Chiropractic management of Bell palsy with low level laser and manipulation: a case report.
Rubis, Lisa M
2013-12-01
The purpose of this case report is to describe chiropractic management including the use of cold laser and chiropractic manipulation in the treatment of a patient with Bell palsy. A 40-year-old male patient had a 10-day history of facial paralysis on his left side, including the inability to close his left eye, which also had tearing and a burning sensation. The patient had trouble lifting his left lip and complained of drooling while brushing his teeth. There was no previous history of similar symptoms or a recent infection. Prior treatment had included oral steroids. The patient was treated with low-level laser therapy and chiropractic manipulation 2 times in 4 days. The laser was applied along the course of the facial nerve for 30 seconds at each point and for 1 minute at the stylomastoid foramen. The laser used was a GaAs class 4 laser with a wavelength of 910 nm. The patient perceived a 70% to 80% improvement of facial movement after the first treatment. After the second treatment, the patient reported full control of his facial movements. A patient with acute facial paralysis appeared to have complete resolution of his symptoms following the application of low-level laser therapy and chiropractic manipulation.
Chiropractic management of Bell palsy with low level laser and manipulation: a case report
Rubis, Lisa M.
2013-01-01
Objective The purpose of this case report is to describe chiropractic management including the use of cold laser and chiropractic manipulation in the treatment of a patient with Bell palsy. Clinical features A 40-year-old male patient had a 10-day history of facial paralysis on his left side, including the inability to close his left eye, which also had tearing and a burning sensation. The patient had trouble lifting his left lip and complained of drooling while brushing his teeth. There was no previous history of similar symptoms or a recent infection. Prior treatment had included oral steroids. Intervention and outcome The patient was treated with low-level laser therapy and chiropractic manipulation 2 times in 4 days. The laser was applied along the course of the facial nerve for 30 seconds at each point and for 1 minute at the stylomastoid foramen. The laser used was a GaAs class 4 laser with a wavelength of 910 nm. The patient perceived a 70% to 80% improvement of facial movement after the first treatment. After the second treatment, the patient reported full control of his facial movements. Conclusion A patient with acute facial paralysis appeared to have complete resolution of his symptoms following the application of low-level laser therapy and chiropractic manipulation. PMID:24396332
Chiropractic Manipulation Increases Maximal Bite Force in Healthy Individuals.
Haavik, Heidi; Özyurt, Mustafa Görkem; Niazi, Imran Khan; Holt, Kelly; Nedergaard, Rasmus Wiberg; Yilmaz, Gizem; Türker, Kemal Sitki
2018-04-27
Recent research has shown that chiropractic spinal manipulation can alter central sensorimotor integration and motor cortical drive to human voluntary muscles of the upper and lower limb. The aim of this paper was to explore whether spinal manipulation could also influence maximal bite force. Twenty-eight people were divided into two groups of 14, one that received chiropractic care and one that received sham chiropractic care. All subjects were naive to chiropractic. Maximum bite force was assessed pre- and post-intervention and at 1-week follow up. Bite force in the chiropractic group increased compared to the control group ( p = 0.02) post-intervention and this between-group difference was also present at the 1-week follow-up ( p < 0.01). Bite force in the chiropractic group increased significantly by 11.0% (±18.6%) post-intervention ( p = 0.04) and remained increased by 13.0% (±12.9%, p = 0.04) at the 1 week follow up. Bite force did not change significantly in the control group immediately after the intervention (−2.3 ± 9.0%, p = 0.20), and decreased by 6.3% (±3.4%, p = 0.01) at the 1-week follow-up. These results indicate that chiropractic spinal manipulation can increase maximal bite force.
Impact of Chiropractic Manipulation on Bone and Skeletal Muscle of Ovariectomized Rats.
López-Herradón, A; Fujikawa, R; Gómez-Marín, M; Stedile-Lovatel, J P; Mulero, F; Ardura, J A; Ruiz, P; Muñoz, I; Esbrit, P; Mahíllo-Fernández, I; Ortega-de Mues, A
2017-11-01
Evidence suggests that chiropractic manipulation might exert positive effects in osteoporotic patients. The aim of this study was to evaluate the effects of chiropractic manipulation on bone structure and skeletal muscle in rats with bone loss caused by ovariectomy (OVX). The 6-month old Sprague-Dawley rats at 10 weeks following OVX or sham operation (Sh) did not suffer chiropractic manipulation (NM group) or were submitted to true chiropractic manipulation using the chiropractic adjusting instrument Activator V ® three times/week for 6 weeks as follows: Force 1 setting was applied onto the tibial tubercle of the rat right hind limb (TM group), whereas the corresponding left hind limb received a false manipulation (FM group) consisting of ActivatorV ® firing in the air and slightly touching the tibial tubercle. Bone mineral density (BMD) and bone mineral content (BMC) were determined in long bones and L3-L4 vertebrae in all rats. Femora and tibia were analyzed by μCT. Mechano growth factor (MGF) was detected in long bones and soleus, quadriceps and tibial muscles by immunohistochemistry and Western blot. The decrease of BMD and BMC as well as trabecular bone impairment in the long bones of OVX rats vs Sh controls was partially reversed in the TM group versus FM or NM rats. This bone improvement by chiropractic manipulation was associated with an increased MGF expression in the quadriceps and the anterior tibial muscle in OVX rats. These findings support the notion that chiropractic manipulation can ameliorate osteoporotic bone at least partly by targeting skeletal muscle.
Chiropractic management of breast-feeding difficulties: a case report.
Holleman, Annique C; Nee, John; Knaap, Simone F C
2011-09-01
The purpose of this study is to discuss a chiropractic case of management and resolution of breast-feeding difficulties. 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. 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. 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. Copyright © 2011 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Gillman, Scott F.
2004-01-01
Abstract Objective To describe two cases of abrupt resolution of chronic, recurrent, inversion sprain to ankles in young recreational athletes. Clinical Features A 13-year-old, female, avid recreational soccer player with ankles that would spontaneously invert during various inconsistent points in the weight bearing gait cycle, sometimes with acute pain or sprain to the ankle. No intervention was attempted prior to her entry to the chiropractic office. A 17-year-old male avid skate- boarder and snowboarder whose left ankle routinely “gave out” into inversion upon mundane weight bearing activity, usually with pain and with dependence on wearing an ankle support when skateboarding to lessen ankle pain. The patient had used an ankle support prior to seeking chiropractic care. Intervention and Outcome High velocity, low amplitude chiropractic manipulative therapy applied to the spine, pelvis and extremity joints was the primary intervention in both cases, with particular focus on the ankle. Other procedures used included taping and orthotics, but not before the manipulation effect was noted. Conclusion High velocity, low amplitude chiropractic manipulative therapy to the spine, pelvis, and extremities, particularly at the ankle, should be considered when managing young recreational athletes with functional chronic, recurrent, ankle inversion sprains. PMID:19674638
Cuthbert, Scott C; Rosner, Anthony L
2012-03-01
The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time.
Cuthbert, Scott C.; Rosner, Anthony L.
2012-01-01
Objective The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Clinical Features Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Intervention and Outcome Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. Conclusion The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time. PMID:22942842
Francio, Vinicius T; Boesch, Ron; Tunning, Michael
2015-03-01
Posterior cortical atrophy (PCA) is a rare progressive neurodegenerative syndrome which unusual symptoms include deficits of balance, bodily orientation, chronic pain syndrome and dysfunctional motor patterns. Current research provides minimal guidance on support, education and recommended evidence-based patient care. This case reports the utilization of chiropractic spinal manipulation, dynamic neuromuscular stabilization (DNS), and other adjunctive procedures along with medical treatment of PCA. A 54-year-old male presented to a chiropractic clinic with non-specific back pain associated with visual disturbances, slight memory loss, and inappropriate cognitive motor control. After physical examination, brain MRI and PET scan, the diagnosis of PCA was recognized. Chiropractic spinal manipulation and dynamic neuromuscular stabilization were utilized as adjunctive care to conservative pharmacological treatment of PCA. Outcome measurements showed a 60% improvement in the patient's perception of health with restored functional neuromuscular pattern, improvements in locomotion, posture, pain control, mood, tolerance to activities of daily living (ADLs) and overall satisfactory progress in quality of life. Yet, no changes on memory loss progression, visual space orientation, and speech were observed. PCA is a progressive and debilitating condition. Because of poor awareness of PCA by physicians, patients usually receive incomplete care. Additional efforts must be centered on the musculoskeletal features of PCA, aiming enhancement in quality of life and functional improvements (FI). Adjunctive rehabilitative treatment is considered essential for individuals with cognitive and motor disturbances, and manual medicine procedures may be consider a viable option.
Francio, Vinicius T.; Boesch, Ron; Tunning, Michael
2015-01-01
Objective: Posterior cortical atrophy (PCA) is a rare progressive neurodegenerative syndrome which unusual symptoms include deficits of balance, bodily orientation, chronic pain syndrome and dysfunctional motor patterns. Current research provides minimal guidance on support, education and recommended evidence-based patient care. This case reports the utilization of chiropractic spinal manipulation, dynamic neuromuscular stabilization (DNS), and other adjunctive procedures along with medical treatment of PCA. Clinical features: A 54-year-old male presented to a chiropractic clinic with non-specific back pain associated with visual disturbances, slight memory loss, and inappropriate cognitive motor control. After physical examination, brain MRI and PET scan, the diagnosis of PCA was recognized. Intervention and Outcome: Chiropractic spinal manipulation and dynamic neuromuscular stabilization were utilized as adjunctive care to conservative pharmacological treatment of PCA. Outcome measurements showed a 60% improvement in the patient’s perception of health with restored functional neuromuscular pattern, improvements in locomotion, posture, pain control, mood, tolerance to activities of daily living (ADLs) and overall satisfactory progress in quality of life. Yet, no changes on memory loss progression, visual space orientation, and speech were observed. Conclusion: PCA is a progressive and debilitating condition. Because of poor awareness of PCA by physicians, patients usually receive incomplete care. Additional efforts must be centered on the musculoskeletal features of PCA, aiming enhancement in quality of life and functional improvements (FI). Adjunctive rehabilitative treatment is considered essential for individuals with cognitive and motor disturbances, and manual medicine procedures may be consider a viable option. PMID:25729084
Chiropractic management of a patient with persistent headache
West, Jason; Phillips, Reed B.
2013-01-01
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
Trigeminal neuralgia and chiropractic care: a case report
Rodine, Robert J; Aker, Peter
2010-01-01
The following case describes a 68 year-old woman with a 7½ year history of worsening head and neck pain diagnosed as trigeminal neuralgia following surgical resection of a brain tumor. After years of unsuccessful management with medication and physical therapies, a therapeutic trial of chiropractic was carried out. Chiropractic care included ultrasound, manual therapies (manipulation and mobilization), soft tissue therapies, and home stretching exercises. After an initial treatment period followed by 18 months of supportive care the patient reported satisfactory improvement. It became evident that there were at least three sources of her symptoms: mechanical and/or degenerative neck pain, temporomandibular joint syndrome, and trigeminal neuralgia. While never completely pain-free, the patient continued to report that her pains reduced to minimal at times. At the most recent follow-up, the pain had not returned to pre-treatment intractable levels. This case study demonstrates the importance of diagnosing and treating multiple sources of pain and the positive role chiropractic care can have in the management of patients with these clinical conditions. The potential for convergence of sensory input from the upper three cervical segments and the trigeminal nerve via the trigeminocervical nucleus is discussed. PMID:20808617
A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice.
Daniels, Clinton J; Wakefield, Pamela J; Bub, Glenn A; Toombs, James D
2016-12-01
The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion. The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed. The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain. This article describes the indications for fusion, common surgical practice, potential complications, and relevant published chiropractic literature. This review includes 10 cases that showed positive benefits from chiropractic manipulation, flexion-distraction, and/or manipulation under anesthesia for postfusion lumbar pain. Chiropractic care may have a role in helping patients in pain who have undergone lumbar fusion surgery.
Olson, Harold M; Zetocha, Andrew J; Olson, Courtney A
2016-12-01
The purpose of this case report is to describe the chiropractic management of a patient with postoperative perineal numbness as a result of hip arthroscopy. A female patient presented to a chiropractic clinic with 7 weeks of ongoing perineal numbness after right hip arthroscopic surgery with labral repair. The patient reported lack of sensation during urination, sexual intercourse, and the insertion and removal of female hygienic products into the vagina. Conservative care included myofascial therapy to the psoas and obturator internus muscles and instrument-assisted soft tissue mobilization over the obturator internus. Manual manipulation to the pelvis was also performed. The patient reported complete resolution of perineal numbness after 3 chiropractic treatments. With conservative chiropractic management, full resolution of sensation for this patient was achieved.
Description of the case mix experienced by chiropractic students during a clinical internship.
Puhl, Aaron A; Reinhart, Christine J; Injeyan, H Stephen; Tibbles, Anthony
2017-10-01
The primary objective of this study was to describe the case mix experienced by chiropractic students during their clinical internship at the Canadian Memorial Chiropractic College. Secondary objectives were to characterize teaching clinic patient populations, assess the similarity to previously published data for practicing chiropractors, and describe the treatment plans being recommended by interns. A prospective, observational study was conducted using a convenience sample of 24 chiropractic interns. Data were collected by interns using a standardized form that was completed for each new patient and each new complaint examined during the 1-year internship. Standardized forms included data regarding patient demographics, complaint characteristics, and treatment recommendations. Data were included for 23 of 24 participating interns, who described 828 patients and a total of 948 unique complaint presentations. Overall, 60% of patients were female, 86% were 18 to 64 years old, and 23% were naive to chiropractic care. Of all presenting complaints, 93% were pain-based, 67% were chronic, 65% included spinal complaints, and 7% presented with red flags; individual interns' experiences were variable and are described. On average, treatment recommendations called for 9.4 visits and often included multimodal treatment approaches, most commonly soft-tissue therapies (91%), home-based active care (84%), and spine manipulation (70%). The findings of this study suggest that patients presenting to CMCC teaching clinics are similar to those reported previously to attend private chiropractic clinics. While all participating interns encountered multiple complex clinical cases, very few had experience with pediatric populations. This study adds to the few that detail the characteristics of patients attending chiropractic teaching clinics; to our knowledge it is the first to describe average case loads of chiropractic interns.
2010-01-01
The understanding of the relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has evolved considerably over the years. In the beginning the relationship was seen as simple cause-effect, in which CMT was seen to cause VADS in certain susceptible individuals. This was perceived as extremely rare by chiropractic physicians, but as far more common by neurologists and others. Recent evidence has clarified the relationship considerably, and suggests that the relationship is not causal, but that patients with VADS often have initial symptoms which cause them to seek care from a chiropractic physician and have a stroke some time after, independent of the chiropractic visit. This new understanding has shifted the focus for the chiropractic physician from one of attempting to "screen" for "risk of complication to manipulation" to one of recognizing the patient who may be having VADS so that early diagnosis and intervention can be pursued. In addition, this new understanding presents the chiropractic profession with an opportunity to change the conversation about CMT and VADS by taking a proactive, public health approach to this uncommon but potentially devastating disorder. PMID:20682039
Chiropractic biophysics technique: a linear algebra approach to posture in chiropractic.
Harrison, D D; Janik, T J; Harrison, G R; Troyanovich, S; Harrison, D E; Harrison, S O
1996-10-01
This paper discusses linear algebra as applied to human posture in chiropractic, specifically chiropractic biophysics technique (CBP). Rotations, reflections and translations are geometric functions studied in vector spaces in linear algebra. These mathematical functions are termed rigid body transformations and are applied to segmental spinal movement in the literature. Review of the literature indicates that these linear algebra concepts have been used to describe vertebral motion. However, these rigid body movers are presented here as applying to the global postural movements of the head, thoracic cage and pelvis. The unique inverse functions of rotations, reflections and translations provide a theoretical basis for making postural corrections in neutral static resting posture. Chiropractic biophysics technique (CBP) uses these concepts in examination procedures, manual spinal manipulation, instrument assisted spinal manipulation, postural exercises, extension traction and clinical outcome measures.
Hincapié, Cesar A; Cassidy, J David; Côté, Pierre; Rampersaud, Y Raja; Jadad, Alejandro R; Tomlinson, George A
2017-09-18
Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians' beliefs regarding the risk for acute LDH associated with chiropractic SMT. Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants' elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT. Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39-1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64-1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95-1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29-0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11-1.59). Clinicians' beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship.
Hawk, Cheryl; Pfefer, Mark T; Strunk, Richard; Ramcharan, Michael; Uhl, Nathan
2007-12-01
The purpose of this study was to collect preliminary information on the effects of chiropractic spinal manipulation on reducing risk of falls in older adults with impaired balance, as assessed by the Berg Balance Scale (BBS). This information is necessary to develop a line of investigation into the role of chiropractic care on reduction of fall risk in this population. Randomized, 2-group pretest/posttest design feasibility study with a target sample size of 10 (5 per group), conducted within the outpatient health center of a chiropractic college. Inclusion criteria were as follows: aged 60 years or older, able to stand on one leg <5 seconds, and able to attend all sessions. Patients were assigned to chiropractic care (CMT) or supervised exercise (EX) and scheduled for 2 visits per week for 8 weeks. A total of 26 people responded to recruitment; and 11 were enrolled: 6 in the CMT and 5 in the EX group. Two patients dropped out at the baseline visit when they were assigned to the EX group. One CMT patient dropped out in the seventh week because of a fall at home resulting in a leg fracture. All remaining patients were compliant with treatment protocols. Five of 6 CMT patients and 4 of 5 EX patients had baseline BBS scores <45, indicating increased risk of falls. At visit 16, 2 CMT and 1 of the 3 remaining EX patients had BBS scores <45. One mild and transient adverse event was noted. Further investigation of the possible role of chiropractic care in reducing fall risk in this population appears feasible.
Pediatric Chiropractic Care: The Subluxation Question And Referral Risk.
Homola, Samuel
2016-02-01
Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a 'vertebral subluxation' or a 'vertebral subluxation complex' alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations - the International Chiropractic Association and the American Chiropractic Association - support chiropractic care for children, which includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice. © 2016 John Wiley & Sons Ltd.
Hawk, Cheryl; Pfefer, Mark T.; Strunk, Richard; Ramcharan, Michael; Uhl, Nathan
2007-01-01
Abstract Objective The purpose of this study was to collect preliminary information on the effects of chiropractic spinal manipulation on reducing risk of falls in older adults with impaired balance, as assessed by the Berg Balance Scale (BBS). This information is necessary to develop a line of investigation into the role of chiropractic care on reduction of fall risk in this population. Methods Randomized, 2-group pretest/posttest design feasibility study with a target sample size of 10 (5 per group), conducted within the outpatient health center of a chiropractic college. Inclusion criteria were as follows: aged 60 years or older, able to stand on one leg <5 seconds, and able to attend all sessions. Patients were assigned to chiropractic care (CMT) or supervised exercise (EX) and scheduled for 2 visits per week for 8 weeks. Results A total of 26 people responded to recruitment; and 11 were enrolled: 6 in the CMT and 5 in the EX group. Two patients dropped out at the baseline visit when they were assigned to the EX group. One CMT patient dropped out in the seventh week because of a fall at home resulting in a leg fracture. All remaining patients were compliant with treatment protocols. Five of 6 CMT patients and 4 of 5 EX patients had baseline BBS scores <45, indicating increased risk of falls. At visit 16, 2 CMT and 1 of the 3 remaining EX patients had BBS scores <45. One mild and transient adverse event was noted. Conclusion Further investigation of the possible role of chiropractic care in reducing fall risk in this population appears feasible. PMID:19674706
Whedon, James M.; Goertz, Christine M.; Lurie, Jon D.; Stason, William B.
2013-01-01
Objectives Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, and occupational therapists; however, it does not reimburse the same services provided by chiropractic physicians. Advocates for expanded coverage of chiropractic services under Medicare cite clinical effectiveness and patient satisfaction, whereas critics point to unnecessary services, inadequate clinical documentation, and projected cost increases. To further inform this debate, the purpose of this commentary is to address the following questions: (1) What are the barriers to expand coverage for chiropractic services? (2) What could potentially be done to address these issues? (3) Is there a rationale for Centers for Medicare and Medicaid Services to expand coverage for chiropractic services? Methods A literature search was conducted of Google and PubMed for peer-reviewed articles and US government reports relevant to the provision of chiropractic care under Medicare. We reviewed relevant articles and reports to identify key issues concerning the expansion of coverage for chiropractic under Medicare, including identification of barriers and rationale for expanded coverage. Results The literature search yielded 29 peer-reviewed articles and 7 federal government reports. Our review of these documents revealed 3 key barriers to full coverage of chiropractic services under Medicare: inadequate documentation of chiropractic claims, possible provision of unnecessary preventive care services, and the uncertain costs of expanded coverage. Our recommendations to address these barriers include the following: individual chiropractic physicians, as well as state and national chiropractic organizations, should continue to strengthen
Walker, Bruce F
2016-01-01
Physical manipulation and manual therapies are thousands of years old. The most popular western world iteration of these therapies is delivered by chiropractors. It can be argued that the collective public health benefit from chiropractic for spinal pain has been very substantial, however as chiropractic has transitioned from craft to profession it has encountered many internally and externally driven machinations that have retarded its progress to a fully accepted allied health profession. This article sets out a ten point plan for a new chiropractic that will achieve full acceptance for this troubled profession. This article is based on a keynote speech known as the FG Roberts Memorial Address delivered on October 10, 2015, in Melbourne, Australia at the Chiropractic & Osteopathic College of Australasia and Chiropractic Australia national conference. The ten point plan consists of the following: improving the pre-professional education of chiropractors, establishing a progressive identity, developing a special interest for the profession, marginalising the nonsensical elements of the profession, being pro-public health, supporting the legitimate organised elements of the profession, improving clinical practice, embracing evidence based practice, supporting research and showing personal leadership. Adherence to this fresh ten point plan will, over time, see the chiropractic profession gain full legitimacy in the allied health field and acceptance by other health providers, policy makers and the public at large.
Mansholt, Barbara A.; Salsbury, Stacie A.; Corber, Lance G.; Stites, John S.
2017-01-01
Objective: Scientific literature applicable to chiropractic practice proliferates in quantity, quality, and source. Chiropractic is a worldwide profession and varies in scope between states or provinces and from country to country. It is logical to consider that the focus and emphasis of chiropractic education varies between programs as well. This original research study endeavored to determine “essential literature” recommended by chiropractic faculty. The purpose of this article is (1) to share our results and (2) to promote discussion and explore means for future collaboration of chiropractic faculty through a worldwide platform. Methods: A 2-phase recruitment occurred initially at the institutional level and subsequently at the faculty level. A Web-based survey used qualitative data collection methods to gather bibliographic citations. Descriptive statistics were calculated for demographics, and citation responses were ranked per number of recommendations, grouped into categories, and tabulated per journal source and publication date. Results: Forty-one chiropractic programs were contacted, resulting in 30 participating chiropractic programs (16 US and 14 international). Forty-five faculty members completed the entire survey, submitting 126 peer-reviewed publications and 25 additional citations. Readings emphasized clinical management of spine pain, the science of spinal manipulation, effectiveness of manual therapies, teaching of chiropractic techniques, outcomes assessments, and professional issues. Conclusion: A systematic approach to surveying educators in international chiropractic institutions was accomplished. The results of the survey provide a list of essential literature for the chiropractic profession. We recommend establishing a chiropractic faculty registry for improved communication and collaboration. PMID:28768114
Chiropractic management of low back disorders: report from a consensus process.
Globe, Gary A; Morris, Craig E; Whalen, Wayne M; Farabaugh, Ronald J; Hawk, Cheryl
2008-01-01
Although a number of guidelines addressing manipulation, an important component of chiropractic professional care, exist, none to date have incorporated a broad-based consensus of chiropractic research and clinical experts representing mainstream chiropractic practice into a practical document designed to provide standardized parameters of care. The purpose of this project was to develop such a document. Development of the document began with seed materials, from which seed statements were distilled. These were circulated electronically to the Delphi panel until consensus was reached, which was considered to be present when there was agreement by at least 80% of the panelists. The panel consisted of 40 clinically experienced doctors of chiropractic, representing 15 chiropractic colleges and 16 states, as well as both the American Chiropractic Association and the International Chiropractic Association. The panel reached 80% consensus of the 27 seed statements after 2 rounds. Specific recommendations regarding treatment frequency and duration, as well as outcome assessment and contraindications for manipulation were agreed upon by the panel. A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to care for patients with low back pain, based on both the scientific evidence and their clinical experience.
Chiropractic Management Using Multimodal Therapies on 2 Pediatric Patients With Constipation.
Iyer, Madhu Mia; Skokos, Evangelia; Piombo, Denise
2017-12-01
The purpose of this case report is to describe chiropractic management of 7-month-old male twins who had had constipation since birth. Identical male twins presented with the chief complaint of constipation and bloating. Both patients were born premature after 29 weeks of gestation and had invasive abdominal surgeries in the right lower quadrant resulting in healed postsurgical scars. Patient A underwent ileostomy for a perforation in his ileum. Patient B underwent surgery to repair an inguinal hernia. Motion palpation restrictions indicated bilateral sacroiliac, cervical, and thoracic joint restrictions. The treatment plan included chiropractic manipulation, acupressure stimulation, and dynamic neuromuscular stabilization. Manipulation of the sacroiliac, cervical, and thoracic spine joint restrictions was performed using minimal force. Cross-frictional massage and myofascial manipulation and scar tissue mobilization of the abdominal scar in the right lower quadrant were performed. Acupressure stimulation was performed on both patients' feet. Both patients had improved bowel movements after the first treatment. Patient A had 5 weeks of treatment (2 visits per week). Patient B had 4 weeks of treatment (2 visits per week). The patients' clinical progress improved, and once the goal of regular bowel movements was reached, as confirmed by their mother, follow-up visits were reduced to once a week and gradually to once a month. Both pediatric patients with constipation responded to chiropractic care using multimodal therapies.
Combined chiropractic interventions for low-back pain.
Walker, Bruce F; French, Simon D; Grant, William; Green, Sally
2010-04-14
Chiropractors commonly use a combination of interventions to treat people with low-back pain (LBP). To determine the effects of combined chiropractic interventions (that is, a combination of therapies, other than spinal manipulation alone) on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with LBP, aged 18 and older. We searched: The Cochrane Back Review Group Trials Register (May 2009), CENTRAL (The Cochrane Library 2009, Issue 2), and MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982), MANTIS (from Inception) and the Index to Chiropractic Literature (from Inception) to May 2009. We also screened references of identified articles and contacted chiropractic researchers. All randomised trials comparing the use of combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies. At least two review authors selected studies, assessed the risk of bias, and extracted the data using standardised forms. Both descriptive synthesis and meta-analyses were performed. We included 12 studies involving 2887 participants with LBP. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of sub-populations of people with LBP.No trials were located of combined chiropractic interventions compared to no treatment. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (SMD -0.25 (95% CI -0.46 to -0.04) and MD -0.89 (95%CI -1.60 to -0.18)) compared to other treatments, but there was no significant difference in long-term pain (MD -0.46 (95% CI -1.18 to 0.26)). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 (95% CI -0.70 to -0.02)). However, the effect was small and all studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No
Burke, Jeanmarie R
2014-09-01
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. 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. 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. 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.
Goncalves, Guillaume; Le Scanff, Christine; Leboeuf-Yde, Charlotte
2018-01-01
The chiropractic vitalistic approach to the concept of 'subluxation' as a cause of disease lacks both biological plausibility and possibly proof of validity. Nonetheless, some chiropractors purport to prevent disease in general through the use of chiropractic care. Evidence of its effect is needed to be allowed to continue this practice. The objective of this systematic review was therefore to investigate if there is any evidence that spinal manipulations/chiropractic care can be used in primary prevention (PP) and/or early secondary prevention in diseases other than musculoskeletal conditions. We searched PubMed, Embase, Index to Chiropractic Literature , and some specialized chiropractic journals, from inception to October 2017, using terms including: "chiropractic", "subluxation", "wellness", "prevention", "spinal manipulation", "mortality". Included were English language articles that indicated that they studied the clinical preventive effec t of or benefit from manipulative therapy/chiropractic treatment in relation to PP and/or early treatment of physical diseases/morbidity in general, other than musculoskeletal disorders. Also, population studies were eligible. Checklists were designed in relation to the description of the reviewed articles and some basic quality criteria. Outcomes of studies were related to their methodological quality, disregarding results from those unable to answer the research questions on effect of treatment. Of the 13.099 titles scrutinized, 13 articles were included (eight clinical studies and five population studies). These studies dealt with various disorders of public health importance such as diastolic blood pressure, blood test immunological markers, and mortality. Only two clinical studies could be used for data synthesis. None showed any effect of spinal manipulation/chiropractic treatment. We found no evidence in the literature of an effect of chiropractic treatment in the scope of PP or early secondary prevention for
Kendall, Julie C; French, Simon D; Hartvigsen, Jan; Azari, Michael F
2018-01-01
Dizziness in older people is a risk factor for falls. Neck pain is associated with dizziness and responds favourably to neck manipulation. However, it is unknown if chiropractic intervention including instrument-assisted manipulation of the neck in older people with neck pain can also improve dizziness. This parallel two-arm pilot trial was conducted in Melbourne, Australia over nine months (October 2015 to June 2016). Participants aged 65-85 years, with self-reported chronic neck pain and dizziness, were recruited from the general public through advertisements in local community newspapers and via Facebook. Participants were randomised using a permuted block method to one of two groups: 1) Activator II™-instrument-assisted cervical and thoracic spine manipulation plus a combination of: light massage; mobilisation; range of motion exercises; and home advice about the application of heat, or 2) Sham-Activator II™-instrument-assisted manipulation (set to zero impulse) plus gentle touch of cervical and thoracic spinal regions. Participants were blinded to group allocation. The interventions were delivered weekly for four weeks. Assessments were conducted one week pre- and post-intervention. Clinical outcomes were assessed blindly and included: dizziness (dizziness handicap inventory [DHI]); neck pain (neck disability index [NDI]); self-reported concerns of falling; mood; physical function; and treatment satisfaction. Feasibility outcomes included recruitment rates, compliance with intervention and outcome assessment, study location, success of blinding, costs and harms. Out of 162 enquiries, 24 participants were screened as eligible and randomised to either the chiropractic ( n = 13) or sham ( n = 11) intervention group. Compliance was satisfactory with only two participants lost to follow up; thus, post-intervention data for 12 chiropractic intervention and 10 sham intervention participants were analysed. Blinding was similar between groups. Mild harms
Tarola, G A
1994-05-01
This report of two cases illustrates the potential effect of chiropractic manipulative therapy on back pain and curve progression in the at-risk, skeletally mature patient with adolescent idiopathic scoliosis. Two patients suffering from lumbar scoliosis and chronic back pain. Both had scoliosis that had progressed after skeletal maturity. Diversified type chiropractic manipulative therapy was used palliatively for back pain relief in one case, and routinely 1-2 times per month in the other case. The manipulation was applied manually, with the patients in the prone and side-posture positions. Vertebral levels manipulated were identified as fixated/dysfunctional segments based on static and/or motion palpation. They were generally applied to areas above and/or below the curve apex. When applied at the apex, cavitation was more easily achieved when the direction of thrust was into the concave side. This was also tolerated better by the patient. No attempt was made to "straighten the curve" by thrusting into the convex side. Gentle manual intersegmental mobilization, stretching and muscle massage techniques were also applied. The case treated palliatively had curve progression consistent with the literature over an 8-yr period. The case treated routinely did not. The procedure was effective in both cases for subjective relief of back pain. Diversified-type CMT has a favorable effect on acute back pain when used palliatively. The procedure may also have a favorable long term effect of preventing recurrence of back pain and on retarding curve progression when used routinely 1-2 times per month.
Hedlund, Sofia; Nilsson, Hans; Lenz, Markus; Sundberg, Tobias
2014-02-01
The main objective of this pilot study was to explore the effect of chiropractic high-velocity, low-amplitude (HVLA) manipulation on vertical jump height in young female athletes with talocrural joint dysfunction. This was a randomized assessor-blind clinical pilot trial. Twenty-two female handball players with talocrural joint dysfunction were randomized to receive either HVLA manipulation (n = 11) or sham treatment (n = 11) once a week during a 3-week period. The main outcome was change in vertical jump height from baseline to follow-up within and between groups after 3 weeks. Nineteen athletes completed the study. After 3 weeks, the group receiving HVLA manipulation (n = 11) had a statistically significant mean (SD) improvement in vertical jump height of 1.07 (1.23) cm (P = .017). The sham treatment group (n = 8) improved their vertical jump height by 0.59 (2.03) cm (P = .436). The between groups' change was 0.47 cm (95% confidence interval, -1.31 to 2.26; P = .571) in favor of the group receiving HVLA manipulation. Blinding and sham procedures were feasible, and there were no reported adverse events. The results of this pilot study show that a larger-scale study is feasible. Preliminary results suggest that chiropractic HVLA manipulation may increase vertical jump height in young female athletes with talocrural joint dysfunction. However, the clinical result in favor of HVLA manipulation compared with sham treatment needs statistical confirmation in a larger randomized clinical trial. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
An independent review of NCCAM-funded studies of chiropractic.
Ernst, Edzard; Posadzki, Paul
2011-05-01
To promote an independent and critical evaluation of 11 randomised clinical trials (RCTs) of chiropractic funded by the National Centre for Complementary and Alternative Medicine (NCCAM). Electronic searches were conducted to identify all relevant RCTs. Key data were extracted and the risk of bias of each study was determined. Ten RCTs were included, mostly related to chiropractic spinal manipulation for musculoskeletal problems. Their quality was frequently questionable. Several RCTs failed to report adverse effects and the majority was not described in sufficient detail to allow replication. The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile.
Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report
Cox, James M.
2012-01-01
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
The chiropractic care of children.
Alcantara, Joel; Ohm, Jeanne; Kunz, Derek
2010-06-01
The objective of this study was to characterize the practice of pediatric chiropractic. The study design was a cross-sectional descriptive survey. The settings were private practices throughout the United States, Canada, and Europe. The participants were 548 chiropractors, the majority of whom are practicing in the United States, Canada, and Europe. 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. 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. 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.
Best Practices for Chiropractic Care of Children: A Consensus Update.
Hawk, Cheryl; Schneider, Michael J; Vallone, Sharon; Hewitt, Elise G
2016-01-01
Chiropractic care is the most common complementary and integrative medicine practice used by children in the United States, and it is used frequently by children internationally as well. The purpose of this project was to update the 2009 recommendations on best practices for chiropractic care of children. A formal consensus process was completed based on the existing recommendations and informed by the results of a systematic review of relevant literature from January 2009 through March 2015. The primary search question for the systematic review was, "What is the effectiveness of chiropractic care, including spinal manipulation, for conditions experienced by children (<18 years of age)?" A secondary search question was, "What are the adverse events associated with chiropractic care including spinal manipulation among children (<18 years of age)?" The consensus process was conducted electronically, by e-mail, using a multidisciplinary Delphi panel of 29 experts from 5 countries and using the RAND Corporation/University of California, Los Angeles, consensus methodology. Only 2 statements from the previous set of recommendations did not reach 80% consensus on the first round, and revised versions of both were agreed upon in a second round. All of the seed statements in this best practices document achieved a high level of consensus and thus represent a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Chiropractic Treatment of Temporomandibular Dysfunction: A Retrospective Case Series
Pavia, Steven; Fischer, Rebecca; Roy, Richard
2015-01-01
Objective The purpose of this study is to describe chiropractic treatment of 14 patients who presented with signs and symptoms of temporomandibular joint dysfunction (TMD). Methods This is a retrospective case series of 14 patients, including 13 adults and 1 child. The majority of these patients were undergoing chiropractic care for spine-related conditions when they presented with additional TMD signs and symptoms. They were evaluated and treated with Activator Methods International published protocols relative to the temporomandibular joint before the addition of treatment to the suprahyoid muscles. Results All pre- and postadjustment assessments were recorded using a numeric pain scale. The resulting average showed a reduction in the patients’ pain scores from the initial visit of 8.3 ± 1.6 to the last visit at 1.4 ± 1.1 with an 80.9% ± 15.4% improvement. The average number of visits was 13.6 ± 8.2. Conclusion All patients selected for this case series showed a reduction of temporomandibular dysfunction symptoms. PMID:26793040
Prevalence of musculoskeletal injuries sustained by students while attending a chiropractic college.
Ndetan, Harrison T; Rupert, Ronald L; Bae, Sejong; Singh, Karan P
2009-02-01
The purpose of this study was to assess the prevalence, distribution, severity, risk factors of, and response to musculoskeletal injuries to the low back, hand/wrist, and neck/shoulder among chiropractic students while receiving and/or administering adjustments/manipulation while attending a chiropractic college. The study was an epidemiologic survey of chiropractic students at all levels of training (n = 890) at one chiropractic college. A self-administered anonymous 3-paged questionnaire was used. The questionnaire was divided into sections for collecting data separately on injuries associated with receiving or administering chiropractic adjustments. The response rate was 64.3% with 62.6% male respondents. The overall prevalence of injuries sustained in college was 31.5%, 44.4% of which was exacerbations of prior complaints. Injuries from receiving adjustments/manipulation were most prevalent to neck/shoulder (65.7%), whereas hand/wrist injuries were most common when administering adjustments (45.6%). The risk difference among students receiving adjustments was 81.6/1000 neck/shoulder injuries, and the etiologic fraction was 76.6%. The risk difference was 170/1000 hand/wrist injuries with etiologic fraction of 96.5% among students administering adjustments. Diversified, Gonstead, and upper cervical adjusting techniques were perceived to be the most injury-related. Some students enroll in a chiropractic college with preexisting injuries that can easily be exacerbated. Others sustain new injuries of moderate severity from receiving and administering adjustments. Potential risk factors may include height, body mass index, and nonexercising. The risk factors and mechanisms responsible for the high levels of hand/wrist injuries need further examination. This research identifies an important need to design a comprehensive and logical protocol to prevent injury to chiropractic students.
Utilization of Chiropractic Care at the World Games 2013.
Nook, Debra D; Nook, Erik C; Nook, Brian C
The purpose of this study was to describe chiropractic care use at the World Games 2013. In this retrospective study, we reviewed treatment charts of athletes and non-athletes who sought chiropractic care at The World Games in Cali, Colombia, from July 25 to August 4, 2013. Doctors of chiropractic of the International Federation of Sports Chiropractic provided care. Chart notes included body region treated, treatment modality, and pretreatment and posttreatment pain ratings. Of the participants, 537 of 2964 accredited athletes and 403 of 4131 accredited non-athletes sought chiropractic treatment; these represent utilization rates of 18.1% for athletes and 9.8% for non-athletes. A total of 1463 treatments were recorded for athletes (n = 897) and non-athletes (n = 566). The athletes who were treated represented 28 of 33 sports and 68 of 93 countries that were present at the games. Among athletes, the thoracic spine was the most frequent area of treatment (57.2%), followed by the lumbar spine (48.7%) and the cervical spine (38.9%). Myotherapy was the most frequently used treatment method (80.9%), followed by chiropractic manipulation (78.5%), taping (38.0%), and mobilization (24.6%). Reports of acute injury were higher among athletes (45.4%) compared with non-athletes (23.8%). Reported pain was reduced after treatment (P < .001), and 86.9% patients reported immediate improvement after receiving chiropractic treatment. The majority of people seeking chiropractic care at an international sporting competition were athletes. For those seeking care, the injury rate was higher among athletes than among non-athletes. The majority of patients receiving chiropractic care reported improvement after receiving care. Copyright © 2016. Published by Elsevier Inc.
French, Simon D; Beliveau, Peter J H; Bruno, Paul; Passmore, Steven R; Hayden, Jill A; Srbely, John; Kawchuk, Greg N
2017-01-01
) Neurophysiological mechanisms and effects of spinal manipulative therapy; 8) General mechanisms and effects of spinal manipulative therapy. This project identified research priority areas for the Canadian chiropractic profession. The top three priority areas were all in the area of health services research: 1) Integration of chiropractic care into multidisciplinary settings; 2) Costs and cost-effectiveness of chiropractic care; 3) Effect of chiropractic care on reducing medical services.
Hess, J A; Mootz, R D
1999-06-01
Resource-based relative value scales (RBRVS) have become a standard method for identifying costs and determining reimbursement for physician services. Development of RBRVS systems and methods are reviewed, and the RBRVS concept of physician "work" is defined. Results of work and time inputs from chiropractic physicians are compared with those reported by osteopathic and medical specialties. Last, implications for reimbursement of chiropractic fee services are discussed. Total work, intraservice work, and time inputs for clinical vignettes reported by chiropractic, osteopathic, and medical physicians are compared. Data for chiropractic work and time reports were drawn from a national random sample of chiropractors conducted as part of a 1997 workers' compensation chiropractic fee schedule development project. Medical and osteopathic inputs were drawn from RBRVS research conducted at Harvard University under a federal contract reported in 1990. Both data sets used the same or similar clinical vignettes and similar methods. Comparisons of work and time inputs are made for clinical vignettes to assess whether work reported by chiropractors is of similar magnitude and variability as work reported by other specialties. Chiropractic inputs for vignettes related to evaluation and management services are similar to those reported by medical specialists and osteopathic physicians. The range of variation between chiropractic work input and other specialties is of similar magnitude to that within other specialties. Chiropractors report greater work input for radiologic interpretation and lower work input for manipulation services. Chiropractors seem to perform similar total "work" for evaluation and management services as other specialties. No basis exists for excluding chiropractors from using evaluation and management codes for reimbursement purposes on grounds of dissimilar physician time or work estimates. Greater work input by chiropractors in radiology interpretation may
Chiropractic management of a 47-year–old firefighter with lumbar disk extrusion
Schwab, Matthew J.
2008-01-01
Abstract Objective This case report describes the effect of exercise-based chiropractic treatment on chronic and intractable low back pain complicated by lumbar disk extrusion. Clinical Features A 47-year–old male firefighter experienced chronic, unresponsive low back pain. Pre- and posttreatment outcome analysis was performed on numeric (0-10) pain scale, functional rating index, and the low back pain Oswestry data. Secondary outcome assessments included a 1-rep maximum leg press, balancing times, push-ups and sit-ups the patient performed in 60 seconds, and radiographic analysis. Intervention and Outcome The patient was treated with Pettibon manipulative and rehabilitative techniques. At 4 weeks, spinal decompression therapy was incorporated. After 12 weeks of treatment, the patient's self-reported numeric pain scale had reduced from 6 to 1. There was also overall improvement in muscular strength, balance times, self-rated functional status, low back Oswestry scores, and lumbar lordosis using pre- and posttreatment radiographic information. Conclusion Comprehensive, exercise-based chiropractic management may contribute to an improvement of physical fitness and to restoration of function, and may be a protective factor for low back injury. This case suggests promising interventions with otherwise intractable low back pain using a multimodal chiropractic approach that includes isometric strengthening, neuromuscular reeducation, and lumbar spinal decompression therapy. PMID:19646377
Hincapié, Cesar A; Tomlinson, George A; Côté, Pierre; Rampersaud, Y Raja; Jadad, Alejandro R; Cassidy, J David
2017-10-16
Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery. Using a self-controlled case series design and population-based healthcare databases in Ontario, Canada, we investigated all adults with acute LDH requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004. The relative incidence of acute LDH with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and compared with the relative incidence of acute LDH with early surgery following PCP visits. 195 cases of acute LDH with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years. Strong positive associations were found between acute LDH and both chiropractic and PCP visits. The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits. Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.
Pelletier, Jacques C.
1987-01-01
Two cases of primary benign bone tumors were diagnosed radiographically in a chiropractic practice. Although primary osseous tumors are somewhat uncommon, their potential presence emphasizes the importance of x-ray diagnosis as an essential adjunct to chiropractic practice. This procedure may preclude underlying lesions before considering treatment of seemingly uncomplicated injuries. Two such cases are presented: unicameral bone cyst and osteochondroma. ImagesFigure 1Figure 2Figure 3
Sikorski, David M.; KizhakkeVeettil, Anupama; Tobias, Gene S.
2016-01-01
Objective: Surveys for the National Board of Chiropractic Examiners indicate that diversified chiropractic technique is the most commonly used chiropractic manipulation method. The study objective was to investigate the influences of our diversified core technique curriculum, a technique survey course, and extracurricular technique activities on students' future practice technique preferences. Methods: We conducted an anonymous, voluntary survey of 1st, 2nd, and 3rd year chiropractic students at our institution. Surveys were pretested for face validity, and data were analyzed using descriptive and inferential statistics. Results: We had 164 students (78% response rate) participate in the survey. Diversified was the most preferred technique for future practice by students, and more than half who completed the chiropractic technique survey course reported changing their future practice technique choice as a result. The students surveyed agreed that the chiropractic technique curriculum and their experiences with chiropractic practitioners were the two greatest bases for their current practice technique preference, and that their participation in extracurricular technique clubs and seminars was less influential. Conclusions: Students appear to have the same practice technique preferences as practicing chiropractors. The chiropractic technique curriculum and the students' experience with chiropractic practitioners seem to have the greatest influence on their choice of chiropractic technique for future practice. Extracurricular activities, including technique clubs and seminars, although well attended, showed a lesser influence on students' practice technique preferences. PMID:26655282
Sikorski, David M; KizhakkeVeettil, Anupama; Tobias, Gene S
2016-03-01
Surveys for the National Board of Chiropractic Examiners indicate that diversified chiropractic technique is the most commonly used chiropractic manipulation method. The study objective was to investigate the influences of our diversified core technique curriculum, a technique survey course, and extracurricular technique activities on students' future practice technique preferences. We conducted an anonymous, voluntary survey of 1st, 2nd, and 3rd year chiropractic students at our institution. Surveys were pretested for face validity, and data were analyzed using descriptive and inferential statistics. We had 164 students (78% response rate) participate in the survey. Diversified was the most preferred technique for future practice by students, and more than half who completed the chiropractic technique survey course reported changing their future practice technique choice as a result. The students surveyed agreed that the chiropractic technique curriculum and their experiences with chiropractic practitioners were the two greatest bases for their current practice technique preference, and that their participation in extracurricular technique clubs and seminars was less influential. Students appear to have the same practice technique preferences as practicing chiropractors. The chiropractic technique curriculum and the students' experience with chiropractic practitioners seem to have the greatest influence on their choice of chiropractic technique for future practice. Extracurricular activities, including technique clubs and seminars, although well attended, showed a lesser influence on students' practice technique preferences.
Chiropractic approach to the management of children
2010-01-01
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
Alagha, Babak
2015-01-01
Disc herniation is one of the most common causes of low back pain with radicular pain. Among various types of disc herniation, the extraforaminal disc herniation is a rare cause of lumbar radiculopathy. The aim of presenting this case study is to demonstrate the benefits of Chiropractic care including spine and extremity manipulation and rehabilitation in the treatment of a rare case of extraforaminal L4 nerve entrapment causing severe L4 radiculopathy and chronic mild low back pain (LBP). The aim of presenting this case study is to demonstrate the benefits of Chiropractic care including spine and extremity manipulation and rehabilitation in treatment of rare case of extraforaminal L4 nerve entrapment which caused severe L4 radiculopathy and chronic mild low back pain (LBP). A 45-year old female patient arrived at the clinic with chronic mild low back pain and right buttock pain, all of which had presented for two years' duration. During the preceding month, the radicular pain initiated in medium to high intensity, radiating to her right leg following the L4 dermatomal pattern with a periodic tingling sensation in her right foot. A neuro exam demonstrated a proprioception deficit in her right leg. A Romberg test was positive. The patient was treated by low amplitude high velocity spinal and extremity manipulation for 10 consecutive sessions (2 weeks), followed by rehabilitation and exercise therapy including advanced myofascial release therapy for an additional 12 sessions (4 weeks). After treatment, the patient reported a significant improvement in her low back pain and radiculopathy. In addition, she achieved some improvement in balance. It seems that Chiropractic care and rehabilitation therapy may be a safe and effective modality in treatment of an L4 radiculopathy in a patient with an extraforaminal L4 nerve entrapment. Although it is rare, an L4 extraforaminal disc herniation should be considered as a possible cause of symptoms in patients with chronic mild
Charlton, Keith H
2005-01-01
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
Chiropractic Identity: A Neurological, Professional, and Political Assessment.
Rosner, Anthony L
2016-12-01
The purpose of this article is to propose a focused assessment of the identity of chiropractic and its profession, triangulating multiple viewpoints converging upon various aspects and definitions of neurology, manual medicine, and alternative or mainstream medicine. Over 120 years since its inception, chiropractic has struggled to achieve an identity for which its foundations could provide optimal health care. Despite recognition of the benefits of spinal manipulation in various government guidelines, advances in US military and Veterans Administration, and persistently high levels of patient satisfaction, the chiropractic profession remains underrepresented in most discussions of health care delivery. Distinguishing characteristics of doctors of chiropractic include the following: (1) they embrace a model of holistic, preventive medicine (wellness); (2) they embrace a concept of neurological imbalance in which form follows function, disease follows disturbed biochemistry, and phenomenology follows physiology; (3) they diagnose, and their institutions of training are accredited by a body recognized by the US Department of Education; (4) they manage patients on a first-contact basis, often as primary care providers in geographical areas that are underserved; (5) the spine is their primary-but not exclusive-area of interaction; (6) they deliver high-velocity, low-amplitude adjustments with a superior safety record compared with other professions; and (7) they use a network of institutions worldwide that have shown increasing commitments to research. This article provides an overview of chiropractic identity from 6 points of view: (1) concepts of manual medicine; (2) areas of interest beyond the spine; (3) concepts of the chiropractic subluxation; (4) concepts of neurology; (5) concepts of mainstream or alternative health care; and (6) concepts of primary care, first-contact provider, or specialist.
Peterson, Caroline
2012-01-01
This case study reports on chiropractic care for pregnancy-related heartburn. The purpose of this article is to relate the benefit of chiropractic treatment for one individual, to contrast chiropractic management with the biomedical standard of care for pregnancy-related heartburn, and to point to potential epigenetic implications of the standard of care. A 32-year-old woman who was 24 weeks pregnant presented with persistent heartburn that she was treating with ranitidine (Zantac®) and calcium carbonate (Tums®) daily at the initiation of chiropractic care. Findings of the initial examination were thoracic intersegmental dysfunction and pain upon palpation of the diaphragm, with hypertonicity noted. Therapy localization was positive for reflexes associated with the esophagus and lower esophageal sphincter, suggesting spasms. Emotional components also were identified in association with the symptoms by the use of a mind-body therapy called NeuroEmotional Technique. The patient was treated by adjusting the thoracic spine, manually releasing the diaphragm spasms, and releasing the esophageal spasm with an activator (a small hand-held instrument that creates a percussive force). The patient was symptom-free and did not use medication after the fifth treatment. She was followed throughout the remainder of her pregnancy and was asymptomatic and required no further treatment. A larger study should investigate the effectiveness of chiropractic care for the treatment of pregnancy-related heartburn. Copyright © 2012 Elsevier Inc. All rights reserved.
Nykoliation, J. W.; Cassidy, J. D.
1984-01-01
The temporomandibular pain-dysfunction syndrome (TMJ-PDS) is a frequent but often unappreciated cause of head, neck, and facial pain. Information regarding its etiology, pathophysiology, diagnosis, and treatment is fragmentary, and often reflects an approach influenced by the background specialty of the involved practitioner. Current treatment is often multidisciplinary, involving the use of various dental splints in conjunction with physiotherapy, psychotherapy, and analgesic medication. This paper suggests that chiropractic manipulation to the temporomandibular joints (TMJ) may be an effective approach to treatment of TJM-PDS. Illustrative cases are presented. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 6Figure 7Figure 8Figure 9
Evidence-based guidelines for the chiropractic treatment of adults with neck pain.
Bryans, Roland; Decina, Philip; Descarreaux, Martin; Duranleau, Mireille; Marcoux, Henri; Potter, Brock; Ruegg, Richard P; Shaw, Lynn; Watkin, Robert; White, Eleanor
2014-01-01
The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults. Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations. Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain. Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used. © 2014. Published by National
Beliveau, Peter J H; Wong, Jessica J; Sutton, Deborah A; Simon, Nir Ben; Bussières, André E; Mior, Silvano A; French, Simon D
2017-01-01
Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were
French, Simon D; Charity, Melanie J; Forsdike, Kirsty; Gunn, Jane M; Polus, Barbara I; Walker, Bruce F; Chondros, Patty; Britt, Helena C
2013-11-18
COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia. Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice. 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study. Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor-patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care. Data were collected on 4464 chiropractor-patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25-64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%-3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54-67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33-47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55-71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage. A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.
A proposed protocol for hand and table sanitizing in chiropractic clinics and education institutions
Evans, Marion Willard; Ramcharan, Michael; Floyd, Rod; Globe, Gary; Ndetan, Harrison; Williams, Ronald; Ivie, Ronald
2009-01-01
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
Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study
Vining, Robert D; Salsbury, Stacie A; Cooley, W Carl; Gosselin, Donna; Corber, Lance; Goertz, Christine M
2018-01-01
Objectives Individuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions. Design Chiropractic services were integrated into Crotched Mountain Specialty Hospital (CMSH) through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available. Setting CMSH, a 62-bed subacute multidisciplinary rehabilitation, skilled nursing facility located in Greenfield, New Hampshire, USA. Results Patient mean (SD) age (n=27) was 42.8 (13) years, ranging from 20 to 64 years. Males (n=18, 67%) and those of white race/ethnicity (n=23, 85%) comprised the majority. Brain injury (n=20) was the most common admitting condition caused by trauma (n=9), hemorrhage (n=7), infarction (n=2), and general anoxia (n=2). Three patients were admitted for cervical SCI, 1 for ankylosing spondylitis, 1 for traumatic polyarthropathy, and 2 for respiratory failure with encephalopathy. Other common comorbid diagnoses potentially complicating the treatment and recovery process included myospasm (n=13), depression (n=11), anxiety (n=10), dysphagia (n=8), substance abuse (n=8), and candidiasis (n=7). Chiropractic procedures employed, by visit (n=641), included manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address patients with spinal-related pain (n=15, 54%), joint or regional stiffness (n= 14, 50%), and extremity pain (n=13, 46%). Care often required adapting to participant limitations or conditions. Such adaptations not commonly encountered in outpatient settings where chiropractic care is usually delivered
Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study.
Vining, Robert D; Salsbury, Stacie A; Cooley, W Carl; Gosselin, Donna; Corber, Lance; Goertz, Christine M
2018-01-01
Individuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions. Chiropractic services were integrated into Crotched Mountain Specialty Hospital (CMSH) through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available. CMSH, a 62-bed subacute multidisciplinary rehabilitation, skilled nursing facility located in Greenfield, New Hampshire, USA. Patient mean (SD) age (n=27) was 42.8 (13) years, ranging from 20 to 64 years. Males (n=18, 67%) and those of white race/ethnicity (n=23, 85%) comprised the majority. Brain injury (n=20) was the most common admitting condition caused by trauma (n=9), hemorrhage (n=7), infarction (n=2), and general anoxia (n=2). Three patients were admitted for cervical SCI, 1 for ankylosing spondylitis, 1 for traumatic polyarthropathy, and 2 for respiratory failure with encephalopathy. Other common comorbid diagnoses potentially complicating the treatment and recovery process included myospasm (n=13), depression (n=11), anxiety (n=10), dysphagia (n=8), substance abuse (n=8), and candidiasis (n=7). Chiropractic procedures employed, by visit (n=641), included manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address patients with spinal-related pain (n=15, 54%), joint or regional stiffness (n= 14, 50%), and extremity pain (n=13, 46%). Care often required adapting to participant limitations or conditions. Such adaptations not commonly encountered in outpatient settings where chiropractic care is usually delivered included the need for lift
A focus group study of chiropractic students following international service learning experiences
Boysen, James C.; Salsbury, Stacie A.; Derby, Dustin; Lawrence, Dana J.
2016-01-01
Objective: One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. Methods: Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. Results: The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor–patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. Conclusion: Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices. PMID:27258817
A retrospective study of chiropractic treatment of 276 danish infants with infantile colic.
Wiberg, Karin R; Wiberg, Jesper M M
2010-09-01
The aim of this study was to investigate if the outcome of excessively crying infants treated with chiropractic manipulation (1) was associated with age and/or (2), at least partially, can be explained by age according to the natural decline in crying. This was a retrospective evaluation of clinical records of 749 infants from a private Danish chiropractic practice. All of the infants were healthy, thriving infants born to term within the age of 0 to 3 months who fulfilled the diagnostic criteria for excessively crying infants (infantile colic), whose parents sought chiropractic treatment. The infants were treated using chiropractic management as decided by the treating doctor of chiropractic, and changes in crying based upon the parents' report were noted as improved, uncertain, or nonrecovered. Age predictor groups were cross-tabulated against the outcome variables, and difference between classification groups was tested with χ(2) tables and confidence intervals. Slightly older age was found to be linked to excessively crying infants who experienced clinical improvement. However, no apparent link between the clinical effect of chiropractic treatment and a natural decline in crying was found for this group of infants. The findings of this study do not support the assumption that effect of chiropractic treatment of infantile colic is a reflection of the normal cessation of this disorder. Copyright © 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Educational Standards for Chiropractic Colleges.
