build. It is hoped that other papers will be written to add to our understanding of this important era in chiropractic’s early development. The years from 1917-1958 deal mainly with medicine’s intransigent opposition; then the tide began to turn in chiropractic’s favour. Governments appointed commissions of enquiry to bring some order into the health care field. Our profession’s brief to the Royal Commission on Health Services was described by the Minister of National Health and Welfare as “a very powerful document”. The government enquiries, in addition to identifying professional weaknesses, also made favourable recommendations which encouraged the further growth and development of chiropractic. Commenting on his work as a Royal Commissioner, Mr. Justice Gerard Lacroix said that the medical opposition to chiropractic was: “... based on bias and prejudice, ignorance and refusal to learn about chiropraxy. I thought it safer to know and understand before judging” (p. 13).8
Adams, Jon; Steel, Amie; Chang, Sungwon; Sibbritt, David
Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic 'big-picture' planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others - arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic's research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care. PMID:25834727
William C. Meeker; Scott Haldeman
Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine. Chiropractic has taken on many of the attributes of an established profession, improving its educational and licensing systems and substantially
The role and position of chiropractic care in the health care system must be transformed from being alternative and separate to alternative and mainstream. This transformation requires that chiropractic services become integrated in the many health care delivery organizations that collectively constitute the health care system. There is solid and impressive economic and related justification for the desired integration. Chiropractic
Gorrell, Lindsay; Beirman, Robyn L.; Vemulpad, Subramanyam R.
Objective This study sought to determine congruence between student assessment tasks within the master of chiropractic curriculum at Macquarie University and 2 separate but related domains: (1) disorders commonly presenting to chiropractors and (2) musculoskeletal conditions for which there is published evidence that chiropractic treatment is effective. Methods A literature review was undertaken to determine which musculoskeletal disorders commonly present to chiropractors and the conditions for which there is published evidence that chiropractic treatment is effective. These 2 domains were then mapped to the assessment tasks within the curriculum and analyzed. The proportion of time allocated to theory versus skill acquisition was also determined. Results Assessment tasks within the curriculum specifically focus on low back pain, neck pain, lower extremity pain, thoracic pain, and adhesive capsulitis. This curriculum mapping demonstrates congruence between the student assessment tasks and published evidence for chiropractic. The assessments also contain an appropriate balance between theory and skills acquisition. Conclusion There is congruence between the assessment tasks within the curriculum and the 2 domains against which it was mapped. Thus, completion of the curriculum provides training relevant to conditions that commonly present to chiropractors and musculoskeletal conditions for which chiropractic treatment is effective. PMID:25162981
This paper examines a recent report on Medical Education entitled “Physicians for the Twenty First Century.” The conclusions of this study are summarized. Using the Canadian Memorial Chiropractic College as the focus, chiropractic education is then examined with regard to these same solutions. The results of this comparison show that in many areas, chiropractic education is favourably positioned vis-a-vis medical education, but in other areas it shares the same or similar problems. In the areas of problem based learning and competency based learning, CMCC has already implemented programmes. Further, the objective of our programme is the graduation of a “general” practitioner and our programme is, therefore, a broad based, general professional education. In the areas of the humanities and the social sciences, our programme is deficient and this is something that must be addressed in the coming years.
Green, Bart N
This editorial introduces new developments with the Journal of Chiropractic Education that will help the journal fulfill its mission more effectively. Recent improvements include a website upgrade, early online posting of accepted and edited papers, "in press" citations in PubMed, a new electronic web-based manuscript submission and peer-review system, cross linking of references, a new appearance for the journal cover, and improved page format. Improvements in publication processes with the journal will better enable it to publish research pertaining to educational theory and methods relevant to chiropractic education. PMID:23518800
Gatterman, Meridel I; Dobson, Thomas P; LeFevbre, Ron
Chiropractic quality assurance involves development of both clinical guidelines and standards. Confusion generated by poor differentiation of guidelines from standards contributes to mistrust of the guideline development process. Guidelines are considered to be recommendations that allow for flexibility and individual patient differences. Standards are more binding and require a high level of supporting evidence. While guidelines serve as educational tools to improve the quality of practice, standards that outline minimum competency are used more as administrative tools on which to base policy. Barriers to development of clinical guidelines and standards include fear that they will create prescriptive “cookbook” practice, and the distrust that guidelines are developed primarily for cost containment. Clinicians also criticize guidelines developed by academics that don't relate to practice, and those based on evidence that lacks clinical relevance. Conflicting guidelines perceived to be based on strong bias or conflict of interest are also suspect. To reduce barriers to acceptance and implementation, guidelines should be inclusive, patient-centered, and based on a variety of evidence and clinical experience.
Background Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor. Methods The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author. Results A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi. Conclusion Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia. PMID:23927011
Green, Bart N.; Johnson, Claire D.
Objective: This paper presents the origins and development of the organized chiropractic orthopedics movement in the United States from 1954–1973. Methods: Hand searches of early periodicals were performed and information was organized chronologically to create a timeline. Context for the timeline was provided by extracting pertinent information from audio recordings of interviews. Relevant background information was located using the cumulative index of the journal Chiropractic History and searching the MANTIS database. Historical Features: After World War I, The advent of third party reimbursement for health care created a new environment for health care practitioners. For doctors of chiropractic, this event provided the impetus to begin the postgraduate chiropractic orthopedics program over 50 years ago. In 1954, Alvin A. Hancock, DC and F. Maynard Lipe, DC successfully launched an active orthopedics movement after several earlier attempts failed during the 1940s and early 1950s. The movement generated from the desire to train and certify chiropractors to manage personal injury and workers’ compensation low back injuries. In addition to developing interdisciplinary educational programs, the chiropractic orthopedics group was responsible for producing a research agenda, some of the profession’s early orthopedic-focused research, and for starting the National Council on Chiropractic Orthopedics of the National Chiropractic Association, which later became the American Chiropractic Association Council on Orthopedics. These organizations produced thousands of specialists in chiropractic orthopedics, later known as Diplomates of the American Board of Chiropractic Orthopedists. Conclusion: Several orthopedics interest groups were formed and credentialing processes were created to qualify doctors as recognized chiropractic orthopedics specialists. The popularity of this movement resulted in the inclusion of orthopedics into core chiropractic college curricula and the production of various research studies before the development of the modern science of chiropractic. PMID:19488411
This case report describes the chiropractic management of a 30-year-old female patient with severe postpartum pelvic pain secondary to pubic symphysis diastasis. No literature was found on the chiropractic management of postpartum symphysis pubis diastasis. The existing literature concerning chiropractic care for symphysis pubis dysfunction during pregnancy is limited and indicates a potential benefit. Separation of the pubic symphysis may include ligamentous injury to the sacroiliac joints and may lead to chronic pain. Pubic symphysis separation of 17 millimeters was present on digital radiograph. Management consisted of chiropractic adjustments, trigger point release, electrical stimulation, moist heat, sacroiliac belt, and specific stabilizing exercises. The patient’s pain improved immediately following treatment on the initial visit. Pain was reduced from 8/10 VAS at the first visit to 2/10 at the fourth visit. She was able to resume normal activities and reached a final pain level of 1/10. The diastasis was reduced by 7 millimeters at 14-weeks post radiograph for a final separation of just under 10 millimeters. Collaboration between obstetricians, midwives and chiropractors may be warranted. PMID:25729083
Chiropractic spinal manipulation (CSM) is often used as a treatment for neck pain. However, its effectiveness is unclear. The aim of this article was to evaluate systematically and critically the effectiveness of CSM for neck pain. Six electronic databases were searched for all relevant randomized clinical trials. Strict inclusion\\/exclusion criteria had been predefined. Key data were validated and extracted. Methodologic
Epstein, Nancy E; Forte Esq, Carol L
A 45 year old male with multiple comorbidities presented to his internist with a 2 week history of right sided neck pain and tenderness, accompanied by tingling in the hand. The internists' neurological examination was normal, except for decreased range of motion of the right arm. He referred the patient to a chiropractor; he performed plain X rays which revealed mild spasm, but never ordered a magnetic resonance imaging study. The chiropractor manipulated the patient's neck on two successive days. By the morning of the third visit, the patient reported extreme pain and difficulty walking. Without performing a new neurological examination or obtaining an MR scan, the chiropractor again manipulated the patient's neck. He immediately became quadriplegic. Despite undergoing an emergency C5 C6 anterior cervical diskectomy/fusion to address a massive disc found on the MR scan (CT was negative), the patient remained quadriplegic (e.g., C4 sensory, C6 motor levels). A major point of negligence in this case was the failure of both the referring internist and chiropractor to order an MR of the cervical spine prior to the chiropractic manipulation. The internist claimed that there was no known report of permanent quadriplegia resulting from neck manipulation in any medical journal, article or book, or in any literature of any kind or on the internet and that the risk of this injury must be vanishingly small given the large numbers of manipulations performed annually. The total amount of the verdict was $14,596,000.00 the internist's liability was 5% ($759,181.65). PMID:23878767
Epstein, Nancy E.; Forte Esq, Carol L.
A 45 year old male with multiple comorbidities presented to his internist with a 2 week history of right sided neck pain and tenderness, accompanied by tingling in the hand. The internists’ neurological examination was normal, except for decreased range of motion of the right arm. He referred the patient to a chiropractor; he performed plain X rays which revealed mild spasm, but never ordered a magnetic resonance imaging study. The chiropractor manipulated the patient's neck on two successive days. By the morning of the third visit, the patient reported extreme pain and difficulty walking. Without performing a new neurological examination or obtaining an MR scan, the chiropractor again manipulated the patient's neck. He immediately became quadriplegic. Despite undergoing an emergency C5 C6 anterior cervical diskectomy/fusion to address a massive disc found on the MR scan (CT was negative), the patient remained quadriplegic (e.g., C4 sensory, C6 motor levels). A major point of negligence in this case was the failure of both the referring internist and chiropractor to order an MR of the cervical spine prior to the chiropractic manipulation. The internist claimed that there was no known report of permanent quadriplegia resulting from neck manipulation in any medical journal, article or book, or in any literature of any kind or on the internet and that the risk of this injury must be vanishingly small given the large numbers of manipulations performed annually. The total amount of the verdict was $14,596,000.00 the internist's liability was 5% ($759,181.65). PMID:23878767
Waalen, David Paul; White, T Peter; Waalen, Judith Kelly
This study focused on the attributes of all new patients (N = 15,174) treated at CMCC clinics from 1986 to 1990. The average age of patients (33 years) was similar to that of other teaching clinics (36.5 years) but lower than private practice patients (46 years). The average number of treatments (6.6) was similar to some other chiropractic college teaching clinic settings but lower than private practice patients in Ontario (9.8) and the United States (16.6). The cervical spine was the most common site (32.4%) of chief complaint followed by lumbar (24.4%), nonspinal (18.8%), thoracic (11.2%), sacroiliac (10.0%) and other (3.2%). Radiographs were taken on 34.4% of the patients, similar to other chiropractic college teaching clinics but lower than for private practice patients (73%). Complaints persisted for at least 6 months prior to treatment in 47.5% of the CMCC patients whereas other studies indicated that 81.4% of complaints treated by private chiropractic practitioners were of 6 months or greater duration. In general, as duration of complaint lengthened, the number of treatments required to reach resolution also increased. More than 70% of CMCC’s patients obtained complete or substantial relief from symptoms which compared well with other teaching clinics and private chiropractic practice. Recommendations for the development of new data gathering instruments, and involvement of private practitioners in this type of clinical research are made.
Pollard, Henry; Hoskins, Wayne; McHardy, Andrew; Bonello, Rod; Garbutt, Peter; Swain, Mike; Dragasevic, George; Pribicevic, Mario; Vitiello, Andrew
Sports chiropractic within Australia has a chequered historical background of unorthodox individualistic displays of egocentric treatment approaches that emphasise specific technique preference and individual prowess rather than standardised evidence based management. This situation has changed in recent years with the acceptance of many within sports chiropractic to operate under an evidence informed banner and to embrace a research culture. Despite recent developments within the sports chiropractic movement, the profession is still plagued by a minority of practitioners continuing to espouse certain marginal and outlandish technique systems that beleaguer the mainstream core of sports chiropractic as a cohesive and homogeneous group. Modern chiropractic management is frequently multimodal in nature and incorporates components of passive and active care. Such management typically incorporates spinal and peripheral manipulation, mobilisation, soft tissue techniques, rehabilitation and therapeutic exercises. Externally, sports chiropractic has faced hurdles too, with a lack of recognition and acceptance by organized and orthodox sports medical groups. Whilst some arguments against the inclusion of chiropractic may be legitimate due to its historical baggage, much of the argument appears to be anti-competitive, insecure and driven by a closed-shop mentality.sequently, chiropractic as a profession still remains a pariah to the organised sports medicine world. Add to this an uncertain continuing education system, a lack of protection for the title 'sports chiropractor', a lack of a recognized specialist status and a lack of support from traditional chiropractic, the challenges for the growth and acceptance of the sports chiropractor are considerable. This article outlines the historical and current challenges, both internal and external, faced by sports chiropractic within Australia and proposes positive changes that will assist in recognition and inclusion of sports chiropractic in both chiropractic and multi-disciplinary sports medicine alike. PMID:17880724
Cheryl Hawk; Cynthia R. Long; Karen T. Boulanger
Objective: To identify patient and practice characteristics that might contribute to people's seeking chiropractic care for nonmusculoskeletal complaints.Design: This was a cross-sectional study conducted through the methods of practice-based research.Setting: Data were collected in 1998-1999 in chiropractic offices in the United States, Canada, and Australia; data were managed by a practice-based research office operating in a chiropractic research center.Population: The
Background Research involving chiropractors is evolving and expanding in Europe while resources are limited. Therefore, we considered it timely to initiate a research agenda for the chiropractic profession in Europe. The aim was to identify and suggest priorities for future research in order to best channel the available resources and facilitate advancement of the profession. Methods In total, 60 academics and clinicians working in a chiropractic setting, and who had attended any of the annual European Chiropractors’ Union/European Academy of Chiropractic (ECU/EAC) Researchers’ Day meetings since their inception in 2008, were invited to participate. Data collection consisted of the following phases: phase 1 identification of themes; phase 2 consensus, which employed a Delphi process and allowed us to distill the list of research priorities; and phase 3 presentation of the results during both the Researchers’ Day and a plenary session of the annual ECU Convention in May 2013. In addition, results were distributed to all ECU member countries. Results The response rate was 42% from phase 1 and 68% from phase 2. In general, participants were middle-aged, male and had been awarded a Doctor of Philosophy (PhD) as well as chiropractic degree. Approximately equal numbers of participants had obtained their chiropractic degree from the UK/Europe and North America. The majority of participants worked primarily in an academic/research environment and approximately half worked in an independent institution. In total, 58% of the participants were from the UK and Denmark, collectively representing 44% of the chiropractors working in Europe. In total, 70 research priorities were identified, of which 19 reached consensus as priorities for future research. The following three items were thought to be most important: 1) cost-effectiveness/economic evaluations, 2) identification of subgroups likely to respond to treatment, and 3) initiation and promotion of collaborative research activities. Conclusions This is the first formal and systematic attempt to develop a research agenda for the chiropractic profession in Europe. Future discussion and study is necessary to determine whether the themes identified in this survey should be broadly implemented. PMID:24512854
Alcantara, Joel; Cossette, Martine
The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy. PMID:19880080
Cooper, Richard A; McKee, Heather J
Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers. However, the profession's efforts to validate the effectiveness of spinal manipulative therapy, its principal modality, have yielded only modest and often contrary results. At the same time, reimbursement is shrinking, the number of practitioners is growing, and competition from other healing professions is increasing. The profession's efforts to establish a role in primary care are meeting resistance, and its attempts to broaden its activities in alternative medicine have inherent limitations. Although patients express a high level of satisfaction with chiropractic treatment and politicians are sympathetic to it, this may not be enough as our nation grapples to define the health care system that it can afford. PMID:12669653
Jennifer R Jamison
Background: Stress is a recognized variable in the diagnosis, management, and prognosis of musculoskeletal conditions; chiropractic care is reputed to be successful in the management of stress-related visceral conditions. It may be useful for chiropractors to include stress management as a clinical care option.Objective: To explore screening tools to aid stress self-assessment, investigate patients' perceptions of stress management as a
Di Duro, Joseph O
Background The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care. Case presentation Fifteen patients are presented (9 male, 6 female) with a mean age of 54.3 (range 34–71). A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB), 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB. All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone. Conclusion A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system. PMID:16423302
Keating, Joseph C
This paper provides a cursory overview of attempts to discover, preserve and disseminate the history of the chiropractic profession, up to and including the organization of the Association for the History of Chiropractic (AHC). A surprisingly wide range of materials have been available for many decades, but sustained efforts at historical scholarship are more recent (past quarter century). The quality of these works has been uneven, but has improved with the emergence of chiropractic scholarly periodicals and interest from non-chiropractor investigators. Affiliates of the American-based AHC are located in Australia and Canada; organized historical scholarship in other regions of the world has yet to develop. Several substantial archival resources for historical investigations are available, and merit greater scrutiny and support within the profession. ImagesFigure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16Figure 17Figure 18Figure 19Figure 20Figure 21Figure 22Figure 23Figure 24Figure 25p136-ap136-bp136-cp136-dp136-e
Kruse, Ralph A.; Gudavalli, Sharina; Cambron, Jerrilyn
Abstract Objective The purpose of this report is to describe chiropractic treatment of lower back and unilateral leg pain in a pregnant patient. Clinical Features A 26-year-old woman in her second trimester of pregnancy had severe pain in her lower back that radiated to her hips bilaterally and to her right leg. She reported tingling down her right lower leg to the dorsum of her foot. Although no diagnostic imaging was performed, her differential diagnoses included lumbalgia with associated radiculopathy. Intervention and Outcome Treatment consisted of manual traction in the side-lying position using a specialized chiropractic table and treatment technique (Cox flexion-distraction decompression) modified for pregnancy. Relief was noted after the first treatment, and complete resolution of her subjective and objective findings occurred after 8 visits. Conclusion When modified, this chiropractic technique appears to be an effective method for treating lower back pain with radiation to the leg in a pregnant patient who cannot lie prone. PMID:19674710
Dwain M Daniel; Ronald L Rupert
BackgroundUltrasound therapy is a commonly used therapeutic modality within the chiropractic profession. Previous calibration studies of ultrasound units within the physical therapy communities in Scotland and Canada have shown that approximately two thirds of units tested did not conform to minimum calibration standards. Similar failure rates may exist in the chiropractic profession and need to be addressed.
Kara Burnham; David Peterson; Darcy Vavrek; Mitchell Haas
ObjectiveA baseline microbial survey was conducted to identify the microbes present on the headpieces of chiropractic adjusting tables from across the Western States Chiropractic College, Portland, Ore, facilities. This included the instructional adjustive technique laboratories, the student health center, the campus outpatient clinic, and an off-site clinic. The objective of this study was to evaluate the effect of disinfection protocols
Marion Willard Evans; Jennell Breshears; Alan Campbell; Chris Husbands; Ronald Rupert
BACKGROUND: To investigate the presence of pathogenic microbes on chiropractic treatment tables in one outpatient teaching clinic. Additional aims were to test inexpensive disinfectants on tables that may kill microbes and suggest infection control measures for chiropractic offices, clinics and classrooms. The aim of the study was to assess the presence of pathogenic microbes on treatment tables in one outpatient
Gotlib, Allan C; Injeyan, H Stephen; Crawford, John P
The purpose of this paper is to provide an historical review of the progression of events within the jurisdiction of the province of Ontario related to the issue of laboratory diagnosis and the profession of chiropractic. The provisions of relevant legislation, task forces, Councils, reviews, consensus statements, Commissions and committees, are highlighted and discussed during respective time periods. Chiropractors had entitlement to order and perform laboratory tests until 1972 when a regulatory amendment, made without consultation with the chiropractic profession, precluded their continuing entitlement. Chiropractic patients require access to diagnostic laboratory services and equitable access to necessary laboratory services should be restored and preserved. This is consistent with the academic institutional accreditation standards of chiropractic education and the jurisdictional regulatory mechanisms of chiropractic practice and is consistent with both protecting and enhancing the public interest.
Objective: The life and contribution to chiropractic science of Dr. Ronald Gitelman is reviewed. Methods: Sources for this article included review of the notes prepared by Dr. Joseph Keating in his “biography” of the Canadian Memorial Chiropractic College (CMCC); review of the important articles published by Dr. Gitelman; review of the important projects undertaken by him along with various colleagues; notes from reminiscences obtained from many of these colleagues and discussions with his family. Discussion: Dr. Gitelman’s academic career spanned from 1963 to the late 1980’s. During that time, he made foundational contributions to the development of chiropractic science including: developing the Archives (1974), the first collection of scientific articles supporting chiropractic science (which was subsequently published as the Chiropractic Archives Research Collection (CRAC)); delivering one of the few chiropractic papers at the seminal NINCDS conference (1975) and, developing the collaboration between CMCC and Dr. Kirkaldy-Willis at the University of Saskatoon (1976). He practiced in Toronto from 1961 to 2007. Summary: Dr. Gitelman was a pioneer in the development of chiropractic science. He died on October 7, 2012. PMID:23482630
Davis, Matthew A; Sirovich, Brenda E; Weeks, William B
Objective To investigate national utilization and expenditures on chiropractic care between 1997 and 2006. Data Source The nationally representative Medical Expenditure Panel Survey (MEPS). Study Design We performed descriptive analyses and generated national estimates from data obtained from U.S. adult (?18 years) MEPS respondents who reported having visited a chiropractor (annual sample size between 789 and 1,082). For each year, we examined the estimated total national expenditure, the total number of U.S. adults who received chiropractic care, the total number of ambulatory visits to U.S. chiropractors, and the inflation-adjusted charges and expenditures per U.S. adult chiropractic patient. Principal Findings The total number of U.S. adults who visited a chiropractor increased 57 percent from 7.7 million in 2000 to 12.1 million in 2003. From 1997 to 2006, the inflation-adjusted national expenditures on chiropractic care increased 56 percent from U.S.$3.8 billion to U.S.$5.9 billion. Inflation-adjusted total mean expenditures per patient and expenditures per office visit remained unchanged. Conclusion The large increase in U.S. adult expenditures on chiropractic care between 1997 and 2006 was due to a 57 percent increase in the total number of U.S. adult chiropractic patients that occurred from 2000 to 2003. From 2003 to 2006, the total number of U.S. adult chiropractic patients has remained stable. PMID:20002763
Evans, Marion Willard; Ramcharan, Michael; Floyd, Rod; Globe, Gary; Ndetan, Harrison; Williams, Ronald; Ivie, Ronald
Abstract Objective By nature, chiropractic is a hands-on profession using manipulation applied to the joints with direct skin-to-skin contacts. Chiropractic tables are designed with a face piece to accommodate the prone patient's head in a neutral position and hand rests to allow for relaxed shoulders and upper spine so treatment is facilitated. The purpose of this article is to present a proposed guideline for hand and treatment table surface sanitizing for the chiropractic profession that is evidence-based and can easily be adopted by teaching institutions and doctors in the field. Methods A review of the chiropractic literature demonstrated that pathogenic microbes are present on treatment tables in teaching clinics at multiple facilities, yet no standardized protocols exist in the United States regarding table sanitizing and hand hygiene in chiropractic clinics or education institutions. This article reviews the scientific literature on the subject by using several search engines, databases, and specific reviews of documents pertaining to the topic including existing general guidelines. Results The literature has several existing guidelines that the authors used to develop a proposed protocol for hand and table sanitizing specific to the chiropractic profession. Recommendations were developed and are presented on hand hygiene and table sanitizing procedures that could lower the risk of infection for both clinical personnel and patients in chiropractic facilities. Conclusion This article offers a protocol for hand and table sanitizing in chiropractic clinics and education institutions. The chiropractic profession should consider adoption of these or similar measures and disseminate them to teaching clinics, institutions, and private practitioners. PMID:19646384
Waalen, Judith Kelly
Case studies involve utilizing a distinct research approach. They are often confused with case reports, case series, cases used in rounds, and cases without control groups or baseline measures. The case study approach can provide a way to investigate broad chiropractic issues, policies, or practices in their real settings. Case study research designs are appropriate in both clinical and nonclinical settings. They require good conceptual skills not elaborate equipment; extensive “thinking” time but not sophisticated statistical analysis; and, a well-designed case study protocol but no control groups or randomized trials.
Hoskins, Wayne; Pollard, Henry; Reggars, John; Vitiello, Andrew; Bonello, Rod
Purpose To document the number of journal publications attributed to the academic faculty of Australian chiropractic tertiary institutions. To provide a discussion of the significance of this output and to relate this to the difficulty the profession appears to be experiencing in the uptake of evidence based healthcare outcomes and cultures. Methods The departmental websites for the three Australian chiropractic tertiary institutions were accessed and a list of academic faculty compiled. It was noted whether each academic held a chiropractic qualification or research Doctoral (not professional) degree qualification A review of the literature was conducted using the names of the academics and cross-referencing to publications listed independently in the PubMed and Index to Chiropractic Literature (ICL) databases (from inception to February 27 2006). Publications were excluded that were duplicates, corrected reprints, conference abstracts/proceedings, books, monographs, letters to the editor/comments or editorials. Using this information an annual and recent publication rate was constructed. Results For the 41 academics there was a total of 155 PubMed listed publications (mean 3.8, annual rate per academic 0.31) and 415 ICL listed publications (mean 10.1, annual rate 0.62). Over the last five years there have been 50 PubMed listed publications (mean 1.2, annual rate 0.24) and 97 ICL listed publications (mean 2.4, annual rate 0.47). Chiropractor academics (n = 31) had 29 PubMed listed publications (mean 2.5, annual rate 0.27) and 265 ICL listed publications (mean 8.5, annual rate 0.57). Academics with a doctoral degree (n = 13) had 134 PubMed listed publications (mean 10.3, annual rate 0.70) and 311 ICL listed publications (mean 23.9, annual rate 1.44). Academics without a Doctoral degree (n = 28) had 21 PubMed listed publications (mean 0.8, annual rate 0.13) and 104 ICL listed publications (mean 3.7, annual rate 0.24). Conclusion While several academics have compiled an impressive list of publications, overall there is a significant paucity of published research authored by the majority of academics, with a trend for a falling recent publication rate and not having a doctoral degree being a risk factor for poor publication productivity. It is suggested that there is an urgent necessity to facilitate the acquisition of research skills in academic staff particularly in research methods and publication skills. Only when undergraduate students are exposed to an institutional environment conducive to and fostering research will concepts of evidence based healthcare really be appreciated and implemented by the profession. PMID:16872544
The 2010 Patient Protection and Affordable Care Act provides incentives for both patients and providers to engage in evidence-based clinical preventive services recommended by the United States Preventive Services Task Force (USPSTF). Depending upon the application of the new health care act, Doctors of Chiropractic (DC) may be considered to be covered providers of many of these services. It is therefore essential that DCs’ training prepare them to competently deliver them. The aim of this commentary is to describe a framework for training in clinical preventive services, based largely on the USPSTF recommendations, which could be readily integrated into existing DC educational programs. PMID:23962353
In this paper, the argument will be made that present day “chiropractic philosophy” must be rejected as a professional obstacle. It is an unscientific relic of D.D. Palmer’s personal religious beliefs. A philosophy of chiropractic can only emerge from the application of philosophy of science to our scientific and clinical practices. This new philosophy should incorporate the general healing perspective of the ancient Coan tradition which will be described. This perspective can be made distinctively chiropractic by a synthesis with D.D. Palmer’s principle of Tone. Discussion will focus on how our philosophy can be developed to guide us into the 21st century.
Green, Bart N; Johnson, Claire
Social justice in public health involves the process and product of a community acting to fairly distribute advantages and burdens to improve the health of its population and to reasonably take care of the disadvantaged. Although publications are available about chiropractic public health history, programs, and policy, the potential role of chiropractic in social justice has received little attention. This article discusses Beauchamp's 4 principles of social justice and suggests actions that the chiropractic profession may consider to participate in the practice of social justice in the field of public health. PMID:20732576
Livdans-Forret, Anna B.; Harvey, Phyllis J.; Larkin-Thier, Susan M.
Introduction To make chiropractors more aware of menorrhagia and how they can serve a role in their patient’s care and education since women make up 60% of the population seeking chiropractic care. Method A review of the biomedical literature on menorrhagia was conducted. Items that were retrieved were synthesized and interpreted in order to give the best information to practicing chiropractors. Discussion Most of the information available relative to menorrhagia is medically oriented. Other treatment options can include: chiropractic, various types of herbs, and nutritional supplements. Conclusion Knowledge of medical treatment, nutritional supplements, along with chiropractic treatment options may be beneficial to doctors in their practice. PMID:18060009
Meeker, William C.; Watkins, R.W.; Kranz, Karl C.; Munsterman, Scott D.; Johnson, Claire
Objective This report summarizes the closing plenary session of the Association of Chiropractic Colleges Educational Conference—Research Agenda Conference 2014. The purpose of this session was to examine patient-centered medical homes and accountable care organizations from various speakers’ viewpoints and to discuss how chiropractic could possibly work within, and successfully contribute to, the changing health care environment. Discussion The speakers addressed the complex topic of patient-centered medical homes and accountable care organizations and provided suggestions for what leadership strategies the chiropractic profession may need to enhance chiropractic participation and contribution to improving our nation’s health. Conclusion There are many factors involved in the complex topic of chiropractic inclusion in health care models. Major themes resulting from this panel included the importance of building relationships with other professionals, demonstrating data and evidence for what is done in chiropractic practice, improving quality of care, improving health of populations, and reducing costs of health care. PMID:25431542
Lystad, Reidar P; Pollard, Henry
There is a need to further our understanding of the neurophysiological effects of chiropractic spinal manipulation on brain activity as it pertains to both musculoskeletal and non-musculoskeletal complaints. This paper aims to provide a basic overview of the most commonly utilised techniques in the neurosciences for functional imaging the brain (positron emission tomography, single-photon emission computerised tomography, functional magnetic resonance imaging, electroencephalography, and magnetoencephalography), and discuss their applicability in future chiropractic research. Functional neuroimaging modalities are used in a wide range of different research and clinical settings, and are powerful tools in the investigation of neuronal activity in the human brain. There are many potential applications for functional neuroimaging in future chiropractic research, but there are some feasibility issues, mainly pertaining to access and funding. We strongly encourage the use of functional neuroimaging in future investigations of the effects of chiropractic spinal manipulation on brain function. PMID:19421353
Millar, Neil; Budgell, Brian S.; Kwong, Alice
In this pilot study, a collection of peer-reviewed articles from the Journal of the Canadian Chiropractic Association was analyzed by computer to identify the more commonly occurring words and phrases. The results were compared to a reference collection of general English in order to identify the vocabulary which is distinctive of chiropractic. From texts with a combined word count in excess of 280,000, it was possible to identify almost 2,500 words which were over-represented in the chiropractic literature and therefore likely to hold special importance within this domain. Additionally, readability statistics were calculated and suggest that the peer-reviewed chiropractic literature is approximately as challenging to read as that of nursing, public health and midwifery. Certain words widely considered to be of importance to the profession, for example “subluxation and adjustment,” were not particularly prevalent in the literature surveyed. PMID:21403783
Crawford, John P; Gotlib, Allan C; Injeyan, H Stephen
Current provincial legislation in various jurisdictions across Canada, serves to impede the utilization of the diagnostic laboratory by doctors of chiropractic. Chiropractic students both in Canada and the United States, are required to successfully complete an intensive course of study in the area of laboratory diagnosis, as a necessary aspect of the undergraduate educational curriculum. Unfortunately, Canadian graduate doctors of chiropractic and their patients, are not currently afforded the privilege of direct referral to a community diagnostic laboratory. Rather, chiropractors must enlist the assistance of other health care providers, namely medical doctors, to acquire various laboratory testing procedures. The premise of this paper is intended to demonstrate the necessity of revising such laws, in order to address the needs of those health care consumers who seek the services of the rapidly growing profession of chiropractic. Two clinical cases are presented as illustrative examples.
Matthew E. Collins; Tom M. Misukanis
ObjectiveTo illustrate a case of vertigo in a patient with cervical spine injury and mild traumatic brain injury following a motor vehicle accident and present chiropractic and rehabilitative procedures used for management.
Evans, Marion W.; Campbell, Alan; Husbands, Chris; Breshears, Jennell; Ndetan, Harrison; Rupert, Ronald
Abstract Objective Vinyl chiropractic tables have been found to harbor pathogenic bacteria, but wiping with a simple disinfection agent can significantly reduce the risk of bacteria. The aim of this study was to assess the presence of microbes and other allergens or pathogens on cloth chiropractic tables. Methods Cloth-covered tables in a chiropractic college teaching clinic were selected. Samples were taken from the facial piece and hand rests with RODAC plates containing nutrient agar, followed by confirmatory testing when indicated. Results Numerous microbacteria strains were found, including Staphylococcus aureus and Propionibacterium. Allergen-producing molds, including Candida, were also found. Conclusion Cloth tables were shown to contain pathogenic microbacteria and allergens. The chiropractic profession should establish an infection control protocol relevant to treatment tables and discard use of cloth-covered treatment tables in this process. PMID:19674718
Faculty of Medicine Canadian Chiropractic Research Foundation Professorship in Epidemiology/Biomechanics Research Foundation (CCRF) Professorship in Epidemiology/Biomechanics (www in candidates with research skills in epidemiology, spine biomechanics, neurophysiology or cell biology
Johnson, Claire; Killinger, Lisa Zaynab; Christensen, Mark G; Hyland, John K; Mrozek, John P; Zuker, R Fred; Kizhakkeveettil, Anupama; Perle, Stephen M; Oyelowo, Tolu
The purpose of this article is to provide expert viewpoints on the topic of diversity in the chiropractic profession, including cultural competency, diversity in the profession, educational and clinical practice strategies for addressing diversity, and workforce issues. Over the next decades, changing demographics in North America will alter how the chiropractic profession functions on many levels. As the population increases in diversity, we will need to prepare our workforce to meet the needs of future patients and society. PMID:23966884
Johnson, Claire; Killinger, Lisa Zaynab; Christensen, Mark G.; Hyland, John K.; Mrozek, John P.; Zuker, R. Fred; Kizhakkeveettil, Anupama; Perle, Stephen M.; Oyelowo, Tolu
The purpose of this article is to provide expert viewpoints on the topic of diversity in the chiropractic profession, including cultural competency, diversity in the profession, educational and clinical practice strategies for addressing diversity, and workforce issues. Over the next decades, changing demographics in North America will alter how the chiropractic profession functions on many levels. As the population increases in diversity, we will need to prepare our workforce to meet the needs of future patients and society. PMID:23966884
Mitchell Haas; Elyse Groupp; Dale F. Kraemer
Abstract,BACKGROUND CONTEXT: There have been no trials of optimal chiropractic care in terms of number,of office visits for spinal manipulation and other therapeutic modalities. PURPOSE: To conduct a pilot study to make,preliminary identification of the effects of number of chiropractic treatment visits for manipulation,with and without physical modalities (PM) on chronic low back pain and disability. STUDY DESIGN\\/SETTING: Randomized,controlled trial
Wong, Jessica J.; Di Loreto, Luciano; Kara, Alim; Yu, Kavan; Mattia, Alicia; Soave, David; Weyman, Karen; Kopansky-Giles, Deborah
Objective We assessed the change in attitudes, knowledge, and perspectives of medical students towards chiropractic after a 1-hour educational intervention. Methods A mixed-methods approach was used with a 52-item cross-sectional paper survey and 1 focus group of third-year medical students. The views of these medical students towards chiropractic were assessed previously in their second-year of medical school. ANOVA and the Wilcoxon rank-sum test were used to assess between-group differences between the medical students' views before and after the educational intervention. The constant comparative method for analyzing qualitative data was used to identify emergent themes from the focus group transcript. Results Of 112 third-year medical students, 58 completed the survey (51.7% response rate). The focus group consisted of 6 medical students. Self-reported understanding of chiropractic and number of attitude-positive responses were significantly higher in the group after the educational session. The average number of correct responses assessing knowledge on chiropractic also was significantly higher. Focus group themes were that medical students wanted exposure to chiropractic in clinical settings, had negative attitudes towards chiropractic formed from hidden curriculum, had concerns regarding evidence and safety of chiropractic, and thought that timing of the session on chiropractic was too late in the curriculum. Conclusions The attitudes and knowledge of medical students towards chiropractic improved immediately after a 1-hour educational intervention. Formally educating medical students on chiropractic may help minimize hidden curriculum issues regarding chiropractic, as identified by the medical students, and facilitate collaboration between medical and chiropractic providers. PMID:25237768
Wong, Jessica J; Di Loreto, Luciano; Kara, Alim; Yu, Kavan; Mattia, Alicia; Soave, David; Weyman, Karen; Kopansky-Giles, Deborah
Objective : We assessed the change in attitudes, knowledge, and perspectives of medical students towards chiropractic after a 1-hour educational intervention. Methods : A mixed-methods approach was used with a 52-item cross-sectional paper survey and 1 focus group of third-year medical students. The views of these medical students towards chiropractic were assessed previously in their second-year of medical school. ANOVA and the Wilcoxon rank-sum test were used to assess between-group differences between the medical students' views before and after the educational intervention. The constant comparative method for analyzing qualitative data was used to identify emergent themes from the focus group transcript. Results : Of 112 third-year medical students, 58 completed the survey (51.7% response rate). The focus group consisted of 6 medical students. Self-reported understanding of chiropractic and number of attitude-positive responses were significantly higher in the group after the educational session. The average number of correct responses assessing knowledge on chiropractic also was significantly higher. Focus group themes were that medical students wanted exposure to chiropractic in clinical settings, had negative attitudes towards chiropractic formed from hidden curriculum, had concerns regarding evidence and safety of chiropractic, and thought that timing of the session on chiropractic was too late in the curriculum. Conclusions : The attitudes and knowledge of medical students towards chiropractic improved immediately after a 1-hour educational intervention. Formally educating medical students on chiropractic may help minimize hidden curriculum issues regarding chiropractic, as identified by the medical students, and facilitate collaboration between medical and chiropractic providers. PMID:25237768
Gleberzon, Brian J.
Geriatric care has assumed a more dominant position in the health care delivery system. This article discusses the results of a literature search on geriatric chiropractic care with the ultimate goal of promoting a“best practice” approach. Fifty nine articles were found that discussed geriatric chiropractic education (N = 3), demographic and epidemiological studies (N = 9), case studies (N = 25), clinical trials (N = 4) and clinical guidelines (N = 18). The literature revealed that chiropractic pedagogy has recognized the importance of geriatric education, and epidemiological studies reported an increase in utilization rates of chiropractic care by older persons, along with greater acceptance within the medical community. Most older persons sought out chiropractic care for neuromusculoskeletal (NMS) conditions, with several studies reporting the successful resolution of these conditions with spinal manipulative therapy as well as an eclectic group of other treatment interventions. Many older persons enter a maintenance care program, which they believe to be important to their health. Although the results of this article are encouraging, it underscores the need for continued research, especially in the areas of chiropractic maintenance care and the management of non-NMS conditions.
Kinsinger, F. Stuart; Sutton, Wendy
Health practitioners work under fiduciary constraint, and are obligated to favour patient needs over all others and in particular their own. The principles of professionalism demand that professionals take great care to ensure that boundaries are maintained safely to provide an optimal setting in facilitating patient care. Boundary violations cause serious harm to the patient. Any romantic or sexual activity between parties is the most serious form of boundary violation. The chiropractic profession is included in the list of disciplines which are at an increased risk for boundary violations. The authors propose a four stage protocol which is designed to offer all parties maximal protection beginning with undergraduate professional education and then mandatory continuing education for registrants in professional practice. The protocol would affect all aspects of professional life including training in boundaries and jurisdictional regulation. PMID:22457543
McGregor, Marion; Giuliano, Dominic
Objective: The purpose of this pilot investigation was to describe the development and implementation of simulation exercises and investigate the feasibility, satisfaction, and relative effectiveness of a manikin-based simulation program in chiropractic undergraduate education. Methods: This investigation consisted of (1) a qualitative review of other simulation environments and evaluation of related simulation literature to develop the educational processes to be used, (2) implementation of simulation scenarios for 95 student interns and their 11 supervising clinicians, and (3) implementation of simulation scenarios in a random sample of 35 1st-year and 24 2nd-year chiropractic students. Assessment of success was based on results from satisfaction and usability questionnaires and perceived achievement of learning outcomes. Anxiety scores were measured for all participants via a visual analog scale. The level of successful integration of 2nd-year basic science material was assessed using a t test comparing test results between students who participated in the pilot and those who did not. Results: Implementation methods were developed on the basis of qualitative investigation. Simulation program feedback from all participants indicated high levels of satisfaction, usability, and perceived achievement of learning outcomes. Anxiety levels among interns differed according to role chosen (F = 8.07, p =.00). Mean difference in course examination scores of students who participated in simulations versus those who did not was 3.25% favoring students who participated (t = 1.28, p =.10). Conclusions: High levels of student satisfaction and perceived achievement of learning outcomes were consistently achieved. A trend to successful integration of basic science knowledge provides reason for cautious optimism. More research is recommended. PMID:22778526
Biggs, Lesley; Hay, David; Mierau, Dale
The development of effective implementation strategies for chiropractic clinical practice guidelines (CPGs) presumes knowledge about the attitudes of the Canadian chiropractic profession. The purpose of this study was to explore the attitudes of Canadian chiropractors to philosophy and scope of practice. We hypothesized that given most Canadian chiropractors are trained at one school, the Canadian Memorial Chiropractic College (CMCC) in Toronto, there would be a reasonable degree of consensus about the practice of chiropractic in Canada, and therefore, effective implementation strategies could be developed. Drawing on a stratified random sample of Canadian chiropractors (n = 401), we found that 18.6% of respondents held conservative views, 22% held liberal views and 59.4% held moderate views. Conservative chiropractic philosophy rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer, and emphasizes the scientific validation of chiropractic concepts and methods. A conservative philosophy is associated with a narrow scope of practice in which chiropractic practice is restricted to musculoskeletal problems. A liberal chiropractic philosophy adheres to traditional chiropractic philosophy (offered either by D.D. or B.J. Palmer) and is associated with a broad scope of practice which includes the treatment of non-musculoskeletal conditions. Liberal-minded respondents are more likely to identify chiropractic as an alternate form of health care. Using ANOVA and MCA, the best predictors of the philosophy index were college of training and province of practice. Chiropractors who trained at the CMCC held more conservative views than those who were trained elsewhere. Moreover, we found significant provincial differences among the provinces on the philosophy index. Saskatchewan chiropractors held the most conservative views on the philosophy index; Quebec chiropractors held the most liberal views. We concluded that given the divergence of opinions among Canadian chiropractors, one implementation strategy would not be effective. We also questioned whether CPGs are the most efficacious method of changing clinical behaviour.
Evans, Marion Willard; Breshears, Jennell; Campbell, Alan; Husbands, Chris; Rupert, Ronald
Background To investigate the presence of pathogenic microbes on chiropractic treatment tables in one outpatient teaching clinic. Additional aims were to test inexpensive disinfectants on tables that may kill microbes and suggest infection control measures for chiropractic offices, clinics and classrooms. The aim of the study was to assess the presence of pathogenic microbes on treatment tables in one outpatient teaching clinic and determine a simple behavioral model for infection control including table disinfection and accepted hand washing and sanitizing protocols. Methods 10 treatment tables were selected and sampled for possible microbial flora on face and hand pieces. Samples were cultured on MacConky's agar and mannitol salt agar, labeled and incubated for up to 48 hours. Confirmatory testing of microbes to determine if drug resistant flora were present was performed. Among tables tested, 5 were selected to test disinfectants. One-half of the face piece and 1 hand piece were treated with two different wipes and then post-tested for microbes. Results Pathogenic microbes were present on chiropractic treatment tables including methicillin-resistant Staph aureus. Simple disinfectants neutralized the pathogens. A rudimentary disinfection procedure and infection control measures are suggested based on the findings. Conclusion Pathogenic microbes may be present on chiropractic treatment tables and can be effectively killed with proper disinfecting. Hand washing/sanitizing is an important measure in infection control as is table disinfecting. Rudimentary behavioral changes to improve chiropractic clinic infection control are needed. More comprehensive behavioral models are needed. All teaching clinics and private chiropractic offices should adopt infection control practices including routine table disinfecting and hand sanitizing. Effective measures can be put in place at minimal costs. Accrediting bodies of chiropractic institutions should mandate an infection control plan for member institutions immediately. PMID:17555579
Background Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors. Objective The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. Methods Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. Conclusions To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD. PMID:20525195
Whillier, Stephney; Lystad, Reidar P.; Abi-Arrage, David; McPhie, Christopher; Johnston, Samara; Williams, Christopher; Rice, Mark
Objective The aims of our study were to measure the learning style preferences of chiropractic students and to assess whether they differ across the 5 years of chiropractic study. Methods A total of 407 (41.4% females) full-degree, undergraduate, and postgraduate students enrolled in an Australian chiropractic program agreed to participate in a cross-sectional survey comprised of basic demographic information and the Visual, Aural, Read/Write, Kinesthetic (VARK) questionnaire, which identifies learning preferences on four different subscales: visual, aural, reading/writing, and kinesthetic. Multivariate analysis of variance and the ?2 test were used to check for differences in continuous (VARK scores) and categorical (VARK category preference) outcome variables. Results The majority of chiropractic students (56.0%) were found to be multimodal learners. Compared to the other learning styles preferences, kinesthetic learning was preferred by a significantly greater proportion of students (65.4%, p < .001) and received a significantly greater mean VARK score (5.66 ± 2.47, p < .001). Conclusions To the best of our knowledge, this is the first time chiropractic students have been shown to be largely multimodal learners with a preference for kinesthetic learning. While this knowledge may be beneficial in the structuring of future curricula, more thorough research must be conducted to show any beneficial relationship between learning style preferences and teaching methods. PMID:24350945
Violato, Claudio; Marini, Anthony; Nixdorf, Don; Lawson, Douglas
A cardinal characteristic of any profession is self-regulation. It is argued in the present paper that chiropractic has now reached a level of professional maturity that indicates the need for the final aspect of self-regulation: a standardized selection approach into professional schools or colleges. Quality control of membership can then begin at the entry point into the profession. An admission test - the Chiropractic College Admission Test (CCAT) - is proposed and outlined for use for the selection of candidates into chiropractic colleges. Such a test would be beneficial for students applying to the colleges, regulatory and licensing boards, to the profession as a whole, to the chiropractic colleges, to other professions, and to government as well as the general public. The proposed CCAT contains elements that are general to many health professions such as knowledge of the biological and physical sciences, verbal and linguistic reasoning and visual perceptual ability. The test, however, is proposed to have elements that are unique to chiropractic. Based on the performance of other admission tests (e.g. Dental Admission Test, Medical College Admission Test), it is argued that the CCAT could be constructed and used to have the highest technical properties of validity and reliability. Such a test would become an integral tool in maintaining quality assurance, beginning at the earliest point of the profession.
Green, Bart N.; Johnson, Claire D.; Lisi, Anthony J.; Tucker, John
Objective To summarize scholarly literature that describes practice, utilization, and/or policy of chiropractic services within international active duty and/or veteran health care environments. Data Sources PubMed, the Cumulative Index to Nursing and Allied Health Literature, and the Index to Chiropractic Literature were searched from their starting dates through June 2009. Review Methods All authors independently reviewed each of the articles to verify that each met the inclusion criteria. Citations of included papers and other pertinent findings were logged in a summary table. Results Thirteen articles were included in this study. Integration of chiropractic care into military or veteran health care systems has been described in 3 systems: the United States Department of Defense, the United States Department of Veterans Affairs, and the Canadian Forces. Conclusion Chiropractic services seem to be included successfully within military and veteran health care facilities. However, there is a great need for additional written evaluation of the processes, policies, practices, and effectiveness of chiropractic services in these environments. PMID:19714234
Whillier, Stephney; Lystad, Reidar P; Abi-Arrage, David; McPhie, Christopher; Johnston, Samara; Williams, Christopher; Rice, Mark
Objective : The aims of our study were to measure the learning style preferences of chiropractic students and to assess whether they differ across the 5 years of chiropractic study. Methods : A total of 407 (41.4% females) full-degree, undergraduate, and postgraduate students enrolled in an Australian chiropractic program agreed to participate in a cross-sectional survey comprised of basic demographic information and the Visual, Aural, Read/Write, Kinesthetic (VARK) questionnaire, which identifies learning preferences on four different subscales: visual, aural, reading/writing, and kinesthetic. Multivariate analysis of variance and the ?(2) test were used to check for differences in continuous (VARK scores) and categorical (VARK category preference) outcome variables. Results : The majority of chiropractic students (56.0%) were found to be multimodal learners. Compared to the other learning styles preferences, kinesthetic learning was preferred by a significantly greater proportion of students (65.4%, p < .001) and received a significantly greater mean VARK score (5.66 ± 2.47, p < .001). Conclusions : To the best of our knowledge, this is the first time chiropractic students have been shown to be largely multimodal learners with a preference for kinesthetic learning. While this knowledge may be beneficial in the structuring of future curricula, more thorough research must be conducted to show any beneficial relationship between learning style preferences and teaching methods. PMID:24350945
Hecimovich, Mark D.; Volet, Simone E.
Purpose: One important objective of chiropractic education is to foster student professional confidence and competence in patient communication and clinical skills. Therefore, the aim of this article is to review the extant literature on this topic, stressing the significance of building students' confidence for effective practice and the need for more research in this area. Methods: The authors reviewed MEDLINE and ERIC from 1980 through 2008 using several key words pertinent to confidence and health care. Three distinct, but interrelated, bodies of literature were assessed, including professional confidence in health care research, the nature and development of confidence in educational psychology research, and fostering professional confidence in chiropractic education. Results: It was apparent through the review that chiropractic education has developed educational methods and opportunities that may help develop and build student confidence in patient communication and clinical skills. However, there has not been sufficient research to provide empirical evidence of the impact. Conclusion: Fostering chiropractic students' development of confidence in what they say and do is of paramount importance not only to them as new practitioners but more importantly to the patient. There is no doubt that a better understanding of how confidence can be developed and consolidated during tertiary study should be a major goal of chiropractic education PMID:19826543
Angus, Katherine; Asgharifar, Sepideh; Gleberzon, Brian
The purpose of this study was to provide a narrative review of the literature of studies describing the management of disorders of the gastro-intestinal (GI) tract using ‘chiropractic therapy’ broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches. Search limiters include access to full text studies published between 1980 and November 2012 in peer-reviewed journals, English language only involving human subjects. Twenty-one articles were found that met our inclusion criteria. Retrievable articles varied from case reports to clinical trials to review articles of management options. The majority of articles chronicling patient experiences under chiropractic care reported they demonstrated mild to moderate improvements in presenting symptoms. No adverse side effects were reported. This suggests chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities. PMID:26136604
Murphy, Donald R; Schneider, Michael J; Seaman, David R; Perle, Stephen M; Nelson, Craig F
Background The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions which had their start at around the same time as chiropractic have disappeared. Despite chiropractic's longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society. Objective To present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority. Discussion There are several key areas in which the podiatric medical profession has succeeded and in which the chiropractic profession has not. The authors contend that it is in these key areas that changes must be made in order for our profession to overcome its shrinking market share and its present low status amongst healthcare professions. These areas include public health, education, identity and professionalism. Conclusion The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise. Several lessons can be learned from the podiatric medical profession in this effort. PMID:18759966
Chiropractic spinal manipulation (CSM) is often used as a treatment for neck pain. However, its effectiveness is unclear. The aim of this article was to evaluate systematically and critically the effectiveness of CSM for neck pain. Six electronic databases were searched for all relevant randomized clinical trials. Strict inclusion/exclusion criteria had been predefined. Key data were validated and extracted. Methodologic quality was assessed by using the Jadad score. Statistical pooling was anticipated but was deemed not feasible. Four studies met the inclusion/exclusion criteria. Two studies were on single interventions, and 2 included series of CSM treatments, both with a 12-month follow-up. The 2 short-term trials used spinal mobilization as a control intervention. The 2 long-term studies compared CSM with exercise therapy. None of the 4 trials convincingly demonstrated the superiority of CSM over control interventions. In conclusion, the notion that CSM is more effective than conventional exercise treatment in the treatment of neck pain was not supported by rigorous trial data. PMID:14622659
Marcus A. Doel; Jeremy Segrott
The paper explores the materiality of complementary and alternative medicine (CAM), with particular reference to aromatherapy, Chinese herbal medicine, and chiropractic, as presented in the journals of UK-based practitioner associations. The paper begins by arguing for a poststructuralist approach to materiality. It then considers how certain materials play a signature (or emblematic) role in the definition and practice of various
Elaine Morschhauser; Cynthia R. Long; Cheryl Hawk; Karen Boulanger; Jeanne Black; Thomas Carpenter; Grant Iannelli; Owen T. Lynch; John Stites
Objective: This study involved the collection of data on the demographic characteristics and chief complaints of patients of chiropractic college teaching clinics to study whether patients who visited different types of teaching clinics were demographically or clinically dissimilar. It represents a first step toward our ability to collect data from teaching clinics to test for differences between specific clinic populations.
Stephan J. Troyanovich; Donald D. Harrison; Deed E. Harrison
Background: Low back pain exists in epidemic proportions in the United States. Studies that demonstrate innervation to the intervertebral disk provide evidence that may account for instances of discogenic low back pain encountered in general medical and chiropractic practice. Many patients and health care practitioners believe that intervertebral disk lesions require surgery as the only method of treatment that will
Cooperstein, Robert; Lisi, Anthony; Burd, Andrew
Objective The purpose of this case report is to describe chiropractic management of a patient with overactive bladder (OAB) and to describe an hypothetical anatomical basis for a somato-vesical reflex and possible clinical link between pelvic and symphysis pubis dysfunction to OAB. Clinical features A 24-year-old nulliparous female with idiopathic OAB, with a primary complaint of nocturia presented for chiropractic care. Her sleep was limited to 2 consecutive hours due to bladder urgency. Pubic symphysis shear dysfunction was observed on physical examination. Intervention and outcomes The primary treatment modality used was chiropractic side-posture drop-table manipulation designed to reduce pubic shear dysfunction. After 8 treatments in 1 month, the pubic shear gradually reduced while nocturia diminished and consecutive sleep hours increased from 2 to 7. At 1-year follow-up, the nocturia remained resolved. Conclusion The patient reported in this case responded favorably to chiropractic care, which resulted in reduced nocturia and increased sleep continuity. PMID:25685115
Erin L. Elster
Objective: To discuss the use of upper cervical chiropractic management in managing a single patient with Parkinson's disease and to describe the clinical picture of the disease. Clinical Features: A 60-year-old man was diagnosed with Parkinson's disease at age 53 after a twitch developed in his left fifth finger. He later developed rigidity in his left leg, body tremor, slurring
Sheppard, Lorraine A.; Jorgensen, Anna Maria S.; Crowe, Michael J.
Participatory action research (PAR) can be used in the health professions to redefine their roles. This study investigated a small health professional group, the members of The Chiropractic Association Singapore (TCAS), by using a PAR method; researchers and participants gained insights into the self-regulation of a health profession. A…
Strunk, Richard G.; Hanses, Mark
Objective The purpose of this case report is to describe the response to chiropractic care of a geriatric patient with left hip pain, a history of repetitive falls, poor balance, myofascial dysfunction, and hip osteoarthritis. Clinical Features A 70-year-old, white, female patient presented for chiropractic care with a chief complaint of left hip pain of 1 year's duration and a history of 2 falls within the past 5 years. The patient's initial Lower Extremity Functional Index score was 42%. Important initial examination findings include a body mass index of 45.0, a One Leg Standing Test of 4 seconds, a Timed Up and Go test of 17 seconds, decreased active range of motion findings, and degenerative radiological findings of the left hip joint. Intervention and Outcome Chiropractic treatment primarily consisted of hip and spinal manipulation, mobilization, and passive stretching. The patient was seen 16 times over a 12-week period. After 12 weeks of care, the patient had a significant decrease on the Lower Extremity Functional Index and had demonstrated improvements in left hip internal rotation and in Timed Up and Go and One Leg Standing Test times. The Patient Global Impression of Change scale indicated that the patient was “very much better.” Conclusion This case illustrates a patient who had increased range of motion, improved balance and gait speed, and decreased disability after a 12-week course of chiropractic care. PMID:22027209
Gert Bronfort; Roni L. Evans; Paul Kubic; Patty Filkin
Objectives: The first objective was to determine if chiropractic spinal manipulative therapy (SMT) in addition to optimal medical management resulted in clinically important changes in asthma-related outcomes in children. The second objective was to assess the feasibility of conducting a full-scale, randomized clinical trial in terms of recruitment, evaluation, treatment, and ability to deliver a sham SMT procedure. Study Design:
Cunningham, Christine M.; Larzelere, Elizabeth D.; Arar, Ilija
Purpose: As human tissue pathology slides become increasingly difficult to obtain, other methods of teaching microscopy in educational laboratories must be considered. The purpose of this study was to evaluate our students' satisfaction with newly implemented computer imagery based laboratory instruction and to obtain input from their perspective on the advantages and disadvantages of computerized vs. traditional microscope laboratories. Methods: This undertaking involved the creation of a new computer laboratory. Robbins and Cotran Pathologic Basis of Disease, 7th ed, was chosen as the required text which gave students access to the Robbins Pathology website, including complete content of text, Interactive Case Study Companion, and Virtual Microscope. Students had experience with traditional microscopes in their histology and microbiology laboratory courses. Student satisfaction with computer based learning was assessed using a 28 question survey which was administered to three successive trimesters of pathology students (n=193) using the computer survey website Zoomerang. Answers were given on a scale of 1-5 and statistically analyzed using weighted averages. Results: The survey data indicated that students were satisfied with computer based learning activities during pathology laboratory instruction. The most favorable aspect to computer imagery was 24–7 availability (weighted avg. 4.16), followed by clarification offered by accompanying text and captions (weighted avg. 4.08). Conclusion: Although advantages and disadvantages exist in using conventional microscopy and computer imagery, current pathology teaching environments warrant investigation of replacing traditional microscope exercises with computer applications. Chiropractic students supported the adoption of computer-assisted instruction in pathology laboratories PMID:19043534
Background Complementary and alternative medicine (CAM) is growing in popularity, especially within the pediatric population. Research on CAM practitioners and their specialties, such as pediatrics, is lacking. Within the chiropractic profession, pediatrics is one of the most recently established post-graduate specialty programs. This paper describes the demographic and practice characteristics of doctors of chiropractic with a pediatric diplomate. Methods 218 chiropractors with a pediatric diplomate were invited to complete our survey using either web-based or mailed paper survey methods. Practitioner demographics, practice characteristics, treatment procedures, referral patterns, and patient characteristics were queried with a survey created with the online survey tool, SurveyMonkey©®. Results A total of 135 chiropractors responded (62.2% response rate); they were predominantly female (74%) and white (93%). Techniques most commonly used were Diversified, Activator ®, and Thompson with the addition of cranial and extremity manipulation to their chiropractic treatments. Adjunctive therapies commonly provided to patients included recommendations for activities of daily living, corrective or therapeutic exercise, ice pack\\cryotherapy, and nutritional counseling. Thirty eight percent of respondents' patients were private pay and 23% had private insurance that was not managed care. Pediatrics represented 31% of the survey respondents' patients. Chiropractors also reported 63% of their work time devoted to direct patient care. Health conditions reportedly treated within the pediatric population included back or neck pain, asthma, birth trauma, colic, constipation, ear infection, head or chest cold, and upper respiratory infections. Referrals made to or from these chiropractors were uncommon. Conclusions This mixed mode survey identified similarities and differences between doctors of chiropractic with a pediatric diplomate to other surveys of doctors of chiropractic, CAM professionals, and pediatric healthcare providers. The pediatric diplomate certificate was established in 1993 and provides didactic education over a 2 to 3 year span. The results of this study can be used for historical information as this specialty continues to grow. PMID:20546582
This article provides a brief review of the history and origins of the Journal of Chiropractic Humanities. The reason for starting the journal, its purpose, and a timeline from 1991 to 2009 are offered. PMID:22693460
Background Typically a large amount of information is collected during healthcare research and this information needs to be organised in a way that will make it manageable and to facilitate clear reporting. The Chiropractic Observation and Analysis STudy (COAST) was a cross sectional observational study that described the clinical practices of chiropractors in Victoria, Australia. To code chiropractic encounters COAST used the International Classification of Primary Care (ICPC-2) with the PLUS general practice clinical terminology to code chiropractic encounters. This paper describes the process by which a chiropractic-profession specific terminology was developed for use in research by expanding the current ICPC-2 PLUS system. Methods The coder referred to the ICPC-2 PLUS system when coding chiropractor recorded encounter details (reasons for encounter, diagnoses/problems and processes of care). The coder used rules and conventions supplied by the Family Medicine Research Unit at the University of Sydney, the developers of the PLUS system. New chiropractic specific terms and codes were created when a relevant term was not available in ICPC-2 PLUS. Results Information was collected from 52 chiropractors who documented 4,464 chiropractor-patient encounters. During the study, 6,225 reasons for encounter and 6,491 diagnoses/problems were documented, coded and analysed; 169 new chiropractic specific terms were added to the ICPC-2 PLUS terminology list. Most new terms were allocated to diagnoses/problems, with reasons for encounter generally well covered in the original ICPC 2 PLUS terminology: 3,074 of the 6,491 (47%) diagnoses/problems and 274 of the 6,225 (4%) reasons for encounter recorded during encounters were coded to a new term. Twenty nine new terms (17%) represented chiropractic processes of care. Conclusion While existing ICPC-2 PLUS terminology could not fully represent chiropractic practice, adding terms specific to chiropractic enabled coding of a large number of chiropractic encounters at the desired level. Further, the new system attempted to record the diversity among chiropractic encounters while enabling generalisation for reporting where required. COAST is ongoing, and as such, any further encounters received from chiropractors will enable addition and refinement of ICPC-2 PLUS (Chiro). More research is needed into the diagnosis/problem descriptions used by chiropractors. PMID:23311664
Chapman, Peter D.; Meyer, Amanda; Young, Kenneth; Wibowo, Daniel; Walker, Bruce
Objective The aim of this study was to conduct an international survey of the perceived optimal level of anatomy teaching from anatomy academics and practicing chiropractors. We hypothesized that the optimum level of anatomical understanding for chiropractic students does not differ between the anatomists teaching the students and practicing chiropractors. Methods The opinion of anatomists teaching in a chiropractic course (n = 16) was compared to practicing chiropractors (n = 589). The students' level of understanding was based on the revised Bloom's taxonomy for 16 different curriculum areas. Anatomists were recruited by contacting the accredited chiropractic courses worldwide. Snowball sampling was used for the practicing chiropractors. Independent-samples Mann-Whitney U tests were used to compare the results of anatomists and chiropractors. Results Opinions differed between anatomists and chiropractors on 9 out of the 16 questions. Where opinions differed, chiropractors recommended a higher standard of anatomical knowledge. The level suggested by chiropractors for these curriculum areas is equal to the “evaluating” level where chiropractic students can remember, understand, apply, and analyze anatomical knowledge to be able to justify a clinical decision. Conclusion Compared to anatomists working in chiropractic programs, chiropractors suggest a higher standard of anatomy be taught to undergraduates. Collaboration between chiropractors and anatomists would likely be beneficial in creating or modifying anatomy curricula for chiropractic students. PMID:25517738
Gibbons, R W
Alma Cusian Arnold (1871-19??) was one of the first woman chiropractors, having graduated from Langsworthy's American School in 1903. Within the next decade, she would establish dual practices in Washington and New York with a patient constituency which included members of Congress, a Vice President and Clara Barton, the founder of the American Red Cross. She authored a book, was president of two schools of chiropractic and was arrested and imprisoned for her advocacy of the new profession. Engaging in critical dialogue over her technique with both Palmers, Arnold would establish a "Healtharium" with Terrance V. Powderly, the most prominent labor leader of the late 19th century and later Commissioner of Immigration. Her story is a personification of the exceptional men and women who formulated early chiropractic. PMID:11619052
Cofano, Gregory P.; Anderson, Benjamin C.; Stumpff, Eric R.