ERIC Educational Resources Information Center
Council on Chiropractic Education, Des Moines, IA.
The policy of accreditation for the chiropractic profession and educational standards for chiropractic colleges are presented. The following types are historical development of chiropractic accreditation; the structure and function of the Council on Chiropractic Education; and eligibility, procedures, and classifications for status as an…
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre; Hestbaek, Lise; Injeyan, H Stephen; Puhl, Aaron; Green, Bart; Napuli, Jason G; Dunn, Andrew S; Dougherty, Paul; Killinger, Lisa Zaynab; Page, Stacey A; Stites, John S; Ramcharan, Michael; Leach, Robert A; Byrd, Lori D; Redwood, Daniel; Kopansky-Giles, Deborah R
2012-09-01
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession to public health? What public health roles can chiropractic interns perform for underserved communities in a collaborative environment? Can the chiropractic profession contribute to community health? What opportunities do doctors of chiropractic have to be involved in health care reform in the areas of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change? Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Department of Defense Chiropractic Internships
Dunn, Andrew S.
2006-01-01
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
The chiropractic care of patients with cancer: a systematic review of the literature.
Alcantara, Joel; Alcantara, Joey D; Alcantara, Junjoe
2012-12-01
Cancer is the leading cause of death worldwide and accounted for 7.4 million deaths in 2004. By 2030, deaths from cancer have been estimated at 12 million with 30% being preventable. Complementary and alternative medicine remains popular among cancer patients; particularly with chiropractic services. However, the nature of the chiropractic clinical encounter and its reported benefits remains to be fully investigated. Towards these efforts, we begin with a systematic review of the literature on the chiropractic care of patients with cancer. The following electronic databases were searched: MANTIS [1965-2010]; Index to Chiropractic Literature [1984-2010]; Pubmed [1966-2010]; Medline [1965-2010] EMBASE [1974-2010], AMED [1975-2010], CINAHL Plus [1965-2010], Alt-Health Watch [1965-2010] and PsychINFO [1965-2010]. Key words used were "cancer" and "neoplasm" in Boolean combination with "chiropractic." Primary investigation/reports in peer-reviewed English journals involving chiropractic care were reviewed. Our review revealed 60 case reports, 2 case series, 21 commentaries, 2 survey studies, and 2 literature reviews. The case reports were diagnostic with commentaries highlighting the importance of recognizing the patient presenting with NMS complaints due to an underlying neoplasm. The chiropractic clinical encounter prior to cancer diagnosis and subsequent medical referral is poorly characterized in the literature. Patients with cancer seek the care of chiropractors. The literature does not reflect or describe the totality of the chiropractic clinical encounter. We encourage further research in this field.
Distraction manipulation reduction of an L5-S1 disk herniation.
Cox, J M; Hazen, L J; Mungovan, M
1993-06-01
A computed tomography (CT)-confirmed L5-S1 disk protrusion is reported to be reduced following chiropractic adjustment, as seen on repeat CT scanning. Correlation of the CT reports with the patient's symptoms before and after manipulation is reported. A 38-yr-old female was treated for low back pain and right lower extremity first sacral dermatome sciatica. CT confirmed disk herniations at both the L4-L5 and L5-S1 levels were found. Motor weakness of the right gluteus maximus muscle was found and extremely tight hamstring muscles accompanying positive straight leg signs were elicited. A clinical and imaging diagnosis of an L5-S1 disk herniation was made. Distraction type chiropractic manipulation, electrical stimulation, exercises, nutrition advice and low back wellness class were administered with complete relief of sciatic pain and nearly complete relief of low back pain. Chiropractic distraction manipulation is an effective treatment of lumbar disk herniation, if the chiropractor is observant during its administration for patient tolerance to manipulation under distraction and any signs of neurological deficit demanding other types of care.
Chiropractic: origins, controversies, and contributions.
Kaptchuk, T J; Eisenberg, D M
1998-11-09
Chiropractic is an important component of the US health care system and the largest alternative medical profession. In this overview of chiropractic, we examine its history, theory, and development; its scientific evidence; and its approach to the art of medicine. Chiropractic's position in society is contradictory, and we reveal a complex dynamic of conflict and diversity. Internally, chiropractic has a dramatic legacy of strife and factionalism. Externally, it has defended itself from vigorous opposition by conventional medicine. Despite such tensions, chiropractors have maintained a unified profession with an uninterrupted commitment to clinical care. While the core chiropractic belief that the correction of spinal abnormality is a critical health care intervention is open to debate, chiropractic's most important contribution may have to do with the patient-physician relationship.
Chiropractic care for back pain
... this page: //medlineplus.gov/ency/patientinstructions/000416.htm Chiropractic care for back pain To use the sharing ... discussed in your first session. What Conditions Does Chiropractic Treat Best? Chiropractic treatment is most effective for: ...
THE JOURNAL OF THE CHIROPRACTIC & OSTEOPATHIC COLLEGE OF AUSTRALASIA
Walker, Bruce F.
1998-01-01
The first edition of the Journal of the Chiropractic and Osteopathic College of Australasia was known as COMSIG Review and was published in November, 1992 to coincide with a large conference that COCA had organised in Melbourne. In the first few years the majority of articles were magazine style reviews, similar to these found in the Australian Family Physician. The first Editor was Bruce Walker and subsequent Editors have included John Drinkwater, Stephanie Campbell and John Reggars. The current Editors in Chief, Peter Tuchin and Henry Pollard, are staff members at Macquarie University, Centre of Chiropractic, with a strong background in science and research and both are currently undertaking post-graduate research degrees. Over several years the magazine review style was changed in keeping with a more full journal format. An Editorial Board was formed, comprised of chiropractors, osteopaths and medical practitioners, some of whom are world renowned in their particular field of research. By March, 1996 it was decided to change the name of the journal to Australasian Chiropractic and Osteopathy (ACO). This was a purposeful move to reflect the maturing of the journal and also the growth of the College and in the five years since November 1992, seventy-nine scientific articles have been published. It is anticipated that the journal will continue to be widely distributed throughout the world, with current subscriptions from all Australian undergraduate chiropractic and osteopathic institutions and the vast majority of international undergraduate institutions. ACO is currently indexed with Mantis (formerly Chirolars). The Editorial Panel continue to strive for Australasian Chiropractic and Osteopathy inclusion into Index Medicus and thereby Medline. However, it is recognised that readership of chiropractic journals is very low throughout the world and it is unlikely in the near future that any chiropractic journal other than the Journal of Manipulative and
The simulated early learning of cervical spine manipulation technique utilising mannequins.
Chapman, Peter D; Stomski, Norman J; Losco, Barrett; Walker, Bruce F
2015-01-01
Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy. We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks. This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either "usual learning" (n = 19) or "mannequin learning" (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ(2) = 0.10, p = 0.75), four weeks (χ(2) = 0.40, p = 0.53), and eight weeks (χ(2) = 0.07, p = 0.79). This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially
Learning spinal manipulation: A best-evidence synthesis of teaching methods.
Stainsby, Brynne E; Clarke, Michelle C S; Egonia, Jade R
2016-10-01
The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance.
Learning spinal manipulation: A best-evidence synthesis of teaching methods*
Stainsby, Brynne E.; Clarke, Michelle C.S.; Egonia, Jade R.
2016-01-01
Objective: The purpose of this study was to evaluate the effectiveness of different reported methods used to teach spinal manipulative therapy to chiropractic students. Methods: For this best-evidence literature synthesis, 5 electronic databases were searched from 1900 to 2015. Eligible studies were critically appraised using the criteria of the Scottish Intercollegiate Guidelines Network. Scientifically admissible studies were synthesized following best-evidence synthesis principles. Results: Twenty articles were critically appraised, including 9 randomized clinical trials, 9 cohort studies, and 2 systematic reviews/meta-analyses. Eleven articles were accepted as scientifically admissible. The type of teaching method aids included a Thrust in Motion cervical manikin, instrumented cardiopulmonary reanimation manikin, padded contact with a load cell, instrumented treatment table with force sensor/transducer, and Dynadjust instrument. Conclusions: Several different methods exist in the literature for teaching spinal manipulative therapy techniques; however, future research in this developing area of chiropractic education is proposed. It is suggested that various teaching methods be included in the regular curricula of chiropractic colleges to aid in developing manipulation skills, efficiency, and knowledge of performance. PMID:26998630
On-Site Chiropractic Care as an Employee Benefit: A Single-Location Case Study.
Minicozzi, Salvatore J; Russell, Brent S
2017-09-01
The purpose of this report is to describe the role of on-site chiropractic care in one corporate environment. A part-time chiropractic practice that provides services to a single company on site, 1 day per week, is described. Most care is oriented toward "wellness," is paid for by the employer, and is limited only by the chiropractor's few weekly hours of on-site availability. With approval from the company, the authors conducted an absenteeism analysis after obtaining ethics approval and consent from employee-patients who received care between 2012 and 2014. Comparisons of absenteeism rates of the sample were compared with lost worktime rates from the US Bureau of Labor Statistics' Labor Force Statistics. Of 40 current employees, 35 used chiropractic services; 17 employee-patients met the inclusion criteria. The lost worktime rates of those using chiropractic services (0.72%, 0.55%, and 0.67%, for 2012, 2013, and 2014, respectively) were lower than corresponding rates from Labor Force Statistics (1.5%, 1.2%, and 1.1%). Absenteeism for the employee-patients was lower than equivalent national figures in this sample of workers. Though these results may or may not be related to the chiropractic care, these findings prompt further investigation into this relationship.
A Cochrane review of combined chiropractic interventions for low-back pain.
Walker, Bruce F; French, Simon D; Grant, William; Green, Sally
2011-02-01
Cochrane systematic review of randomized controlled trials. To determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement, and patient satisfaction in adults with low-back pain (LBP). Chiropractors commonly use a combination of interventions to treat people with LBP, but little is known about the effects of this care. We used a comprehensive search strategy. All randomized trials comparing combined chiropractic interventions (rather than spinal manipulation alone) with no treatment or other therapies were included. At least two authors selected studies, assessed bias risk, and extracted data. Descriptive synthesis and meta-analyses were performed. We included 12 studies involving 2887 LBP participants. Three studies had low risk of bias. Included studies evaluated a range of chiropractic procedures in a variety of subpopulations with LBP. For acute and subacute LBP, chiropractic interventions improved short- and medium-term pain (standardized mean difference [SMD] -0.25 [95% CI: -0.46 to -0.04] and MD -0.89 [95%CI: -1.60 to -0.18]) compared with other treatments, but there was no significant difference in long-term pain (MD -0.46 [95% CI -1.18 to 0.26]). Short-term improvement in disability was greater in the chiropractic group compared to other therapies (SMD -0.36 [95% CI: -0.70 to -0.02]). However, the effect was small and studies contributing to these results had high risk of bias. There was no difference in medium- and long-term disability. No difference was demonstrated for combined chiropractic interventions for chronic LBP and studies that had a mixed population of LBP. Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when
Acupuncture, chiropractic and osteopathy use in Australia: a national population survey
Xue, Charlie CL; Zhang, Anthony L; Lin, Vivian; Myers, Ray; Polus, Barbara; Story, David F
2008-01-01
Background There have been no published national studies on the use in Australia of the manipulative therapies, acupuncture, chiropractic or osteopathy, or on matters including the purposes for which these therapies are used, treatment outcomes and the socio-demographic characteristics of users. Methods This study on the three manipulative therapies was a component of a broader investigation on the use of complementary and alternative therapies. For this we conducted a cross-sectional, population survey on a representative sample of 1,067 adults from the six states and two territories of Australia in 2005 by computer-assisted telephone interviews. The sample was recruited by random digit dialling. Results Over a 12-month period, approximately one in four adult Australians used either acupuncture (9.2%), chiropractic (16.1%) or osteopathy (4.6%) at least once. It is estimated that, adult Australians made 32.3 million visits to acupuncturists, chiropractors and osteopaths, incurring personal expenditure estimated to be A$1.58 billion in total. The most common conditions treated were back pain and related problems and over 90% of the users of each therapy considered their treatment to be very or somewhat helpful. Adverse events are reported. Nearly one fifth of users were referred to manipulative therapy practitioners by medical practitioners. Conclusion There is substantial use of manipulative therapies by adult Australians, especially for back-related problems. Treatments incur considerable personal expenditure. In general, patient experience is positive. Referral by medical practitioners is a major determinant of use of these manipulative therapies. PMID:18377663
Adherence to radiography guidelines for low back pain: a survey of chiropractic schools worldwide.
Ammendolia, Carlo; Taylor, John A M; Pennick, Victoria; Côté, Pierre; Hogg-Johnson, Sheilah; Bombardier, Claire
2008-01-01
This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain. Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain. Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that "routine radiography should be used prior to spinal manipulative therapy," 29 (91%) disagreed that there "was a role for full spine radiography for assessing patients with low back pain," and 29 (91%) disagreed that "oblique views should be part of a standard radiographic series for low back pain." However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there "is a role for radiography in acute low back pain in the absence of 'red flags' for serious disease." This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without "red flags" for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain.
Weigel, Paula A M; Hockenberry, Jason M; Bentler, Suzanne E; Kaskie, Brian; Wolinsky, Fredric D
2012-01-01
The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine. Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample. There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period. Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Weeks, William B; Goertz, Christine M; Meeker, William C; Marchiori, Dennis M
2016-01-01
The purpose of this study was to compare characteristics, likelihood to use, and actual use of chiropractic care for US survey respondents with positive and negative perceptions of doctors of chiropractic (DCs) and chiropractic care. From a 2015 nationally representative survey of 5422 adults (response rate, 29%), we used respondents' answers to identify those with positive and negative perceptions of DCs or chiropractic care. We used the χ(2) test to compare other survey responses for these groups. Positive perceptions of DCs were more common than those for chiropractic care, whereas negative perceptions of chiropractic care were more common than those for DCs. Respondents with negative perceptions of DCs or chiropractic care were less likely to know whether chiropractic care was covered by their insurance, more likely to want to see a medical doctor first if they were experiencing neck or back pain, less likely to indicate that they would see a DC for neck or back pain, and less likely to have ever seen a DC as a patient, particularly in the recent past. Positive perceptions of chiropractic care and negative perceptions of DCs appear to have greater influence on DC utilization rates than their converses. We found that US adults generally perceive DCs in a positive manner but that a relatively high proportion has negative perceptions of chiropractic care, particularly the costs and number of visits required by such care. Characteristics of respondents with positive and negative perceptions were similar, but those with positive perceptions were more likely to plan to use-and to have already received-chiropractic care. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Adams, Jon; Peng, Wenbo; Steel, Amie; Lauche, Romy; Moore, Craig; Amorin-Woods, Lyndon; Sibbritt, David
2017-09-29
The Australian Chiropractic Research Network (ACORN) practice-based research network (PBRN) cohort was established to provide sustainable infrastructure necessary to address lack of rigorous investigation and to bridge the research-practice gap focused on chiropractic care for future years. This paper presents the profile of chiropractors recruited to the ACORN PBRN, a nationally representative sample of chiropractors working in Australia. Cross-sectional analysis of baseline data from a cohort study of chiropractors in Australia. All registered chiropractors in Australia were invited to participate in the ACORN study and those who completed a practitioner questionnaire and consent form were included in the PBRN cohort. A total of 1680 chiropractors (36%) were recruited to the cohort database. The average age of the PBRN participants is 41.9 years and 63% are male. The vast majority of the PBRN participants hold a university degree. General practitioners were identified as the most popular referral source for chiropractic care and low back pain and neck pain were the most common conditions 'often' treated by the PBRN chiropractors. The chiropractors in this PBRN cohort rated high velocity, low amplitude adjustment/manipulation/mobilisation as the most commonly used technique/method and soft tissue therapy as the most frequently employed musculoskeletal intervention in their patient management. The ACORN PBRN cohort constitutes the largest coverage of any single healthcare profession via a national voluntary PBRN providing a sustainable resource for future follow-up. The ACORN cohort provides opportunities for further nested substudies related to chiropractic care, chiropractors, their patients and a vast range of broader healthcare issues with a view to helping build a diverse but coordinated research programme and further research capacity building around Australian chiropractic. © Article author(s) (or their employer(s) unless otherwise stated in the text of the
Kuhn, Kurt W.; Cambron, Jerrilyn
2013-01-01
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
... Shareable Graphics Back Pain Prevention Headaches and Chiropractic Neck Pain and Chiropractic Posture Backpack Safety Spinal Health Winter ... new science and healing art. Among his early students were Palmer’s son, Bartlett Joshua (BJ), as well ...
Starmer, David J; Guist, Brett P; Tuff, Taylor R; Warren, Sarah C; Williams, Matthew G R
2016-05-01
The purpose of this study was to analyze differences in peak force modulation and time-to-peak thrust in posterior-to-anterior (PA) high-velocity-low-amplitude (HVLA) manipulations in first-year chiropractic students prior to and following a 12-week detraining period. Chiropractic students (n=125) performed 2 thrusts prior to and following a 12-week detraining period: total peak force targets were 400 and 600 N, on a force-sensing table using a PA hand contact of the participant's choice (bilateral hypothenar, bilateral thenar, or cross bilateral). Force modulation was compared to defined target total peak force values of 600 and 400 N, and time-to-peak thrust was compared between data sets using 2-tailed paired t-tests. Total peak force for the 600 N intensity varied by 124.11 + 65.77 N during the pre-test and 123.29 + 61.43 N during the post-test compared to the defined target of 600 N (P = .90); total peak force for the 400 N intensity varied by 44.91 + 34.67 N during the pre-test and 44.60 + 32.63 N during the post-test compared to the defined target of 400 N (P = .57). Time-to-peak thrust for the 400 N total peak force was 137.094 + 42.47 milliseconds during the pre-test and 125.385 + 37.46 milliseconds during the post-test (P = .0004); time-to-peak thrust for the 600 N total peak force was 136.835 + 40.48 milliseconds during the pre-test and 125.385 + 33.78 milliseconds during the post-test (P = .03). The results indicate no drop-off in the ability to modulate force for either thrust intensity, but did indicate a statistically significant change in time-to-peak thrust for the 400 N total peak force thrust intensity in first-year chiropractic students following a 12-week detraining period. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Innes, Stanley I; Leboeuf-Yde, Charlotte; Walker, Bruce F
2017-01-01
Psychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students' intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief. Between October and November of 2016, students from two Australian chiropractic programs ( N = 444) answered a questionnaire on measures of IU levels, patient case scenarios for neck and low back pain, and questions about self-ratings of their future chiropractic abilities and perceived need for the adoption of a chiropractic technique system. Associations were tested by the IU score and the therapeutic choices relating to a) a neck pain case scenario, b) a low back pain scenario, c) various technique systems, and d) the self-rated competence level treating the IU score both as a continuous and a categorical variable. There was an overall response rate of 53%. Those students who were high in levels of IU were significantly more likely to make incorrect clinical decisions than those with normal or low levels of IU for the neck pain case scenario. No differences were found on the low back pain scenario, on preferences to use a technique system in the future, or on predicted self-rating of competence after graduation. Psychological factors, such as IU, may have an impact on chiropractic students' clinical decisions. However, it does not impact on all aspects of practice. This finding has implications for chiropractic educators, especially when dealing with neck pain. However, it may be relevant to continue the search for specific personality profiles in relation to various favourable and unfavourable practice patterns, as it is
Russell, David G; Glucina, Tanja T; Sherson, Matthew W; Bredin, Melinda
2017-12-01
The purpose of this study was to assess public perception of chiropractic public place marketing events. A chiropractic public place marketing program was held at 3 events (a community sports event, an exposition, and a university campus market day) over a 5-month period in Auckland, New Zealand, between 2008 and 2009. Participants were interviewed by chiropractic students. Interview questions were standardized and sought to find out participants' perception of chiropractic and whether it was influenced in a positive or negative manner after their exposure to the marketing program. Three hundred forty-five interviews were completed during 3 events. The minority of participants (15.9%) had a negative view of chiropractic, 29.2% were neutral, and 54.9% had a positive view of chiropractic. Of the responses of those surveyed, 54% did not change their opinion of chiropractic, 44.3% were more positive, and 1.7% were more negative. This study found that direct or indirect exposure to chiropractic public place marketing events may possibly influence the public perception of chiropractic. Because of the limited sample, these findings cannot be extrapolated to other regions or populations. Further studies are needed to test these findings in other world regions and in more controlled environments.
Brown, Benjamin T; Bonello, Rod; Fernandez-Caamano, Ramon; Eaton, Sharyn; Graham, Petra L; Green, Hilary
2014-05-01
The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia. This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services. A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received. The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Hawk, Cheryl; Schneider, Michael; Ferrance, Randy J; Hewitt, Elise; Van Loon, Meghan; Tanis, Lora
2009-10-01
There has been much discussion about the role of chiropractic care in the evaluation, management, and treatment of pediatric patients. To date, no specific guidelines have been adopted that address this issue from an evidence based perspective. Previous systematic reviews of the chiropractic literature concluded that there is not yet a substantial body of high quality evidence from which to develop standard clinical guidelines. The purpose of this project was to develop recommendations on "best practices" related primarily to the evaluation and spinal manipulation aspects of pediatric chiropractic care; nonmanipulative therapies were not addressed in detail. Based on both clinical experience and the results of an extensive literature search, a set of seed documents was compiled to inform development of the seed statements. These were circulated electronically to the Delphi panel until consensus was reached, which was considered to be present when there was agreement by at least 80% of the panelists. A multidisciplinary panel of 37 was made up primarily of doctors of chiropractic with a mean of 18 years in practice, many with post-graduate training in pediatrics. The panel represented 5 countries and 17 states; there were members of the American Chiropractic Association, the International Chiropractors Association, and the International Chiropractic Pediatric Association. The panel reached a minimum of 80% consensus on the 51 seed statements after 4 rounds. A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to clinical evaluation, management, and manual treatment for pediatric patients, based on both scientific evidence and clinical experience.
Puhl, Aaron A; Reinhart, Christine J; Doan, Jon B; McGregor, Marion; Injeyan, H Stephen
2014-01-01
The objectives of this study were to determine if faction membership among Canadian doctors of chiropractic (DCs) is associated with differences in educational program characteristics among English-speaking Canadian and United States chiropractic colleges and to determine if those differences are expressed in terms of surveyed attitudes and behaviors regarding treatment efficacy, radiographic imaging, vaccinations, and interprofessional referrals. This study also aims to identify if educational programs may be a potential source of multiple professional identities. A randomly selected sample of Canadian DCs, stratified across the English-speaking provinces, was surveyed by mail. Survey items included school of graduation, self-categorization by chiropractic subgroup, perceptions of condition-specific treatment efficacy, use of plain film radiographic imaging, vaccination attitudes/behaviors, and patient referral patterns. Self-categorization by chiropractic subgroup included: the unorthodox faction (associates the chiropractic subluxation as an encumbrance to the expression of health) and the orthodox perspective (associates with musculoskeletal joint dysfunction, public health, and lifestyle concerns). For data analysis, chiropractic schools were divided into 2 groups according to location: English-speaking Canada and the US. The US was further clustered into liberal ("interested in mixing elements of modern and alternative therapies into the practice of chiropractic") and conservative categories ("chiropractors who believe in continuing the traditions of chiropractic"). Of 740 deliverable questionnaires, 503 were returned for a response rate of 68%. χ(2) Testing revealed significant differences in self-categorized faction membership associated with the clustering of colleges based on ideological viewpoints (χ(2) = 27.06; P = .000). Descriptive results revealed a relationship between school of origin and perceived treatment efficacy, use of radiographic imaging
Davis, Matthew A; Smith, Monica; Weeks, William B
2012-01-01
Previous studies suggest a possible association between using chiropractic care and lower influenza vaccination rates. We examined adult influenza vaccination rates for chiropractic patients to determine if they are different than those for users of other complementary and alternative medicine (CAM). We used the 2007 National Health Interview Survey to examine influenza vaccination rates among adult respondents who were considered high priority for the influenza vaccine (n=12,164). We separated respondents into clinically meaningful categories according to age and whether or not they had recently used chiropractic care, some other type of CAM, or neither. We used adjusted logistic regression to determine whether user status predicted influenza vaccination. Only 33% of younger and 64% of older high priority Chiropractic Users were vaccinated in 2007; these rates approximated those of Non-CAM Users. However, younger Non-Chiropractic CAM Users were more likely than Non-CAM Users to have been vaccinated (p-value=0.05). In adjusted logistic regressions, we found statistically insignificant differences when comparing Chiropractic Users to Non-CAM Users for younger adults (OR=0.93(95% CI:0.76-1.13), or for older adults OR=0.90 (95% CI:0.64-1.20). Chiropractic Users appear no less likely to be vaccinated for influenza; whereas, younger Non-chiropractic CAM Users are more likely than Non-CAM Users to be vaccinated. Copyright © 2011 Elsevier Inc. All rights reserved.
Spinal Health: The Backbone of Chiropractic's Identity.
Brown, Richard A
2016-12-01
The purpose of this commentary is to explore the concepts underpinning professional identity, assess their relevance to chiropractic, and propose a model by which a strong identity for the chiropractic profession may be achieved. The professional identity of chiropractic has been a constant source of controversy throughout its history. Attempts to establish a professional identity have been met with resistance from internal factions divided over linguistics, philosophy, technique, and chiropractic's place in the health care framework. Consequently, the establishment of a clear identity has been challenging, and the chiropractic profession has failed to capitalize on its potential as the profession of spine care experts. Recent identity consultations have produced similar statements that position chiropractors as spinal health and well-being experts. Adoption of this identity, however, has not been universal, perpetuating the uncertainty with which the public regards the chiropractic profession. To gain public and professional acceptance, chiropractic must be unequivocal in declaring its scope, expertise, and intent. Failure to do so will lead to obscurity as other professions acquire necessary skills and position themselves as the custodians of spine care.
Educational Standards for Chiropractic Colleges.
ERIC Educational Resources Information Center
Council on Chiropractic Education, Des Moines, IA.
Contents include: background information on the historical development, purpose, structure, and function of chiropractic accreditation; accreditation policy (eligibility, procedures, classifications, commission actions, and reports); standards for chiropractic colleges (organization, administration, scholastic regulations curriculum, faculty,…
Green, B N; Johnson, C D; Keating, J C
1998-06-01
Long before technology assessment and continuous quality improvement were in vogue in chiropractic, Ted L. Shrader, D.C., F.I.C.C., was working toward these goals in the profession. Convinced that chiropractic must change from within for the benefit of society, Dr. Shrader has made a career-long commitment to evaluating chiropractic procedures and establishing consensus statements regarding chiropractic principle. Determined in mind, moral by nature, and unobtrusive in manner, Dr. Shrader has been decidedly effective in his endeavors. He has encouraged in chiropractic a mind for critical thinking. The fruits of his labor can be seen today in chiropractic publication, among chiropractic scholars, within the American Chiropractic Association Council on Technique, in conference proceedings, and in our institutions.
Chiropractic and self-care for back-related leg pain: design of a randomized clinical trial
2011-01-01
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
A History of Manipulative Therapy
Pettman, Erland
2007-01-01
Manipulative therapy has known a parallel development throughout many parts of the world. The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE. Over the centuries, manipulative interventions have fallen in and out of favor with the medical profession. Manipulative therapy also was initially the mainstay of the two leading alternative health care systems, osteopathy and chiropractic, both founded in the latter part of the 19th century in response to shortcomings in allopathic medicine. With medical and osteopathic physicians initially instrumental in introducing manipulative therapy to the profession of physical therapy, physical therapists have since then provided strong contributions to the field, thereby solidifying the profession's claim to have manipulative therapy within in its legally regulated scope of practice. PMID:19066664
Chiropractic. State of the Art.
ERIC Educational Resources Information Center
Schafer, R. C., Ed.
The review covers: (1) the discipline (description, scientific theories and principles, its practice, contributions to the health field, and history); (2) the profession (a doctor profile, patients, students, and the American Chiropractic Association); (3) chiropractic education (colleges, career opportunities, standard basic curriculum,…
Early chiropractic education in Oregon
Keating, Joseph C
2002-01-01
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
Chiropractic as spine care: a model for the profession
Nelson, Craig F; Lawrence, Dana J; Triano, John J; Bronfort, Gert; Perle, Stephen M; Metz, R Douglas; Hegetschweiler, Kurt; LaBrot, Thomas
2005-01-01
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
Weeks, William B; Goertz, Christine M; Meeker, William C; Marchiori, Dennis M
2015-10-01
The purpose of this study was to determine whether general perceptions of doctors of chiropractic (DCs) varied according to likeliness to use chiropractic care, whether particular demographic characteristics were associated with chiropractic care use, and whether perception of DCs varied according to the per-capita supply of DCs in local health care markets. We performed a secondary analysis of results from a 26-item nationally representative survey of 5422 members of The Gallup Panel that was conducted in the spring of 2015 (response rate, 29%) that sought to elicit the perceptions and use of DCs by US adults. We compared survey responses across: (1) respondents who had different likelihoods to use DCs for treatment of neck or back pain and (2) respondents who had different experiences using DCs. We linked respondents' zip codes to hospital referral regions for which we had the per-capita supply of DCs. Using the χ(2) test, we examined relationships between likeliness to use a DC, experience using a DC, respondent demographic variables, perceptions of DCs, and the per-capita supply of DCs in the local health care market. Most (61.4%) respondents believed that chiropractic care was effective at treating neck and back pain, 52.6% thought DCs were trustworthy, and 24.2% thought chiropractic care was dangerous; however, as respondents' likelihood to use a DC increased, perceptions of effectiveness and trustworthiness increased, and perceptions of danger decreased. Of all 5422 survey respondents, 744 or 13.7% indicated that they had seen a DC within the last 12 months. As one moved from distant to more recent experience using a DC, respondents were more likely to be female, married, white, and employed; those who had a distant history of using a DC were older and more likely to be retired than the other groups. A higher per-capita supply of DCs was associated with higher utilization rates and showed a more favorable regard for DCs. US adults often use chiropractic
Wanlass, Paul W; Sikorski, David M; Kizhakkeveettil, Anupama; Tobias, Gene S
2018-03-12
To assess students' opinions of the potential influence of taking elective courses in chiropractic techniques and their future practice preferences. An anonymous, voluntary survey was conducted among graduating students from a doctor of chiropractic program. The survey included questions regarding the chiropractic technique elective courses they had completed and the potential influence of these courses on their chiropractic technique choices in future practice. Surveys were pretested for face validity, and data were analyzed using descriptive and inferential statistics. Of the 56 surveys distributed, 46 were completed, for a response rate of 82%. More than half of the students reported having taken at least 1 elective course in diversified technique (80%), Cox technique (76%), Activator Methods (70%), or sacro-occipital technique (63%). Less than half of the respondents reported taking technique elective courses in Gonstead or Thompson techniques. More than half of the students stated they were more likely to use Activator (72%), Thompson (68%), diversified (57%), or Cox (54%) techniques in their future practice after taking an elective course in that technique. Females stated that they were more likely to use Activator Methods ( p = .006) in future practice. Chiropractic technique elective courses in the doctor of chiropractic curriculum may influence students' choices of future practice chiropractic technique.
Core and Complementary Chiropractic: Lowering Barriers to Patient Utilization of Services.
Triano, John J; McGregor, Marion
2016-12-01
The use of chiropractic services has stalled while interest in accessing manipulation services is rising. The purpose of this paper is to consider this dilemma in the context of the dynamics of professional socialization, surveys of public attitudes, and a potential strategic action. This is a reflection work grounded in the literature on professional socialization and the attitudes held regarding chiropractic in modern society, to include its members, and in original data on training programs. Data were interpreted on the background of the authors' cross-cultural experiences spanning patient care, research, education, and interprofessional collaboration. Recommendation on a strategic action to counter barriers in patient referrals was synthesized. Professional socialization is the process by which society enables professional privilege. Illustration of typical and divergent professional socialization models emerged that explain cognitive dissonance toward the profession. Questions of trust are commensurate with the experiences during patient encounters rather than with a common identity for the profession. Diversity among encounters perpetuates the uncertainty that affects referral sources. Commonality as an anchor for consistent professional identity and socialization through the content of core chiropractic, defined by training and practice, offers a means to offset uncertainty. Complementary chiropractic, analogous to complementary medicine, provides an outlet under professional socialization for the interests to explore additional methods of care. The practice workplace is an effective lever for altering barriers to the use of services. Clarifying rhetoric through conceptualization of core and complementary practices simplifies the socialization dynamic. Further, it takes advantage of accepted cultural semantics in meaningful analogy while continuing to empower practical diversity in care delivery in response to evolving scientific evidence.
Adams, Jon; Kawchuk, Greg; Breen, Alexander; De Carvalho, Diana; Eklund, Andreas; Fernandez, Matthew; Funabashi, Martha; Holmes, Michelle M; Johansson, Melker S; de Luca, Katie; Moore, Craig; Pagé, Isabelle; Pohlman, Katherine A; Swain, Michael S; Wong, Arnold Y L; Hartvigsen, Jan
2018-01-01
In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.
Chiropractic and CAM utilization: a descriptive review.
Lawrence, Dana J; Meeker, William C
2007-01-22
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 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. A total of 137 papers were selected, based upon including information about chiropractic utilization, CAM utilization and low back pain and other conditions. Information was extracted from each paper addressing use of chiropractic and CAM, and is summarized in tabular form. 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. 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.
Human subject research: reporting ethics approval and informed consent in 3 chiropractic journals.
Lawrence, Dana J
2011-11-01
To date, there have been no reports of ethics board approval or informed consent within the chiropractic literature or within chiropractic research. The purpose of this study was to assess the reporting of ethics approval and informed consent in articles published during the 2008 volume year of 3 chiropractic research journals included in PubMed. A quantitative assessment of the articles published in each journal for the 2008 volume year was performed. Information collected included if the article involved human subject research, if it reported ethics board approval, and if informed consent was given to subjects. Data were collected as descriptive statistics (frequency counts and percentages). In aggregate, 50 articles of a total of 143 published involved human subject research (35%). 44 reported ethics board approval (88%), and 28 reported that informed consent had been obtained (56%). Forty-five percent of articles published in the Journal of Manipulative and Physiological Therapeutics involved human subject research (39/87), of which 95% reported ethics board approval (37/39) and 64% reported informed consent (25/39); 12.5% of articles from the Journal of the Canadian Chiropractic Association involved human subject research (5/40), of which 80% reported ethics board approval (4/5) and 40% reported informed consent (2/5); and 37.5% of articles published in Chiropractic and Osteopathy involved human subject research (6/16), of which 50% reported ethics board approval (3/6) and 17% reported informed consent (1/6). Overall, most articles reported ethics approval, and more than half reported consent. This was harmonious with research on this topic from other disciplines. This situation indicates a need for continued quality improvement and for better instruction and dissemination of information on these issues to researchers, to manuscript reviewers, to journal editors, and to the readers. Copyright © 2011 National University of Health Sciences. Published by Mosby
Grieves, Brian; Menke, J Michael; Pursel, Kevin J
2009-01-01
A managed care organization (MCO) examined differences in allowed cost for managing low back pain by medical providers vs chiropractors in an integrated care environment. The purpose of this study is to provide a retrospective cost analysis of administrative data of chiropractic vs medical management of low back pain in a managed care setting. All patients with a low back pain-related diagnosis presenting for health care from January 2004 to June 2004 who were insured by an MCO in northeast Wisconsin were tracked. The cumulative health care costs incurred by this MCO during the 2-year period from January 2004 to December 2005 related to these back pain diagnoses were collected. Allowed costs of chiropractic treatment were 12% greater than medical primary care and 60% less per case than other types of medical care combined, on a per-case basis: median cost of medical primary care was $365.00, chiropractic care was $417.00, and medical nonprimary care was $669.00. This study of an MCO's low back pain allowed costs may be better redirected to primary care or chiropractic, given equivalent levels of case complexity. This study suggests chiropractic management as less expensive compared with medical management of back pain when care extends beyond primary care. Primary care management alone is virtually indistinguishable from chiropractic management in terms of costs.
Craniocervical chiropractic procedures – a précis of upper cervical chiropractic
Woodfield, H. Charles; York, Craig; Rochester, Roderic P.; Bales, Scott; Beebe, Mychal; Salminen, Bryan; Scholten, Jeffrey N.
2015-01-01
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
He, Xiaohua; La Rose, James; Zhang, Niu
2009-01-01
Most chiropractic colleges do not offer independent neuroscience courses because of an already crowded curriculum. The Palmer College of Chiropractic Florida has developed and implemented an integrated neuroscience program that incorporates neurosciences into different courses. The goals of the program have been to bring neurosciences to students, excite students about the interrelationship of neuroscience and chiropractic, improve students' understanding of neuroscience, and help the students understand the mechanisms underpinning the chiropractic practice. This study provides a descriptive analysis on how the integrated neuroscience program is taught via students' attitudes toward neuroscience and the comparison of students' perceptions of neuroscience content knowledge at different points in the program. A questionnaire consisting of 58 questions regarding the neuroscience courses was conducted among 339 students. The questionnaire was developed by faculty members who were involved in teaching neuroscience and administered in the classroom by faculty members who were not involved in the study. Student perceptions of their neuroscience knowledge, self-confidence, learning strategies, and knowledge application increased considerably through the quarters, especially among the 2nd-year students. The integrated neuroscience program achieved several of its goals, including an increase in students' confidence, positive attitude, ability to learn, and perception of neuroscience content knowledge. The authors believe that such gains can expand student ability to interpret clinical cases and inspire students to become excited about chiropractic research. The survey provides valuable information for teaching faculty to make the course content more relevant to chiropractic students.
Constructing a philosophy of chiropractic: evolving worldviews and premodern roots().
Senzon, Simon A
2011-12-01
The philosophy of chiropractic can be framed as an attempt to correct the problems inherited from the Western Enlightenment. Its origins can be found in the long tradition of Western philosophy. The purpose of this article is to describe in a broad context chiropractic's roots in premodernity and establish the structural and hermeneutical differences between chiropractic's original philosophical ideas and those of premodern philosophers. The worldview or cultural mindset the philosophy arose from must be situated in the context of its time, the birth of the unique postmodern worldview, aperspectival consciousness, and the modern sense of self. This is accomplished by exploring several metatheories about the development of the self through history, with an emphasis on the premodern roots to the chiropractic terms; Universal Intelligence and Innate Intelligence. By contextualizing the philosophy of chiropractic in terms of a structural genealogy of the self and of ideas, a new approach to philosophy in chiropractic emerges. Without accounting for chiropractic's origins as a reflection of the unique time, place, and culture, in terms of the evolution of worldviews through history, any approach to construct or reconstruct a philosophy of chiropractic will potentially miss the seminal feature of chiropractic's emergence.
The interrelationships of wellness, public health, and chiropractic
Hawk, Cheryl
2005-01-01
Abstract Objectives To explicate the relationships among the definitions and practices of chiropractic, wellness and public health and to make recommendations for strengthening these relationships. Background Public health-related topics comprise less than 2% of chiropractic coursework at most chiropractic colleges, and few connections currently exist between chiropractic and public health practice. The concept of well-ness is common to both, and might serve to bridge the gap between the individual health services provided by chiropractors and the community health services provided by public health agencies. Conclusion It is time for chiropractic to join the public health movement to improve the health and promote wellness not just in their patient populations, but in their communities, and demonstrate their commitment to patient wellness by integrating their efforts with the healthcare mainstream. PMID:19674661
Diversity in the Chiropractic Profession: Preparing for 2050
Johnson, Claire D.; Green, Bart N.
2012-01-01
As the diversity of the United States (US) population continues to change, concerns about minority health and health disparities grow. Health professions must evolve to meet the needs of the population. The purpose of this editorial is to review current trends in the diversity of chiropractic students, faculty, and practitioners in the United States. This editorial was informed by a search of the literature, to include PubMed, using the terms chiropractic and diversity, minority, and cultural competency. Demographic information for the chiropractic profession was obtained from the National Board of Chiropractic Examiners and The Chronicle of Higher Education. These data were compared to diversity data for medical doctors and the national and state populations from the American Association of Medical Colleges and the US Census, respectively. Surprisingly little has been published in the peer-reviewed literature on the topic of diversity in the chiropractic profession. For the variables available (sex and race), the data show that proportions in the US chiropractic profession do not match the population. State comparisons to associated chiropractic colleges show similar relationships. No reliable data were found on other diversity characteristics, such as gender identity, religion, and socioeconomic status. The chiropractic profession in the United States currently does not represent the national population with regard to sex and race. Leaders in the profession should develop a strategy to better meet the changing demographics of the US population. More attention to recruiting and retaining students, such as underrepresented minorities and women, and establishing improved cultural competency is needed. PMID:22778525
... physical function. Why it's done Low back pain, neck pain and headache are the most common problems for ... headaches and other spine-related conditions, such as neck pain. Not everyone responds to chiropractic adjustments. A lot ...
Polkinghorn, B S
1994-09-01
To present the first reported case of successful chiropractic intervention in treatment of a torn medial meniscus of the knee, the meniscal tear being documented by magnetic resonance imaging (MRI). A 54-yr-old woman complaining of right knee pain of several months' duration with accompanying marked functional impairment was diagnosed as having a tear in the posterior horn of the ipsilateral medial meniscus, verified by MRI studies of the same. Independent consultation with three medical specialists resulted in the unanimous decision that surgical intervention for the purpose of meniscectomy provided the only therapeutic approach indicated for the problem. However, the patient was reticent to undergo said surgical procedure and chose, instead, to utilize chiropractic care and conservative management in an effort to resolve her condition without having to resort to surgery. The patient received chiropractic treatment to the knee via mechanical force, manually assisted short lever chiropractic adjusting procedures (MFMA) utilizing an Activator Adjusting Instrument. Auxiliary treatment included the use of homeopathic therapy as an adjunct to chiropractic care. Said treatment resulted in a complete resolution of the patient's disability, the patient recovering full function of the knee joint and achieving an asymptomatic status without having to submit to surgical intervention and its possible adverse sequelae. Conservative management of meniscal tears via chiropractic treatment may provide a therapeutically effective and financially cost containing alternative to routine meniscectomy in certain cases involving torn medial menisci of the knee.
A History of The Journal of Chiropractic Education
Green, Bart N.; Jacobs, Grace E.; Johnson, Claire D.; Phillips, Reed B.
2011-01-01
Purpose: The Journal of Chiropractic Education celebrates its 25th anniversary in the year 2011. The purpose of this article is to chronicle the history of the journal, which is unreported at this time. Methods: The entire collection of the journal was reviewed and information pertaining to important events and changes in the format, personnel, and processes of the journal were extracted. This information was used to create a chronology of the journal. The chronology was complemented with information obtained from people who were involved in the evolution of the journal and the Association of Chiropractic Colleges Educational Conferences. Results: Starting as a humble newsletter in 1987 and produced for a small cadre of readers primarily from the United States, the journal is now a full-sized and bound peer-reviewed international journal. Initially cataloged by the Index to Chiropractic Literature and MANTIS, the indexing expanded to interdisciplinary indexing systems such as CINAHL and ultimately PubMed. The journal has grown to serve the needs of chiropractic educators from around the world with representatives on the editorial board from 39 colleges and universities from 15 different countries. The journal has grown in tandem with the profession’s leading education and research conference and has been the primary repository for the scholarship of chiropractic education. Conclusion: The history of the journal represents a significant milestone in the development of the chiropractic profession, particularly the discipline of chiropractic education. The journal has had an interesting history and the future promises to bring more opportunities and challenges to the field of chiropractic education and to the journal. PMID:22069342
Professional Identity at Los Angeles College of Chiropractic.
Kimura, Melissa Nagare; Russell, Robb; Scaringe, John
2016-12-01
The objective of this article is to describe chiropractic professional identity as espoused by the Los Angeles College of Chiropractic. Professional identity is a construct that begins formation prior to career selection, can be considered the backbone of health care education, and has been linked to career success. Los Angeles College of Chiropractic's professional identity is shaped by a philosophy of health care that is focused on vitalism, holism, naturalism, therapeutic conservatism, critical rationalism, phenomenology, humanism, and interprofessionalism. Other distinguishing aspects include portal-of-entry professionals with broad diagnostic skills; a focus on spine care; promotion of public-health; and delivery of manual treatments. The chiropractic professional identity at the Los Angeles College of Chiropractic focuses on serving the needs of the people who entrust their health to its graduates and will continue to evolve on the basis of many factors, such as politics, social perceptions, and economic conditions.
Variations in the implementation and characteristics of chiropractic services in VA.
Lisi, Anthony J; Khorsan, Raheleh; Smith, Monica M; Mittman, Brian S
2014-12-01
In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking. To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems. Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach. Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.
Chaibi, Aleksander; Šaltytė Benth, Jūratė; Tuchin, Peter J; Russell, Michael Bjørn
2015-01-01
Introduction Migraine affects 15% of the population, and has substantial health and socioeconomic costs. Pharmacological management is first-line treatment. However, acute and/or prophylactic medicine might not be tolerated due to side effects or contraindications. Thus, we aim to assess the efficacy of chiropractic spinal manipulative therapy (CSMT) for migraineurs in a single-blinded placebo-controlled randomised clinical trial (RCT). Method and analysis According to the power calculations, 90 participants are needed in the RCT. Participants will be randomised into one of three groups: CSMT, placebo (sham manipulation) and control (usual non-manual management). The RCT consists of three stages: 1 month run-in, 3 months intervention and follow-up analyses at the end of the intervention and 3, 6 and 12 months. The primary end point is migraine frequency, while migraine duration, migraine intensity, headache index (frequency x duration x intensity) and medicine consumption are secondary end points. Primary analysis will assess a change in migraine frequency from baseline to the end of the intervention and follow-up, where the groups CSMT and placebo and CSMT and control will be compared. Owing to two group comparisons, p values below 0.025 will be considered statistically significant. For all secondary end points and analyses, a p value below 0.05 will be used. The results will be presented with the corresponding p values and 95% CIs. Ethics and dissemination The RCT will follow the clinical trial guidelines from the International Headache Society. The Norwegian Regional Committee for Medical Research Ethics and the Norwegian Social Science Data Services have approved the project. Procedure will be conducted according to the declaration of Helsinki. The results will be published at scientific meetings and in peer-reviewed journals. Trial registration number NCT01741714. PMID:26586317
Weeks, William B; Goertz, Christine M
2016-05-01
The purpose of this study was to determine whether the per-capita supply of doctors of chiropractic (DCs) or Medicare spending on chiropractic care was associated with opioid use among younger, disabled Medicare beneficiaries. Using 2011 data, at the hospital referral region level, we correlated the per-capita supply of DCs and spending on chiropractic manipulative therapy (CMT) with several measures of per-capita opioid use by younger, disabled Medicare beneficiaries. Per-capita supply of DCs and spending on CMT were strongly inversely correlated with the percentage of younger Medicare beneficiaries who had at least 1, as well as with 6 or more, opioid prescription fills. Neither measure was correlated with mean daily morphine equivalents per opioid user or per chronic opioid user. A higher per-capita supply of DCs and Medicare spending on CMT were inversely associated with younger, disabled Medicare beneficiaries obtaining an opioid prescription. However, neither measure was associated with opioid dosage among patients who obtained opioid prescriptions. Copyright © 2016. Published by Elsevier Inc.
Should the chiropractic profession embrace the doctrine of informed consent?
Lehman, James J.; Conwell, Timothy D.; Sherman, Paul R.
2008-01-01
Abstract This commentary provides a narrative review of the literature focusing on the use of a health care informed consent process in the United States. This article reviews the current positions of the World Medical Association, American Medical Association, American Chiropractic Association, Wisconsin and New Jersey State Courts, US Federal Government Office of Health Policy and Clinical Outcomes, and 1 college of chiropractic regarding the doctrine of informed consent. The authors recommend that the chiropractic profession embrace the doctrine of informed consent and promulgate it as a standard of care. The implementation of this doctrine by chiropractic physicians promotes and improves the safety of chiropractic interventions. PMID:19646372
Strunk, Richard G
2017-06-01
The purpose of this article is to describe the clinical response to multimodal chiropractic treatment of a patient diagnosed with Ehlers-Danlos syndrome, hypermobility type (EDS-HT), and chronic pain. A 22-year-old woman presented with severe chronic neck and low back pain, headaches, and bilateral hand pain and stiffness. In addition to these pain complaints, the patient had a family history of EDS, weekly or daily recurring joint dislocations, and upper and lower extremity joint hypermobility. As a result of her significant history and examination findings, which met the Brighton and Villefranche criteria, she was diagnosed with EDS-HT. Treatment primarily consisted of low force joint manipulative therapy and soft tissue therapy intermittently over 21 months concurrently with conventional and complementary medical care. Multiple outcome questionnaires were administered pragmatically at follow-up intervals of 3, 5½, 8½, 19, and 21 months, including but not limited to the Headache and Neck Disability Indices and the Oswestry Low Back Questionnaire. The patient had clinically meaningful improvements on the Neck Disability Index, the Headache Disability Index, and the Revised Oswestry after 3, 5½, 8½, and 21 months from baseline. This patient with EDS-HT had clinically meaningful decreases in disability, headache, and spine pain after a course of multimodal chiropractic care combined with conventional and complementary medical care.
Haldeman, Scott; Chapman-Smith, David
2012-01-01
This editorial reviews the scientific sessions and announces the 4 award-winning scientific articles from the World Federation of Chiropractic 11th Biennial Congress held in Rio de Janeiro from April 6, to 9, 2011, that are published in this issue of the Journal of Manipulative and Physiological Therapeutics. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
ERIC Educational Resources Information Center
New York State Education Dept., Albany. Office of the Professions.
This reference guide contains laws, regulations, and licensing requirements and procedures governing chiropractic practice in New York State. Following a general introduction to professional regulation in New York State, licensure requirements are spelled out in detail, including general requirements, education requirements, examination…
Russell, David G.; Kimura, Melissa N.; Cowie, Harriet R.; de Groot, Caroline M.M.; McMinn, Elise A.P.; Sherson, Matthew W.
2016-01-01
Objective The purpose of this case series is to report on symptomatic and quality of life (QoL) changes in 7 older adult chiropractic patients who were receiving care using Activator Methods Chiropractic Technique (AMCT). Clinical Features Seven patients were selected from 2 chiropractic offices in Auckland, New Zealand. Patients were included if they were older adults receiving AMCT care and for whom at least 2 QoL assessments had been performed. The patients, aged 69-80 years, primarily received care for a variety of musculoskeletal complaints. Intervention and Outcomes The patients reported improvements in their presenting complaints as well as a number of nonmusculoskeletal symptoms. Each patient demonstrated clinical improvements in their RAND 36-Item Short Form Health Survey (SF-36) results. The average improvement in QoL measured using a SF-36 questionnaire was 8.0 points in the physical component and 4.1 points in the mental component. Four cases had a second progress evaluation using the SF-36 and showed an overall improvement of 5.2 in the physical and 9.8 in the mental components from baseline. Conclusion This case series describes an improvement in QoL, as measured by the SF-36 instrument, as well as subjectively reported improvements in both musculoskeletal and nonmusculoskeletal symptoms in 7 older adults receiving chiropractic care. PMID:27069434
Practice patterns of doctors of chiropractic with a pediatric diplomate: a cross-sectional survey
2010-01-01
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
Attitudes and views on chiropractic: a survey of United States midwives.
Mullin, Linda; Alcantara, Joel; Barton, Derek; Dever, Lydia
2011-08-01
A survey of midwives' knowledge and views about chiropractic. Cross-sectional descriptive survey. An anonymous on-line self-administered survey. United States midwives. Respondent demographics, professional training, personal and professional clinical experience, opinions on safety of chiropractic, and scope of chiropractic practice. A total of 187 midwife respondents completed the questionnaire resulting in a superficial response rate of 2.1%. Responders were certified nurse-midwives and had some form of training regarding chiropractic. The responders were aware that chiropractors worked with "birthing professionals" and attended to patients with both musculoskeletal and non-musculoskeletal disorders. A vast majority indicated a positive personal and professional clinical experience with chiropractic and that chiropractic was safe for pregnant patients and children. There is great awareness of and positive personal and professional experience with chiropractic on the part of midwives who participated in this survey. We encourage further research in this field. Copyright © 2010 Elsevier Ltd. All rights reserved.
A treatise for a new philosophy of chiropractic medicine.
Mirtz, Timothy A
2017-01-01
The philosophy of chiropractic has been a much debated entity throughout the existence of the chiropractic profession. Much criticism has been passed upon the historical philosophy of chiropractic and propagated by contemporary adherents. To date, a new philosophy has not been detailed nor presented that demonstrates principles by which to follow. The purpose of this paper is to expand upon the work of Russell Kirk (b.1918, d. 1994), an American political theorist, as a basis for principles to guide the formation of a philosophy of chiropractic medicine (PCM). Each of Kirk's principles will be explained and expounded upon as applicable to a PCM. The addition of the term "medicine" to chiropractic is indicative of a new direction for the profession. The ten principles that provide a foundation for a PCM include: (a) moral order, (b) custom, convention and continuity, (c) prescription, (d) prudence, (e) variety, (f) imperfectability, (g) freedom and property linkage, (h) voluntary community and involuntary collectivism, (i) prudent restraints upon power and human passions, and (j) permanence and change. Each of these principles offers not a dogmatic approach but provides insight into the application of chiropractic medicine to the entire station of the patient and society at large especially that of the economic, social and political. These principles provide direction in not only the approach to the doctor-patient encounter but can be used to visualize the wider world and its potential impact. Instead, these principles examine many tangential issues worthy of discussion that may impact health, social, political, and economic policy and how the chiropractic profession can approach these issues. This paper provides the initial steps in formulating a PCM using principles from a sociological, political and economic standpoint which may impact on how chiropractic medicine approaches the patient and society in totality. In addition, these principles provide the necessary
... the sciences. Chiropractic training is a 4-year academic program that includes both classroom work and direct ... health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does ...
2013-01-01
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
Hennius, Bjorn J
2013-08-08
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. 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. 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. Although
Multinational survey of chiropractic patients: reasons for seeking care
Blum, Charles; Globe, Gary; Terre, Lisa; Mirtz, Timothy A.; Greene, Leon; Globe, Denise
2008-01-01
Introduction This study explores the extent to which consumers seek wellness care when choosing chiropractors whose practice methods are known to include periodic evaluative and interventional methods to maintain wellness and prevent illness. Methods Using an international convenience sample of Sacro-Occipital Technique (SOT) practitioners, 1316 consecutive patients attending 27 different chiropractic clinics in the USA, Europe and Australia completed a one-page survey on intake to assess reason for seeking care. A forced choice response was obtained characterizing the patient’s reason for seeking chiropractic care. Results More than 40% of chiropractic patient visits were initiated for the purposes of health enhancement and/or disease prevention. Conclusion Although prudence dictates great caution when generalizing from this study, if confirmed by subsequent research among other similar cohorts, the present results may lend support to continued arguments of consumer demand for a more comprehensive paradigm of chiropractic care, beyond routine musculoskeletal complaints, that conceptualizes the systemic, nonspecific effects of the chiropractic encounter in much broader terms. PMID:18769601
Multinational survey of chiropractic patients: reasons for seeking care.
Blum, Charles; Globe, Gary; Terre, Lisa; Mirtz, Timothy A; Greene, Leon; Globe, Denise
2008-08-01
This study explores the extent to which consumers seek wellness care when choosing chiropractors whose practice methods are known to include periodic evaluative and interventional methods to maintain wellness and prevent illness. Using an international convenience sample of Sacro-Occipital Technique (SOT) practitioners, 1316 consecutive patients attending 27 different chiropractic clinics in the USA, Europe and Australia completed a one-page survey on intake to assess reason for seeking care. A forced choice response was obtained characterizing the patient's reason for seeking chiropractic care. More than 40% of chiropractic patient visits were initiated for the purposes of health enhancement and/or disease prevention. Although prudence dictates great caution when generalizing from this study, if confirmed by subsequent research among other similar cohorts, the present results may lend support to continued arguments of consumer demand for a more comprehensive paradigm of chiropractic care, beyond routine musculoskeletal complaints, that conceptualizes the systemic, nonspecific effects of the chiropractic encounter in much broader terms.
Iowa Chiropractic Students Outlook for Practitioners and Need for State-Funded Assistance.
ERIC Educational Resources Information Center
Greiner, Keith
This state-mandated study examined the needs of Iowa chiropractic students and the Iowa demand for chiropractic health care in order to determine the feasibility of establishing a chiropractic forgivable loan program. The project used financial aid data and repayment rate data to evaluate the need for financial aid for chiropractic students;…
The Fountain Head Chiropractic Hospital: the dream that almost came true
Bakkum, Barclay W.; Nolan, Delores Bakkum
2010-01-01
Objective The purpose of this article is to relate information about the life of Dr William Ivens and describe the worldwide effort led by him to establish a chiropractic hospital at the Palmer School of Chiropractic. Discussion Dr William Ivens, a colorful politician and chiropractor from Winnipeg, Canada, was the driving force behind the idea of establishing a chiropractic hospital at the Palmer School of Chiropractic in Davenport, IA, during the late 1930s. With the blessings of Dr BJ Palmer, president of the Palmer School of Chiropractic, Dr Ivens led an aggressive, worldwide campaign to raise the funds necessary to establish what was to be called the Fountain Head Chiropractic Hospital. During the tumultuous years of 1937-1942, this campaign successfully raised the target sum of $50 000, thought necessary to create the hospital, but the idea never became a reality. These funds were eventually used to purchase the Clear View Sanitarium, a chiropractic psychiatric facility, in Davenport, IA, in 1952. Conclusion Dr William Ivens stands as a prime example of a relatively small, but dedicated, number of chiropractors during the mid-20th century who not only believed in, but toiled for, the idea of chiropractic care being given in an in-patient setting. PMID:22693476
Process versus outcome: challenges of the chiropractic wellness paradigm
Russell, Eric G.
2010-01-01
Objective The purpose of this article is to discuss the term wellness in the context of the philosophy of chiropractic. Discussion PubMed and Index to Chiropractic Literature show an upward trend in use of the term wellness. Wellness may be used differently depending upon the profession and may be considered a process by some and an outcome by others. Conclusion There appears to be no consensus on the definition of wellness or how it is being used. Wellness is not exclusive to chiropractic, and wellness is not synonymous with health, although is often used that way. Wellness is a societal trend, and chiropractic as a health care profession may be a good fit for this concept. PMID:22693468
ERIC Educational Resources Information Center
New York State Education Dept., Albany. Office of the Professions.
The laws, rules and regulations of the State Education Department governing chiropractic practice in New York State are provided in this handbook. Requirements and procedures are also highlighted, and the forms for obtaining a license and first registration as a chiropractor are provided. The booklet is divided into the following sections:…
Lisi, Anthony J; Salsbury, Stacie A; Hawk, Cheryl; Vining, Robert D; Wallace, Robert B; Branson, Richard; Long, Cynthia R; Burgo-Black, A Lucille; Goertz, Christine M
2018-02-01
The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain. Copyright © 2018. Published by Elsevier Inc.
A narrative review of the published chiropractic literature regarding older patients from 2001–2010
Gleberzon, Brian J.
2011-01-01
Introduction: The purpose of this article was to perform a narrative review of the chiropractic literature regarding older patients between 2001 and 2010. Methods: A three step search strategy of the literature involved electronic searching, hand searching and reference tracking. Results: One hundred and eighty eight articles germane to chiropractic geriatric practice and education were retrieved. Discussion: Compared to the review of the literature conducted prior to 2000, the number of references on chiropractic geriatric education increased from 3 to 11, the number of demographic studies increased from 9 to 18, the number of case reports increased from 25 to 83, the number of clinical trials increased from 4 to 21 (only two RCTs found) and the number of references on clinical guidelines and general clinical information increased from 18 to 55. Conclusion: This review found 188 retrievable articles available to practitioners to effectively care plan for their older patients, a better than three fold increase in the number of references found during a similar review conducted at the end of the previous decade. However, there is clearly a gap in the evidence base of chiropractic geriatric care, particularly the under-representation of clinical trials of all kinds involving older chiropractic patients. PMID:21629461
The Chiropractic Care of Infants with Breastfeeding Difficulties.
Alcantara, Joel; Alcantara, Joey D; Alcantara, Junjoe
2015-01-01
Chiropractors have long advocated on the benefits of breastfeeding and given the realized and potential role of chiropractors in the care of infants with breastfeeding difficulties, we performed this review of the literature on the subject to inform clinical practice. For this article, we searched Pubmed [1966-2013], Manual, Alternative and Natural Therapy Index System (MANTIS) [1964-2013] and Index to Chiropractic Literature [1984-2013] for the relevant literature. The search terms utilized "breastfeeding", "breast feeding", "breastfeeding difficulties", "breastfeeding difficulty", "TMJ dysfunction", "temporomandibular joint", "birth trauma" and "infants", in the appropriate Boolean combinations. We also examined non-peer-reviewed articles as revealed by Index to Chiropractic Literature and secondary analysis of references. Inclusion criteria for review included breastfeeding difficulties regardless of peer-review and written in the English language. A total of 24 articles met our inclusion criteria. These consisted of 8 case reports, 2 case series, and 3 cohort studies. We were also able to identify 6 manuscripts (5 case reports and a case series) that involved breastfeeding difficulties as a secondary complaint. Our findings reveal a theoretical and clinical framework based on the detection of spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex and assessment of the infant while breastfeeding. Chiropractors care of infants with breastfeeding difficulties by addressing spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex. Copyright © 2015 Elsevier Inc. All rights reserved.
United States Chiropractic Practice Acts and Institute of Medicine defined primary care practice
Duenas, Richard
2002-01-01
Abstract Objective This review was conducted to analyze the law for the practice of chiropractic throughout the United States, including the District of Columbia, Puerto Rico and the U.S. Virgin Islands, to determine the legal ability of the Doctor of Chiropractic in each jurisdiction to provide primary care service as described by the 1996 Institute of Medicine Definition of Primary Care. Method The practice acts for each State, the District of Columbia, Puerto Rico and the U.S. Virgin Islands were reviewed for language that would permit the chiropractic doctor to meet the 9 criteria of primary care practice described by the Institute of Medicine. Forty-four practice acts were cross referenced with the results of a scope of practice survey of State Boards of Chiropractic in 1999. Results The review of the practice acts and the survey on chiropractic scope of practice revealed a varied degree of chiropractic scope of practice with 23 of 53 of the jurisdictions limiting the ability of the chiropractic doctor to fully provide IOM defined primary care. Conclusion The varied practice act definitions for chiropractic practice throughout the United States the District of Columbia, Puerto Rico and the U.S. Virgin Islands reveal an inability of the chiropractic profession to respond to a call for a standard nationally-based primary-care policy that could be readily achieved by all chiropractic practitioners throughout the Union. This void of primary-care qualification in many State and Commonwealth practice acts will need to be addressed by the leaders of the profession if government entities and national third party organizations are to utilize chiropractic health care services to the standard of chiropractic education and clinical experience. The need for a broad range chiropractic scope of practice model practice act is suggested. PMID:19674578
Concussion assessment and management knowledge among chiropractic fourth year interns and residents.
Kazemi, Mohsen; Pichini, Alessandro; Scappaticci, Steven; Savic, Mitchell
2016-12-01
To investigate the degree of knowledge chiropractic fourth year interns and post-graduate chiropractic residents have in regard to concussion diagnosis and management. A survey modified from a study conducted by Boggild and Tator (2012), was administered to fourth year chiropractic interns and post-graduate residents via SurveyMonkey.com. Chiropractic fourth year interns and postgraduate chiropractic specialty college residents scored 5.2 and 5.25 out of 9 respectively, which compares well with Bogglid and Tator's reports on medical students and residents. Several knowledge gaps were identified in the sample population. The results from this survey show that the concussion knowledge among Canadian fourth year chiropractic interns and specialty college residents compares favorably with the knowledge of fourth year medical students and residents in diagnosing and managing concussions. Chiropractors appear to possess the skills and knowledge to diagnose and manage concussion equal to their medical counterparts. However, knowledge gaps regarding concussion diagnosis and management were found among chiropractic students and residents.
Development of the Murdoch Chiropractic Graduate Pledge
Simpson, J. Keith; Losco, Barrett; Young, Kenneth J.
2010-01-01
Purpose: This paper reviews the origins of the learned professions, the foundational concepts of professionalism, and the common elements within various healer's oaths. It then reveals the development of the Murdoch Chiropractic Graduate Pledge. Methods: A committee comprised of three Murdoch academics performed literature searches on the topic of professionalism and healer's oaths and utilized the Quaker consensus process to develop the Murdoch Chiropractic Graduate Pledge. Results: The committee in its deliberations utilized over 200 relevant papers and textbooks to formulate the Murdoch Chiropractic Graduate Pledge that was administered to the 2010 Murdoch School of Chiropractic and Sports Science graduates. The School of Chiropractic and Sports Science included professionalism as one of its strategic goals and began the process of curriculum review to align it with the goal of providing a curriculum that recognizes and emphasizes the development of professionalism. Conclusions: The reciting of a healer's oath such as the Hippocratic Oath is widely considered to be the first step in a new doctor's career. It is seen as the affirmation that a newly trained health care provider will use his or her newfound knowledge and skill exclusively for the benefit of mankind in an ethical manner. Born from the very meaning of the word profession, the tradition of recitation of a healer's oath is resurgent in health care. It is important for health care instructors to understand that the curriculum must be such that it contributes positively to the students' professional development. PMID:21048880
Assessing the attitudes, knowledge and perspectives of medical students to chiropractic
Wong, Jessica J.; Di Loreto, Luciano; Kara, Alim; Yu, Kavan; Mattia, Alicia; Soave, David; Weyman, Karen; Kopansky-Giles, Deborah
2013-01-01
Objective: To assess second-year medical students’ views on chiropractic. Methods: A three-step triangulation approach was designed, comprising a 53-item survey, nine key informant interviews and one focus group of 8 subjects. ANOVA was used to assess attitude-response survey totals over grouping variables. Constant comparison method and NVivo was used for thematic analysis. Results: 112 medical students completed the survey (50% response rate). Subjects reporting no previous chiropractic experience/exposure or interest in learning about chiropractic were significantly more attitude-negative towards chiropractic. Thematically, medical students viewed chiropractic as an increasingly evidence-based complementary therapy for low back/chronic pain, but based views on indirect sources. Within formal curriculum, they wanted to learn about clinical conditions and benefits/risks related to treatment, as greater understanding was needed for future patient referrals. Conclusion: The results highlight the importance of exposure to chiropractic within the formal medical curriculum to help foster future collaboration between these two professions. PMID:23482682
Wotherspoon, Sheena E; McCarthy, Peter W
2016-01-01
There are many professional associations representing chiropractors and chiropractic in the United Kingdom (UK). Each has its unique selling points (USPs) and chiropractors can choose to join as many as they like; however, cost of membership has to be weighed against perceived benefits. The predictors of UK chiropractic association membership and motivational factors to join these associations, have not formally been identified. This research study aimed to identify some of the factors and motivations in Welsh Institute of Chiropractic (WIOC) Alumni regarding their decision to join (or not) a UK chiropractic professional association. An online survey instrument, comprising 23 questions, was administered from November-December 2015 via a link announced on 'The WIOC Alumni' Facebook group (N = 655), the active platform for the WIOC Alumni Organisation. One hundred forty-eight respondents (approximately 22.6 % of 'The WIOC Alumni' Facebook group membership) completed the survey. Ten factors were reported to be important in decision making: 'promoting public awareness of chiropractic' (91.2 %), 'access to professional indemnity insurance' (89.2 %), 'overall professionalism of the association' (87.2 %), 'the identity of the association' (77.7 %), 'positive attitude to research' (77.0 %), 'workplace support and advice' (68.9 %), 'access to events \\ courses \\ seminars' (64.2 %), 'Continuing Professional Development (CPD) activities' (62.2 %), 'cost of membership' (59.5 %) and 'addresses my area of interest' (56.1 %). 'Many of my friends have joined' (71.6 %) was considered unimportant, whereas 'Lobbying: Influencing policy' and 'career development' were considered important by almost twice as many as those that consider them unimportant (45.3 %: 25.7 % and 43.9 %: 27.0 % respectively), 'requirement of employment' and 'associations newsletter' were seen as unimportant by roughly twice as many as those considering them important (44.6 %: 28.4 % and
Trends and predictors of publicly subsidized chiropractic service use among adults age 50+.
Votova, Kristine; Penning, Margaret J; Zheng, Chi; Brackley, Moyra E
2010-09-01
This article examines trends in and predictors of publicly subsidized chiropractic use from 1991 to 2000, a decade characterized by health care system reforms throughout North America. The sample included adults age 50+ who visited a publicly subsidized chiropractor in the Canadian province of British Columbia during the study period. Administrative claims data for chiropractic service use were drawn from the Medical Services Plan (MSP) Master file in the British Columbia Linked Health Data resource. The MSP Master file contains claims reported for every provincially insured medical service and supplementary health benefit including chiropractic visits. Joinpoint regression analyses demonstrate that while annual rates of chiropractic users did not change over the decade, visit rates decreased during this period. Predictors of a greater number of chiropractic visits include increasing age, female gender, urban residence, low to moderate income, and use of chiropractic services earlier in the decade. The trend toward decreasing visit rates over the 1990s both conflicts with and is consistent with findings from other North American chiropractic studies using similar time periods. Results indicating that low and moderate income and advancing age predict more frequent chiropractic service are novel. However, given that lower income and older individuals were exempted from chiropractic service limits during this period, these results suggest support for the responsive nature of chiropractic use to financial barriers.
Sherrod, Charles W.; Casey, George; Dubro, Robert E.; Johnson, Dale F.
2013-01-01
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
Bowden, Briana S; Ball, Lisa
2016-10-01
The purpose of this study was to assess nurse practitioner (NP) and physician assistant (PA) students' views of chiropractic. As the role of these providers progresses in primary care settings, providers' views and knowledge of chiropractic will impact interprofessional collaboration and patient outcomes. Understanding how NP and PA students perceive chiropractic may be beneficial in building integrative health care systems. This descriptive quantitative pilot study utilized a 56-item survey to examine attitudes, knowledge, and perspectives of NP and PA students in their 2nd year of graduate studies. Frequencies and binomial and multinomial logistic regression models were used to examine responses to survey totals. Ninety-two (97%) students completed the survey. There were conflicting results as to whether participants viewed chiropractic as mainstream or alternative. The majority of participants indicated lack of awareness regarding current scientific evidence for chiropractic and indicated a positive interest in learning more about the profession. Students who reported prior experience with chiropractic had higher attitude-positive responses compared to those without experience. Participants were found to have substantial knowledge deficits in relation to chiropractic treatments and scope of practice. The results of this study emphasize the need for increased integrative initiatives and chiropractic exposure in NP and PA education to enhance future interprofessional collaboration in health care.
Concussion assessment and management knowledge among chiropractic fourth year interns and residents
Kazemi, Mohsen; Pichini, Alessandro; Scappaticci, Steven; Savic, Mitchell
2016-01-01
Objectives: To investigate the degree of knowledge chiropractic fourth year interns and post-graduate chiropractic residents have in regard to concussion diagnosis and management. Methods: A survey modified from a study conducted by Boggild and Tator (2012), was administered to fourth year chiropractic interns and post-graduate residents via SurveyMonkey.com. Results: Chiropractic fourth year interns and postgraduate chiropractic specialty college residents scored 5.2 and 5.25 out of 9 respectively, which compares well with Bogglid and Tator’s reports on medical students and residents. Several knowledge gaps were identified in the sample population. Conclusion: The results from this survey show that the concussion knowledge among Canadian fourth year chiropractic interns and specialty college residents compares favorably with the knowledge of fourth year medical students and residents in diagnosing and managing concussions. Chiropractors appear to possess the skills and knowledge to diagnose and manage concussion equal to their medical counterparts. However, knowledge gaps regarding concussion diagnosis and management were found among chiropractic students and residents. PMID:28065987
Funk, Matthew F; Lisi, Anthony J
2009-05-01
The purpose of this study is to document and describe the policies governing conflict of interest (COI) among select organizations and institutions offering chiropractic continuing education. Surveys were sent to the following: all North American chiropractic colleges; major national chiropractic organizations; and state chiropractic organizations in states with more than 3500 licensed Doctors of Chiropractic. Each organization or institution was surveyed regarding written and verbal COI policies. Half of the respondents in this survey indicated that they had written policies for management of COI, whereas half did not. None included most of the common elements typically outlined in continuing medical education COI policies. Content varied among the policies available for review. Relevant financial interest is the issue most often defined, and respondents generally prohibit presenters from selling products or services directly during presentations. Overall, these results suggest that processes for managing COI in chiropractic CE are less robust than those previously described for continuing medical education. This study provides preliminary insight into the status of COI management in chiropractic CE.
Impact of chiropractic services at an on-site health center.
Kindermann, Sylvia L; Hou, Qingjiang; Miller, Ross M
2014-09-01
To compare the influence of employer-sponsored, on-site chiropractic care against community-obtained care on health care utilization. This was a retrospective claims analysis of members of a single employee health plan receiving chiropractic care on-site or off-site from 2010 to 2012. Utilization differences were evaluated by having 1 health care event or more, including radiology or clinical visits. There were 876 on-site and 759 off-site participants. The off-site group received more radiology services overall (55.5% vs 38.2%; P < 0.001) including magnetic resonance imaging, ultrasound, and radiograph (all P < 0.0001); had higher outpatient (P < 0.0001) and emergency department (P = 0.022) utilization; and demonstrated greater use of chiropractic care and physical therapy (both P < 0.0001). Compared with off-site care, on-site chiropractic services are associated with lower health care utilization. These results support the value of chiropractic services offered at on-site health centers.
Young, Kenneth J
2017-01-01
Over the past 20 years, various authors have addressed the question of the future of chiropractic. Most were positive about the future, with some advocating evidence-based practice and integration with mainstream healthcare, some advocating continued separation with an emphasis on subluxation-based care or the traditional/historical paradigm of chiropractic, and some calling for tolerance and unity. No papers were found specifically inquiring about the future of chiropractic radiology. The study population consisted of all current members of the American Chiropractic College of Radiology (ACCR), estimated at 190 people, known as chiropractic radiologists or Diplomates of the American Chiropractic Board of Radiology (DACBRs). An internet-based, anonymous survey using SurveyMonkey was implemented, supplemented by hard copies distributed at a conference. The main point of interest for this paper is the final item of the overall questionnaire. This item inquired about the future of chiropractic radiology. Thematic analysis was used on the responses, coded in both constructionist and inductive ways to extract both a general outlook and more specific themes. The inductive themes were also assigned secondarily to a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The overall response rate to the survey was 38% (73/190); within the group of respondents, 71 of 73 (98%) answered the item that is the subject of this paper. Opinions on the outlook for chiropractic radiology in the future were more negative than positive, with 14 respondents giving a positive outlook, 26 negative, and 14 non-committal. 28 respondents advocated integration with the wider healthcare community, 11 recommended emphasising separateness or a focus on working within chiropractic, and 15 did not express an opinion on this issue. Ten strengths were noted, 11 weaknesses, 57 opportunities, and 30 threats. The increasing necessity of demonstrating evidence for diagnostic and therapeutic
The origins and early history of the National Chiropractic Association
Keating, Joseph C; Rehm, William S
1993-01-01
Early organization in chiropractic was prompted by the profession’s need to promote itself and to defend against the onslaught of political medicine and organized osteopathy. The first priorities were legal defense against prosecution for unlicensed practice and malpractice insurance. The Universal Chiropractors’ Association (UCA), organized at the Palmer School of Chiropractic (PSC) in 1906, sought to meet these needs by insuring its members and by developing a legal department under the supervision of attorney Tom Morris, one time lieutenant governor of Wisconsin. The public relations and marketing needs of chiropractors were largely served by the PSC and its legendary leader. However, as chiropractors increasingly sought to avoid prosecution by passage of chiropractic laws, Palmer’s efforts to direct this legislation so as to limit chiropractors’ scope of practice increasingly alienated many in the profession. The American Chiropractic Association (ACA) was founded in 1922 to provide a broadscope alternative to BJ’s UCA. With Palmer’s departure from the UCA following the neurocalometer debacle, ACA and UCA sought amalgamation. Simultaneously, organized medicine renewed its attack on the profession by introducing basic science legislation, which prompted chiropractors to try to upgrade and standardize chiropractic education. Early efforts to bring about the needed consensus were centered in the International Chiropractic Congress (ICC), particularly its division of state examining boards. In 1930 the ACA and UCA combined to form the National Chiropractic Association (NCA), and by 1934 the ICC had merged with the NCA to form part of its council structure. With this modicum of solidarity the NCA began the process of educational boot-strapping at its 1935 convention in Los Angeles, when its Committee on Education, a forerunner of today’s Council on Chiropractic Education, was proposed by C.O. Watkins of Montana. ImagesFigure 2Figure 3Figure 4Figure 5
The STarT back tool in chiropractic practice: a narrative review.
Khan, Yasmeen
2017-01-01
The Keele STarT Back Tool was designed for primary care medical physicians in the UK to determine the risk for persistent disabling pain in patients with musculoskeletal pain and to tailor treatments accordingly. In medical and physical therapy settings, STarT Back Tool's tailored care plans improved patients' low back pain outcomes and lowered costs. Review studies using the STarT Back Tool in chiropractic patient populations. PubMed, The Cochrane Library, Index to Chiropractic Literature, and Science Direct databases were searched. Articles written in English, published in peer-reviewed journals, that studied the STarT Back Tool in patients seeking chiropractic care were included. Seven articles were selected based on inclusion and exclusion criteria. The STarT Back Tool was feasibly incorporated into 19 chiropractic clinics in Denmark. Total STarT Back 5-item score correlated moderately with total Bournemouth Questionnaire score. Two studies reported that the STarT Back Tool's predictive ability was poor, while another reported that the tool predicted outcomes in patients scoring in the medium and high risk categories who completed the STarT Back 2 days after their initial visit. A study examining Danish chiropractic, medical and physical therapy settings revealed that only baseline episode duration affected STarT Back's prognostic ability across all care settings. The tool predicted pain and disability in chiropractic patients whose episode duration was at least 2 weeks, but not in patients with an episode duration <2 weeks. While the STarT Back Tool can be incorporated into chiropractic settings and correlates with some elements of the Bournemouth Questionnaire, its prognostic ability is sometimes limited by the shorter low back pain episodes with which chiropractic patients often present. It may be a better predictor in patients whose episode duration is at least 2 weeks. Studies examining outcomes of stratified care in chiropractic patients are needed.
Physician-applied contact pressure and table force response during unilateral thoracic manipulation.
Kirstukas, S J; Backman, J A
1999-06-01
To measure the applied loading to human subjects during the reinforced unilateral thoracic manipulation. Biomechanical descriptive study. The National College of Chiropractic Clinical Biomechanical Laboratory in Lombard, Illinois. Seven men, ages 24 to 47, with no positive responses regarding muscle relaxants or thoracic spinal fractures, surgeries, or pain. We measured the contact pressure distribution at the physician-subject contact region and extracted three biomechanical parameters. From the measured time-dependent support force magnitudes, we extracted five additional biomechanical parameters. In the application of the reinforced unilateral manipulative treatment, the physician establishes contact and applies a near-static preload force of 250 to 350 N. The dynamic portion of the typical thrust is preceded by a 22% decrease in force magnitude, and the peak thrust magnitude is linearly related to the preload force magnitude. We estimate that the peak contact pressure beneath the chiropractor's pisiform can exceed 1000 kPa, with the highest pressures transmitted over areas as small as 3.6 cm2, depending on manipulative style. This work represents the first attempt at performing simultaneous measurements of the physician-applied loading and table force response and measuring the contact pressure distribution at the physician-patient contact region during chiropractic manipulation. This type of work will lead to a better understanding of the relationship between the dynamic physician-applied normal forces and the resulting load response at the table and gives us additional outcome parameters to quantify manipulative technique.
Chiropractic at the crossroads or are we just going around in circles?
2011-01-01
Background Chiropractic in Australia has seen many changes over the past 30 years. Some of these changes have advanced the professional status of chiropractic, improved undergraduate training and paved the way for a research culture. Unfortunately, other changes or lack of changes, have hindered the growth, public utilisation and professional standing of chiropractic in Australia. This article explores what influences have impacted on the credibility, advancement and public utilisation of chiropractic in Australia. Discussion The 1970's and 1980's saw a dramatic change within the chiropractic profession in Australia. With the advent of government regulation, came government funded teaching institutions, quality research and increased public acceptance and utilisation of chiropractic services. However, since that time the profession appears to have taken a backward step, which in the author's opinion, is directly linked to a shift by sections of the profession to the fundamentalist approach to chiropractic and the vertebral subluxation complex. The abandonment, by some groups, of a scientific and evidenced based approach to practice for one founded on ideological dogma is beginning to take its toll. Summary The future of chiropractic in Australia is at a crossroads. For the profession to move forward it must base its future on science and not ideological dogma. The push by some for it to become a unique and all encompassing alternative system of healthcare is both misguided and irrational. PMID:21599991
Attitudes toward chiropractic: a survey of North American orthopedic surgeons.
Busse, Jason W; Jacobs, Craig; Ngo, Trung; Rodine, Robert; Torrance, David; Jim, Janey; Kulkarni, Abhaya V; Petrisor, Brad; Drew, Brian; Bhandari, Mohit
2009-12-01
Questionnaire survey. To elicit orthopedic surgeons' attitudes toward chiropractic. Orthopedic surgeons and chiropractors often attend to similar patient populations, but little is known about the attitudes of orthopedic surgeons toward chiropractic. We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopedic surgeons that inquired about demographic variables and their knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ). 487 surgeons completed the survey (response rate, 49%). North American orthopedic surgeons' attitudes toward chiropractic were diverse, with 44.5% endorsing a negative impression, 29.4% holding favorable views, and 26.1% being neutral. Approximately half of respondents referred patients for chiropractic care each year, mainly due to patient request.The majority of surgeons believed that chiropractors provide effective therapy for some musculoskeletal complaints (81.8%), and disagreed that chiropractors could provide effective relief for nonmusculoskeletal conditions (89.5%). The majority endorsed that chiropractors provide unnecessary treatment (72.7%), engage in overly-aggressive marketing (63.1%) and breed dependency in patients on short-term symptomatic relief (52.3%). In our adjusted generalized linear model, older age (-2.62 points on the CAQ for each 10 year increment; 95% confidence interval [CI] = -3.74 to -1.50), clinical interest in foot and ankle (-2.77; 95% CI = -5.43 to -0.10), and endorsement of the research literature (-4.20; 95% CI = -6.29 to -2.11), the media (-3.05; 95% CI = -5.92 to -0.19), medical school (-7.42; 95% CI = -10.60 to -4.25), or 'other' (-4.99; 95% CI = -8.81 to -1.17) as a source of information regarding chiropractic were associated with more negative attitudes; endorsing a relationship with a specific chiropractor (5.05; 95% CI = 3.00 to 7.10) or residency (3.79;95% CI = 0.17 to 7.41) as sources of information regarding
The role of pulse oximetry in chiropractic practice: a rationale for its use
Hall, Michael W.; Jensen, Anne M.
2012-01-01
Objective Pulse oximetry is used regularly to assess oxygen saturation levels. The objective of this commentary is to discuss a rationale for using pulse oximetry in chiropractic practice. Discussion Pulse oximetry may offer doctors of chiropractic a way to monitor patients' oxygen saturation levels. Quantification of saturation values with heart rate may give clinical aid to the management of chiropractic patients. Markedly reduced saturation levels may necessitate medical referral, whereas mildly reduced levels could lead to changes in chiropractic management. Conclusions Pulse oximetry has the potential to be an integral part of chiropractic practice. PMID:23204957
Ethics education in chiropractic colleges: a North American survey.
Kinsinger, Stuart; Soave, David
2012-07-01
The purposes of this study were to survey Council on Chiropractic Education-accredited chiropractic colleges in North America and to describe curricular details on the teaching of bioethics. A custom-designed survey was sent to chiropractic colleges. Total number of contact hours, whether the ethics was a stand-alone course or integrated elsewhere, type of instructor, and if there was a required or recommended course text were queried. Of 19 surveys sent by mail, 15 surveys were returned. The average time in ethics instruction was 18.7 hours including lecture format, small group tutorial, and self-study. Chiropractic ethics education includes 8 areas of content (boundaries, law and jurisprudence, professionalism, basic ethic tenets/principles, ethical codes of conduct, prevention of financial and of sexual abuse, and resolving an ethical dilemma). Some colleges include content taught to students under the domain of law and jurisprudence. The results of this survey indicate that there are opportunities to further develop the educational ethics program at Council on Chiropractic Education-accredited colleges. All colleges currently offer bioethics teaching. An expanded role for this content is recommended so as to offer optimal benefit for students and practitioners. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Triano, John J; Goertz, Christine; Weeks, John; Murphy, Donald R; Kranz, Karl C; McClelland, George C; Kopansky-Giles, Deborah; Morgan, William; Nelson, Craig F
2010-06-01
This report describes the process, participation, and recommendations of a set of consensus conferences on strategy for professional growth that emphasized elements of public trust and alignment between the chiropractic profession and its stakeholders. In February and August 2006, an invitational group of leaders in the chiropractic profession convened an ad hoc Chiropractic Strategic Planning Conference. Public notice was given and support solicited through the Foundation of Chiropractic Education and Research. A series of international and interdisciplinary speakers gave presentations on the shifting of external social dynamics and medical culture, illuminating opportunities for the profession to extend its privilege and service. A systematic round-robin discussion was followed by group breakout sessions to develop recommendations on priorities for the profession to respond to challenges and opportunities. Recommendations were reviewed by the group as a whole and voted to consensus requiring more than 70% agreement. Participants determined a series of recommendations within 5 key domains for improving health professions practice: education, research, regulation, workplace, and leadership. The action steps proposed by the Strategic Planning Committee are first steps to provide better service to the public while making use of the inherent strengths of the profession. Copyright (c) 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
An Investigation into the Faculty Development Practices in Chiropractic Education Programs
ERIC Educational Resources Information Center
Scaringe, John G.
2010-01-01
A descriptive case study design using a cross-sectional quantitative survey method was used to investigate the impact of faculty development programs on teaching effectiveness perceived by faculty teaching at chiropractic colleges in the United States. The availability of faculty development programs related to teaching and student learning was…
Towards a 21 century paradigm of chiropractic: stage 1, redesigning clinical learning.
Ebrall, Phillip; Draper, Barry; Repka, Adrian
2008-01-01
To describe a formal process designed to determine the nature and extent of change that may enhance the depth of student learning in the pre-professional, clinical chiropractic environment. Project teams in the Royal Melbourne Institute of Technology (RMIT) School of Health Sciences and the Division of Chiropractic explored questions of clinical assessment in several health care disciplines of the School and the issue of implementing change in a manner that would be embraced by the clinicians who supervise student-learning in the clinical environment. The teams applied to RMIT for grant funding within the Learning and Teaching Investment Fund to support two proposed studies. Both research proposals were fully funded and are in process. The genesis of this work is the discovery that the predominant management plan in the chiropractic teaching clinics is based on diagnostic reductionism. It is felt this is counter-productive to the holistic dimensions of chiropractic practice taught in the classroom and non-supportive of chiropractic's paradigm shift towards wellness. A need is seen to improve processes around student assessment in the contemporary work-integrated learning that is a prime element of learning within the clinical disciplines of the School of Health Sciences, including chiropractic. Any improvements in the manner of clinical assessment within the chiropractic discipline will need to be accompanied by improvement in the training and development of the clinicians responsible for managing the provision of quality patient care by Registered Chiropractic Students.
GPs opinions and perceptions of chiropractic in Sweden and Norway: a descriptive survey
2013-01-01
Background In Sweden, chiropractic is not included in mainstream health care. In Norway chiropractic is a recognized health care profession. The aim of this study was to explore the perceptions of chiropractic among Swedish and Norwegian General Practitioners (GPs). Methods Eight hundred surveys in each country were distributed randomly by post to Swedish and Norwegian GPs offices. The survey contained two main sections: Experiences and opinions about chiropractic and referral patterns. The data were then described and compared between the countries. Results In Sweden the response rate was 44.8% and in Norway 45.3%. More than half of the Swedish GPs participating in this study stated that they had poor knowledge about chiropractic, while just a tenth of Norwegian GPs stated the same. Nearly all Norwegian GPs had some experience of chiropractic treatment whilst a fairly large number of the Swedish GPs said that they had no experience at all of chiropractic. It was twice as common for GPs in Norway to refer patients to a chiropractor as compared to Sweden. However, Swedish and Norwegian GPs agreed that chiropractors were competent to treat musculo-skeletal conditions with an adequate education to be part of mainstream medicine. Conclusions Swedish and Norwegian GPs agree that chiropractors are competent to treat musculoskeletal conditions. However, there are many differences in GPs perceptions of chiropractic between the two countries and the overall picture indicates that chiropractic is more accepted and recognised as a health care profession in Norway. PMID:24128386
DeVocht, James W; Owens, Edward F; Gudavalli, Maruti Ram; Strazewski, John; Bhogal, Ramneek; Xia, Ting
2013-01-01
The objectives of this study were to examine the force-time profiles of toggle recoil using an instrumented simulator to objectively measure and evaluate students' skill to determine if they become quicker and use less force during the course of their training and to compare them to course instructors and to field doctors of chiropractic (DCs) who use this specific technique in their practices. A load cell was placed within a toggle recoil training device. The preload, speed, and magnitude of the toggle recoil thrusts were measured from 60 students, 2 instructors, and 77 DCs (ie, who use the toggle recoil technique in their regular practice). Student data were collected 3 times during their toggle course (after first exposure, at midterm, and at course end.) Thrusts showed a dual-peak force-time profile not previously described in other forms of spinal manipulation. There was a wide range of values for each quantity measured within and between all 3 subject groups. The median peak load for students decreased over the course of their class, but they became slower. Field doctors were faster than students or instructors and delivered higher peak loads. Toggle recoil thrusts into a dropping mechanism varied based upon subject and amount of time practicing the task. As students progressed through the class, speed reduced as they increased control to lower peak loads. In the group studies, field DCs applied higher forces and were faster than both students and instructors. There appears to be a unique 2-peak feature of the force-time plot that is unique to toggle recoil manipulation with a drop mechanism. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Chiropractic Identity in the United States: Wisdom, Courage, and Strength.
Good, Christopher J
2016-12-01
The objective of this paper was to discuss the chiropractic profession's identity and 3 contentious issues related to identity. The various clinical specialties and independent groups in the chiropractic profession are so different in their beliefs, practice styles, and political agendas that a common identity is unlikely to be created. Areas of disagreement, including advanced practice, vertebral subluxation, and the philosophy of chiropractic, continue to separate those in the profession. Doctors of chiropractic should accept that differences within the profession will remain for the foreseeable future and that the profession should allow each group to live peacefully and supportively alongside each other. If the profession embraces the ideals of truth, respect, and tolerance, it can continue to grow and provide diverse health care services well into the future.
National Board Scores versus Student GPA's in Chiropractic Education.
ERIC Educational Resources Information Center
Kalthoff, Theodore J.
1985-01-01
The relationship between student GPAs and scores on the National Board of Chiropractic Examiners tests was investigated in an effort to determine if the chiropractic curriculum was properly preparing students to be licensed. The study found that there was a significant correlation between GPAs and board scores. (Author/MLW)
Chiropractic utilization in Taekwondo athletes
Kazemi, Mohsen; Shearer, Heather
2008-01-01
The purpose of the present study was to examine chiropractic utilization following a sport-related injury among National Team members and other high level Taekwondo athletes. Methods Retrospective surveys were conducted among Canadian male and female Taekwondo athletes (Group A, n = 60) competing in a national tournament and National Taekwondo team athletes (Group B, n = 16) at a training camp. Results A response rate of 46.7% (Group A) and 100% (Group B) was achieved. Twenty five percent (n = 4) of Group A athletes reported never seen a doctor of chiropractic (DC) regarding their injuries. Over 12% (n = 2) reported visiting a DC often, while just over 6% (n = 1) reported that they usually visited the DC following an injury. When injured, over 36% (n = 7) of the National Team members visit their family physician, over 15% (n = 3) visit a chiropractor or physiotherapist and the remaining athletes (n = 6) equally visit osteopaths, massage therapists, or athletic therapist following an injury. Conclusion There is a lack of information surrounding chiropractic utilization in the majority of sports and minimal research published regarding the health care utilization of Taekwondo athletes. Chiropractors, and particularly those with extensive athlete contact, should endeavour to further utilization studies. PMID:18516286
Well-being outcomes of chiropractic intervention for lower back pain: a systematic review.
Parkinson, Lynne; Sibbritt, David; Bolton, Philip; van Rotterdam, Joan; Villadsen, Inger
2013-02-01
The usefulness of chiropractic for treatment of low back pain is a contentious issue. Chiropractors advocate holism and general well-being as a key principle on which they base their clinical practice, yet the quality of life, lifestyle, health and economic impacts of chiropractic intervention for back pain in adults have rarely been investigated. This article provides an overview of chiropractic principles and practices, together with the results of a systematic review of peer-reviewed publications between 2000 and 2010 retrieved from MEDLINE, CINAHL, EMBASE, AMED and Cochrane Database of Systematic Reviews. This review sought to determine the benefits of chiropractic treatment and care to well-being, and to what extent chiropractic treatment and care improve quality of life. Of 1,165 articles, 12 articles were retained, representing six studies (four randomised controlled trial, two observational) of varying quality. There was a high degree of inconsistency and lack of standardisation in measurement instruments and outcome measures. Three studies reported reduced use of other/extra treatments as a positive outcome; two studies reported a positive effect of chiropractic intervention on pain, and two studies reported a positive effect on disability. The six studies reviewed concentrated on the impact of chiropractic care on physical health and disability, rather than the wider holistic view which was the focus of this study. It is difficult, therefore, to defend any conclusion about the impact of chiropractic intervention on the quality of life, lifestyle, health and economic impact on chiropractic patients presenting with back pain.
Johnson, Claire
2011-01-01
The term subluxation has come to have different meanings for different health care professions in the United States for over the past century. This controversy has resulted in some contention both internal and external to the chiropractic profession. Some current factions within the chiropractic profession hold the term subluxation to be synonymous with the identity of chiropractic itself; however, this term was not solely used by chiropractic during its formative years. The purpose of this article is to look at uses of the term by various professions (osteopathy, medicine, and chiropractic) at the turn of the century, a time in which the chiropractic profession was developing. PMID:22693477
Tobacco cessation via doctors of chiropractic: results of a feasibility study.
Gordon, Judith S; Istvan, Joseph; Haas, Mitchell
2010-03-01
There is a sizeable and growing body of empirical literature on the effects of physician advice to quit smoking. Because of the association between tobacco use and the health problems that may provoke referral to chiropractic care, doctors of chiropractic (DCs) may be able to give patients personalized proximal health feedback that may motivate them to quit. However, DCs have not been utilized in this role. The primary aim of this study was to design and refine a brief office-based tobacco intervention for use within chiropractic settings. This study was conducted in 20 private chiropractic practices in 2 phases: (a) intervention development, in which we created and focus tested practitioner and patient materials, and (b) feasibility, in which we evaluated the impact of the intervention on 210 tobacco-using chiropractic patients. Analyses were conducted on 156 patients who exclusively smoked cigarettes. Using an intent-to-treat approach, assuming all nonresponders to be smokers, 13 (8.3%) reported 7-day abstinence at 6 weeks, 22 (14.1%) at the 6-month follow-up, and 35 (22.4%) at the 12-month assessment. Eleven participants (7.1%) reported prolonged abstinence at the 6-month follow-up, and 15 (9.6%) reported prolonged abstinence at 12 months. To our knowledge, this is the first study to refine a brief office-based treatment for tobacco dependence for use in chiropractic settings. The results of this study were promising and will lead to a randomized clinical trial. If found to be effective, this model could be disseminated to chiropractic practitioners throughout the United States.
Seaman, David R.; Soltys, Jonathan R.
2013-01-01
Objective The purpose of this commentary is to discuss potential 5 factors within straight chiropractic philosophy and practice that may prevent Medicare compliance. Discussion The national Medicare Benefit Policy Manual and the Florida Local Coverage Determination were reviewed to identify documentation and conceptual issues regarding chiropractic practice. Five Medicare positions were contrasted with tenets of straight chiropractic philosophy. Based on Medicare’s documentation requirements, Medicare defines subluxation and chiropractic practice from the perspective of treating spinal pain and related functional disability. In contrast, traditional straight chiropractic philosophy is not based on the treatment of spinal pain and disability or other symptomatic presentations. In this context, 5 potential areas of conflict are discussed. Conclusion The Medicare version of chiropractic practice is not consistent with traditional straight chiropractic philosophy, which may play a role in preventing Medicare compliance. The chiropractic profession may need to consider the fashion in which “philosophy” as it relates to technique and practice is presented to students and doctors to facilitate compliance with the documentation requirements of Medicare. PMID:25067928
Prevalence and associated risk factors of burnout among US doctors of chiropractic.
Williams, Shawn P; Zipp, Genevieve P
2014-01-01
The purpose of this study was to establish the frequency of burnout among doctors of chiropractic in the United States. Using a nonprobability convenience sampling methodology, we e-mailed the Maslach Burnout Inventory-Human Services Survey and a sociodemographic questionnaire to a randomized sample of licensed doctors of chiropractic (n = 8000). The survey return rate was 16.06%. Twenty-one percent of the participants had high emotional exhaustion (EE), 8% had low personal accomplishment, and 8% had high depersonalization. Significant differences (P < .001) were found in the level of EE, depersonalization, and personal accomplishment as a function of sex, time dedicated to clinical care and administrative duties, source of reimbursement, the type of practice setting, the nature of practitioners' therapeutic focus, the location of chiropractic college, self-perception of burnout, the effect of suffering from a work-related injury, the varying chiropractic philosophical perspectives, and the public's opinion of chiropractic. Although doctors of chiropractic in the United States who responded to the survey had a relatively low frequency of burnout, higher levels of EE remain workplace issues for this professional group. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
The life and contribution of Dr. Ronald Gitelman: a pioneer of modern chiropractic science.
Vernon, Howard
2013-03-01
The life and contribution to chiropractic science of Dr. Ronald Gitelman is reviewed. 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. 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. Dr. Gitelman was a pioneer in the development of chiropractic science. He died on October 7, 2012.
Win, Ni Ni; Nadarajah, Vishna Devi V; Win, Daw Khin
2015-01-01
Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students' perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students' motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.
Beyerman, Kathleen L; Palmerino, Mark B; Zohn, Lee E; Kane, Gary M; Foster, Kathy A
2006-02-01
To evaluate the efficacy of chiropractic spinal manipulation, manual flexion/distraction, and hot pack application for the treatment of low back pain from osteoarthritis (OA) compared with moist heat alone. Two hundred fifty-two patients with low back pain secondary to OA were randomly assigned to either the treatment group (moist hot pack plus chiropractic care) or the moist heat group subjects, which attended 20 treatment sessions over several weeks. At sessions 1, 5, 10, 15, and 20, they rated pain using a visual analog pain scale, activities of daily living using the Oswestry Low Back Pain Questionnaire, and a range of motion (ROM) using the J-Tech Dual Digital Inclinometer (JTECH Medical Model no. AA036). Session I ratings indicated that the two groups were equivalent on all pain and flexion scores. The treatment group reported greater and more rapid pain reduction and greater and more rapid ROM improvement than the moist heat group. The treatment group also had greater improvements than the moist heat group in daily living activities in 4 of the 9 areas measured. Chiropractic care combined with heat is more effective than heat alone for treating OA-based lower back pain. Pain reduction occurs more rapidly and to a greater degree, and ROM increases more rapidly and to a greater degree.
Constructing a philosophy of chiropractic: evolving worldviews and premodern roots☆
Senzon, Simon A.
2011-01-01
Objective The philosophy of chiropractic can be framed as an attempt to correct the problems inherited from the Western Enlightenment. Its origins can be found in the long tradition of Western philosophy. The purpose of this article is to describe in a broad context chiropractic’s roots in premodernity and establish the structural and hermeneutical differences between chiropractic’s original philosophical ideas and those of premodern philosophers. Discussion The worldview or cultural mindset the philosophy arose from must be situated in the context of its time, the birth of the unique postmodern worldview, aperspectival consciousness, and the modern sense of self. This is accomplished by exploring several metatheories about the development of the self through history, with an emphasis on the premodern roots to the chiropractic terms; Universal Intelligence and Innate Intelligence. By contextualizing the philosophy of chiropractic in terms of a structural genealogy of the self and of ideas, a new approach to philosophy in chiropractic emerges. Conclusion Without accounting for chiropractic’s origins as a reflection of the unique time, place, and culture, in terms of the evolution of worldviews through history, any approach to construct or reconstruct a philosophy of chiropractic will potentially miss the seminal feature of chiropractic’s emergence. PMID:22693478
Young, Kenneth J.; Siordia, Lawrence
2012-01-01
Objective The purpose of this study was to track the graduates of the Los Angeles College of Chiropractic (LACC) radiology residency program, review their scholarly productivity, and report those involved in teaching and leadership positions. Methods Former LACC residents’ career information was identified through publicly available electronic documents including Web sites and social media. PubMed and the Index to Chiropractic Literature databases were searched for chiropractic graduate job surveys, and proportional comparisons were made between the career paths of LACC radiology residency graduates and those of non–residency-trained chiropractors. Results Of 47 former LACC residents, 28 (60%) have or previously had careers in tertiary (chiropractic) education; and 12 (26%) have attained a department chair position or higher at tertiary teaching institutions. Twenty-two (47%) have or previously had private radiology practices, whereas 11 (23%) have or previously had clinical chiropractic practices. Often, residency graduates hold or have held 2 of these positions at once; and one, all 3. Chapters or books were authored by 13 (28%). Conclusion Radiology residency LACC graduates are professionally active, particularly in education, and demonstrate scholarly productivity. PMID:23966885
2011-01-01
Background There is increasing interest by chiropractors in North America regarding integration into mainstream healthcare; however, there is limited information about attitudes towards the profession among conventional healthcare providers, including orthopaedic surgeons. Methods We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopaedic surgeons that inquired about demographic variables and their attitudes towards chiropractic. Our survey included an option for respondants to include written comments, and our present analysis is restricted to these comments. Two reviewers, independantly and in duplicate, coded all written comments using thematic analysis. Results 487 surgeons completed the survey (response rate 49%), and 174 provided written comments. Our analysis revealed 8 themes and 24 sub-themes represented in surgeons' comments. Reported themes were: variability amongst chiropractors (n = 55); concerns with chiropractic treatment (n = 54); areas where chiropractic is perceived as effective (n = 43); unethical behavior (n = 43); patient interaction (n = 36); the scientific basis of chiropractic (n = 26); personal experiences with chiropractic (n = 21); and chiropractic training (n = 18). Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration, endorsement for chiropractic treatment of musculoskeletal complaints, criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based. Conclusions Our analysis identified a number of issues that will have to be considered by the chiropractic profession as part of its efforts to further integrate chiropractic into mainstream healthcare. PMID:21970333
Visceral responses to spinal manipulation.
Bolton, Philip S; Budgell, Brian
2012-10-01
While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. This controversy is due in part to the perception that there is no robust neurobiological rationale to justify using a biomechanical treatment of the spine to address a disorder of visceral function. This paper therefore looks at the physiological evidence that spinal manipulation can impact visceral function. A structured search was conducted, using PubMed and the Index to Chiropractic Literature, to construct of corpus of primary data studies in healthy human subjects of the effects of spinal manipulation on visceral function. The corpus of literature is not large, and the greatest number of papers concerns cardiovascular function. Authors often attribute visceral effects of spinal manipulation to somato-autonomic reflexes. While this is not unreasonable, little attention is paid to alternative mechanisms such as somato-humoural pathways. Thus, while the literature confirms that mechanical stimulation of the spine modulates some organ functions in some cohorts, a comprehensive neurobiological rationale for this general phenomenon has yet to appear. Copyright © 2012 Elsevier Ltd. All rights reserved.
Effects of Expanded Coverage for Chiropractic Services on Medicare Costs in a CMS Demonstration
Stason, William B.; Ritter, Grant A; Prottas, Jeffrey; Tompkins, Christopher; Shepard, Donald S.
2016-01-01
Background Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head. Methods The demonstration was conducted in 2005–2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework. Results Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa. Conclusion The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased. PMID:26928221
Effects of Expanded Coverage for Chiropractic Services on Medicare Costs in a CMS Demonstration.
Stason, William B; Ritter, Grant A; Martin, Timothy; Prottas, Jeffrey; Tompkins, Christopher; Shepard, Donald S
2016-01-01
Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head. The demonstration was conducted in 2005-2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework. Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa. The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.
Chiropractic Use by Urban and Rural Residents with Insurance Coverage
ERIC Educational Resources Information Center
Lind, Bonnie K.; Diehr, Paula K.; Grembowski, David E.; Lafferty, William E.
2009-01-01
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…
Gleberzon, Brian J
2010-03-01
the purpose of this study was to conduct a comparative audit of the jurisprudence and business management courses offered at a number of different accredited chiropractic colleges. Faculty members responsible for teaching students jurisprudence and/or business management courses at a number of accredited colleges were contacted and asked to electronically submit their course outlines for review. Of the 62 different topics delivered at the 11 chiropractic colleges surveyed, not one topic was taught at all of them. The following topics were taught at 10 of the 11 respondent chiropractic colleges: business plan development; ethics and codes of conduct and; office staff/employees. Several topics were only taught at one accredited chiropractic college. While most chiropractic colleges provide some education in the areas of jurisprudence and business management, it would appear that there is no consensus opinion or 'model curriculum' on these topics towards which chiropractic programs may align themselves. Based on a literature search, this study is the first of its kind. A more extensive study is required, as well as a Delphi process to determine what should be taught to chiropractic students with respect to jurisprudence and business management in order to protect the public interest.
Fall risk profile and quality-of-life status of older chiropractic patients.
Holt, Kelly R; Noone, Paul L; Short, Krystal; Elley, C Raina; Haavik, Heidi
2011-02-01
The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status. A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older. One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community-dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04). A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Chiropractic: MedlinePlus Health Topic
... visit chiropractors for treatment of low back pain , neck pain, and headaches . NIH: National Center for Complementary and ... of Low-Back... Article: Changes in female veterans' neck pain following chiropractic care at... Article: The Use of ...
Wangler, Martin; Zaugg, Beatrice; Faigaux, Eric
2010-01-01
The purpose of this survey was to assess the use of and the attitude toward prescribing medication among doctors of chiropractic in 1 of 26 Swiss cantons. A Likert scale electronic questionnaire was sent to licensed doctors of chiropractic of the canton of Berne (n = 47). Percentages, mean values, and standard deviations were calculated. A follow-up survey was used to assess comments from the main survey. A probability value of P < .05 indicated a statistically significant difference. The response rate was 77%. Forty-one percent of the respondents stated that medications are a necessary component of the chiropractic treatment. Although 92% actively prescribe medication at least once a week, this is significantly less than asked for by their patients (P < .01). Seventy-two percent of the doctors of chiropractic rated the present privilege to prescribe nonprescription medications as an advantage for chiropractic care. Fifty-eight percent thought that chiropractic should aim at expanding the options of nonsteroidal anti-inflammatory drugs, analgesics, and muscle relaxants that can be prescribed. Ninety-one percent agreed on continuing education in pharmacology. Despite prescribing medication at least once a week, less than half of Bernese doctors of chiropractic perceived medications as a necessary component of their treatment, mainly using them to help patients who cannot sleep because of pain and to speed up recovery. When asked if they would be allowed to prescribe medications of the "B-list," the majority would want structured continuing education. Limited medication prescription was judged as an advantage for the chiropractic profession by this group of survey participants. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Gleberzon, Brian J.
2010-01-01
Introduction: the purpose of this study was to conduct a comparative audit of the jurisprudence and business management courses offered at a number of different accredited chiropractic colleges. Methods: Faculty members responsible for teaching students jurisprudence and/or business management courses at a number of accredited colleges were contacted and asked to electronically submit their course outlines for review. Results: Of the 62 different topics delivered at the 11 chiropractic colleges surveyed, not one topic was taught at all of them. The following topics were taught at 10 of the 11 respondent chiropractic colleges: business plan development; ethics and codes of conduct and; office staff/employees. Several topics were only taught at one accredited chiropractic college. Conclusion: While most chiropractic colleges provide some education in the areas of jurisprudence and business management, it would appear that there is no consensus opinion or ‘model curriculum’ on these topics towards which chiropractic programs may align themselves. Based on a literature search, this study is the first of its kind. A more extensive study is required, as well as a Delphi process to determine what should be taught to chiropractic students with respect to jurisprudence and business management in order to protect the public interest. PMID:20195426
DeVocht, James W; Smith, Dean L; Long, Cynthia R; Corber, Lance; Kane, Bridget; Jones, Thomas M; Goertz, Christine M
2016-09-20
Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment. However, it is unknown whether or not chiropractic treatment is able to improve reaction and response times in specific populations of interest. One such population is the U.S. military special operation forces' (SOF) personnel. This study is a randomized controlled trial of 120 asymptomatic volunteer SOF personnel. All participants are examined by a study doctor of chiropractic (DC) for eligibility prior to randomization. The participants are randomly allocated to either a treatment group receiving four treatments of chiropractic manipulative therapy (CMT) over 2 weeks or to a wait-list control group. The wait-list group does not receive any treatment but has assessments at the same time interval as the treatment group. The outcome measures are simple reaction times for dominant hand and dominant foot, choice reaction time with prompts calling for either hand or either foot, response time using Fitts' law tasks for small movements involving eye-hand coordination, and brief whole body movements using the t-wall, a commercially available product. At the first visit, all five tests are completed so that participants can familiarize themselves with the equipment and protocol. Assessments at the second and the final visits are used for data analysis. SOF personnel are highly motivated and extremely physically fit individuals whose occupation requires reaction times that are as quick as possible during the course of their assigned duties. A goal of CMT is to maximize the functionality and integration of the neuromusculoskeletal
A survey of interprofessional education in chiropractic continuing education in the United States.
Bednarz, Edward M; Lisi, Anthony J
2014-10-01
Objective : The purpose of this study is to describe the state of chiropractic continuing education vis-à-vis interprofessional education (IPE) with medical doctors (MD) in a survey of a sample of US doctors of chiropractic (DC) and through a review of policies. Methods : Forty-five chiropractors with experience in interprofessional settings completed an electronic survey of their experiences and perceptions regarding DC-MD IPE in chiropractic continuing education (CE). The licensing bodies of the 50 US states and the District of Columbia were queried to assess the applicability of continuing medical education (CME) to chiropractic relicensure. Results : The majority (89.1%) of survey respondents who attend CE-only events reported that they rarely to never experienced MD-IPE at these activities. Survey respondents commonly attended CME-only events, and 84.5% stated that they commonly to very commonly experienced MD-IPE at these activities. More than half (26 of 51) of the licensing bodies did not provide sufficient information to determine if CME was applicable to DC relicensure. Thirteen jurisdictions (25.5%) do not, and 12 jurisdictions (23.5%) do accept CME credits for chiropractic relicensure. Conclusion : The majority of integrated practice DCs we surveyed reported little to no IPE occurring at CE-only events, yet significant IPE occurring at CME events. However, we found only 23.5% of chiropractic licensing bodies allow CME credit to apply to chiropractic relicensure. These factors may hinder DC-MD IPE in continuing education.
ERIC Educational Resources Information Center
New York State Education Dept., Albany. Office of the Professions.
A reference guide to laws, rules, and regulations that govern the chiropractic practice in New York State is presented. After an overview of professional regulation in the state, licensing requirements/procedures for chiropractors are described. Provisions of Title VIII, Articles 130 and 132, of the Education Law are also covered, along with…
Chiropractic treatment and the enhancement of sport performance: a narrative literature review
Miners, Andrew L.
2010-01-01
A literature search and narrative review was carried out with the intent of determining the current level of knowledge regarding the chiropractic treatment of athletes for the purpose of sport performance enhancement. Of the fifty-nine relevant articles retrieved, only 7 articles of variable quality were obtained which specifically investigated/discussed chiropractic treatment and its involvement in sport performance enhancement. The role of the chiropractor in sport, unsubstantiated claims of performance enhancement, theories of how chiropractic treatment may influence sport performance, and the available evidence for the benefit of chiropractic treatment on sport performance are reviewed and discussed. Areas and directions for future studies are postulated. At this time there is insufficient evidence to convincingly support the notion that treatment provided by chiropractors can directly improve sport performance. PMID:21120012
Goto, Viviane; Frange, Cristina; Andersen, Monica L; Júnior, José M S; Tufik, Sergio; Hachul, Helena
2014-05-01
Insomnia is a frequent postmenopausal symptom and may be due to hormonal changes, depressive states related to this period of life, hot flashes or nocturia. Chiropractic care has been demonstrated to be effective in the treatment of these symptoms. The aim of this study was to review chiropractic interventions in postmenopausal women as a possible management approach to menopausal symptoms and insomnia. A PubMed search was conducted by cross-referencing the key words insomnia, sleep, and menopause with chiropractic. The search used an end date of January 2014 and retrieved 17 articles. Three articles were eligible for the study. All epidemiological data from large surveys demonstrated a lack of evidence for chiropractic intervention as a complementary and alternative therapeutic method in the management of menopausal symptoms and insomnia. There is no evidence for the effectiveness of chiropractic intervention as a complementary and alternative therapy for menopausal symptoms and insomnia. Further studies with proper methodological designs are warranted. Copyright © 2014. Published by Elsevier Ireland Ltd.