Objective The purpose of this case report is to describe chiropractic care of an adolescent with acute low back pain and incidental finding of spina bifida occulta managed with high-velocity low-amplitude manipulation. Clinical Features A 10-year-old boy was referred for chiropractic care by his pediatrician for the management of low back pain after a fall 3 days prior. Examination and medical records revealed the patient also had spina bifida occulta at the level of L5. Intervention and Outcome High-velocity low-amplitude treatment for lower back pain showed resolution of patient's pain after 6 visits. No adverse effects were reported. Conclusion An adolescent patient with lower back pain and incidental finding of spina bifida occulta improved with a course of care that included with high-velocity low-amplitude manipulation therapy. PMID:25435841
Rubis, Lisa M.; Rubis, David; Winchester, Brett
Objective The purpose of this case report is to describe the chiropractic and dental comanagement of a patient with temporomandibular dysfunction, headaches, and myalgia. Clinical features A 38-year-old black female patient presented for chiropractic care with a chief concern of jaw pain, tinnitus, headaches, and neck and shoulder soreness of 8 months’ duration. The patient rated the pain a 6/10. The patient had a maximum mouth opening of 42 mm, graphed evidence of disk displacement, loss of translation on opening of the right temporomandibular joint viewed on the lateral radiograph, and numerous areas of point tenderness on the Kinnie-Funt Chief Complaint Visual Index. She had decreased lateral cervical flexion. Intervention and outcome Dental treatment consisted of an anterior repositioning splint. Chiropractic care consisted of Activator treatment to the pelvis and the thoracic and cervical spine. Manual manipulation of the temporomandibular joint was performed along with a soft tissue technique intraorally on the lateral pterygoid. Postisometric relaxation in the head and neck region was also done. The patient was treated 6 times over 3 weeks. At the end of treatment, the patient had a pain rating of 0/10, maximum mouth opening of 49 mm, no tender points on the follow-up Kinnie-Funt, and increased cervical range of motion. Conclusion The patient demonstrated increased mouth opening, decreased pain rating, improved Kinnie-Funt visual index, and an increased cervical lateral flexion range of motion after 3 weeks of a combination of chiropractic and dental care. PMID:24711786
Maxwell J. Walsh; Barbara I. Polus
Objective: To evaluate the efficacy of chiropractic therapy on the treatment of symptoms associated with premenstrual syndrome. Design: A prospective, randomized, placebo-controlled, crossover clinical trial. Setting: Multicenter private clinics. Subjects: Twenty-five subjects with diagnosed premenstrual syndrome (with a Moos premenstrual syndrome questionnaire plus daily symptom monitoring). Intervention: After randomization, 16 of the subjects received high-velocity, low-amplitude spinal manipulation plus soft
Gleberzon, Brian; Lameris, Marlee; Schmidt, Catherine; Ogrady, Jillian
The Palmers espoused anti-vaccination opinions in the early part of the 20th century, rejecting the germ theory of disease in favor of a worldview that a subluxation-free spine, achieved by spinal adjustments, would result in an unfettered innate intelligence; this, along with other healthful lifestyle choices, would allow a person to thwart disease by marshaling the body’s natural recuperative abilities. Some chiropractors continue to staunchly champion the Palmer postulates, while others do not. At the national level, advocacy organizations publish conflicting position statements. We explore how this divisiveness has impacted chiropractic ideology, perceptions among students and practitioners, politics and issues of jurisprudence as reflected by the evolution of a standard of chiropractic practice in at least one Canadian province (Ontario). We opine that the chiropractic profession should champion a health promotion and disease prevention approach to vaccination, which would allow it to align itself with the broader healthcare community while not abandoning its traditional tenets. PMID:23997246
Jackson, R B
The first few chiropractors in Massachusetts practiced as they desired, unmolested by the authorities. All this changed after Joe Shelby Riley, D.C., established his New England College of Chiropractic in Boston in 1911. Printed publicity got out as to the tuition costs, length of the course and what graduates could expect to earn in a short time, when the police stepped in. They arrested first J.O. Zimmerman, D.C., of Boston, followed by Dr. Riley, a school president, then Samuel Mendelson, D.C., in Lynn, all for illegal practices. From the judical decision in Commonwealth v Zimmerman, 1915 by the Supreme Judicial Court (State Supreme Court), the high court held that the practice of chiropractic to be the illegal practice of medicine without a license, according to the Commonwealth laws of 1902. Next came the Commonwealth v New England College of Chiropractic; this case was shortly followed on appeal from the Municipal Court in Boston, to the Suffolk County Superior Court, to the Supreme Judicial Court like Zimmerman. In this case against Dr. Riley and his school, the high court affirmed the school to be illegal because Dr. Riley had failed to receive authority from the Great General Court (the Legislature) to get a bill passed authorizing the school to have the right of granting degrees. According to the Boston Herald, all this legal action was the culmination of a campaign spearheaded by the Massachusetts Medical Society. PMID:11624039
Moreau, William J.; Nabhan, Dustin C.
Objective The purpose of this article is to provide a summary of the development of the American Chiropractic Board of Sports Physicians (ACBSP) Position Statement on Concussion in Athletics regarding the management of concussion in sport and to offer suggestions to qualifying doctors of chiropractic (DCs) to make return-to-play decisions and clarify common concepts pertaining to evaluating and managing concussion in sport. Methods A literature review of position statements from sports medicine organizations was performed. The authors reviewed each statement for content. Key issues in the management of concussion in sport were identified with special consideration to concussion management by DCs. A position statement on the management of concussion in sport was drafted by the authors and submitted to the Board of Directors of the ACBSP for review. The Board of Directors called for minor revision; and after all revisions were made, the document was resubmitted. The Board of Directors of the ACBSP accepted the document for publication and presentation. The document was presented and disseminated to certificants by the ACBSP at the 2011 Chiropractic Sports Sciences Symposium. Results The 2012 ACBSP Position Statement on Concussion in Athletics was accepted by the ACBSP Board of Directors. Conclusion The Position Statement on Concussion in Athletics has been accepted by the ACBSP. This document offers guidance on the management of concussion in sport and provides qualifying DCs information to make return-to-play decisions. PMID:24396329
Estrin Dashe, Alejandra A.
Background Several studies have reported on the health benefits of applying an integrated complementary health care model. Purpose This paper presents the results of pilot research focusing on the observations massage therapy students made about complementary health care education and integration during massage, chiropractic, and acupuncture treatments at two university clinics. Setting: Observations took place at Northwestern Health Sciences University’s associated clinics that offered massage, chiropractic, and acupuncture. Research Design: Students directly observed how clinicians and interns educated their patients and integrated other forms of complementary health care into their practice. Participants: chiropractors, massage therapists, and acupuncturists, and their patients. All participants were English-speaking and 18–65 years old. Main Outcome Measures: Observations recorded by students in journals about education and integration during massage therapy, chiropractic, and acupuncture treatments were coded and counted. Results Qualitative observations showed that clinicians and interns educated patients to some degree, but the clinicians were less apt to integrate other modalities than the interns. Conclusions Observations support that professional integrity may limit clinicians in their ability to integrate multiple modalities of health care while treating patients. Since it is well established that integration of multiple health care modalities is beneficial to patient health, it is recommended that clinics assist their clinical staff in applying an integrative approach to their practice. PMID:22811755
R. N. Nadgir; L. A. Loevner; T. Ahmed; G. Moonis; J. Chalela; K. Slawek; S. Imbesi
Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation.
Charles E. Sawyer; Roni L. Evans; Patrick D. Boline; Richard Branson; Anne Spicer
Background: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to support their claims. Objective: A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for
Lise Hestbaek; Mette Jensen Stochkendahl
Five to ten percent of chiropractic patients are children and adolescents. Most of these consult because of spinal pain, or other musculoskeletal complaints. These musculoskeletal disorders in early life not only affect the quality of children's lives, but also seem to have an impact on adult musculoskeletal health. Thus, this is an important part of the chiropractors' scope of practice,
Background The Internet has become a common source of information for patients wishing to learn about health information. Previous studies found information related to back pain poor and often contradictory to current guidelines. Wellness has become a common topic in the field of chiropractic and accrediting agencies have standards on delivery of wellness-based content in college curricula as well as directives for clinical applications. The purpose of this study was to evaluate the quality of the information on the Internet using the terms "chiropractic wellness," or "wellness chiropractic". Methods Five commonly used search engines were selected and the first 10 sites found using the strategy above were evaluated by two raters. Demographic assessments of the sites were made along with whether they were Health on the Net Foundation (HON) certified, contained standard wellness content, mentioned any Healthy People Focus Areas, and other chiropractic topics. Kappa statistics compared inter-rater agreement. Results Potential patients appeared to be the audience 87% of the time and a private doctor of chiropractic appeared to be the typical site owner. The sites usually promoted the provider. No sites displayed HON certification logo nor did any appear to meet the HON certification criteria. Twenty-six sites (55%) promoted regular physical activity in some manner and 18 (38%) had information on health risks of tobacco. Four (9%) had mental health or stress-reduction content but none had information supportive of vaccination. Some had information contradictory to common public health measures. Conclusions Patients searching the Internet for chiropractic wellness information will often find useless information that will not help them maintain health or become well. Most simply market the chiropractic practice or allow for a patients to provide personal information in exchange for more 'wellness' information. More research should be done on how providers determine site content, pay any attention to the details on their sites, or agree with content as some appear to be prefabricated sites. Website content could be enhanced by sharing of information from reputable sources like US Centers for Disease Control, the National Institutes of Health and other authoritative sources. HON certification should also be sought. PMID:21288336
Young, Kenneth J.
Objective The purpose of this study was to evaluate publicly available information of chiropractic technique systems that advocate radiography for subluxation detection to identify links between chiropractic technique systems and to describe claims made of the health effects of the osseous misalignment component of the chiropractic subluxation and radiographic paradigms. Methods The Internet and publicly available documents were searched for information representing chiropractic technique systems that advocate radiography for subluxation detection. Key phrases including chiropractic, x-ray, radiography, and technique were identified from a Google search between April 2013 and March 2014. Phrases in Web sites and public documents were examined for any information about origins and potential links between these techniques, including the type of connection to BJ Palmer, who was the first chiropractor to advocate radiography for subluxation detection. Quotes were gathered to identify claims of health effects from osseous misalignment (subluxation) and paradigms of radiography. Techniques were grouped by region of the spine and how they could be traced back to B.J Palmer. A genealogy model and summary table of information on each technique were created. Patterns in year of origination and radiographic paradigms were noted, and percentages were calculated on elements of the techniques’ characteristics in comparison to the entire group. Results Twenty-three techniques were identified on the Internet: 6 full spine, 17 upper cervical, and 2 techniques generating other lineage. Most of the upper cervical techniques (14/16) traced their origins to a time when the Palmer School was teaching upper cervical technique, and all the full spine techniques (6/6) originated before or after this phase. All the technique systems’ documents attributed broad health effects to their methods. Many (21/23) of the techniques used spinal realignment on radiographs as one of their outcome measures. Conclusion Chiropractic technique systems in this study (ie, those that advocate for radiography for subluxation misalignment detection) seem to be closely related by descent, their claims of a variety of health effects associated with chiropractic subluxation, and their radiographic paradigms. PMID:25431540
Gleberzon, Brian J.
Introduction: The process by which the jurisprudence course was restructured at the Canadian Memorial Chiropractic College is chronicled. Method: A Delphi process used to restructure the course is described, and the results of a student satisfaction survey are presented. Results: When asked “I think this material was clinically relevant,” over 81% of the 76 students who respondents strongly agreed or agreed with this statement; 100% of students agreed or strongly agreed that scope of practice; marketing, advertising and internal office promotion; record keeping; fee schedules; malpractice issues and; professional malpractice issues and negligence was clinically relevant. When asked “I think this material was taught well,” a minimum of 89% of students agreed or strongly agreed with this statement. Discussion: This is the first article published that described the process by which a jurisprudence course was developed and assessed by student survey. Summary: Based on a survey of student perceptions, restructuring of the jurisprudence course was successful in providing students with clinically relevant information in an appropriate manner. This course may serve as an important first step in development a ‘model curriculum’ for chiropractic practice and the law courses in terms of content, format and assessment strategies. PMID:20195427
Gay, Charles W.; Bishop, Mark D.; Beres, Jacqueline L.
Introduction The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic. Case Report/Methods After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult. Results Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement. Conclusion It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment. PMID:23204955
Wall, James C; Turnbull, George I; Vernon, Howard
This paper compares the efforts of physiotherapy and chiropractic to move towards the development of a scientific body of knowledge through research. The history of both professions is discussed with particular reference to the education of the clinical practitioners and the educational faculty. Four cited factors contributing to the paucity of research in chiropractic, namely anti-scientific elements in philosophy, lack of suitable role-models, lack of funds and a lack of understanding of research methodology are also seen as barriers to physiotherapy research. These obstacles are discussed in the light of the strategies being employed by both professions to deal with this issue and their success or otherwise. It is stressed that research by members of both professions is fundamental to ensure professional survival. Solutions are principally concerned with increasing the research output from those institutions which educate future professionals. This new generation will likely ensure that the professions are soundly based on scientific principles. The paper considers, therefore, the pre-professional curriculum primarily, although not exclusively, from a Canadian perspective.
Bova, Joseph; Sergent, Adam
Objective The purpose of this case report is to describe the chiropractic management of a patient with idiopathic, intermittent right-sided hemiparesthesia. Clinical Features A 24-year-old woman presented with a 2-year history of intermittent idiopathic right arm paresthesia. She also had a 3-month history of intermittent idiopathic right leg/face paresthesia. These symptoms were strongest at night and caused insomnia and worsened over time. She rated her discomfort at 5/10 on a numeric scale. Intervention and Outcome Care included vibration stimulation therapy, spinal manipulation and cold laser therapy. She had a noticeable reduction in her paresthesia both subjectively and objectively. She showed improvement in paresthesia on the right side of her body after the first visit. The following week, after 2 visits she returned and stated that she was symptom free with 0/10 discomfort on a numeric scale. Conclusion This patient's symptoms of idiopathic, intermittent right-sided hemi-paresthesia seemed to improve with a short course of chiropractic care using manipulation, vibration therapy and cold laser therapy. PMID:25435843
Eric L Hurwitz; Lu-May Chiang
BACKGROUND: Scientifically rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published. The objective of this study is to compare care seekers of doctors of chiropractic (DCs) and general practitioners (GPs) in the United States and Canada on a comprehensive set of sociodemographic, quality of life, and health-related variables. METHODS: Data are
Kobrossi, Toffy; Schut, Brian
An Objective Structured Clinical Examination (O.S.C.E.) utilized in the Canadian Memorial Chiropractic College’s teaching clinics is examined. The need for valid, reliable, objective, relevant and practical clinical examinations is emphasized. The development and administration of an O.S.C.E. is described and sample testing stations are presented. It is suggested that O.S.C.E. provides chiropractic colleges with an objective tool for assessing clinical competence. ImagesFigure 4Figure 5Figure 6
Munck, Anders; Jarbøl, Dorte Ejg; Søndergaard, Jens
Study Design. Baseline description of a multicenter cohort study. Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark. Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice. Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson's chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out of five patients had had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often females, and generally worse on all disease-related parameters than chiropractic patients. All differences were statistically significant. Conclusions. LBP in primary care was recurrent, causing sick leave and activity limitations. There were clear differences between the chiropractic and general practice populations in this study. PMID:25436149
Crowther, Edward R.
Introduction: Improving the quality of healthcare is a common goal of consumers, providers, payer groups, and governments. There is evidence that patient satisfaction influences the perceptions of the quality of care received. Methods: This exploratory, qualitative study described and analyzed, the similarities and differences in satisfaction and dissatisfaction experiences of patients attending physicians (social justice) and chiropractors (market justice) for healthcare services in Niagara Region, Ontario. Using inductive content analysis the satisfaction and dissatisfaction experiences were themed to develop groups, categories, and sub-categories of quality judgments of care experiences. Results: Study participants experienced both satisfying and dissatisfying critical incidents in the areas of standards of practice, professional and practice attributes, time management, and treatment outcomes. Cost was not a marked source of satisfaction or dissatisfaction. Conclusion: Patients may be more capable of generating quality judgments on the technical aspects of medical and chiropractic care, particularly treatment outcomes and standards of practice, than previously thought. PMID:24587494
Powell, James P.; Leonard, Joseph S.
Abstract Objective This study retrospectively examined the effects of a 21-day nutritional intervention program, which included fruit and vegetable consumption, energy restriction, and nutritional supplements, on serum lipid measures in 28 chiropractic patients. Methods Medical records were reviewed for 28 chiropractic patients who had completed a commercially available 21-day nutritional intervention program between April 2005 and August 2007 and for whom complete serum lipid and weight measures immediately pre- and postintervention were available. The primary outcome was change in serum lipids, and change in body weight was a secondary outcome variable. Results Significant reductions in total, low-density lipoprotein, very low-density lipoprotein, and high-density lipoprotein cholesterol, and triglycerides were observed. Serum triglycerides decreased from 116.3 ± 54.6 (mean ± SD) to 88.6 ± 40.5 mg/dL (P < .01). Total cholesterol decreased from 223.3 ± 40.7 to 176.2 ± 30.0 mg/dL (P < .0001). Low-density lipoprotein cholesterol decreased from 145.7 ± 36.8 to 110.9 ± 25.3 mg/dL (P < .0001). High-density lipoprotein cholesterol decreased from 54.3 ± 14.6 to 47.6 ± 10.5 mg/dL (P < .001). Weight for patients decreased from 191.2 ± 38.8 to 182.2 ± 36.3 lb (P < .0001). Conclusions This retrospective case series supports the hypothesis that a nutritional purification intervention program emphasizing fruit and vegetable consumption, energy restriction, and nutritional supplements reduces serum lipids and weight. PMID:19646370
DeVocht, James W.; Goertz, Christine M.; Hondras, Maria A.; Long, Cynthia R.; Schaeffer, Wally; Thomann, Lauren; Spector, Michael; Stanford, Clark M.
Background Temporomandibular pain has multiple etiologies and a range of therapeutic options. In this pilot study, the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporomandibular disorders (TMDs). Methods The authors assigned 80 participants randomly into one of the following four groups, all of which included a comprehensive self-care program: reversible interocclusal splint therapy (RIST), Activator Method Chiropractic Technique (AMCT) (Activator Methods International, Phoenix), sham AMCT and self-care only. They made assessments at baseline and at month 2 and month 6, including use of the Research Diagnostic Criteria for Temporomandibular Disorders. Results The authors screened 721 potential participants and enrolled 80 people; 52 participants completed the six-month assessment. The adjusted mean change in current pain over six months, as assessed on the 11-point numerical rating scale, was 2.0 (95 percent confidence interval, 1.1-3.0) for RIST, 1.7 (0.9-2.5) for self-care only, 1.5 (0.7-2.4) for AMCT and 1.6 (0.7-2.5) for sham AMCT. The authors also assessed bothersomeness and functionality. Conclusions The authors found the study design and methodology to be manageable. They gained substantial knowledge to aid in conducting a larger study. AMCT, RIST and self-care should be evaluated in a future comparative effectiveness study. Practical Implications. This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD. PMID:24080932
Ronald J Feise; Jaroslaw P Grod; Anne Taylor-Vaisey
BACKGROUND: Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing
Background Back-related leg pain (BRLP) is a common variation of low back pain (LBP), with lifetime prevalence estimates as high as 40%. Often disabling, BRLP accounts for greater work loss, recurrences, and higher costs than uncomplicated LBP and more often leads to surgery with a lifetime incidence of 10% for those with severe BRLP, compared to 1-2% for those with LBP. In the US, half of those with back-related conditions seek CAM treatments, the most common of which is chiropractic care. While there is preliminary evidence suggesting chiropractic spinal manipulative therapy is beneficial for patients with BRLP, there is insufficient evidence currently available to assess the effectiveness of this care. Methods/Design This study is a two-site, prospective, parallel group, observer-blinded randomized clinical trial (RCT). A total of 192 study patients will be recruited from the Twin Cities, MN (n = 122) and Quad Cities area in Iowa and Illinois (n = 70) to the research clinics at WHCCS and PCCR, respectively. It compares two interventions: chiropractic spinal manipulative therapy (SMT) plus home exercise program (HEP) to HEP alone (minimal intervention comparison) for patients with subacute or chronic back-related leg pain. Discussion Back-related leg pain (BRLP) is a costly and often disabling variation of the ubiquitous back pain conditions. As health care costs continue to climb, the search for effective treatments with few side-effects is critical. While SMT is the most commonly sought CAM treatment for LBP sufferers, there is only a small, albeit promising, body of research to support its use for patients with BRLP. This study seeks to fill a critical gap in the LBP literature by performing the first full scale RCT assessing chiropractic SMT for patients with sub-acute or chronic BRLP using important patient-oriented and objective biomechanical outcome measures. Trial Registration ClinicalTrials.gov NCT00494065 PMID:21426558
Wittman, Rebekah A.; Vallone, Sharon A.
Abstract Objective The purpose of this paper is to present a case of a child with Prader-Willi syndrome and the observed improvement in the degree of scoliosis, immune function, and behavior documented during the course of her treatment. Clinical Features A 7-year-old girl presented to Kentuckiana Children's Center with a 15° lumbar levoscoliosis and diagnosis of Prader-Willi syndrome. Intervention and Outcome The treatment plan consisted of chiropractic adjustments, craniosacral therapy, movement therapy, and nutritional therapy. Over the course of treatment, her muscle strength, tone, and motor activity increased. She improved in coordination of gait and balance. Over the course of 3 years, her scoliosis decreased to 4° to 5°. Improvements in immune function and a reduction in anxiety type behaviors were documented by the parents and doctor of chiropractic over the course of 5 years. Conclusions This case report describes the improvements and progression of one female child with Prader-Willi syndrome under chiropractic and multidisciplinary care. PMID:19948310
Liebich, Julia M.; Reinke, Tari S.
Objective The purpose of this case is to describe a patient who had a stroke preceding a chiropractic appointment and was unaware that the cerebrovascular event had occurred. Clinical features An 85-year-old established patient presented for chiropractic treatment of pain in the left side of the neck, hip, and low back associated with known advanced degenerative spinal disease and lumbar stenosis. On the day of presentation, the patient reported morning nausea, double vision, and right-sided vision loss; she related that she had collided into a car while driving to the appointment. Review of her medical history divulged residual neurological deficits related to a previous subdural hematoma, resulting in craniotomy. Examination revealed a right inferior quadrantanopia in the right eye and right nasal hemianopia in the left eye. Nystagmus was present in the left eye with saccadic intrusion on pursuit right to left. Intervention and outcome The patient was transported immediately to an emergency room,where diagnosis of an Acute infarct in the left cerebrum at the junction of the left occipital, parietal and temporal lobes in the watershed area was confirmed. Conclusion Patients with signs and symptoms of stroke in progress may occasionally present for chiropractic care. It is imperative to complete a thorough history and examination prior to care. PMID:24711785
Sherrod, Charles W.; Casey, George; Dubro, Robert E.; Johnson, Dale F.
Objective This report describes the case management of musculoskeletal disorders for an employee in a college work environment using both chiropractic care and applied ergonomics. Clinical Findings A 54-year-old male office worker presented with decreased motor function in both wrists; intermittent moderate-to-severe headaches; and pain or discomfort in the neck, both shoulders, left hand and wrist, and lumbosacral region resulting from injuries sustained during recreational soccer and from excessive forces and awkward postures when interacting with his home and office computer workstations. Intervention and Results Ergonomic training, surveillance, retrofitted equipment with new furniture, and an emphasis on adopting healthy work-style behaviors were applied in combination with regular chiropractic care. Baseline ergonomic job task analysis identified risk factors and delineated appropriate control measures to improve the subject's interface with his office workstation. Serial reevaluations at 3-month, 1-year, and 2-year periods recorded changes to the participant's pain, discomfort, and work-style behaviors. At end of study and relative to baseline, pain scale improved from 4/10 to 2/10; general disability improved from 4 to 0; and hand grip strength (pounds) increased from 20 to 105 (left) and 45 to 100 (right). Healthy work habits and postures adopted in the 3-month to 1-year period regressed to baseline exposures for 3 of 6 risk priorities identified in the ergonomic job task analysis. Conclusion The patient responded positively to the intervention of chiropractic care and applied ergonomics. PMID:23997724
Background The number of households in the United States that are not proficient in the English language is growing and presenting a challenge to the health care system. Over nineteen percent of the US population speak a language other than English in the home. This increase in language discordance generates a greater need to find and implement accommodations in the clinical setting to insure accurate and efficient diagnosis and treatment as well as provide for patient safety. Aim: The purpose of this study is to determine the percentage of patients accessing the chiropractic college teaching clinics who are not proficient in the English language and to what extent the colleges provide accommodations for that language disparity. Methods The clinic directors and deans of the Association of Chiropractic Colleges were surveyed via an on-line survey engine. The survey queried the percentage of the patient population that is not English language proficient, the accommodations the college currently has in place, if the college has a language specific consent to treat document and if the college has a written policy concerning patients without English proficiency. Results Fifty percent of the contacted chiropractic colleges responded to the survey. In the respondent college clinics 16.5% of the patient population is not proficient in English, with over 75% speaking Spanish. All but one of the respondents provide some level of accommodation for the language non-concordance. Forty five percent of the responding colleges employ a language specific consent to treat form. The implementation of accommodations and the use of a language specific consent to treat form is more prevalent at colleges with a higher percentage of non-English speaking patients. Conclusions The percentage of patients with limited English proficiency accessing services at the teaching clinics of the chiropractic colleges mirrors the numbers in the general population. There is a wide disparity in the accommodations that the individual colleges make to address this language discordance. There is a need to further develop accurate and meaningful accommodations to address language disparity in the chiropractic teaching clinics. PMID:23369245
Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor
OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to, or better than the published evidence. REPORTED BENEFITS, HARMS AND COSTS The expected benefits from the recommendations include more rapid recovery from pain, impairment and disability (improved pain and ROM). The GDC identified evidence-based pain benefits from 10 unimodal treatments and more than 7 multimodal treatments. There were no pain benefits from magnets in necklaces, education or relaxation alone, occipital release alone, or head retraction-extension exercise combinations alone. The specificity of the studied treatments meant few studies could be generalized to more than a minority of patients. Adverse events were not addressed in most studies, but where they were, there were none or they were minor. The theoretic harm of vertebral artery dissection (VAD) was not reported, but an analysis suggested that 1 VAD may occur subsequent to 1 million cervical manipulations. Costs were not analyzed in this guideline, but it is the understanding of the GDC that recommendations limiting ineffective care and promoting a more rapid return of patients to full functional capacity will reduce patient costs, as well as increase patient safety and satisfaction. For simplicity, this version of the guideline includes primarily data synthesized across studies (evidence syntheses), whereas the technical and the interactive versions of this guideline (http://ccachiro.org/cpg) also include relevant data from individual studies (evidence extractions). RECOMMENDATIONS The GDC developed treatment, risk-management and research recommendations using the available evidence. Treatment recommendations addressing 13 treatment modalities revolved around a decision algorithm comprising diagnosis (or assessment leading to diagnosis), treatment and reassessment. Several specific variations of modalities of treatment were not recommended. For adverse events not associated with a treatment modality, but that occur in the clinical setting, there was evidence to recommend reconsideration of treatment options or referral to the appropriate health services. For adverse eve
Cox, James M.
Introduction The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. Case Report A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst–induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. Intervention and Outcomes Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. Conclusion Lumbar synovial cyst and stenosis–generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation. PMID:22942836
Chapman, Cynthia; Bakkum, Barclay W.
Objective The purpose of this article is to present the case of a patient with an anatomical anomaly of the piriformis muscle who had a piriformis syndrome and was managed with chiropractic care. Case Report A 32-year-old male patient presented to a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. The complaint began 5 years prior as a result of injuries during Airborne School in the US Army resulting in a 60% disability rating from the Veterans Administration. Magnetic resonance imaging demonstrated a mildly decreased intradiscal T2 signal with shallow central subligamentous disk displacement and low-grade facet arthropathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic magnetic resonance imaging evidence of piriformis syndrome. Intervention and Outcome Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation. Conclusion A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained. PMID:22942838
Khorsan, Raheleh; Cohen, Angela B; Lisi, Anthony J; Smith, Monica M; Delevan, Deborah; Armstrong, Courtney; Mittman, Brian S
Maximizing the quality and benefits of newly established chiropractic services represents an important policy and practice goal for the US Department of Veterans Affairs' healthcare system. Understanding the implementation process and characteristics of new chiropractic clinics and the determinants and consequences of these processes and characteristics is a critical first step in guiding quality improvement. This paper reports insights and lessons learned regarding the successful application of mixed methods research approaches-insights derived from a study of chiropractic clinic implementation and characteristics, Variations in the Implementation and Characteristics of Chiropractic Services in VA (VICCS). Challenges and solutions are presented in areas ranging from selection and recruitment of sites and participants to the collection and analysis of varied data sources. The VICCS study illustrates the importance of several factors in successful mixed-methods approaches, including (1) the importance of a formal, fully developed logic model to identify and link data sources, variables, and outcomes of interest to the study's analysis plan and its data collection instruments and codebook and (2) ensuring that data collection methods, including mixed-methods, match study aims. Overall, successful application of a mixed-methods approach requires careful planning, frequent trade-offs, and complex coding and analysis. PMID:24489589
Morgan, William E.; Morgan, Clare P.
Objective The purpose of this case report is to describe the use of chiropractic care for a patient with neurogenic heterotopic ossification of the anterior longitudinal ligament in the cervical spine and soft tissues of the right hip after a traumatic brain injury and right femur fracture. Clinical Features A 25-year-old military officer was referred to a hospital-based chiropractic clinic with complaints of pain and stiffness of the neck and back along with reduced respiratory excursions that began several months after a motor vehicle accident in which he had a traumatic brain injury. The patient had a fractured right femur from the accident, which had since been treated surgically, but had complications of heterotopic ossification in the soft tissues of the hip. His overall pain level was 3 of 10 on a verbal pain scale during use of oxycodone HCL/acetaminophen. Chest excursion was initially measured at .5 cm. Intervention and Outcome With the intent to restore respiratory chest motion and to reduce the patient's back and neck pain, the patient was placed on a program of chiropractic and myofascial manipulation, exercise therapy, and respiratory therapy. After a year of care, the patient rated overall pain at 3 of 10 verbal pain scale level but was no longer taking medications for pain and an increase in respiratory chest excursions measured at 3.5 cm. Conclusion This case demonstrated that chiropractic treatment provided benefit to a patient with heterotopic ossification concurrent with musculoskeletal pain. PMID:25435839
Stainsby, Brynne E.; Muir, Bradley J.; Miners, Andrew L.
Objective The purpose of this case series is to describe the presentation of 2 patients who presented to a chiropractic teaching clinic with Paget-Schroetter syndrome (PSS) and to discuss the potential role for conservative therapy in the management of symptoms. Clinical Features Two patients presented with a vascular and muscular findings suggesting activity-related upper extremity deep vein thrombosis. One patient presented with recent onset of symptoms (pain in the neck with a “pinched nerve sensation” in the left upper trapezius); and the other presented with chronic, low-grade neck pain of 1 year's duration. Intervention and Outcome The initial treatment approach for the patient with acute symptoms included soft tissue therapy. During the second appointment, he was immediately referred for medical evaluation and management because of worsening symptoms. He was diagnosed with thrombus in the left brachial vein, started immediately on a thrombolytic agent, and referred to a thrombosis clinic. Treatment for the second patient with chronic symptoms included soft tissue therapy, spinal manipulative therapy, and active care. Two months after 3 treatments, she reported improved symptoms. She remains under supportive care and has reported continued relief of her symptoms. Conclusion Although a rare condition, PSS has the potential to result in significant morbidity and potentially fatal complications; thus, it is critical that practitioners recognize the signs and symptoms to facilitate appropriate and timely referrals. Clinicians should be aware of the presentation and proposed pathogenesis of PSS, and consider this diagnosis in patients with unilateral upper limb and/or neck pain. PMID:23843762
Kelner, Merrijoy; Wellman, Beverly; Welsh, Sandy; Boon, Heather
This paper examines the efforts of two complementary and alternative occupations, chiropractors and homeopaths, to move from the margins to the mainstream in health care in the province of Ontario. We use a variety of theoretical perspectives to understand how health occupations professionalize: the trait functionalist framework, social closure, the system of professions, and the concept of countervailing powers. The research traces the strategies that the leaders of the two groups are employing, as well as the resources they are able to marshal. These are analyzed within the context of the larger institutional and cultural environment. The data are derived from in-person interviews with 16 leaders (10 chiropractic and 6 homeopathic) identified through professional associations, teaching institutions and informants from the groups. The responses were analyzed with qualitative content analysis. We also used archival materials to document what the leaders were telling us. The data revealed four main strategies: (1) improving the quality of educational programs, (2) elevating standards of practice, (3) developing more peer reviewed research, and (4) increasing group cohesion. Although both groups identified similar strategies, the chiropractors were bolstered by more resources as well as state sanctioned regulation. The efforts of the homeopaths were constrained by scarce resources and the absence of self-regulation. In both cases the lack of strong structural support from government and the established health professions played an important role in limiting what was possible. In the future, it may be to the state's advantage to modify the overall shape of health care to include alternative paradigms of healing along with conventional medical care. Such a shift would put complementary and alternative medicine occupations in a better position to advance professionally and become formal elements of the established health care system. PMID:16926065
This paper reports findings of a research study undertaken to determine the attitudes and perceptions of acupuncture, chiropractic, and massage therapy faculty with regard to online learning within their respective disciplines, and to determine how they might be persuaded to teach online. The study surveyed faculty teaching at schools in these three fields and followed up with additional interviews. The study results indicate that, in general, acupuncture, chiropractic, and massage therapy faculty lack awareness of the capabilities of online education and the elements of good online learning. There is also a perception that what they teach cannot be taught online because of its kinesthetic requirements. The faculty hold this perception in spite of the success of medical science and related health care fields in the online environment, and they do not seem to separate the kinesthetic from the didactic. The present study indicates that faculty opinions about online instruction in this alternative type of education range from being willing to look at the potential of online education to outright dismissing it. PMID:21589712
Gleberzon, Brian; Statz, Rachel; Pym, Matthew
Background: The purpose of this study was to survey a group of female chiropractors and inquire as to whether or not they had been sexually harassed by their patients. Methods: An online questionnaire was emailed via Survey Monkey to 47 female faculty members at the Canadian Memorial Chiropractic College (CMCC). Respondents were asked if they had been sexual harassed and, if so, the characteristics of the incident(s), their response to it, how serious they perceived the problem to be and whether or not they felt prepared to deal with it. Results: Nineteen of 47 questionnaires were completed and returned. Of these 19, eight respondents reported being sexually harassed by a patient (all male), most commonly within the first 5 years of practice and most commonly involving a ‘new’ patient. It was rarely anticipated. The nature of the harassment varied and respondents often ignored the incident. Most respondents perceive this to be a problem facing female chiropractors. Discussion: Although this is the first survey of its kind, this is a significant problem facing other healthcare professionals. Conclusions: Among this group of respondents, sexual harassment by patients was a common occurrence. More training on how to handle it, during either a student’s chiropractic education or offered as a continuing education program, may be warranted.