Chiropractic practice in military and veterans health care: The state of the literature
Green, Bart N.; Johnson, Claire D.; Lisi, Anthony J.; Tucker, John
2009-01-01
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
Financial attitudes, knowledge, and habits of chiropractic students: A descriptive survey
Lorence, Julie; Lawrence, Dana J.; Salsbury, Stacie A.; Goertz, Christine M.
2014-01-01
Objective: Our purpose was to describe the financial knowledge, habits and attitudes of chiropractic students. Methods: We designed a cross-sectional survey to measure basic financial knowledge, current financial habits, risk tolerance, and beliefs about future income among 250 students enrolled in business courses at one US chiropractic college. Descriptive statistical analyses were performed. Results: We received 57 questionnaires (23% response rate). Most respondents would accumulate over $125,000 in student loan debt by graduation. Financial knowledge was low (mean 77%). Most respondents (72%) scored as average financial risk takers. Chiropractic students reported recommended short-term habits such as having checking accounts (90%) and health insurance (63%) or paying monthly bills (88%) and credit cards (60%). Few saved money for unplanned expenses (39%) or long-term goals (26%), kept written budgets (32%), or had retirement accounts (19%). Conclusion: These chiropractic students demonstrated inadequate financial literacy and did not engage in many recommended financial habits. PMID:24587498
Utilization and expenditures on chiropractic care in the United States from 1997 to 2006.
Davis, Matthew A; Sirovich, Brenda E; Weeks, William B
2010-06-01
To investigate national utilization and expenditures on chiropractic care between 1997 and 2006. The nationally representative Medical Expenditure Panel Survey (MEPS). We performed descriptive analyses and generated national estimates from data obtained from U.S. adult (>or=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. 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. 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.
Branson, Richard A
2009-01-01
The purpose of this article is to describe a model of chiropractic integration developed over a 10-year period within a private hospital system in Minnesota. Needs were assessed by surveying attitudes and behaviors related to chiropractic and complementary and alternative medicine (CAM) of physicians associated with the hospital. Analyzing referral and utilization patterns assessed chiropractic integration into the hospital system. One hundred five surveys were returned after 2 mailings for a response rate of 74%. Seventy-four percent of respondents supported integration of CAM into the hospital system, although 45% supported the primary care physician as the gatekeeper for CAM use. From 2006 to 2008, there were 8294 unique new patients in the chiropractic program. Primary care providers (medical doctors and physician assistants) were the most common referral source, followed by self-referred patients, sports medicine physicians, and orthopedic physicians. Overall examination of the program identified that facilitators of chiropractic integration were (1) growth in interest in CAM, (2) establishing relationships with key administrators and providers, (3) use of evidence-based practice, (4) adequate physical space, and (5) creation of an integrated spine care program. Barriers were (1) lack of understanding of chiropractic professional identity by certain providers and (2) certain financial aspects of third-party payment for chiropractic. This article describes the process of integrating chiropractic into one of the largest private hospital systems in Minnesota from a business and professional perspective and the results achieved once chiropractic was integrated into the system. This study identified key factors that facilitated integration of services and demonstrates that chiropractic care can be successfully integrated within a hospital system.
ERIC Educational Resources Information Center
von Kuster, Thomas, Jr.
Results from the first federally sponsored study of the chiropractic health care profession are presented, and a broad range of facts and issues of concern to policy-makers, the profession, and the public are described. The two-year project included three national surveys of: service providers (doctors of chiropractic in practice more than two…
The learning style preferences of chiropractic students: A cross-sectional study
Whillier, Stephney; Lystad, Reidar P.; Abi-Arrage, David; McPhie, Christopher; Johnston, Samara; Williams, Christopher; Rice, Mark
2014-01-01
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 χ2 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
Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature.
Todd, Angela J; Carroll, Matthew T; Mitchell, Eleanor K L
2016-01-01
The purpose of this study is to review the available literature that describes forces of the most commonly used chiropractic techniques for children. Review of the English-language literature using search terms Chiropract* and technique, protocol, or approach in databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and Index to Chiropractic Literature and direct contact with authors of articles and book chapters. Eleven articles that discussed the 7 most commonly used pediatric chiropractic techniques and the forces applied were identified. Chiropractic techniques reviewed described forces that were modified based on the age of the patient. Force data for mechanically assisted devices were varied, with the minimum force settings for some devices outside the age-specific safe range recommended in the literature when not modified in some way. This review found that technique selection and application by chiropractors treating infants and young children are typically modified in force and speed to suit the age and development of the child. Copyright © 2016. Published by Elsevier Inc.
Federal Register 2010, 2011, 2012, 2013, 2014
2013-04-17
... DEPARTMENT OF JUSTICE Antitrust Division United States v. Chiropractic Associates, Ltd. of South... District of South Dakota in United States of America v. Chiropractic Associates Ltd, of South Dakota, (CASD... terms for chiropractic services. Copies of the Complaint, proposed Final Judgment, and Competitive...
Quantitative corpus-based analysis of the chiropractic literature – a pilot study
Millar, Neil; Budgell, Brian S.; Kwong, Alice
2011-01-01
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
Cloth-covered chiropractic treatment tables as a source of allergens and pathogenic microbes.
Evans, Marion W; Campbell, Alan; Husbands, Chris; Breshears, Jennell; Ndetan, Harrison; Rupert, Ronald
2008-03-01
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. 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. Numerous microbacteria strains were found, including Staphylococcus aureus and Propionibacterium. Allergen-producing molds, including Candida, were also found. 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.
Goertz, Christine M; Long, Cynthia R; Vining, Robert D; Pohlman, Katherine A; Kane, Bridget; Corber, Lance; Walter, Joan; Coulter, Ian
2016-02-09
Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone. This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation. Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability. The trial discussed in this
ERIC Educational Resources Information Center
Walton, E. V.; Brzozowski, Walter T.
The effects of chiropractic treatment on children with learning and behavioral problems was investigated with 24 elementary and secondary level students, 12 receiving regular chiropractic treatment and 12 receiving medication. Results indicated that chiropractic treatment was more effective for the wide range symptoms common in the neurological…
Lehman, James J.; Suozzi, Paul J.; Simmons, George R.; Jegtvig, Shereen K.
2011-01-01
Objectives The purpose of this study was to determine chiropractic patients' perceptions of chiropractors serving as primary care providers and having a limited prescriptive authority. Methods Four doctors of chiropractic in Albuquerque and Santa Fe, NM, participated in surveying their patients during the summer of 2008. The chiropractors distributed the questionnaires consecutively to chiropractic patients. Patients answered questions regarding their perceptions of their chiropractors, use of chiropractic care, and medications for pain. The participating chiropractors collected the completed patient questionnaires and mailed them to the primary investigator. Results The chiropractic providers collected 275 chiropractic patient questionnaires. The number of patient questionnaires collected by each of the 4 participating chiropractors ranged from 35 to 100. The patients primarily sought care for the management and treatment of pain (98.5%), and 57.5% considered that their chiropractors were “primary care providers.” Eighty-five percent preferred that their chiropractor be qualified to prescribe medications and provide hands-on treatment, whereas 97.5% perceived their chiropractors to be chiropractic physicians. Conclusions This small group of chiropractic patients from 4 offices in New Mexico perceived that their doctors of chiropractic were physicians and primary care providers, and 85% preferred that their chiropractor treat patients with limited prescriptive authority when appropriately trained. PMID:22027203
Senzon, Simon A
2014-12-01
The purpose of this commentary is to describe the conflicts in the history of chiropractic's professionalization and conflict through the path of increasing educational standards and accreditation using the lens of developmental structuralism. Within the story of chiropractic's professionalization and accreditation lie the battles between competing worldviews. Gibbons proposed 4 periods of chiropractic's educational history; this article proposes a fifth period along with a new methodological approach to explore the complexity of chiropractic's history. The methodology draws upon constructive developmental psychology and proposes 5 levels of thinking common to the individuals from chiropractic's history. By using a psychological framework to analyze historical events, it appears that the battle within chiropractic education continues at present. Several important issues are explored: the Council on Chiropractic Education's origins in the medical paradigm and rational thinking, the pre-rational, rational, and post-rational critics of the Council on Chiropractic Education, the schools of thought that were reified or emerged from the history, as well as the more recent legal, economic, and social pressures, which helped to shape chiropractic's accreditation and professionalization. A transrational approach, one that includes the partial truths of all perspectives, is a first step to allow for a richer understanding of how the interior worldviews, individual actions, and the exterior forces (legal, economic, political, and educational) brought forth the chiropractic clashes together. Viewing the conflicts within chiropractic from this approach may foster new educational structures to evolve.
Critique of a practice-based pilot study in chiropractic practices in Western Australia.
Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F; Nedkoff, Lee; Fisher, Colleen
2016-01-01
Practice-based data collection can offer insight into the nature of chiropractic practice and contribute to resolving the conundrum of the chiropractic profession's role in contemporary healthcare, subsequently informing care service policy. However, there is little formal data available about chiropractic practice to inform decision-makers about the nature and role of chiropractic within the context of a modern multidisciplinary healthcare context in Australia, particularly at a local and regional level. This was a mixed-methods data transformation model (qualitative to quantitative) pilot study the purpose of which was to provide a critique of the research design and collect data from a selected sample of chiropractic practices in Western Australia, with a view to offer recommendations related to the design, feasibility and implementation of a future confirmatory study. A narrative critique of the research methods of this pilot study is offered in this paper covering: (a) practice and patient recruitment, (b) enrollment of patients, (c) data collection methods, (d) acceptability of the study methods, (e) sample size calculations, and (f) design critique. The result of this critique provides a sensible sample size estimate and recommendations as to the design and implementation of a future confirmatory study. Furthermore, we believe that a confirmatory study is not only feasible, but indeed necessary, with a view to offer meaningful insight into chiropractic practice in Western Australia. ACTRN12616000434493 Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 5 April 2016. First participant enrolled 01 July 2014, retrospectively registered.
Cloth-covered chiropractic treatment tables as a source of allergens and pathogenic microbes☆
Evans, Marion W.; Campbell, Alan; Husbands, Chris; Breshears, Jennell; Ndetan, Harrison; Rupert, Ronald
2008-01-01
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
Value of chiropractic services at an on-site health center.
Krause, Curt A; Kaspin, Lisa; Gorman, Kathleen M; Miller, Ross M
2012-08-01
Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions. A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes. Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001). These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.
How can chiropractic become a respected mainstream profession? The example of podiatry
Murphy, Donald R; Schneider, Michael J; Seaman, David R; Perle, Stephen M; Nelson, Craig F
2008-01-01
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
Federal Register 2010, 2011, 2012, 2013, 2014
2013-08-12
... DEPARTMENT OF JUSTICE Antitrust Division United States v. Chiropractic Associates, Ltd. of South... proposed Final Judgment in United States v. Chiropractic Associates, Ltd. of South Dakota., Civil Action No... SOUTH DAKOTA SOUTHERN DIVISION UNITED STATES OF AMERICA, Plaintiff, v. CHIROPRACTIC ASSOCIATES, LTD. OF...
Chiropractic and social justice: a view from the perspective of Beauchamp's principles.
Green, Bart N; Johnson, Claire
2010-01-01
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. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Brosnan, Caragh
2017-10-01
Sociological studies of the complementary and alternative medicine (CAM) occupations have documented the professionalisation strategies these groups use to establish boundaries between themselves and their competitors, including seeking educational accreditation and statutory regulation/licensure. Chiropractic has been particularly successful at professionalising and in Australia and the UK it is taught within public universities. Recent events have threatened chiropractic's university foothold, however, showing that professionalisation needs to be understood as an ongoing process of negotiation. Based on interviews with chiropractors in Australia and the UK, this paper examines the professionalisation strategies deployed by chiropractors within and outside of the university. Highly divergent strategies are identified across different sectors of the profession, relating to defining the chiropractic paradigm, directing education and constructing professional identity. In each domain, chiropractic academics tended to prioritise building the evidence base and becoming more aligned with medicine and other allied health professions. Although some practitioners supported this agenda, others strove to preserve chiropractic's vitalistic philosophy and professional distinction. Following Bourdieu, these intra-professional struggles are interpreted as occurring within a field in which chiropractors compete for different forms of capital, pulled by two opposing poles. The differing orientations and strategies pursued at the two poles of the field point to a number of possible futures for this CAM profession, including a potential split within the profession itself. Copyright © 2017 Elsevier Ltd. All rights reserved.
Knowledge and opinions of Downsview physicians regarding the chiropractic profession
Newton-Leo, Linda; King-Isaacs, Debra; Lichti, Janice
1994-01-01
This study was a preliminary investigation into the knowledge of and current attitudes towards the chiropractic profession by medical practitioners with varying years of clinical experience. A questionnaire was designed and mailed to seventy general practitioners in Downsview, Ontario who agreed to participate in the study. Twenty-six were returned for a response rate of 37%. The data were analyzed and responses from doctors with differing years of practice experience were compared using the chi square statistic. When comparing attitudes towards the chiropractic profession between medical practitioners with greater and less than 15 years of clinical experience a statistically significant difference was found (p = 0.0005). However, no significant differences were observed in terms of their interaction with or knowledge of the chiropractic profession. Further, 88% of respondents reported that they had referred a patient to a chiropractor. The limitations of the study and suggestions for improvement are discussed.
Palmgren, Per J; Sandström, Peter J; Lundqvist, Fredrik J; Heikkilä, Hannu
2006-02-01
The objective of this study was to examine alteration in head repositioning accuracy (HRA), range of motion, and pain intensity in patients with chronic cervical pain syndrome without a history of cervical trauma. The study was a prospective, randomized, controlled trial. Forty-one patients with chronic cervical pain were randomly assigned to either a control group or a chiropractic treatment group. All patients were clinically examined, given general information on cervical pain, and provided with training instructions based on the clinical evaluation. The treatment included sessions with high-velocity and low-amplitude manipulation, proprioceptive neuromuscular facilitation, ischemic compression of myofascial trigger points, and spinal rehabilitation exercises aiming to normalize cervical range of motion (CROM) and HRA. Subjective pain intensity, cervical kinesthetic sensibility, and CROM were recorded before and after the study period. There was no difference between the treatment patients and the control subjects at the beginning with regard to age, sex, subjective pain intensity, range of motion, and HRA. At the 5-week follow-up, the treatment patients showed significant reductions in pain and improvement of all HRA aspects measured whereas the control subjects did not show any reduction in pain and improvement in only one HRA aspect. No significant difference was detected in CROM. The results of this study suggest that chiropractic care can be effective in influencing the complex process of proprioceptive sensibility and pain of cervical origin. Short, specific chiropractic treatment programs with proper patient information may alter the course of chronic cervical pain.
Hecimovich, Mark D.; Volet, Simone E.
2009-01-01
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
Descarreaux, Martin; Blouin, Jean-Sébastien; Drolet, Marc; Papadimitriou, Stanislas; Teasdale, Normand
2004-10-01
To document the potential role of maintenance chiropractic spinal manipulation to reduce overall pain and disability levels associated with chronic low-back conditions after an initial phase of intensive chiropractic treatments. Thirty patients with chronic nonspecific low-back pain were separated into 2 groups. The first group received 12 treatments in an intensive 1-month period but received no treatment in a subsequent 9-month period. For this group, a 4-week period preceding the initial phase of treatment was used as a control period to examine the sole effect of time on pain and disability levels. The second group received 12 treatments in an intensive 1-month period and also received maintenance spinal manipulation every 3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated with a visual analog scale and a modified Oswestry questionnaire, respectively. The 1-month control period did not modify the pain and disability levels. For both groups, the pain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the postintensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their postintensive treatment scores. The disability scores of the other group went back to their pretreatment levels. Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.
The effect of low force chiropractic adjustments for 4 weeks on body surface electromagnetic field.
Zhang, John; Snyder, Brian J
2005-01-01
To study the effects of 4 weeks of low-force chiropractic adjustments on body surface electromagnetic fields (EMFs). Thirty-five chiropractic students randomly assigned into control (17 subjects) and experimental groups (28 subjects). A triaxial fluxgate magnetometer was used for EMF detection. The subjects' body surface EMF was determined in the prone position before and after the chiropractic adjustment. A Toftness low-force chiropractic adjustment was applied to the cervical, thoracic, lumbar, and sacral areas as determined by the practitioner. Heart rate variability analysis was recorded once a week to determine autonomic nervous system activity in both the control and experimental groups. The EMF on the subjects' body surface decreased after chiropractic adjustment at the cervical, thoracic, lumbar, and sacral regions in all 6 visits during the 4-week treatment period. The EMF showed a downtrend over the 4-week period after the low-force adjustment. The same changes were not observed in the control group. The chiropractic adjustment group had a slight decrease in heart rate over the 4-week treatment period, and no significant change was observed in the control group. Heart rate variability analysis did not show consistent changes before and after the low-force adjustments during the treatment period. Low-force chiropractic adjustment in the cervical and thoracic areas resulted in a consistent reduction of the body surface EMF after 4 weeks of active treatment. No statistically significant differences were found in the heart rate and heart rate variability in the 4-week study.
Daniel David Palmer: alchemy in the creation of chiropractic.
Gaucher-Peslherbe, P L
1995-12-01
D.D. Palmer has been a much ignored man in the discipline he founded. The same applies to several early concepts he used to develop from a mere healer's background: D.D. Palmer invested them with an entirely different meaning. When considered, they help to understand the inner logic that allowed for chiropractic survival. There was an alchemy in the creation of chiropractic and the senior Palmer was the alchemist. He has not been recognized even within his own profession for the self-taught scholar and clinician that he was, knowledgeable about the various medical and scientific theories of his time.
Philosophy of chiropractic: lessons from the past — guidance for the future 1
Donahue, Joseph
1990-01-01
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.
Meeker, William C.; Watkins, R.W.; Kranz, Karl C.; Munsterman, Scott D.; Johnson, Claire
2014-01-01
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
Chiropractic Care for a Patient with Spasmodic Dysphonia Associated with Cervical Spine Trauma
Waddell, Roger K.
2005-01-01
Abstract Objective To discuss the diagnosis and response to treatment of spasmodic dysphonia in a 25-year-old female vocalist following an auto accident. Clinical Features The voice disorder and neck pain appeared after the traumatic incident. Examination of the cervical spine revealed moderate pain, muscle spasm and restricted joint motion at C-1 and C-5 on the left side. Cervical range of motion was reduced on left rotation. Bilateral manual muscle testing of the trapezius and sternocleidomastoid muscles, which share innervation with the laryngeal muscles by way of the spinal accessory nerve, were weak on the left side. Pre and post accident voice range profiles (phonetograms) that measure singing voice quality were examined. The pre- and post-accident phonetograms revealed significant reduction in voice intensity and fundamental frequency as measured in decibels and hertz. Intervention and Outcome Low-force chiropractic spinal manipulative therapy to C-1 and C-5 was employed. Following a course of care, the patient's singing voice returned to normal, as well as a resolution of her musculo- skeletal complaints. Conclusion It appears that in certain cases, the singing voice can be adversely affected if neck or head trauma is severe enough. This case proposes that trauma with irritation to the cervical spine nerve roots as they communicate with the spinal accessory, and in turn the laryngeal nerves, may be contributory in some functional voice disorders or muscle tension dysphonia. PMID:19674642
Empowerment and organizational commitment of chiropractic faculty.
Henkin, Alan B; Marchiori, Dennis M
2003-06-01
Professionals in chiropractic education retain much of the authority over their work. Their work is impacted, negatively or positively, by their perceptions of their organization's value for their skills and knowledge. Specifically, empowerment and organizational commitment are 2 psychological constructs that may mediate work circumstances and therefore are the focus of this study. The purpose of this study is to explore associations between empowerment and organizational commitment among chiropractic faculty. Study design Full faculty survey utilizing descriptive statistics and multivariable analysis. Surveys were distributed to full- and part-time faculty working in the United States and Canada. The survey included Spreitzer's multidimensional measure of psychological empowerment, Meyer and Allen's multidimensional measure of organizational commitment, and additional survey items focusing on faculty demographics and workplace variables including sex, age, academic rank, employment status, and primary area of work assignment. More than 54% of the study population (N = 609) completed and returned the instrument. A general profile of a chiropractic faculty member emerges as a middle-aged male employed full-time as a teacher in the academic program. Regression analyses suggest that the observed faculty characteristics and the workplace variables are not associated with fit between the faculty member's work role and his/her own beliefs, norms, and behaviors regarding the value of the work-related tasks. The level of institutional commitment experienced by the faculty member was associated with the fit between the task, goal or purpose of the job, and the internal standards held by the individual.
Prevalence of burnout among doctors of chiropractic in the northeastern United States.
Williams, Shawn; Zipp, Genevieve P; Cahill, Terrence; Parasher, Raju K
2013-01-01
The purpose of this study was to measure the prevalence of burnout among doctors of chiropractic (DCs) in the New York, New Jersey, and Pennsylvania geographical region and compare these results with burnout data from other health care professions. This exploratory study applied cross-sectional data collection methods. Using nonprobability convenience sampling, a New York-New Jersey-Pennsylvania chiropractic governance body provided contact information of a randomized sample of licensed DCs from their membership directory. Participants included any DC licensed to practice chiropractic whose primary occupation encompassed the chiropractic profession. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and a demographic questionnaire were e-mailed to a randomized sample of licensed DCs. Of the 772 surveys deployed, 90 returned the survey with usable data. Nearly 40% of the DCs reported a moderate (24%) or high (18%) level of emotional exhaustion, whereas the majority of respondents scored a high (72%) level of personal accomplishment. In total, only 2 participants (2%) met the criteria for high burnout, whereas 42 participants (47%) were low. Statistically significant relationships (P < .001) were found between burnout subscales and the effect of time dedicated to administrative duties, the type of practice setting, the varying chiropractic philosophical perspectives, the public's opinion of chiropractic, and the effect of suffering from a work-related injury. When compared with data from previously published studies using the MBI-HSS for other health professions (ie, medical, nursing, physical therapy, occupational therapy, and dentistry), the values for DCs were significantly lower. The sample of DCs in this study fared more favorably on all 3 dimensions of burnout. They reported lower emotional exhaustion and depersonalization scores and higher personal accomplishment scores than their medical, nursing, physical therapy, occupational therapy, and
The effect of low force chiropractic adjustments on body surface electromagnetic field.
Zhang, John; Snyder, Brian J; Vernor, Lori
2004-03-01
The purpose of this study was to investigate the body surface electromagnetic field (EMF) changes using a sensitive magnetometer before and after a specific Toftness chiropractic adjustment in asymptomatic human subjects. Forty-four subjects were randomly assigned into control (20 subjects) and experimental groups (24 subjects) in a pre and post-test design. The Triaxial Fluxgate Magnetometer FGM-5DTAA (Walker Scientific, Worcester, Massachusetts) with five digit display and resolution of 1 nanotesla (nT) was used for EMF detection. The EMF in the research room and on the adjustment table was monitored and recorded. The subjects' body surface (cervical, thoracic, lumbar and sacral areas) EMF was determined in the prone position before and after the chiropractic adjustment. A low force Toftness chiropractic adjustment was applied to the cervical, thoracic, lumbar and sacral areas as determined by the practitioner. The EMF in the research room was recorded as 41611 nT at the Z axis (earth field), 13761 nT at the X axis and 7438 nT at the Y axis. The EMF on the adjusting table changed minimally during the 15 minute observation period. The EMF on the subjects' body surface decreased at 4 spinal locations after chiropractic adjustment. The EMF (mean +/- SD in nT) decreased significantly at the cervical region from 42449 +/- 907 to 41643 +/- 1165 (p < 0.01) and at the sacral regions from 43206 +/- 760 to 42713 +/- 552 (p < 0.01). The EMF at the lumbar and thoracic regions decreased but did not reach a statistically significant level. No significant changes of the body surface EMF were found in the control group. A low force Toftness chiropractic adjustment in the cervical and sacral areas resulted in a significant reduction of the cervical and sacral surface EMF. No significant body surface EMF changes were observed in the lumbar and thoracic regions. The mechanisms of the EMF reduction after chiropractic adjustment are not known.
The effect of low force chiropractic adjustments on body surface electromagnetic field
Zhang, John; Snyder, Brian J; Vernor, Lori
2004-01-01
Objective The purpose of this study was to investigate the body surface electromagnetic field (EMF) changes using a sensitive magnetometer before and after a specific Toftness chiropractic adjustment in asymptomatic human subjects. Method Forty-four subjects were randomly assigned into control (20 subjects) and experimental groups (24 subjects) in a pre and post-test design. The Triaxial Fluxgate Magnetometer FGM-5DTAA (Walker Scientific, Worcester, Massachusetts) with five digit display and resolution of 1 nanotesla (nT) was used for EMF detection. The EMF in the research room and on the adjustment table was monitored and recorded. The subjects’ body surface (cervical, thoracic, lumbar and sacral areas) EMF was determined in the prone position before and after the chiropractic adjustment. A low force Toftness chiropractic adjustment was applied to the cervical, thoracic, lumbar and sacral areas as determined by the practitioner. Results The EMF in the research room was recorded as 41611 nT at the Z axis (earth field), 13761 nT at the X axis and 7438 nT at the Y axis. The EMF on the adjusting table changed minimally during the 15 minute observation period. The EMF on the subjects’ body surface decreased at 4 spinal locations after chiropractic adjustment. The EMF (mean ± SD in nT) decreased significantly at the cervical region from 42449 ± 907 to 41643 ± 1165 (p < 0.01) and at the sacral regions from 43206 ± 760 to 42713 ± 552 (p < 0.01). The EMF at the lumbar and thoracic regions decreased but did not reach a statistically significant level. No significant changes of the body surface EMF were found in the control group. Conclusion A low force Toftness chiropractic adjustment in the cervical and sacral areas resulted in a significant reduction of the cervical and sacral surface EMF. No significant body surface EMF changes were observed in the lumbar and thoracic regions. The mechanisms of the EMF reduction after chiropractic adjustment are not known. PMID
Charity, Melanie J; Britt, Helena C; Walker, Bruce F; Gunn, Jane M; Forsdike-Young, Kirsty; Polus, Barbara I; French, Simon D
2016-01-01
COAST (Chiropractic Observational and Analysis STudy) reported the clinical practices of chiropractors. The aims of this study were to: 1) describe the chiropractic patient demographic and health characteristics; 2) describe patient-stated reasons for visiting a chiropractor; 3) describe chiropractic patient lifestyle characteristics; 4) compare, where possible, chiropractic patient characteristics to the general Australian population. Fifty-two chiropractors in Victoria, Australia, provided information for up to 100 consecutive encounters. If patients attended more than once during the 100 encounters, only data from their first encounter were included in this study. Where possible patient characteristics were compared with the general Australian population. Data were collected from December 2010 to September 2012. Data were provided for 4464 encounters, representing 3287 unique individuals. The majority of chiropractic encounters were for musculoskeletal conditions or for wellness/maintenance. The majority of patient comorbidities were musculoskeletal, circulatory or endocrine/metabolic in nature. Eight hundred chiropractic patients (57 %, 95 % CI: 53-61) described their self-reported health as excellent or very good and 138 patients (10 %, 95 % CI: 8-12) as fair or poor. Seventy-one percent of adult male patients (18 years and older), and 53 % of adult female patients, were overweight or obese. Fourteen percent (n = 188, 95 % CI: 12-16) were current smokers and 27 % (n = 359, 95 % CI: 24-31) did not meet Australian alcohol consumption guidelines. Less than half of the chiropractic patients participated in vigorous exercise at least twice per week. Approximately 20 % ate one serving of vegetables or less each day, and approximately 50 % ate one serve of fruit or less each day. Compared to the general Australian population, chiropractic patients were less likely to smoke, less likely to be obese and more likely to describe their health in positive terms
Spinal Manipulative Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review.
Théroux, Jean; Stomski, Norman; Losco, Christine Dominique; Khadra, Christelle; Labelle, Hubert; Le May, Sylvie
The purpose of this study was to perform a systematic review of clinical trials of spinal manipulative therapy for adolescent idiopathic scoliosis. Search strategies were developed for PubMed, CINHAL, and CENTRAL databases. Studies were included through June 2016 if they were prospective trials that evaluated spinal manipulative therapy (eg, chiropractic, osteopathic, physical therapy) for adolescent idiopathic scoliosis. Data were extracted and assessed by 2 independent reviewers. Cochrane risk of bias tools were used to assess the quality of the included studies. Data were reported qualitatively because heterogeneity prevented statistical pooling. Four studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small sample sizes precluded robust estimation of the interventions' effect sizes. There is currently insufficient evidence to establish whether spinal manipulative therapy may be beneficial for adolescent idiopathic scoliosis. The results of the included studies suggest that spinal manipulative therapy may be a promising treatment, but these studies were all at substantial risk of bias. Further high-quality studies are warranted to conclusively determine if spinal manipulative therapy may be effective in the management of adolescent idiopathic scoliosis. Copyright © 2017. Published by Elsevier Inc.
Neck pain in children: a retrospective case series.
Cox, Jocelyn; Davidian, Christine; Mior, Silvano
2016-09-01
Spinal pain in the paediatric population is a significant health issue, with an increasing prevalence as they age. Paediatric patients attend for chiropractor care for spinal pain, yet, there is a paucity of quality evidence to guide the practitioner with respect to appropriate care planning. A retrospective chart review was used to describe chiropractic management of paediatric neck pain. Two researchers abstracted data from 50 clinical files that met inclusion criteria from a general practice chiropractic office in the Greater Toronto Area, Canada. Data were entered into SPSS 15 and descriptively analyzed. Fifty paediatric neck pain patient files were analysed. Patients' age ranged between 6 and 18 years (mean 13 years). Most (98%) were diagnosed with Grade I-II mechanical neck pain. Treatment frequency averaged 5 visits over 19 days; with spinal manipulative therapy used in 96% of patients. Significant improvement was recorded in 96% of the files. No adverse events were documented. Paediatric mechanical neck pain appears to be successfully managed by chiropractic care. Spinal manipulative therapy appears to benefit paediatric mechanical neck pain resulting from day-today activities with no reported serious adverse events. Results can be used to inform clinical trials assessing effectiveness of manual therapy in managing paediatric mechanical neck pain.
Posterior rib fractures in a young infant who received chiropractic care.
Wilson, Paria Majd; Greiner, Mary V; Duma, Elena M
2012-11-01
We report on a 21-day-old infant with healing posterior rib fractures that were noted after a chiropractic visit for colic. Chiropractors are the third largest group of health care professionals in the United States, and colic is the leading complaint for pediatric chiropractic care. Rib fractures, specifically when posterior, are traditionally considered to be secondary to nonaccidental trauma. Thorough investigation is necessary to rule out bone fragility and genetic disorders, but patient history is key when evaluating unexplained fractures.
Essential literature for the chiropractic profession: a survey of chiropractic research leaders
2013-01-01
Background Evidence-based clinical practice (EBCP) is an accepted practice for informed clinical decision making in mainstream health care professions. EBCP augments clinical experience and can have far reaching effects in education, policy, reimbursement and clinical management. The proliferation of published research can be overwhelming—finding a mechanism to identify literature that is essential for practitioners and students is desirable. The purpose of this study was to survey leaders in the chiropractic profession on their opinions of essential literature for doctors of chiropractic, faculty, and students to read or reference. Methods Deployment of an IRB exempted survey occurred with 68 academic and research leaders using SurveyMonkey®. Individuals were solicited via e-mail in August of 2011; the study closed in October of 2011. Collected data were checked for citation accuracy and compiled to determine multiple responses. A secondary analysis assessed the scholarly impact and Internet accessibility of the recommended literature. Results Forty-three (43) individuals consented to participate; seventeen (17) contributed at least one article of importance. A total of 41 unique articles were reported. Of the six articles contributed more than once, one article was reported 6 times, and 5 were reported twice. Conclusions A manageable list of relevant literature was created. Shortcomings of methods were identified, and improvements for continued implementation are suggested. A wide variety of articles were reported as “essential” knowledge; annual or bi-annual surveys would be helpful for the profession. PMID:24289298
Leach, Robert A; Cossman, Ronald E; Yates, Joyce M
2011-01-01
The purpose of this study was to determine the familiarity with and stated advocacy of Healthy People 2010 objectives by member doctors of the Mississippi Chiropractic Association. Peer experts established face validity of a questionnaire regarding the Leading Health Indicators. This survey was distributed to 157 Mississippi Chiropractic Association members in 2009 during a conference and a follow-up by postal mail. Most doctors of chiropractic in the sample (n = 68, or 43% response) consider themselves wellness-oriented health care providers. Forty-two percent had read, 29% had not read, and another 29% were unsure whether they had read the Healthy People 2010 national objectives. Almost half (44%) strongly or somewhat agreed that their office practice reflects support for the Healthy People 2010 objective. In contrast, 27% disagree and 29% were unsure if their practice reflects the Healthy People 2010 objectives. There were differences between support and practice behaviors for some of the objectives. Chiropractors who have read the objectives tend to be more supportive of the national goals. Doctors of chiropractic in this sample are supportive of most Leading Health Indicators, and the majority reports that they incorporate these public health goals into their practices. Familiarity with reading the Health People objectives seems to be related to reported practice behaviors. There is a need to improve the percentage of practicing doctors of chiropractic who are familiar with Healthy People objectives. Future health education initiatives may assist doctors of chiropractic in further incorporating public health objectives into their practice behaviors and improving quality health care. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Moreau, William J; Nabhan, Dustin C; Roecker, Christopher; Kimura, Melissa Nagare; Klein, Andrew; Guimard, Brett; Pierce, Kevin; Helma, Patrick; Nelson, Robert; Bahr, Kelly Shockley; Nelson, Laney; Williams, Perry
2015-09-01
The purpose of this paper is to present a position statement of best practices for the provision of a safe and high-quality pre-participation examination (PPE) and to provide recommendations on education requirements for doctors of chiropractic providing the PPE. In 2014, the American Chiropractic Board of Sports Physicians (ACBSP) Board of Directors identified a need to review and update the ACBSP position statements and practice guidelines in order to be current with evolving best practices. Twelve ACBSP certificants, 10 Diplomates of the ACBSP, and 2 Certified Chiropractic Sports Physicians, met in April 2015 to author a pre-participation position statement using an expert consensus process. Panel members excluded anyone with commercial conflicts of interest and included individuals with expertise in clinical sports medicine and the performance of PPEs. A literature review was performed and circulated in advance for use by the panel in addressing the topic. The position statement was written through a consensus process and accepted by the ACBSP Board of Directors in May of 2015. The ACBSP Position Statement on Pre-participation Examinations identifies the qualifications and best practices for doctors of chiropractic to perform a PPE. This position statement states that doctors of chiropractic with post graduate education and current Diplomates of the ACBSP or Certified Chiropractic Sports Physicians certification have the prerequisite education and qualifying skills to perform PPEs.
Moreau, William J.; Nabhan, Dustin C.; Roecker, Christopher; Kimura, Melissa Nagare; Klein, Andrew; Guimard, Brett; Pierce, Kevin; Helma, Patrick; Nelson, Robert; Bahr, Kelly Shockley; Nelson, Laney; Williams, Perry
2015-01-01
Objective The purpose of this paper is to present a position statement of best practices for the provision of a safe and high-quality pre-participation examination (PPE) and to provide recommendations on education requirements for doctors of chiropractic providing the PPE. Methods In 2014, the American Chiropractic Board of Sports Physicians (ACBSP) Board of Directors identified a need to review and update the ACBSP position statements and practice guidelines in order to be current with evolving best practices. Twelve ACBSP certificants, 10 Diplomates of the ACBSP, and 2 Certified Chiropractic Sports Physicians, met in April 2015 to author a pre-participation position statement using an expert consensus process. Panel members excluded anyone with commercial conflicts of interest and included individuals with expertise in clinical sports medicine and the performance of PPEs. A literature review was performed and circulated in advance for use by the panel in addressing the topic. The position statement was written through a consensus process and accepted by the ACBSP Board of Directors in May of 2015. Results The ACBSP Position Statement on Pre-participation Examinations identifies the qualifications and best practices for doctors of chiropractic to perform a PPE. Conclusion This position statement states that doctors of chiropractic with post graduate education and current Diplomates of the ACBSP or Certified Chiropractic Sports Physicians certification have the prerequisite education and qualifying skills to perform PPEs. PMID:26778931
Gleberzon, Brian; Lameris, Marlee; Schmidt, Catherine; Ogrady, Jillian
2013-09-01
The Palmers espoused anti-vaccination opinions in the early part of the 20(th) 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.
Before Nugent took charge: early efforts to reform chiropractic education, 1919-1941
Keating, Joseph C
2003-01-01
John J. Nugent, D.C. is remembered by many as either the “Abraham Flexner of Chiropractic” or the “anti-Christ of Chiropractic.” From 1941 until his forced retirement in 1959, the Irish-born Palmer graduate was one of the most important factors in the profession's educational reforms. Yet Nugent's work as the National Chiropractic Association's (NCA's) director of research was not the beginning of the campaign to upgrade chiropractic education. This paper looks at earlier influences and events which set the stage for Nugent's campaign. Among these were the introduction of licensure for chiropractors, the self-defeating actions of B.J. Palmer, the introduction of basic science legislation, the lethargy of the schools, and the struggle for control of education between the schools, on the one hand, and the NCA and the Council of State Chiropractic Examining Boards on the other ImagesFigure 1Figure 3Figure 4Figure 5Figure 6Figure 7Figure 9Figure 10Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16Figure 17Figure 18Figure 19Figure 20Figure 21Figure 22Figure 23Figure 24Figure 25Figure 26Figure 28Figure 29Figure 30Figure 31Figure 32Figure 33Figure 34Figure 35Figure 36Figure 37Figure 38
2012-03-01
AD_________________ Award Number: W81XWH-11-2-0107 TITLE: Assessment of Chiropractic Treatment for...February 2012 4. TITLE AND SUBTITLE Assessment of Chiropractic Treatment for Low Back Pain, Military Readiness and Smoking Cessation in Military Active...Assessment of Chiropractic Treatment (or ACT). the most significant work during the last reporting period was the finalization of the protocol for ACT1
2013-03-01
AD_________________ Award Number: W81XWH-11-2-0107 TITLE: Assessment of Chiropractic Treatment for...2013 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Assessment of Chiropractic Treatment for Low Back Pain, Military Readiness and Smoking Cessation...the Assessment of Chiropractic Treatment (or ACT). The most significant work during the last reporting period has occurred in the ACT 1 (RCT which is
2014-03-01
AD_________________ Award Number: W81XWH-11-2-0107 TITLE: Assessment of Chiropractic Treatment for...Annual 3. DATES COVERED 15 February 2013 – 14 February 2014 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Assessment of Chiropractic Treatment for...SUPPLEMENTARY NOTES 14. ABSTRACT This study is comprised of three trials, referred to as the Assessment of Chiropractic Treatment (ACT). The
Todd, Angela J; Carroll, Matthew T; Russell, David G; Mitchell, Eleanor K L
2017-03-01
To compare chiropractic students' perceptions of preparedness for practice before and after a clinical placement in Rarotonga and to report demographics from these experiences. The students completed deidentified pre- and postplacement surveys assessing pediatric practice preparedness. Students tallied the patient numbers, age, and chiropractic techniques used per visit for each day of clinic placement. On completion of the program, participating students (27/34, or 79% of the student cohort) did a postplacement survey on their perception of practice preparedness. Data were analyzed with the Spearman rho correlation, the Mann-Whitney U test, and regression analysis. There was an increase in perceived preparedness for pediatric practice, ranging from 24.1% of the student cohort at the start of the study to 82.1% following clinical placement in Rarotonga. The change in student preparedness to practice with children was positively correlated with the total number of children managed (r s = .05, p = .01) and the number of children managed who were under 10 years of age (r s = .60, p = .001). Multiple regression analysis demonstrated a medium positive effect for postprogram preparedness (F [4, 20] = 3.567, p = .024). Clinical outreach to Rarotonga provided a broad case mix of patients and a change in student perceptions of preparedness to practice with children, which was positively affected by the total number of children managed and the number of children managed who were under 10 years of age.
Marziani, Jessica A
2018-05-01
The nontraditional therapies of Traditional Chinese Veterinary Medicine and chiropractic care are adjunct treatments that can be used in conjunction with more conventional therapies to treat a variety of medical conditions. Nontraditional therapies do not need to be alternatives to Western medicine but, instead, can be used simultaneously. Exotic animal practitioners should have a basic understanding of nontraditional therapies for both client education and patient referral because they can enhance the quality of life, longevity, and positive outcomes for various cases across multiple taxa. Copyright © 2018 Elsevier Inc. All rights reserved.
Spinal manipulation under anesthesia: a narrative review of the literature and commentary
2013-01-01
As exhibited throughout the medical literature over many decades, there is a lack of uniformity in the manner in which spine pain patients have historically qualified for and received manipulation under anesthesia (MUA). Also, for different professions that treat the same types of spinal conditions via the same means, fundamental MUA decision points vary within the published protocols of different professional associations. The more recent chiropractic literature communicates that the evidence to support the efficacy of MUA of the spine remains largely anecdotal. In addition, it has been reported that the types of spinal conditions most suitable for MUA are without clear-cut consensus, with various indications for MUA of the low back resting wholly upon the opinions and experiences of MUA practitioners. This article will provide a narrative review of the MUA literature, followed by a commentary about the current lack of high quality research evidence, the anecdotal and consensus basis of existing clinical protocols, as well as related professional, ethical and legal concerns for the chiropractic practitioner. The limitations of the current medical literature related to MUA via conscious/deep sedation need to be recognized and used as a guide to clinical experience when giving consideration to this procedure. More research, in the form of controlled clinical trials, must be undertaken if this procedure is to remain a potential treatment option for chronic spine pain patients in the chiropractic clinical practice. PMID:23672974
Garner, Michael J; Aker, Peter; Balon, Jeff; Birmingham, Michael; Moher, David; Keenan, Dirk; Manga, Pran
2007-01-01
This study was part of a larger demonstration project integrating chiropractic care into publicly funded Canadian community health centers. This pre/post study investigated the effectiveness of chiropractic care in reducing pain and disability as well as improving general health status in a unique population of urban, low-income, and multiethnic patients with musculoskeletal (MSK) complaints. All patients who presented to one of two community health center-based chiropractic clinics with MSK complaints between August 2004 and December 2005 were recruited to participate in this study. Outcomes were assessed by a general health measure (Short Form-12), a pain scale (VAS), and site-specific disability indexes (Roland-Morris Questionnaire and Neck Disability Index), which were administered before and after a 12-week treatment period. Three hundred twenty-four patients with MSK conditions were recruited into the study, and 259 (80.0%) of them were followed to the study's conclusion. Clinically important and statistically significant positive changes were observed for all outcomes (Short Form-12: physical composite score mean change = 4.9, 95% confidence interval [CI] = 3.8-6.0; VAS: current pain mean change = 2.3, 95% CI = 1.9-2.6; Neck Disability Index: mean change = 6.8, 95% CI = 5.4-8.1; Roland-Morris Questionnaire: mean change = 4.3, 95% CI = 3.6-5.1). No adverse events were reported. Patients of low socioeconomic status face barriers to accessing chiropractic services. This study suggests that chiropractic care reduces pain and disability as well as improves general health status in patients with MSK conditions. Further studies using a more robust methodology are needed to investigate the efficacy and cost-effectiveness of introducing chiropractic care into publicly funded health care facilities.
2009-12-08
www.journalchiromed.com Journal of Chiropractic Medicine (2010) 9, 17–21Resolution of low back and radicular pain in a 40-year-old male United States...Navy Petty Officer after collaborative medical and chiropractic care☆ Gregory R. Lillie DC, MS⁎ Chiropractic Physician, Naval Branch Health Clinic...Military personnel; ChiropracticObjective: The aim of this study is to describe the interdisciplinary care, including chiropractic services, in a military
Kawchuk, Gregory Neil
2017-12-01
The McAndrews Leadership Lecture was developed by the American Chiropractic Association to honor the legacy of Jerome F. McAndrews, DC, and George P. McAndrews, JD, and their contributions to the chiropractic profession. This article is an edited and truncated version of the McAndrews Leadership Lecture given by Dr Greg Kawchuk on February 27, 2016, in Washington, DC, at the National Chiropractic Leadership Conference. This was the second McAndrews lecture in this annual series.
Humphreys, B Kim; Peterson, Cynthia K
2016-12-01
In 2007, chiropractic became 1 of the 5 medical professions in Switzerland. This required a new chiropractic program that was fully integrated within a Swiss medical school. The purpose of this article was to discuss the Master in Chiropractic Medicine (MChiroMed) program at the University of Zürich, including advantages, opportunities, and challenges. In 2008, the MChiroMed program began with its first student cohort. The MChiroMed program is a 6-year Bologna model 2-cycle (bachelor and master) "spiral curriculum," with the first 4 years being fully integrated within the medical curriculum. A review of the main features of the curriculum revealed the advantages, opportunities, and challenges of this program in comparison with other contemporary chiropractic educational programs. Advantages and opportunities include an integrated curriculum within a university, medical school, and musculoskeletal hospital, with their associated human and physical resources. Many opportunities exist for high-level research collaborations. The rigorous entrance qualifications and small student cohorts result in bright, motivated, and enthusiastic students; appropriate assessments; and timely feedback on academic and clinical subjects. Early patient contact in hospitals and clinical facilities encourages the integration of academic theory and clinical practice. The main challenges faced by this program include difficulty recruiting a sufficient number of students because of the rigorous entrance requirements and curriculum overload resulting from undertaking a full medical curriculum and chiropractic modules. The MChiroMed program is a unique chiropractic curriculum that integrates medical and chiropractic education within a spiral curriculum at a world-class Swiss university medical school. The expectation is that graduates, with their expanded diagnostic and therapeutic knowledge, skills, and experience, will become future experts in primary spine care in Switzerland. It is hoped
Utilizing doctors' attitudes toward staff training to inform a chiropractic technology curriculum.
Eberhart, Catherine A; Martel, Stacie S
2015-03-01
The purpose of this study is to determine attitudes of doctors of chiropractic regarding the importance of staff training in specific skill areas to inform the curriculum management process of a chiropractic technology program. A survey was distributed to registrants of a chiropractic homecoming event. On a 5-point Likert scale, respondents were asked to rate the degree of importance that staff members be trained in specific skills. Descriptive statistics were derived, and a 1-way analysis of variance (ANOVA) was used to test differences between groups based on years in practice and level of staff training. Doctors place a high level of importance on oral communication skills and low importance on nutrition and physical examinations. Comparing groups based on years in practice revealed differences in the areas of passive physiotherapies (F = 3.61, p = .015), legal issues/regulations (F = 3.01, p = .032), occupational safety and health regulation (F = 4.27, p = .006), and marketing (F = 2.67, p = .049). Comparing groups based on level of staff training revealed differences in the areas of occupational safety and health regulations (F = 4.56, p = .005) and cardiopulmonary resuscitation (F = 4.91, p = .003). With regard to their assistants, doctors of chiropractic tend to place high importance on office skills requiring effective communication and place less importance on clinical skills such as physical examinations and physiotherapy.
Chiropractic care of a patient with vertebral subluxation and Bell's palsy.
Alcantara, Joel; Plaugher, Gregory; Van Wyngarden, Darwin L
2003-05-01
To describe the chiropractic care of a patient medically diagnosed with Bell's palsy and discuss issues clinically relevant to this disorder, such as its epidemiology, etiology, diagnosis, care, and prognosis. A 49-year-old woman with a medical diagnosis of Bell's palsy sought chiropractic care. Her symptoms included right facial paralysis, extreme phonophobia, pain in the right temporomandibular joint (TMJ), and neck pain. Signs of cervical vertebral and TMJ subluxations included edema, tenderness, asymmetry of motion and posture, and malalignment detected from plain film radiographs. The patient was cared for with full spine contact-specific, high-velocity, low-amplitude adjustments (Gonstead Technique) to sites of vertebral and occipital subluxations. The patient's left TMJ was also adjusted. The initial symptomatic response to care was positive, and the patient made continued improvements during the 6 months of care. There are indications that patients suffering from Bell's palsy may benefit from a holistic chiropractic approach that not only includes a focus of examination and care of the primary regional areas of complaint (eg, face, TMJ) but also potentially from significant vertebral subluxation concomitants.
The chiropractic scope of practice in the United States: a cross-sectional survey.
Chang, Mabel
2014-01-01
The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998. A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability. Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30). The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Fredericks, Marcel; Kondellas, Bill; Hang, Lam; Fredericks, Janet; Ross, Michael WV
2011-01-01
Objective The purpose of this article is to present select concepts and theories of bureaucratic structures and functions so that chiropractic physicians and other health care professionals can use them in their respective practices. The society-culture-personality model can be applied as an organizational instrument for assisting chiropractors in the diagnosis and treatment of their patients irrespective of locality. Discussion Society-culture-personality and social meaningful interaction are examined in relationship to the structural and functional aspects of bureaucracy within the health care institution of a society. Implicit in the examination of the health care bureaucratic structures and functions of a society is the focus that chiropractic physicians and chiropractic students learn how to integrate, synthesize, and actualize values and virtues such as empathy, integrity, excellence, diversity, compassion, caring, and understanding with a deep commitment to self-reflection. Conclusion It is essential that future and current chiropractic physicians be aware of the structural and functional aspects of an organization so that chiropractic and other health care professionals are able to deliver care that involves the ingredients of quality, affordability, availability, accessibility, and continuity for their patients. PMID:22693481
An International Survey of Gross Anatomy Courses in Chiropractic Colleges
Ball, Jennette J.; Petrocco-Napuli, Kristina L.; Zumpano, Michael P.
2012-01-01
Purpose: The purpose of this study is to provide the first comprehensive description of gross anatomy course design in chiropractic colleges internationally and to provide baseline data for future investigation, future comparison with other health care professions, and identification of trends. Methods: A 72-question cross-sectional electronic survey was sent to the anatomy department chair at 36 chiropractic colleges internationally using Zoomerang, a web-based survey instrument. To augment the survey response data, public sources of data also were collected. Results: Forty-four percent of the electronic surveys were returned and information was gathered for 31 institutions from public sources. These results indicate (1) the most common degrees held by anatomy faculty were MS and PhD in anatomy, and DC degrees; (2) 75% of institutions utilized human cadavers and 75% presented laboratory anatomical demonstrations; (3) 62% used PowerPoint and 100% provided students with copies of lecture presentations; (4) 88% required attendance in laboratory and 50% in lecture; (5) 69% issued one grade for lecture and laboratory; (6) 100% of laboratory examinations were anatomical identification; and (7) 80% of written examinations were multiple-choice format. Conclusions: While individual variations existed, chiropractic institutions internationally have similar gross anatomy faculty, course design, delivery methods, and assessment methods. PMID:23362365
Poulsen, Erik; Christensen, Henrik W; Overgaard, Søren; Hartvigsen, Jan
2012-05-01
The purposes of this study were to measure the prevalence of clinical and radiographic hip osteoarthritis (OA) and first-time diagnosis of hip OA in consecutive patients presenting to chiropractic practices in Denmark and to report the components of the initial treatment rendered by the chiropractic practitioner. A total of 2000 patient records and 1000 radiographs were reviewed retrospectively in 20 chiropractic clinics throughout Denmark. Information obtained included patients' primary complaint, physical examination and radiographic findings of hip OA, and treatment. Subsequently, the 20 clinics participated in a prospective survey where they collected equivalent information over a 2-week period. Retrospective review of records revealed that 1.4% of patients in Danish chiropractic practice had signs of clinical hip OA. Of these, 59% demonstrated radiographic signs of hip OA. Prospective data collection revealed that 3.4% of new patients had signs of clinical hip OA. Fifty-four percent of these demonstrated radiographic signs of hip OA, and of these 70% were diagnosed as having OA of the hip for the first time. Initial treatment involved manual treatment and advice on over-the-counter pain medication and/or supplements. Of all 1000 retrospectively reviewed radiographs in patients 40 years or older, 19.2% demonstrated radiographic signs of hip OA. Osteoarthritis of the hip is diagnosed and managed in primary care chiropractic practice in Denmark; however, it is likely underdiagnosed. In those newly presenting to chiropractic practitioners, first-time diagnosis with clinical and radiographic signs of hip OA appears to be common. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
An integrative treatment approach of a patient with cervical radiculitis: A case report
Apfelbeck, Leanne
2005-01-01
Abstract Objective To describe a case report of the use of 3 treatment methods for treatment of cervical radiculitis; manual intermittent traction, instrumental chiropractic spinal manipulation, and interferential therapy. Clinical Features A 54-year-old man experienced neck and left arm pain with positive orthopedic tests indicating cervical spinal nerve root involvement; he was diagnosed with cervical radiculitis Intervention and Outcome The patient received 10 treatments over a period of 8 weeks. Instrumental spinal manipulation, manual intermittent traction, and interferential therapy were integrated as a treatment plan for the patient. The patient's condition appeared to resolve. Outcome measures were evaluated at baseline, weeks 3, 5, and 8. Neck Disability Index scores were 32%, 14%, 8%, and 4% respectively, and the Visual Analog Scales were 8.5/10, 2.0/10, 1.0/10, and 0.5/10. The symptoms of cervical radiculitis was resolved in an 8 week period after 10 treatments. Conclusion The integration of instrumental spinal manipulation, manual intermittent traction, and interferential may work well together for patients with similar signs and symptoms as presented in this case. PMID:19674652
Polus, Barbara I; Paterson, Charlotte; van Rotterdam, Joan; Vindigni, Dein
2012-11-26
Improving the health of Indigenous Australians remains a major challenge. A chiropractic service was established to evaluate this treatment option for musculoskeletal illness in rural Indigenous communities, based on the philosophy of keeping the community involved in all the phases of development, implementation, and evaluation. The development and integration of this service has experienced many difficulties with referrals, funding and building sustainability. Evaluation of the program was a key aspect of its implementation, requiring an appropriate process to identify specific problems and formulate solutions to improve the service. We used the normalisation process model (May 2006) to order the data collected in consultation meetings and to inform our strategy and actions. The normalisation process model provided us with a structure for organising consultation meeting data and helped prioritise tasks. Our data was analysed as it applied to each dimension of the model, noting aspects that the model did not encompass. During this process we reworded the dimensions into more everyday terminology. The final analysis focused on to what extent the model helped us to prioritise and systematise our tasks and plans. We used the model to consider ways to promote the chiropractic service, to enhance relationships and interactions between clinicians and procedures within the health service, and to avoid disruption of the existing service. We identified ways in which chiropractors can become trusted team members who have acceptable and recognised knowledge and skills. We also developed strategies that should result in chiropractic practitioners finding a place within a complex occupational web, by being seen as similar to well-known occupations such as physiotherapy. Interestingly, one dimension identified by our data, which we have labelled 'emancipatory', was absent from the model. The normalisation process model has resulted in a number of new insights and questions. We
Chiropractic Colleges Seek Legitimacy amid Financial Woes
ERIC Educational Resources Information Center
Fuller, Andrea
2012-01-01
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…
Effect of Spinal Manipulative Therapy on the Singing Voice.
Fachinatto, Ana Paula A; Duprat, André de Campos; Silva, Marta Andrada E; Bracher, Eduardo Sawaya Botelho; Benedicto, Camila de Carvalho; Luz, Victor Botta Colangelo; Nogueira, Maruan Nogueira; Fonseca, Beatriz Suster Gomes
2015-09-01
This study investigated the effect of spinal manipulative therapy (SMT) on the singing voice of male individuals. Randomized, controlled, case-crossover trial. Twenty-nine subjects were selected among male members of the Heralds of the Gospel. This association was chosen because it is a group of persons with similar singing activities. Participants were randomly assigned to two groups: (A) chiropractic SMT procedure and (B) nontherapeutic transcutaneous electrical nerve stimulation (TENS) procedure. Recordings of the singing voice of each participant were taken immediately before and after the procedures. After a 14-day period, procedures were switched between groups: participants who underwent SMT on the first day were subjected to TENS and vice versa. Recordings were subjected to perceptual audio and acoustic evaluations. The same recording segment of each participant was selected. Perceptual audio evaluation was performed by a specialist panel (SP). Recordings of each participant were randomly presented thus making the SP blind to intervention type and recording session (before/after intervention). Recordings compiled in a randomized order were also subjected to acoustic evaluation. No differences in the quality of the singing on perceptual audio evaluation were observed between TENS and SMT. No differences in the quality of the singing voice of asymptomatic male singers were observed on perceptual audio evaluation or acoustic evaluation after a single spinal manipulative intervention of the thoracic and cervical spine. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Adams, Jon; Lauche, Romy; Peng, Wenbo; Steel, Amie; Moore, Craig; Amorin-Woods, Lyndon G; Sibbritt, David
2017-01-05
This paper reports the profile of the Australian chiropractic workforce and characteristics of chiropractic care from a large nationally-representative sample of practitioners. A 21-item questionnaire examining practitioner, practice and clinical management characteristics was distributed to all registered chiropractors (n = 4,684) in Australia in 2015 via both online and hard copy mail out. The survey attracted a response rate of 43% (n = 2,005), and the sample is largely representative of the national chiropractic workforce on a number of key indicators. The average age of the chiropractors was 42.1 years, nearly two-thirds are male, and the vast majority hold a bachelor degree or higher qualification. Australian chiropractors are focused upon treating people across a wide age range who mainly present with musculoskeletal conditions. Australian chiropractors have referral relationships with a range of conventional, allied health and complementary medicine (CAM) providers. The chiropractic profession represents a substantial component of the contemporary Australian health care system with chiropractors managing an estimated 21.3 million patient visits per year. While the Australian chiropractic workforce is well educated, research engagement and research capacity remains sub-optimal and there is much room for further capacity building to help chiropractic reach full potential as a key integrated profession within an evidence-based health care system. Further rich, in-depth research is warranted to improve our understanding of the role of chiropractic within the Australian health care system.