Abstract Objective To discuss the treatment of a patient with type 1 diabetes presenting with chronic neck and shoulder pain by using chiropractic manipulation and an active rehabilitation program with emphasis on correcting postural imbalances. Clinical Features A 46-year-old insulin dependant (type1) diabetic female presented with neck and right shoulder pain of 6 to 8 months duration. Her history included similar left-sided complaints 2 years prior at which time she underwent 3 months of rehabilitation at a local medical center, which improved her condition. Over time her pain resolved but the residuals of restricted left shoulder range of motion remained. The patient had postural changes consisting of forward head posture, rounded shoulders and internally rotated arms. Intervention and Outcome Treatment included spinal manipulation, ultrasound and active rehabilitation consisting of at home exercises initially and followed with in office low-tech rehabilitation. Rehabilitation was primarily aimed at improving postural abnormalities, muscle imbalances and abnormal movement patterns. The patient improved with this course of treatment. Conclusion Chiropractic care including active rehabilitation may be helpful in treating diabetic patients suffering from chronic neck and shoulder problems. PMID:19674636
Burke, Jeanmarie R.
Objective The purpose of this study was to test the utility of Patient-Reported Outcomes Measurement Information System (PROMIS) as a resource for collecting data on patient-reported outcomes (PRO) within academic health centers at a chiropractic college; and, to describe changes in PRO following pragmatic chiropractic care incorporating instrument-assisted soft tissue mobilization (IASTM) on pain symptoms. Methods This was a pre-post intervention design without a control group (case series) involving 25 patients (14 females and 11 males; 40.5 ± 16.39 years, range 20-70 years) who completed their chiropractic care and their baseline and post-treatment pain assessments. The pragmatic chiropractic care intervention included both spinal manipulation and IASTM to treat pain symptoms. PRO’s were collected using PROMIS to measure pain behavior, pain interference and pain intensity. Results The average pre-post assessment interval was 33 ± 22.5 days (95% CI, 23-42 days). The durations of treatments ranged from one week to 10 weeks. The median number of IASTM treatments was six. Pre-post decreases in T-scores for pain behavior and pain interference were 55.5 to 48.4 and 57.7 to 48.4, respectively (P < .05). Only 12 patients had a baseline T-score for pain intensity greater than 50. The pre-post decrease in pain intensity T-scores for these 12 patients was from 53.4 to 40.9. Conclusion Within the limitations of a case series design, these data provide initial evidence on the utility of PROMIS instruments for clinical and research outcomes in chiropractic patients. PMID:25225465
Gotlib, Allan C; Beingessner, Melanie
Biomedical literature retrieval, both indexed and non-indexed, with respect to the application of manipulative therapy with therapeutic intent and pediatric health conditions (ages 0 to 17 years) yielded 66 discrete documents which met specified inclusion and exclusion criteria. There was one experimental study (RCT’s), 3 observational (cohort, case control) studies and 62 descriptive studies (case series, case reports, surveys, literature reviews). An independent rating panel determined consistency with a modified quality of evidence scale adopted from procedure ratings system 1 of Clinical Guidelines for Chiropractic Practice in Canada. Results indicate minimal Class 1 and Class 2 and some Class 3 evidence for a variety of pediatric conditions utilizing the application of manipulation with therapeutic intent.
Feise, Ronald J; Grod, Jaroslaw P; Taylor-Vaisey, Anne
Background Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing education setting. Methods We developed and evaluated a continuing education workshop on evidence-based principles and methods for chiropractic practitioners. Forty-seven chiropractors participated in the training and testing. The course consisted of 12.5 hours of training in which practitioners learned to develop focused questions, search electronic data bases, critically review articles and apply information from the literature to specific clinical questions. Following the workshop, we assessed the program performance through the use of knowledge testing and anonymous presentation quality surveys. Results Eighty-five percent of the participants completed all of the test, survey and data collection items. Pretest knowledge scores (15-item test) were low (47%). Post intervention scores (15-item test) improved with an effect size of 2.0. A 59-item knowledge posttest yielded very good results (mean score 88%). The quality of presentation was rated very good, and most participants (90%) would "definitely recommend" or "recommend" the workshop to a colleague. Conclusion The results of the study suggest that the continuing education course was effective in enhancing knowledge in the evidence-based approach and that the presentation was well accepted. PMID:16930482
Background As health care has increased in complexity and health care teams have been offered as a solution, so too is there an increased need for stronger interprofessional collaboration. However the intraprofessional factions that exist within every profession challenge interprofessional communication through contrary paradigms. As a contender in the conservative spinal health care market, factions within chiropractic that result in unorthodox practice behaviours may compromise interprofessional relations and that profession’s progress toward institutionalization. The purpose of this investigation was to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions. Methods A stratified random sample of 740 Canadian chiropractors was surveyed to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guidelines. Stratification in practice behaviours is a stated concern of mainstream medicine when considering interprofessional referrals. Results Of 740 deliverable questionnaires, 503 were returned for a response rate of 68%. Less than 20% of chiropractors (18.8%) were aligned with a predefined unorthodox perspective of the conditions they treat. Prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use and vaccinations were strongly associated with unorthodox group membership (X2 =13.4, p?=?0.0002). Conclusion Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices. Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral. PMID:24512507
Erin L. Elster
Objective: To review the effectiveness of chiropractic care using an upper cervical technique in the case of a nine-year- old male who presented with Tourette Syndrome (TS), Atten- tion Deficit Hyperactivity Disorder (ADHD), depression, asthma, insomnia, and headaches. Clinical Features: This nine-year-old boy suffered from asthma and upper respiratory infections since infancy; head- aches since age 6; TS, ADHD, depression
Howard Vernon; Gwen Jansz; Charles H. Goldsmith; Cameron McDermaid
ObjectivesTension-type headache (TTH) is the most common headache experienced by adults in Western society. Only 2 clinical trials of spinal manipulation for adult tension-type headache have been reported, neither of which was fully controlled. In 1 trial, spinal manipulation was compared to amitriptyline. There is an urgent need for well-controlled studies of chiropractic spinal manipulation for TTH. This trial was
Howard Vernon; Gwen Jansz; Charles H. Goldsmith; Cameron McDermaid
Objectives: Tension-type headache (TTH) is the most common headache experienced by adults in Western society. Only 2 clinical trials of spinal manipulation for adult tension-type headache have been reported, neither of which was fully controlled. In 1 trial, spinal manipulation was compared to amitriptyline. There is an urgent need for well-controlled studies of chiropractic spinal manipulation for TTH. This trial
Degree of Vertical Integration Between the Undergraduate Program and Clinical Internship With Respect to Cervical and Cranial Diagnostic and Therapeutic Procedures Taught at the Canadian Memorial Chiropractic College
Leppington, Charmody; Gleberzon, Brian; Fortunato, Lisa; Doucet, Nicolea; Vandervalk, Kyle
Objective: The purpose of this study was to determine if diagnostic and therapeutic procedures for the cervical and cranial spine taught to students during the undergraduate program at Canadian Memorial Chiropractic College are required to be used during their internship by their supervising clinicians and, if so, to what extent these procedures are used. Methods: Course manuals and course syllabi from the Applied Chiropractic and Clinical Diagnosis faculty of the undergraduate chiropractic program for the academic year 2009–2010 were consulted and a list of all diagnostic and therapeutic procedures for the cranial and cervical spine was compiled. This survey asked clinicians to indicate if they themselves used or if they required the students they were supervising to use each procedure listed and, if so, to what extent each procedure was used. Demographic information of each clinician was also obtained. Results: In general, most diagnostic procedures of the head and neck were seldom used, with the exception of postural observation and palpation. By contrast, most cervical orthopaedic tests were often used, with the exception of tests for vertigo. Most therapeutic procedures were used frequently with the exception of prone cervical and “muscle” adjustments. Conclusion: There was a low degree of vertical integration for cranial procedures as compared to a much higher degree of vertical integration for cervical procedures between the undergraduate and clinical internship programs taught. Vertical integration is an important element of curricular planning and these results may be helpful to aid educators to more appropriately allocate classroom instruction PMID:22778531
Bakkum, Barclay W; Chapman, Cynthia; Johnson, Claire
Objective : The purposes of this study were to investigate the overall publication rates of presentations at the Association of Chiropractic Colleges Educational Conference/Research Agenda Conference (ACC/RAC) meetings (2002-2008), differences in the publication rates of platform vs poster presentations, and the consistency of the meeting abstract compared to the full-length journal article. Methods : Abstracts were obtained from proceedings published in the Journal of Chiropractic Education. Literature searches using PubMed and the Index to the Chiropractic Literature (ICL) were performed to locate peer-reviewed journal articles based upon those abstracts. Whether the article was based upon a poster or platform presentation, and the congruence of the information in the abstract and article were recorded. Results : We identified 776 proceeding abstracts, 249 of which eventually were published between 2002 and 2012. The overall publication rate was 32.2%. A total of 42.7% of platform presentations eventually were published vs 20.3% of posters. Congruency showed that 43.2% had the same title as the meeting abstract, 59.7% had the same authorship, and 88.8% had the same methods. Conclusion : Publication rates of abstracts from spine and orthopedic surgery national meetings range from 34% to 59%. The ACC/RAC meetings have similar publication rates. More platform than poster presentations reach full publication. The congruency of ACC/RAC abstracts to published articles is higher than national meetings in other fields. PMID:24295363
Background Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults. Methods/design This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits of progress notes and content analysis of clinical trial notes. Discussion This pragmatic, pilot randomized controlled trial uses a mixed method approach to evaluate the clinical effectiveness, feasibility, and participant and provider perceptions of collaborative care between medical doctors and doctors of chiropractic in the treatment of older adults with low back pain. Trial registration This trial registered in ClinicalTrials.gov on 04 March 2011 with the ID number of NCT01312233. PMID:23324133
Kuhn, Kurt W.; Cambron, Jerrilyn
Objective The purpose of this report is to describe chiropractic management, using a brain-based model of care, of a teen who had migraine headaches and several social and learning difficulties. Clinical features A 15-year-old adolescent boy with a chronic history of migraines and more than 10 years of learning and behavioral difficulties, including attention-deficit/hyperactivity disorder, obsessive compulsive disorder, and Tourette syndrome, presented for chiropractic care. Intervention and outcome The patient received spinal manipulation and was given home physical coordination activities that were contralateral to the side of the involved basal ganglia and ipsilateral to the involved cerebellum, along with interactive metronome training. Quantitative changes were noted in neurological soft signs, tests of variables of attention Conners’ Parent Rating Scale, the California Achievement Test, grade point, and reduction of medications. The patient reported qualitative improvements in tics, attention, reading, vision, health, relationships with his peers and his family, and self-esteem. Conclusion The patient with migraine headaches and learning difficulties responded well to the course of chiropractic care. This study suggests that there may be value in a brain-based model of care in the chiropractic management of conditions that are beyond musculoskeletal in nature. PMID:24396330
Gudavalli, Maruti Ram; Vining, Robert D; Salsbury, Stacie A; Goertz, Christine M
Objective : Doctors of chiropractic (DCs) use manual cervical distraction to treat patients with neck pain. Previous research demonstrates variability in traction forces generated by different DCs. This article reports on a training protocol and monthly certification process using bioengineering technology to standardize cervical traction force delivery among clinicians. Methods : This longitudinal observational study evaluated a training and certification process for DCs who provided force-based manual cervical distraction during a randomized clinical trial. The DCs completed a 7-week initial training that included instructional lectures, observation, and guided practice by a clinical expert, followed by 3 hours of weekly practice sessions delivering the technique to asymptomatic volunteers who served as simulated patients. An instrument-modified table and computer software provided the DCs with real-time audible and visual feedback on the traction forces they generated and graphical displays of the magnitude of traction forces as a function of time immediately after the delivery of the treatment. The DCs completed monthly certifications on traction force delivery throughout the trial. Descriptive accounts of certification attempts are provided. Results : Two DCs achieved certification in traction force delivery over 10 consecutive months. No certification required more than 3 attempts at C5 and occiput contacts for 3 force ranges (0-20 N, 21-50 N, and 51-100 N). Conclusions : This study demonstrates the feasibility of a training protocol and certification process using bioengineering technology for training DCs to deliver manual cervical distraction within specified traction force ranges over a 10-month period. PMID:25237767
Longo, Matthew; Grabowski, Michael; Gleberzon, Brian; Chappus, Jesse; Jakym, Crystal
The purpose of this study was to survey a random sample of Toronto chiropractors and gather their perceptions of the effects that the delisting of chiropractic services from OHIP had on their practices profiles. Methods: A survey was mailed to 199 chiropractors who were asked to disclose demographic information, if they were in practice at the time when OHIP coverage was in effect, the perceived effect OHIP delisting had on their patient volumes, income, the profession’s credibility and if they would be in favor of having OHIP reinstated. Results: Among the 123 respondents in practice during OHIP coverage (n = 92), 48.9% indicated they perceived their practice income and 36.6% perceived their patient volume was negatively affected; 57.5% reported both had subsequently recovered. Almost 50% perceived OHIP delisting negatively affected the profession’s credibility and 46.1% of respondents were in favor of it being reinstated for chiropractic services; this percentage was much higher among chiropractors who were not in practice during the time of OHIP coverage. Conclusion: Most chiropractors reported that patient volumes and incomes have returned to pre-delisting levels and few chiropractors who were in practice during OHIP coverage expressed interest in having it reinstated. PMID:21886281
Shane, Eric R.; Pierce, Kevin M.; Gonzalez, Jannet K.; Campbell, Nathan J.
Objective The purpose of this case series is to report how the symptom section of the Sport Concussion Assessment Tool 2 (SCAT2) was used to manage athletes with concussions in a high school training room setting and to address the need for SCAT2 baseline measurements. Clinical features During a 4-month period, 3 doctors of chiropractic with certification from the American Chiropractic Board of Sports Physicians managed 15 high school athletes with concussions in a multidisciplinary setting. Fourteen athletes were male American football players, and one was a female volleyball player. Intervention and outcome Of the 15 athletes, 3 athletes had baseline SCAT2 documentation. Athletes were evaluated and returned to play with a graded return to play protocol using the SCAT2 symptoms and serial physical examinations. Once participants were asymptomatic, they began a graded return to play process. A total of 47 SCAT2 tests were performed on the 15 athletes, averaging 3.13 SCAT2 evaluations per patient. Of the 15 athletes evaluated, 6 were managed and cleared for return to play; 2 of the athletes sustained concussions in the last week of the season, thus ending their season; and 3 athletes were cleared by medical doctors. None of the athletes under care reported an adverse event. Conclusion The utilization of the SCAT2 with serial physical examinations provided objective measures for athlete’s injuries, allowing the practitioners to evaluate concussions. More efforts are needed to collect baseline SCAT2 to compare these scores with subsequent SCAT2 scores following athletic injuries. PMID:24396327
... The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints ... adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, and allowing ...
Degree of Vertical Integration Between the Undergraduate Program and Clinical Internship with Respect to Lumbopelvic Diagnostic and Therapeutic Procedures Taught at the Canadian Memorial Chiropractic College
Vermet, Shannon; McGinnis, Karen; Boodham, Melissa; Gleberzon, Brian J.
Purpose: The objective of this study was to determine to what extent the diagnostic and therapeutic procedures taught in the undergraduate program used for patients with lumbopelvic conditions are expected to be utilized by students during their clinical internship program at Canadian Memorial Chiropractic College or are being used by the clinical faculty. Methods: A confidential survey was distributed to clinical faculty at the college. It consisted of a list of diagnostic and therapeutic procedures used for lumbopelvic conditions taught at that college. Clinicians were asked to indicate the frequency with which they performed or they required students to perform each item. Results: Seventeen of 23 clinicians responded. The following procedures were most likely required to be performed by clinicians: posture; ranges of motion; lower limb sensory, motor, and reflex testing; and core orthopedic tests. The following were less likely to be required to be performed: Waddell testing, Schober's test, Gillet tests, and abdominal palpation. Students were expected to perform (or clinicians performed) most of the mobilization (in particular, iliocostal, iliotransverse, and iliofemoral) and spinal manipulative therapies (in particular, the procedures referred to as the lumbar roll, lumbar pull/hook, and upper sacroiliac) taught at the college. Conclusion: This study suggests that there was considerable, but not complete, vertical integration between the undergraduate and clinical education program at this college. PMID:20480014
... requirements. You may want to contact your employer’s human resources department—or the insurance plan directly—to find out if there are any referral requirements. Most plans allow you to just call and ... clinical diagnosis including laboratory procedures, diagnostic imaging, ...
... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...
California Health Benefits Review Program (CHBRP)
Treatment of Musculoskeletal Disorders Pain Relief Pattern toward favorable for comparisons between spinal manipulative therapy (SMT) and placebo/placebo Decrease in pain after SMT vs. rest or no treatmenttreatments (short- wave diathermy, massage, exercises, analgesics, placebo, physiotherapy, corset) Patients with neck pain (
French, Simon; Werth, Peter; Walker, Bruce
Case study. A man aged 42 years, who works as a police officer, presented with severe lower back pain, which he had experienced for 24 hours after spending the previous day helping his brother to move house. He had difficulty ambulating and most movements aggravated the pain. There were no lower limb symptoms and no red flags present on history or examination. He was otherwise well and was not taking any regular medications. PMID:24563894
Vlay, S C
Electromagnetic interference is well known to cause false sensing in ICDs. Sources may include instrumentation involved with acupuncture, arc welding, electrocautery, diathermy, electrolysis, and transcutaneous electric nerve stimulator units as well as power lines. Patients with ICDs are cautioned to avoid exposure to these sources. PMID:9793103
Brown, Douglas M
This paper is an historical biography of a fortunate man. It begins with a glimpse of Ross E. Baker's origins in south-western Ontario, watches him going to school and working in Hamilton before joining the Canadian Army and shipping off to Europe to fight in the Second World War. At War's end, the article picks up Dr. Baker as he comes home, starts a family, becomes a chiropractor and sustains a viable practice. Now in the twilight of life, the good doctor is last seen content with his retirement, spending days at his cottage property, reviewing his memoirs and reflecting on the tumult, terror and eventual triumph of the D-Day landing at Normandy. PMID:24587499
Brown, Douglas M.
This paper is an historical biography of a fortunate man. It begins with a glimpse of Ross E. Baker’s origins in south-western Ontario, watches him going to school and working in Hamilton before joining the Canadian Army and shipping off to Europe to fight in the Second World War. At War’s end, the article picks up Dr. Baker as he comes home, starts a family, becomes a chiropractor and sustains a viable practice. Now in the twilight of life, the good doctor is last seen content with his retirement, spending days at his cottage property, reviewing his memoirs and reflecting on the tumult, terror and eventual triumph of the D-Day landing at Normandy. PMID:24587499
Asthma affects one in seven children and one in 25 adults in the United Kingdom with a cost of £466.2 million to the NHS. Considering the cost and the adverse effects of long term use of ?-agonists and inhaled corticosteroids, an alternative approach reducing the need for medication would be valuable. The present paper presents a case of chronic asthma
Jennette Ball (New York Chiropractic College Department of Basic Sciences)
This resource is part of the AAA Education and Teaching Session. In particular this resource is a pdf of the presentation from the AAA 2012 Anatomical Education for Allied Health Care Professionals Seminar.
Shelley Young Kong
Increased awareness and improved tests have contributed to the identification of rising numbers of dyslexic students entering higher education in the United Kingdom. Nearly half of these students are not diagnosed until they start their HE courses. Studies of experiences of dyslexic students diagnosed as children exist; however, there is little comparable information on dyslexic students diagnosed as adults.This qualitative
Shelley Young Kong
Increased awareness and improved tests have contributed to the identification of rising numbers of dyslexic students entering higher education in the United Kingdom. Nearly half of these students are not diagnosed until they start their HE courses. Studies of experiences of dyslexic students diagnosed as children exist; however, there is little comparable information on dyslexic students diagnosed as adults.This qualitative
Shoulder pain and dysfunction is a chief complaint commonly presenting to a chiropractor's office. The purpose of this article is to review the most common etiologies of shoulder pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the author draws upon his own clinical experience to describe a method to diagnose and manage, patients with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient. ImagesFigure 7
Brown, Douglas M.
This biographical study investigates the complex tribulations and impressive accomplishments of Dr. Colin Greenshields. Part I (the Formative Years) goes back to his ancestors in Great Britain and forward to his graduation from CMCC in 1948. Part II (the Professional Years) begins with the opening of Colin’s office in St. Catharines, ON, and proceeds through his professional career and multiple leadership roles to his retirement in 1986. PMID:22675227
Kanga, Ismat; Taylor, John A.; Jacobs, Craig; Outerbridge, Geoff
Tuberculosis caused by Mycobacterium tuberculosis is a major public heath problem world-wide, particularly in low-income countries. Increased number of immunocompromised patients and immigration from countries where tuberculosis is endemic has resulted in increased number of cases in high-income countries. Tuberculosis can affect any organ system, but is of particular interest to chiropractors when it affects the neuromusculoskeletal system. Patients with tuberculosis of the neuromusculoskeletal system can present with mechanical low back pain or with complex neurologic deficits. The aim of this paper is to highlight the importance of considering a diagnosis of tuberculosis in susceptible populations and the devastating consequences of the disease. The epidemiology, clinical features and management of tuberculosis will also be presented to facilitate early diagnosis, appropriate referral and multidisciplinary care of these patients. PMID:25729081
by the relationships among the skeletal system, muscles, and nerves. The major therapeutic tool used by chiropractors, the adjustment by hand of the body's skeletal system and soft tissues, results in improvement in the function that the nervous system, the body's communication network, is central to health and is greatly affected
Guagliardo, Joseph G.; Hoiriis, Kathryn T.
Objective We report the differences in final examination scores achieved by students at the culmination of two different teaching strategies in an introductory skills course. Methods Multiple choice examination scores from six consecutive academic calendar sessions over 18 months (n = 503) were compared. Two groups were used: Cohort A (n = 290) represented students who were enrolled in the course 3 consecutive academic sessions before an instructional change and Cohort B (n = 213) included students who were enrolled in 3 consecutive academic sessions following the instructional change, which included a more active learning format. Statistical analyses used were 2-tailed independent t-test, one-way ANOVA, Tukey's honestly significant difference (HSD), and effect size. Results The 2-tailed independent t-test revealed a significant difference between the two groups (t = ?3.71, p < .001; 95% confidence interval [CI] 1.29–4.20). Significant difference was found in the highest performing subgroup compared to the lowest performing subgroup in Cohort A (F = 3.343, p = .037). For Cohort A subgroups 1 and 2, Tukey's HSD was p < .028. In Cohort B, no difference was found among subgroups (F = 1.912, p = .150, HSD p > .105). Conclusion Compared to previous versions of the same course taught by the same instructor, the students in the new course design performed better, suggesting that using active learning techniques helps improve student achievement. PMID:23964739
Mark W Morningstar; Burl R Pettibon; Heidi Schlappi; Mark Schlappi; Trevor V Ireland
OBJECTIVE: This review details the anatomy and interactions of the postural and somatosensory reflexes. We attempt to identify the important role the nervous system plays in maintaining reflex control of the spine and posture. We also review, illustrate, and discuss how the human vertebral column develops, functions, and adapts to Earth's gravity in an upright position. We identify functional characteristics
Fay Karpouzis; Rod Bonello; Henry Pollard
BACKGROUND: Psychostimulants are first line of therapy for paediatric and adolescent AD\\/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders
Madeline Behrendt; Nathan Olsen
Objective: This case report reviews the application of chiro- practic care for the purpose of subluxation correction in a 19 year old female diagnosed with a mental health disorder, Gen- eral Anxiety Disorder (GAD). Clinical Features: In November 1999 the patient first expe- rienced symptoms of dizziness, trembling, sweating, heart pal- pitations, sleep deprivation, poor concentration, depersonal- ization, and headaches.
Craig A Schulz; Maria A Hondras; Roni L Evans; Maruti R Gudavalli; Cynthia R Long; Edward F Owens; David G Wilder; Gert Bronfort
Background Back-related leg pain (BRLP) is a common variation of low back pain (LBP), with lifetime prevalence estimates as high as 40%.\\u000a Often disabling, BRLP accounts for greater work loss, recurrences, and higher costs than uncomplicated LBP and more often\\u000a leads to surgery with a lifetime incidence of 10% for those with severe BRLP, compared to 1-2% for those with LBP.
Lothe, Lise R.; Bolton, Jennifer E.
Objective The subject of research methods is not commonly covered in continuing professional development (CPD) courses in spite of its emphasis in undergraduate education. This initiative aimed to develop postgraduate research competency and recruit chiropractors to musculoskeletal research. Methods The program was delivered as a university-based program with 20 credits over seven contact weekends covering topics of evidence-based practice, research methods, statistics, ethics, resources, and funding. Students were assessed through assignments showing competency in critical literature review, case report writing, and production of a research protocol as the final assessment. Non-student participation for CPD points was possible. A student evaluation survey was completed after the end of the academic year. Results There were 26 participants: 16 as students handing in assignments, 10 as non-student participants for up to 94 CPD points. Three submitted a final protocol and two registered at a university PhD program. A network of research clinics was established for data collection for future multicenter studies. Conclusions The program was well received by the participants and gave them the tools and resources to perform research. The two-level attendance system afforded a basis for setting up a network of research clinics with a fundamental understanding of optimal data collection. This initiative has shown that research skills can be revisited through CPD programs as part of evidence-based lifelong learning. PMID:23519168
Michele J Maiers; Jan Hartvigsen; Craig Schulz; Karen Schulz; Roni L Evans; Gert Bronfort
BACKGROUND: Low back pain (LBP) and neck pain (NP) are common conditions in old age, leading to impaired functional ability and decreased independence. Manual and exercise therapies are common and effective therapies for the general LBP and NP populations. However, these treatments have not been adequately researched in older LBP and NP sufferers. The primary aim of these studies is
Jennifer R Jamison
Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of \\
Janine S Riksman; Owen D Williamson; Bruce F Walker
Background An instrument known as the Mechanical and Inflammatory Low Back Pain (MAIL) Scale was drafted using the results of a previous\\u000a expert opinion study. A pilot survey was conducted to test the feasibility of a larger study designed to determine the MAIL\\u000a Scale's ability to distinguish two potential subgroups of low back pain: inflammatory and mechanical.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Patients with a primary
Suggested guidelines for rating cardiac disability in workers' compensation. Medical and Chiropractic Advisory Committee to the Administrative Director of the California Division of Industrial Accidents.
Clark, W L; Alpern, H L; Breall, W S; Hyman, R M; Markovitz, A; O'Brien, J B; Starke, R D
Cardiac disability ratings in workers' compensation cases currently lack any consistent scientific basis, with varying medical evidence used by different examiners in the same case. Opinions about the extent of disability may differ with the same patient, delaying resolution and the delivery of benefits. We describe guidelines for determining cardiac impairment and suggest a schedule for rating disability based on evidence. Our experience is in California, but arriving at equitable ratings for disability purposes is a nationwide challenge. Exercise stress testing provides the best reproducible data to test the heart's ability to do work. When exercise stress testing is not possible or adequate, alternative or supplemental testing is necessary. Certain conditions, such as hypertension, arrhythmias, coronary artery spasm, and a history of coronary artery operations or myocardial infarction, may affect "cardiac disability" but may not necessarily be reflected in exercise testing. PMID:8460507
Michael Perillo; Ronald Bulbulian
Background: The assessment of health-related quality-of-life outcome information has become an essential feature in the delivery of quality health care. Outcome assessment and increased clinical research capacity have been identified as recommended areas of priority for chiropractic research, chiropractic colleges, and the profession. Objective: This article reports the results of a multisite pilot project utilizing New York Chiropractic College's 3
... Sleep Medicine Physical Therapist Occupational Therapist Physiatrist/Rehabilitation Medicine Nurse Researcher Pediatrics Geriatrics Dentist Alternative Medicine Chiropractic Social Services Other ...
alternatives Murdoch scientists turning algae into fuel Pampering for camels New camel health facility Autumn 2010 Helping India Chiropractic, Nursing and Pharmacy Schools making a difference Fossil fuel
Nickrent, Daniel L.
............................................................................................................. 6 Requirements: Chiropractic, Dentistry, Medicine, Occupational Therapy, Optometry Pierson, (CoChair), Physiology phone number: (618) 5362147 Dr. Latasha Redmond, Biological Science
, optometry, chiropractic, physical, and occupational therapy, mortuary science, and veterinary medicine, and pharmaceutical firms. The primary objective the BS in Bioinformatics program (also called Computational Biology
Keating, Joseph C
If there is any one individual who stands out in the saga of the early growth and development of the Canadian Memorial Chiropractic College, it must be Albert Earl Homewood (1916–1990). His contributions included steering the institution through the lean 1950s, coping with the metropolitan transit authorities’ devastating incursion upon the first campus, and arranging the construction and financing of the school’s second campus. Along the way, this feisty gentleman and respected instructor, “chiropractic’s Mr. Chips,” raised the standard for scholarship among DCs and assisted in the administration of several additional chiropractic colleges (Lincoln and Los Angeles). PMID:17549169
...Health; Area Health Education Centers; Chiropractic...Career Award; Geriatric Education Centers; Quentin N...Graduate Psychology Education; and Preventive and...cultural, religious, or socioeconomic status. Qualified...
Ralph Kruse; Jerrilyn A. Cambron
Objective: Although chiropractic manipulation is commonly utilized for low back pain, applying this procedure to the post lumbar spine surgery patient has not been adequately studied. The purpose of this retrospective chart review is to report on the results of chiropractic management (including Cox flexion distraction technique) of patients with post-surgical lumbar spine pain to determine the change in reported
Leonard F. Vernon; Christopher Kent
This article traces the historical and philosophical roots of the provaccination and anti-vaccination movements through to the present day, with a focus on the role of chiropractic within those movements. Political, legal, and scientific issues are considered. Attempts to portray the anti-vaccination chiropractors as unscientific extremists, by both orthodox medicine and from within the chiropractic community itself, clouds the informed
Brown, Douglas M.
This paper reviews the leadership role, contributions, accolades, and impact of Professor Allan Freedman through a 30 year history of service to CMCC and the chiropractic profession in Canada. Professor Freedman has served as an educator, philanthropist and also as legal counsel. His influence on chiropractic organizations and chiropractors during this significant period in the profession is discussed. PMID:18060008
Jerrilyn A. Cambron
Objective: To report on recruitment efforts and accrual rates for a nonmusculoskeletal chiropractic clinical trial. Design: Information regarding the method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screening. Setting: A suburban chiropractic teaching clinic with recruitment efforts extending throughout the larger metropolitan area. Patients: A total of 2312 women were
-Chiropractic Pre-Naturopathic (Pre-Physician Assistant)* Kimberly Felipe Pre Medicine Pre-Nursing Pre-Physician Assistant Pre-Radiation Therapy Joan Jagodnik Pre-Medicine Pre-Dentistry Pre-Physical Therapy Pre
Williams II, Robert L.
palpation that lymph nodes that are swollen and muscles in spasm, as well as neoplasms in breasts, prostate, such as chiropractic, physical therapy and massage, students receive extensive training in palpating muscles, bones
medical, dental, veterinary medical, osteopathic medical, podiatry, chiropractic, pharmacy, physician test to apply to many of the health professions schools: MCAT (Medical College Admission Test), DAT (Dental Admission Test), GRE (Graduate Record Examination), OAT (Optometry Admission Test), PCAT (Pharmacy
... classes, or trained individuals. Bodywork includes myofascial release (Smith, 1997) , various types of massage, craniosacral therapy, chiropractic ... 1987) ; therapeutic touch, developed in nursing (Gerber, 1988; Smith, 1997) ; and reiki and polarity (Goldberg, 1995) . All ...
...veterinary medicine, optometry, podiatric medicine, pharmacy, public health, chiropractic, health administration and clinical psychology. The basic purpose of the program is to encourage lenders to make loans to students in these fields who desire to...
...or a graduate program in health administration, clinical psychology, or allied health may borrow up to $50,000 under this...health, chiropractic, health administration, or clinical psychology may borrow up to $50,000 under this part including...
...or a graduate program in health administration, clinical psychology, or allied health may borrow up to $50,000 under this...health, chiropractic, health administration, or clinical psychology may borrow up to $50,000 under this part including...
...or a graduate program in health administration, clinical psychology, or allied health may borrow up to $50,000 under this...health, chiropractic, health administration, or clinical psychology may borrow up to $50,000 under this part including...
...veterinary medicine, optometry, podiatric medicine, pharmacy, public health, chiropractic, health administration and clinical psychology. The basic purpose of the program is to encourage lenders to make loans to students in these fields who desire to...
...veterinary medicine, optometry, podiatric medicine, pharmacy, public health, chiropractic, health administration and clinical psychology. The basic purpose of the program is to encourage lenders to make loans to students in these fields who desire to...
...Graduate or equivalent degree in Public Health Doctor of Chiropractic or equivalent degree Doctoral degree in Clinical Psychology Masters or doctoral degree in Health Administration (c) He or she must be carrying or plan to carry, during...
...Graduate or equivalent degree in Public Health Doctor of Chiropractic or equivalent degree Doctoral degree in Clinical Psychology Masters or doctoral degree in Health Administration (c) He or she must be carrying or plan to carry, during...
...Graduate or equivalent degree in Public Health Doctor of Chiropractic or equivalent degree Doctoral degree in Clinical Psychology Masters or doctoral degree in Health Administration (c) He or she must be carrying or plan to carry, during...
...pharmacy, public health, allied health, or chiropractic, and graduate students in health administration or clinical psychology through September 30, 1998. Eligible lenders, such as banks, savings and loan associations, credit unions, pension...
...pharmacy, public health, allied health, or chiropractic, and graduate students in health administration or clinical psychology through September 30, 1998. Eligible lenders, such as banks, savings and loan associations, credit unions, pension...
Hardy, Christopher R.
312] · First Aid and CPR [WSSD 311] · Zoology [BIOL 211] · Calculus [MATH 161] · Cell Biology [BIOL Assistant, Chiropractic, Podiatry, Nursing, or Medicine. Earning a dual credential not only increases job
Rubisco frequently undergoes unproductive interactions with its sugar-phosphate substrate that stabilize active sites in an inactive conformation. Restoring catalytic competence to these sites requires the “molecular chiropractic” activity of Rubisco activase (activase). To make the study of activas...
Programs and services to enhance your health and wellness From acupuncture to natural supplements Acupuncture Chiropractic Care Massage Therapy Mind/Body HealthyroadsTM Mind/Body Program Fitness Fitness Club
... Photo: iStock Herbal supplements, meditation, chiropractic manipulation, and acupuncture are types of complementary and alternative medicine (CAM) ... effective. For example, NCCAM studies have shown that: Acupuncture can provide pain relief and improve function for ...
Hutcheon, James M.
Programs and services to enhance your health and wellness From acupuncture to natural supplements® Alternative Medicine Acupuncture Chiropractic Care Massage Therapy Mind/Body Healthy Roads Mind/Body Program
... Public 3 One type of spinal stenosis, cauda equine syndrome, is very serious. This type occurs when ... spinal stenosis, such treatments include chiropractic treatment and acupuncture. More research is needed on the value of ...
for careers in various health professions, including allopathic medicine, osteopathic medicine, dentistry, veterinary medicine, podiatry, optometry, pharmacy, physi- cal therapy, physician assistant, and chiropractic medicine. Please note that advising for physical therapy and nursing are done by the Departments
Paediatric use of complementary and alternative medicine is common and increasing, particularly for the sickest children. This review discusses the various options available including dietary supplements, hypnosis, massage, chiropractic, and acupuncture.?? PMID:11124773
...by irrigation, tweezers, cotton swabs or other simple means; (L) Using finger guards; (M) Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping purposes); or (N) Drinking fluids...
...by irrigation, tweezers, cotton swabs or other simple means; (L) Using finger guards; (M) Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping purposes); or (N) Drinking fluids...
... Special Section CAM Quiz on Complementary and Alternative Medicine Past Issues / Winter 2009 Table of Contents For ... low back pain. True False Complementary and alternative medicine (CAM) includes: Meditation Chiropractic Use of natural products, ...
Young, K J
Born in Brooklyn in 1909, Michael A. Giammarino was one of the first chiropractic radiologists. After receiving his D.C. from Palmer in 1932, he worked in private practice in Brooklyn for six years. However, chiropractic was not licensed in New York so he moved to Coatesville, Pennsylvania, where he ran a successful private practice until his retirement in 1985. During that time, he became interested in radiology and attended many seminars and lectures on the subject, including one in 1946, taught by Waldo G. Poehner, D.C., the first postgraduate course in chiropractic roentgenology ever given. Poehner surprised him at the next convention of the National Chiropractic Association by nominating him for the position of vice-president of the Council on Roentgenology. Giammarino then became involved in the creation of the certification program in roentgenology, which evolved into today's Diplomate of the American Chiropractic Board of Radiology. Giammarino is a past-president of the Board as well as the Pennsylvania Licensed Chiropractors' Association. In addition to these activities, he taught many courses in radiology and undertook an extensive radiographic study of scoliosis in identical twins. He still lives in Coatesville and is very active in the community. PMID:11623681
Biggs, Lesley; Hay, David; Mierau, Dale
This article is a follow-up on our previous work examining Canadian chiropractors’ attitudes towards chiropractic philosophy and scope of practice and their implications for the implementation of clinical practice guidelines. In this current study, we examined Canadian chiropractors’ attitudes toward standards of care, the organizations developing them and their relationship to the philosophy index. The findings indicated that there was no agreement about the definition of standards of care among chiropractors, although there was strong support for the concept. Most chiropractors preferred that chiropractic organizations set standards of care - the strongest support was for the Canadian Chiropractic Association. Finally, we found differences among chiropractors’ attitudes toward standards of care and the organizations developing them with respect to philosophy. Empirically oriented chiropractors supported only a narrow definition of standards of care limited to issues surrounding safety and diagnosis. In addition, empirically oriented chiropractors would only support the development of standards of care by an expert panel of chiropractors. Rationalist and moderates supported the development of standards of care by a broader range of chiropractic organizations. We concluded that successful implementation of standards of care could occur if the CCA, in consultation with other chiropractic organizations, was actively committed to this initiative. Imagesp257-ap257-bp257-cp257-dp257-e
Houle, Sébastien; Descarreaux, Martin
Abstract Objective This article describes the chiropractic clinical management and therapeutic benefits accruing to a patient with temporomandibular joint (TMJ) disorder and spinal muscular atrophy type III. Clinical Features A 35-year-old white man presented at the university chiropractic outpatient clinic with a complaint of masseter muscle pain and mouth-opening restriction. Temporomandibular joint range of motion evaluation revealed restricted opening (11 mm interincisival), and pain was rated by the patient at an intensity of 5 on a pain scale of 0 to 10. Intervention and Outcome Chiropractic care was provided and included TMJ mobilization, myofascial therapy, trigger point therapy, and light spinal mobilizations of the upper cervical vertebrae. Final evaluation of TMJ range of motion showed active opening of 12 mm with absence of pain and muscle tenderness of the jaw. Conclusion This case suggests that a patient with musculoskeletal disorders related to underlying neurodegenerative pathologies may benefit from chiropractic management adapted to their condition. In the present case, chiropractic treatment of the TMJ represented a viable, low-cost approach with limited adverse effects compared with surgery. PMID:19948309
Adhesive capsulitis or frozen shoulder is an uncommon entity in athletes. However, it is a common cause of shoulder pain and disability in the general population. Although it is a self limiting ailment, its rather long, restrictive and painful course forces the affected person to seek treatment. Conservative management remains the mainstay treatment of adhesive capsulitis. This includes chiropractic manipulation of the shoulder, therapeutic modalities, mobilization, exercise, soft tissue therapy, nonsteroidal anti-inflammatory drugs, and steroid injections. Manipulation under anesthesia is advocated when the conservative treatment fails. A case of secondary adhesive capsulitis in a forty-seven-year-old female recreational squash player is presented to illustrate clinical presentation, diagnosis, radiographic assessment and conservative chiropractic management. The patient’s shoulder range of motion was full and pain free with four months of conservative chiropractic care. ImagesFigure 1Figure 2Figure 3
Brown, Douglas M.
This article focuses primarily on Ontario, identifying a number of the profession’s allies and their advocacy effectiveness, under two main headings: The Ontario Chiropractic Association; and the Canadian Memorial Chiropractic College during the period of 1902 to 2012. While part of our success in gaining recognition has been attributed to intense lobbying by the profession, here the public support of several labour unions is reviewed. The part played by various politicians, educators, entrepreneurs, legal counsel, academic administrators and historians is also discussed. PMID:23482916
Evidence-based medicine is switching from the analysis of single diseases at a time toward an integrated assessment of a diseased person. Complementary and alternative medicine (CAM) offers multiple hol- istic approaches, including osteopathy, homeopathy, chiropractic, acupuncture, herbal and energy medi- cine and meditation, all potentially impacting on major human diseases. It is now becoming evident that acupuncture can modify the
Matthew E. Alix; Deanna K. Bates
Objective: To examine the neurophysiologic basis and anatomic relationship between the dura mater and the rectus capitis posterior minor muscle in the etiologic proposition of cervicogenic headache. Data Source: On-line searches in MEDLINE and the Index to Chiropractic Literature, manual citation searches, and peer inquiries. Results: Connective tissue bridges were noted at the atlanto-occipital junction between the rectus capitis posterior
Stout, Robert J.
This study examined attitudes of people about benefits of the economic impacts of two local colleges (Palmer College of Chiropractic and Scott Community College) in the metropolitan Quad Cities area of Rock Island County (Illinois) and Scott County (Iowa). The study compared impacts considered important by the community with those estimated by the…
New Mexico, University of
Chiropractic Services 34 Cancer Clinical Trials 34 Dental Care and Medical Conditions of the Mouth and Jaw 35MEDICAL PLAN Participant Benefit Booklet July 1, 2012 - June 30, 2013 #12;unm medical plan medical COMPANY UNM PBB Effective July 1, 2012 UNM Medical PLAN Medical Benefit Plan EFFECTIVE: July 1, 2012
O'Toole, Alice J.
University of Antigua College of Medicine, School of Nursing Boston University-Mental Health Counseling Science Center School of Nursing Texas Tech University Health Sciences Center - School of Allied Health Chiropractic College Texas Health and Science University Texas Tech University Texas Tech University Health
covered by Medicare, including dental, optical, physiotherapy and chiropractic. With Corporate Extras your orthodontic treatment $800 per person per calendar year Optical set benefits per item: Members First Optical Providers Frames for prescription lenses (one per calendar year) $192.70 standard single vision lenses $92
brand, non-formulary brand, bio-tech) with an annual out-of-pocket maximum of $1,000 per individual for chiropractic services shall be covered under the Community Blue plan with office visit co-pays consistent January 1, 2003, IRS qualified health care spending accounts, consistent with the currently offered plan
Anne Rampacher; Cynthia Peterson
Physical manipulation in the form of spinal adjustments is the primary form of treatment offered by chiropractors. Entry requirements and teaching methods outlined by the Anglo-European College of Chiropractic (AECC) have to ensure that students are selected and trained in a way that will allow them to eventually leave the college as a group of competently skilled practitioners. If significant
van Why, Richard P., Comp.
This comprehensive bibliography of research and writings on massage therapy for chronic illness, disabilities, and general health, is addressed to students of therapeutic bodywork, massage therapists, osteopathic and chiropractic physicians, as well as schools and research centers for health professionals. The work draws its citations from…
John A. Astin; Kenneth R. Pelletier; Ariane Marie; William L. Haskell
Background. Large scale surveys in the United States and abroad suggest that 35-60% of adults have used some form of complementary\\/alternative medicine (CAM). However, no studies to date have focused on predictors and patterns of CAM use among elderly persons. Methods. The population surveyed were Calilbrnians enrolled in a Medicare risk product that offers coverage for acu- puncture and chiropractic
John A. Astin; Ariane Marie; Kenneth R. Pelletier; Erik Hansen; William L. Haskell
of the surveyed physicians believed in the efficacy of acu- puncture (51%), chiropractic (53%), and massage (48%), while fewer believed in the value of homeopathy (26%) and herbal approaches (13%). Conclusions: This review suggests that large numbers of physicians are either referring to or practicing some of the more prominent and well-known forms of CAM and that many physicians believe
-of-Pocket Max (Individual/Family) (deductible is included) $1,500/$3,000 $3,000/$6,000 $3,000/$6000 $6 deductible Physical Therapy 35% 35% after deductible 35% 35% after deductible Chiropractic 35% 40% after deductible 35% 40% after deductible Massage Therapy 35% 40% after deductible 35% 40% after deductible Durable
Brown, Douglas M.
This paper reviews the story of two childhood friends, Dr. Wm. Lloyd Stackhouse and Dr. Robert E. Kinsman, who attended the Canadian Memorial Chiropractic College (CMCC) together, graduated in 1953 to form an enduring partnership that included their immediate relatives, and to this day persists as a supportive tribe. PMID:23997249
Linaker, Kathleen Linda
Diagnostic radiology education is a specialty within healthcare education and encompasses education at both the undergraduate and resident level. There is little research regarding what constitutes effective radiology education. The broad purpose of this study was to investigate through the student perspective how chiropractic students learned…
5 Tips on Safety of Mind and Body Practices for Children and Teens Nearly 12 percent of children (about 1 in 9) in the United States are ... such as chiropractic care, deep breathing, and yoga. Mind and body interventions are physical techniques usually administered ...
Henry Pollard; Lotte Hansen; Wayne Hoskins
BACKGROUND: This paper describes a case of C7 radiculopathy in a professional rugby league player after repeated cervical spine trauma. The report outlines the management of the patient following an acute cervical hyperflexion injury with chiropractic manipulation and soft tissue therapies. It also presents a change in approach to include distractive techniques on presentation of a neurological deficit following re-injury.
Chiropractic is an increasingly-recognised health profession and systematic reviews of the effectiveness of manipulation for back pain are responsible for much of that recognition. Establishement on this basis, however demands that the profession learns to operate in the new clinical culture of evidence based practice if it is to progress. This calls for changes in emphases in education for self-monitoring
Vear, Herbert J
In the past, standards of care in chiropractic were based upon the bias, empiricism and little if any scientific work by the author. This was due, in part, to history which fostered the belief that all that was needed was anecdotal testimony and in part to the isolation of chiropractic colleges from main stream science. Today, standards are being based upon the scientific evaluation of the clinical procedures used and formulated by consensus of experts within the profession. The chiropractic profession has the duty to create standards of practice that will advance its clinical practice, protect the patient, ensure its contribution to health care and promote research into the assessment of outcomes and effectiveness. Although such steps are being actively pursued, significant discrepancies exist between the 60 statutes regulating chiropractic practice. Absence of consensus not only in the scope of practice but also in lexicon, adds confusion within and outside the profession. In addition, the profession is facing the same difficult task as the other health care professions, the need to develop quality assurance parameters for standards of care, quality of care and outcome of care measurements. Each of the parameters must be rational, defensible and modifiable as advances in science and technology become available. It is the responsibility of each chiropractor to maintain the appropriate level of professional skills to ensure that the patient receives the best care possible.
THERAPY AND ACUPUNCTURE Benefits Checklist 2013/14 Patient Name) is the primary provider for Physical Therapy and Acupuncture services. Ø A referral by an SHCS provider must Acupuncture, Chiropractic Care & Osteopathic Manipulation: all covered at 80% in-network after $300 deductible
Gleeson, Joseph G.
+HRA Core (fee-for-service) Plus (point-of-service) American Specialty Health Networks (ASH Networks) 800XO Van Nuys, CA 91409 American Specialty Health Networks (ASH Networks) discounts on Acupuncture Specialty Health Networks (ASH Networks) discounts on Acupuncture, Chiropractic, Massage and Nutrition
Describes development and expansion of Life University (Georgia) to an institution with 3,500 students offering the doctor of chiropractic degree, a master's degree in sport health science, and bachelor's degrees in 32 related areas. Notes the president's dominant role and critics' objections to high salaries for the president and his family…
medicine, dentistry, veterinary medicine, podiatry, optometry, pharmacy, physi- cian assistant, and chiropractic medicine. Please note that advising for physical therapy and nursing are done by the Departments-related programs are in the sciences, most students earn degrees in biology or chemistry before going
medicine, dentistry, veterinary medicine, podiatry, optometry, pharmacy, physi- cal therapy, physician assistant, and chiropractic medicine. Please note that advising for physical therapy and nursing are done for admission to health-related programs are in the sciences, most students earn degrees in biology or chemistry
Oliver, Douglas L.
Benefit Maximum Unlimited Pharmacy Maximum Unlimited Out-Patient Maximum Unlimited Mental Health Maximum Visit $25 co-pay per visit, then paid at 100% of PA 70% of R&C Mental Health Office Visit $25 co-pay per to deductible) 90% of PA 70% of R&C Physical/Chiropractic//Occupational Therapy $25 co-pay per visit, then paid
281, Phone (407) 823-3466 - Help with Engineering and Computer Science courses. Math Lab MAP 113, Phone (407) 823-2811 - Personal and career counseling. - http care, dental center, pharmacy, and services including but not limited to: chiropractic care, flu shots
Michael H. Cohen
Complementary and alternative medical (CAM) therapies include chiropractic, acupuncture and traditional Oriental medicine, massage therapy, and herbal remedies; mind–body therapies (such as meditative practices and visualization); and folk practices and religious healing. Of these, modalities based on spiritual healing create a number of conundrums for the clinician, including legal, regulatory, and ethical issues. Further, the historic relationship between the study
James W. Brantingham; Gary A. Globe; Tammy Kay Cassa; Denise Globe; Katie de Luca; Henry Pollard; Felix Lee; Charles Bates; Muffit Jensen; Stephan Mayer; Charmaine Korporaal
ObjectiveHip osteoarthritis (HOA) affects 30 million Americans or more, and is a leading cause of disability, suffering, and pain. Standard treatments are minimally effective and carry significant risk and expense. This study assessed treatment effects of a chiropractic protocol for HOA.
Karonis, Nicholas T.
Decorative personal journal Jennifer Woolbright Mark Beaird Property Control Music CD School of Music Bonnie pizza with one topping Papa John's Sherri Bolek Bursar Music CD School of Music Thomas Brickner Retiree William Crase Physical Plant Healthy Life Chiropractic Trigger wheel Operating Staff Council Jody Crocker
de Lijser, Peter
Flexible Spending Account Summary Partial list of qualified medical expenses: Deductibles Copays and not used to treat a medical condition Warranties What is a Flexible Spending Account? A Flexible Spending Chiropractic services $240 $168 $72 and many others... #12;Flexible Spending Account Summary Dependent Care FSA
The medical coverage is designed to help protect you and your covered dependents against financial loss. The chart below summarizes the key features of the medical plan options available to you and your covered dependents.
Kay, Mark A.
loss. The chart below summarizes the key features of the medical plan options available to you and your, occupational, speech therapy & chiropractic care $20 copay (physician); $35 copay (specialist) 20% Preventive-baby & well-child care No copay No copay 40% Vision/hearing exams No copay No copay 40% Covered immunizations
Jesper M. M. Wiberg; Jan Nordsteen; Niels Nilsson
Objective: To determine whether there is a short-term effect of spinal manipulation in the treatment of infantile colic. Design: A randomized controlled trial. Setting: A private chiropractic practice and the National Health Service's health visitor nurses in the uburb Ballerup (Copenhagen, Denmark). Subjects: Infants seen by the health visitor nurses, who fulfilled the diagnostic criteria for infantile colic. Intervention: One
Background: To date, no substantiated studies have been performed to investigate the efficacy of spinal manipulative therapy on thoracic spinal syndromes. Objective: To investigate the effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain. Study Design: A single-blind, randomized, comparative, controlled pilot study. Setting: Technikon Natal Chiropractic Clinic in Durban, South Africa. Participants: Thirty subjects selected
Gudavalli, Maruti Ram; Cox, James M.
A form of chiropractic procedure known as Cox flexion-distraction is used by chiropractors to treat low back pain. Patient lies face down on a specially designed table having a stationery thoracic support and a moveable caudal support for the legs. The Doctor of Chiropractic (DC) holds a manual contact applying forces over the posterior lumbar spine and press down on the moving leg support to create traction effects in the lumbar spine. This paper reports on the development of real-time feedback on the applied forces during the application of the flexion-distraction procedure. In this pilot study we measured the forces applied by experienced DCs as well as novice DCs in using this procedure. After a brief training with real-time feedback novice DCs have improved on the magnitude of the applied forces. This real-time feedback technology is promising to do systematic studies in training DCs during the application of this procedure. PMID:24932023
Passmore, Steven R.; Murphy, Bernadette; Lee, Timothy D.
Somatosensory evoked potentionals (SEPs) can be used to elucidate differences in cortical activity associated with a spinal manipulation (SM) intervention. The purpose of this narrative review is to overview the origin and application of SEPs, a neurophysiological technique to investigate neuroplasticity. Summaries of: 1) parameters for SEP generation and waveform recording; 2) SEP peak nomenclature, interpretation and generators; 3) peaks pertaining to tactile information processing (relevant to both chiropractic and other manual therapies); 4) utilization and application of SEPs; 5) SEPs concurrent with an experimental task and at baseline/control/pretest; 6) SEPs pain studies; and 7) SEPs design (pre/post) and neural reorganization/neuroplasticity; and 8) SEPs and future chiropractic research are all reviewed. Understanding what SEPs are, and their application allows chiropractors, educators, and other manual therapists interested in SM to understand the context, and importance of research findings from SM studies that involve SEPs. PMID:24932021
Brown, Douglas M
This paper focuses on Dr. Ian Coulter’s accomplishments from the time he became Executive Vice-President of CMCC in 1981, until he ended his presidency with a year’s administrative leave in 1990. Annual planning initiatives, pedagogy, scholarship, conflicts, and the quest for university affiliation are discussed as well as his legacy to the College and the chiropractic profession. The term “adventurous” was first attributed to Coulter by Oswald Hall, PhD, Professor Emeritus, University of Toronto who had worked closely with Coulter in a major investigation of the chiropractic profession from 1976 to 1979. Throughout this article the author tries to capture the spirit of daring, innovation and intellect that permeated Coulter’s presidency, enthralling his advocates and confounding his detractors. PMID:17549218
Donovan, James; Cassidy, J. David; Cancelliere, Carol; Poulsen, Erik; Stochkendahl, Mette Jensen; Kilsgaard, Jørgen; Blanchette, Marc-André; Hartvigsen, Jan
Over the past two decades, clinical research within the chiropractic profession has focused on the spine and spinal conditions, specifically neck and low back pain. However, there is now a small group of chiropractors with clinical research training that are shifting their focus away from traditional research pursuits towards new and innovative areas. Specifically, these researchers are now delving into areas such as brain injury, work disability prevention, undifferentiated chest pain, hip osteoarthritis, and prevention of pain in children and adolescents to name a few. In this paper, we highlight recent research in these new areas and discuss how clinical research efforts in musculoskeletal areas beyond the spine can benefit patient care and the future of the chiropractic profession. PMID:25729080
Snider, Karen T; Jorgensen, Douglas J
Some osteopathic physicians are not properly reimbursed by insurance companies after providing osteopathic manipulative treatment (OMT) to their patients. Common problems associated with lack of reimbursements include insurers bundling OMT with the standard evaluation and management service and confusing OMT with chiropractic manipulative treatment or physical therapy services. The authors suggest methods of appeal for denied reimbursement claims that will also prevent future payment denials. PMID:19706830
Paul A. Oakley; Robert H. Berry; Deed E. Harrison
Objective: Case report of a patient, having persistent low back and leg pain following a L4-L5 surgical laminectomy, who underwent Clinical Biomechanics of Posture? (CBP?) protocol designed to correct postural distortions. Clinical features: A thirty-five year-old male suffered from low back\\/leg pain following a work injury despite having a lumbar spine laminectomy 6 months prior to chiropractic care. Radiographic analysis
Tony S. Keller; Christopher J. Colloca
Objective: The objective of this study was to determine whether mechanical force, manually-assisted (MFMA) spinal manipulative therapy (SMT) affects paraspinal muscle strength as assessed through use of surface electromyography (sEMG). Design: Prospective clinical trial comparing sEMG output in 1 active treatment group and 2 control groups. Setting: Outpatient chiropractic clinic, Phoenix, AZ. Subjects: Forty subjects with low back pain (LBP)
Yuen, Tammy; Wells, Kayla; Benoit, Samantha; Yohanathan, Sahila; Capelletti, Lauren; Stuber, Kent
Introduction: Due to different biomechanical, nutritional, and hormonal considerations, it is possible that chiropractors may employ different therapeutic interventions and recommendations for pregnant patients than non-pregnant ones. The objective of this study was to determine the therapeutic interventions that chiropractors who are members of the Ontario Chiropractic Association in the Greater Toronto Area most commonly provide to pregnant patients. Methods: An introductory e-mail was sent in October 2011 to 755 members of the Ontario Chiropractic Association within the Greater Toronto Area five days prior to a 15 question survey being distributed via e-mail. Reminder e-mails were sent 13 days and 27 days later. Using descriptive statistics, demographic information was reported along with reported use of different treatments and recommendations for pregnant patients Results: A response rate of 23% was obtained. The majority of the respondents (90%) reported using the Diversified technique on pregnant patients, followed by soft tissue therapy (62%) and Activator (42%). The most common adjunctive therapy recommended to pregnant patients was referral to massage therapy (90%). Most of the respondents (92%) indicated that they prescribe stretching exercises to pregnant patients and recommend a multivitamin (84%) or folic acid (81%) to pregnant patients. Conclusion: In agreement with previous research on chiropractic technique usage on non-pregnant patients, the majority of respondents indicated treating pregnant patients with the Diversified technique, with other chiropractic techniques being utilized at varying rates on pregnant patients. Most respondents indicated prescribing exercise, and making adjunctive and nutritional recommendations frequently for their pregnant patients. PMID:23754858
K J Thomas; J Carr; L Westlake; B T Williams
OBJECTIVE--To describe the characteristics of patients using non-orthodox health care and their pattern of use of conventional health care with respect to a particular problem. DESIGN--Postal survey of all 2152 practitioners of acupuncture, chiropractic, homeopathy, naturopathy, and osteopathy identified from 11 national professional association registers. Patients attending a representative sample of 101 responding practitioners completed questionnaires covering demographic characteristics, presenting
Charlotte Leboeuf-Yde; Kirsten Ohm Kyvik
Objective: To determine the prevalence of positive chiropractic test results in relation to low back pain status and to determine the sensitivity, specificity, and predictive (positive and negative) values of these tests.Design: Study subjects were examined by a chiropractor who was unaware of their low back pain status. Information on low back pain was then collected in a self-report questionnaire.Setting:
Robert C. Kessinger; Dessy V. Boneva
Objective: To discuss the case of a patient who received upper cervical chiropractic care after trauma-induced arcual kyphosis in the cervical spine. A practical application of conservative management for posttrauma cervical spine injury in the private office setting is described.Clinical Features: A 17-year-old female patient suffered an unstable C3\\/C4 motor segment after a lateral-impact motor vehicle collision. Additional symptoms on
Michael Haneline; John Triano
Objective: To examine the similarities and dissimilarities between cervical chiropractic manipulative therapy and whiplash, and their respective relation to cervical artery dissection. Data Sources: AliteraturesynthesisusedMEDLINE-PubMedandMANTISliteraturesearches.Atotallistof99relevant articles was generated. Additional references were collected from citations incorporated within the included articles. Results: Both neck manipulation and motor vehicle collision events apply loads to the spinal column rapidly. While neck manipulation loads are
Meyer, Amanda J; Armson, Anthony; Losco, C Dominique; Losco, Barrett; Walker, Bruce F
It has been demonstrated that a positive correlation exists between clinical knowledge and retained concepts in basic sciences. Studies have demonstrated a modest attrition of anatomy knowledge over time, which may be influenced by students' perceived importance of the basic sciences and the learning styles adopted. The aims of this study were to: (1) conduct a cross-sectional evaluation of the retention of anatomical knowledge in preclinical (second-year) and clinical (fifth-year) chiropractic students at Murdoch University; and (2) examine students' perceptions of factors that may influence their anatomy knowledge retention. Second- and fifth-year chiropractic students at Murdoch University were invited to participate in the study. Ninety-one students voluntarily participated. The Carpal Bone Test, previously utilized to determine the retention of anatomical knowledge, was utilized to determine the extent to which participants retained gross anatomy knowledge. Participants also completed a questionnaire specifically designed to identify the factors that may have influenced their retention of gross anatomy knowledge. A two-sided Pearson chi-square test of association was used to ascertain statistically significant differences in carpal bone retention and students' responses between the two cohorts. Seventy percent of the fifth-year (clinical) chiropractic students correctly identified all eight carpal bones compared to only six percent of second-year chiropractic students. The majority of participants in both cohorts believed that gross anatomy knowledge is of clinical importance. The use of mnemonics and the clinical application of anatomy knowledge were identified as factors that significantly influenced participants' gross anatomy knowledge retention within this study. PMID:24838440
Guy Hains; François Hains
Objectives: To provide preliminary information on whether a regimen of 30 chiropractic treatments that combines ischemic compression and spinal manipulation effectively reduces the intensity of pain, sleep disturbance, and fatigue associated with fibromyalgia. In addition, to study the dose-response relation and identify the baseline characteristics that may serve as predictors of outcome.Design: Subjects were assessed with self-administered questionnaires taken at
Maruti Ram Gudavalli; Jerrilyn A. Cambron; Marion McGregor; James Jedlicka; Michael Keenum; Alexander J. Ghanayem; Avinash G. Patwardhan
Many clinical trials on chiropractic management of low back pain have neglected to include specific forms of care. This study compared two well-defined treatment protocols. The objective was to compare the outcome of flexion–distraction (FD) procedures performed by chiropractors with an active trunk exercise protocol (ATEP) performed by physical therapists. A randomized clinical trial study design was used. Subjects, 18 years
Kizhakkeveettil, Anupama; Sikorski, David; Tobias, Gene; Korgan, Christos
Objective : The main objective of this study was to determine characteristics of injuries experienced by students while learning chiropractic procedures in the classroom. Methods : Injury was defined as any physical adverse effect such as pain, stiffness, headache, and muscle spasm. Survey questions included age, sex, role, anatomical areas of injury, adjustive technique utilized, types of injury, treatment (if any), and recovery time. The survey was administered among the students in the 5th, 6th, and 8th trimesters of our doctor of chiropractic program. Only students who had completed one or more chiropractic procedures courses at the institution were asked to participate in the study. Results : Female recipients had a higher prevalence of adverse effects as the recipient of the adjustment than did male recipients. The most common site for injury overall was the lower back. The relationship between recipient role and sacroiliac joint injury and the relationship between adjustor role and wrist/hand injury were statistically significant. Students were more likely to be injured in the beginning of their technique education. Conclusion : This study suggests that students in technique courses learning adjustive procedures experience minor adverse physical effects related to the physical skills being learned. Strategies for prevention need to be considered. PMID:24955948
Background The "Put Prevention into Practice" campaign of the US Public Health Service (USPHS) was launched with the dissemination of the Clinician's Handbook of Preventive Services that recommended standards of clinical care for various prevention activities, including preventive clinical strategies to reduce the risk of adverse drug events. We explored whether nonprescribing clinicians such as chiropractors may contribute to advancing drug safety initiatives by identifying potential adverse drug events in their chiropractic patients, and by bringing suspected adverse drug events to the attention of the prescribing clinicians. Methods Mail survey of US chiropractors about their detection of potential adverse drug events in their chiropractic patients. Results Over half of responding chiropractors (62%) reported having identified a suspected adverse drug event occurring in one of their chiropractic patients. The severity of suspected drug-related events detected ranged from mild to severe. Conclusions Chiropractors or other nonprescribing clinicians may be in a position to detect potential adverse drug events in the community. These detection and reporting mechanisms should be standardized and policies related to clinical case management of suspected adverse drug events occurring in their patients should be developed. PMID:21083911
Jensen, Anne M.; Bewketu, Brutawit; Sanford, Douglas
Objective The purpose of this case study is to describe the clinical course and treatment of a female patient with intermittent low back pain (LBP) that was associated with a uterine adenomyosis. Clinical Features A 45-year-old woman presented for chiropractic care with intermittent LBP of 4 years' duration. History revealed concurrent dysmenorrhea, menorrhagia, and a uterine leiomyoma (fibroid). Physical and radiological examination findings were unremarkable, and the LBP was not reproducible. Intervention and Outcome Activator Methods chiropractic adjustments/manipulations were given twice per week for 4 months with moderate results. The frequency and duration of low back and pelvic pains were reduced; however, the severity remained constant. A further gynecological opinion was sought, a transvaginal ultrasound was performed, and the patient's diagnosis was changed from leiomyoma to adenomyosis. Conclusion In this case report, a woman presented with a 4-year history of intermittent LBP, which was sometimes associated with menstruation. Despite being diagnosed with uterine adenomyosis, she received some relief from chiropractic care. PMID:22027211
Paravicini, Inga; Peterson, Cynthia K.