Walker, Bruce F; Losco, Barrett; Clarke, Brenton R; Hebert, Jeff; French, Simon; Stomski, Norman J
2011-10-31
Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention. One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Australia and New Zealand Clinical Trials Register (ANZCTR
2011-01-01
Background Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention. Methods One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Trial registration Australia and New Zealand
Blanchette, Marc-André; Stochkendahl, Mette Jensen; Borges Da Silva, Roxane; Boruff, Jill; Harrison, Pamela; Bussières, André
2016-01-01
Background Context Low back pain (LBP) is one of the leading causes of disability worldwide and among the most common reasons for seeking primary sector care. Chiropractors, physical therapists and general practitioners are among those providers that treat LBP patients, but there is only limited evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. Purpose To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP. Study Design Systematic reviews of interventions and economic evaluations. Methods A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared to standard care delivered by other healthcare providers. Studies published between 1990 and 4th June 2015 were considered. Primary outcomes included pain, functional status and global improvement. Study selection, critical quality appraisal and data extraction were conducted by two independent reviewers. Data from RCTs with low risk of bias were included in a meta-analysis to determine effect estimates. Cost estimates of full economic evaluations were converted to 2015 USD and results summarized using Slavin’s qualitative best-evidence synthesis. Results Six RCTs and three full economic evaluations were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). Overall, we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three low to high quality full economic evaluations studies (one cost-effectiveness, one cost-minimization and one cost-benefit) compared chiropractic to medical care. Given the divergent
Johnson, Claire; Killinger, Lisa Zaynab; Christensen, Mark G; Hyland, John K; Mrozek, John P; Zuker, R Fred; Kizhakkeveettil, Anupama; Perle, Stephen M; Oyelowo, Tolu
2012-12-01
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.
Pohlman, Katherine A; Carroll, Linda; Hartling, Lisa; Tsuyuki, Ross; Vohra, Sunita
2016-09-01
The purpose of this cross-sectional survey was to evaluate attitudes and opinions of doctors of chiropractic (DCs) specializing in pediatric care toward patient safety. The Medical Office Survey on Patient Safety Culture of the Agency for Healthcare Research and Quality was adapted for providers who use spinal manipulation therapy and sent out to 2 US chiropractic organizations' pediatric council members (n = 400) between February and April 2014. The survey measured 12 patient safety dimensions and included questions on patient safety items and quality issues, information exchange, and overall clinic ratings. Data analyses included a percent composite average and a nonrespondent analysis. The response rate was 29.5% (n = 118). Almost one- third of respondents' patients were pediatric (≤17 years of age). DCs with a pediatric certification were 3 times more likely to respond (P < .001), but little qualitative differences were found in responses. The patient safety dimensions with the highest positive composite percentages were Organizational Learning (both administration and clinical) and Teamwork (>90%). Patient Care Tracking/Follow-up and Work Pressure and Pace were patient safety dimensions that had the lowest positive composite scores (<85%). The responses also indicated that there was concern regarding information exchange with insurance/third-party payors. Two quality issues identified for improvement were (1) updating a patient's medication list and (2) following up on critically abnormal results from a laboratory or imaging test within 1 day. The average overall patient safety rating score indicated that 83% of respondents rated themselves as "very good" or "excellent." Compared with 2014 Agency for Healthcare Research and Quality physician referent data from medical offices, pediatric DCs appear to have more positive patient safety attitudes and opinions. Future patient safety studies need to prospectively evaluate safety performance with direct feedback
Terre, Lisa; Globe, Gary; Pfefer, Mark T
2006-01-01
Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.
Senzon, Simon A.
2014-01-01
Objective The purpose of this commentary is to describe the conflicts in the history of chiropractic’s professionalization and conflict through the path of increasing educational standards and accreditation using the lens of developmental structuralism. Discussion Within the story of chiropractic’s professionalization and accreditation lie the battles between competing worldviews. Gibbons proposed 4 periods of chiropractic’s educational history; this article proposes a fifth period along with a new methodological approach to explore the complexity of chiropractic’s history. The methodology draws upon constructive developmental psychology and proposes 5 levels of thinking common to the individuals from chiropractic’s history. By using a psychological framework to analyze historical events, it appears that the battle within chiropractic education continues at present. Several important issues are explored: the Council on Chiropractic Education's origins in the medical paradigm and rational thinking, the pre-rational, rational, and post-rational critics of the Council on Chiropractic Education, the schools of thought that were reified or emerged from the history, as well as the more recent legal, economic, and social pressures, which helped to shape chiropractic's accreditation and professionalization. Conclusion A transrational approach, one that includes the partial truths of all perspectives, is a first step to allow for a richer understanding of how the interior worldviews, individual actions, and the exterior forces (legal, economic, political, and educational) brought forth the chiropractic clashes together. Viewing the conflicts within chiropractic from this approach may foster new educational structures to evolve. PMID:25431541
Page, Stacey A; Grod, Jaroslaw P
2009-01-01
This study describes the extent to which chiropractors with Web sites practicing in Canada advertise health products for sale and considers this practice in the context of chiropractic codes of ethics and conduct. Chiropractic Web sites in Canada were identified using a public online business directory (Canada 411). The Web sites were searched, and an inventory of the health products for sale was taken. The influences of type of practice and province of practice on the sale of health product were assessed. Textual comments about health product marketing were summarized. National and provincial codes of ethics were reviewed, and the content on health product advertising was summarized. Two hundred eighty-seven Web sites were reviewed. Just more than half of the Web sites contained information on health products for sale (n = 158, 54%). Orthotics were advertised most often (n = 136 practices, 47%), followed by vitamins/nutritional supplements (n = 53, 18%), pillows and supports (n = 40, 14%), and exercise/rehabilitation products (n = 20, 7%). Chiropractors in solo or group chiropractic practices were less likely to advertise health products than those in multidisciplinary practice (P < .001), whereas chiropractors in BC were less likely to advertise nutritional supplements (P < .01). Provincial codes of ethics and conduct varied in their guidelines regarding health product sales. Variations in codes of ethics and in the proportions of practitioners advertising health products for sales across the country suggest that opinions may be divided on the acceptability of health product sales. Such practices raise questions and considerations for the chiropractic profession.
A preliminary assessment of the fifth-year chiropractic students' knowledge of anatomy.
Strkalj, Goran; Schroder, Tania; Pather, Nalini; Solyali, Veli
2011-01-01
Anatomy has been at the foundation of medical students' training. In recent decades, medical programs in many countries have undergone major reform in both pedagogy and content. These reforms generated intense debates, focusing mainly on the way the new programs affected medical graduates' knowledge of anatomy and their clinical capabilities. Anatomy, however, is not only core to medicine, but also to a number of allied and complementary health disciplines. While the evaluation of anatomy teaching and learning in the medical programs has been heavily scrutinized, anatomy education in the complementary and alternative medicine (CAM) professions, including those, such as chiropractic, in which anatomy has traditionally been one of the main preclinical subjects, has been less frequently evaluated. The study aimed to make a preliminary assessment of the final year chiropractic students' knowledge of anatomy using the "carpal bone test." The testing was conducted on the final-year chiropractic students at Macquarie University in 2009. In this test, the students were given 5 minutes to label an illustration of the bony skeleton of the carpal region. The results of this assessment were then compared to results of previously published surveys using the "carpal bone test." A total of 84 students participated in the study. Thirty-eight percent (38%) of students identified all eight bones, while 60% of students identified five or more carpal bones. The most frequent correctly identified bone was the pisiform, followed by the scaphoid bone (82% and 74% of students, respectively). The trapezium and trapezoid bones were least frequently identified: both by 52% of students each. These results were generally better than those of the previously tested final-year medical students. The importance of anatomy in chiropractors' education has been generally acknowledged. This study suggests that the comparatively high number of hours devoted to anatomy in Macquarie University
Myburgh, Corrie
2014-01-01
The purpose of this study was to construct a substantive framework of the manner in which the Danish government interacts with the Danish chiropractic profession and influences professional practice. An exploratory, qualitative study was performed using a substantive grounded theory (GT) approach. Unstructured, face-to-face, individual interviews were conducted during the years 2012 and 2013 and thematically analyzed. Six people were interviewed for this study including a gatekeeper and witness to legislative history, a previous chiropractic political representative and witness to legislative history, a previous Department of Health negotiator and previous administrator of chiropractic affairs and witness to legislative history, a current administrator of chiropractic affairs, an active chiropractic political representative and witness to legislative history, and a chief negotiator for Danish Regional Health Care Services. Open and axial coding yielded 2 themes centering on licensing chiropractors in Denmark and the resultant developmental issues encountered. Through further selective coding, the GT core construct, "chiropractic practice in the Danish heath care system" emerged. The GT highlights the tension between the strategic political importance of legislation and the restrictive nature of the overly specific act currently regulating chiropractic practice. Moreover, the GT also revealed the perceived negative effect that the National Board of Health may exert on clinical practice due to its conservative interpretation of the act. The Danish government is perceived to act as a countervailing power related to chiropractic practice. The derived substantive GT suggests that the Danish government's dualistic action relative to the Danish chiropractic community may inhibit the spontaneous evolution of contemporary Danish chiropractic practice. Although historically narrow legislation may limit chiropractic practice, conservative interpretations by the Danish
Caplan, R L
1991-01-01
This paper is divided into three main parts. The first part describes chiropractic in the 1960s, 1970s and 1980s. While harassment by the medical profession largely characterized the 1960s, the health care environment of the 1970s was more favorable. However, during the 1980s, the spread of prospective payment schemes and the intensification of competition have largely hurt the development of chiropractic. All three possibilities: co-optation, subordination and nationalization are problematic as far as chiropractic is concerned. In light of these prospects, this paper makes four policy recommendations: research, education, alliance-building and politics (or REAP). The paper concludes with a brief discussion of each one.
Page, Stacey A
2007-06-01
Chiropractic's success as a health care profession is evidenced in part by the rising number of practitioners. Paradoxically, this success may start to cost the profession, as the number of consumers may not be increasing proportionally. Fewer patients mean less income for practitioners. Some chiropractors are responding to these pressures by marketing health products, and services. To describe the extent to which Alberta chiropractors with websites sold health products and the extent to which fee discounts/service inducements were advertised. To consider these practices in the context of chiropractic codes of conduct and ethics. Chiropractic websites in the province of Alberta were identified using the online Telus Business Finder and cross-referenced with the Yellow Pages print directories. The websites were searched and an inventory of the health products for sale was recorded. Fee discounts and service inducements were also recorded. 56 websites were identified and reviewed. Just under two-thirds of the chiropractic websites surveyed contained information on health products for sale. Orthotics were sold most often (N = 29 practices; 51.8%), followed by pillows and supports (N = 15: 26.8%), vitamins/nutritional supplements (N = 15; 26.8%) and exercise/rehabilitation products (N = 10; 17.9%). Nine practices (16.1%) offered some type of inducement to potential customers. These included discounts on treatment packages (N = 2; 3.6%), free gait/ posture analyses (N = 2; 3.6%) and free general consultations with the chiropractors (N = 3; 5.4%) The marketing of health care products and services by chiropractors in Alberta is common. Such practices raise ethical considerations for the profession. Professional guidelines vary on the acceptability of these practices. Consumer and practitioner perspectives and practices regarding retailing need to be further examined.
Hansen, D T; Adams, A H; Meeker, W C; Phillips, R B
1992-09-01
With the advent of health care's "era of accountability", the chiropractic profession is now faced with generating implicit standards and guidelines for care or having it done for us by outside agencies. Already we see chiropractic groups in individual states and provinces being pressured into naive efforts of guideline development. Current knowledge and experience are available through recent health care literature that clearly defines the structure and process of guideline development and offers suggestions on how to measure outcomes of those processes. In addition, the United States Congress has directed a new federal agency to oversee this activity and monitor outcomes of quality improvement programs. The time has come for the chiropractic profession to define its exact role in health care delivery and develop implicit standards of care and practice guidelines. This sentinel effort should be managed by a commissioned body of empaneled experts that generally represent the academic and clinical chiropractic profession. A protocol for selection of these panelists and the panel chairperson needs to be developed and memorialized. Appropriate methodology (with definitions) needs to be developed for the process of standards/guideline development. Adherence to the accepted structure and process of guideline development will ensure the continuity of this dynamic process in the coming generations. This proposal offers a preliminary definition of the structure and process, including a "seed" policy statement and decision flow chart, specific to guideline development. Once the structure and process of guideline development for chiropractic are defined, the profession can then present this product to federal and state agencies, private sector health care purchasers, patient advocacy groups and other stakeholders of chiropractic care.(ABSTRACT TRUNCATED AT 250 WORDS)
Weeks, William B; Whedon, James M; Toler, Andrew; Goertz, Christine M
2013-10-01
The purposes of this study were to examine the direct costs associated with Medicare's 2005-2007 "Demonstration of Expanded Coverage of Chiropractic Services" (Demonstration) and their drivers, to explore practice pattern variation during the Demonstration, and to describe scenarios of cost implications had provider behavior and benefit coverage been different. Using Medicare Part B data from April 1, 2005, and March 31, 2007, and 2004 Rural Urban Continuum Codes, we conducted a retrospective analysis of traditionally reimbursed and expanded chiropractic services provided to patients aged 65 to 99 years who had a neuromusculoskeletal condition. We compared chiropractic care costs, supply, and utilization patterns for the 2-year periods before, during, and after the Demonstration for 5 Chicago area counties that participated in the Demonstration to those for 6 other county aggregations-urban or rural counties that participated in the Demonstration; were designated comparison counties during the Demonstration; or were neither participating nor comparison counties during the Demonstration. When compared with other groups, doctors of chiropractic in 1 region (Chicago area counties) billed more aggressively for expanded services and were reimbursed significantly more for traditionally reimbursed chiropractic services provided before, during, and after the Demonstration. Costs would have been substantially lower had doctors of chiropractic in this 1 region had responded similarly to those in other demonstration counties. We found widespread geographic variation in practice behavior and patterns. Our findings suggest that Medicare might reduce the risk of accelerated costs associated with the introduction of a new benefit by applying appropriate limits to the frequency of use and overall costs of those benefits, particularly in highly competitive markets. © 2013. Published by National University of Health Sciences All rights reserved.
Exploring approaches to patient safety: the case of spinal manipulation therapy.
Rozmovits, Linda; Mior, Silvano; Boon, Heather
2016-06-02
The purpose of this study was to gain insight into the current safety culture around the use of spinal manipulation therapy (SMT) by regulated health professionals in Canada and to explore perceptions of readiness for implementing formal mechanisms for tracking associated adverse events. Fifty-six semi-structured telephone interviews were conducted with professional leaders and frontline practitioners in chiropractic, physiotherapy, naturopathy and medicine, all professions regulated to perform SMT in the provinces of Alberta and Ontario Canada. Interviews were digitally audio-recorded for verbatim transcription. Transcripts were entered into HyperResearch software for qualitative data analysis and were coded for both anticipated and emergent themes using the constant comparative method. A thematic, descriptive analysis was produced. The safety culture around SMT is characterized by substantial disagreement about its actual rather than putative risks. Competing intra- and inter-professional narratives further cloud the safety picture. Participants felt that safety talk is sometimes conflated with competition for business in the context of fee-for-service healthcare delivery by several professions with overlapping scopes of practice. Both professional leaders and frontline practitioners perceived multiple barriers to the implementation of an incident reporting system for SMT. The established 'measure and manage' approach to patient safety is difficult to apply to care which is geographically dispersed and delivered by practitioners in multiple professions with overlapping scopes of practice, primarily in a fee-for-service model. Collaboration across professions on models that allow practitioners to share information anonymously and help practitioners learn from the reported incidents is needed.
de Zoete, Annemarie; Ostelo, Raymond; Knol, Dirk L; Algra, Paul R; Wilmink, Jan T; van Tulder, Maurits W
2015-06-01
A cross-sectional diagnostic accuracy study was conducted in 2 sessions. It is important to know whether it is possible to accurately detect "specific findings" on lumbosacral magnetic resonance (MR) images and whether the results of different observers are comparable. Health care providers frequently use magnetic resonance imaging in the diagnostic process of patients with low back pain. The use of MR scans is increasing. This leads to an increase in costs and to an increase in risk of inaccurately labeling patients with an anatomical diagnosis that might not be the actual cause of symptoms. A set of 300 blinded MR images was read by medical radiologists, chiropractors, and chiropractic radiologists in 2 sessions. Each assessor read 100 scans in round 1 and 50 scans in round 2. The reference test was an expert panel.For all analyses, the magnetic resonance imaging findings were dichotomized into "specific findings" or "no specific findings." For the agreement, percentage agreement and κ values were calculated and for validity, sensitivity, and specificity. Sensitivity analysis was done for classifications A and B (prevalence of 31% and 57%, respectively). The intraobserver κ values for chiropractors, chiropractic radiologists, and medical radiologists were 0.46, 0.49, and 0.69 for A and 0.55, 0.75, and 0.64 for B, respectively.The interobserver κ values were lowest for chiropractors (0.28 for A, 0.37 for B) and highest for chiropractic radiologists (0.50 for A, 0.49 for B).The sensitivities of the medical radiologists, chiropractors, and chiropractic radiologists were 0.62, 0.71, and 0.75 for A and 0.70, 0.74, 0.84 for B, respectively.The specificities of medical radiologists, chiropractic radiologists, and chiropractors were 0.82, 0.77, and 0.70 for A and 0.74, 0.52, and 0.61 for B, respectively. Agreement and validity of MR image readings of chiropractors and chiropractic and medical radiologists is modest at best. This study supports recommendations in
Constructing a philosophy of chiropractic: evolving worldviews and modern foundation☆
Senzon, Simon A.
2011-01-01
Objective The purpose of this article is to trace the foundations of DD Palmer's sense of self and philosophy of chiropractic to its sources in modern Western philosophy as well as current metatheories about modernity. Discussion DD Palmer's sense of self was indicative of a modern self. A modern self is characterized as a self that developed after the Western Enlightenment and must come to terms with the insights of modernity such as Cartesian dualism, Spinoza's substance, Rousseau's expressivism, and Kant's critiques. It is argued that Palmer's philosophy can be viewed as part of the this tradition alongside his involvement in the 19th century American metaphysical religious culture, which was itself a response to these challenges of the modern self of modernity. Conclusion Palmer's development of chiropractic and its philosophy was a reaction to the challenges and promises of modernity. PMID:22693479
Horizontal integration of the basic sciences in the chiropractic curriculum.
Ward, Kevin P
2010-01-01
Basic science curricula at most chiropractic colleges consist of courses (eg, general anatomy, physiology, biochemistry, etc) that are taught as stand-alone content domains. The lack of integration between basic science disciplines causes difficulties for students who need to understand how the parts function together as an integrated whole and apply this understanding to solving clinical problems. More horizontally integrated basic science curricula could be achieved by several means: integrated Part I National Board of Chiropractic Examiners questions, a broader education for future professors, an increased emphasis on integration within the current model, linked courses, and an integrated, thematic basic science curriculum. Horizontally integrating basic science curricula would require significant efforts from administrators, curriculum committees, and instructional faculty. Once in place this curriculum would promote more clinically relevant learning, improved learning outcomes, and superior vertical integration.
Horizontal Integration of the Basic Sciences in the Chiropractic Curriculum
Ward, Kevin P.
2010-01-01
Basic science curricula at most chiropractic colleges consist of courses (eg, general anatomy, physiology, biochemistry, etc) that are taught as stand-alone content domains. The lack of integration between basic science disciplines causes difficulties for students who need to understand how the parts function together as an integrated whole and apply this understanding to solving clinical problems. More horizontally integrated basic science curricula could be achieved by several means: integrated Part I National Board of Chiropractic Examiners questions, a broader education for future professors, an increased emphasis on integration within the current model, linked courses, and an integrated, thematic basic science curriculum. Horizontally integrating basic science curricula would require significant efforts from administrators, curriculum committees, and instructional faculty. Once in place this curriculum would promote more clinically relevant learning, improved learning outcomes, and superior vertical integration. PMID:21048882
Constructing a philosophy of chiropractic: evolving worldviews and modern foundation().
Senzon, Simon A
2011-12-01
The purpose of this article is to trace the foundations of DD Palmer's sense of self and philosophy of chiropractic to its sources in modern Western philosophy as well as current metatheories about modernity. DD Palmer's sense of self was indicative of a modern self. A modern self is characterized as a self that developed after the Western Enlightenment and must come to terms with the insights of modernity such as Cartesian dualism, Spinoza's substance, Rousseau's expressivism, and Kant's critiques. It is argued that Palmer's philosophy can be viewed as part of the this tradition alongside his involvement in the 19th century American metaphysical religious culture, which was itself a response to these challenges of the modern self of modernity. Palmer's development of chiropractic and its philosophy was a reaction to the challenges and promises of modernity.
Blanchette, Marc-André; Rivard, Michèle; Dionne, Clermont E; Cassidy, J David
2015-01-01
The purpose of this study was to identify characteristics of Canadian doctors of chiropractic (DCs) associated with the number of patients referred by medical doctors (MDs). Secondary data analyses were performed on the 2011 cross-sectional survey of the Canadian Chiropractic Resources Databank. The Canadian Chiropractic Resources Databank survey included 81 questions about the practice of DCs. Of the 6533 mailed questionnaires, 2529 (38.7%) were returned and 489 did not meet our inclusion criteria. Our analyzed sample included 2040 respondents. Bivariate analyses were conducted between predetermined potential predictors and the annual number of patients referred by MDs, and negative binomial multivariate regression was performed. On average, DCs reported receiving 15.6 (standard deviation, 31.3) patient referrals from MDs per year and nearly one-third did not receive any. The type of clinic (multidisciplinary with MD), the province of practice (Atlantic provinces), the number of treatments provided per week, the number of practicing hours, rehabilitation and sports injuries as the main sector of activity, prescription of exercises, use of heat packs and ultrasound, and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking his/her own radiographs, being the client of a chiropractic management service, and considering maintenance/wellness care as a main sector of activity were associated with fewer MD referrals. Canadian DCs who interacted with other health care workers and who focus their practice on musculoskeletal conditions reported more referrals from MDs. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Smith, Sara Dawn; Beran, Tanya N
2012-01-01
The purpose of this study was to describe the current scope of practice of chiropractic radiologists by identifying frequent tasks conducted as well as those conditions most often seen and those that present the greatest risk of harm to patients. A mixed-methods approach was used. An online survey was conducted with 91 diplomates listed with the American Chiropractic Board of Radiology. Participants rated the frequency of tasks they perform and conditions they see on a 5-point scale from "never" to "daily." They also rated the level of risk each condition presents to patients on a 5-point scale from "no risk" to "severe risk." Frequency and risk ratings were then presented in rank order to 22 subject matter experts at 3 focus groups. The most frequent task reported was writing radiology reports (mean [SD], 4.29 [1.58]). Ratings of the frequency of conditions seen in practice and the risk they present to patients were ranked from the highest to lowest for frequency and risk separately. The most frequent conditions seen were reportedly those with structural or joint derangement; the highest risk conditions seen are those that are systemic. Focus group members recommended that some conditions receive higher rankings and that certain conditions be recategorized for future practice analyses. This study helps to define the current scope of practice of chiropractic radiologists and identify frequent tasks and conditions. These results inform the development of a new test outline for Part I of the chiropractic radiology certification examination to ensure that examinees are tested on the most important conditions chiropractic radiologists see in practice. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Page, Stacey A; Mbadiwe, Chinyere; McMorland, D Gordon; Grod, Jaroslaw P
2015-01-01
This study describes the opinions and behaviors of chiropractic patients in a large, western Canadian urban center regarding the sale of health products by doctors of chiropractic. A brief, descriptive survey consisting of both fixed-choice and open-ended questions was distributed by clinic reception staff at 4 chiropractic offices in Calgary, Alberta, Canada. Each practice sold a range of health products, including those relating to musculoskeletal care and nutrition, and served between 275 and 320 clients per week. After a 10-week recruitment interval between January and March 2013, a convenience sample of 103 chiropractic patients was obtained. Most patients supported the sale of health products by doctors of chiropractic (n = 101; 98.1%), and most had made health product purchases from a doctor of chiropractic at some point (n = 73; 70.9%). Products relating to muscular care, exercise/rehabilitation products, and pillows were purchased most often (>40%). Consumers were most supportive of doctors of chiropractic selling products they perceived to be directly related to musculoskeletal care. Some participants believed that there should be limits placed on the range of products sold including the products had to be consistent with the practitioner's area of expertise and had to have some demonstrated level of effectiveness. Primary reasons for health product purchase included the doctor's recommendations, convenience, and perception that the product would improve well-being (>50%). This study found that chiropractic patients were supportive of health product sales by doctors of chiropractic, assuming certain conditions were met. Consumers believed that product sales should be undertaken with integrity and should be consistent with the doctor's area of expertise. Consumer beliefs appeared to impact their purchasing behaviors. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Pohlman, Katherine A; Potocki, Eric N; Lawrence, Dana J
2009-10-01
The purpose of this study was to conduct a bibliographic analysis and assessment of the literature published in the Journal of Clinical Chiropractic Pediatrics (JCCP). The content of the 13 existing issues of the JCCP (1996-2007) were assessed. Articles were categorized by type, and information concerning author affiliation, academic/professional background and gender were tabulated. A second-level analysis applied specific criteria checklists to applicable articles to determine the quality rating of each paper. There were 72 articles included in the analysis, of which 46% were case reports, 17% editorials, 13% case series, 10% narrative literature reviews, 10% commentaries, 4% "other," and 1% cross-sectional studies. Seventy-five percent of the authors were "private practitioners." A certification in chiropractic pediatrics was held by 43% of the authors; 65% of the authors were females, and 83% of the articles had a single author. After applying the checklist to specific articles, 13 articles (18%) scored 40% or better (range of 40%-67%), whereas 59 articles (82%) scored less than 40%. The findings of this analysis suggest there is room for improvement in article type and publication quality of papers in the JCCP.
Young, Kenneth J.
2014-01-01
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
Young, Kenneth J
2014-12-01
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. 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. 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. Chiropractic
OVERCOMING BARRIERS To DIVERSITY IN CHIROPRACTIC PATIENT AND PRACTITIONER POPULATIONS: A COMMENTARY.
Young, Kenneth J
2015-01-01
Increasing the diversity of practitioner and patient populations has been identified as a worthy goal in the chiropractic profession, which has predominantly white male practitioners and white female patients in the USA. Toward that end, 'diversity' has been the topic of several papers and was the theme of a 2012 conference of chiropractic educators. However, generally just the microcosm of the interactions of practitioners with patients or teachers with students has been discussed. The macrocosm of larger societal issues and government policies has not been broached. Examples of issues and policies that affect diversity within a profession include portrayals of, and value judgements on diversity by the media and politicians, as well as public funding for healthcare and education. Diversity was defined in this paper to mean differences in race, sex, sexual orientation, economic status, ethnicity, religion and other life circumstances in a population. The purpose of this paper is to raise awareness of evidence that social issues and government policy affect the diversity of practitioners and patients, and to suggest that the barriers to diversity present in these realms be addressed with a cogent, profession-wide effort in order to help increase the diversity of people involved with chiropractic.
Grod, J P; Sikorski, D; Keating, J C
2001-10-01
To determine the presence or absence of claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or are intrinsically untestable. A survey of patient education and promotional material produced by national, state, and provincial societies and research agencies in Canada and the United States. Patient brochures were solicited from the 3 largest provincial, 3 largest state, and the 3 largest national professional associations in the United States and Canada. Similar requests were made of 2 research agencies supported by the national associations. Brochures were reviewed for the presence or absence of unsubstantiated claims. Of the 11 organizations sampled, 9 distribute patient brochures. Of these 9 organizations, all distribute patient brochures that make claims for chiropractic services that have not been scientifically validated. The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of scientific behavior.
Femoral neck stress fracture in a female athlete: a case report
Avrahami, Daniel; Pajaczkowski, Jason A.
2012-01-01
Objective The purpose of this case report is to describe chiropractic rehabilitation of a master's-level athlete with proximal femoral stress fracture and provide a brief discussion of stress fracture pathology. Clinical Features A 41-year-old female master's-level endurance athlete presented with chronic groin pain later diagnosed and confirmed by magnetic resonance imaging as a stress fracture of the femoral neck. After diagnosis, the patient was referred to a doctor of chiropractic at week 1 of the non–weight-bearing physical rehabilitation process. At that time, the patient presented with sharp and constant groin pain rated 6/10 on a numeric rating scale. Intervention and Outcome This patient avoided weight-bearing activity for 8 weeks while cross-training and was able to return to her sport after this period. The patient was progressed through a series of non–weight-bearing strengthening exercises for the lower extremity. Myofascial release therapy was performed on the gluteal, hip flexor, and groin muscle groups to improve range of motion. Motion palpation testing the lumbar and sacroiliac joints was performed during each session, and manipulative therapy was performed when necessary. The patient was seen once a week for 8 weeks. Reevaluation was performed at week 8; at that time, the patient reported no groin pain (0/10). The patient was discharged from care and referred back to the supervising physician for clearance to return to sporting activities. One month after discharge, she reported that she was pain free and had fully returned to sport activities. Conclusion This case report demonstrates the importance of a through clinical history, physical examination, and magnetic resonance imaging in the accurate diagnosis of a patient with chronic groin pain and that chiropractic care can contribute to rehabilitation programs for these injuries. PMID:23843760
Changes in female veterans' neck pain following chiropractic care at a hospital for veterans.
Corcoran, Kelsey L; Dunn, Andrew S; Green, Bart N; Formolo, Lance R; Beehler, Gregory P
2018-02-01
To determine if U.S. female veterans had demonstrable improvements in neck pain after chiropractic management at a Veterans Affairs (VA) hospital. This was a retrospective cross-sectional study of medical records from female veterans attending a VA chiropractic clinic for neck pain from 2009 to 2015. Paired t-tests were used to compare baseline and discharge numeric rating scale (NRS) and Neck Bournemouth Questionnaire (NBQ) scores with a minimum clinically important difference (MCID) set at a 30% change from baseline. Thirty-four veterans met the inclusion criteria and received a mean of 8.8 chiropractic treatments. For NRS, the mean score improvement was 2.7 (95%CI, 1.9-3.5, p < .001). For the NBQ, the mean score improvement was 13.7 (95%CI, 9.9-17.5, p < .001). For the MCID, the average percent improvement was 45% for the NRS and 38% for the NBQ. Female veterans with neck pain experienced a statistically and clinically significant reduction in NRS and NBQ scores. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hawk, Cheryl; Schneider, Michael; Evans, Marion Willard; Redwood, Daniel
2012-09-01
The purposes of this project were to develop consensus definitions for a set of best practices that doctors of chiropractic may use for promoting health and wellness and preventing disease and to describe the appropriate components and procedures for these practices. A multidisciplinary steering committee of 10 health care professionals developed seed statements based on their clinical experience and relevant literature. A Delphi consensus process was conducted from January to July 2011, following the RAND methodology. Consensus was reached when at least 80% of the panelists were in agreement. There were 44 Delphi panelists (36 doctors of chiropractic, 6 doctors of philosophy, 1 doctor of naturopathy, 1 registered nurse). The statements developed defined the terms and practices for chiropractic care to promote health and wellness and prevent disease. This document describes the procedures and features of wellness care that represent a reasonable approach to wellness care and disease prevention in chiropractic clinical practice. This living document provides a general framework for an evidence-based approach to chiropractic wellness care. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Innes, Stanley I; Leboeuf-Yde, Charlotte; Walker, Bruce F
2018-01-01
Evidence suggests that a students' beliefs already prior to entering a program may be important as a determinant in sustaining unsuitable health care beliefs. Our objectives were to investigate the proportion of Australian chiropractic students who hold non-evidence-based beliefs in the first year of study and the extent to which they may be involved in non-musculoskeletal health conditions. Finally, to see if this proportion varies over the course of the chiropractic program. In 2016, students from two Australian chiropractic programs answered a questionnaire on how often they would give advice on five common health conditions in their future practices as well as their opinion on whether chiropractic spinal adjustments could prevent or help seven health-related conditions. From a possible 831 students, 444 responded (53%). Students were highly likely to offer advice (often/quite often) on a range of non-musculoskeletal conditions. The proportions were lowest in first year and highest the final year. Also, high numbers of students held non-evidence-based beliefs about 'chiropractic spinal adjustments' which tended to occur in gradually decreasing in numbers in sequential years, except for fifth year when a reversal of the pattern occurred. New strategies are required for chiropractic educators if they are to produce graduates who understand and deliver evidence-based health care and able to be part of the mainstream health care system.
Current efforts in chiropractic quality assurance and standards of care †
Hansen, Daniel T
1991-01-01
The chiropractic profession has recently begun to proactively address the problems identified by the health care industry. Prompted by rising health care costs, careful analysis revealed that the major culprit was the variance in the delivery of health care. Concerned with outside regulation, health professionals, both in the USA and Canada, are generating clinical guidelines that will serve as templates for the development of standards of care. More specifically, the chiropractic profession is identifying and establishing standards of practice. This in part is due to published data illustrating the variations in treatment frequencies between geographic locations. Acknowledging these variations will enable the identification of solutions. The solutions will be formulated from a growing knowledge base comprised of printed literature and the opinions of recognized experts through consensus panels. The result is the creation of practice standards and guidelines that will serve to answer concerns of accountability and ultimately to protect the public. The process from the creation to the implementation of the guidelines is necessarily detailed; but can be enhanced by the use of clinical algorithms. Clinical algorithms describe a step wise procedure to patient management that may impact upon patient care, health care costs and outcome measures. As chiropractic achieves greater visibility, it will be expected to perform at the same level of accountability as the other health provider groups. Each chiropractor should understand the process and its limitations, and be prepared to contribute in the development, distribution and implementation of reasonable practice guidelines.
Caught in the crosshairs: identity and cultural authority within chiropractic.
Villanueva-Russell, Yvonne
2011-06-01
In this paper the discourse over identity and cultural authority within the profession of chiropractic in the United States has been analyzed using critical discourse analysis. As the profession struggles to construct one singular image, versions of self must be internally debated and also shaped in consideration of larger, external forces. The dilemma of remaining tied to a marginal professional status must be balanced against considerations of integration. Written texts from chiropractic journals and newspapers are analyzed in a multidimensional approach that considers the rhetorical devices and thematic issues of identity construction; the representation of various voices within the discourse (both heard and unheard); and the extent to which external pressures affect the projection of cultural authority for the profession. A heterogeneous discourse characterized by conflict was found, with discrepancies between everyday chiropractors in actual practice versus academic chiropractors and leaders particularly over the idea, practice and significance of science for the profession. Copyright © 2011 Elsevier Ltd. All rights reserved.
Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor
2005-01-01
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
Qi, Yue-Feng; Chen, Fa-Lin; Bao, Shu-Ren; Li, Cheng-Huan; Zhao, Xing-Wei; Liu, Shi-Ming; Chen, Wen-Xue; Li, Ye; Wang, Peng
2012-08-01
To explore therapeutic effects of bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle,and analyze manipulative reduction mechanism. From 2005 to 2008, 95 patients with over degree II supination-eversion fractures of ankle were treated respectively by manipulation and operation. There were 43 cases [11 males and 32 females with an average age of (44.95 +/- 12.65) years] in manipulation group, and 2 cases were degree II, 11 cases were degree III, and 30 cases were degree IV. There were 52 cases [21 males and 31 females with an average age of (39.96 +/- 13.28) years] in operative group,and 6 cases were degree II, 18 cases were degree III, and 28 cases were degree IV. Bone setting manipulation and hard splint external fixation were applied to manipulative group. Operative reduction internal fixation was performed in operative group. X-ray was used to evaluate reduction of fracture before and after treatment, 2 months after treatment. Ankle joint function was evaluated according to Olerud-Molander scoring system after 6 months treatment. All patients were followed up with good reduction. Three cases occurred wound complication in operative group, but not in manipulative group. In manipulation group, 19 cases got excellent results, 20 cases good and 4 cases fair; while in operative group, 30 cases got excellent results, 20 cases good and 2 cases poor. There were no significant differences in fracture reduction and ankle joint function recovery between two groups (P > 0.05). Efficacy of operative treatment was better than that of manipulative treatment at degree IV fracture (P < 0.05). Bone setting manipulation is a good method for treating supination-eversion ankle joint fractures, which has advantages of simple and safe operation, reliable efficacy. For ankle join fracture at degree IV, manipulative reduction should be adopted earlier, and operative treatment also necessary
Marchand, Aurélie M
2012-06-01
Few studies have addressed the practice of chiropractic care of children in Europe. No systematic classification of conditions currently exists in chiropractic pediatrics. The objective of this study was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age. An Internet cross-sectional survey was conducted in 20 European countries with 4109 doctors of chiropractic invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices. Of the 956 (23.3%) participating chiropractors, 921 reported 19821 pediatric patients per month. Children represented 8.1% of chiropractors' total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age. This study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Blanchette, Marc-André; Bussières, André; Stochkendahl, Mette Jensen; Boruff, Jill; Harrison, Pamela
2015-03-18
Chiropractic care is a common treatment for low back pain (LBP). Previous studies have failed to clarify the relative cost-effectiveness of chiropractic care in comparison with other commonly used approaches because previous attempts to synthetize the economic literature has only included partial economic evaluations. The objective of this project is to estimate the clinical effectiveness and cost-effectiveness of chiropractic care compared to other commonly used care approaches among adult patients with non-specific LBP. Two systematic reviews will be conducted to identify 1) randomized controlled trials and 2) full economic evaluations of chiropractic care for low back pain compared to standard care provided by other healthcare providers. We will conduct searches in specialized electronic databases for randomized controlled trials and full economic evaluations published between 1990 and 2014 using a combination of keywords and MeSH terms. This will be supplemented by a search of the gray literature. Citations, abstracts, and relevant papers will be screened for eligibility by two reviewers independently. Studies will be critically appraised using 1) the Cochrane risk of bias tool and 2) the Drummond (BMJ) checklist. Results will be summarized using Slavin's qualitative best-evidence synthesis approach. Data relating to the primary outcomes of the effectiveness study will be evaluated for inclusion in meta-analyses. The costs will be standardized to the same currency (USD) and adjusted to the same year for inflation. The incremental cost-effectiveness, incremental net benefit, and relevant confidant intervals will be recalculated in order to facilitate comparison between studies. Our review will evaluate both the clinical effectiveness and the cost-effectiveness associated with chiropractic care for LBP. A more precise estimate of the cost-effectiveness of chiropractic care for LBP relative to other forms of conservative care is needed for decision-makers and
Alcantara, Joel; Ohm, Jeanne; Kunz, Derek
2009-01-01
With continued popularity of complementary and alternative medicine (CAM) therapies for children, their safety and effectiveness are of high concern for both CAM and conventional therapy providers. Chiropractic is the most popular form of practitioner-based CAM therapies for children. The objective of this study was to describe the practice of pediatric chiropractic, including its safety and effectiveness. This study used a cross-sectional survey. A practice-based research network was used for this study. Participants were chiropractors and parents of pediatric patients (aged < or =18 years) attending chiropractic visits ranging from one to 12 visits. This is a survey study. No interventions were rendered in the completion of this study. Demographics, clinical presentations, treatment-associated aggravations, complications and improvements. The indicated primary reason for chiropractic care of children was "wellness care." With respect to condition-based presentations, musculoskeletal conditions were the most common, in addition to nonmusculoskeletal conditions of childhood. The most common techniques used were diversified technique, Gonstead technique, Thompson technique, and activator methods. Treatment-associated complications were not indicated by the chiropractic and parent responders. Chiropractor responders indicated three adverse events per 5,438 office visits from the treatment of 577 children. The parent responders indicated two adverse events from 1,735 office visits involving the care of 239 children. Both sets of responders indicated a high rate of improvement with respect to the children's presenting complaints, in addition to salutary effects unrelated to the children's initial clinical presentations.
Self-Regulation of a Chiropractic Association through Participatory Action Research
ERIC Educational Resources Information Center
Sheppard, Lorraine A.; Jorgensen, Anna Maria S.; Crowe, Michael J.
2012-01-01
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…
Gorrell, Lindsay M; Beath, Kenneth; Engel, Roger M
2016-06-01
The purpose of this study was to compare the effects of 2 different cervical manipulation techniques for mechanical neck pain (MNP). Participants with MNP of at least 1 month's duration (n = 65) were randomly allocated to 3 groups: (1) stretching (control), (2) stretching plus manually applied manipulation (MAM), and (3) stretching plus instrument-applied manipulation (IAM). MAM consisted of a single high-velocity, low-amplitude cervical chiropractic manipulation, whereas IAM involved the application of a single cervical manipulation using an (Activator IV) adjusting instrument. Preintervention and postintervention measurements were taken of all outcomes measures. Pain was the primary outcome and was measured using visual analogue scale and pressure pain thresholds. Secondary outcomes included cervical range of motion, hand grip-strength, and wrist blood pressure. Follow-up subjective pain scores were obtained via telephone text message 7 days postintervention. Subjective pain scores decreased at 7-day follow-up in the MAM group compared with control (P = .015). Cervical rotation bilaterally (ipsilateral: P = .002; contralateral: P = .015) and lateral flexion on the contralateral side to manipulation (P = .001) increased following MAM. Hand grip-strength on the contralateral side to manipulation (P = .013) increased following IAM. No moderate or severe adverse events were reported. Mild adverse events were reported on 6 occasions (control, 4; MAM, 1; IAM, 1). This study demonstrates that a single cervical manipulation is capable of producing immediate and short-term benefits for MNP. The study also demonstrates that not all manipulative techniques have the same effect and that the differences may be mediated by neurological or biomechanical factors inherent to each technique. Copyright © 2016. Published by Elsevier Inc.
Sonography of occult rib and costal cartilage fractures: a case series.
Mattox, Ross; Reckelhoff, Kenneth E; Welk, Aaron B; Kettner, Norman W
2014-06-01
The purpose of this case series is to describe the use of diagnostic ultrasound (US) in the detection of occult rib and costal cartilage fractures presenting as chest wall pain to a chiropractic clinic. Three patients presented with chest wall pain and tenderness. Two of the patients presented with acute chest wall injury and 1 carried a previous diagnosis of rib fracture after trivial trauma 2 months earlier. Diagnostic US was selected as a non-ionizing imaging tool for these patients after negative digital radiography studies. All fractures were considered isolated as there was no associated injury, such as pneumothorax. Both of the acute cases were followed up to complete healing (evidence of osseous union) using US. All patients eventually achieved pain-free status. In these cases, US was more sensitive than radiography for diagnosing these cases of acute rib and costal cartilage fractures. Early recognition of rib injury could avoid potential complications from local manipulative therapy.
Mandolesi, Sandro; Marceca, Giuseppe; Moser, Jon; Niglio, Tarcisio; d'Alessandro, Aldo; Ciccone, Matteo Marco; Zito, Annapaola; Mandolesi, Dimitri; d'Alessandro, Alessandro; Fedele, Francesco
2015-01-01
The aim of the study is to evaluate the clinical and X-ray results of the Upper Cervical Chiropractic care through the specific adjustments (corrections) of C1-C2 on patients with chronic venous cerebral-spinal insufficiency (CCSVI) and multiple sclerosis (MS). We studied a sample of 77 patients before and after the Upper Cervical Chiropractic care, and we analyzed: A) The change of the X-ray parameters; B) The clinical results using a new set of questions. The protocol of the C1- C2 upper Cervical Chiropractic treatment, specific for these patients, lasts four months. From a haemodynamic point of view we divided the patients in 3 types: Type 1 - purely vascular with intravenous alterations; Type 2 - "mechanical" with of external venous compressions; Type 3 - mixed. We found an improvement in all kinds of subluxations after the treatment with respect to the pre-treatment X-ray evaluation, with a significant statistical difference. The differences between the clinical symptoms before and after the specific treatment of C1-C2 are statistically significant with p<0.001 according to the CHI-Square test revised by Yates. The preliminary X-ray and clinical improvements of the Upper Cervical Chiropractic corrections on C1- C2 on these patients with CCSVI and MS encourage us to continue with our studies. We believe that the Upper Cervical correction on C1-C2 could be the main non-invasive treatment of the CCSVI mechanical type in patients with MS. Further studies are required to evaluate the correlation between the Upper Cervical Chiropractic correction on C1-C2 on the cerebral venous drainage and the cerebro-spinal fluid.
Evans, Marion Willard; Perle, Stephen M; Ndetan, Harrison
2011-02-02
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". 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. 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. 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
2011-01-01
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
Shane, Eric R.; Pierce, Kevin M.; Gonzalez, Jannet K.; Campbell, Nathan J.
2013-01-01
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
Ward, John S.; Coats, Jesse; Sorrels, Kenneth; Walters, Mathew; Williams, Trevor
2013-01-01
Objective The purpose of this study was to evaluate the feasibility of engaging in a series of larger studies measuring the effect of sacroiliac joint manipulation on walking kinematics using motion analysis technology. Methods Twelve college students engaged in a baseline 90-second gait analysis at 1.5 mph using infrared VICON cameras. Following this, they underwent a prone heel comparison test for functional leg length inequality. Upon examination, participants were then classified as follows: left short leg, right short leg, or no short leg. Participants in each of the 2 short leg branches of this study were then randomized to receive either chiropractic manipulative therapy to the posterior superior iliac spine on the short limb side or no manipulation. Recruitment was ongoing for this pilot study until 1 participant was recruited in each of the following 5 comparative study groups: left short leg—manipulation, left short leg—no manipulation (control 1), right short leg—manipulation, right short leg—no manipulation (control 2), and no short leg (control 3). All participants then underwent another 90-second gait analysis. Data were then grouped and submitted to a blinded biomechanist to determine if there were any unique biomechanical differences between the groups. Results No statistically significant differences were measured because of this being a pilot study with a small sample size. Conclusions The data from this study indicate that a series of larger studies with this design is feasible. PMID:24396314
Texas Chiropractic College Practice Management Education: The Patient's Point of View.
ERIC Educational Resources Information Center
Waigandt, Alex; And Others
A survey was conducted to determine the patient's perception of treatment received from clinicians at the Texas Chiropractic College Clinic in Pasadena, Texas. A questionnaire designed to assess various aspects of the school's clinical and dispensary services was administered to 79 patients who had completed their treatment prescriptions. The…
Quon, Jeffrey A; Bishop, Paul B; Arthur, Brian
2015-06-01
The aim of this study was to determine if effectiveness differs between community-based doctors of chiropractic administering standardized evidence-based care that includes high-velocity low-amplitude spinal manipulative therapy (SMT) for acute low back pain (LBP). A secondary analysis of randomized controlled trial and observational pilot study data was performed with nonrandom allocation to 4 DCs. Patients included those with Quebec Task Force categories less than or equal to 2 and acute LBP of 2 to 4 weeks' duration. The intervention provided was clinical practice guidelines-based care including high-velocity low-amplitude SMT. Primary outcomes included changes from baseline in modified Roland Disability Questionnaire (RDQ) at 24 weeks. Comparisons of simple main effects at 24 weeks and of marginal main effects in repeated-measures analyses were performed. Between groups, adjusted point-specific differences in RDQ change were minimally clinically important but not statistically significant at 24 weeks (largest pairwise difference, -3.1; 95% confidence interval, -6.3 to 0.1; overall P = .10). However, in optimal analyses that considered the repeated nature of the measurements for each outcome, significant differences in marginal mean RDQ changes were found between groups (largest pairwise difference, -3.8; 95% confidence interval, -4.9 to 2.6; overall P = .03). Overall, DCs differed modestly in their effectiveness in improving LBP-specific disability. The point estimates mirrored typically reported effect sizes from recent systematic reviews of SMT; however, confidence limits did not exclude clinically negligible effects. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Globe, Gary; Redwood, Daniel; Brantingham, James W; Hawk, Cheryl; Terre, Lisa; Globe, Denise; Mayer, Stephan
2009-01-01
Over the past decade, chiropractic colleges have introduced clinical prevention services (CPS) training. This has included an updated public health curriculum and procedures for student interns to determine the need for preventive services and to provide these services directly or through referral to other health professionals. The purpose of this study was to evaluate the effect of a program to train chiropractic interns to deliver CPS to patients. Program evaluation used retrospective chart review, comparing the proportion of patients receiving CPS recommendations before and after implementation of the program. The main outcome measures were the percentage of appropriate CPS recommendations based upon chart reviews. Chart reviews in 2006 indicated appropriate CPS recommendations in 47.4% of cases (295/623). Chart reviews in 2007, after an additional year of sustained implementation of procedures to ensure intern and faculty accountability, showed appropriate counseling recommendations in 87% of files (137/156). Requiring interns to attend didactic presentations on CPS had no measurable effect on their performance. Major improvements occurred after a series of clinically relevant training interventions; new forms and audit procedures were implemented to increase intern and clinical faculty accountability.
Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review
Romano, Michele; Negrini, Stefano
2008-01-01
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
Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review.
Romano, Michele; Negrini, Stefano
2008-01-22
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. 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. 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. 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.
Saporito, Richard P
2013-02-01
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. 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. 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. 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. 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
Perceived stress and fatigue among students in a doctor of chiropractic training program.
Kizhakkeveettil, Anupama; Vosko, Andrew M; Brash, Marissa; Ph, Dr; Philips, Michael A
2017-03-01
High levels of stress and fatigue are associated with decreased academic success, well-being, and quality of life. The objective of this research was to quantify levels of perceived stress and fatigue among chiropractic students to identify sources of and student coping mechanisms for perceived stress and fatigue and to identify the relationship between students' perceived stress and fatigue. A survey comprised of the Perceived Stress Scale, the Undergraduate Sources of Stress Survey, and the Piper Fatigue Scale was administered to chiropractic students in their 2nd, 5th, and 8th trimesters of doctoral study. Data were analyzed by descriptive statistics, 1-way analysis of variance, and linear correlation tests. Students reported having moderate to high levels of stress and fatigue, with higher levels of stress and fatigue seen in women than in men. A nonsignificant difference among stress scores and a significant difference among fatigue scores were observed based on program term. Levels of stress predicted levels of fatigue, and stress was strongly correlated with psychological health, relationships with family members, mood, and need for learning accommodations. Fatigue was strongly correlated with psychological health, academic demands, and conflicts between studies and other activities. There are differences in the reporting of perceived stress and fatigue levels in this chiropractic student population based on gender. The correlation between fatigue and stress also suggests that measures that may alleviate one may likely affect the other.
Pohlman, Katherine A; Carroll, Linda; Tsuyuki, Ross T; Hartling, Lisa; Vohra, Sunita
2017-12-01
Patient safety performance can be assessed with several systems, including passive and active surveillance. Passive surveillance systems provide opportunity for health care personnel to confidentially and voluntarily report incidents, including adverse events, occurring in their work environment. Active surveillance systems systematically monitor patient encounters to seek detailed information about adverse events that occur in work environments; unlike passive surveillance, active surveillance allows for collection of both numerator (number of adverse events) and denominator (number of patients seen) data. Chiropractic manual therapy is commonly used in both adults and children, yet few studies have been done to evaluate the safety of chiropractic manual therapy for children. In an attempt to evaluate this, this study will compare adverse event reporting in passive versus active surveillance systems after chiropractic manual therapy in the pediatric population. This cluster randomized controlled trial aims to enroll 70 physicians of chiropractic (unit of randomization) to either passive or active surveillance system to report adverse events that occur after treatment for 60 consecutive pediatric (13 years of age and younger) patient visits (unit of analysis). A modified enrollment process with a two-phase consent procedure will be implemented to maintain provider blinding and minimize dropouts. The first phase of consent is for the provider to confirm their interest in a trial investigating the safety of chiropractic manual therapy. The second phase ensures that they understand the specific requirements for the group to which they were randomized. Percentages, incidence estimates, and 95% confidence intervals will be used to describe the count of reported adverse events in each group. The primary outcome will be the number and quality of the adverse event reports in the active versus the passive surveillance group. With 80% power and 5% one-sided significance
Dagenais, Simon; Brady, O'Dane; Haldeman, Scott; Manga, Pran
2015-10-19
Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise. A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining: 1. private health plans, 2. workers' compensation (WC) plans, and 3. clinical outcomes. The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list. The search uncovered 1276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear. Although cost comparison studies suggest that health care costs were generally lower among patients whose spine pain was managed with chiropractic care, the studies reviewed had many methodological limitations. Better research is needed to determine if these differences in health care costs were attributable to the
The role of chiropractic adjusting tables as reservoirs for microbial diseases.
Bifero, Antonio E; Prakash, Jaya; Bergin, Jeff
2006-04-01
Our goal was to enumerate the microbial flora on the headrest, armrest, and thoracic portion of chiropractic adjusting tables to determine the presence of pathogenic microorganisms and identify the potential for nosocomial transmission. Defined portions of the headrest, armrest, and thoracoabdominal pieces from 9 chiropractic adjusting tables were randomly sampled using the ACT II culture transport system (Remel, Lenexa, KS). Samples were incubated using standard culture techniques for bacteriology and mycology that included 15 mL of heart infusion agar at 35 degrees C for 24 hours and 15 mL of Sabouraud dextrose agar at 30 degrees C up to 7 days. Identification of microorganisms by biochemical analysis yielded a wide variety of gram-positive (G+) and gram-negative (G-) cocci and bacilli as well as standard fungi. Many were of the genus Staphylococcus. Methicillin-resistant S. aureus (MRSA) isolates were recovered from 2 separate tables. This study supports a growing consensus that those outpatient facilities that do not adhere to strict infection control protocols may become ecological reservoirs of potentially harmful human pathogens.
McKay, Naomi D; Langworthy, Jennifer
2011-09-13
People with physical disabilities experience barriers to healthcare across all services despite a legal and moral obligation to the contrary. Complementary medicine is considered as supplementary to conventional care and integration of these approaches is essential to achieve optimal care. This paper explores the utilisation of chiropractic services and practitioner experiences of treating wheelchair-users which appears under-reported. A 20 item questionnaire was posted to 250 randomly selected chiropractors registered with the General Chiropractic Council. Follow-up questionnaires were sent 7 days after the initial return date. Quantitative data were subjected to frequency analysis. The response rate was 64% (n = 161). The majority (66%) of chiropractors had been in practice less than 10 years and were practice owners (50%). Fifty-two percent of chiropractors sampled had treated a patient in a wheelchair in the previous 5 years. The majority (87%) had treated between 1 and 5 such patients. Patients with multiple sclerosis, stroke and cerebral palsy most commonly presented for treatment. The majority of patients' presenting complaint was musculoskeletal in origin, primarily for pain control. Only 13% of respondents worked in a fully accessible clinic. Impracticality of alterations was the most common reason for inaccessibility. Wheelchair-users seem to be an underserved patient group in relation to chiropractic services. Chiropractic management is primarily utilised for pain control in patients with physical disabilities in which mobility may be improved or maintained. Co-management of wheelchair-users with GPs appears to be desirable in order to achieve optimal patient care however more research is required regarding the efficacy of chiropractic treatment for a range of disabling conditions. Physical access was identified as a key barrier to accessing care.
Schutz, Christine M; Dalton, Leanne; Tepe, Rodger E
2013-01-01
This study was designed to extend research on the relationship between chiropractic students' learning and study strategies and national board examination performance. Sixty-nine first trimester chiropractic students self-administered the Learning and Study Strategies Inventory (LASSI). Linear trends tests (for continuous variables) and Mantel-Haenszel trend tests (for categorical variables) were utilized to determine if the 10 LASSI subtests and 3 factors predicted low, medium and high levels of National Board of Chiropractic Examiners (NBCE) Part 1 scores. Multiple regression was performed to predict overall mean NBCE examination scores using the 3 LASSI factors as predictor variables. Four LASSI subtests (Anxiety, Concentration, Selecting Main Ideas, Test Strategies) and one factor (Goal Orientation) were significantly associated with NBCE examination levels. One factor (Goal Orientation) was a significant predictor of overall mean NBCE examination performance. Learning and study strategies are predictive of NBCE Part 1 examination performance in chiropractic students. The current study found LASSI subtests Anxiety, Concentration, Selecting Main Ideas, and Test Strategies, and the Goal-Orientation factor to be significant predictors of NBCE scores. The LASSI may be useful to educators in preparing students for academic success. Further research is warranted to explore the effects of learning and study strategies training on GPA and NBCE performance.