Objective To determine if the clinical evaluation exercise (CEX) format is reliable, applicable and useful for evaluating clinical competency in the postgraduate chiropractic program as formative feedback. Methods Twelve mini-CEX clinical encounters were evaluated by 2 assessors per clinical encounter (7 assessors per session) in 23 chiropractic residents over a 12-month period. Two different rating scales (9 point and 5 point) were used, and the 2 assessors completed the forms independently. Individual competencies assessed consisted of history taking, physical examination, organization/efficiency, clinical judgment, professionalism/communication, counseling, and overall clinical performance. Interassessor reliability was calculated using ? and intraclass correlation coefficient statistics. Cronbach ? assessed internal consistency of the mini-CEX. Spearman correlation coefficient evaluated correlation between the various competencies. The Mann-Whitney U test evaluated differences between the assessors' median numerical scores. Results The ? value for the 9-point rating scale was 0.31 (fair) and for the 5-point scale was 0.42 (moderate) with statistically significant intraclass correlation values (p < .05) for 4 of the 6 competencies. High correlation coefficients (p = .0001) were found when comparing the various competencies at each clinical encounter. There were no significant differences between the 2 assessors per clinical encounter for the scores awarded to the residents. Conclusions The mini-CEX is a reliable and useful tool to provide valuable formative feedback to postgraduate chiropractic residents. The 5-point grading scale was more user-friendly with better reliability. PMID:25408995
Gudavalli, Maruti Ram; DeVocht, James; Tayh, Ali; Xia, Ting
Objective Quantification of chiropractic high-velocity, low-amplitude spinal manipulation (HVLA-SM) may require biomechanical equipment capable of sampling data at high rates. However, there are few studies reported in the literature regarding the minimal sampling rate required to record the HVLA-SM force-time profile data accurately and precisely. The purpose of this study was to investigate the effect of different sampling rates on the quantification of forces, durations, and rates of loading of simulated side posture lumbar spine HVLA-SM delivered by doctors of chiropractic. Methods Five doctors of chiropractic (DCs) and 5 asymptomatic participants were recruited for this study. Force-time profiles were recorded during (i) 52 simulated HVLA-SM thrusts to a force transducer placed on a force plate by 2 DCs and (ii) 12 lumbar side posture HVLA-SM on 5 participants by 3 DCs. Data sampling rate of the force plate remained the same at 1000 Hz, whereas the sampling rate of the force transducer varied at 50, 100, 200, and 500 Hz. The data were reduced using custom-written MATLAB (Mathworks, Inc, Natick, MA) and MathCad (version 15; Parametric Technologies, Natick, MA) programs and analyzed descriptively. Results The average differences in the computed durations and rates of loading are smaller than 5% between 50 and 1000 Hz sampling rates. The differences in the computed preloads and peak loads are smaller than 3%. Conclusions The small differences observed in the characteristics of force-time profiles of simulated manual HVLA-SM thrusts measured using various sampling rates suggest that a sampling rate as low as 50 to 100 Hz may be sufficient. The results are applicable to the manipulation performed in this study: manual side posture lumbar spine HVLA-SM. PMID:23790603
Romano, Michele; Negrini, Stefano
Background The treatment of adolescent idiopathic scoliosis is contingent upon many variables. Simple observation is enough for less serious curvatures, but for very serious cases surgical intervention could be proposed. Between these there is a wide range of different treatments. Manual therapy is commonly used: the aim of this paper is to verify the data existing in the literature on the efficacy of this approach. Methods A systematic review of the scientific literature published internationally has been performed. We have included in the term manual therapy all the manipulative and generally passive techniques performed by an external operator. In a more specific meaning, osteopathic, chiropractic and massage techniques have been considered as manipulative therapeutic methods. We performed our systematic research in Medline, Embase, Cinhal, Cochrane Library, Pedro with the following terms: idiopathic scoliosis combined with chiropractic; manipulation; mobilization; manual therapy; massage; osteopathy; and therapeutic manipulation. The criteria for inclusion were as follows: Any kind of research; diagnosis of adolescent idiopathic scoliosis; patients treated exclusively by one of the procedures established as a standard for this review (chiropractic manipulation, osteopathic techniques, massage); and outcome in Cobb degrees. Results We founded 145 texts, but only three papers were relevant to our study. However, no one of the three satisfied all the required inclusion criteria because they were characterized by a combination of manual techniques and other therapeutic approaches. Conclusion The lack of any kind of serious scientific data does not allow us to draw any conclusion on the efficacy of manual therapy as an efficacious technique for the treatment of Adolescent idiopathic scoliosis. PMID:18211702
Zoboski, Robert J.
Objective The purpose of this case study is to describe the clinical course and treatment of a patient with recalcitrant shoulder pain and osteoid osteoma. Clinical Features A 28-year-old man had a 2-year history of progressively worsening shoulder and midscapular pain. Intervention and Outcome Before chiropractic consultation, he had been evaluated and treated by his family physician, an orthopedic surgeon, a neurologist, and a pain management specialist. The patient underwent arthroscopy with examination under anesthesia and debridement of a posterior labral tear and cervical spine epidural injections, but neither procedure relieved his symptoms. After seeking chiropractic care, presenting symptoms were reproducible during direct clinical examination; and an initial working diagnosis of secondary right glenohumeral impingement syndrome with coexisting scapulothoracic dyskinesis was made. After 2 weeks of chiropractic rehabilitation, therapy was stopped because of no change in symptoms. The patient was referred for orthopedic consultation. Another series of plain films were ordered, and follow-up magnetic resonance imaging revealed an osseous mass at the medial aspect of the proximal metadiaphyseal region of the right humerus, with a diagnosis of osteoid osteoma. The patient underwent radiofrequency thermoablation of the tumor nidus, which was unsuccessful and resulted in open surgical resection. Resolution of symptoms with minimal pain was reported 3 weeks after the surgery. Four years later, the patient's shoulder remains asymptomatic. Conclusion This case demonstrates that osteoid osteoma may present with clinical features that mimic common functional musculoskeletal conditions of the shoulder. Information from the patient history and diagnostic imaging are important for diagnosis and appropriate management. PMID:23450098
Goldszmidt, M; Levitt, C; Duarte-Franco, E; Kaczorowski, J
OBJECTIVE: To determine the referral practices, perceived usefulness, knowledge, prior training and desire for training of general practitioners (GPs) in Quebec with regard to complementary health care services such as acupuncture, chiropractic and hypnosis. DESIGN: Cross-sectional mail survey. SETTING: Province of Quebec. PARTICIPANTS: Random sample of 200 GPs. Of the 146 who responded, 25 were excluded because they were no longer in practice; this left 121 (83%). OUTCOME MEASURES: Self-reported referral practices for complementary health care services, perceived usefulness and self-assessed knowledge of such services, and prior training and desire for training in these services. RESULTS: Sixty percent (72/121) of the GPs knew at least one practitioner of a complementary health care service for referral; 59% (70/119) reported referring patients to physicians who practise such services and 68% (80/118) to nonmedical practitioners. At least one of the three services studied were regarded as having some use by 83% (101/121). Overall, self-reported knowledge was poor: the proportions of GPs who reported knowing a lot about acupuncture, chiropractic and hypnosis were 11% (13/121), 10% (12/121) and 8% (10/121) respectively. Prior training was also lacking: only 8% (9/118) of the GPs had received previous training in acupuncture, 2% (2/111) in chiropractic and 3% (3/103) in hypnosis. In all, 48% (57/118) indicated that they would like further training in at least one of the services studied, and 13% (16/121) indicated that they currently provided one service. CONCLUSIONS: Referral of patients by GPs to practitioners of complementary health care services is common in Quebec. Although self-assessed knowledge about such services is relatively poor, interest in learning more about them is high. These findings identify a demand for future educational initiatives. PMID:7796373
Brown, Douglas M.
This biographical study tracks the life of Robert Goddard Young; a member of the Canadian Memorial Chiropractic College’s (CMCC) Class of 1950. The paper begins with an overview of Robert Young’s origins, his childhood and early training, moves to his tour of duty in World War II, followed by his education at CMCC, before converging on the core of this matter; Robert Young’s professional career, which spanned over half a century. Now in his twilight years, the paper ends with a discussion on the substance of Dr. Young’s largely-forgotten contributions. PMID:19714235
Keating, Joseph C
The objectivity (interexaminer reliability) of measurement in chiropractic provides a basis for judging the quality of information in clinical research and practice. Objectivity may be determined by formal measurement evaluation studies and by sampling within clinical trials. Interpretation of inter-examiner reliability requires descriptive and inferential statistics selected on the basis of the mathematical properties of data, appreciation of the clinical meaning of a particular measure, and recognition of the role of chance. Methods of data analysis include scatter-plots, contingency tables, time-series graphs, and correlational and concordance coefficients. Many kinds of objectivity evaluations are well within the capacities of private practitioners and student clinicians.
Hughes, A; Penner, M
Beginning in the 1990s, researchers indicate a growing acceptance of complementary/alternative medicine in America. In this 1999 study, we surveyed California HMOs to determine the extent they reimburse for the following complementary/alternative therapies: nutrition counseling, chiropractic, acupuncture, massage and herbal medicine, as well as whether they require these providers to be licensed or otherwise credentialed. As hypothesized, California HMOs are more likely to reimburse for each of these therapies vs. an aggregate of 13 western U.S. states of which California is one. California's huge and competitive HMO market may be a factor. PMID:11813452
Hadida, Camille; Rajwani, Moez
A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3
Decina, Philip A; Vallee, Dwight; Mierau, Dale
A man with acute back pain presented to a chiropractic clinic with clinical symptoms and signs suggesting abdominal disease rather than mechanical spine pain. He was referred to a local hospital emergency where a diagnosis of acute pancreatitis secondary to chronic cholecystitis was made. The diagnostic images are compared to normal studies. The characteristic clinical examination findings found with back pain due to acute pancreatitis are compared to those typically seen with mechanical spine pain. ImagesFigure 1Figure 2aFigure 2bFigure 3Figure 4aFigure 4bFigure 5aFigure 5b
Bayme, Michael J.; Geftler, Alex; Netz, Uri; Kirshtein, Boris; Glazer, Yair; Atias, Shahar; Perry, Zvi
More than 11,000 articles lauding alternative medicine appear in the PubMed database, but there are only a few articles describing the complications of such care. Two patients suffering from complications of alternative medicine were treated in our hospital: one patient developed necrotizing fasciitis after acupuncture, and the second developed an epidural hematoma after chiropractic manipulation. These complications serve as a clarion call to the Israeli Health Ministry, as well as to health ministries around the world, to include complementary medicine under its inspection and legislative authority. PMID:25120919
Whedon, James M; Glassey, Donald
We hypothesize that stasis of the cerebrospinal fluid (CSF) occurs commonly and is detrimental to health. Physiologic factors affecting the normal circulation of CSF include cardiovascular, respiratory, and vasomotor influences. The CSF maintains the electrolytic environment of the central nervous system (CNS), influences systemic acid-base balance, serves as a medium for the supply of nutrients to neuronal and glial cells, functions as a lymphatic system for the CNS by removing the waste products of cellular metabolism, and transports hormones, neurotransmitters, releasing factors, and other neuropeptides throughout the CNS. Physiologic impedance or cessation of CSF flow may occur commonly in the absence of degenerative changes or pathology and may compromise the normal physiologic functions of the CSF. CSF appears to be particularly prone to stasis within the spinal canal. CSF stasis may be associated with adverse mechanical cord tension, vertebral subluxation syndrome, reduced cranial rhythmic impulse, and restricted respiratory function. Increased sympathetic tone, facilitated spinal segments, dural tension, and decreased CSF flow have been described as closely related aspects of an overall pattern of structural and energetic dysfunction in the axial skeleton and CNS. Therapies directed at affecting CSF flow include osteopathic care (especially cranial manipulation), craniosacral therapy, chiropractic adjustment of the spine and cranium, Network Care (formerly Network Chiropractic), massage therapy (including lymphatic drainage techniques), yoga, therapeutic breath-work, and cerebrospinal fluid technique. Further investigation into the nature and causation of CSF stasis, its potential effects upon human health, and effective therapies for its correction is warranted. PMID:19472865
Cuthbert, Scott; Rosner, Anthony
Objective The purpose of this case report is to describe the chiropractic care of a 10-year-old boy who presented with developmental delay syndromes, asthma, and chronic neck and head pain and to present an overview of his muscular imbalances during manual muscle testing evaluation that guided the interventions offered to this child. Clinical Features The child was a poor reader, suffered eye strain while reading, had poor memory for classroom material, and was unable to move easily from one line of text to another during reading. He was using 4 medications for the asthma but was still symptomatic during exercise. Intervention and Outcome Chiropractic care, using applied kinesiology, guided evaluation, and treatment. Following spinal and cranial treatment, the patient showed improvement in his reading ability, head and neck pain, and respiratory distress. His ability to read improved (in 3 weeks, after 5 treatments), performing at his own grade level. He has remained symptom free for 2 years. Conclusion The care provided to this patient seemed to help resolve his chronic musculoskeletal dysfunction and pain and improve his academic performance. PMID:22027037
Brown, Douglas M
The Canadian Memorial Chiropractic College (CMCC) or it’s agents, have been seeking some form of university affiliation for at least 30 years, yet to date those efforts have been fruitless. It has been said that one’s success is not measured by the position you have attained - but by the obstacles you have had to overcome to get there. CMCC has run into many stumbling blocks on the road to amalgamation. This triad of papers, Part 1 (JCCA 1992; 36(1):33-37) and Part III to follow at a later date, will endeavour to describe and document those barriers and the resourceful attempts that have been marshalled to surmount them. Part I, 1945 to 1969, concentrates on the first recorded proposals, emanating from the Western Divisions of the Canadian Chiropractic Association (CCA). Part II, 1969 to 1988, will outline the scattergun method that was used to approach numerous institutions, primarily in Ontario. Part III, 1988 to 1991, will focus on an account of the push for union with the University of Victoria, in British Columbia (U Vic).
Clarke, David B; Doel, Marcus A; Segrott, Jeremy
In conjunction with its growing popularity, complementary and alternative medicine (CAM) in the United Kingdom has witnessed increasing professionalization, partly prompted by the landmark Parliamentary Inquiry that reported in November 2000. Professionalization has become a significant strategy for practitioner associations and a key focus for the government, media, and patient groups. It is being driven by concern over the interests of patients and consumers, and in relation to the possible integration of certain forms of CAM into publicly funded healthcare. It is, moreover, being reconfigured in explicitly national terms. This paper draws on research into practitioner associations representing nine CAM modalities in the UK-aromatherapy, Chinese herbal medicine, chiropractic, crystal healing, feng shui, 'lay' homeopathy, medical homeopathy, osteopathy, and Radionics-, examining the recent wave of professionalization in relation to Foucault's concern with 'techniques of the self.' It highlights the contrasting experience of an association of Chinese herbalists seeking statutory self-regulation (SSR) and an association of chiropractors that was instrumental in securing SSR for chiropractic. PMID:15491893
Nelson, M V; Bailie, G R; Areny, H
A survey was sent to 1,000 United States (U.S.) pharmacists (19.7% responded) and 750 British pharmacists (63.0% responded) to assess their perceived knowledge, perceived usefulness, referrals, and utilization of alternative health approaches (AHA). More than 50% of U.S. and British citizens had 'never heard of' or 'only heard of' about half of the 21 AHA assessed. Acupuncture was the AHA felt to be most useful by the majority of pharmacists, both in the U.S. (83.8%) and in Britain (91.0%). Osteopathy (38.6%) and chiropractic (33.5%) were most often referrals by U.S. pharmacists, whereas homeopathy (14.7%) and osteopathy (14.5%) were most often referrals by British pharmacists. The most utilized AHAs were osteopathy (21.8%) and chiropractic (19.3%) by U.S. pharmacists and homeopathy (10.1%) and herbal medicine (6.0%) by British pharmacists. Differences exist in the perceived knowledge, perception of usefulness, referrals, and utilization of AHAs between U.S. and British pharmacists. It is quite likely that the low-response rates, particularly among the U.S. pharmacists, may mask even greater ignorance about AHAs. It may also underestimate the proportion of pharmacists who are of the view that AHAs are useless and not worthy of answering questions about. PMID:2341492
Whedon, James M.; Glassey, Donald
We hypothesize that stasis of the cerebrospinal fluid (CSF) occurs commonly and is detrimental to health. Physiologic factors affecting the normal circulation of CSF include cardiovascular, respiratory, and vasomotor influences. The CSF maintains the electrolytic environment of the central nervous system (CNS), influences systemic acid-base balance, serves as a medium for the supply of nutrients to neuronal and glial cells, functions as a lymphatic system for the CNS by removing the waste products of cellular metabolism, and transports hormones, neurotransmitters, releasing factors, and other neuropeptides throughout the CNS. Physiologic impedance or cessation of CSF flow may occur commonly in the absence of degenerative changes or pathology and may compromise the normal physiologic functions of the CSF. CSF appears to be particularly prone to stasis within the spinal canal. CSF stasis may be associated with adverse mechanical cord tension, vertebral subluxation syndrome, reduced cranial rhythmic impulse, and restricted respiratory function. Increased sympathetic tone, facilitated spinal segments, dural tension, and decreased CSF flow have been described as closely related aspects of an overall pattern of structural and energetic dysfunction in the axial skeleton and CNS. Therapies directed at affecting CSF flow include osteopathic care (especially cranial manipulation), craniosacral therapy, chiropractic adjustment of the spine and cranium, Network Care (formerly Network Chiropractic), massage therapy (including lymphatic drainage techniques), yoga, therapeutic breathwork, and cerebrospinal fluid technique. Further investigation into the nature and causation of CSF stasis, its potential effects upon human health, and effective therapies for its correction is warranted. PMID:19472865
Chaibi, Aleksander; Šaltyt? Benth, J?rat?; Bjørn Russell, Michael
At present, no consensus exists among clinical and academic experts regarding an appropriate placebo for randomized controlled trials (RCTs) of spinal manipulative therapy (SMT). Therefore, we investigated whether it was possible to conduct a chiropractic manual-therapy RCT with placebo. Seventy migraineurs were randomized to a single-blinded placebo-controlled clinical trial that consisted of 12 treatment sessions over 3 months. The participants were randomized to chiropractic SMT or placebo (sham manipulation). After each session, the participants were surveyed on whether they thought they had undergone active treatment ("yes" or "no") and how strongly they believed that active treatment was received (numeric rating scale 0-10). The outcome measures included the rate of successful blinding and the certitude of the participants' beliefs in both treatment groups. At each treatment session, more than 80% of the participants believed that they had undergone active treatment, regardless of group allocation. The odds ratio for believing that active treatment was received was >10 for all treatment sessions in both groups (all p?0.001). The blinding was maintained throughout the RCT. Our results strongly demonstrate that it is possible to conduct a single-blinded manual-therapy RCT with placebo and to maintain the blinding throughout 12 treatment sessions given over 3 months. PMID:26145718
Chaibi, Aleksander; Šaltyt? Benth, J?rat?; Bjørn Russell, Michael
At present, no consensus exists among clinical and academic experts regarding an appropriate placebo for randomized controlled trials (RCTs) of spinal manipulative therapy (SMT). Therefore, we investigated whether it was possible to conduct a chiropractic manual-therapy RCT with placebo. Seventy migraineurs were randomized to a single-blinded placebo-controlled clinical trial that consisted of 12 treatment sessions over 3 months. The participants were randomized to chiropractic SMT or placebo (sham manipulation). After each session, the participants were surveyed on whether they thought they had undergone active treatment (“yes” or “no”) and how strongly they believed that active treatment was received (numeric rating scale 0–10). The outcome measures included the rate of successful blinding and the certitude of the participants’ beliefs in both treatment groups. At each treatment session, more than 80% of the participants believed that they had undergone active treatment, regardless of group allocation. The odds ratio for believing that active treatment was received was >10 for all treatment sessions in both groups (all p?0.001). The blinding was maintained throughout the RCT. Our results strongly demonstrate that it is possible to conduct a single-blinded manual-therapy RCT with placebo and to maintain the blinding throughout 12 treatment sessions given over 3 months. PMID:26145718
Aggarwal, Anoop; Kumar, Suraj; Kumar, Ratnesh
Background. Hallux rigidus is a chronic, disabling condition of foot characterized by reduced great toe extension. The manual therapy approaches are described theoretically however their practical published evidence has not been analyzed well. Objective. Aim of the present paper was to systematically review the literature available for therapeutic management of the hallux rigidus by identifying and evaluating the randomized controlled trials (RCTs) and non-RCTs. Methods. To view the hallux rigidus and its rehabilitation, a webbased published literature search of Pubmed, Ovid Medline, Science direct, Cochrane Database, PEDro database, CINAHL was conducted for last 35 years in August 2010 using 4 specific keywords “hallux rigidus, physical therapy, chiropractic, and manual therapy” typed in exactly same manner in the search column of the databases. Result. the review finds that there is acute need of the quality studies and RCTs for the manual therapy, chiropractic, or physiotherapeutic management of the hallux rigidus. Conclusion. Review conclude that conservative programs for hallux rigidus consists of comprehensive intervention program that includes great toe mobilization, toe flexor strengthening, sesamoid bones mobilization and long MTP joint. The clinician should put an emphasis on the mobilization program with proper follow up along with comparative studies for rehabilitation of hallux rigidus. PMID:22991669
A review of the literature was conducted to find relevant publications on the validity, reliability and utilization of the tuning fork test in detection of stress and simple fractures. Medline 1966-1998, Cumulative Index to Nursing and Allied Health Literature (CINAHL) 1982-1997, Science Citation Index 1961-1997, Index to chiropractic literature 1980-1998 and Chiropractic Research Archives Collection 1984-1990 data bases were searched. Key words such as tuning fork, vibration, diapason, fracture, stress fracture were used. The literature regarding the utilization of the tuning fork test in detection of fractures is very scarce. There was no study found in the above data bases on the validity and or reliability of the tuning fork test in detection of simple acute fractures. This review of the literature indicates the necessity of such a study since the tuning fork test has been used on the field for diagnosis of simple acute fractures. Imagesp124-ap124-bp124-cp124-dp124-e
Gala, Thaddeus R.; Seaman, David R.
Objective This purpose of this case study is to describe a natural method to help in management of obstructive sleep apnea syndrome (OSAS), which is known to be a common and debilitating condition. Clinical Features Obstructive sleep apnea syndrome is typically managed with a continuous positive airway pressure (CPAP) device, which the patient wears during sleep to help maintain respiration. This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years. Intervention and Outcome After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later. Conclusion Dietary modifications may be an effective tool to improve the management of OSAS. PMID:22014867
Vining, Robert; Potocki, Eric; Seidman, Michael; Morgenthal, A. Paige
Introduction: While clinicians generally accept that musculoskeletal low back pain (LBP) can arise from specific tissues, it remains difficult to confirm specific sources. Methods: Based on evidence supported by diagnostic utility studies, doctors of chiropractic functioning as members of a research clinic created a diagnostic classification system, corresponding exam and checklist based on strength of evidence, and in-office efficiency. Results: The diagnostic classification system contains one screening category, two pain categories: Nociceptive, Neuropathic, one functional evaluation category, and one category for unknown or poorly defined diagnoses. Nociceptive and neuropathic pain categories are each divided into 4 subcategories. Conclusion: This article describes and discusses the strength of evidence surrounding diagnostic categories for an in-office, clinical exam and checklist tool for LBP diagnosis. The use of a standardized tool for diagnosing low back pain in clinical and research settings is encouraged. PMID:23997245
Lehman, James J.; Jegtvig, Shereen K.
Abstract Objective To discuss attachment disorders; most specifically, Reactive Attachment Disorder, its etiology, background causes, symptoms, and its prevention with the intervention of allopathic, chiropractic, naturopathic, and osteopathic physicians. Methods An online search and review of the literature regarding Reactive Attachment Disorder was performed through Pubmed and Google. The articles, interview information, and books utilized for this paper were selected by historical significance, date of publication, pertinent information, and, most specifically, those sources of pertinent data regarding Reactive Attachment Disorder. Discussion Reactive Attachment Disorder is a mental health disease with neurological implications, which may be caused by abuse during the first five years of life. Recognition of this disease, its background causes, and knowledge of effective parenting guidelines, are reasonable expectations for all physicians and mental health care providers. Conclusion A collaborative effort by all physicians to prevent Reactive Attachment Disorder through the implementation of effective parenting might reduce the incidence of this mental health disease in children and adults. PMID:19674627
Brown, Douglas M
The period between 1988 and 1992 is reviewed with respect to the Canadian Memorial Chiropractic College (CMCC) and its attempted affiliation with the University of Victoria in British Columbia. Part I, published earlier, detailed the period between 1945 and 1969 and the proposals for university affiliation with the University of Alberta and Brandon College in Manitoba. Part II focused on the period between 1969 and 1988 and discussed government inquiries, strategic planning and political intervention. In Part III of this triad, the chronology of events with respect to CMCC’s sustained, sophisticated and focused attempt at affiliation with the University of Victoria is discussed and the problems encountered with the Senate are described which lead to the eventual breakdown of any potential union.
Convictions about established medical safety and the danger of alternative remedies and practitioners are discussed in this article. While most alternative medicines continue to be denounced as unscientific and unsafe, government reviews have concluded that chiropractic and osteopathy and (more recently) acupuncture should be registered occupations and that qualifying courses of tertiary education should be instituted in Australia. This paradoxical result follows the widespread adoption of acupuncture and spinal manipulation by established practitioners of medicine and physiotherapy. The practices become intrinsically dangerous as their efficacy is accepted. Consequently, the argument is that only established practitioners are safe enough to use them. But alternative groups can use the established announcement of danger to represent the desirability of official action to protect the public. The article concludes with a review of the idea that therapies become dangerous as they are introduced. PMID:8184313
Landesberg, Warren H.
Objective The purpose of this case report is to describe a female athlete with back and right scapular pain due to pulmonary embolism. Clinical Features A 20-year-old female collegiate cross-country runner presented to a chiropractic clinic with pain in the right scapular area that was severe, stabbing, and worsened with respiration. She had a cough and experienced difficulty lying on her right side. She had an elevated d-dimer. Chest radiograph demonstrated pleural effusion, prompting a thoracic computed tomographic angiogram that showed a large right lower lobe embolus and pulmonary infarct. Intervention and Outcome The patient was hospitalized, prescribed anticoagulant therapy, and monitored for 6 months. She was able to return to competitive running 8 months later. Conclusion This case raises awareness of the occurrence of birth control medication for the purpose of enhanced performance in female athletes and the associated risks of using this medication for enhanced performance. PMID:23449383
Stainsby, Brynne; Howitt, Scott; Porr, Jason
Objective: To detail the presentation of three health care workers diagnosed with sudden acute respiratory syndrome (SARS) who later presented to a CMCC teaching clinic with neuromusculoskeletal sequelae and underwent conservative treatments. This case series aims to inform practitioners of the potential pathogenesis of these neuromuscular complaints and describes their treatment in a chiropractic practice. Clinical Features: Three patients presented with a variety of neurological, muscular and joint findings. Conservative treatment was aimed at decreasing hypertonic muscles, increasing joint mobility, and improving ability to perform activities of daily living. Intervention and Outcome: The conservative treatment approach utilized in these cases involved spinal manipulative therapy, soft tissue therapy, modalities, and rehabilitation. Outcome measures included subjective pain ratings, disability indices, and return to work. Conclusion: Three patients previously diagnosed with SARS presented with neuromusculoskeletal complaints and subjectively experienced intermittent relief of pain and improvement in disability status after conservative treatments. PMID:21403780
The chiropractic profession has struggled with how it is viewed and perceived by those within the profession and the powerful forces outside the profession. This commentary suggests that the vast majority of professional unrest is largely due to lines drawn upon philosophical boundaries and how we perceive what we know. For the profession to advance, it is imperative that unsubstantiated claims are eliminated from our justification for being and that we continue to test theories using scientific methods. Theories espoused must be able to be supported by valid research, and we must be ready to accept the results of these investigations and either build upon that body of research or accept the findings and move in alternative directions that science will take us. In doing so, we will contribute to the philosophy of health and perhaps help to change the health care paradigm from disease focused to wellness, which is based upon evidence and not emotion. PMID:23966888
Sun-Edelstein, Christina; Mauskop, Alexander
There is a growing body of evidence supporting the efficacy of various complementary and alternative medicine approaches in the management of headache disorders. These treatment modalities include nutraceutical, physical and behavioral therapies. Nutraceutical options comprise vitamins and supplements (magnesium, riboflavin, coenzyme Q(10), and alpha lipoic acid) and herbal preparations (feverfew, and butterbur). Although controversial, there are some reports demonstrating the benefit of recreational drugs such as marijuana, lysergic acid diethylamide and psilocybin in headache treatment. Behavioral treatments generally refer to cognitive behavioral therapy and biobehavioral training (biofeedback, relaxation training). Physical treatments in headache management are not as well defined but usually include acupuncture, oxygen therapy, transcutaneous electrical nerve stimulation, occlusal adjustment, cervical manipulation, physical therapy, massage, chiropractic therapy, and osteopathic manipulation. In this review, the available evidence for all these treatments will be discussed. PMID:21352222
Wyatt, Lawrence H; Ferrance, Randy J
Diabetes mellitus (DM) is a multi-system disease characterized by persistent hyperglycemia that has both acute and chronic biochemical and anatomical sequelae, with Type-2 DM representing the most common form of the disease. Neuromusculoskeletal sequelae of DM are common and the practicing chiropractor should be alert to these conditions, as some are manageable in a chiropractic office, while others are life and/or limb threatening. This paper reviews the effects of DM on the musculoskeletal system so as assist the chiropractor in making appropriate clinical decisions regarding therapy, understanding contraindications to therapy, referring patients to medical physicians when appropriate and understanding the impact that DM may have on the prognosis for their patients suffering from the myriad musculoskeletal conditions associated with this disease. PMID:17549168
Newell, D; Field, J; Pollard, D
It is likely that individuals with nonspecific LBP (nsLBP) constitute a heterogenic group and targeting treatment appropriately to those most likely to respond is of major relevance. The STarT Back Tool (SBT) has been developed to stratify patients into risk groups to aid management choices. However, there is controversy over its generalisability and uncertainty as to the timing of use. This study investigated whether SBT categorisation early in a course of treatment would prove more prognostic than categorising patients at baseline. Seven hundred and forty nine patients over the age of 16 were recruited at 11 chiropractic clinics within the UK. The SBT was used to categorise these patients at presentation and 2 days following initial treatment with patient characteristics and condition specific markers also collected at baseline. The primary outcome was the Patient Global Impression of Change (PGIC) collected at 14, 30 and 90 days following the initial visit. In this population undergoing chiropractic care, patients had similar outcomes irrespective of their STarT back risk ranking. Multivariate prognostic models included only the post initial visit SBT as an independent predictor of favourable outcome for the medium risk group but only at 30 days. Follow up improvement was dominated by previous improvement in 30 and 90-day models. Over one third of patients swapped SBT risk groups in the 2 day period between initial stratification and post initial visit although there was little difference in eventual improvement at follow-up. Understanding the impact of timing of SBT stratification is indicated. PMID:25175750
Fleming, Sara; Rabago, David P; Mundt, Marlon P; Fleming, Michael F
Background Complementary and alternative medicine (CAM) is an increasingly common therapy used to treat chronic pain syndromes. However; there is limited information on the utilization and efficacy of CAM therapy in primary care patients receiving long-term opioid therapy. Method A survey of CAM therapy was conducted with a systematic sample of 908 primary care patients receiving opioids as a primary treatment method for chronic pain. Subjects completed a questionnaire designed to assess utilization, efficacy and costs of CAM therapies in this population. Results Patients were treated for a variety of pain problems including low back pain (38.4%), headaches (9.9%), and knee pain (6.5%); the average duration of pain was 16 years. The median morphine equivalent opioid dose was 41 mg/day, and the mean dose was 92 mg/day. Forty-four percent of the sample reported CAM therapy use in the past 12 months. Therapies utilized included massage therapy (27.3%, n = 248), chiropractic treatment (17.8%, n = 162), acupuncture (7.6%, n = 69), yoga (6.1%, n = 55), herbs and supplements (6.8%, n = 62), and prolotherapy (5.9%, n = 54). CAM utilization was significantly related to age female gender, pain severity income pain diagnosis of neck and upper back pain, and illicit drug use. Medical insurance covered chiropractic treatment (81.8%) and prolotherapy (87.7%), whereas patients primarily paid for other CAM therapies. Over half the sample reported that one or more of the CAM therapies were helpful. Conclusion This study suggests CAM therapy is widely used by patients receiving opioids for chronic pain. Whether opioids can be reduced by introducing such therapies remains to be studied. PMID:17506893
Lafferty, William E.; Tyree, Patrick T.; Bellas, Allen S.; Watts, Carolyn A.; Lind, Bonnie K.; Sherman, Karen J.; Cherkin, Daniel C.; Grembowski, David E.
Objective Since 1996, Washington State law has required private health insurance to cover licensed CAM providers. This study evaluated how insured people used CAM providers and what role this played in health care utilization and expenditures. Study Design Cross sectional analysis of calendar year 2002 insurance enrollees from Western Washington State. Methods Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and health care expenditures for three large health insurance companies. Results Among over 600,000 enrollees, 13.7% made CAM claims. This included 1.6% of enrollees with claims for naturopathy, 1.3% acupuncture, 2.4% massage and 10.9% chiropractic. Patients enrolled in Preferred Provider Organizations and Point of Service products were significantly more likely to use CAM than those with Health Maintenance Organization coverage. CAM use was greater in women and people between 31 and 50 years of age. Chiropractic was more frequent in less populous counties. CAM provider visits usually focused on musculoskeletal complaints, except for naturopathic physicians who treated a broader array of problems. Median per visit expenditures for CAM care were $39.00 compared to $74.40 for conventional outpatient care. Total expenditures per enrollee were $2,589 of which $75 (2.9%) was spent on CAM. Conclusions The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest. Because the long term trajectory of CAM cost under third party payment is unknown, utilization of these services should be followed. PMID:16834526
Dye, Claire E.; Chyu, Laura; Gold, Ellen B.; Greendale, Gail A.
Abstract Objective This study investigated the demographic, behavioral, and health correlates of the most frequently used types of complementary and alternative medicine (CAM) therapy and the use of prayer for health among midlife women. We also examined the extent to which women used CAM for treatment of health conditions, including menopausal symptoms, and for general health and well-being. Methods Data from the 2002 National Health Interview Survey (NHIS), a cross-sectional, household survey representative of the U.S. civilian adult population, were used. Midlife women aged 40–59 years (n?=?5849) were analyzed. Bivariate prevalence estimates were obtained, and binomial logistic regression models were estimated; all analyses were weighted. Results Overall, 46% of midlife women used any type of CAM in the past 12 months, and 54% reported using prayer for health reasons. The top five specific CAM therapies used were herbs and natural products; relaxation techniques; chiropractic care; yoga, tai chi, or qi gong; and massage. Multivariate results demonstrated different patterns of association between demographic, health, and behavioral characteristics and specific CAM therapies. A higher percentage of women used chiropractic care for an existing health condition than those using relaxation techniques, and few women used CAM specifically for menopausal symptoms. Conclusions CAM and prayer are frequently used by midlife women, and herbs and natural supplements are the mostly frequently used. The findings underscore the importance, particularly in the clinical setting, of asking women about their use of individual CAM therapies. Such clinical assessment is also important because of the potential for interactions of CAM therapies with prescribed therapies. PMID:20088655
Costa, Soraya M.V.; Chibana, Yumi E.T.; Giavarotti, Leandro; Compagnoni, Débora S.; Shiono, Adriana H.; Satie, Janice; Bracher, Eduardo S.B.
Abstract Objective There has been a steady growth of chiropractic treatment using spinal manipulative therapy (SMT) that aims to increase the performance of athletes in various sports. This study evaluates the effect of SMT by chiropractors on the performance of golf players. Methods Golfers of 2 golf clubs in São Paulo, Brazil, participated in this study. They were randomized to 1 of 2 groups: Group I received a stretch program, and group II received a stretch program in addition to SMT. Participants in both groups performed the same standardized stretching program. Spinal manipulative therapy to dysfunctional spinal segments was performed on group II only. All golfers performed 3 full-swing maneuvers. Ball range was considered as the average distance for the 3 shots. Treatment was performed after the initial measurement, and the same maneuvers were performed afterward. Each participant repeated these procedures for a 4-week period. Student t test, Mann-Whitney nonparametric test, and 1-way analysis of variance for repeated measures with significance level of 5% were used to analyze the study. Results Forty-three golfers completed the protocol. Twenty participants were allocated to group I and 23 to group II. Average age, handicap, and initial swing were comparable. No improvement of full-swing performance was observed during the 4 sessions on group I (stretch only). An improvement was observed at the fourth session of group II (P = .005); when comparing the posttreatment, group II had statistical significance at all phases (P = .003). Conclusions Chiropractic SMT in association with muscle stretching may be associated with an improvement of full-swing performance when compared with muscle stretching alone. PMID:19948307
Saxe, Gordon A.; Madlensky, Lisa; Kealey, Sheila; Wu, David P.; Freeman, Karen L.; Pierce, John P.
Background Physician awareness of their patients’ use of complementary and alternative medicine (CAM) is crucial, particularly in the setting of a potentially life-threatening disease such as cancer. The potential for harmful treatment interactions may be greatest when a patient sees a CAM practitioner – perceived as a physician-like authority figure – but does not disclose this to their physician. We therefore investigated the extent of nondisclosure in a large cohort of cancer patients. Methods We investigated CAM use in participants of the UCSD Women’s Healthy Eating and Living (WHEL) Study, a multicenter study of the effect of diet and lifestyle on disease-free and overall survival in women ages 18–70 who had completed treatment for invasive breast cancer between 1995 and 2000. Data regarding CAM use and disclosure was collected via a telephone-administered questionnaire in 2003–2004. This questionnaire asked about different CAM modalities including those requiring a “skilled CAM practitioner” (acupuncturist, chiropractor, homeopath, or naturopath) for administration. Demographic data was obtained at the WHEL baseline clinic interview. Modality-specific disclosure rates were determined and a comparison of demographic variables of disclosers versus nondisclosers was conducted using Chi-squared tests for categorical variables, and t-tests for continuous variables. Results Of 3088 total WHEL participants, 2527 completed the CAM questionnaire. Of these, 2017 reported using some form of CAM. Of these, 300 received treatment from an acupuncturist, chiropractor, homeopath, or naturopath and also provided information on whether or not they disclosed this care to their conventional physician. The highest disclosure rate was for naturopathy (85%), followed by homeopathy (74%), acupuncture (71%), and chiropractic (47%). Among demographic characteristics, only education (p = 0.047) and study site (p=0.039) were associated with disclosure. College graduates and postgraduates, in particular, were more likely to disclose CAM use to their physicians than those with lesser education. Conclusion Overall, we observed moderately high rates of physician disclosure of CAM use for all modalities except chiropractic. Education and study site associations suggest that disclosure may be greater when CAM use is more prevalent and possibly more socially accepted. These findings underscore the importance of open, destigmatized patient-physician communication regarding CAM use. PMID:18956493
Bourke-Taylor, Helen; Cotter, Claire; Stephan, Rebecca
ABSTRACT Families raising a young child with multiple disabilities are charged with significant responsibilities such as learning about their child's condition and navigating mainstream and alternative services. Aim: Describe service choices, costs, out of pocket expenses, and the impact on families. Methods: Survey design using a custom questionnaire was used to collect extensive retrospective and current data. Purposive sampling (N = 29) occurred from one early intervention facility specialized in servicing children with cerebral palsy (CP) and, or multiple disabilities in Australia. Descriptive statistics were used for analysis of data. Results: Twenty-three (79%) families reported caring for a child with CP. Twenty-three families reported using at least one complementary/alternative intervention. Out-of-pocket amounts were reported including: chiropractic services (10 families); naturopathy (9 families); point percussion therapy (7 families), and Chinese medicine (6 families). Expenses resulted in families reporting forgoing clothing items, family entertainment, recreation/hobbies for parents (55%); family holidays (59%); time for parents alone (66%); and health services for parents (38%). Conclusions: Families of young children with multiple disabilities select a wide range of services for their child, with consequential out of pocket expenses. Early intervention professionals can be an important resource for families as they evaluate their choices and select interventions for their child. PMID:25365470
Conable, Katharine M.
Objective The purpose of this study is to investigate the difference in results (strong/facilitated vs weak/functionally inhibited) between short (1 second) and long (3 seconds) manual muscle tests (MMTs) on the same subject and to pilot the use of thin-film force transducers for characterizing the parameters of MMT and for measuring maximum voluntary isometric contraction (MVIC). Method Forty-four healthy chiropractic students were tested. A thin-film force transducer recorded force over time during MVIC of the middle deltoid and 1- and 3-second MMTs of the same subjects. The MMTs were graded as strong (able to resist the testing pressure) or weak (unable to resist testing pressure, breaking away). Results Forty-two short tests were strong, and 2 were weak. Thirty-nine long tests were strong, and 5 were weak. ? (0.54) showed fair agreement for results between short and long tests. Peak force in both short and long weak tests was higher than that in strong tests when expressed as a proportion of maximum contraction. All manual tests used less force than MVICs. Conclusions This study demonstrated that a study of this nature is feasible. Longer test durations demonstrate some muscle weaknesses that are not evident on 1-second MMTs. Thin-film transducers show promise for recording MMT parameters for research purposes. PMID:21572637
Marcotte, Justin; Normand, Martin C
Scientific literature on the dynamic palpation test in chiropractic usually indicates that it is not very reliable and clinically insufficient. The frequent references to the unreliability of this test may be due to the lack of sufficient standardization in performing the test. The multiple nature of the test may be the cause: the test is actually a group of six tests peformed in six directions at each intervertebral level. The palpation pressure and the interpretive aspects of the examiner's tactile perception are other elements to be standardized. In addition, using students without a history of mechanical problems of the spine as subjects is not representative of the usual clinical clientele and could lead to a search for injuries that are too subtle. This pilot-study performed on typical patients, limits the test to the cervical region in only one direction of movement and also standardizes the other parameters of the test. This results in greater reliability between examiners than demonstrated until now. Statistical significance tables established for this type of testing have revealed reliability from moderate to very strong. In the final analysis, the author's observations clearly illustrate the significant effect of standardization of the test on results obtained outside the study.
Reckelhoff, Kenneth E.; Miller, Anthony
Objective The purpose of this case report is to describe a patient who experienced deep venous thrombosis (DVT) during pre-operative rehabilitation of an acute rupture of an anterior cruciate ligament (ACL) reconstruction graft, to increase awareness of DVT occurring in a healthy individual after periodic immobilization, and to describe the interdisciplinary management for this patient. Clinical features A 30-year-old male was referred to a chiropractic clinic for presurgical treatment of a left ACL rupture and medial meniscus tear confirmed at magnetic resonance imaging. During the course of preoperative rehabilitation, the patient became limited in ambulation and presented for a routine rehabilitation visit. During this visit, he experienced increased leg swelling, pain and tenderness. The patient was assessed for DVT and was referred to the local emergency department for further evaluation where multiple DVTs were found in the left popliteal, posterior tibial, and peroneal veins. Intervention/outcome The patient was treated with a 17-week course of warfarin during which time the clinical signs and symptoms of DVT resolved. Meanwhile, the patient completed the rehabilitation treatment plan in preparation for ACL reconstruction without further complications. Conclusions This case raises awareness that DVT may occur in a healthy individual after periodic immobilization. While there may be controversy regarding the appropriate application of pharmaceutical anticoagulants in patients with DVT of the leg, the most risk averse strategy is for a short duration prescription medication with compression stockings. Through interdisciplinary management, the patient experienced a successful outcome. PMID:25685121
Jacobson, Bert H; Boolani, Ali; Dunklee, Guy; Shepardson, Angela; Acharya, Hom
The purpose of this study was to assess sleep quality and comfort of participants diagnosed with low back pain and stiffness following sleep on individually prescribed mattresses based on dominant sleeping positions. Subjects consisted of 27 patients (females, n=14; males, n=13; age 44.8 yrs ± SD 14.6, weight 174 lb. ± SD 39.6, height 68.3 in. ± SD 3.7) referred by chiropractic physicians for the study. For the baseline (pretest) data subjects recorded back and shoulder discomfort, sleep quality and comfort by visual analog scales (VAS) for 21 days while sleeping in their own beds. Subsequently, participants' beds were replaced by medium-firm mattresses specifically layered with foam and latex based on the participants' reported prominent sleeping position and they again rated their sleep comfort and quality daily for the following 12 weeks. Analysis yielded significant differences between pre- and post means for all variables and for back pain, we found significant (p<0.01) differences between the first posttest mean and weeks 4 and weeks 8-12, thus indicating progressive improvement in both back pain and stiffness while sleeping on the new mattresses. Additionally, the number of days per week of experiencing poor sleep and physical discomfort decreased significantly. It was concluded that sleep surfaces are related to sleep discomfort and that is indeed possible to reduce pain and discomfort and to increase sleep quality in those with chronic back pain by replacing mattresses based on sleeping position. PMID:20579971
Bielory, Leonard; Russin, Jonathan; Zuckerman, Gary B
Complementary and Alternative Medicine (CAM) therapies such as herbal therapy, acupuncture, yoga, homeopathy, chiropractic medicine, and massage therapy, continue to gain popularity as modalities for the treatment of asthma. In the Chinese, Japanese, Korean, Indian, and Western cultures, herbal therapies appear to be commonly used for allergies. Although well-controlled scientific studies have not been performed on many of the Asian herbal therapies and some basic studies have been performed on various herbal components (active ingredients), more needs to be done to assess the composite effects of many herbal remedies. An important part of the assessment of CAM modalities is the therapeutic-toxicologic safety profile (risk-benefit ratio), and further research evaluating the clinical efficacy and mechanism of action of various CAM interventions for asthma is greatly needed. This paper focuses on clinical and laboratory research regarding various CAM therapies that have been used in the treatment of asthma. The references cited are confined to literature originally published or translated into English. PMID:15603200
Though there are myriad etiologies of CPP, common therapeutic targets include inflammation, somatic dysfunction, and psychological disturbances. Inflammation may be addressed not only with dietary changes including nutritional and botanical supplements but also with mind-body therapies. Somatic dysfunction may respond to manipulative therapies provided by osteopaths, naturopaths, chiropractors, and some physical therapists. Therapists may also offer visceral, craniosacral, myofascial, and other whole-body therapies, as can highly trained massage therapists and bodyworkers. Mental health care may be key in many cases. Integrative medicine heralds the return to a sense of the human being's intrinsic capacity for healing, incorporating the vitalism of many of the therapies' origins (traditional Chinese medicine, indigenous medicine, ayurveda, osteopathy, chiropractic, etc) with the gains made by a more reductionistic tradition. Given the complexity and wide variation of etiologies and symptoms of CPP, using an integrative approach may offer expanded therapeutic solutions. We must expand our capacity to listen to each patient-with ears, eyes, mind, heart, and hands. Each treatment plan may then be tailored to the unique history and perspective that lie within the individual. Doing so requires the essential elements of time, skill, and love. PMID:20085175
Background Meningiomas are the most common brain tumor in the adult population. This case report describes the epidemiology, the clinical presentation as well as the current treatment options for this condition. Case presentation A 49 year-old man attended a chiropractic clinic with non-specific chronic low back pain. Upon the history taking and the systems review, he reported a loss of both smell and taste for which investigations conducted by two different otolaryngologists did not yield a specific diagnosis. The patient was referred to a neurologist who ordered a computer tomography scan that eventually revealed a compression brain tumor. Brain tumors can produce a large variety of clinical presentations, such as upper motor neuron lesion symptoms, altered consciousness or vital functions which are easy to identify. However, subtle signs, such as those presented in this case, can be neglected. Conclusion Clinicians should be aware of uncommon clinical presentations including cranial nerve or neurological dysfunction and refer their patient to a specialist when detected. PMID:24490991
Krengel, Walter F; Kim, Paul H; Wiater, Brett
Study Design?Case report. Objective?We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods?This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results?The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion?When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing "spontaneous" ankylosis needs to be considered. PMID:26131392
Gudavalli, M. R.; Potluri, T.; Carandang, G.; Havey, R. M.; Voronov, L. I.; Cox, J. M.; Rowell, R. M.; Kruse, R. A.; Joachim, G. C.; Patwardhan, A. G.; Henderson, C. N. R.; Goertz, C.
The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction. PMID:24023587
Hebert, Jeffrey J; Fritz, Julie M
Clinical decision rules are an increasingly common presence in the biomedical literature and represent one strategy of enhancing clinical-decision making with the goal of improving the efficiency and effectiveness of healthcare delivery. In the context of rehabilitation research, clinical decision rules have been predominantly aimed at classifying patients by predicting their treatment response to specific therapies. Traditionally, recommendations for developing clinical decision rules propose a multistep process (derivation, validation, impact analysis) using defined methodology. Research efforts aimed at developing a "diagnosis-based clinical decision rule" have departed from this convention. Recent publications in this line of research have used the modified terminology "diagnosis-based clinical decision guide." Modifications to terminology and methodology surrounding clinical decision rules can make it more difficult for clinicians to recognize the level of evidence associated with a decision rule and understand how this evidence should be implemented to inform patient care. We provide a brief overview of clinical decision rule development in the context of the rehabilitation literature and two specific papers recently published in Chiropractic and Manual Therapies. PMID:22726639
Mansholt, Barbara A.; Vining, Robert D.; Long, Cynthia R.; Goertz, Christine M.
Introduction: A few spinal manipulation techniques use paraspinal surface thermography as an examination tool that informs clinical-decision making; however, inter-examiner reliability of this interpretation has not been reported. The purpose of this study was to report inter-examiner reliability for classifying cervical paraspinal thermographic findings. Methods: Seventeen doctors of chiropractic self-reporting a minimum of 2 years of experience using thermography classified thermographic scans into categories (full pattern, partial +, partial, partial ?, and adaptation). Kappa statistics (k) were calculated to determine inter-examiner reliability. Results: Overall inter-examiner reliability was fair (k=0.43). There was good agreement for identifying full pattern (k=0.73) and fair agreement for adaptation (k=0.55). Poor agreement was noted in partial categories (k=0.05–0.22). Conclusion: Inter-examiner reliability demonstrated fair to good agreement for identifying comparable (full pattern) and disparate (adaptation) thermographic findings; agreement was poor for those with moderate similarity (partial). Further research is needed to determine whether thermographic findings should be used in clinical decision-making for spinal manipulation.
Cohen, Michael H; Kemper, Kathi J
Increasing use of complementary and alternative medicine (CAM) therapies such as chiropractic, massage therapy, and herbal medicine, raises questions about the clinically appropriate use of CAM in pediatrics. Nonjudicious use of CAM therapies may cause either direct harm or, by creating an unwarranted financial and emotional burden, indirect harm. When advising patients concerning CAM therapies, pediatricians face 2 major legal risks: medical malpractice and professional discipline. Pediatricians can incorporate these considerations into advising and clinical decision-making about CAM therapies to address the best interest of the pediatric patient while helping to manage potential liability risk. This article provides a suggested framework, including asking the following questions: (1) Do parents elect to abandon effective care when the child's condition is serious or life-threatening? (2) Will use of the CAM therapy otherwise divert the child from imminently necessary conventional treatment? (3) Are the CAM therapies selected known to be unsafe and/or ineffective? (4) Have the proper parties consented to the use of the CAM therapy? (5) Is the risk-benefit ratio of the proposed CAM therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature? Such an approach ideally can help guide the pediatrician toward clinical conduct that is clinically responsible, ethically appropriate, and legally defensible. PMID:15741385
Objective The purpose of this study is to describe and discuss the treatment of a cervical disk herniation using a sequential multimodal conservative management approach. Clinical Features A 40-year-old man had complaints of headache and severe sharp neck pain radiating to his left shoulder down to his arm, forearm, and hand. Results of electromyography/nerve conduction studies were abnormal. Magnetic resonance imaging revealed a large disk protrusion at C5-C6 with indentation of the thecal sac and a spur at the posterior margin. Moderate left neural foraminal narrowing was present at C5-C6 with narrowed intervertebral disk space at C5-C6 and C6-C7. Intervention and Outcome High-velocity, low-amplitude chiropractic manipulation; electrotherapy; ice; and exercise were used for treatment. The Neck Disability Index was used as a primary and electromyography/nerve conduction studies as a secondary outcome measurement. Based on the Neck Disability Index, there was an overall 89.65% symptoms improvement from the baseline. Conclusions This case study demonstrated possible beneficial effects of the multimodal treatment approach in a patient with cervical radiculopathy. PMID:22027207
Stuber, Kent; Sajko, Sandy; Kristmanson, Kevyn
Background: Nutritional supplements are commonly used for a variety of musculoskeletal conditions, including knee and hip degenerative joint disease. Although these supplements are occasionally recommended for patients with degenerative disc disease and spinal degenerative joint disease, the evidence supporting this use is unknown. Objective: To systematically search and assess the quality of the literature on the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane for the treatment of spinal osteoarthritis / degenerative joint disease, and degenerative disc disease. Data Sources: The Index of Chiropractic Literature, AMED, Medline, and CINAHL were searched for randomized controlled trials in English from 1984 to July 2009. Data Extraction and Synthesis: Data from studies meeting the inclusion criteria was extracted and reviewed by three reviewers. The Jadad scale was used to assess study quality. No attempts were made at meta-analysis due to variation in study design. Results: Two articles met the inclusion criteria. One study was found to have good quality but reported negative results for the supplemented group compared with placebo, the other study had low quality but reported significant positive results for the supplemented group when compared with a no intervention control group. Conclusion: There was little literature found to support the use of common nutritional supplements for spinal degeneration, making it difficult to determine whether clinicians should recommend them. PMID:21403782
Carmo-Silva, A Elizabete; Salvucci, Michael E
Rubisco frequently undergoes unproductive interactions with its sugar-phosphate substrate that stabilize active sites in an inactive conformation. Restoring catalytic competence to these sites requires the "molecular chiropractic" activity of Rubisco activase (activase). To make the study of activase more routine and physiologically relevant, an assay was devised for measuring activase activity in leaf extracts based on the ATP-dependent activation of inactive Rubisco. Control experiments with an Arabidopsis activase-deficient mutant confirmed that the rate of Rubisco activation was dependent on the concentration of activase in the extracts. Activase catalyzed Rubisco activation at rates equivalent to 9-14% catalytic sites per min in desalted extracts of Arabidopsis, camelina, tobacco, cotton, and wheat. Faster rates were observed in a transgenic line of Arabidopsis that expresses only the ?-isoform of activase, whereas no activity was detected in a line that expresses only the ?-isoform. Activase activity was also low or undetectable in rice, maize, and Chlamydomonas, revealing differences in the stability of the enzyme in different species. These differences are discussed in terms of the ability of activase subunits to remain associated or to reassociate into active oligomers when the stromal milieu is diluted by extraction. Finally, the temperature response of activase activity in leaf extracts differed for Arabidopsis, camelina, tobacco, and cotton, corresponding to the respective temperature responses of photosynthesis for each species. These results confirmed the exceptional thermal lability of activase at physiological ratios of activase to Rubisco. PMID:21728079
Cuellar, Norma; Aycock, Teresa; Cahill, Bridgett; Ford, Julie
Background The use of CAM is at an all time high. There is very little research that compares the use of CAM in elders by ethnicity in rural settings. The purpose of the study was to determine if there was a difference between African American and Caucasian American rural elders on use of CAM and self-reported satisfaction with CAM. Methods The design was a descriptive, comparative study of 183 elders who reported the number of CAM used and satisfaction with CAM. A convenience sample was recruited through community service organizations in the state of Mississippi. The availability of elders through the support groups, sampling bias, subject effect, and self-report were limitations of the study. Results The commonest examples of CAM used by rural elders were prayer, vitamins, exercise, meditation, herbs, chiropractic medicine, glucosamine, and music therapy. Significant findings on SES and marital status were calculated. Differences on ethnicity and demographic variables were significant for age, education, and the use of glucosamine. Conclusions Health care providers must be aware that elders are using CAM and are satisfied with their use. Identifying different uses of CAM by ethnicity is important for health care practitioners, impacting how health care is provided. PMID:14622445
Stamboulis, Elefterios; Raptis, Georgios; Andrikopoulou, Athina; Arvaniti, Chrisa; Brountzos, Elias; Oikonomopoulos, Nikos; Stefanis, Leonidas; Voumvourakis, Konstantinos
Postpartum spontaneous cervicocephalic artery dissection is an uncommon, poorly understood condition following pregnancy. We report a case of a 32-year-old woman with no history of trauma, chiropractic manipulation, connective tissue disorder, or previous headache who developed a mild, unilateral headache 7 days after the uneventful delivery of her third child (no general or neuraxial anesthesia was delivered). Seven days latter she presented to our emergency department complaining of recurrent episodes of right-sided headache coupled with a transient episode of sensory deficits in her left lower limb. Brain magnetic resonance imaging disclosed small infarctions in the internal watershed distribution of right internal carotid artery (ICA). Carotid artery dissection was diagnosed using DSA and T1 FAT-SAT sequences for the depiction of intramural hematoma. The patient was placed under oral anticoagulation and remained asymptomatic during a follow-up period of 6 months. The present case report highlights that cervicocephalic artery dissection is a condition that should be looked for in women with persisting or remitting unilateral headache following childbirth. PMID:19453826
Tepe, Rodger; Tepe, Chabha
Objective To develop and psychometrically evaluate an information literacy (IL) self-efficacy survey and an IL knowledge test. Methods In this test–retest reliability study, a 25-item IL self-efficacy survey and a 50-item IL knowledge test were developed and administered to a convenience sample of 53 chiropractic students. Item analyses were performed on all questions. Results The IL self-efficacy survey demonstrated good reliability (test–retest correlation = 0.81) and good/very good internal consistency (mean ? = .56 and Cronbach's ? = .92). A total of 25 questions with the best item analysis characteristics were chosen from the 50-item IL knowledge test, resulting in a 25-item IL knowledge test that demonstrated good reliability (test–retest correlation = 0.87), very good internal consistency (mean ? = .69, KR20 = 0.85), and good item discrimination (mean point-biserial = 0.48). Conclusions This study resulted in the development of three instruments: a 25-item IL self-efficacy survey, a 50-item IL knowledge test, and a 25-item IL knowledge test. The information literacy self-efficacy survey and the 25-item version of the information literacy knowledge test have shown preliminary evidence of adequate reliability and validity to justify continuing study with these instruments. PMID:25517736
Krengel, Walter F.; Kim, Paul H.; Wiater, Brett
Study Design?Case report. Objective?We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods?This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results?The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1–C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion?When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing “spontaneous” ankylosis needs to be considered.
Kaeser, Martha A.; Scali, Frank; Lanzisera, Frank P.; Bub, Glenn A.; Kettner, Norman W.
Objective This case report describes a rare presentation of multiple sclerosis (MS) that was initially diagnosed as a peripheral nerve lesion in the emergency department. Clinical Features A 30-year-old woman presented to a chiropractic teaching clinic with a complaint of a sudden right foot drop. Magnetic resonance imaging of the brain revealed a large mass in the left parietal lobe with additional white matter lesions. The mass and smaller lesions were consistent with a rare presentation of demyelinating disease, tumefactive MS. Intervention and Outcome The patient was referred to a neurologist for further evaluation and treatment. Her short-term clinical course was punctuated by recurrent myospasms and neurologic deficits. Conclusion Tumefactive MS may mimic the clinical and magnetic resonance imaging characteristics of glioma or a cerebral abscess. The clinical presentation, pathophysiology, differential diagnosis, role of diagnostic imaging, and treatment options of MS are described. This case report illustrates that the timely diagnosis and optimal treatment of MS require recognition of its varied, sometimes atypical, and often nonspecific clinical and imaging manifestations. PMID:22027206
Joachim, George C.
Objective The purpose of this case report is to describe combined treatment utilizing Cox distraction manipulation and guided rehabilitation for a patient with spine pain and post-surgical C6-7 fusion with spondylotic myelopathy and L5-S1 radiculopathy. Clinical features A 38-year-old man presented to a chiropractic clinic with neck pain and a history of an anterior cervical spine plate fusion at C6-7 after a work related accident 4 years earlier. He had signs and symptoms of spondolytic myelopathy and right lower back, right posterior thigh pain and numbness. Intervention and outcome The patient was treated with Cox technique and rehabilitation. The patient experienced a reduction of pain on a numeric pain scale from 8/10 to 3/10. The patient was seen a total of 12 visits over 3 months. No adverse effects were reported. Conclusions A patient with a prior C6-7 fusion with spondylotic myelopathy and concurrent L5-S1 radiculopathy improved after a course of rehabilitation and Cox distraction manipulation. Further research is needed to establish its efficiency. PMID:25685119
Amorin-Woods, Lyndon G.; Beck, Randy W.; Parkin-Smith, Gregory F.; Lougheed, James; Bremner, Alexandra P.
Aim: To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature. Methods: A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors. Results: The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%). Conclusions: This review showed that quality papers in this area of research are very limited. Notwithstanding, chiropractors appear to adhere to clinical practice guidelines more so than physiotherapists and medical practitioners, although there is scope for improvement across all three professions. PMID:25202150
Zhang, Niu; He, Xiaohua
Purpose: The purpose of this study was to investigate the effect of an innovative exhibitory eye model simulation in a physical examination laboratory format on explaining Listing's Law concerning the individual extraocular muscle action and the rationale for cranial nerve testing. Methods: Participants were 71 volunteers in the third quarter of a chiropractic training program. The study involved a specially designed eyeball model used to explain the movements of individual extraocular muscles based on Listing's law and their cranial innervations in conjunction with the physical examination. Pre- and post-written tests were used to assess participants' understanding of the subjects taught. The test results were compared with those of nonparticipants who also took the same pre- and posttests. Results: An independent samples t-test of the posttest showed a significant difference between the groups. The study group students achieved higher scores than their counterparts in the control group. Conclusion: Using an innovative approach to explain Listing's law and rationale for cranial nerve tests can improve physical examination skill and help produce more effective written test results. PMID:21048877
Brown, Courtney K.; Stainsby, Brynne; Sovak, Guy
Objective: To present the clinical diagnostic features including management of Guyon canal syndrome in a case with unresolved sensory deficits in a young female cyclist. Clinical Presentation: After 14 days of cycling across Canada, a 23-year old female experienced sensory loss, followed by atrophy and a “claw” hand appearance of her left hand. Intervention and Outcome: Treatment included cervical chiropractic manipulation, soft tissue therapy and the use of cycling gloves. Seven years after the initial injury a lack of sensation in the ulnar nerve distribution of her left hand has persisted. Discussion: This case demonstrates that a lack of proper management can lead to permanent sensory loss and is worth highlighting. Various therapists evaluated the patient’s symptoms and provided minimal care. No diagnosis was given, nor were appropriate measures taken for her to understand the risks of continuing to ride. Summary: Although treatment for Guyon Canal Syndrome can be as easy as cessation from cycling until symptoms subside, other treatment options could be utilized to help manage ulnar nerve compression injuries in cyclists. PMID:25550666
Blum, Charles L.
Introduction: The concept of a systematic or predictive relationship between distant vertebral levels distinct from accumulative functional compensatory mechanisms, such as in scoliosis, has been perpetuated within chiropractic technique systems based on clinical observation and experience. This study seeks to investigate this relationship between the cervical and lumbar vertebrae. Methods: Patients (experimental group n=26 and control group n=12) were selected from the patient base of one office, and were limited to patients that had sensitivity at specific cervical reflex points. Using a pre and post outcome measurement and sacro occipital technique R + C protocols, the related lumbar vertebra was adjusted in the direction indicated by the cervical vertebral sensitivity. Results: Statistical analysis revealed there was a statistically significant difference between pre- and post-VAS measurements and found that the notable difference in mean change in VAS scores were statistically significantly different between the experimental and control groups (p < .001). Conclusion: The findings of this study suggest that further research into cervical and lumbar vertebra interrelationships, and the efficacy of orthopedic block treatment, may be warranted. Further studies are needed to confirm whether a causal relationship exists between lumbar manipulation and decreased cervical spine sensitivity. PMID:26136605
Mussmann, Stephanie E.; Poirier, Jean-Nicolas
Objective The purpose of this case report is to describe the clinical presentation of a patient who had a lateral talar process fracture due to a wakeboarding injury. Clinical Features A 29-year-old male patient sustained a left ankle injury when the front edge of his wakeboard became immersed in the water. As he fell forward, his foot remained attached to the board, leading to inversion and dorsiflexion stress of the ankle. He presented to a chiropractic clinic with diffuse ankle swelling, tenderness, and pain at the distal aspect of the lateral malleolus. Mild ligamentous laxity of the lateral supporting structures was observed during the physical examination. Intervention and Outcome Static and stress radiographs of the left ankle demonstrated a small (McCrory-Bladin type 1) lateral talar process fracture without evidence of gross instability. The patient was referred to a local orthopedic medical specialist for immobilization of the ankle. The patient was treated conservatively with an air cast walking boot for 2 weeks (non–weight-bearing) followed by a 2-week period of partial weight-bearing. At 6 weeks following the injury, a repeated radiographic examination demonstrated complete healing of the fracture. The patient reported minimal tenderness and normal ankle function. Conclusion Because of the similar mechanism of injury to those sustained in snowboarding, this case demonstrates the need for increased awareness of lateral process fractures in wakeboarders. PMID:22027109
Teperman, Lorne J
The rehabilitation of elbow fracture and dislocation is not generally considered a mainstream chiropractic concern. The clinician who is able to successfully manage the elbow articulation will rely upon his/her knowledge of functional anatomy, pathobiomechanics, history and examination principles, when selecting the appropriate treatment available. A case is presented of an individual that sustained a radial head fracture and dislocation following a motor vehicle accident. Subsequent to receiving 1½ years of physiotherapy for post-surgical complications (decreased range of motion, pain, stiffness and tingling to the 4th and 5th fingers), the patient was referred to a multidisciplinary clinic for a Work Hardening/Conditioning Program. This article discusses the need for active functional restoration vs. passive therapy, work hardening regimens and outcome measures. After 6 months of rehabilitation and 3 years following his motor vehicle accident, the patient has successfully returned to his previous work environment. A summary of the sequential steps in providing appropriate management has been provided.
Vavrek, Darcy A; Sharma, Rajiv; Haas, Mitchell
Objective The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP). Methods We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits over 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year following study enrollment were estimated using patient reports of healthcare utilization and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data. Results Lost productivity accounts for a majority of societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P=0.03), greater disability (P=0.01), lower QALY scores (P=0.01), and higher costs in the period preceding enrollment (P<0.01). Pain-free and disability-free days were greater for all SMT doses compared to control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P=0.03) and 19.8 disability-free days (P=0.04). No statistically significant group differences in QALYs were noted. Conclusions A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity. PMID:24928639
Meseke, Christopher A.; Nafziger, Rita; Meseke, Jamie K.