Ward, John; Sorrels, Ken; Coats, Jesse; Pourmoghaddam, Amir; Deleon, Carlos; Daigneault, Paige
2014-03-01
The purpose of this study was to pilot test our study procedures and estimate parameters for sample size calculations for a randomized controlled trial to determine if bilateral sacroiliac (SI) joint manipulation affects specific gait parameters in asymptomatic individuals with a leg length inequality (LLI). Twenty-one asymptomatic chiropractic students engaged in a baseline 90-second walking kinematic analysis using infrared Vicon® cameras. Following this, participants underwent a functional LLI test. Upon examination participants were classified as: left short leg, right short leg, or no short leg. Half of the participants in each short leg group were then randomized to receive bilateral corrective SI joint chiropractic manipulative therapy (CMT). All participants then underwent another 90-second gait analysis. Pre- versus post-intervention gait data were then analyzed within treatment groups by an individual who was blinded to participant group status. For the primary analysis, all p-values were corrected for multiple comparisons using the Bonferroni method. Within groups, no differences in measured gait parameters were statistically significant after correcting for multiple comparisons. The protocol of this study was acceptable to all subjects who were invited to participate. No participants refused randomization. Based on the data collected, we estimated that a larger main study would require 34 participants in each comparison group to detect a moderate effect size.
Predictors of performance of students in biochemistry in a doctor of chiropractic curriculum.
Shaw, Kathy; Rabatsky, Ali; Dishman, Veronica; Meseke, Christopher
2014-01-01
Objective : This study investigated the effect of completion of course prerequisites, undergraduate grade point average (GPA), undergraduate degree, and study habits on the performance of students in the biochemistry course at Palmer College of Chiropractic Florida. Methods : Students self-reported information regarding academic preparation at the beginning of the semester using a questionnaire. Final exam grade and final course grade were noted and used as measures of performance. Multivariate analysis of variance was used to determine if number of prerequisites completed, undergraduate GPA, undergraduate degree, hours spent studying in undergraduate study, and hours spent studying in the first quarter of the chiropractic program were associated significantly with the biochemistry final exam grade or the final grade for the biochemistry course. Results : The number of prerequisites completed, undergraduate degree, hours spent studying in undergraduate study, and hours spent studying in the first quarter of the chiropractic program did not significantly affect the biochemistry final exam grade or the final grade for the biochemistry course, but undergraduate GPA did. Subsequent univariate analysis and Tukey's post hoc comparisons revealed that students with an undergraduate GPA in the 3.5 to 3.99 range earned significantly higher final course grades than students with an undergraduate GPA in the 2.5 to 2.99 range. Conclusion : No single variable was determined to be a factor that determines student success in biochemistry. The interrelationship between the factors examined warrants further investigation to understand fully how to predict the success of a student in the biochemistry course.
Page, Stacey A.
2007-01-01
Background Chiropractic’s success as a health care profession is evidenced in part by the rising number of practitioners. Paradoxically, this success may start to cost the profession, as the number of consumers may not be increasing proportionally. Fewer patients mean less income for practitioners. Some chiropractors are responding to these pressures by marketing health products, and services Objectives To describe the extent to which Alberta chiropractors with websites sold health products and the extent to which fee discounts/service inducements were advertised. To consider these practices in the context of chiropractic codes of conduct and ethics. Methods Chiropractic websites in the province of Alberta were identified using the online Telus Business Finder and cross-referenced with the Yellow Pages print directories. The websites were searched and an inventory of the health products for sale was recorded. Fee discounts and service inducements were also recorded. Results 56 websites were identified and reviewed. Just under two-thirds of the chiropractic websites surveyed contained information on health products for sale. Orthotics were sold most often (N = 29 practices; 51.8%), followed by pillows and supports (N = 15: 26.8%), vitamins/nutritional supplements (N = 15; 26.8%) and exercise/rehabilitation products (N = 10; 17.9%). Nine practices (16.1%) offered some type of inducement to potential customers. These included discounts on treatment packages (N = 2; 3.6%), free gait/ posture analyses (N = 2; 3.6%) and free general consultations with the chiropractors (N = 3; 5.4%) Conclusions The marketing of health care products and services by chiropractors in Alberta is common. Such practices raise ethical considerations for the profession. Professional guidelines vary on the acceptability of these practices. Consumer and practitioner perspectives and practices regarding retailing need to be further examined. PMID:17657302
Moreau, William J; Nabhan, Dustin C; Walden, Taylor
2015-09-01
The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.
Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases
Cashley, David G.; Cochrane, Lynda
2015-01-01
Objective The purpose of this retrospective case series is to describe treatment outcomes for patients with plantar digital neuralgia (PDN) (Morton’s neuroma) who were treated using foot manipulation. Methods Charts were reviewed retrospectively for patients with a diagnosis of PDN and who received a minimum of 6 treatments consisting of manipulation alone. Visual analogue pain scales (VAS) and pressure threshold meter readings (PTM) were extracted as outcome measures. Results Thirty-eight cases met inclusion criteria. Mean pretreatment duration of pain was 28 months. Mean pretreatment VAS was 69.5/100 mm. Mean pretreatment PTM was 2.54 Kp. By the sixth treatment, 30 (79%) of the 38 patients scored a VAS of 0 mm and a further 4 (10%) were below 10 mm. Contralateral limb PTM showed a mean pre-treatment score of 5.5 Kp, which rose slightly to 5.85 Kp. This compared to a pre-treatment score of 2.54 Kp rising to 5.86 Kp in the affected limb. This represents a 126% increase in the affected side compared to 6.5% in the unaffected limb. Statistical analysis demonstrated a significant linear trend between decreasing VAS and manipulation (P < .001). Conclusion The patients with PDN who were included in this case series improved with conservative care that included only foot manipulation. PMID:26257593
Young, Kenneth John
2014-01-01
Chiropractic technique systems have been historically documented to advocate overutilization of radiography. Various rationales for this have been explored in the literature. However, little consideration has been given to the possibility that the healthcare belief system of prominent early chiropractors may have influenced the use of the diagnostic modality through the years. The original rationale was the visualisation of chiropractic subluxations, defined as bones slightly out of place, pressing on nerves, and ultimately causing disease. This paradigm of radiography has survived in parts of the chiropractic profession, despite lacking evidence of clinical validity. The purpose of this paper is to compare the characteristics of the chiropractic technique systems that have utilised radiography for subluxation detection with the characteristics of religion, and to discover potential historical links that may have facilitated the development of those characteristics. Twenty-three currently or previously existing technique systems requiring radiography for subluxation analysis were found using a search of the internet, books and consultation with experts. Evidence of religiosity from the early founders' writings was compared with textbooks, published papers, and websites of subsequently developed systems. Six criteria denoting religious thinking were developed using definitions from various sources. They are: supernatural concepts, claims of supremacy, rules and rituals, sacred artefacts, sacred stories, and special language. All of these were found to a greater or lesser degree in the publicly available documents of all the subluxation-based chiropractic x-ray systems. The founders and early pioneers of chiropractic did not benefit from the current understanding of science and research, and therefore substituted deductive and inductive reasoning to arrive at conclusions about health and disease in the human body. Some of this thinking and rationalisation
Bussières, André E.; Terhorst, Lauren; Leach, Matthew; Stuber, Kent; Evans, Roni; Schneider, Michael J.
2015-01-01
Objectives: To identify Canadian chiropractors’ attitudes, skills and use of evidence based practice (EBP), as well as their level of awareness of previously published chiropractic clinical practice guidelines (CPGs). Methods: 7,200 members of the Canadian Chiropractic Association were invited by e-mail to complete an online version of the Evidence Based practice Attitude & utilisation SurvEy (EBASE); a valid and reliable measure of participant attitudes, skills and use of EBP. Results: Questionnaires were completed by 554 respondents. Most respondents (>75%) held positive attitudes toward EBP. Over half indicated a high level of self-reported skills in EBP, and over 90% expressed an interest in improving these skills. A majority of respondents (65%) reported over half of their practice was based on evidence from clinical research, and only half (52%) agreed that chiropractic CPGs significantly impacted on their practice. Conclusions: While most Canadian chiropractors held positive attitudes towards EBP, believed EBP was useful, and were interested in improving their skills in EBP, many did not use research evidence or CPGs to guide clinical decision making. Our findings should be interpreted cautiously due to the low response rate. PMID:26816412
Haavik, Heidi; Murphy, Bernadette A; Kruger, Jennifer
2016-06-01
The aim of this study was to investigate whether a single session of spinal manipulation of pregnant women can alter pelvic floor muscle function as measured using ultrasonographic imaging. In this preliminary, prospective, comparative study, transperineal ultrasonographic imaging was used to assess pelvic floor anatomy and function in 11 primigravid women in their second trimester recruited via notice boards at obstetric caregivers, pregnancy keep-fit classes, and word of mouth and 15 nulliparous women recruited from a convenience sample of female students at the New Zealand College of Chiropractic. Following bladder voiding, 3-/4-dimensional transperineal ultrasonography was performed on all participants in the supine position. Levator hiatal area measurements at rest, on maximal pelvic floor contraction, and during maximum Valsalva maneuver were collected before and after either spinal manipulation or a control intervention. Levator hiatal area at rest increased significantly (P < .05) after spinal manipulation in the pregnant women, with no change postmanipulation in the nonpregnant women at rest or in any of the other measured parameters. Spinal manipulation of pregnant women in their second trimester increased the levator hiatal area at rest and thus appears to relax the pelvic floor muscles. This did not occur in the nonpregnant control participants, suggesting that it may be pregnancy related. Copyright © 2016. Published by Elsevier Inc.
Palmgren, Per J.; Liljedahl, Matilda; Lindquist, Ingrid; Laksov, Klara Bolander
2018-01-01
Objective: There has been increasing scholarly interest in the role of environments in health care professional education, and the value of these has been widely acknowledged as an influential factor in educational quality. However, little is known about how teachers experience the environment, and there is a recognizable absence of a perspective from chiropractic and physiotherapy faculties. The aim of this study was to explore and contrast chiropractic and physiotherapy teachers' experiences and conceptualizations of the meaning of the educational environment. Methods: In this qualitative study, we performed semistructured interviews with 14 teachers, purposefully selected to obtain richness, variation, and breadth in the data. The data were analyzed using inductive qualitative content analysis. Results: The most noteworthy findings were, first, that chiropractic teachers experienced the meaning of the environment as motivating a vocational practice and modeling ideal, supporting and managing stressed students, and including students in the community of chiropractors. Physiotherapy teachers experienced the meaning of the environment as putting the pedagogical vision into practice, balancing students' expectations, and providing the prerequisites to grow within the profession. Second, both groups of teachers held common conceptualizations of the constituents of the environment as physical, organizational, relational, communicational, and pedagogical; however, they attached different connotations to these dimensions. Conclusion: The findings conveyed a variance in the experience of the meaning of the educational environment that can be attributed to contextual and cultural differences. PMID:29257707
Moreau, William J.; Nabhan, Dustin C.; Walden, Taylor
2015-01-01
Objective The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. Methods A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Results Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool–3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). Conclusion This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool–3 as a sideline assessment tool. PMID:26778930
Pregnant Students in the Gross Anatomy Laboratory: Policies and Practices at Chiropractic Colleges
ERIC Educational Resources Information Center
Duray, Stephen M.; Mekow, Craig L.
2011-01-01
Chiropractic and medical colleges have experienced a significant increase in the number of female applicants in recent years, a percentage of whom are pregnant or become pregnant following admission. It is therefore important to ask the question: How do institutions that educate future health care providers address the issue of pregnancy and the…
Paulus, Jessica K; Thaler, David E
2016-01-01
For patients and health care providers who are considering spinal manipulative therapy of the neck, it is crucial to establish if it is a trigger for cervical artery dissection and/or stroke, and if it is, the magnitude of the risk. We discuss the biological plausibility of how neck manipulation could cause cervical artery dissection. We also discuss how case misclassification threatens the validity of influential published studies that have investigated the relationship between neck manipulation and dissection. Our position is supported by the fact that the largest epidemiologic studies of neck manipulation safety with respect to neurological outcomes have relied on International Classification of Diseases-9 codes for case identification. However, the application of these codes in prior studies failed to identify dissections (rather than strokes in general) and so conclusions from those studies are invalid. There are several methodological challenges to understanding the association between neck manipulation and vertebral artery dissection. Addressing these issues is critical because even a modest association between neck manipulation and cervical artery dissection could translate into a significant number of avoidable dissections given the widespread use of neck manipulation by providers from various backgrounds. We believe that valid case classification, accurate measurement of manipulative procedures, and addressing reverse causation bias should be top priorities for future research.
Hao, Bo-Chuan; Xie, Ke-Bo
2014-07-01
To investigate the therapeutic effects of manipulative reduction for calcaneal fractures. From January 2009 to June 2012, 53 cases (60 affected feet) of Sanders type I-IV calcaneal fractures were treated by manipulative reduction and external fixation with cardboard splint,including 45 males and 8 females with an average age of (33.5 +/- 1.54) years old ranging from 18 to 65. The course of disease ranged 0.5 h to 7 d. Before treatment the feet were swelling, ache and activity limitation in evidence, some feet were wide flat deformity, the cortical bone was broken in the imaging examination. All selected cases were evaluated using Creighton-Nebraska health foundation assessment scale for fractures of calcaneus. All cases were followed up at 12 months after treatment, 13 feet got excellent curative effect, 34 good, 11 moderate and 2 poor. Manipulative reduction for Sanders type I-IV calcaneal fractures could get excellent curative effect. Manipulative reduction for calcaneal fractures could avoid surgical trauma while assure high curative effects. Manipulative reduction is not only economical and easy therapy, but also can restore maximum function of the calcaneus with few complications and facilitate early rehabilitation of ankle and joint function.
Hart, John
2011-03-01
This study describes a model for statistically analyzing follow-up numeric-based chiropractic spinal assessments for an individual patient based on his or her own baseline. Ten mastoid fossa temperature differential readings (MFTD) obtained from a chiropractic patient were used in the study. The first eight readings served as baseline and were compared to post-adjustment readings. One of the two post-adjustment MFTD readings fell outside two standard deviations of the baseline mean and therefore theoretically represents improvement according to pattern analysis theory. This study showed how standard deviation analysis may be used to identify future outliers for an individual patient based on his or her own baseline data. Copyright © 2011 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Alcantara, Joel; Lamont, Andrea E; Ohm, Jeanne; Alcantara, Junjoe
2018-04-01
To characterize pediatric chiropractic and assess pediatric quality of life (QoL). A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States. A convenience sample of children (8-17 years) under chiropractic care and their parents. Chiropractic spinal adjustments and adjunctive therapies. Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome. The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1
Eklund, Andreas; Bergström, Gunnar; Bodin, Lennart; Axén, Iben
2015-10-19
Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics. In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared. A: Four hundred eighty subjects from chiropractic primary care clinics. B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity). C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic. D: Two hundred thirty-five subjects from secondary care clinics. The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed). The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D. The chiropractic primary care sample was more affected by pain and worse off with regards to psychological and behavioral characteristics compared to the other primary care sample. Based on our findings from the MPI-S instrument the 4 samples may be considered statistically and clinically different. Sample A comes from an ongoing trial registered at clinical trials.gov; NCT01539863 , February 22, 2012.
Costa, Soraya M.V.; Chibana, Yumi E.T.; Giavarotti, Leandro; Compagnoni, Débora S.; Shiono, Adriana H.; Satie, Janice; Bracher, Eduardo S.B.
2009-01-01
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
Lawrence, Dana J; Meeker, William C
2006-01-01
This commentary reports on the advances that have occurred over the 10-year period since the first National Workshop to Develop the Chiropractic Research Agenda was held and introduces the second set of white papers that were produced as a result of the 10th annual Research Agenda Conference. Four working groups were convened to update the original 5 white papers that represented the most significant results from the first workshop in 1996. Each group was to review the first report, examine the action steps and recommendations that were published in each report to see how much had been completed in the past decade, and develop new action steps and recommendations for the future. Four new articles were developed, each updating and adding significant amounts of new research to the original versions. New action steps and recommendations will help move the profession forward into the future. Chiropractic scientists have worked diligently over the past decade to address the recommendations noted in the first set of white papers. Despite significant advances in knowledge and scientific capacity, the chiropractic profession is still confronted with a large number of research challenges.
Spears, Lolita G.
2005-01-01
Abstract Objective Primary dysmenorrhea and related issues are discussed as they influence the gynecological and social health of females during adolescence, adulthood, and senior maturity. Health practitioners are exposed to multiple approaches towards the management of menstrual pain. Clinical and social viewpoints target the causation, development, diagnosis, manifestation and management of primary dysmenorrhea. This narrative review includes the topic of the doctor-patient relationship in efforts of cultivating effectively communicative health practitioners. Controversial topics related to primary dysmenorrhea and the quality of life for women are addressed. Data Sources A search for literature reviews, case studies, laboratory research, and clinical trials from 1985–2004 was performed using the MEDLINE database. Sources of additional information included textbooks, national organizational literature and contemporary articles. Discussion Menstrual pain is a prevalent experience yet it is socially taboo for conversation; as such, it poses a hindrance to its management. The communication between the doctor and patient is a critical barrier point between establishing a diagnosis and determining an appropriate treatment plan. A multi-disciple treatment plan varies as much as patients themselves vary in personal experiences, needs, and preferences. Conclusions Medicinal prophylactics, physical therapeutics, non-acidic diets, herbal supplements, eastern therapies and the chiropractic manual adjustments of the spine are effective methods for the management of primary dysmenorrhea. The non-invasive management of primary dysmenorrhea includes the chiropractic adjustment with complimentary modalities, and other alternative health care practices. Medicinal prophylactics are invasive and pose a higher risk to long-term chemical exposure, side effects or irreversible conditions. PMID:19674650
Whillier, Stephney; Au, Kent; Feng, Louie; Su, Helen
2017-10-01
The shift toward evidence-based health care has reoriented tertiary clinical education in a way that necessitates and incorporates research. This study assesses the inclination and suitability of chiropractic students for research over a 5-year educational program. Research attributes of chiropractic students were assessed in this cross-sectional study using a validated and modified academic self-concept analysis scale. Students in first and final year were assessed in 4 domains: creativity, motivation, self-regulation, and general intellectual ability. Univariable differences were assessed using Welch 2-sample t tests, and multivariable analysis was carried out with multiple linear regression models. The response rate was 71% (n = 165). First- and fifth-year students scored highly on all 4 domains (80% to 96%). Compared to first-year students, fifth-year students rated themselves significantly lower in 3 of the domains: general intellectual abilities (t[126] = -2.01; p = 0.047), motivation (t[115] = -4.82; p < 0.001), and creativity (t[136] = -3.00; p = 0.003). Research suitability is high in chiropractic students. Both cohorts scored high in all domains despite the disparity between first and fifth years. First-year students outperformed fifth-year students in 3 domains, indicating a potential decline in the inclination to do research over time. However, unaccounted factors, such as the Dunning-Kruger effect, life changes, and "burnout," may have contributed to these differences. Future studies should include questions about stress, fatigue, clinical orientation, and educational environment to inform the interpretation of findings.
Characteristics of manipulative in mathematics laboratory
NASA Astrophysics Data System (ADS)
Istiandaru, A.; Istihapsari, V.; Prahmana, R. C. I.; Setyawan, F.; Hendroanto, A.
2017-12-01
A manipulative is a teaching aid designed such that students could understand mathematical concepts by manipulating it. This article aims to provide an insight to the characteristics of manipulatives produced in the mathematics laboratory of Universitas Ahmad Dahlan, Indonesia. A case study was conducted to observe the existing manipulatives produced during the latest three years and classified the manipulatives based on the characteristics found. There are four kinds of manipulatives: constructivism manipulative, virtual manipulative, informative manipulative, and game-based manipulative. Each kinds of manipulative has different characteristics and impact towards the mathematics learning.
ERIC Educational Resources Information Center
Meyer, Amanda J.; Stomski, Norman J.; Innes, Stanley I.; Armson, Anthony J.
2016-01-01
Ubiquitous smartphone ownership and reduced face-to-face teaching time may lead to students making greater use of mobile technologies in their learning. This is the first study to report on the prevalence of mobile gross anatomy software applications (apps) usage in pre-clinical chiropractic students and to ascertain if a relationship exists…
Image manipulation as research misconduct.
Parrish, Debra; Noonan, Bridget
2009-06-01
A growing number of research misconduct cases handled by the Office of Research Integrity involve image manipulations. Manipulations may include simple image enhancements, misrepresenting an image as something different from what it is, and altering specific features of an image. Through a study of specific cases, the misconduct findings associated with image manipulation, detection methods and those likely to identify such manipulations, are discussed. This article explores sanctions imposed against guilty researchers and the factors that resulted in no misconduct finding although relevant images clearly were flawed. Although new detection tools are available for universities and journals to detect questionable images, this article explores why these tools have not been embraced.
Sherrod, Chuck; Johnson, Dale; Chester, Bruce
2014-01-01
One hundred and sixty million office workers (knowledge workers) in the U.S. and 2/3 of the developed countries use computers on a daily basis. Investigate the effectiveness of ergonomic and diversified chiropractic care for the reduction of pain, discomfort and impaired productivity in knowledge workers presenting with neck and upper extremity musculoskeletal complaints. A one-year prospective case series (n=5 applying ergonomic job task analyses and ongoing surveillance at baseline, 8 weeks, 16 weeks and one-year for musculoskeletal discomfort (CMDQ and VAS, quality of life (Rand SF-36, productivity and forward head posture (FHP). CMDQ and VAS scores decreased by 45% (neck) and 80% (upper extremities); productivity increased from 65% to 100%; physical functioning, role physical and role emotional improved for 4 of 5 subjects; body pain and general health improved for 3 of 5. Average FHP changed from 1-inch (baseline) to 1/4-inch (16-weeks) to 1/2-inch (one year). Effectiveness of this intervention for the reduction of risks depended upon the subject's adoption of safe workstyle behaviors and postures. A transtheoretical model (TTM) for behavior change is discussed as a possible methodology to enhance the adoption of safer work habits.
Fernandez, Charles E; Delaney, Paul M
2004-05-01
To describe and measure the effectiveness of a problem-based educational strategy for teaching evidence-based health care (EBHC) to chiropractic interns, which focused on the development and appraisal of answerable clinical questions using actual musculoskeletal patients. A 1-group pretest-posttest design (simple panel design) with investigator-blinded survey administration was used to measure effectiveness of educational activities using adult learning theory with a study population of interns (n=31) at a chiropractic college (Los Angeles College of Chiropractic, Southern California University of Health Sciences [LACC/SCUHS]) teaching clinic. Activities included 2 workshops on constructing clinical questions and critical appraisal of published research and independent patient-based EBHC assignments. A qualitative self-assessment survey was administered before and after a 6-week period of EBHC activities to measure their effectiveness. Sign tests and paired t tests were utilized to determine P values for significant difference of score results. Eighty-one percent of subjects completed the pretest-posttest surveys. All survey item responses showed an average increase in subjects' self-rating of skills and attitudes from pretest to posttest. There were statistically significant differences in interns' self-assessed ability to construct an answerable clinical question and appraise research articles and apply them to patient management, as well as their rating of importance of EBHC in patient decision making. The results of this study suggest that having chiropractic interns apply EBHC to actual musculoskeletal patients along with attending EBHC workshops had a positive impact on interns' perceived ability to practice EBHC.
Mechanical versus manual manipulation for low back pain: An observational cohort study
Schneider, Michael J; Brach, Jennifer; Irrgang, James J.; Abbott, Katherine Verdolini; Wisniewski, Stephen R.; Delitto, Anthony
2010-01-01
Objective This is an observational prospective cohort study to explore the treatment effect of mechanical vs. manual manipulation for acute low back pain. Methods Ninety two patients with a history of acute low back pain were recruited from 3 private chiropractic offices, 2 of which utilized manual lumbar manipulation and 1 used mechanical instrument manipulation (Activator) as their primary modes of treatment. The chiropractors used their “treatment as usual” protocols for a maximum of 8 visits or 4 weeks, which ever occurred first. Primary outcome measures were changes in Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores from baseline to 4 weeks. The linear regression models were adjusted for baseline NPRS and ODI scores, age, and treatment expectancy. Results Comparison of baseline characteristics did not show any significant differences between the groups except for age (38.4 vs. 49.7 years; p < .001) and treatment expectancy (5.7 vs. 6.3; p = .003). Linear regression revealed significantly lower NPRS scores in the manual manipulation group at four weeks [β = −1.2; 95% CI (−2.1, −.28)] but no significant difference in ODI scores between the two groups at four weeks [β = 1.5; 95% CI (−8.3, 2.4)]. Treatment expectancy, but not age, was found to have a significant main effect on both NPRS and ODI scores at 4 weeks. Exploratory analysis of the clinical patterns of care between the clinicians revealed significant differences in treatment frequency, duration, modality and radiograph usage between the 2 cohorts. Conclusions This study highlights the challenges inherent with conducting research that allows for “treatment-as-usual”. The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol. PMID:20350672
Johnson, Claire
2010-01-01
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
DOE Office of Scientific and Technical Information (OSTI.GOV)
Buehler, M.T.; Hrejsa, A.F.
X-raying the entire spinal column in the standing position in a single exposure (mainly the AP projection) is an often-used chiropractic radiography procedure which has also found some application in medical scoliosis screening program. Aside from any controversy of clinical objectives or medical necessity, the primary agreed-upon requisite for such procedure is twofold; achieving the best possible film image quality with the least amount of radiation exposure to the patient. A popular method of accomplishing this objective is by the use of collimator-attached devices designed to selectively filter the primary x-ray beam in accordance with regional variations of body thicknessmore » and/or density. This study was conducted to evaluate the use of a new lead-acrylic filter system under specialized chiropractic conditions. In comparison to other available systems, it was concluded that this new system; a) is generally equivalent in its radiation dose reduction capabilities; b) is capable of producing full spine radiographs with good to above average image quality; and c) is appreciably easier to use.« less
Restructuring of the jurisprudence course taught at the Canadian Memorial Chiropractic College
Gleberzon, Brian J.
2010-01-01
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
Building a chiropractic academy of educators: A needs assessment of selected faculty educators
Tunning, Michael J.; Derby, Dustin C.; Krell-Mares, Kelly A.; Barber, Michelle R.
2017-01-01
Objective: Professional demands have led to health-care educator specialization in research or patient care. The academy movement is an avenue that attempts to return prestige and importance to improved instruction. The authors performed a needs analysis of selected faculty at 3 chiropractic colleges to assess the need for, and willingness to participate in, an academy of educators program. Methods: An expert-developed, pretested survey was deployed using SurveyMonkey. Analysis of variance and regression analysis were used to address 3 research questions related to the academy of educators program. Results: The study achieved a 53% response rate and reflected that an overwhelming majority of chiropractic faulty members (89%) reported the need for an academy of educators. The study found no significant differences between faculty ranks, years of experience, and participation willingness. Conclusion: A structured approach, such as an academy, to foster professional teaching development may create positive outcomes for an institution. Faculty educators were willing to engage in an efficient program that may improve teaching methods and create opportunities for collaborative working relationships, which signals the potential for wide acceptance of the program. PMID:28768113
Rodríguez-van Lier, María Esperanza; Simón, Luis Manuel Hernández; Gómez, Rosa Estela López; Escalante, Ignacio Peón
2014-01-01
There are various models of health care, such as the epidemiological, psychosocial, sociological, economic, systemic of Neuman, cognitive medicine or ecological, ayurvedic, supraparadigmatic among others. All of them are seeking to combine one or more elements to integrate a model of health care. The article presents a systemic approach to health care with complementary medicines such as rehabilitative acupuncture, homeopathy and chiropractic through the application of a method of holistic care and integrated approach. There was a participatory action research in January 2012 to January 2013, with a comprehensive approach in 64 patients using the clinical method. We included the environmental aspects, biological, emotional, and behavioral to identify, recognize and integrate the form of manifestation of the disease. Later, it was ordered in a coherent way the etiologic factors, precipitating factors and identified the vulnerability of the patients as well as the structural alterations, classifying them in immediate, mediate and late. Referred to the three disciplines: rehabilitative acupuncture, homeopathy and chiropractic to be seen doing references and against-references between them, evaluating the current state of health and each meeting by noting the clinical and behavioral changes submitted and thus the area of attention to which would be forwarded to continue their treatment. 64 patients rotated by the 3 areas taking an average of 30 meetings with rehabilitative acupuncture, 12 with homeopathy and 10 with chiropractic. The changes were submitted clinical attitudinal, behavioral, clinical and organic. The model of care was multifaceted and interdisciplinary with a therapeutic approach of individualization and a holistic view to carry out a comprehensive diagnosis and provide quality health care to the population.
Frutiger, Martin; Tuchin, Peter Jeffery
2017-01-01
Objective: The purpose of this study was to provide a best-synthesis summary of the literature for effective workplace health promotion interventions (WHPI) for work-related mechanical neck pain (MNP) and to determine the congruence between knowledge of WHPI for work-related MNP and coverage of MNP in the chiropractic postgraduate program at Macquarie University. Methods: A literature review was undertaken to determine effective WHPI for work-related MNP. We searched Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro (from 1991 to 2016) for systematic reviews and meta-analyses. The PRISMA (2009) 27-item checklist was used to critically appraise included articles. Lectures, tutorials, and assessment tasks within the chiropractic postgraduate program were mapped to the literature review findings and analyzed. Results: There was moderate-quality evidence for multidimensional WHPI, including aspects of mental and physical functioning, activity performance and modifications, and environmental modifications, to reduce MNP and disability in workers, particularly in the long term. Education on coverage of MNP and effective WHPI for MNP was inadequately covered although congruent with synthesis of current literature. Education on body functions and structures and personal factors were the most commonly covered components. Conclusion: Multidimensional WHPI, focusing on physical, mental, and environmental modifications, appear to reduce self-reported MNP primarily in office workers. There is adequate congruence between the chiropractic postgraduate program at Macquarie University and the published literature on some WHPI. However, there is inadequate coverage on aspects of MNP and effective WHPI for MNP, particularly those focusing on activity and participation and environmental factors. PMID:28742974
Whillier, Stephney; Au, Kent; Feng, Louie; Su, Helen
2017-01-01
Objective: The shift toward evidence-based health care has reoriented tertiary clinical education in a way that necessitates and incorporates research. This study assesses the inclination and suitability of chiropractic students for research over a 5-year educational program. Methods: Research attributes of chiropractic students were assessed in this cross-sectional study using a validated and modified academic self-concept analysis scale. Students in first and final year were assessed in 4 domains: creativity, motivation, self-regulation, and general intellectual ability. Univariable differences were assessed using Welch 2-sample t tests, and multivariable analysis was carried out with multiple linear regression models. Results: The response rate was 71% (n = 165). First- and fifth-year students scored highly on all 4 domains (80% to 96%). Compared to first-year students, fifth-year students rated themselves significantly lower in 3 of the domains: general intellectual abilities (t[126] = −2.01; p = 0.047), motivation (t[115] = −4.82; p < 0.001), and creativity (t[136] = −3.00; p = 0.003). Conclusion: Research suitability is high in chiropractic students. Both cohorts scored high in all domains despite the disparity between first and fifth years. First-year students outperformed fifth-year students in 3 domains, indicating a potential decline in the inclination to do research over time. However, unaccounted factors, such as the Dunning-Kruger effect, life changes, and “burnout,” may have contributed to these differences. Future studies should include questions about stress, fatigue, clinical orientation, and educational environment to inform the interpretation of findings. PMID:28768108
Frutiger, Martin; Tuchin, Peter Jeffery
2017-10-01
The purpose of this study was to provide a best-synthesis summary of the literature for effective workplace health promotion interventions (WHPI) for work-related mechanical neck pain (MNP) and to determine the congruence between knowledge of WHPI for work-related MNP and coverage of MNP in the chiropractic postgraduate program at Macquarie University. A literature review was undertaken to determine effective WHPI for work-related MNP. We searched Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro (from 1991 to 2016) for systematic reviews and meta-analyses. The PRISMA (2009) 27-item checklist was used to critically appraise included articles. Lectures, tutorials, and assessment tasks within the chiropractic postgraduate program were mapped to the literature review findings and analyzed. There was moderate-quality evidence for multidimensional WHPI, including aspects of mental and physical functioning, activity performance and modifications, and environmental modifications, to reduce MNP and disability in workers, particularly in the long term. Education on coverage of MNP and effective WHPI for MNP was inadequately covered although congruent with synthesis of current literature. Education on body functions and structures and personal factors were the most commonly covered components. Multidimensional WHPI, focusing on physical, mental, and environmental modifications, appear to reduce self-reported MNP primarily in office workers. There is adequate congruence between the chiropractic postgraduate program at Macquarie University and the published literature on some WHPI. However, there is inadequate coverage on aspects of MNP and effective WHPI for MNP, particularly those focusing on activity and participation and environmental factors.
Bussières, André E; Al Zoubi, Fadi; Stuber, Kent; French, Simon D; Boruff, Jill; Corrigan, John; Thomas, Aliki
2016-07-13
Evidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic. A scoping review using the Arksey and O'Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted. Nearly 85 % (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely. Findings suggest that the majority of chiropractors hold favourable attitudes and beliefs toward EBP. However, much remains to be done for
Lee, Alexander D; Szabo, Kaitlyn; McDowell, Kirstie; Granger, Sydney
2016-01-01
Introduction: A Canadian sports chiropractic research agenda has yet to be defined. The Delphi method can be utilized to achieve this purpose; however, the sample of experts who participate can influence the results. To better inform sample selection for future research agenda development, we set out to determine if differences in opinions about research priorities exist between chiropractors who have their sports specialty designation and those who do not. Methods: Fifteen sports clinical practice chiropractors who have their sports fellowship designation and fifteen without, were interviewed with a set of standardized questions about sports chiropractic research priorities. A centering resonance analysis and cluster analysis were conducted on the interview responses. Results: The two practitioner groups differed in their opinions about the type of research that they would like to see conducted, the research that would impact their clinical practice the most, and where they believed research was lacking. However, both groups were similar in their opinions about research collaborations. Conclusion: Sports clinical practice chiropractors, with their sports specialty designation and those without, differed in their opinions about sports chiropractic research priorities; however, they had similar opinions about research collaborations. These results suggest that it may be important to sample from both practitioner groups in future studies aimed at developing research agendas for chiropractic research in sport. PMID:28065995
Brown, Douglas M.
2001-01-01
This paper profiles Dr. Lyman Johnston and his contributions in the field of chiropractic research. Postural concepts, diagnostic instruments, therapeutic devices and treatment protocols are reviewed. Set out and briefly discussed are the Posturometer, Pyramidal Man, anterior-posterior gravity line, Postural Spinal Index, tension master, Spine Power Belt and the Mini-Gym. ImagesFigure 1
Meyer, Anne-Laure; Meyer, Amanda; Etherington, Sarah; Leboeuf-Yde, Charlotte
2017-01-01
Functional Neurology (FN), a seemingly attractive treatment approach used by some chiropractors, proposes to have an effect on a multitude of conditions but some of its concepts are controversial. A scoping review was performed to describe, in the context of chiropractic manual therapy, 1) the FN theories, and 2) its clinical applications (i.e. its indications, examination procedures, treatment modalities, treatment plans, and clinical outcomes) using four sources: i) one key textbook, ii) the scientific peer-reviewed literature, iii) websites from chiropractors using FN, and iv) semi-structured interviews of chiropractors using FN. The scientific literature was searched in PubMed, PsycINFO, and SPORTDiscus, completed by a hand search in the journal Functional Neurology, Rehabilitation and Ergonomics (November 2016 and March 2017, respectively). The only textbook on the topic we found was included and articles were chosen if they had an element of manual therapy. There was no restriction for study design but discussion papers were excluded. Websites were found in Google using the search term "Functional Neurology". Chiropractors, known to use FN, were invited based on their geographical location. Theories were mainly uncovered in the textbook as were all aspects of the clinical applications except treatment plans. The other three sources were used for the five aspects of clinical applications. Results were summarized and reported extensively in tables. Eleven articles were included, five websites scrutinized, and four semi-structured interviews performed. FN is based on the belief that reversible lesions in the nervous system are the cause of a multitude of conditions and that specific clusters of neurons can be positively affected by manipulative therapy, but also by many other stimuli. Diagnostic procedures include both conventional and unusual tests, with an interpretation specific to FN. Initial treatment is intense and clinical outcomes reported as positive
Young, Kenneth J; Bakkum, Barclay W; Siordia, Lawrence
2016-01-01
Chiropractic first adopted the X-ray in 1910 for the purpose of demonstrating tiny misalignments of spinal bones, theorised to cause all disease, which they called chiropractic subluxations. This paper explores the apparent contradiction and resultant controversy of a system of natural healing adopting a medical technology. It centres on the actions of B.J. Palmer, the first chiropractor to use X-rays. It also clarifies details of Palmer's decision to incorporate the technology and interprets the change in the sociological context of boundary work. The continuing use of the subluxation paradigm for radiography by chiropractors has had a lingering effect on the profession, a metaphorical hangover of vitalism that is not consistent with modern healthcare practice. As a result of this conflict, arguments within the profession on the use of X-rays contribute to the continuing schism between evidence-based and subluxation-based chiropractors.
Gleberzon, Brain J
2002-01-01
In a previous article, the author reported on the recommendations gathered from student projects between 1996 and 1999 investigating their preferences for including certain chiropractic Name technique systems into the curriculum at the Canadian Memorial Chiropractic College (CMCC). These results were found to be congruent with the professional treatment technique used by Canadian chiropractors. This article reports on the data obtained during the 2000 and 2001 academic years, comparing these results to those previously gathered. In addition, because of the implementation of a new curriculum during this time period, there was unique opportunity to observe whether or not student perceptions differed between those students in the `old' curricular program, and those students in the `new' curricular program. The results gathered indicate that students in both curricular programs show an interest in learning Thompson Terminal Point, Activator Methods, Gonstead, and Active Release Therapy techniques in the core curriculum, as an elective, or during continuing educational programs provided by the college. Students continue to show less interest in learning CranioSacral Therapy, SacroOccipital Technique, Logan Basic, Applied Kinesiology and Chiropractic BioPhysics. Over time, student interest has moved away from Palmer HIO and other upper cervical techniques, and students show a declining interest in being offered instruction in either Network Spinal Analysis or Torque Release Techniques. Since these findings reflect the practice activities of Canadian chiropractors they may have implications not only towards pedagogical decision-making processes at CMCC, but they may also influence professional standards of care.
Page, Stacey A; Grod, Jaroslaw P; McMorland, D Gordon
2011-09-01
The purpose of this study is to describe the practices and perspectives of doctors of chiropractic in Alberta, Canada, regarding the sale of health products. This practice is considered in terms of ethical principles and professional practice standards. Chiropractic Web sites in Alberta were identified using the publically available Web site of the Alberta College and Association of Chiropractors. A random sample of chiropractors was drawn and mailed a brief 4-page survey and return envelope. There was a follow-up mail out to nonrespondents 3 weeks later. Practitioners provided responses regarding their personal and professional characteristics and their perspectives and practices regarding health product sales. A total of 265 responses were received (response rate, 51.2%). Most practitioners endorsed health product sales by chiropractors (95%), and most were engaged in the practice (89%). Orthotics (77%) and pillows (69%) were sold most often, followed by nutritional supplements (68%), hot/cold packs (68%), and vitamins (52%). Some respondents identified areas of potential ethical concern, including product safety and efficacy, professional influence on consumer product purchase, and potential conflict of interest. Codes of ethics and conduct offer some guidance to practitioners, but their awareness of standards varied. The chiropractic profession within Alberta condones product sales, and most of its membership engages in the practice. Individual members differ in their perspectives on this practice and in their awareness of the national code of ethics and conduct. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Conventional Microscopy vs. Computer Imagery in Chiropractic Education.
Cunningham, Christine M; Larzelere, Elizabeth D; Arar, Ilija
2008-01-01
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. This undertaking involved the creation of a new computer laboratory. Robbins and Cotran Pathologic Basis of Disease, 7(th)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. 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). 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.
Student-generated case reports.
Good, Christopher J
2009-01-01
When students create teaching materials, learning can be enhanced. Therefore, a project was designed based on the traditional clinical case report and the chiropractic technique and principles curriculum at the University of Bridgeport College of Chiropractic. The objectives were to increase mastery in a clinical topic, increase awareness of different patient presentations and management options, and enhance information technology skills. Following lectures about the components of a case report and neurological reflexes related to visceral comorbidities and subluxation and joint dysfunction, students created a case report based on a template provided by the instructor. A survey gathered student perspectives on the exercise. More than 70% of the surveyed students felt the project was at least moderately helpful in improving understanding of a case report, the condition investigated, their clinical reasoning, and the ability to integrate information. Most felt that they improved their understanding of neurological reflexes, use of the literature, and the practice of evidence-based care. The majority believed that they identified weakness in knowledge, improved self-learning skills, and increased confidence in managing patients. Most enjoyed it at least somewhat and 70% agreed that the project should be continued. Many believed that they were better prepared for national boards and had improved their writing skills.
Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D; Long, Cynthia R; Pohlman, Katherine A; Weeks, William B; Lamas, Gervasio A
2016-06-01
The purpose of this pilot sham-controlled clinical trial was to estimate the treatment effect and safety of toggle recoil spinal manipulation for blood pressure management. Fifty-one participants with prehypertension or stage 1 hypertension (systolic blood pressure ranging from 135 to 159 mm Hg or diastolic blood pressure ranging from 85 to 99 mm Hg) were allocated by an adaptive design to 2 treatments: toggle recoil spinal manipulation or a sham procedure. Participants were seen by a doctor of chiropractic twice weekly for 6 weeks and remained on their antihypertensive medications, as prescribed, throughout the trial. Blood pressure was assessed at baseline and after study visits 1, 6 (week 3), and 12 (week 6), with the primary end point at week 6. Analysis of covariance was used to compare mean blood pressure changes from baseline between groups at each end point, controlling for sex, age, body mass index, and baseline blood pressure. Adjusted mean change from baseline to week 6 was greater in the sham group (systolic, -4.2 mm Hg; diastolic, -1.6 mm Hg) than in the spinal manipulation group (systolic, 0.6 mm Hg; diastolic, 0.7 mm Hg), but the difference was not statistically significant. No serious and few adverse events were noted. Six weeks of toggle recoil spinal manipulation did not lower systolic or diastolic blood pressure when compared with a sham procedure. No serious adverse events from either treatment were reported. Our results do not support a larger clinical trial. Further research to understand the potential mechanisms of action involving upper cervical manipulation on blood pressure is warranted before additional clinical investigations are conducted. Copyright © 2016. Published by Elsevier Inc.
ERIC Educational Resources Information Center
Wolfenberger, Virginia
1999-01-01
A study at one institution found significant correlations between students' scores on the National Board of Chiropractic Examiners test and academic achievement data. Results indicate that it is not always course subject matter that influences the relationship between course grade and board scores, but may instead be the ability to assimilate…
Kenya, Amilliah W.; Hart, John F.; Vuyiya, Charles K.
2016-01-01
Objective: This study compared National Board of Chiropractic Examiners part I test scores between students who did and did not serve as tutors on the subject matter. Methods: Students who had a prior grade point average of 3.45 or above on a 4.0 scale just before taking part I of the board exams were eligible to participate. A 2-sample t-test was used to ascertain the difference in the mean scores on part I between the tutor group (n = 28) and nontutor (n = 29) group. Results: Scores were higher in all subjects for the tutor group compared to the nontutor group and the differences were statistically significant (p < .01) with large effect sizes. Conclusion: The tutors in this study performed better on part I of the board examination compared to nontutors, suggesting that tutoring results in an academic benefit for tutors themselves. PMID:26998665
Chiropractic quality assurance: standards and guidelines
Gatterman, Meridel I; Dobson, Thomas P; LeFevbre, Ron
2001-01-01
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.
Dane, Andrew B; Teh, Elaine; Reckelhoff, Kenneth E; Ying, Pee Kui
2017-09-01
The aim of this study was to investigate if there were differences in the two-point discrimination (2-PD) of fingers among students at different stages of a chiropractic program. This study measured 2-PD thresholds for the dominant and nondominant index finger and dominant and nondominant forearm in groups of students in a 4-year chiropractic program at the International Medical University in Kuala Lumpur, Malaysia. Measurements were made using digital calipers mounted on a modified weighing scale. Group comparisons were made among students for each year of the program (years 1, 2, 3, and 4). Analysis of the 2-PD threshold for differences among the year groups was performed with analysis of variance. The mean 2-PD threshold of the index finger was higher in the students who were in the higher year groups. Dominant-hand mean values for year 1 were 2.93 ± 0.04 mm and 1.69 ± 0.02 mm in year 4. There were significant differences at finger sites (P < .05) among all year groups compared with year 1. There were no significant differences measured at the dominant forearm between any year groups (P = .08). The nondominant fingers of the year groups 1, 2, and 4 showed better 2-PD compared with the dominant finger. There was a significant difference (P = .005) between the nondominant (1.93 ± 1.15) and dominant (2.27 ± 1.14) fingers when all groups were combined (n = 104). The results of this study demonstrated that the finger 2-PD of the chiropractic students later in the program was more precise than that of students in the earlier program. Copyright © 2017. Published by Elsevier Inc.
Goertz, Christine M; Salsbury, Stacie A; Vining, Robert D; Long, Cynthia R; Andresen, Andrew A; Jones, Mark E; Lyons, Kevin J; Hondras, Maria A; Killinger, Lisa Z; Wolinsky, Fredric D; Wallace, Robert B
2013-01-16
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. 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
Bussières, André E; Sales, Anne E; Ramsay, Timothy; Hilles, Steven; Grimshaw, Jeremy M
2013-01-01
Nonspecific back pain is associated with high use of diagnostic imaging in primary care, yet current evidence suggests that routine imaging of the spine is unnecessary. The objective of this study is to describe current practice patterns in spine radiograph utilization among doctors of chiropractic enrolled in an American provider network. A cross-sectional analysis of administrative claims data from one of the largest providers of complementary health care networks for health plans in the United States was performed. Survey data containing provider demographics were linked with routinely collected data on spine radiograph utilization and patient characteristics aggregated at the provider level. We calculated rates and variations of spine radiographs over 12 months. Negative binomial regression was performed to identify significant predictors of high radiograph utilization and to estimate the associated incidence risk ratio. Complete data for 6946 doctors of chiropractic and 249193 adult patients were available for analyses. In 2010, claims were paid for a total of 91542 new patient examinations and 23369 spine radiographs (including 17511 ordered within 5 days of initial patient examination). The rate of spine radiographs within 5 days of an initial patient visit was 204 per 1000 new patient examinations. Significant predictors of higher radiograph utilization rates included the following: practicing in the Midwest or South US census regions, practicing in an urban or suburban setting, chiropractic school attended, and being a male provider in full-time practice with more than 20 years of experience. Chiropractic school attended and practice location were the most influential predictors of spine radiograph utilization among network chiropractors. This information may help to inform the development and evaluation of a tailored intervention to address overuse of radiograph utilization. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc
Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F
2012-03-14
A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.
Myburgh, Corrie; Boyle, Eleanor; Larsen, Johanne Brinch; Christensen, Henrik Wulff
2016-01-01
Perceived value is the key ingredient to carving and maintaining a competitive business niche. The opportunities to interact with consumers to understand and enhance perceived value are termed 'touch points'. Due to the out-of-pocket expense incurred by patients, Danish chiropractors are subject to consumer trends and behaviors. The purpose of this investigation was to explore and describe consumer touch points relevant to perceived value through healthcare journeys in chiropractic practices. We designed a convergent parallel, mixed methods study. Our purposive sampling framework identified 11 chiropractic clinics from which we collected observational field notes, video recordings and face-to-face interviews. Data was collected between April 14(th) and June 26(th) 2014. We described the exteriors and interiors of all participant clinics, interviewed 32 staff members, 12 new patients and 36 follow-up patients and finally video recorded 11 new and 24 follow-up consultations. Categorization and analysis led to the emergence six consumer touch point themes: 'the internet', 'the physical environment', 'practice models', 'administrative staff', 'the consultation sequence and timing' and 'a consultation that adds value'. The Internet functions as a tool when choosing/confirming a clinic as appropriate, developing and initial image and managing appointments. The administrative hub appears integral to the shaping of positive consumer experiences outside of the consultation. Clinic location, practice model and interior design may contribute to context effects and thus may influence value perception during the clinical encounter. The duration of hands-on treatment received from the chiropractor is not an apparent consumer focus point. Rather, through a seven stage clinical procedure patients value consultations with clinicians who demonstrate professional competence by effective communication diagnosis/management and facilitating satisfactory treatment outcomes. At least six
Constructing a philosophy of chiropractic: evolving worldviews and postmodern core☆
Senzon, Simon A.
2011-01-01
Objective The purpose of this article is to explore the postmodern, postrational, and postconventional core of DD Palmer's self-sense and philosophy. Discussion DD Palmer's self and philosophy can be viewed as a reaction to the self of modernity and its challenges of a fracture between mind and body, spirit, and nature. It is argued that Palmer's solution to these vexing problems facing the modern self was to use postrational and postconventional logic to overcome the dualisms. His philosophy resonates with similar postrational approaches, most notably, the German idealist Schelling. Conclusion It is argued that Palmer was one of the first postrational individuals in America and that chiropractic was an attempt at the first postrational health profession. PMID:22693480
Constructing a philosophy of chiropractic: evolving worldviews and postmodern core().
Senzon, Simon A
2011-12-01
The purpose of this article is to explore the postmodern, postrational, and postconventional core of DD Palmer's self-sense and philosophy. DD Palmer's self and philosophy can be viewed as a reaction to the self of modernity and its challenges of a fracture between mind and body, spirit, and nature. It is argued that Palmer's solution to these vexing problems facing the modern self was to use postrational and postconventional logic to overcome the dualisms. His philosophy resonates with similar postrational approaches, most notably, the German idealist Schelling. It is argued that Palmer was one of the first postrational individuals in America and that chiropractic was an attempt at the first postrational health profession.
Bakkum, Barclay W.; Chapman, Cynthia; Johnson, Claire
2014-01-01
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
Lee, Mi Kyung; Amorin-Woods, Lyndon; Cascioli, Vincenzo; Adams, Jon
2018-01-01
Food consumption and nutritional status affect an individual's health throughout their life-course and an unhealthy diet is a major risk factor for the current global burden of chronic disease. The promotion of health and good nutrition through healthy eating requires the active involvement of all health professionals including chiropractors. This paper reports findings from the first nationally representative examination of the use of nutritional guidance within chiropractic patient management in Australia. A sample of 1000 practising chiropractors was randomly selected from the Australian Chiropractic Research Network (ACORN) practice-based research network database for a cross-sectional study and 33% participated in the online survey in November 2016. The questionnaire, based on previous designs used in similar surveys and nutrition resources developed by the National Health and Medical Research Council, was pretested prior to the survey. Pearson's Chi square and bivariate logistic regression were undertaken to explore relationships with variables of interest. The demographic details of the respondents are similar to those of the chiropractic workforce registered in Australia. Most chiropractors provided nutritional advice as part of their patient care and around a quarter provided specific dietary advice to their patients, including the use of nutrition supplements. Nutrition-related conditions most commonly encountered by the chiropractors were musculoskeletal, usually inflammatory in origin. Common nutritional assessment methods used included questioning patients to assess their nutritional and health status and physical appearance. Most of the participants provided nutritional resources to their patients in their clinics. However, the Australian Dietary Guidelines and the accompanying Australian Guide to Healthy Eating were not well utilised by the respondents. Australian chiropractors often referred patients with nutrition issues to qualified dietitians and
2013-01-01
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
Johnson, Claire D; Green, Bart N
2008-01-01
To review trends in articles published during the first 20 years of The Journal of Chiropractic Education (JCE), which is the primary periodical that publishes chiropractic educational research. This study focused on article type, country of origin, contributions by institutions, use of references, and use of structured abstracts. All volumes of the JCE were retrieved (1987-2006). Only full articles were included in this study; abstracts from proceedings and ephemera were excluded from this analysis. Articles that presented no data (eg, commentary, narrative descriptions) were classified as nondata articles. Articles that reported data (eg, experimental studies, survey research, etc) were classified as data articles. Each article was reviewed by hand for the type of study (data vs nondata), geographic region of origin, college of origin, use of references, and the presence of a structured or unstructured abstract. After applying the inclusion and exclusion criteria, 153 papers were assessed. Published articles came from 5 countries and represented 23 chiropractic colleges. A majority (80.2%) of papers were from the United States. Of all articles, 101 articles (66%) were nondata in nature. Consistent use of references and structured abstracts increased over time. During its first 20 years, the JCE has published more nondata than data studies and the number of data papers published per year has remained constant. The journal has reached a consistent level of quality in its publication of manuscripts containing structured abstracts and references, and articles have been authored primarily by US authors. It is recommended that more efforts and resources are dedicated to data-driven studies and that greater geographic diversity is obtained to better represent the worldwide distribution of the chiropractic profession's educational institutions.
Leach, Robert A; Yates, Joyce M
2008-01-01
The purpose of this pilot novel chiropractic health education intervention was to gather preliminary evidence regarding possible benefits from recreational youth soccer and nutrition education in overweight women. A secondary purpose was to determine whether some nutrition knowledge is an independent predictor of changes in body mass index (BMI). A quiz developed and validated on separate age and sex appropriate blinded cohorts was used on study participants-22 volunteers of 57 eligible fourth-grade, overweight female Mississippi public school students. At the beginning of a 5-month study period, a 15-minute baseline nutrition intervention, grounded in Social Cognitive Theory and based on the United States Department of Agriculture's "My Tips for Families" information, was applied in a chiropractic clinic. Subjects were then randomized to 2 months of recreational soccer (n = 14) or waiting list control (n = 8). No preintervention differences were found in height, weight, BMI, or age. Higher follow-up BMI scores were found in both groups, and no significant differences between groups were found, possibly because of the small sample sizes and the short 8-week soccer intervention period. Gains in nutrition knowledge were sustained (P < .002); however, there was no association between nutrition knowledge and follow-up BMI (r = -.185; P < .462). Minimal nutrition education alone may be an ineffective intervention for overweight children. The study provides an example of how youth soccer may benefit overweight children.
NASA Technical Reports Server (NTRS)
Kwon, Dong-Soo
1991-01-01
All research results about flexible manipulator control were integrated to show a control scenario of a bracing manipulator. First, dynamic analysis of a flexible manipulator was done for modeling. Second, from the dynamic model, the inverse dynamic equation was derived, and the time domain inverse dynamic method was proposed for the calculation of the feedforward torque and the desired flexible coordinate trajectories. Third, a tracking controller was designed by combining the inverse dynamic feedforward control with the joint feedback control. The control scheme was applied to the tip position control of a single link flexible manipulator for zero and non-zero initial condition cases. Finally, the contact control scheme was added to the position tracking control. A control scenario of a bracing manipulator is provided and evaluated through simulation and experiment on a single link flexible manipulator.
Alcantara, Joel; Ohm, Jeanne; Alcantara, Junjoe
2016-05-01
Our ongoing efforts to demonstrate effectiveness of care examined the quality of life (QoL) and patient satisfaction of chiropractic patients presenting for care in a PBRN. In addition to socio-demographic and clinical care information, we examined visit-specific satisfaction and QoL using the RAND VSQ and PROMIS-29, respectively. Our study population was comprised of 126 subjects (average age = 39.68; 97 females). The majority of respondents presented with musculoskeletal complaints with an average mean duration of 7.188 years. The mean PROMIS-25 mean T Scores were: depression (47.80); pain interference (53.49); fatigue (51.02); physical function (49.02); satisfaction with social role (52.10); anxiety (50.14); and sleep disturbance (49.88). The VSQ9 mean score was 93.4% indicating high satisfaction. Adults attending care in a chiropractic PBRN were able to successfully complete the PROMIS29 and VSQ9 instruments. Future longitudinal studies should quantify the minimal clinically important difference in mean T score changes. Copyright © 2015 Elsevier Ltd. All rights reserved.
Field, Jonathan R; Newell, Dave
2016-01-01
An innovative commissioning pathway has recently been introduced in the United Kingdom allowing chiropractic organizations to provide state-funded chiropractic care to patients through referral from National Health Service (NHS) primary care physicians. The purpose of this study was to examine the outcomes of NHS and private patient groups presenting with musculoskeletal conditions to chiropractors under the Any Qualified Provider scheme and compare the clinical outcomes of these patients with those presenting privately. A prospective cohort design monitoring patient outcomes comparing self-referring and NHS-referred patients undergoing chiropractic care was used. The primary outcome was the change in Bournemouth Questionnaire scores. Within- and between-group analyses were performed to explore differences between outcomes with additional analysis of subgroups as categorized by the STarT back tool. A total of 8222 patients filled in baseline questionnaires. Of these, NHS patients (41%) had more adverse health measures at baseline and went on to receive more treatment. Using percent change in Bournemouth Questionnaire scores categorized at minimal clinical change cutoffs and adjusting for baseline differences, patients with low back and neck pain presenting privately are more likely to report improvement within 2 weeks and to have slightly better outcomes at 90 days. However, these patients were more likely to be attending consultations beyond 30 days. This study supports the contention that chiropractic services as provided in United Kingdom are appropriate for both private and NHS-referred patient groups and should be considered when general medical physicians make decisions concerning referral routes and pain pathways for patients with musculoskeletal conditions. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy
2012-07-01
The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one
A survey of wellness management strategies used by Canadian doctors of chiropractic.
Stainsby, Brynne E; Porr, Jason T C; Kim, Peter; Collinge, Ashley M; Hunter, Julie C
2011-01-01
The purpose of this study was to investigate if Canadian doctors of chiropractic consider using wellness strategies after functional recovery in acute and chronic conditions. This study also attempted to determine if there is a difference in the use of wellness management strategies between broad and narrow scope practitioners. Forty-one practicing, licensed chiropractors were recruited to complete an interview survey regarding 2 mock clinical case presentations. Interviews were recorded, and influential words or word pairings were identified. Investigators formulated criteria to divide practitioners into broad scope (mixers) and narrow scope (straights). Data were analyzed using Crawdad Analysis Software (version 1.2). All subjects indicated that they would provide information regarding public health and wellness strategies to a patient after functional resolution of the presenting chronic or acute complaints. The responses of broad scope (mixer) chiropractors appeared to be focused on the patient specifically, whereas narrow scope (straight) responses appeared to be more varied when analyzed for noun and noun-pair influence. This study of practicing, licensed Canadian chiropractors suggests that wellness strategies may be commonly considered in practice. All subjects in this study reported a number of strategies to educate patients regarding wellness after functional recovery of a complaint. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Closed reduction of a rare type III dislocation of the first metatarsophalangeal joint.
Tondera, E K; Baker, C C
1996-09-01
To discuss a rare Type III dislocation of the first metatarsophalangeal (MP) joint, without fracture, that used a closed reduction technique for correction. A 43-yr-old man suffered from an acute severe dislocation of his great toe as the result of acute forceful motion applied to the toe as his foot was depressed onto a brake pedal to avoid a motor vehicle accident. Physical examination and X-rays revealed the dislocation, muscle spasm, edema and severely restricted range of motion. The dislocation was corrected using a closed reduction technique, in this case a chiropractic manipulation. Fourteen months after reduction, the joint was intact, muscle strength was graded +5 normal, ranges of motion were within normal limits and no crepitation was noted. X-rays revealed normal intact joint congruency. The patient experienced full weight bearing, range of motion and function of the joint. Although a Type III dislocation of the great toe has only once been cited briefly in the literature, this classification carries a recommended surgical treatment protocol for correction. No literature describes a closed reduction of a Type III dislocation as described in this case report. It is apparent that a closed reduction technique using a chiropractic manipulation may be considered a valid alternative correction technique for Type III dislocations of the great toe.
Attitudes of Australian chiropractic students toward whole body donation: a cross-sectional study.
Alexander, Michelle; Marten, Mathew; Stewart, Ella; Serafin, Stanley; Štrkalj, Goran
2014-01-01
Cadavers play an important role in anatomy education. In Australia, bodies for anatomy education are acquired only through donations. To gain insight into educational dynamics in an anatomy laboratory as well as to facilitate body donation programs and thanksgiving ceremonies, it is important to understand students' attitudes toward body donation. In this cross-sectional study, the attitudes of Macquarie University's first, second, and fifth year chiropractic students toward body donation were investigated. Macquarie University chiropractic students have a four semester long anatomy program, which includes cadaver-based instruction on prosected specimens. A questionnaire was used to record respondents' demographics and attitudes toward body donation: personal, by a relative, and by a stranger. It was found that ethnicity and religion affect attitudes toward body donation, with Australian students being more willing to donate a stranger's body and atheists and agnostics being more willing to donate in general. Furthermore, willingness to donate one's own or a family member's body decreases as year of study increases, suggesting a possible negative impact of exposure to cadavers in the anatomy laboratory. This was only true, however, after controlling for age. Thus, the impact of viewing and handling prosected specimens, which is the norm in anatomy classes in Australia, may not be as strong as dissecting cadavers. It is suggested that anatomists and educators prepare students for cadaver-based instruction as well as exhibit sensitivity to cultural differences in how students approach working with cadavers, when informing different communities about body donation programs and in devising thanksgiving ceremonies. © 2013 American Association of Anatomists.
Engagement as predictors of performance in a single cohort of undergraduate chiropractic students.
Rix, Jacqueline; Dewhurst, Philip; Cooke, Caroline; Newell, David
2017-03-01
To investigate the potential association of novel academic and nonacademic factors with chiropractic student academic performance. Students enrolled into year 1 of a chiropractic master's degree (MChiro) at our college were selected for this study. Data collected included demographics, attendance, virtual learning environment use, additional learning needs, previous degree qualifications, and summative marks. Differences between students who had to take an examination more than once (resit) and nonresit students were explored using t test and χ 2 analysis. Relationships between attendance and end-of-year marks were explored using regression analysis. Male students outperformed female students in four of the six units and as the total year average. Students who attended <80% of classes were more likely to have a resit in one or more units (relative risk [ RR] = 2.6; 95% confidence interval [CI], 1.4-4.9). Students who performed poorly (<70%) in the semester 1 unit of a course on human structure and failed the semester 1 practical assessment of a course on clinical management were significantly more likely to have one or more resit assessments in semester 2 units ( RR = 3.5 [95% CI, 2.2-5.7]; RR = 3.2 [95% CI, 2.0-4.9]). Attendance and unit 105 were independent predictors of one or more resits at the end-of-year ( R 2 = 0.86, p < .001). Attendance and first semester summative marks were associated with end-of-year performance. As such, these markers of performance may be used to flag struggling students in the program.
Engagement as predictors of performance in a single cohort of undergraduate chiropractic students
Rix, Jacqueline; Dewhurst, Philip; Cooke, Caroline; Newell, David
2018-01-01
Objective: To investigate the potential association of novel academic and nonacademic factors with chiropractic student academic performance. Methods: Students enrolled into year 1 of a chiropractic master's degree (MChiro) at our college were selected for this study. Data collected included demographics, attendance, virtual learning environment use, additional learning needs, previous degree qualifications, and summative marks. Differences between students who had to take an examination more than once (resit) and nonresit students were explored using t test and χ2 analysis. Relationships between attendance and end-of-year marks were explored using regression analysis. Results: Male students outperformed female students in four of the six units and as the total year average. Students who attended <80% of classes were more likely to have a resit in one or more units (relative risk [RR] = 2.6; 95% confidence interval [CI], 1.4–4.9). Students who performed poorly (<70%) in the semester 1 unit of a course on human structure and failed the semester 1 practical assessment of a course on clinical management were significantly more likely to have one or more resit assessments in semester 2 units (RR = 3.5 [95% CI, 2.2–5.7]; RR = 3.2 [95% CI, 2.0–4.9]). Attendance and unit 105 were independent predictors of one or more resits at the end-of-year (R2 = 0.86, p < .001). Conclusion: Attendance and first semester summative marks were associated with end-of-year performance. As such, these markers of performance may be used to flag struggling students in the program. PMID:29332429
An Overview of the Identification and Management of the Metabolic Syndrome in Chiropractic Practice
Seaman, David R.; Palombo, Adam D.
2014-01-01
Objective This article presents an overview of metabolic syndrome (MetS), which is a collection of risk factors that can lead to diabetes, stroke, and heart disease. The purposes of this article are to describe the current literature on the etiology and pathophysiology of insulin resistance as it relates to MetS and to suggest strategies for dietary and supplemental management in chiropractic practice. Methods The literature was searched in PubMed, Google Scholar, and the Web site of the American Heart Association, from the earliest date possible to May 2014. Review articles were identified that outlined pathophysiology of MetS and type 2 diabetes mellitus (T2DM) and relationships among diet, supplements, and glycemic regulation, MetS, T2DM, and musculoskeletal pain. Results Metabolic syndrome has been linked to increased risk of developing T2DM and cardiovascular disease and increased risk of stroke and myocardial infarction. Insulin resistance is linked to musculoskeletal complaints both through chronic inflammation and the effects of advanced glycosylation end products. Although diabetes and cardiovascular disease are the most well-known diseases that can result from MetS, an emerging body of evidence demonstrates that common musculoskeletal pain syndromes can be caused by MetS. Conclusions This article provides an overview of lifestyle management of MetS that can be undertaken by doctors of chiropractic by means of dietary modification and nutritional support to promote blood sugar regulation. PMID:25225471
Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil
2016-02-01
Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3.A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4-C5 and C5-C6 that caused severe spinal cord compression and surrounding edema. We performed C4-C5-C6 anterior cervical
Effective management of low back pain: it’s time to accept the evidence
Manga, Pran; Angus, Douglas E; Swan, William R
1993-01-01
Low back pain is a ubiquitous and economically costly problem. Unfortunately, the clinical management of low back pain is not yet well understood. Chiropractic management of back pain, long the black sheep of back care, has undergone a transition and is now a more respected and understood alternative to conservative medical care, itself under increased scrutiny due to unsatisfactory outcomes and unacceptable iatrogenic side effects. The substantial amount of clinical and related research on the effectiveness of manipulation for low back pain is summarized here from a larger study, divided into randomized control trials, case-control trials, meta-analyses and descriptive studies. The chiropractic management of low back pain is found to be a more effective way of dealing with this medical, social and economic problem. It is suggested that greater utilization of chiropractors be encouraged such that the “right people are doing the right things at the right time”.
Kinematic sensitivity of robot manipulators
NASA Technical Reports Server (NTRS)
Vuskovic, Marko I.
1989-01-01
Kinematic sensitivity vectors and matrices for open-loop, n degrees-of-freedom manipulators are derived. First-order sensitivity vectors are defined as partial derivatives of the manipulator's position and orientation with respect to its geometrical parameters. The four-parameter kinematic model is considered, as well as the five-parameter model in case of nominally parallel joint axes. Sensitivity vectors are expressed in terms of coordinate axes of manipulator frames. Second-order sensitivity vectors, the partial derivatives of first-order sensitivity vectors, are also considered. It is shown that second-order sensitivity vectors can be expressed as vector products of the first-order sensitivity vectors.
Modeling of Continuum Manipulators Using Pythagorean Hodograph Curves.
Singh, Inderjeet; Amara, Yacine; Melingui, Achille; Mani Pathak, Pushparaj; Merzouki, Rochdi
2018-05-10
Research on continuum manipulators is increasingly developing in the context of bionic robotics because of their many advantages over conventional rigid manipulators. Due to their soft structure, they have inherent flexibility, which makes it a huge challenge to control them with high performances. Before elaborating a control strategy of such robots, it is essential to reconstruct first the behavior of the robot through development of an approximate behavioral model. This can be kinematic or dynamic depending on the conditions of operation of the robot itself. Kinematically, two types of modeling methods exist to describe the robot behavior; quantitative methods describe a model-based method, and qualitative methods describe a learning-based method. In kinematic modeling of continuum manipulator, the assumption of constant curvature is often considered to simplify the model formulation. In this work, a quantitative modeling method is proposed, based on the Pythagorean hodograph (PH) curves. The aim is to obtain a three-dimensional reconstruction of the shape of the continuum manipulator with variable curvature, allowing the calculation of its inverse kinematic model (IKM). It is noticed that the performances of the PH-based kinematic modeling of continuum manipulators are considerable regarding position accuracy, shape reconstruction, and time/cost of the model calculation, than other kinematic modeling methods, for two cases: free load manipulation and variable load manipulation. This modeling method is applied to the compact bionic handling assistant (CBHA) manipulator for validation. The results are compared with other IKMs developed in case of CBHA manipulator.
DeVocht, James W.; Goertz, Christine M.; Hondras, Maria A.; Long, Cynthia R.; Schaeffer, Wally; Thomann, Lauren; Spector, Michael; Stanford, Clark M.
2014-01-01
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
Taylor, John Am; Burke, Jeanmarie; Gavencak, John; Panwar, Pervinder
2005-03-01
Cervical spine injuries sustained in rear-end crashes cost at least $7 billion in insurance claims annually in the United States alone. When positioned correctly, head restraint systems have been proven effective in reducing the risk of whiplash associated disorders. Chiropractors should be knowledgeable about the correct use of head restraint systems to educate their patients and thereby prevent or minimize such injuries. The primary objective of this study was to determine the prevalence of correct positioning of car seat head restraints among the interns at our institution. The secondary objective was to determine the same chiropractic interns' knowledge of the correct positioning of car seat head restraints. It was hypothesized that 100 percent of interns would have their head restraint correctly positioned within an acceptable range and that all interns would possess the knowledge to instruct patients in the correct positioning of head restraints. Cross-sectional study of a convenient sample of 30 chiropractic interns from one institution. Interns driving into the parking lot of our health center were asked to volunteer to have measurements taken and to complete a survey. Vertical and horizontal positions of the head restraint were measured using a beam compass. A survey was administered to determine knowledge of correct head restraint position. The results were recorded, entered into a spreadsheet, and analyzed. 13.3 percent of subjects knew the recommended vertical distance and only 20 percent of subjects knew the recommended horizontal distance. Chi Square analyses substantiated that the majority of subjects were unaware of guidelines set forth by the National Highway Traffic Safety Administration (NHTSA) for the correct positioning of the head restraint (chi(2) (vertical) = 16.13, chi(2) (horizontal) = 10.80, p <.05). Only 6.7 percent of the subjects positioned their head restraint at the vertical distance of 6 cm or less (p <.05). However, 60 percent of
Grades as Predictors of College and Career Success: The Case of a Health-Related Institution.
ERIC Educational Resources Information Center
Tan, David L.
1991-01-01
Examined relationship between grades, academic performance, and career success in case of nontraditional, health-related educational institution (Palmer College of Chiropractic). Found direct relationship between entering grade point average and subsequent college performance. Relationship between good grades in professional schools and career…
2016-03-01
personnel as a special service of the Physical Therapy Department. Chiropractic services have been available at NMCSD since 2003. A single DC provides...man- agement. Physical therapy and referral to a pain clinic may also be prescribed as a component of UMC. UMC providers report prescription medication...Reed National Military Medical Center. www.wrnmmc. capmed.mil/SitePages/home.aspxl. Accessed 18 Jun 2015. 33. An American Physical Therapy
Fernández-de-las-Peñas, César; Alonso-Blanco, Cristina; San-Roman, Jesús; Miangolarra-Page, Juan C
2006-03-01
Literature review of quality of clinical trials. To determine the methodological quality of published randomized controlled trials that used spinal manipulation and/or mobilization to treat patients with tension-type headache (TTH), cervicogenic headache (CeH), and migraine (M) in the last decade. TTH, CeH, and M are the most prevalent types of headaches seen in adults. Individuals who have headaches frequently use physical therapy, manual therapy, or chiropractic care. Randomized controlled trials are considered an optimal method with which to assess the efficacy of any intervention. Computerized literature searches were performed in MEDLINE, EMBASE, COCHRANE, AMED, MANTIS, CINHAL, and PEDro databases. Randomized controlled trials in which spinal manipulation and/or mobilization had been used for TTH, CeH, and M published in a peer-reviewed journal as full text, and with at least 1 clinically relevant outcome measure (ie, headache intensity, duration, or frequency) were reviewed. The methodological quality of the studies was assessed independently by 2 reviewers using a set of predefined criteria. Only 8 studies met all the inclusion criteria. One clinical trial evaluated spinal manipulation and mobilization together, and the remaining 7 assessed spinal manipulative therapy. No controlled trials analyzing exclusively the effects of spinal mobilization were found. Methodological scores ranged from 35 to 56 points out of a theoretical maximum of 100 points, indicating an overall poor methodology of the studies. Only 2 studies obtained a high-quality score (greater than 50 points). No significant differences in quality scores were found based on the type of headache investigated. Methodological quality was not associated with the year of publication (before 2000, or later) nor with the results (positive, neutral, negative) reported in the studies. The most common flaws were a small sample size, the absence of a placebo control group, lack of blinded patients, and no
Children and Complementary Health Approaches
... were natural products 2 (fish oil, melatonin, and probiotics), and chiropractic or osteopathic manipulation. For children, complementary ... nih.gov E-mail: ods@nih.gov U.S. Food and Drug Administration (FDA) The FDA oversees the ...
A Note on Complementary Medicines
... 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 ...
Manipulation under Anesthesia for Stiffness after Total Knee Arthroplasty
Yoo, Ju-Hyung; Oh, Jin-Cheol; Park, Sang-Hoon
2015-01-01
Purpose This study evaluated the incidence of manipulation under anesthesia (MUA) for stiffness after total knee arthroplasty (TKA) and the degree of joint motion recovery after MUA. Materials and Methods A total of 4,449 TKAs (2,973 patients) were performed between March 2000 and August 2014. Cases that underwent MUA for stiffness after TKA were reviewed. TKAs were performed using the conventional procedure in 329 cases and using the minimally invasive procedure in 4,120 cases. The preoperative range of joint motion, timing of manipulation, diagnosis and the range of joint motion before and after MUA were retrospectively investigated. Results MUA was carried out in 22 cases (16 patients), resulting in the incidence of 0.5%. The incidence after the conventional procedure was 1.2% and 0.4% after the minimally invasive procedure. In the manipulated knees, the preoperative range of motion (ROM) was 102.5°±26.7°, and the preoperative diagnosis was osteoarthritis in 19 cases, rheumatoid arthritis in two, and infection sequela in one. MUA was performed 4.7±3.0 weeks after TKA. The average ROM was 64.5°±13.5° before manipulation. At an average of 64.3±41.3 months after manipulation, the ROM was recovered to 113.4°±31.2°, which was an additional 49.9° improvement in flexion. Conclusions The satisfactory recovery of joint movement was achieved when MUA for stiffness was performed relatively early after TKA. PMID:26676186
Data science for assessing possible tax income manipulation: The case of Italy
NASA Astrophysics Data System (ADS)
Ausloos, Marcel; Cerqueti, Roy; Mir, Tariq A.
2017-11-01
This paper explores a real-world fundamental theme under a data science perspective. It specifically discusses whether fraud or manipulation can be observed in and from municipality income tax size distributions, through their aggregation from citizen fiscal reports. The study case pertains to official data obtained from the Italian Ministry of Economics and Finance over the period 2007-2011. All Italian (20) regions are considered. The considered data science approach concretizes in the adoption of the Benford first digit law as quantitative tool. Marked disparities are found, - for several regions, leading to unexpected "conclusions". The most eye browsing regions are not the expected ones according to classical imagination about Italy financial shadow matters.
Misfeld, Martin; Brereton, R John L; Sweetman, Elizabeth A; Doig, Gordon S
2011-08-01
Neurologic complications after coronary artery bypass grafting remain a concern. Off-pump coronary artery bypass grafting is a surgical strategy proposed to decrease this risk. Use of an off-pump anaortic technique, which leaves the ascending aorta untouched, may result in further reductions. This systematic review of all published evidence compares neurologic complications after anaortic off-pump coronary artery bypass grafting versus that with aortic manipulation. PubMed and Embase were searched up to August 2008. Experts were contacted, and reference lists of retrieved articles were hand searched. The search process was not limited to English-language sources. Observational studies comparing standard off-pump coronary artery bypass grafting technique with anaortic technique were eligible for inclusion if they reported neurologic complications (stroke and transient ischemic attack). Meta-analysis was conducted to assess differences between groups with regard to neurologic complications. Electronic search identified 1428 abstracts, which resulted in retrieval and detailed review of 331 full-text articles. Eight observational studies reported neurologic complications in 5619 anaortic off-pump coronary artery bypass grafting cases and 5779 cases with aortic manipulation. Postsurgical neurologic complications were significantly lower in anaortic off-pump coronary artery bypass grafting cases (odds ratio, 0.46; 95% confidence interval, 0.29-0.72; I(2) = 0.8%; P = .0008). Avoidance of aortic manipulation during off-pump coronary artery bypass grafting decreases neurologic complications relative to standard technique in which the ascending aorta is manipulated. In patients at high risk for stroke or transient ischemic attack, we recommend avoidance of aortic manipulation during off-pump coronary artery bypass grafting. Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Federal Register 2010, 2011, 2012, 2013, 2014
2013-01-22
... DEPARTMENT OF JUSTICE Antitrust Division United States v. Oklahoma State Chiropractic Independent... Chiropractic Independent Physicians Association and Larry M. Bridges, Civil Case No. 13-CV-21- TCK-TLW. On... prices or terms for chiropractic services. Copies of the Complaint, proposed Final Judgment, and...
Complementary and alternative medicine for pediatric otitis media.
Levi, Jessica R; Brody, Robert M; McKee-Cole, Katie; Pribitkin, Edmund; O'Reilly, Robert
2013-06-01
To review the literature involving complementary and alternative medicine (CAM) for pediatric otitis media. Multiple modalities are discussed, including prevention involving breastfeeding, nutrition, and vaccination; symptomatic treatment involving homeopathy, natural health products, and probiotics; manual manipulations involving osteopathy and chiropractics; and traditional Chinese and Japanese medicine. The information presented will assist physicians in advising patients on their decision-making during the early stages of otitis media when antibiotics and surgery are not yet indicated. A systematic literature search was conducted through January 2012 in PubMed using MESH term "otitis media" in conjunction with "complementary therapies," "homeopathy," "manipulation, osteopathic," "manipulation, chiropractic," "acupuncture therapy," "probiotics," "naturopathy," and "xylitol." Theses searches yielded 163 unique results. Abstracts and titles were evaluated for relevance. Case reports, case series, randomized controlled trials, and basic science research were included. Publications not relevant to the discussion of alternative medicine in otitis media were excluded. Bibliographies were checked for further publications. Thirty-six unique publications were reviewed. Of all therapies in complementary and alternative medicine, only xylitol has been studied in well-designed, randomized, blinded trials; it is likely effective, but compliance limits its applicability. Management of acute otitis media begins with watchful waiting. Herbal eardrops may help relieve symptoms. Homeopathic treatments may help decrease pain and lead to faster resolution. Prevention should be emphasized with elimination of risk factors, such as second hand smoke and bottle-feeding, as well as maintaining nutrition and vaccinations. Vitamin supplementation may be helpful. Probiotics and xylitol may be beneficial as well. Traditional Chinese/Japanese therapies show promising results but remain
[Spinal manipulative therapy and cervical artery dissections].
Saxler, G; Schopphoff, E; Quitmann, H; Quint, U
2005-06-01
Severe complications after cervical spine manipulation are rare. As experts for medical treatment errors, we received between July 2002 and February 2004 cases with serious complications in the central nervous system after manipulation. 5 vertebral artery dissections with subsequent brain infarction were registered. In all cases, the patients showed complete persisting remission of symptoms. In addition, a kinematic estimation model was developed to study the possible causes of vertebral artery damage. We were able to demonstrate that material extension is dependent on cervical rotation and the "free length" of the vertebral artery in the upper cervical spine.
Joint Manipulation: Toward a General Theory of High-Velocity, Low-Amplitude Thrust Techniques.
Harwich, Andrew S
2017-12-01
The objective of this study was to describe the initial stage of a generalized theory of high-velocity, low-amplitude thrust (HVLAT) techniques for joint manipulation. This study examined the movements described by authors from the fields of osteopathy, chiropractic, and physical therapy to produce joint cavitation in both the metacarpophalangeal (MCP) joint and the cervical spine apophysial joint. This study qualitatively compared the kinetics, the similarities, and the differences between MCP cavitation and cervical facet joint cavitation. A qualitative vector analysis of forces and movements was undertaken by constructing computer-generated, simplified graphical models of the MCP joint and a typical cervical apophysial joint and imposing the motions dictated by the clinical technique. Comparing the path to cavitation of 2 modes of HVLAT for the MCP joint, namely, distraction and hyperflexion, it was found that the hyperflexion method requires an axis of rotation, the hinge axis, which is also required for cervical HVLAT. These results show that there is an analogue of cervical HVLAT in one of the MCP joint HVLATs. The study demonstrated that in a theoretical model, the path to joint cavitation is the same for asymmetric separation of the joint surfaces in the cervical spine and the MCP joints.
Triano, John J; Giuliano, Dominic; Kanga, Ismat; Starmer, David; Brazeau, Jennifer; Screaton, C Elaine; Semple, Curtis
2015-01-01
The purpose of this study was to sample the stability of spinal manipulation performance in peak impulse force development over time and the ability of clinicians to adapt to arbitrary target levels with short-duration training. A pre-post experimental design was used. Human analog mannequins provided standardized simulation for performance measures. A convenience sample was recruited consisting of 41 local doctors of chiropractic with 5 years of active clinical practice experience. Thoracic impulse force was measured among clinicians at baseline, after 4 months at pretraining, and again posttraining. Intraclass correlation coefficient values and within-subject variability defined consistency. Malleability was measured by reduction of error (paired t tests) in achieving arbitrary targeted levels of force development normalized to the individual's typical performance. No difference was observed in subgroup vs baseline group characteristics. Good consistency was observed in force-time profiles (0.55 ≤ intraclass correlation coefficient ≤ 0.75) for force parameters over the 4-month interval. With short intervals of focused training, error rates in force delivery were reduced by 23% to 45%, depending on target. Within-subject variability was 1/3 to 1/2 that of between-subject variability. Load increases were directly related to rate of loading. The findings of this study show that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values in the thoracic spine is feasible. This study found that experienced clinicians are internally consistent in performance of procedures under standardized conditions and that focused training may help clinicians learn to modulate procedure characteristics. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Dennis, Alyssa K; Oakley, Paul A; Weiner, Michael T; VanVranken, Tara A; Shapiro, David A; Harrison, Deed E
2018-04-01
[Purpose] To present a case of the therapeutic reversal of a cervical kyphosis into a lordosis in a patient who presented with neck pain and headaches. [Subject and Methods] A 24-year-old male irritated his neck while dancing. Upon examination it was revealed he had an excessive, 45 mm forward head translation and a 15° cervical kyphosis from C3-C6. The patient was treated with Chiropractic BioPhysics ® methods aimed at restoring the cervical lordosis by mirror image ® , neck extension exercises, cervical extension traction, and spinal manipulative therapy. [Results] After two weeks of treatments the patient reported a complete resolution of neck pain. After 24 treatments over 10-weeks, a lateral radiograph demonstrated the restoration of a cervical lordosis and a complete reduction of forward head translation. [Conclusion] This case demonstrates that a cervical kyphosis may be reversed into a lordosis in as little as 10-weeks by specific care incorporating cervical extension protocols. This case also supports the biomechanical literature that suggests those with cervical kyphosis may be predisposed to spinal injury. We suggest that correcting even asymptomatic patients with obvious cervical spine deformity should be accomplished prior to future injury and/or degenerative changes.
Test anxiety and academic performance in chiropractic students.
Zhang, Niu; Henderson, Charles N R
2014-01-01
Objective : We assessed the level of students' test anxiety, and the relationship between test anxiety and academic performance. Methods : We recruited 166 third-quarter students. The Test Anxiety Inventory (TAI) was administered to all participants. Total scores from written examinations and objective structured clinical examinations (OSCEs) were used as response variables. Results : Multiple regression analysis shows that there was a modest, but statistically significant negative correlation between TAI scores and written exam scores, but not OSCE scores. Worry and emotionality were the best predictive models for written exam scores. Mean total anxiety and emotionality scores for females were significantly higher than those for males, but not worry scores. Conclusion : Moderate-to-high test anxiety was observed in 85% of the chiropractic students examined. However, total test anxiety, as measured by the TAI score, was a very weak predictive model for written exam performance. Multiple regression analysis demonstrated that replacing total anxiety (TAI) with worry and emotionality (TAI subscales) produces a much more effective predictive model of written exam performance. Sex, age, highest current academic degree, and ethnicity contributed little additional predictive power in either regression model. Moreover, TAI scores were not found to be statistically significant predictors of physical exam skill performance, as measured by OSCEs.
Inferior Lumbar Triangle Hernia as a Rarely Report Cause of Low Back Pain: A Report of 4 Cases
2010-01-01
FACPd,e,f aContracted Chiropractic Physician, Naval Hospital Pensacola, Naval Branch Health Clinic NATTC, Pensacola, FL 32508 bAdjunct Clinical Faculty...Palmer College of Chiropractic , Davenport, IA 52803 cAdjunct Clinical Faculty, National University of Health Sciences, Lombard, IL 60148 dPrimary...medical and chiropractic clinicians detect these conditions, and aid in appropriate management. © 2010 National University of Health Sciences
Bussières, André E; Stewart, Gregory; Al-Zoubi, Fadi; Decina, Philip; Descarreaux, Martin; Haskett, Danielle; Hincapié, Cesar; Pagé, Isabelle; Passmore, Steven; Srbely, John; Stupar, Maja; Weisberg, Joel; Ornelas, Joseph
2018-05-01
The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments. The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee. For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises). A multimodal approach including SMT, other commonly used active interventions, self
A new method used in laparoscopic hysterectomy for uterine manipulation: uterine rein technique.
Boztosun, Abdullah; Atılgan, Remzi; Pala, Şehmus; Olgan, Şafak
2018-03-22
The aim of this study is to define a new method of manipulating the uterus during laparoscopic hysterectomy. A total laparoscopic hysterectomy (TLH) with the newly defined technique was performed in 29 patients between July 2016 and July 2017. In this new technique, the uterus was bound from uterine corpus and fundus like a bridle with polyester tape, to allow abdominal manipulation. The technique was successfully performed at the first attempt in 93.1% of cases. It was repeated in two cases (6.9%) since the polyester tape departed away from the uterus at the first attempt. The mean application time was 11.2 min. The vaginal manipulator was not required in any of the cases. There were no intraoperative complications. In conclusion, this method has the advantages of not requiring any vaginal manipulator, reducing the number of people required during operation, permitting a near maximum manipulation of the uterus in all three dimensions, and giving the control of these manipulations directly to the surgeon. On the other hand, the technique also has some inadequacies which should be discussed and improved on in the future. Impact of statement What is already known on this subject? In a laparoscopic hysterectomy, manipulation of the uterus is essential for anatomical dissection of the regions and completion of the operation without complications. An ideal uterine manipulator is defined as inexpensive, as convenient, fast and suitable for injecting solutions, removing the need for an assistant and most importantly offering the most suitable range of motion. In this study, we describe a new and different technique (rein technique) allowing the abdominal manipulation of the uterus in a laparoscopic hysterectomy and discuss the advantages and disadvantages of this method. What do the results of this study add? The procedure was easily accomplished in most patients. We did not need to use an extra uterine manipulator in any of the cases. What are the implications of these
Leppington, Charmody; Gleberzon, Brian; Fortunato, Lisa; Doucet, Nicolea; Vandervalk, Kyle
2012-01-01
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. 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. 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. 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.
Gleberzon, Brian; Statz, Rachel; Pym, Matthew
2015-01-01
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. PMID:26136603
ERIC Educational Resources Information Center
Strickland, Tricia K.
2014-01-01
This case study analyzed the impact of a concrete manipulative program on the understanding of quadratic expressions for a high school student with a learning disability. The manipulatives were utilized as part of the Concrete-Representational-Abstract Integration (CRA-I) intervention in which participants engaged in tasks requiring them to…
Duarte, Felipe Coutinho Kullmann; Kolberg, Carolina; Barros, Rodrigo R; Silva, Vivian G A; Gehlen, Günter; Vassoler, Jakson M; Partata, Wania A
2014-05-01
This study was designed to assess the peak force of a manually operated chiropractic adjusting instrument, the Activator Adjusting Instrument 4 (AAI 4), with an adapter for use in animals, which has a 3- to 4-fold smaller contact surface area than the original rubber tip. Peak force was determined by thrusting the AAI 4 with the adapter or the original rubber tip onto a load cell. First, the AAI 4 was applied perpendicularly by a doctor of chiropractic onto the load cell. Then, the AAI 4 was fixed in a rigid framework and applied to the load cell. This procedure was done to prevent any load on the load cell before the thrust impulse. In 2 situations, trials were performed with the AAI 4 at all force settings (settings I, II, III, and IV, minimum to maximum, respectively). A total of 50000 samples per second over a period of 3 seconds were collected. In 2 experimental protocols, the use of the adapter in the AAI 4 increased the peak force only with setting I. The new value was around 80% of the maximum value found for the AAI 4. Nevertheless, the peak force values of the AAI 4 with the adapter and with the original rubber tip in setting IV were similar. The adapter effectively determines the maximum peak force value at force setting I of AAI 4. Copyright © 2014 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Zhang, Niu; Chawla, Sudeep
2012-01-01
This study examined the effect of implementing instructional video in ophthalmic physical examination teaching on chiropractic students' laboratory physical examination skills and written test results. Instructional video clips of ophthalmic physical examination, consisting of both standard procedures and common mistakes, were created and used for laboratory teaching. The video clips were also available for student review after class. Students' laboratory skills and written test results were analyzed and compared using one-way analysis of variance (ANOVA) and post hoc multiple comparison tests among three study cohorts: the comparison cohort who did not utilize the instructional videos as a tool, the standard video cohort who viewed only the standard procedure of video clips, and the mistake-referenced video cohort who viewed video clips containing both standard procedure and common mistakes. One-way ANOVA suggested a significant difference of lab results among the three cohorts. Post hoc multiple comparisons further revealed that the mean scores of both video cohorts were significantly higher than that of the comparison cohort (p < .001). There was, however, no significant difference of the mean scores between the two video cohorts (p > .05). However, the percentage of students having a perfect score was the highest in the mistake-referenced video cohort. There was no significant difference of written test scores among all three cohorts (p > .05). The instructional video of the standard procedure improves chiropractic students' ophthalmic physical examination skills, which may be further enhanced by implementing a mistake-referenced instructional video.
Alcantara, Joel; Nazarenko, Andrea Lamont; Ohm, Jeanne; Alcantara, Junjoe
2018-01-01
To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women. A prospective cohort within a practice-based research network (PBRN). Setting/Locations: Individual chiropractic offices. Pregnant women (age ≥18 years) attending chiropractic care. Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies). The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS ® )-29 to measure QoL. A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks (median = 28 weeks; range = 0-42 weeks) and parity (i.e., the number of live births) of 0.92 live births (median = 1; range = 0-6). From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects (i.e., the mean difference of baseline minus comparative measures = -0.7322; p < 0.005). The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 (standard deviation [SD] = 22.69) and 3.30 (SD = 22.71), respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue (p < 0.05), pain interference (p < 0.05), sleep disturbance (p < 0.05), and an improvement in satisfaction with social roles (p < 0.05). A significant decrease was also found with pain interference (p < 0.05). No evidence was found that anxiety (p = 0.1404) or depression (p = 0
Nazarenko, Andrea Lamont; Ohm, Jeanne; Alcantara, Junjoe
2018-01-01
Abstract Objective: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women. Design: A prospective cohort within a practice-based research network (PBRN). Setting/Locations: Individual chiropractic offices. Subjects: Pregnant women (age ≥18 years) attending chiropractic care. Intervention(s): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies). Main outcome measures: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL. Results: A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks (median = 28 weeks; range = 0–42 weeks) and parity (i.e., the number of live births) of 0.92 live births (median = 1; range = 0–6). From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects (i.e., the mean difference of baseline minus comparative measures = −0.7322; p < 0.005). The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 (standard deviation [SD] = 22.69) and 3.30 (SD = 22.71), respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue (p < 0.05), pain interference (p < 0.05), sleep disturbance (p < 0.05), and an improvement in satisfaction with social roles (p < 0.05). A significant decrease was also found with pain interference
Floden, Lysbeth; Howerter, Amy; Matthews, Eva; Nichter, Mark; Cunningham, James K; Ritenbaugh, Cheryl; Gordon, Judith S; Muramoto, Myra L
2015-05-02
Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States. Using a cross-sectional telephone survey of DCs (n = 32), LAcs (n = 70), and LMTs (n = 184) in the Tucson, AZ metropolitan area, we collected data about each location where practitioners work, as well as measures on practitioner and practice characteristics including: patient volume, number of locations where practitioners worked, CAM practitioner types working at each location, and business models of practice. The majority of practitioners reported having one practice location (93.8% of DCs, 80% of LAcs and 59.8% of LMTs) where they treat patients. Patient volume/week was related to practitioner type; DCs saw 83.13 (SD = 49.29) patients/week, LAcs saw 22.29 (SD = 16.88) patients/week, and LMTs saw 14.21 (SD =10.25) patients per week. Practitioners completed surveys for N = 388 practice locations. Many CAM practices were found to be multidisciplinary and/or have more than one practitioner: 9/35 (25.7%) chiropractic practices, 24/87 (27.6%) acupuncture practices, and 141/266 (53.0%) massage practices. Practice business models across CAM practitioner types were heterogeneous, e.g. sole proprietor, employee, partner, and independent contractor. CAM practices vary across and within disciplines in ways that can significantly impact design and implementation of practice-based research. CAM research and intervention programs need to be mindful of the heterogeneity of CAM practices in order to create appropriate interventions, study
McRae, Marc P
2010-01-01
Organic chemistry has been shown to correlate with academic success in the preclinical years of medicine, dentistry, and graduate physiology. The purpose of this study is to examine the relationship between undergraduate organic chemistry grades and first-semester biochemistry grades at a Midwest chiropractic doctoral program. Students enrolled in a first-semester biochemistry course who had completed the prerequisite courses in organic chemistry offered at this same institution were entered into the study. The total grade for each of the three courses was calculated using the midterm and final exam raw scores with a weighting of 50% each. Analysis consisted of obtaining correlation coefficients between the total grades of organic 1 with biochemistry and organic 2 with biochemistry. Using the biochemistry total grade, the students were divided into quartiles and course grades for both organic chemistry 1 and 2 were calculated. For the 109 students in the study, the correlation coefficient between the biochemistry and organic chemistry 1 and biochemistry and organic chemistry 2 courses was r = 0.744 and r = 0.725, respectively. The difference in organic chemistry grades between those in the first and fourth quartiles was 63.2% and 86.9% for organic chemistry 1 (p < .001) and 60.9% and 79.4% for organic chemistry 2 (p < .001). This study shows that organic chemistry can be used as an indicator of future academic success in a chiropractic biochemistry course. Knowledge of such a relationship could prove useful to identify students who may potentially run into academic difficulty with first-year biochemistry.
McMurtry, Angus; Wilson, Kumanan; Clarkin, Chantalle; Walji, Rishma; Kilian, Brendan C; Kilian, Carney C; Lohfeld, Lynne; Alolabi, Bashar; Hagino, Carol; Busse, Jason W
2015-12-01
An important influence on parents' decisions about pediatric vaccination (children under 6 years of age) is the attitude of their health care providers, including complementary and alternative medicine (CAM) providers. Very limited qualitative research exists, however, on how attitudes towards vaccination develop among healthcare professionals in-training. We explored perspective development among three groups of students: medical, chiropractic, and naturopathic. We conducted focus group sessions with participants from each year of study at three different healthcare training programs in Ontario, Canada. Semi-structured and open-ended questions were used to elicit dynamic interaction among participants and explore how they constructed their attitudes toward vaccination at the beginning and part way through their professional training. Analyses of verbatim transcripts of audiotaped interviews were conducted both inductively and deductively using questions structured by existing literature on learning, professional socialization and interprofessional relations. We found five major themes and each theme was illustrated with representative quotes. Numerous unexpected insights emerged within these themes, including students' general open-mindedness towards pediatric vaccination at the beginning of their training; the powerful influence of both formal education and informal socialization; uncritical acceptance of the vaccination views of senior or respected professionals; students' preference for multiple perspectives rather than one-sided, didactic instruction; the absence of explicit socio-cultural tensions among professions; and how divergences among professional students' perspectives result from differing emphases with respect to lifestyle, individual choice, public health and epidemiological factors-rather than disagreement concerning the biomedical evidence. This last finding implies that their different perspectives on pediatric vaccination may be complementary
Kania-Richmond, Ania; Weeks, Laura; Scholten, Jeffrey; Reney, Mikaël
2016-03-01
Practice based research networks (PBRNs) are increasingly used as a tool for evidence based practice. We developed and tested the feasibility of using software to enable online collection of patient data within a chiropractic PBRN to support clinical decision making and research in participating clinics. To assess the feasibility of using online software to collect quality patient information. The study consisted of two phases: 1) Assessment of the quality of information provided, using a standardized form; and 2) Exploration of patients' perspectives and experiences regarding online information provision through semi-structured interviews. Data analysis was descriptive. Forty-five new patients were recruited. Thirty-six completed online forms, which were submitted by an appropriate person 100% of the time, with an error rate of less than 1%, and submitted in a timely manner 83% of the time. Twenty-one participants were interviewed. Overall, online forms were preferred given perceived security, ease of use, and enabling provision of more accurate information. Use of online software is feasible, provides high quality information, and is preferred by most participants. A pen-and-paper format should be available for patients with this preference and in case of technical difficulties.
An optimal resolved rate law for kindematically redundant manipulators
NASA Technical Reports Server (NTRS)
Bourgeois, B. J.
1987-01-01
The resolved rate law for a manipulator provides the instantaneous joint rates required to satisfy a given instantaneous hand motion. When the joint space has more degrees of freedom than the task space, the manipulator is kinematically redundant and the kinematic rate equations are underdetermined. These equations can be locally optimized, but the resulting pseudo-inverse solution was found to cause large joint rates in some case. A weighting matrix in the locally optimized (pseudo-inverse) solution is dynamically adjusted to control the joint motion as desired. Joint reach limit avoidance is demonstrated in a kinematically redundant planar arm model. The treatment is applicable to redundant manipulators with any number of revolute joints and to nonplanar manipulators.
An optimal resolved rate law for kinematically redundant manipulators
NASA Technical Reports Server (NTRS)
Bourgeois, B. J.
1987-01-01
The resolved rate law for a manipulator provides the instantaneous joint rates required to satisfy a given instantaneous hand motion. When the joint space has more degrees of freedom than the task space, the manipulator is kinematically redundant and the kinematic rate equations are underdetermined. These equations can be locally optimized, but the resulting pseudo-inverse solution has been found to cause large joint rates in some cases. A weighting matrix in the locally optimized (pseudo-inverse) solution is dynamically adjusted to control the joint motion as desired. Joint reach limit avoidance is demonstrated in a kinematically redundant planar arm model. The treatment is applicable to redundant manipulators with any number of revolute joints and to non-planar manipulators.
On the manipulability of dual cooperative robots
NASA Technical Reports Server (NTRS)
Chiacchio, P.; Chiaverini, S.; Sciavicco, L.; Siciliano, B.
1989-01-01
The definition of manipulability ellipsoids for dual robot systems is given. A suitable kineto-static formulation for dual cooperative robots is adopted which allows for a global task space description of external and internal forces, and relative velocities. The well known concepts of force and velocity manipulability ellipsoids for a single robot are formally extended and the contributions of the two single robots to the cooperative system ellipsoids are illustrated. Duality properties are discussed. A practical case study is developed.
Manipulations of Totalitarian Nazi Architecture
NASA Astrophysics Data System (ADS)
Antoszczyszyn, Marek
2017-10-01
The paper takes under considerations controversies surrounding German architecture designed during Nazi period between 1933-45. This architecture is commonly criticized for being out of innovation, taste & elementary sense of beauty. Moreover, it has been consequently wiped out from architectural manuals, probably for its undoubted associations with the totalitarian system considered as the most maleficent in the whole history. But in the meantime the architecture of another totalitarian system which appeared to be not less sinister than Nazi one is not stigmatized with such verve. It is Socrealism architecture, developed especially in East Europe & reportedly containing lots of similarities with Nazi architecture. Socrealism totalitarian architecture was never condemned like Nazi one, probably due to politically manipulated propaganda that influenced postwar public opinion. This observation leads to reflection that maybe in the same propaganda way some values of Nazi architecture are still consciously dissembled in order to hide the fact that some rules used by Nazi German architects have been also consciously used after the war. Those are especially manipulations that allegedly Nazi architecture consisted of. The paper provides some definitions around totalitarian manipulations as well as ideological assumptions for their implementation. Finally, the register of confirmed manipulations is provided with use of photo case study.
Interprofessional collaboration and job satisfaction of chiropractic physicians.
Konrad, Thomas R; Fletcher, Grant S; Carey, Timothy S
2004-05-01
Despite the fact that chiropractic physicians (DCs) are growing in number and legitimacy in the community of health care professionals, little recent research describes how their relationships with medical doctors (MDs) affect their job and career perceptions. This study explores interprofessional relations by identifying factors associated with variations in how DCs evaluate their interaction with MDs. It also adapts a previously validated multifaceted measure of MD job satisfaction for use with DCs. Cross-sectional survey of 311 DC physicians in North Carolina. The hypothesized multifaceted nature of DC job satisfaction was confirmed. Four distinct job facets and global career satisfaction were measured effectively in DCs. DCs' career satisfaction is related to satisfaction with compensation, intrinsic motivation of relating to patients, and having positive relationships with DC colleagues. DCs report referring patients to MDs more often than they report MDs referring patients to them. Satisfaction with relationships between DCs and MDs is relatively low and is strongly linked to the quantity of referrals from MDs and the perception that MDs practice collaboratively with DCs. However, DCs' global career satisfaction is unrelated to their relationships with MDs. Global career satisfaction of DCs is relatively high and unaffected by the low level of satisfaction DCs report having with their relationships with MDs. These findings suggest that despite increasing interaction and interdependence, DCs' relationship with MDs is of minor importance in their professional self-image.
Villafañe, Jorge H.; Silva, Guillermo B.; Dughera, Andrea
2012-01-01
Objective The purpose of this case report is to describe management and outcomes of a patient with scoliosis. Clinical Features A 9-year-old female patient with a double curve pattern with Cobb angles of 18° and 24° (thoracic/thoracolumbar) compatible with scoliosis presented for physical therapy treatment. Intervention and Outcome Physiotherapy treatment with a combination of manipulative and rehabilitation techniques was used. After finishing the treatment, the patient had Cobb angles of 7° and 11°, an improvement of 55% and 54%, respectively. After 6 months, these effects were maintained, as the patient had Cobb angles of 11° and 11°. The clinical appearance of the patient improved after the course of care. The patient was evaluated for psychological outcomes by applying the following tests: Scoliosis Research Society 22, Bad Sobernheim Stress, and the Brace Questionnaire The patient had the maximum score in all tests at the conclusion of therapy. Conclusion The patient responded favorably to manipulative and rehabilitation techniques. At the end of care, the patient did not show psychological sequelae with selected outcome measures. PMID:23204954
Green, Bart N; Sims, John; Allen, Rachel
2006-01-01
Background Low back pain can diminish jet pilot concentration and function during flight and be severe enough to ground pilots or cause decreased flying time. The objective of this case report is to present an example of the integration of chiropractic care with conventional treatments for the management of low back pain in a F/A-18 aviator. Case presentation The patient had insidious severe low back pain without radiation or neurological deficit, resulting in 24 hours of hospitalization. Spinal degeneration was discovered upon imaging. Four months later, it still took up to 10 minutes for him to get out of bed and several minutes to exit the jet due to stiffness and pain. He had discontinued his regular Marine Corps fitness training due to pain avoidance. Pain severity ranged from 1.5–7.1 cm on a visual analog scale. His Roland Morris Disability Questionnaire score was 5 out of 24. The pilot's pain was managed with the coordinated efforts of the flight surgeon, physiatrist, physical therapist, and doctor of chiropractic. Following this regimen he had no pain and no functional disability; he was able to fly multiple training missions per week and exercise to Marine Corps standards. Conclusion A course of care integrating flight medicine, chiropractic, physical therapy, and physiatry appeared to alleviate pain and restore function to this F/A-18 aviator with low back pain. PMID:16820063
Lumen, Nicolaas; Hoebeke, Piet; Troyer, Bart De; Ysebaert, Barbara; Oosterlinck, Willem
2009-03-01
We retrospectively analyzed cases of anastomotic urethroplasty for posttraumatic urethral strictures that were done at our center. Surgical and functional outcomes were evaluated. The impact of previous urethral manipulations was assessed. Between 1993 and 2006, 61 males were treated with anastomotic urethroplasty because of urethral trauma after pelvic fracture. Mean followup was 67 months (range 19 to 173). In 21 of the 61 cases (34.4%) urethral manipulation had been performed previously (secondary cases) but had failed. All patients were treated via the perineal approach. In 9 patients (14.8%) recurrence was reported. The recurrence rate was higher in patients who underwent former treatment than in primary patients (19% vs 12.5%). Posttraumatic impotence was reported by 20 patients (32.8%) but in 2 erectile function was restored after treatment. One patient had minor stress incontinence. In 2 secondary cases the rectum was injured during the procedure but could be repaired. Anastomotic urethroplasty via the perineal approach is an excellent treatment for posttraumatic urethral stricture. Results are good at long-term followup. Although statistical significance has not been attained, failures and complications seem to be higher in patients who have already undergone failed urethroplasty.
Vermet, Shannon; McGinnis, Karen; Boodham, Melissa; Gleberzon, Brian J
2010-01-01
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. 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. 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. This study suggests that there was considerable, but not complete, vertical integration between the undergraduate and clinical education program at this college.
Vermet, Shannon; McGinnis, Karen; Boodham, Melissa; Gleberzon, Brian J.
2010-01-01
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
Leppington, Charmody; Gleberzon, Brian; Fortunato, Lisa; Doucet, Nicolea; Vandervalk, Kyle
2012-01-01
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
Oakley, Paul A.; Harrison, Donald D.; Harrison, Deed E.; Haas, Jason W.
2005-01-01
BACKGROUND Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP®) methods, and (2) to compare the evidence for Diversified, SMT, and CBP®. METHODS Clinical control trials utilizing CBP® methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP® were rated and compared. RESULTS From the evidence from Clinical Control Trials on SMT and CBP®, there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP® (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS While CBP® Technique has approximately as much evidence-based support as SMT for neck pain, CBP® has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP® publications. PMID:17549209
Case Study: Students’ Symbolic Manipulation in Calculus Among UTHM Students
NASA Astrophysics Data System (ADS)
Ali, Maselan; Sufahani, Suliadi; Ahmad, Wan N. A. W.; Ghazali Kamardan, M.; Saifullah Rusiman, Mohd; Che-Him, Norziha
2018-04-01
Words are symbols representing certain aspects of mathematics. The main purpose of this study is to gain insight into students’ symbolic manipulation in calculus among UTHM students. This study make use the various methods in collecting data which are documentation, pilot study, written test and follow up individual interviews. Hence, the results analyzed and interpreted based on action-process-object-schema framework which is based on Piaget’s ideas of reflective abstraction, the concept of relational and instrumental understanding and the zone of proximal development idea. The students’ reply in the interview session is analyzed and then the overall performance is discussed briefly to relate with the students flexibility in symbolic manipulation in linking to the graphical idea, the students interpretation towards different symbolic structure in calculus and the problem that related to overgeneralization in their calculus problems solving.
The missing link in parasite manipulation of host behaviour.
Herbison, Ryan; Lagrue, Clement; Poulin, Robert
2018-04-03
The observation that certain species of parasite my adaptively manipulate its host behaviour is a fascinating phenomenon. As a result, the recently established field of 'host manipulation' has seen rapid expansion over the past few decades with public and scientific interest steadily increasing. However, progress appears to falter when researchers ask how parasites manipulate behaviour, rather than why. A vast majority of the published literature investigating the mechanistic basis underlying behavioural manipulation fails to connect the establishment of the parasite with the reported physiological changes in its host. This has left researchers unable to empirically distinguish/identify adaptive physiological changes enforced by the parasites from pathological side effects of infection, resulting in scientists relying on narratives to explain results, rather than empirical evidence. By contrasting correlative mechanistic evidence for host manipulation against rare cases of causative evidence and drawing from the advanced understanding of physiological systems from other disciplines it is clear we are often skipping over a crucial step in host-manipulation: the production, potential storage, and release of molecules (manipulation factors) that must create the observed physiological changes in hosts if they are adaptive. Identifying these manipulation factors, via associating gene expression shifts in the parasite with behavioural changes in the host and following their effects will provide researchers with a bottom-up approach to unraveling the mechanisms of behavioural manipulation and by extension behaviour itself.
Wang, Hui-Hao; Zhan, Hong-Sheng; Zhang, Ming-Cai; Chen, Bo; Guo, Kai
2012-09-01
To review previously reported injuries cases which were associated with cervical manipulation in China, and to describe the risks and benefits of the therapy. Relevant case reports, review articles, surveys, and investigations regarding treatment of cervical spondylosis with cervical manipulation involving accidents and associated complication were retrived with a search of the literature from SinoMed, CNKI, CQVIP, and Wanfang digital databases between 1979 to March 2011. The data were extracted and statistically analyzed. Total of 150 cases of injury reported in 40 articles corresponded the inclusion criteria. Accidents occurred in 156 cases,of them,syncope was in 45 cases (28.85%), mild spinal cord injury or compression was in 34 cases (21.79%), nerve root injury was in 24 cases (15.38%), ineffective or symptom increased was in 11 cases (7.05%); cervical spine fracture was in 11 cases (7.05%), dislocation or semiluxation was in 6 cases (3.85%), soft tissue injury was in 3 cases (1.92%), serious accident was 22 cases (14.70%, including paralysis, death and cerebrovascular accident). In cases of serious accident, 12 cases (54.55%) had the other primary diseases. Types of related manipulation including rotation reduction (42.00%, 63 cases), rubbing points or muscle resulting strong stimulation (28.00%, 42 cases). 100 cases (66.67%) obtained cured or basically recovered results, 21 cases (14.00%) improved, 4 cases (2.67%) deterioration and 5 cases (3.33%) died. It is imperative for practitioners to complete the patients' management and assessment before manipulation. That the practitioners conduct a detailed physical examination and make a correct diagnosis would be a pivot method of avoiding accidents. Excluding contraindications and potential risks, standardizing evaluation criteria and practitioners' qualification, increasing safety awareness and risk assessment and strengthening the monitoring of the accidents could decrease the incidence of accidents.
Meseke, Jamie K; Nafziger, Rita; Meseke, Christopher A
2008-05-01
This pilot study examines the effect collaborative testing has on achievement of students taking a basic science course at a chiropractic college. The grades of 2 cohorts of students taking a basic science course were compared: the control group from the first academic term (n = 73) and the experimental group from the second academic term (n = 41). The control cohort completed weekly quizzes as individuals. The experimental cohort completed the weekly quizzes in small collaborative groups. All unit examinations and the final examination were taken by both cohorts individually. Grades for each cohort were derived from 6 weekly unit quizzes, 3 unit examinations, and a comprehensive final examination. Overall, the experimental group differed from the control group (Wilks' Lambda = 0.318; F(10,103) = 22.052; and P < .001). All quiz scores were significantly higher for the experimental group as compared with the control group. In addition, overall point totals and final course grades also differed significantly. No significant differences, however, were observed in either the first 2 unit examination scores or the final examination scores. These results confirm previous reports that student performance is enhanced by collaborative learning. Collaborative testing provided students with the opportunity to discuss their reasoning and receive immediate feedback from other group members regarding their rationale, which potentially enhanced understanding of course material. Students were encouraged to become more active in the course as group discussions emerged from individual perspectives. The collaborative learning process may enhance critical thinking abilities, which are vital for future chiropractic practitioners.
Modeling and sensory feedback control for space manipulators
NASA Technical Reports Server (NTRS)
Masutani, Yasuhiro; Miyazaki, Fumio; Arimoto, Suguru
1989-01-01
The positioning control problem of the endtip of space manipulators whose base are uncontrolled is examined. In such a case, the conventional control method for industrial robots based on a local feedback at each joint is not applicable, because a solution of the joint displacements that satisfies a given position and orientation of the endtip is not decided uniquely. A sensory feedback control scheme for space manipulators based on an artificial potential defined in a task-oriented coordinates is proposed. Using this scheme, the controller can easily determine the input torque of each joint from the data of an external sensor such as a visual device. Since the external sensor is mounted on the unfixed base, the manipulator must track the moving image of the target in sensor coordinates. Moreover the dynamics of the base and the manipulator are interactive. However, the endtip is proven to asymptotically approach the stationary target in an inertial coordinate frame by the Liapunov's method. Finally results of computer simulation for a 6-link space manipulator model show the effectiveness of the proposed scheme.
McRae, Marc P.