Introduction: This study examined the effect of collaborative testing on student learning, attitude toward testing, and course satisfaction at a chiropractic college. Methods: The study compared testing performance between two cohorts of students taking an advanced neuroanatomy course: a control group (n = 78) and an experimental group (n = 80). Scores examined for each cohort included sums of quizzes, examination scores, and a comprehensive final examination. The control cohort completed weekly quizzes as individuals, while the experimental cohort completed the quizzes collaboratively in small groups. Both cohorts completed three unit examinations and the comprehensive final examination as individuals. Additionally, pretest–posttest and delayed posttest scores were examined. Multivariate analysis of variance (MANOVA) and multivariate analysis of covariance (MANCOVA) (including repeated measures MANCOVA) were used for statistical analysis. Results: The experimental cohort scored significantly higher compared to the control cohort on all quizzes (F = 217.761; df = 1,156; p < .05) and overall course grades (F = 16.099; df = 1,156; p < .05). There were no significant differences in either the comprehensive final (posttest) (F = 3.138; df = 1,122; p > .05) or the delayed posttest (taken 5 weeks after the end of the course) (F = 0.431; df = 1,122; p > .05) between the two cohorts. The overall scores for both cohorts on the delayed posttest were significantly lower than the posttest scores (F = 4.660; df = 1,122; p < .05). Conclusions: This project extends previous findings that students using collaborative testing have significantly increased short-term course performance compared with those students using traditional testing. No differences in learning or retention were noted. PMID:20480011
Mich, Patrice M
In veterinary school, we learn much about how to repair bone fractures, ligament injuries, and neuropathies. The idea, of course, is to return some level of function to a damaged appendage and decrease pain. When a limb cannot be salvaged for medical or financial reasons, we are taught that dogs and cats do "great" on 3 legs. Three legs may mean a less functional limb or outright total amputation. We espouse this doctrine to our clients. Indeed, most of us have countless stories of triped patients acclimating to their disability with aplomb. Although it is true that many patients adapt, learning to ambulate and negotiate their environment, this is functional adaptation-not necessarily the highest quality of life. As a profession, we have come to expect-even accept-that limited mobility, limb breakdown, and chronic neck or back pain are unavoidable consequences. The short- and long-term consequences of limb loss or altered limb function are not benign as once thought. Furthermore, the quality of care demanded by clients is rising and the breadth of knowledge afforded by technology and global communication spawns innovative therapies readily accessible to the computer-savvy pet owner. Recent examples of therapeutic innovations include the following: dentistry, acupuncture, chiropractic, and rehabilitation. Often there is no precedent for these new therapies in animals, and the onus rests with the veterinary community to educate itself to provide best care for patients and clients and to establish evidence-informed best practice. The newest emerging therapeutic modality is veterinary orthotics and prosthetics. Like the previously mentioned modalities, the origin lies in human health care and subsequently leaps to veterinary health care. PMID:25103884
Dubin, Joshua C.; Comeau, Doug; McClelland, Rebecca I.; Dubin, Rachel A.; Ferrel, Ernest
Objective The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles. Methods Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing. Discussion Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care. Conclusion An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully managed using a nonsurgical approach. PMID:22014912
Background The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively. Methods A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable. Results Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality. Conclusions There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare. PMID:22455720
Ledonio, Charles GT; Polly, David W; Swiontkowski, Marc F; Cummings, John T
Background The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS) surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI) outcomes associated with each of these techniques. Methods A comparative retrospective chart review of patients with sacroiliac joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher’s exact test and two nonparametric tests, ie, the Mann–Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate. Results Forty-nine patients from two institutions underwent sacroiliac joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS sacroiliac joint fusion. The MIS group was significantly older (median age 66 [39–82] years) than the open group (median age 51 [34–74] years). Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44–78]) than in the MIS group (median 53 [14–84]). Postoperative improvement in ODI was statistically significant within and between groups, with MIS resulting in greater improvement. Conclusion The open and MIS sacroiliac joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative management. However, the number of patients reaching the minimal clinically important difference and those showing overall improvement were greater in the MIS group. PMID:24940087
Background Complementary health practices are an important element of health/healthcare seeking behavior among adults in the United States. Reasons for use include medical need, prevention and wellness promotion, and cultural relevance. Survey studies published over the past several decades have provided important information on the use of complementary health practices, such as acupuncture and yoga. A review of the literature, however, reveals an absence of studies looking specifically at who does not use these approaches, and why not. Methods To explore this issue two samples were created using data from the 2007 National Health Interview Survey Complementary and Alternative Medicine supplement. Of particular interest was the relationship between lack of health knowledge, as a reason for non-use, and key independent variables. The first sample was comprised of individuals who had never used any of four common complementary health practices -- acupuncture, chiropractic, natural products, and yoga. The second was a subset of those same non-users who had also reported low back pain, the most frequently cited health concern related to use of complementary therapies. Results A hypothesized association between lack of health knowledge, lower educational attainment, and other key socioeconomic indicators was supported in the findings. Although it was hypothesized that low back pain would be associated with greater information seeking, regardless of level of education, that hypothesis was not supported. Conclusion Lack of knowledge was found to affect utilization of common complementary health practices, regardless of the potentially motivating presence of back pain. Disparities in the utilization of complementary medicine, related to educational attainment and other socioeconomic factors, may negatively affect quality of care for many Americans. Creative approaches are needed to help reduce inequities in understanding and improve access to care for underserved populations. PMID:26083564
Introduction: Resting heart (pulse) rate (RPR) monitoring may be a useful neurological assessment tool in chiropractic practice. Lower RPR generally reflects a better level of fitness and health status than higher RPR. However, the clinical significance of short-term changes in RPR remains unknown. The purpose of this study was to take an initial step towards understanding the clinical significance of short-term RPR changes, first, by describing short-term RPR changes between duplicated measurements, and second, by comparing RPR changes between groups with lower and higher baseline RPR. Methods: Seventy-three healthy adult volunteers received an RPR measurement on two days within a 1-week period. The mean difference between the two measurements (RPR change) in patients with lower versus higher baseline RPR was compared. Results: Mean RPR change in the low baseline group was ?0.3 BPM (95% confidence interval [CI] = ?2.7 to 2.1 BPM) whereas in the high baseline group, it was +4.4 BPM (95% CI = 1.2 to 7.6). This difference between groups was statistically significant (P = 0.02) Testing an association between baseline resting pulse rate averages and short-term changes in resting pulse rates: A pilot study with a large effect size (Cohen’s d = 0.57). Conclusion: In this pilot study, a higher RPR at baseline was associated with increased RPR change, whereas a lower baseline RPR was associated with a stable or reduced RPR change. A future main study with a larger sample size and longer follow-up period is needed to better characterize both the natural variation of RPR over multiple repeated measurements, and the clinical significance of short-term RPR changes in terms of predicting longer-term health outcomes.
Benign paroxysmal positional vertigo Part II: A qualitative review of non-pharmacological, conservative treatments and a case report presenting Epley’s “canalith repositioning procedure”, a non-invasive bedside manoeuvre for treating BPPV
van der Velde, Gabrielle M
Purpose: To review the range of treatment interventions for benign paroxysmal positional vertigo (BPPV) with a focus on recent physical treatments (repositioning manoeuvres) inspired by the theoretical pathophysiology canalithiasis. To qualitatively review clinical trials which have examined the efficacy of these repositioning manoeuvres for treating BPPV and present a case report of BPPV treated with a repositioning manoeuvre. Data sources: Relevant studies were identified using the bibliographic database MEDLINE spanning from 1966 to March 1997. Study selection: A total of 21 studies were selected on the basis of their relevance to Part II of this review. Data extraction: The findings and results of relevant studies, and their subsequent conclusions were compared and compiled into a historical summary of the physical treatment of BPPV, focusing on the state of the knowledge regarding the efficacy of repositioning manoeuvres. Results of the data synthesis: The most recent pathophysiological theories for BPPV, cupulolithiasis and canalithiasis, have inspired a number of physical treatments which seek to reverse the pathological mechanisms believed to be responsible for BPPV. The most recent physical treatments, Epley’s canalith repositioning procedure and its variations, are “bedside” procedures which seeks to reverse canalithiasis by the application of a series of positioning manoeuvres. Conclusion: The efficacy of these repositioning manoeuvres has not been satisfactorily determined, but despite this, their popularity is apparently growing. The repositioning manoeuvre can easily be performed in the chiropractic practice setting. However, prior to undertaking these physical treatments, the chiropractor should be confident in the diagnosis of BPPV, given that numerous causes of vertigo are serious and life-threatening.
Layde, P M; Nordstrom, D L; Stueland, D; Brand, L; Olson, K A
Farm machinery is an important contributor to the high rates of occupational injury in agriculture. As part of a population-based case-control study, we studied risk factors for machine-related farm injuries. Case patients were farm residents residing in a geographically defined area of central Wisconsin who experienced a farm injury associated with a tractor, farm implement, or other machine which required medical or chiropractic care from May 1990 through April 1992. Controls were selected from an ad hoc census of farm residents in the same area. Telephone interviews regarding demographic characteristics, safety behaviors, and farming practices were completed for 97.8% of 90 case patients and for 82.8% of 221 control subjects. Personal characteristics significantly associated with an increased risk of machine-related injury included the number of hours worked per week and working primarily as a farmer. Dairy farms, farms with nonresident workers, and large farms were associated with an increased risk of injury while farms with registered cows and farms where cows were fed in the barn even in summer experienced fewer injuries. Based on a logistic regression model, the independent risk factors for machine-related farm injury included hours worked per week (2% increased risk/nonresident workers on farm (odds ratio) (OR) = 2.32; 95% confidence interval (CI): 1.07 to 5.06), cows fed in barn in summer (OR = 0.28; 95% CI: 0.12 to 0.64), and registered cows on farm (OR = 0.36; 95% CI: 0.17 to 0.79). Farm safety practices did not appreciably influence the risk of machine-related farm injury. PMID:8680603
Kazemi, Mohsen; Chudolinski, Artur; Turgeon, Matt; Simon, Aaron; Ho, Eric; Coombe, Lianne
This retrospective longitudinal study aims to describe reported Taekwondo injuries and to examine associations between competitor experience level, age and gender, and the type, location, and mechanism of injury sustained. Additionally, we examined whether recent rule changes concerning increased point value of head shots in adult Taekwondo competition had affected injury incidence. This study was a summation of 9 years of data of competition injury reports, which included 904 injury reports spanning 58 individual competitions. The data was collected on standardized injury reports at time of injury during competition. Care was provided to the athletes, but the type of care provided was not included in the study. Participants included athletes injured during competition who sought care by the health care team, and for whom an injury report was filled out. The data analysis was performed at the Canadian Memorial Chiropractic College. The three most common locations of presenting injury were the head (19%), foot (16%), and thigh (9%). The most common mechanism of presenting injury was found to be a defensive kick (44%), followed by an offensive kick (35%). The most commonly diagnosed injuries were contusions (36%), sprains (19%), and strains (15%). Coloured belts had a higher incidence of contusions, while black belts sustained more joint irritation injuries. Black belts were more likely to suffer multiple injuries. Colored belts suffered more injuries while receiving a kick, while black belts had a larger influence of past history of injury. We found no significant difference in location or type of injury when comparing pre versus post rule change. The most common locations of injury are head, foot, and thigh respectively, and are areas for concern when considering preventative measures. Colour belt competitors are more likely to sustain contusions, which the authors believe is due to more aggressive tactics and lack of control. Those more likely to be injured tend to be younger than 18 years. Recent rule changes have no significant effect on head injuries. PMID:20037692
Reed, William R.; Pickar, Joel G.; Sozio, Randall S.; Long, Cynthia R.
Objectives High velocity low amplitude spinal manipulation (HVLA-SM), as performed by manual therapists (eg, doctors of chiropractic and osteopathy) results in mechanical hypoalgesia in clinical settings. This hypoalgesic effect has previously been attributed to alterations in peripheral and/or central pain processing. The objective of this study was to determine whether thrust magnitude of a simulated HVLA-SM alters mechanical trunk response thresholds in wide dynamic range (WDR) and/or nociceptive specific (NS) lateral thalamic neurons. Methods Extracellular recordings were carried out in the thalamus of 15 anesthetized Wistar rats. Lateral thalamic neurons having receptive fields which included the lumbar dorsal-lateral trunk were characterized as either WDR (n=22) or NS (n=25). Response thresholds to electronic von Frey (rigid tip) mechanical trunk stimuli were determined in three directions (dorsal-ventral, 45°caudalward, and 45°cranialward) prior to and immediately following the dorsal-ventral delivery of a 100ms HVLA-SM at three thrust magnitudes (control, 55%, 85% body weight; (BW)). Results There was a significant difference in mechanical threshold between 85% BW manipulation and control thrust magnitudes in the dorsal-ventral direction in NS neurons (p=.01). No changes were found in WDR neurons at either HVLA-SM thrust magnitude. Conclusions This study is the first to investigate the effect of HVLA-SM thrust magnitude on WDR and NS lateral thalamic mechanical response threshold. Our data suggest that at the single lateral thalamic neuron level, there may be a minimal spinal manipulative thrust magnitude required to elicit an increase in trunk mechanical response thresholds. PMID:24928636
Habermann, Thomas M.; Thompson, Carrie A; LaPlant, Betsy R.; Bauer, Brent A.; Janney, Carol A.; Clark, Matthew M.; Rummans, Teresa A.; Maurer, Matthew J.; Sloan, Jeff A.; Geyer, Susan M.; Cerhan, James R.
No published survey has specifically addressed the beliefs, knowledge, and usage of complementary and alternative medicine (CAM) in long-term (5 to 20 years) lymphoma survivors alone. In this pilot project, 95 subjects were randomly selected from a population of 2,475 long-term lymphoma survivors and mailed a questionnaire. The median time from lymphoma diagnosis to completion of the questionnaire was 11 years (range 6-20). Overall, 68% (95% CI: 54-80%) of the long-term lymphoma survivors reported that they have used CAM, a rate higher than the estimated usage rate reported for the general population The most commonly used modalities were chiropractic (39%, 95% CI: 27-53%) and massage therapy (21%, 95% CI: 12-34%). Less than 10% used meditation (5%, 95% CI: 1-15%) and relaxation (7%, 95% CI: 2-17%). In terms of common herbal usage, 5% (95% CI: 1-15%) had used St. John’s Wort and 7% (95% CI: 2-17%) had used shark cartilage. While none of the patients reported that CAM usage was directed specifically towards treating their lymphoma, 4% (95% CI: 0-12%) of patients reported that CAM could cure cancer, and 14% (95% CI: 6-26%) reported that CAM could increase their feeling of control over their health. This pilot study suggests that long-term lymphoma survivors appear to use CAM at a rate higher than the general population. The use of potential agents of risk by the survivors and the lack of access to potentially beneficial modalities highlights the need for further study of CAM in this population. PMID:19894247
Background Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. Methods Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. Results During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR?=?0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR?=?0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR?=?4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR?=?1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. Conclusions Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience. PMID:23497179
Healing with color has been researched and documented worldwide for centuries. Every single part of the brain and every cell in the body is effected by light. Chinese and Russian scientists demonstrated that the acupuncture meridians transmit light. Dr. Peter Mandel, German chiropractic physician and acupuncturist, states that the acupuncture points are especially sensitive to electromagnetic waves within the spectrum of visible light and microwave energy, and all cells constantly emit and absorb small pockets of electromagnetic radiation or light, called biophotons. The harmony or disharmony of cells has been documented. Kirlian photography, to photography the aura was invented by Russians Semyon and Valentina Kirlian. Photo therapy and light research are being practiced worldwide. In the United States, Dr. Jacob Lieberman has written an influential book Light Medicine of the Future. In 1992 the first Light Years Ahead conference was held. (#5 1996) Dr. Brian Breiling and Dr. Lee Hartley brought together experts in the field to discuss the many potentials of light therapy. My present research in this area has focused on narrow band frequencies through the use of holography. Its therapeutic applications of color healing in this research are both critical and fundamental. My current work, The Chakras, seven reflection holograms on silver halide, relate to the wheels of light described in the earliest recorded Indian history. I will discus the chakras, this ancient metaphysical system under the new light of popular western metaphors and visionary art, how the chakras relate to the seven colors of the rainbow, the electromagnetic waves, and the connection to color holography in healing light therapy. I will be citing concurrent research in color healing, and the important areas of research that are necessary to have significant impact on future directions. Holography in the future will constitute a major frontier in discovery.
Keller, Tony S; Colloca, Christopher J; Moore, Robert J; Gunzburg, Robert; Harrison, Deed E
Background Spinal manipulation has been found to create demonstrable segmental and intersegmental spinal motions thought to be biomechanically related to its mechanisms. In the case of impulsive-type instrument device comparisons, significant differences in the force-time characteristics and concomitant motion responses of spinal manipulative instruments have been reported, but studies investigating the response to multiple thrusts (multiple impulse trains) have not been conducted. The purpose of this study was to determine multi-axial segmental and intersegmental motion responses of ovine lumbar vertebrae to single impulse and multiple impulse spinal manipulative thrusts (SMTs). Methods Fifteen adolescent Merino sheep were examined. Tri-axial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 lumbar spinous processes under fluoroscopic guidance while the animals were anesthetized. A hand-held electromechanical chiropractic adjusting instrument (Impulse) was used to apply single and repeated force impulses (13 total over a 2.5 second time interval) at three different force settings (low, medium, and high) along the posteroanterior axis of the T12 spinous process. Axial (AX), posteroanterior (PA), and medial-lateral (ML) acceleration responses in adjacent segments (L1, L2) were recorded at a rate of 5000 samples per second. Peak-peak segmental accelerations (L1, L2) and intersegmental acceleration transfer (L1–L2) for each axis and each force setting were computed from the acceleration-time recordings. The initial acceleration response for a single thrust and the maximum acceleration response observed during the 12 multiple impulse trains were compared using a paired observations t-test (POTT, alpha = .05). Results Segmental and intersegmental acceleration responses mirrored the peak force magnitude produced by the Impulse Adjusting Instrument. Accelerations were greatest for AX and PA measurement axes. Compared to the initial impulse acceleration response, subsequent multiple SMT impulses were found to produce significantly greater (3% to 25%, P < 0.005) AX, PA and ML segmental and intersegmental acceleration responses. Increases in segmental motion responses were greatest for the low force setting (18%–26%), followed by the medium (5%–26%) and high (3%–26%) settings. Adjacent segment (L1) motion responses were maximized following the application of several multiple SMT impulses. Conclusion Knowledge of the vertebral motion responses produced by impulse-type, instrument-based adjusting instruments provide biomechanical benchmarks that support the clinical rationale for patient treatment. Our results indicate that impulse-type adjusting instruments that deliver multiple impulse SMTs significantly increase multi-axial spinal motion. PMID:16597343
Green, Bart N.; Johnson, Claire; Moreau, William
Objective The purpose of this study was to perform a systematic review of the literature and other authoritative sources for recommendations regarding the appropriateness of physical and sporting activity for those with scoliosis. Methods The literature was systematically searched in PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Index to Chiropractic Literature, and the National Guidelines Clearinghouse from the earliest date of each database through July 2008. All languages and research designs were included. Web sites of respected organizations were searched for position/white papers on scoliosis and physical activity. Included articles were rated using the Oxford Centre for Evidence-Based Medicine criteria, and recommendations for physical activity were made using the Oxford Centre's criteria for grades of recommendation. Results Of 42 articles retrieved, 11 met the inclusion criteria. The Internet review of 18 organizations yielded no previous guidelines or position papers for physical activity and scoliosis. Recommendations were made from 3 level 3b studies and 8 level 5 studies; they include the following: (1) brace-treated and surgically treated scoliosis patients have demonstrated that they can physically participate in physical activities at the same level as nonsurgical patients (grade C recommendation); (2) nonsurgically treated patients are encouraged to participate in sports and physical activity and (3) scoliosis is not a contraindication to participation in most sports (grade D recommendation); (4) brace-treated scoliosis patients are encouraged to exercise with their brace on; however, exercise may also be done outside of the brace (grade D recommendation); and (5) physical activity may be commenced after surgery for scoliosis; however, no high-quality evidence exists that guides the timing of return to physical activity (grade D recommendation). A potential association between elite-level competition in specific sports at an early age and an increased prevalence of scoliosis has been reported (grade C recommendation). Conclusion This article offers evidence-based guidance to health care providers and to patients with scoliosis when making decisions to participate in physical and sporting activities. PMID:19646383
Cramer, Gregory D.; Ross, J. Kim; Raju, P.K.; Cambron, Jerrilyn A.; Dexheimer, Jennifer M.; Bora, Preetam; McKinnis, Ray; Selby, Scott; Habeck, Adam R.
Objective This project determined the location and distribution of cavitations (audible sounds producing vibrations) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT). Methods This randomized, controlled, clinical study assessed 40 healthy subjects (20 male, 20 female), 18–30 years of age, that were block randomized into SMT (Group 1, n=30) or side-posture positioning only (Group 2, control, n=10) groups. Nine accelerometers were placed on each patient (7 on SPs/sacral tubercles of L1–S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (Groups 1 and 2) and SMT (Group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using chi-square or McNemar’s test were made between number of joints cavitating from: Group 1 vs. Group 2, up-side (contact side for SMT) vs. down-side, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs. outside the target area (L1/L2, L2/L3, sacroiliac). Results Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than Group 2 joints (p<0.0001), up-side joints cavitated more than down-side joints (p<0.0001), and joints inside the target area cavitated more than those outside the target area (p<0.01). Conclusions Most cavitations (93.5%) occurred on the up-side of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than side-posture positioning only subjects (96.7% vs. 30%). Multiple cavitations from the same Z joints had not been previously reported. PMID:21986305
Wall, Geoffrey C.; Krypel, Linda L.; Miller, Michael J.; Rees, Derek M.
Fibromyalgia syndrome (FMS) is a complex disorder, with primary symptoms of sleep disturbances, pain, and fatigue. FMS is one of the most common reasons for patient visits to a rheumatologist. Previous studies have suggested that complementary and alternative medicine (CAM) use in patients with rheumatic diseases is common, but such data specific to FMS patients is limited. Objective The following study sought to describe the prevalence of CAM use in a primary care practice of patients with FMS and assess whether these patients discuss CAM use with their physician, physician-extender, and/or pharmacist. Methods A one-group cross-sectional survey design was implemented in a large, community-based, private physician practice of patients diagnosed with FMS. A self-administered questionnaire was distributed during clinic visits. It solicited information related to demographic characteristics; FMS-specific health background; whether CAM use had been discussed with a health care provider; and the “ever-use” of common types of CAM. Respondents returned the questionnaire via US mail in a postage-paid, self-addressed envelope. Results A total of 115 surveys were distributed with 54 returned for analysis (47% completion rate). The sample was predominantly female, well educated and had a mean age of 55.6 years. All respondents were White. Most respondents (92.6%) reported using some type of CAM. Exercise (92.2%), chiropractic treatment (48.1%), lifestyle and diet (45.8%), relaxation therapy (44.9%), and dietary and herbal supplements (36.5%) were most commonly reported CAM therapies “ever-used” by respondents. Dietary and herbal supplements with the highest prevalence of “ever-use” were magnesium (19.2%), guaifenesin (11.5%), and methylsulfonylmethane (MSM) (9.6%). Respondents most commonly discussed CAM with the clinic rheumatologist and the primary care physician (53.7% and 38.9%, respectively). Only 14.8% of respondents discussed CAM with a pharmacist. However, a significantly higher proportion of respondents who “ever-used” dietary and herbal supplements discussed CAM with a pharmacist compared to those who never used dietary and herbal supplements [chi square=6.03, p=0.014]. Conclusion This pilot study suggests that CAM use is common in patients diagnosed with FMS. Compared to other healthcare providers, respondents were least likely to discuss CAM with a pharmacist. However, respondents who used dietary and herbal supplements were more likely to discuss CAM with a pharmacist compared to those who did not, suggesting the potential influence of pharmacist intervention. PMID:25170357
Background Breast implant displacement or rupture can cause aesthetic problems and serious medical complications. Activities with prone positioning and loading of the anterior chest wall, such as massage, chiropractic or osteopathic therapies may increase the risk of implant failure and can also cause discomfort in women with natural breast tissue. Here we test the effectiveness of a newly developed orthosis on pain, mechanical pressure and displacement of breast tissue in women with cosmetic augmentation, post-mastectomy reconstruction, lactating or natural breast tissue. Methods Thirty-two females volunteers, aged 25–56 years with augmented, reconstructed, natural or lactating breast tissue and cup sizes B-F, participated in this open-label clinical trial. We measured pain perception, peak pressure, maximum force, and breast tissue displacement using different sizes of the orthosis compared to no orthosis. Different densities of the orthosis were also tested in a subgroup of women (n?=?7). Pain perception was rated using a validated 11-point visual-analogue scale. Peak pressure and maximum force were assessed using a bilateral set of capacitance-pliance® sensor strips whilst participants were load bearing in a prone position, and breast displacement was measured by magnetic-resonance-imaging. Results The orthosis significantly reduced pain, breast displacement and mechanical pressures in women with natural and augmented breast tissue in prone position. Greater relief of pain and greater reduction in mechanical forces were found with increased size and density of the orthosis. Use of the orthosis improved overall comfort by 64-100%, lowered peak pressure by up to 85% and maximum force by up to 96%. Medio-lateral displacement of breast tissue was reduced by 16%, resulting in a 51% desirable increase of breast tissue height. Conclusion Our study demonstrated that the newly developed orthosis significantly reduced pain, mechanical pressure and breast tissue displacement in women with augmented and natural breast tissue when lying prone. Our findings are of clinical significance, potentially reducing the risk of complication from prone activities in women with breast augmentation or reconstruction, as well as improving comfort whilst undergoing prone procedures. Trial registration Australia and New Zealand Clinical Trials Register, ACTRN12613000541707. PMID:24410925
Background No consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive interviews as part of a process to develop and validate such a questionnaire. Methods We reviewed questions about expectations of benefits of acupuncture, chiropractic, massage, or yoga for pain. Components of the questions – verbs, nouns, response options, terms and phrases describing back pain – were identified. Using seven different cognitive interview scripts, we conducted 39 interviews to evaluate how individuals with chronic low back pain understood these individual components in the context of expectancy questions for a therapy they had not yet received. Chosen items were those with the greatest agreement and least confusion among participants, and were closest to the meanings intended by the investigators. Results The questionnaire drafted for psychometric evaluation had 18 items covering various domains of expectancy. “Back pain” was the most consistently interpreted descriptor for this condition. The most understandable response options were 0-10 scales, a structure used throughout the questionnaire, with 0 always indicating no change, and 10 anchored with an absolute descriptor such as “complete relief”. The use of words to describe midpoints was found to be confusing. The word “expect” held different and shifting meanings for participants. Thus paired items comparing “hope” and “realistically expect” were chosen to evaluate 5 different aspects of treatment expectations (back pain; back dysfunction and global effects; impact of back pain on specific areas of life; sleep, mood, and energy; coping). “Impact of back pain” on various areas of life was found to be a consistently meaningful concept, and more global than “interference”. Conclusions Cognitive interviews identified wordings with considerable agreement among both participants and investigators. Some items widely used in clinical studies had different meanings to participants than investigators, or were confusing to participants. The final 18-item questionnaire is undergoing psychometric evaluation with goals of streamlining as well as identifying best items for use when questionnaire length is constrained. PMID:24460709
Background and Purpose: Sacroiliac joint dysfunction (SIJD) is a condition affecting 15–30% of patients with low back pain seen in outpatient clinics. Currently there is no well?defined standard of care. The purpose of this case report is to discuss the multidisciplinary management between an athletic trainer and an optometrist for an athlete with bilateral SIJ dysfunction and a visual midline shift syndrome. Case Description: A 21?year?old collegiate baseball player reported to the athletic training room, presenting with low back pain of three day duration, with tenderness over both posterior superior iliac spines (PSIS) (left > right). His pain at its worse was a 7/10 on the Numeric Pain Scale (NPS). The pain increased to the point that it limited his activities of daily living (ADLs) including getting dressed, putting on his shoes, sleeping, and getting in and out of a car. Interventions: The athlete was initially treated using traditional muscle energy techniques (MET) based intervention to correct SIJD, and lumbar stabilization exercises directed by a licensed athletic trainer, as well as manipulation by a chiropractor. Three weeks of treatment did not prove to be beneficial with only a minimal (1 point on the NPRS) decrease in pain. The athlete was then referred to the head athletic trainer for consultation who prescribed orthotics, for bilateral rear?foot valgus, and Postural Restoration (PR) therapeutic exercises. After two weeks of orthotic use and PR exercises the athlete’s pain decreased one additional point on the NPRS. Due to lack of progress, an optometrist was then consulted. The neuro?optometrist prescribed 2 diopter base?down prisms to be worn two hours a day, for four weeks. After four weeks of prisms and new exercises, the athlete was asymptomatic and returned to full pain?free baseball participation without further complications. Outcomes: The Oswestry Disability Index Questionnaire (ODI) was 48% at initial (severe disability), 40% at five weeks and 0% at discharge. The Numeric Pain Scale (NPS) score went from 7/10 to 0/10. Discussion: The athlete demonstrated only minimal relief of symptoms following MET, therapeutic exercises, and chiropractic manipulation. Intervention using prism glasses and PR exercises, designed to optimize posture and correct his visual midline shift syndrome, led to complete resolution of his symptoms. Evidence Level: 3a PMID:24175150
Background Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program. Methods Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author’s jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis. Results After adjusting for baseline, the IMT group had significantly lower average pain for all primary outcomes at 6 weeks compared to the ESC group (p?0.001). These differences were not clinically significant but the IMT group had significantly higher odds of a clinically significant change (p?0.045). There was no significant difference in opening range between the IMT and ESC groups. Both groups achieved statistically significant decreases in all three pain measures at six weeks (p???0.05), but only the IMT group achieved clinically significant changes of 2 or more points. Conclusion This study showed evidence of superiority of IMT compared to ESC over the short-term but not at clinically significant levels. Positive changes over time for both IMT and ESC protocols were noted. A longer term, multi-centre study is warranted. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12610000508077. PMID:23738586
Yang, Shibing; Dubé, Catherine E.; Eaton, Charles B.; McAlindon, Timothy E.; Lapane, Kate L.
Background Osteoarthritis (OA) accounts for more mobility issues in older adults than any other disease. OA is a chronic and often painful disease for which there is no cure. Cross-sectional studies have shown that older adults frequently use complementary and alternative medicine (CAM) and arthritis is the most common reason for CAM use. While previous research has profiled the sociodemographic and clinical characteristics of CAM users, few have provided information on variation in CAM use over time and most only considered use of any CAM, which was often a mixture of heterogeneous therapies. Objectives This study sought to describe the longitudinal patterns of CAM use among older adults with knee OA, and to identify correlates/predictors of different commonly-used CAM therapies. Methods The Osteoarthritis Initiative included 1,121 adults aged 65 years and above with radiographic tibiofemoral OA in one or both knees at baseline. Annual surveys captured current use of conventional therapies and 25 CAM modalities (grouped into 6 categories) for joint pain or arthritis at baseline and during the 4-year follow-up. We assessed longitudinal use of CAM modalities by summing the number of visits with participants reporting use of each modality. Correlates of CAM use under consideration included sociodemographic indicators, body mass index, overall measures of mental and physical wellbeing, and clinical indices of knee OA. Generalized estimation equations provided adjusted odds ratio estimates and 95% confidence intervals. Results Nearly one third of older adults reported using ? one CAM modality for treating OA at all assessments. With the exception of glucosamine and chondroitin (18%), few were persistent users of other CAM modalities. One in five of those using NSAIDs or glucosamine/chondroitin were using them concurrently. Adjusted models showed: 1) adults aged ?75 years were less likely to use dietary supplements than those aged between 65 and 75 years; 2) persons with more severe knee pain or stiffness reported more CAM use; 3) better knee-related physical function was correlated with more use of chiropractic/massage; 4) older adults with more comorbidities were less likely to report use of dietary supplements. Conclusion Patterns of CAM use are, to some extent, inconsistent with current guidelines for OA treatment. Evaluating the potential risks and benefits in older adults from commonly-used CAM modalities, with or without combination use of conventional analgesics, is warranted. PMID:24145044
Wickizer, T M; Franklin, G; Plaeger-Brockway, R; Mootz, R D
This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. That project demonstrated robust improvements in disability reduction; however, worker satisfaction suffered. Our current quality improvement initiative, developed through the Occupational Health Services Project, synthesizes what was learned from the MCP and other pilot studies to make delivery system improvements. This initiative seeks to develop provider incentives and clinical management processes that will improve outcomes and reduce the burden of disability on injured workers. Fundamental to this approach are simultaneously preserving workers' right to choose their own physician and maintaining flexibility in the provision of individualized care based on clinical need and progress. The OHS project then will be a "real world" test to determine if aligning provider incentives and giving physicians the tools they need to optimize occupational health delivery can demonstrate sustainable reduction in disability and improvements in patient and employer satisfaction. Critical to the success of this initiative will be our ability to: (1) enhance the occupational health care management skills and expertise of physicians who treat injured workers by establishing community-based Centers of Occupational Health and Education; (2) design feasible methods of monitoring patient outcomes and satisfaction with the centers and with the providers working with them in order to assess their effectiveness and value; (3) establish incentives for improved outcomes and worker and employer satisfaction through formal agreements with the centers and providers; and (4) develop quality indicators for the three targeted conditions (low back sprain, carpal tunnel syndrome, and fractures) that serve as the basis for both quality improvement processes and performance-based contracting. What lessons or insights does our experience offer thus far? The primary lesson is the importance of making effective partnerships and collaborations. Our policy and research activities have benefited significantly from the positive relationship the DLI established with the practice community through the Washington State Medical and Chiropractic Associations and from the DLI's close association with the Healthcare Subcommittee of the Workers' Compensation Advisory Committee. This committee is established by state regulation and serves as a forum for dialogue between the committee and the employer and labor communities. Our experience thus underscores the importance of establishing broad-based support for delivery system innovations. Our research activities have also benefited from the close collaboration between DLI program staff and UW health services researchers. The DLI staff brought important program and policy experience, along with an appreciation of the context and environment within which the research, policy, and R&D activities were conducted. The UW research team brought scientific rigor and methodological expertise to the design and implementation of the research and policy activities. In Washington State, the DLI represents a "single payer" for the purposes of workers' compensation. As discussed earlier, Washington State, along with five other states, has a state-fund system that requires all employers that are not self-insured to purchase workers' compensation insurance t