2010-01-01
Purpose: Organic chemistry has been shown to correlate with academic success in the preclinical years of medicine, dentistry, and graduate physiology. The purpose of this study is to examine the relationship between undergraduate organic chemistry grades and first-semester biochemistry grades at a Midwest chiropractic doctoral program. Methods: Students enrolled in a first-semester biochemistry course who had completed the prerequisite courses in organic chemistry offered at this same institution were entered into the study. The total grade for each of the three courses was calculated using the midterm and final exam raw scores with a weighting of 50% each. Analysis consisted of obtaining correlation coefficients between the total grades of organic 1 with biochemistry and organic 2 with biochemistry. Using the biochemistry total grade, the students were divided into quartiles and course grades for both organic chemistry 1 and 2 were calculated. Results: For the 109 students in the study, the correlation coefficient between the biochemistry and organic chemistry 1 and biochemistry and organic chemistry 2 courses was r = 0.744 and r = 0.725, respectively. The difference in organic chemistry grades between those in the first and fourth quartiles was 63.2% and 86.9% for organic chemistry 1 (p < .001) and 60.9% and 79.4% for organic chemistry 2 (p < .001). Conclusion: This study shows that organic chemistry can be used as an indicator of future academic success in a chiropractic biochemistry course. Knowledge of such a relationship could prove useful to identify students who may potentially run into academic difficulty with first-year biochemistry PMID:20480012
A Case against Computer Symbolic Manipulation in School Mathematics Today.
ERIC Educational Resources Information Center
Waits, Bert K.; Demana, Franklin
1992-01-01
Presented are two reasons discouraging computer symbol manipulation systems use in school mathematics at present: cost for computer laboratories or expensive pocket computers; and impracticality of exact solution representations. Although development with this technology in mathematics education advances, graphing calculators are recommended to…
Fernández-de-las-Peñas, César; Palomeque-del-Cerro, Luis; Rodríguez-Blanco, Cleofás; Gómez-Conesa, Antonia; Miangolarra-Page, Juan C
2007-05-01
Our aim was to report changes in neck pain at rest, active cervical range of motion, and neck pain at end-range of cervical motion after a single thoracic spine manipulation in a case series of patients with mechanical neck pain. Seven patients with mechanical neck pain (2 men, 5 women), 20 to 33 years old, were included. All patients received a single thoracic manipulation by an experienced manipulative therapist. The outcome measures of these cases series were neck pain at rest, as measured by a numerical pain rating scale; active cervical range of motion; and neck pain at the end of each neck motion (eg, flexion or extension). These outcomes were assessed pre treatment, 5 minutes post manipulation, and 48 hours after the intervention. A repeated-measures analysis was made with parametric tests. Within-group effect sizes were calculated using Cohen d coefficients. A significant (P < .001) decrease, with large within-group effect sizes (d > 1), in neck pain at rest were found after the thoracic spinal manipulation. A trend toward an increase in all cervical motions (flexion, extension, right or left lateral flexion, and right or left rotation) and a trend toward a decrease in neck pain at the end of each cervical motion were also found, although differences did not reach the significance (P > .05). Nevertheless, medium to large within-group effect sizes (0.5 < d < 1) were found between preintervention data and both postintervention assessments in both active range of motion and neck pain at the end of each neck motion. The present results demonstrated a clinically significant reduction in pain at rest in subjects with mechanical neck pain immediately and 48 hours following a thoracic manipulation. Although increases in all tested ranges of motion were obtained, none of them reached statistical significance at either posttreatment point. The same was found for pain at the end of range of motion for all tested ranges, with the exception of pain at the end of forward
Fedorchuk, Curtis; Lightstone, Douglas F; McRae, Christi; Kaczor, Derek
2017-01-01
Objective Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. Clinical Features A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. Interventions and Outcomes The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. Conclusions This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods. PMID:29299090
Outcomes of a pilot study in chiropractic practices in Western Australia.
Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F; Nedkoff, Lee; Fisher, Colleen
2016-01-01
This paper reports the quantitative outcomes of a mixed-methods pilot study of the characteristics and demographics of chiropractic practices and patients in Western Australia. This was a mixed-methods data transformation model (qualitative to quantitative) pilot study. A non-random sample of chiropractic practices across Western Australia was recruited and data collected anonymously from consecutive new patients using an online platform. Data covered practice and patient demographics and characteristics, alongside quality of life measures. A descriptive quantitative analysis characterised the sample, and the patient population was stratified by main reason for presentation to compare characteristics according to the presence of secondary complaints. Odds ratios were calculated to estimate the odds of a secondary complaint for various combinations of main complaints, from univariate logistic regression models. Of the 539 registered practitioners in WA in July 2014, 33 agreed to participate, from 20 different practices. Ten participating practices provided data on 325 adult new patients. The recruited practices (metropolitan n = 8, regional n = 2) had a positive response rate of 79.7 % ( n = 301 metropolitan and n = 24 regional patients), mean age 36.3 years (range 18-74) (53.2 % female). Spinal problems were reported as the main reason for consultation by 67 % and as secondary reasons by 77.2 % of patients. People presented primarily for health maintenance or a general health check in 11.4 %, and as a secondary reason 14.8 %. There were 30 % of people below societal norms for the SF-12 Physical Component Score (mean 47.19, 95 % CI; 46.27-48.19) and 86 % for the Mental Component Score (mean 36.64, 95 % CI; 35.93-37.65), Pain Impact Questionnaire mean scores were 54.60 (95 % CI; 53.32-55.88). Patients presented to chiropractors in Western Australia with a fairly wide range of conditions, but primarily spinal and musculoskeletal
Manipulation Capabilities with Simple Hands
2010-01-01
allowing it to interpret online kinesthetic data, addressing two objectives: • Grasp classification: Distinguish between successful and unsuccessful...determining the grasp outcome before the grasping process is complete, by using the entire time series or kinesthetic signature of the grasping process. As...the grasp proceeds and additional kinesthetic data accumulates, the confidence also increases. In some cases Manipulation Capabilities with Simple Hands
Adaptive hidden Markov model with anomaly States for price manipulation detection.
Cao, Yi; Li, Yuhua; Coleman, Sonya; Belatreche, Ammar; McGinnity, Thomas Martin
2015-02-01
Price manipulation refers to the activities of those traders who use carefully designed trading behaviors to manually push up or down the underlying equity prices for making profits. With increasing volumes and frequency of trading, price manipulation can be extremely damaging to the proper functioning and integrity of capital markets. The existing literature focuses on either empirical studies of market abuse cases or analysis of particular manipulation types based on certain assumptions. Effective approaches for analyzing and detecting price manipulation in real time are yet to be developed. This paper proposes a novel approach, called adaptive hidden Markov model with anomaly states (AHMMAS) for modeling and detecting price manipulation activities. Together with wavelet transformations and gradients as the feature extraction methods, the AHMMAS model caters to price manipulation detection and basic manipulation type recognition. The evaluation experiments conducted on seven stock tick data from NASDAQ and the London Stock Exchange and 10 simulated stock prices by stochastic differential equation show that the proposed AHMMAS model can effectively detect price manipulation patterns and outperforms the selected benchmark models.
Palmgren, Per J; Laksov, Klara Bolander
2015-08-05
The educational environment has a significant impact on students' behavior, sense of well-being, and academic advancement. While various research methodologies have been used to explore the educational environment, there is a paucity of studies employing qualitative research methods. This study engages in an in-depth exploration of chiropractic students' experiences of the meaning of the educational environment. A qualitative approach was employed by interviewing 26 students in four focus group interviews at two different points in time. A conventional manifest and latent content analysis was chosen to investigate and interpret the experiences of the educational environment in an undergraduate chiropractic training institution in Sweden. The analysis resulted in five overarching themes: Personal growth; Being part of a community; A place of meaningfulness; Trust in a regulated system; and Scaffolding relationships. Early in the training, the meaning of the educational environment was experienced as part of a vocational community and the scaffolding of intra-institutional relationships. In later stages, the environment was experienced in terms of personal growth - balancing academic pressures and progress within the professional community - thus laying the foundations for autonomy and motivation. During the clinical training, the environment was experienced as where learning happens, thus creating a place of meaningfulness. Throughout the training, the formal and clinical environments were experienced as isolating, with little bridging between the two. A regulated system - conveying an operative organization with clear communication regarding what to expect - was experienced as important for an apt educational environment. We found that experiences of an educational environment are dynamic and change over time. When restructuring or evaluating curriculums, educational managers can consider the emerged themes as constituting facets relating to the educational
Kania-Richmond, Ania; Weeks, Laura; Scholten, Jeffrey; Reney, Mikaël
2016-01-01
Background: Practice based research networks (PBRNs) are increasingly used as a tool for evidence based practice. We developed and tested the feasibility of using software to enable online collection of patient data within a chiropractic PBRN to support clinical decision making and research in participating clinics. Purpose: To assess the feasibility of using online software to collect quality patient information. Methods: The study consisted of two phases: 1) Assessment of the quality of information provided, using a standardized form; and 2) Exploration of patients’ perspectives and experiences regarding online information provision through semi-structured interviews. Data analysis was descriptive. Results: Forty-five new patients were recruited. Thirty-six completed online forms, which were submitted by an appropriate person 100% of the time, with an error rate of less than 1%, and submitted in a timely manner 83% of the time. Twenty-one participants were interviewed. Overall, online forms were preferred given perceived security, ease of use, and enabling provision of more accurate information. Conclusions: Use of online software is feasible, provides high quality information, and is preferred by most participants. A pen-and-paper format should be available for patients with this preference and in case of technical difficulties. PMID:27069272
Tian, Gang; Shen, Mao-rong; Jiang, Wei-guo; Xie, Fu-rong; Wei, Wen-wu
2015-06-01
To compare clinical effects of spinal leveraging manipulation and medicine for the treatment of degenerative scoliosis in pain and function. From July 2010 to June 2013, 38 patients with degenerative scoliosis were randomly divided into spinal leveraging manipulation group and medicine group by coin tossing. In manipulation group, there were 9 males and 11 females aged from 58 to 74 years old with an average of (66.63±7.73), the courses of diseases ranged from 3 to 8 months with an average of (5.65±2.58), spinal leveraging manipulation(following meridian to straighten tendon,relieving spasm, osteopathy and massage, clearing and activating the channels and collaterals) were performed for 30 min, once a day, 4 days for a period treatment, totally 9 courses. In medicine group, there were 8 males and 10 females aged from 57 to 70 years old with an average of (63.51±6.61) the courses of diseases ranged from 3 to 5 months with an average of (4.82±1.43), celecoxib with eperisone hydrochloride were orally taken, 4 days for a period treatment, totally 9 courses. VAS score, Cobb angle and ODI score were measured. After treatment, VAS score in manipulation group was (5.38±0.99), (6.36±1.31) in medicine group,and had significant meaning (t=2.618, P<0.05); there was significant differences in Cobb angle between manipulation group (16.51±4.89)° and medicine group (19.85±5.03) °(t=2.074,P<0.05); and had obviously meaning in ODI score between manipulation group (20.20±2.93) and medicine group (26.01±3.11) (t=5.592, P<0.05). Spinal leveraging manipulation for degenerative scoliosis could regulate muscle balance on both side of spine, correct coronal imbalances in spine, recover normal sequence of spine, reduce and remove opperssion and stimulation of nerve root, relieve pain in leg and waist and further improve quality of life.
NASA Astrophysics Data System (ADS)
Rybus, T.; Seweryn, K.
2018-06-01
It is considered to use a manipulator-equipped satellite for performing On-Orbit Servicing (OOS) or Active Debris Removal (ADR) missions. In this paper, several possible approaches are reviewed for end-effector (EE) trajectory planning in the Cartesian space, such as application of the Bézier curves for singularity avoidance and method for trajectory optimization. The results of numerical simulations for a satellite equipped with a 7 degree-of-freedom (DoF) manipulator and results of experiments performed on a planar air-bearing microgravity simulator for a simplified two-dimensional (2D) case with a 2-DoF manipulator are presented. Differences between the free-floating case and the case where Attitude and Orbit Control Systems (AOCS) keep constant position and orientation of the satellite are also shown.
2014-01-01
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
McGregor, Marion; Puhl, Aaron A; Reinhart, Christine; Injeyan, H Stephen; Soave, David
2014-02-10
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. 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. 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 (X(2) =13.4, p = 0.0002). 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.
Pohlman, Katherine A; Carroll, Linda; Hartling, Lisa; Tsuyuki, Ross T; Vohra, Sunita
2016-04-01
A reporting and learning system is a method of monitoring the occurrence of incidents that affect patient safety. This cross-sectional survey asked pediatric chiropractors about factors that may limit their participation in such a system. The list of potential barriers for participation was developed using a systematic approach. All members of the 2 pediatric councils associated with US national chiropractic organizations were invited to complete the survey (N = 400). The cross-sectional survey was created using an online survey tool (REDCap) and sent directly to member emails addressed by the respective executive committees. Of the 400 potential respondents, 81 responded (20.3%). The most common limitations to participating were identified as time pressure (96%) and patient concerns (81%). Reporting and learning systems have been utilized to increase safety awareness in many high-risk industries. To be successful, future patient safety studies with pediatric chiropractors need to ensure these barriers are understood and addressed. © The Author(s) 2015.
Hu, Hua; Xiong, Chang-Yuan; Han, Guo-Wu
2012-07-01
To study the changes of displacement and stress in the model of lumbar pelvic and proximal femur during lumbar rotatory manipulation. The date of lumbar pelvic and proximal femur CT scan by Mimics 10.01 software was established a lumbar pelvic and proximal femur geometric model, then the model was modified with Geomagic 9, at last the modified model was imported into hypermesh 10 and meshed with tetrahedron, at the same time,add disc and ligaments. According to the principle of lumbar rotatory manipulation,the lumbar rotatory manipulation were decomposed. The mechanical parameters assigned into the three-dimensional finite element model. The changes of displacement and stress in the model of lunbar pelvic and proximal femur under the four conditions were calculated with Abaqus model of Hypermesh 10. 1) Under the same condition,the displacement order of lumbar was L1>L2>L3>L5 L5, anterior column > middle column > posterior column. 2) Under the different conditions, the displacement order of lumbar,case 3>case 1>case 4>case 2. 3) Under the same conditions, the displacement order of lumbar inter-vertebral disc from L1,2 to L5S1 was L1,2>L2,3>L3,4>L4,5>L5S1, as for the same inter-vertebral disc, the order was: second quadrant>third quadrant>first quadrant>fourth quadrant. 4) Under the different conditions,the displacement order of the inter-vertebral disc was L1,2>L2,3>L3,4>L4,5>L5S1, but to same inter-vertebral disc: case 3>case 4>case 1 >case 2. 5) There were apparent displacement and stress concentration in pelvis and hip during the manipulation. 1) The principles of lumbar rotation manipulation closely related to the relative displacement caused by rotation of various parts of lumbar pelvic and proximal femur model; 2) During the process of lumbar rotatory manipulation, the angle of lateral bending and flexion can not be randomly increased; 3) During the process of lumbar rotatory manipulation, all the conditions of lumbar pelvic and proximal femur must be
Richey, Roberta H; Hughes, Clare; Craig, Jean V; Shah, Utpal U; Ford, James L; Barker, Catrin E; Peak, Matthew; Nunn, Anthony J; Turner, Mark A
2017-02-25
This study sought to determine whether there is an evidence base for drug manipulation to obtain the required dose, a common feature of paediatric clinical practice. A systematic review of the data sources, PubMed, EMBASE, CINAHL, IPA and the Cochrane database of systematic reviews, was used. Studies that considered the dose accuracy of manipulated medicines of any dosage form, evidence of safety or harm, bioavailability, patient experience, tolerability, contamination and comparison of methods of manipulation were included. Case studies and letters were excluded. Fifty studies were eligible for inclusion, 49 of which involved tablets being cut, split, crushed or dispersed. The remaining one study involved the manipulation of suppositories of one drug. No eligible studies concerning manipulation of oral capsules or liquids, rectal enemas, nebuliser solutions, injections or transdermal patches were identified. Twenty four of the tablet studies considered dose accuracy using weight and/or drug content. In studies that considered weight using adapted pharmacopoeial specifications, the percentage of halved tablets meeting these specifications ranged from 30% to 100%. Eighteen studies investigated bioavailability, pharmacokinetics or clinical outcomes following manipulations which included nine delayed or modified release formulations. In each of these nine studies the entirety of the dosage form was administered. Only one of the 18 studies was identified where drugs were manipulated to obtain a proportion of the dosage form, and that proportion administered. The five studies that considered patient perception found that having to manipulate the tablets did not have a negative impact on adherence. Of the 49 studies only two studies reported investigating children. This review yielded limited evidence to support manipulation of medicines for children. The results cannot be extrapolated between dosage forms, methods of manipulation or between different brands of the same
Recruitment and accrual of women in a randomized controlled trial of spinal manipulation.
Cambron, J A
2001-02-01
To report on recruitment efforts and accrual rates for a nonmusculoskeletal chiropractic clinical trial. Information regarding the method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screening. A suburban chiropractic teaching clinic with recruitment efforts extending throughout the larger metropolitan area. A total of 2312 women were screened for participation and the advertisement source was noted for each. Of these, 138 women were recruited and fulfilled all study requirements. The numbers of responses and accrual rates were determined for 8 different recruitment methods: newspaper advertisements, community referrals, radio advertisements, community colleges, press releases, a community electronic sign, public television, and local posters. The most effective recruitment methods were newspaper advertisements, community referrals, and radio advertisements; the least effective methods were public television and local posters. The effort required for the recruitment of subjects was underestimated in this study. Based on the information gained, future recruitment methods for study participants will primarily focus on low-effort, high-yield methods such as newspaper and radio advertising, followed by press releases, campus electronic signs, and public television.
Manipulating glucocorticoids in wild animals: basic and applied perspectives
Sopinka, Natalie M.; Patterson, Lucy D.; Redfern, Julia C.; Pleizier, Naomi K.; Belanger, Cassia B.; Midwood, Jon D.; Crossin, Glenn T.; Cooke, Steven J.
2015-01-01
One of the most comprehensively studied responses to stressors in vertebrates is the endogenous production and regulation of glucocorticoids (GCs). Extensive laboratory research using experimental elevation of GCs in model species is instrumental in learning about stressor-induced physiological and behavioural mechanisms; however, such studies fail to inform our understanding of ecological and evolutionary processes in the wild. We reviewed emerging research that has used GC manipulations in wild vertebrates to assess GC-mediated effects on survival, physiology, behaviour, reproduction and offspring quality. Within and across taxa, exogenous manipulation of GCs increased, decreased or had no effect on traits examined in the reviewed studies. The notable diversity in responses to GC manipulation could be associated with variation in experimental methods, inherent differences among species, morphs, sexes and age classes, and the ecological conditions in which responses were measured. In their current form, results from experimental studies may be applied to animal conservation on a case-by-case basis in contexts such as threshold-based management. We discuss ways to integrate mechanistic explanations for changes in animal abundance in altered environments with functional applications that inform conservation practitioners of which species and traits may be most responsive to environmental change or human disturbance. Experimental GC manipulation holds promise for determining mechanisms underlying fitness impairment and population declines. Future work in this area should examine multiple life-history traits, with consideration of individual variation and, most importantly, validation of GC manipulations within naturally occurring and physiologically relevant ranges. PMID:27293716
Autonomous Object Manipulation Using a Soft Planar Grasping Manipulator
Katzschmann, Robert K.; Marchese, Andrew D.
2015-01-01
Abstract This article presents the development of an autonomous motion planning algorithm for a soft planar grasping manipulator capable of grasp-and-place operations by encapsulation with uncertainty in the position and shape of the object. The end effector of the soft manipulator is fabricated in one piece without weakening seams using lost-wax casting instead of the commonly used multilayer lamination process. The soft manipulation system can grasp randomly positioned objects within its reachable envelope and move them to a desired location without human intervention. The autonomous planning system leverages the compliance and continuum bending of the soft grasping manipulator to achieve repeatable grasps in the presence of uncertainty. A suite of experiments is presented that demonstrates the system's capabilities. PMID:27625916
A chiropractic service arrangement for musculoskeletal complaints in industry: a pilot study.
Jay, T C; Jones, S L; Coe, N; Breen, A C
1998-09-01
Chiropractic services are commonly used by workers with musculoskeletal problems, especially low back and neck complaints. Research into the effectiveness and cost-effectiveness of this approach is, however, difficult to design without prior pilot studies. This study followed 32 workers with these complaints attending one such service and used five measures of outcome over a 6-month period. These measured pain (VAS), disability (FLP), quality of life (SF-36), perceived benefit and satisfaction with care. Additionally, sickness costs to the companies were recorded over two years encompassing the study period. Treatment utilization was also monitored. Over half the population were chronic sufferers. The effect sizes were large for pain and for seven out of eight dimensions of the SF-36 questionnaire at 6-month follow-up, although not for disability (FLP). High levels of satisfaction and perceived improvement were reported and sickness costs to the companies fell. However, the sample size in this pilot study was small and did not include controls. We would, therefore, recommend a full cost-effectiveness study incorporating a randomized trial in this area.
A kinematic analysis of the modified flight telerobotic servicer manipulator system
NASA Technical Reports Server (NTRS)
Crane, Carl; Carnahan, Tim; Duffy, Joseph
1992-01-01
A reverse kinematic analysis is presented of a six-DOF subchain of a modified seven-DOF flight telerobotic servicer manipulator system. The six-DOF subchain is designated as a TR-RT chain, which describes the sequence of manipulator joints beginning with the first grounded hook joint (universal joint) T, where the sequence R-R designates a pair of revolute joints with parallel axes. At the outset, it had been thought that the reverse kinematic analysis would be similar to a TTT manipulator previously analyzed, in which the third and fourth joints intersected at a finite point. However, this is shown not the case, and a 16th-degree tan-half-angle polynomial is derived for the TR-RT manipulator.
Study to design and develop remote manipulator system. [computer simulation of human performance
NASA Technical Reports Server (NTRS)
Hill, J. W.; Mcgovern, D. E.; Sword, A. J.
1974-01-01
Modeling of human performance in remote manipulation tasks is reported by automated procedures using computers to analyze and count motions during a manipulation task. Performance is monitored by an on-line computer capable of measuring the joint angles of both master and slave and in some cases the trajectory and velocity of the hand itself. In this way the operator's strategies with different transmission delays, displays, tasks, and manipulators can be analyzed in detail for comparison. Some progress is described in obtaining a set of standard tasks and difficulty measures for evaluating manipulator performance.
Review of methods used by chiropractors to determine the site for applying manipulation
2013-01-01
Background With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. Methods Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. Results A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use
Manipulability, force, and compliance analysis for planar continuum manipulators
NASA Technical Reports Server (NTRS)
Gravagne, Ian A.; Walker, Ian D.
2002-01-01
Continuum manipulators, inspired by the natural capabilities of elephant trunks and octopus tentacles, may find niche applications in areas like human-robot interaction, multiarm manipulation, and unknown environment exploration. However, their true capabilities will remain largely inaccessible without proper analytical tools to evaluate their unique properties. Ellipsoids have long served as one of the foremost analytical tools available to the robotics researcher, and the purpose of this paper is to first formulate, and then to examine, three types of ellipsoids for continuum robots: manipulability, force, and compliance.
Manipulability, force, and compliance analysis for planar continuum manipulators.
Gravagne, Ian A; Walker, Ian D
2002-06-01
Continuum manipulators, inspired by the natural capabilities of elephant trunks and octopus tentacles, may find niche applications in areas like human-robot interaction, multiarm manipulation, and unknown environment exploration. However, their true capabilities will remain largely inaccessible without proper analytical tools to evaluate their unique properties. Ellipsoids have long served as one of the foremost analytical tools available to the robotics researcher, and the purpose of this paper is to first formulate, and then to examine, three types of ellipsoids for continuum robots: manipulability, force, and compliance.
Brantingham, James W; Globe, Gary A; Cassa, Tammy Kay; Globe, Denise; de Luca, Katie; Pollard, Henry; Lee, Felix; Bates, Charles; Jensen, Muffit; Mayer, Stephan; Korporaal, Charmaine
2010-01-01
Hip 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. Eighteen individuals, who did not qualify due to low baseline Western Ontario and McMaster Osteoarthritis Index scores (WOMAC) for other ongoing HOA randomized control trials, were selected. A prospectively planned protocol, consisting of axial manipulation to the affected hip with modified Thomas and active assisted stretch, was combined with full kinetic chain treatment or manipulative therapy to the spine, knee, ankle, or foot and assessed with use of valid and reliable outcome measures. The primary outcome measure, the Overall Therapy Effectiveness Tool, was assessed with chi(2) and demonstrated that 83.33% of participants were improved after the ninth visit, P = .005, and 78% improved at the 3-month follow-up, P = .018. Using the paired t test, WOMAC was improved 64% at the ninth visit, P = .000, and 47% at follow-up, P = .016. In HOA patients with lower WOMAC scores, a highly organized HOA treatment appears to have resulted in statistically and clinically meaningful intragroup changes in the Overall Effectiveness Therapy Tool, WOMAC, Harris Hip Scale, and range of motion, all with P
Yang, Si-Dong; Chen, Qian; Ding, Wen-Yuan
2018-04-01
Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4-5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.
Kwon, Young Ho; Kwon, Se Hwan; Oh, Joo Hyeong; Jeong, Kyung Hwan; Lee, Tae Won
2014-06-01
To assess the efficacy of fluoroscopic guide wire manipulation in patients with malfunctioning peritoneal dialysis (PD) catheters that were initially placed by interventional radiologists under fluoroscopic guidance. From January 2002 to April 2012, 52 patients (mean age, 52.8 y ± 2.10s; range, 12-79 y) with malfunctioning PD catheters in whom fluoroscopic guide wire manipulation was performed were retrospectively reviewed. Technical success, clinical success, and complications were evaluated. Technical success was defined as fluoroscopically verified, successful catheter repositioning and adequate dialysate drainage after the procedure. Clinical success was defined as maintenance of PD catheter function for at least 30 days after the manipulation. During the study period, 72 manipulations (68 initial manipulations and 4 remanipulations) for malfunctioning PD catheters were done. The technical success rate was 74% (50 of 68) for initial manipulations and 75% (3 of 4) for remanipulations. The overall clinical success rate was 47% (32 of 68) for initial manipulations and 0% (0 of 4) for remanipulations. The primary causes of catheter malfunction were extraluminal obstruction by omental wrapping or adhesions in 43 of 68 cases (63.2%) and catheter malposition in 25 of 68 (36.8%) cases. There were no procedure-related major complications. Fluoroscopic guide wire manipulation in patients with malfunctioning PD catheters initially placed by interventional radiologists is a simple procedure, an effective way of prolonging PD catheter life, and a recommended procedure before invasive surgical procedures. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.
LATE EVALUATION OF PATIENTS UNDERGOING MANIPULATION OF THE KNEE AFTER TOTAL ARTHROPLASTY.
DE Sousa, Pedro Guilme Teixeira; Chisté, Yuri Lubiana; Albuquerque, Rodrigo Sattamini Pires E; Cobra, Hugo Alexandre DE Araújo Barros; Barretto, João Maurício; Cavanellas, Naasson Trindade
2017-01-01
We compared gains in range of motion in patients who underwent manipulation within 12 weeks of total knee arthroplasty (TKA) and after this period. We also evaluated maintenance of the arc obtained from knee manipulation in late follow-up, along with factors associated with poorer outcomes. The study was divided into two groups according to the time after TKA; the surgeries took place between January 2008 and December 2014. When comparing the range of motion between early and late manipulations, the group that underwent manipulation within 12 weeks of the TKA exhibited better outcomes, but these were not statistically significant. We observed that 14.3% of cases retained the same range attained at the time of manipulation. In late evaluation after manipulation, 47.7% of the sample had a range of less than 90 degrees. The significant risk factors for recurrence of knee stiffness in the long term are poor range of motion before TKA and before manipulation, female sex, and secondary arthritis. Women previously diagnosed with secondary osteoarthritis and poor range of motion before TKA or manipulation are at higher risk for late stiffness. Level of Evidence III, Retrospective Comparative Study.
Cramer, Gregory D.; Cambron, Jerrilyn; Cantu, Joe A; Dexheimer, Jennifer M.; Pocius, Judith D; Gregerson, Douglas; Fergus, Michael; McKinnis, Ray; Grieve, Thomas J
2013-01-01
Objective The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). Methods This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N=112, four n=28 MRI protocol groups) had 2 magnetic resonance imaging (MRI) appointments (initial enrollment [M1] and following 2 weeks of chiropractic treatment [M2]; receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (M1 appointment) or assigned (M2 appointment) into SPP (non-manipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior (A-P) joint space was measured. Difference between most painful side A-P measurements taken post- and pre-intervention was the Z joint “gapping difference.” Gapping differences were compared (ANOVA) among protocol groups. Secondary measures of pain visual analog scale (VAS), verbal numeric pain rating scale (VNPRS), and function Bournemouth questionnaire (BQ) were assessed. Results Gapping differences were significant at the first (adjusted, p=0.01; SPP=0.66 +0.48mm; SMT=0.23 +0.86; control=0.18 +0.71) and second (adjusted, p=0.0005; SPP=0.65 +0.92mm, SMT=0.89 +0.71; control=0.35 +0.32) MRI appointments. VNPRS differences were significant at first MRI appointment (p=0.04) with SMT showing the greatest improvement. VAS and BQ improved after two weeks of care in all groups (both p<0.0001). Conclusions SPP showed greatest gapping at baseline. After two weeks, SMT resulted in greatest gapping. SPP appeared to have additive therapeutic benefit to SMT. PMID:23648055
Newell, Dave; Diment, Emily; Bolton, Jenni E
2016-01-01
The purpose of this study was to test the feasibility of collecting valid and widely used health outcomes, including information concerning cost of care, using a Web-based patient-driven patient-reported outcome measure (PROM) collection process within a cohort of UK chiropractic practices. A Web-based PROM system (Care Response) was used. Patients with low back and neck pain were recruited from a group of chiropractic practices located in the United Kingdom. Information collected included demographic data, generic and condition-specific PROMs at the initial consultation and 90 days later, patient-reported experience measures, and additional health seeking to estimate costs of care. A group of 33 clinics provided information from a total of 1895 patients who completed baseline questionnaires with 844 (45%) completing the measures at 90-day follow-up. Subsequent outcomes suggest that more than 70% of patients improved over the course of treatment regardless of the outcome used. Using the baseline as a virtual counterfactual with respect to follow-up, we calculated quality-adjusted life years and the cost thereof resulting in a mean quality-adjusted life years gained of 0.8 with an average cost of £895 per quality-adjusted life year. Routine collection of PROMs, including information about cost, is feasible and can be achieved using an online system within a clinical practice environment. We describe a Web-based collection system and discuss the choice of measures leading to a comprehensive understanding of outcomes and costs in routine practice. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
Kearns, Gary; Wang, Sharon
2012-01-01
This case report describes the effectiveness of thrust manipulation to the elbow and carpals in the management of a patient referred with a medical diagnosis of cubital tunnel syndrome (CuTS). The patient was a 45-year-old woman with a 6-week history of right medial elbow pain, ulnar wrist pain, and intermittent paresthesia in the ulnar nerve distribution. Upon initial assessment, she presented with a positive elbow flexion test and upper limb neurodynamic test with ulnar nerve bias. A biomechanical assessment of the elbow and carpals revealed a loss of lateral glide of the humerus on the ulna and a loss of palmar glide of the triquetral on the hamate. After the patient received two thrust manipulations of the elbow and one thrust manipulation of the carpals over the course of four sessions, her pain and paresthesia were resolved. This case demonstrates that the use of thrust manipulation to the elbow and carpals may be an effective approach in the management of insidious onset CuTS. This patient was successfully treated with thrust manipulation when joint dysfunction of the elbow and wrist were appropriately identified. This case report may shed light on the examination and management of insidious onset CuTS. PMID:23633888
Acoustic manipulation: Bessel beams and active carriers
NASA Astrophysics Data System (ADS)
Rajabi, Majid; Mojahed, Alireza
2017-10-01
In this paper, we address the interaction of zero-order acoustic Bessel beams as an acoustic manipulation tool, with an active spherical shell, as a carrier in drug, agent, or material delivery systems, in order to investigate the controllability of exerted acoustic radiation force as the driver. The active body is comprised of a spherical elastic shell stimulated in its monopole mode of vibrations with the same frequency as the incident wave field via an internally bonded and spatially uniformly excited piezoelectric actuator. The main aim of this work is to examine the performance of a nondiffracting and self-reconstructing zero-order Bessel beam to obtain the full manipulability condition of active carriers in comparison with the case of a plane wave field. The results unveil some unique potentials of the Bessel beams in the company of active carriers, with emphasis on the consumed power of the actuation system. This paper will widen the path toward the single-beam robust acoustic manipulation techniques and may lead to the prospect of combined tweezers and fields, with applications in delivery systems, microswimmers, and trapper designs.
Stress in chiropractic education: a student survey of a five-year course.
Hester, Hilary; Cunliffe, Christina; Hunnisett, Adrian
2013-01-01
Objective : Stress encompasses academic issues, such as time management, increased work load, and new subject matter, but cannot be separated from stressors, such as social adjustment and financial pressure. Our study investigated whether perceived level of academic or practical attainment and the method of study were associated with the amount of perceived stress during students" studies. Methods : A semi-structured self-administered questionnaire was piloted and distributed to 134 students at a chiropractic college at the end of a lecture. Results : The survey had a response rate of 81%. Students in their fourth year consistently reported the highest perceived levels of stress, with 81% feeling that their ability to study was affected by their financial situation and 56% felt overwhelmed at their ability to cope with their college workload. All year groups were stressed during their course of studies, but the stressor varies depending on the year of study. Conclusions : Year 4 consistently demonstrated the highest levels of stress. All students, regardless of year group, experienced varying degrees of stress while studying and the central stressor changed depending on the time position within the course.
Brantingham, James W; Parkin-Smith, Gregory; Cassa, Tammy Kay; Globe, Gary A; Globe, Denise; Pollard, Henry; deLuca, Katie; Jensen, Muffit; Mayer, Stephan; Korporaal, Charmaine
2012-02-01
To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA). Parallel-group randomized trial with 3-month follow-up. Two chiropractic outpatient teaching clinics. Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively. Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period. Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively). There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Schrum, Phillip B.; Cohen, George H.
1993-01-01
Self-contained, waterproof, water-submersible, remote-controlled apparatus is provided for manipulating a device, such as an ultrasonic transducer for measuring crack propagation on an underwater specimen undergoing shock testing. The subject manipulator includes metal bellows for transmittal of angular motions without the use of rotating shaft seals or O-rings. Inside the manipulator, a first stepper motor controls angular movement. In the preferred embodiment, the bellows permit the first stepper motor to move an ultrasonic transducer .+-.45 degrees in a first plane and a second bellows permit a second stepper motor to move the transducer .+-.10 degrees in a second plane orthogonal to the first. In addition, an XY motor-driven table provides XY motion.
Simple robust control laws for robot manipulators. Part 2: Adaptive case
NASA Technical Reports Server (NTRS)
Bayard, D. S.; Wen, J. T.
1987-01-01
A new class of asymptotically stable adaptive control laws is introduced for application to the robotic manipulator. Unlike most applications of adaptive control theory to robotic manipulators, this analysis addresses the nonlinear dynamics directly without approximation, linearization, or ad hoc assumptions, and utilizes a parameterization based on physical (time-invariant) quantities. This approach is made possible by using energy-like Lyapunov functions which retain the nonlinear character and structure of the dynamics, rather than simple quadratic forms which are ubiquitous to the adaptive control literature, and which have bound the theory tightly to linear systems with unknown parameters. It is a unique feature of these results that the adaptive forms arise by straightforward certainty equivalence adaptation of their nonadaptive counterparts found in the companion to this paper (i.e., by replacing unknown quantities by their estimates) and that this simple approach leads to asymptotically stable closed-loop adaptive systems. Furthermore, it is emphasized that this approach does not require convergence of the parameter estimates (i.e., via persistent excitation), invertibility of the mass matrix estimate, or measurement of the joint accelerations.
Osteopathic Manipulative Treatment
... Library Osteopathic Manipulative Treatment Becoming a DO Video Library What is Osteopathic Medicine? Osteopathic Manipulative Treatment Page Content Nearly every day, medical science unveils new discoveries from brain scans to anti- ...
Kim, Hee Jin; Lee, Tae Won; Ihm, Chun Gyoo; Kim, Myung Jae
2002-01-01
Peritoneal catheter is the lifeline for the continuous ambulatory peritoneal dialysis (CAPD) patients. Over the years, obstruction or displacement of the CAPD catheter has been one of the common complications of CAPD. Fluoroscopy-guided wire manipulation or laparoscopic surgery has been developed to manage outflow obstruction. We analyzed the catheter outcome of fluoroscopy-guided wire manipulation or laparoscopic surgery to determine the ultimate benefit of these procedures. From June 1996 to August 2000, catheter complications were manipulated in 24 patients. Eleven (46%) of these patients were initially managed by guide wire under fluoroscopic control. The remaining 13 (54%) patients were manipulated by laparoscopic surgery. A successful outcome was defined as maintained normal peritoneal catheter function at 30 days after the manipulations. Among the catheters manipulated, 18 (75%) were inserted by nephrologist and 6 (25%) by surgeons at the initiation of CAPD. Tenckhoff double-cuff peritoneal catheters were inserted to all patients. The time elapsed between catheter insertion and manipulation varied from 1 to 60 days with a mean of 11 days. The primary causes of catheter malfunction were kinking in 1 case, omental wrapping with adhesions in 9 cases, and catheter displacements in the remaining 14 cases. Thirty-day catheter function was achieved in 50% (12/24) of initial catheter manipulations, with guide wire under fluoroscopic control (46%, 5/11) and laparoscopic surgery (54%, 7/13). Overall success rate of repeated manipulation was 71% (17 of 24). The successful outcome in repairing of the malfunctioning CAPD catheters could be increased by the combination of fluoroscopy-guided wire manipulation and laparoscopic surgery. Copyright 2002 S. Karger AG, Basel
Systems and Methods of Coordination Control for Robot Manipulation
NASA Technical Reports Server (NTRS)
Chang, Chu-Yin (Inventor); English, James (Inventor); Tardella, Neil (Inventor); Bacon, James (Inventor)
2013-01-01
Disclosed herein are systems and methods for controlling robotic apparatus having several movable elements or segments coupled by joints. At least one of the movable elements can include one or more mobile bases, while the others can form one or more manipulators. One of the movable elements can be treated as an end effector for which a certain motion is desired. The end effector may include a tool, for example, or represent a robotic hand (or a point thereon), or one or more of the one or more mobile bases. In accordance with the systems and methods disclosed herein, movement of the manipulator and the mobile base can be controlled and coordinated to effect a desired motion for the end effector. In many cases, the motion can include simultaneously moving the manipulator and the mobile base.
Schrum, P.B.; Cohen, G.H.
1993-04-20
Self-contained, waterproof, water-submersible, remote-controlled apparatus is described for manipulating a device, such as an ultrasonic transducer for measuring crack propagation on an underwater specimen undergoing shock testing. The subject manipulator includes metal bellows for transmittal of angular motions without the use of rotating shaft seals or O-rings. Inside the manipulator, a first stepper motor controls angular movement. In the preferred embodiment, the bellows permit the first stepper motor to move an ultrasonic transducer [plus minus]45 degrees in a first plane and a second bellows permit a second stepper motor to move the transducer [plus minus]10 degrees in a second plane orthogonal to the first. In addition, an XY motor-driven table provides XY motion.
Hydraulic manipulator research at ORNL
DOE Office of Scientific and Technical Information (OSTI.GOV)
Kress, R.L.; Jansen, J.F.; Love, L.J.
1997-03-01
Recently, task requirements have dictated that manipulator payload capacity increase to accommodate greater payloads, greater manipulator length, and larger environmental interaction forces. General tasks such as waste storage tank cleanup and facility dismantlement and decommissioning require manipulator life capacities in the range of hundreds of pounds rather than tens of pounds. To meet the increased payload capacities demanded by present-day tasks, manipulator designers have turned once again to hydraulics as a means of actuation. In order to successfully design, build, and deploy a new hydraulic manipulator (or subsystem), sophisticated modeling, analysis, and control experiments are usually needed. Oak Ridge Nationalmore » Laboratory (ORNL) has a history of projects that incorporate hydraulics technology, including mobile robots, teleoperated manipulators, and full-scale construction equipment. In addition, to support the development and deployment of new hydraulic manipulators, ORNL has outfitted a significant experimental laboratory and has developed the software capability for research into hydraulic manipulators, hydraulic actuators, hydraulic systems, modeling of hydraulic systems, and hydraulic controls. The purpose of this article is to describe the past hydraulic manipulator developments and current hydraulic manipulator research capabilities at ORNL. Included are example experimental results from ORNL`s flexible/prismatic test stand.« less
Pereira, M Graça; Roios, Edite; Pereira, Marta
Low back pain is the leading cause of disability worldwide. There is evidence that depression, anxiety, and external locus of control are negative predictors of functional disability in low back patients. This study focused on the mediator role of suffering and beliefs about pain control in the relationship between psychological morbidity and functional disability in patients receiving physical therapy and chiropractic treatment for chronic low back pain. The sample included 213 patients receiving chiropractic treatment and 125 receiving physical therapy, who answered the following instruments: Beliefs about Pain Control Questionnaire; Inventory of Subjective Experiences of Suffering in Illness; Oswestry Low Back Pain Disability Questionnaire; and the Hospital Anxiety and Depression Scales. Suffering was a mediator in the relationship between depression and functional disability in both treatment groups. Only beliefs related to external chance events mediated the relationship between depression and functional disability in the physical therapy group, but not in the chiropratic teratment group. Intervention should focus on suffering regardless of the type of treatment and target beliefs about pain control, in patients receiving physical therapy treatment since they seem to play a key role in functional disability in patients with low back pain. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.
Non-manipulation quantitative designs.
Rumrill, Phillip D
2004-01-01
The article describes non-manipulation quantitative designs of two types, correlational and causal comparative studies. Both of these designs are characterized by the absence of random assignment of research participants to conditions or groups and non-manipulation of the independent variable. Without random selection or manipulation of the independent variable, no attempt is made to draw causal inferences regarding relationships between independent and dependent variables. Nonetheless, non-manipulation studies play an important role in rehabilitation research, as described in this article. Examples from the contemporary rehabilitation literature are included. Copyright 2004 IOS Press
Xing, Liyang; Qu, Liuxin; Chen, Hong; Gao, Song
2017-06-01
To evaluate the clinical effect of Traditional Chinese Spinal Orthopedic Manipulation (TCSOM) in treating Functional Abdominal Pain Syndrome (FAPS) in comparison with Pinaverium Bromide (Dicetel, PBD), and to assess a possible cause for FAPS. 60 cases of FAPS patients were randomly assigned to the TCSOM group and PBD group according to the random number table method. The TCSOM group was treated with thumb pressing manipulation, every other day in the first week, and once every three days in the second week, for 5 times treatments. Patients in the PBD group were instructed to take 50mg 3 times a day, consistently for 2 weeks. The symptoms of pre-treatment and post-treatment were assessed on a visual analog scale (VAS) pain score. A symptom improvement rating (SIR) was implemented in order to evaluate the effects of the treatments, and to statistically compare the two groups. The symptoms of 21 patients of the TCSOM group were resolved soon after the first spinal manipulation treatment and 4 cases were significantly improved. The VAS pain scores in the TCSOM group were significantly lower than those in the PBD group after 2 weeks treatment. According to the SIR based on VAS, the TCSOM research group included 20 cases with excellent results, 8 cases with good, and 2 cases with poor. There were no side effects in the TCSOM group after treatment. Based on VAS, the PBD research group reported 6 cases with excellent results, 8 cases with good and 16 cases with poor. All cases were statistically analyzed, revealing a significant difference (P<0.001) between the two groups. TCSOM group performed much better than PBD group for relief of the symptoms of FAPS. Thumb pressing manipulation on the thoracic and/or lumbar region can correct the displacement of inter-vertebral discs and/or vertebra, resolving the stimuli caused by pressure exerting on the nerves and vessels around the spine. with thumb pressing manipulation on the Back-Shu acupoints, the Jiaji (EX-B2) and the
Manipulating Topological Edge Spins in One-Dimensional Optical Lattice
NASA Astrophysics Data System (ADS)
Liu, Xiong-Jun; Liu, Zheng-Xin; Cheng, Meng
2013-03-01
We propose to observe and manipulate topological edge spins in 1D optical lattice based on currently available experimental platforms. Coupling the atomic spin states to a laser-induced periodic Zeeman field, the lattice system can be driven into a symmetry protected topological (SPT) phase, which belongs to the chiral unitary (AIII) class protected by particle number conservation and chiral symmetries. In free-fermion case the SPT phase is classified by a Z invariant which reduces to Z4 with interactions. The zero edge modes of the SPT phase are spin-polarized, with left and right edge spins polarized to opposite directions and forming a topological spin-qubit (TSQ). We demonstrate a novel scheme to manipulate the zero modes and realize single spin control in optical lattice. The manipulation of TSQs has potential applications to quantum computation. We acknowledge the support from JQI-NSF-PFC, Microsoft-Q, and DARPA- QuEST.
Hando, Ben R; Rhon, Daniel I; Boyles, Robert E; Whitman, Julie M; English, Jenny L
2017-12-01
Case series study. Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA. Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury. Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulder-related health care. Surgical evaluation revealed no evidence of iatrogenic injury. Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study. Therapy, Level 4.
NASA Astrophysics Data System (ADS)
Chembuly, V. V. M. J. Satish; Voruganti, Hari Kumar
2018-04-01
Hyper redundant manipulators have a large number of degrees of freedom (DOF) than the required to perform a given task. Additional DOF of manipulators provide the flexibility to work in highly cluttered environment and in constrained workspaces. Inverse kinematics (IK) of hyper-redundant manipulators is complicated due to large number of DOF and these manipulators have multiple IK solutions. The redundancy gives a choice of selecting best solution out of multiple solutions based on certain criteria such as obstacle avoidance, singularity avoidance, joint limit avoidance and joint torque minimization. This paper focuses on IK solution and redundancy resolution of hyper-redundant manipulator using classical optimization approach. Joint positions are computed by optimizing various criteria for a serial hyper redundant manipulators while traversing different paths in the workspace. Several cases are addressed using this scheme to obtain the inverse kinematic solution while optimizing the criteria like obstacle avoidance, joint limit avoidance.
NASA Technical Reports Server (NTRS)
Cetinkunt, Sabri; Book, Wayne J.
1990-01-01
The performance limitations of manipulators under joint variable-feedback control are studied as a function of the mechanical flexibility inherent in the manipulator structure. A finite-dimensional time-domain dynamic model of a two-link two-joint planar manipulator is used in the study. Emphasis is placed on determining the limitations of control algorithms that use only joint variable-feedback information in calculations of control decisions, since most motion control systems in practice are of this kind. Both fine and gross motion cases are studied. Results for fine motion agree well with previously reported results in the literature and are also helpful in explaining the performance limitations in fast gross motions.
Tao, Xiao-Yan; Zhao, Bai-Yiao; Han, Xiao; Dong, Xiao-Yu; Yan, An; Ren, Xu-Ru; Liu, Yan-Wen; Qu, Chang; Xia, Shu-Fen; Yang, Jia-Le
2014-05-01
To compare the differences in the efficacy on distant version of naked eye in the patients of juvenile myopia between rotating manipulation and lifting-thrusting manipulation of acupuncture. One hundred and twenty cases (240 eyes) were randomized into a rotating manipulation group and a lifting-thrusting manipulation group, 60 cases (120 eyes) in each group. Additionally, a corrective lenses group, 60 cases (120 eyes), was set up as the control. In both manipulation groups, Cuanzhu (BL 2),Yuyao (EX-HN 4), Sizhukong (TE 23), Taiyang (EX-HN 5), Fengchi (GB 20), Zusanli (ST 36), Guangming (GB 37) and Sanyinjiao (SP 6) were punctured, but stimulated with rotating manipulation and lifting-thrusting manipulation respectively three times per week, 10 times as a treatment session and totally one session was required. In the corrective lenses group, the glasses were applied at daytime. The clinical efficacy and the changes in distant vision of naked eye before and after treatment were compared among the three groups. The total effective rate was 87.5% (105/120) in the rotating manipulation group, which was better than 69.2% (83/120) in the lifting-thrusting manipulation group (P < 0.05). The distant vision of naked eye was improved apparently in the rotating manipulation group and the lifting-thrusting manipulation group after treatment (both P < 0.05). But it was not improved in the corrective lenses group (P > 0.05). The distant vision of naked eye was improved more apparently after treatment in the rotating manipulation group as compared with that in the lifting-thrusting manipulation group (0.75 +/- 0.23 vs 0.68 +/- 0.24, P < 0.05). For 96 cases (192 eyes) with acupuncture treatment, in 3-month follow-up, 87.0% (167/192) of the cases maintained the stable vision as the original level and 13.0% (25/192) of them were reduced in the vision In the acupuncture groups, it was found that the improvement of distant vision of naked eye was more obvious after treatment with
Detecting the manipulation of digital clinical records in dental practice.
Díaz-Flores-García, V; Labajo-González, E; Santiago-Sáez, A; Perea-Pérez, B
2017-11-01
Radiography provides many advantages in the diagnosis and management of dental conditions. However, dental X-ray images may be subject to manipulation with malicious intent using easily accessible computer software. In this study, we sought to evaluate a dentist's ability to identify a manipulated dental X-ray images, when compared with the original, using a variant of the methodology described by Visser and Kruger. Sixty-six dentists were invited to participate and evaluate 20 intraoral dental X-ray images, 10 originals and 10 modified, manipulated using Adobe Photoshop to simulate fillings, root canal treatments, etc. Participating dentists were correct in identifying the manipulated image in 56% of cases, 6% higher than by chance and 10% more than in the study by Visser and Kruger. Malicious changes to dental X-ray images may go unnoticed even by experienced dentists. Professionals must be aware of the legal consequences of such changes. A system of detection/validation should be created for radiographic images. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Understanding pharmaceutical research manipulation in the context of accounting manipulation.
Brown, Abigail
2013-01-01
The problem of the manipulation of data that arises when there is both opportunity and incentive to mislead is better accepted and studied - though by no means solved - in financial accounting than in medicine. This article analyzes pharmaceutical company manipulation of medical research as part of a broader problem of corporate manipulation of data in the creation of accounting profits. The article explores how our understanding of accounting fraud and misinformation helps us understand the risk of similar information manipulation in the medical sciences. This understanding provides a framework for considering how best to improve the quality of medical research and analysis in light of the current system of medical information production. I offer three possible responses: (1) use of the Dodd-Frank whistleblower provisions to encourage reporting of medical research fraud; (2) a two-step academic journal review process for clinical trials; and (3) publicly subsidized trial-failure insurance. These would improve the release of negative information about drugs, thereby increasing the reliability of positive information. © 2013 American Society of Law, Medicine & Ethics, Inc.
An evolutionary resolution of manipulation conflict.
González-Forero, Mauricio
2014-07-01
Individuals can manipulate the behavior of social partners. However, manipulation may conflict with the fitness interests of the manipulated individuals. Manipulated individuals can then be favored to resist manipulation, possibly reducing or eliminating the manipulated behavior in the long run. I use a mathematical model to show that conflicts where manipulation and resistance coevolve can disappear as a result of the coevolutionary process. I find that while manipulated individuals are selected to resist, they can simultaneously be favored to express the manipulated behavior at higher efficiency (i.e., providing increasing fitness effects to recipients of the manipulated behavior). Efficiency can increase to a point at which selection for resistance disappears. This process yields an efficient social behavior that is induced by social partners, and over which the inducing and induced individuals are no longer in conflict. A necessary factor is costly inefficiency. I develop the model to address the evolution of advanced eusociality via maternal manipulation (AEMM). The model predicts AEMM to be particularly likely in taxa with ancestrally imperfect resistance to maternal manipulation. Costly inefficiency occurs if the cost of delayed dispersal is larger than the benefit of exploiting the maternal patch. I discuss broader implications of the process. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.
Torque-Limiting Manipulation Device
NASA Technical Reports Server (NTRS)
Moetteli, John B. (Inventor)
1999-01-01
A device for manipulating a workpiece in space includes a fixture, a stanchion assembly, a manipulation mechanism, an actuation mechanism, and a reaction mechanism. The fixture has an end onto which the workpiece affixes. The stanchion assembly has an upper and a lower end. The manipulation mechanism connects the fixture and the upper end of the stanchion assembly. The lower end of the stanchion assembly mounts, via probe and a socket, to a structure. The actuation mechanism operably connects to the manipulation mechanism, and moves the fixture in space. The reaction mechanism provides a point through which force inputs into the actuation mechanism may react.
A global approach for using kinematic redundancy to minimize base reactions of manipulators
NASA Technical Reports Server (NTRS)
Chung, C. L.; Desa, S.
1989-01-01
An important consideration in the use of manipulators in microgravity environments is the minimization of the base reactions, i.e. the magnitude of the force and the moment exerted by the manipulator on its base as it performs its tasks. One approach which was proposed and implemented is to use the redundant degree of freedom in a kinematically redundant manipulator to plan manipulator trajectories to minimize base reactions. A global approach was developed for minimizing the magnitude of the base reactions for kinematically redundant manipulators which integrates the Partitioned Jacobian method of redundancy resolution, a 4-3-4 joint-trajectory representation and the minimization of a cost function which is the time-integral of the magnitude of the base reactions. The global approach was also compared with a local approach developed earlier for the case of point-to-point motion of a three degree-of-freedom planar manipulator with one redundant degree-of-freedom. The results show that the global approach is more effective in reducing and smoothing the base force while the local approach is superior in reducing the base moment.
Tales from the crypt: a parasitoid manipulates the behaviour of its parasite host
Liu, Sean M.; Forbes, Andrew A.; Egan, Scott P.
2017-01-01
There are many examples of apparent manipulation of host phenotype by parasites, yet few examples of hypermanipulation—where a phenotype-manipulating parasite is itself manipulated by a parasite. Moreover, few studies confirm manipulation is occurring by quantifying whether the host's changed phenotype increases parasite fitness. Here we describe a novel case of hypermanipulation, in which the crypt gall wasp Bassettia pallida (a phenotypic manipulator of its tree host) is manipulated by the parasitoid crypt-keeper wasp Euderus set, and show that the host's changed behaviour increases parasitoid fitness. Bassettia pallida parasitizes sand live oaks and induces the formation of a ‘crypt’ within developing stems. When parasitized by E. set, B. pallida adults excavate an emergence hole in the crypt wall, plug the hole with their head and die. We show experimentally that this phenomenon benefits E. set, as E. set that need to excavate an emergence hole themselves are about three times more likely to die trapped in the crypt. In addition, we discuss museum and field data to explore the distribution of the crypt-keeping phenomena. PMID:28123089
Evidence of photo manipulation in a delusional parasitosis paper.
Shelomi, Matan
2013-06-01
In 2004, an article in the Journal of the New York Entomological Society claimed that individuals with delusory parasitosis actually suffer from collembola infestations. The article has been critiqued for poor methodology and results that contradict all knowledge about collembolans. Less easily accounted for has been a figure in the article purporting to show a collembolan in a skin scraping. The image appears to have been altered using photo manipulation software to an unacceptable degree, and this paper demonstrates that to be the case. The altered figure represents creation of nonexistent data, a form of scientific misconduct. Whether the deception is deliberate or a product of an otherwise well-meaning author ignorant of the limits of acceptable image manipulation is unknown, but the result is peer-reviewed support for a conclusion that complicates patient treatment. In the current era of computers, even regional entomology journals must have detailed standards for what kind of images and image manipulations are acceptable for publication.
Host manipulation by cancer cells: Expectations, facts, and therapeutic implications.
Tissot, Tazzio; Arnal, Audrey; Jacqueline, Camille; Poulin, Robert; Lefèvre, Thierry; Mery, Frédéric; Renaud, François; Roche, Benjamin; Massol, François; Salzet, Michel; Ewald, Paul; Tasiemski, Aurélie; Ujvari, Beata; Thomas, Frédéric
2016-03-01
Similar to parasites, cancer cells depend on their hosts for sustenance, proliferation and reproduction, exploiting the hosts for energy and resources, and thereby impairing their health and fitness. Because of this lifestyle similarity, it is predicted that cancer cells could, like numerous parasitic organisms, evolve the capacity to manipulate the phenotype of their hosts to increase their own fitness. We claim that the extent of this phenomenon and its therapeutic implications are, however, underappreciated. Here, we review and discuss what can be regarded as cases of host manipulation in the context of cancer development and progression. We elaborate on how acknowledging the applicability of these principles can offer novel therapeutic and preventive strategies. The manipulation of host phenotype by cancer cells is one more reason to adopt a Darwinian approach in cancer research. © 2016 WILEY Periodicals, Inc.
Manipulation, salience, and nudges.
Noggle, Robert
2018-03-01
Cass Sunstein and Richard Thaler recommend helping people make better decisions by employing 'nudges', which they define as noncoercive methods of influencing choice for the better. Not surprisingly, healthcare practitioners and public policy professionals have become interested in whether nudges might be a promising method of improving health-related behaviors without resorting to heavy-handed methods such as coercion, deception, or government regulation. Many nudges seem unobjectionable as they merely improve the quality and quantity available for the decision-maker. However, other nudges influence decision-making in ways that do not involve providing more and better information. Nudges of this sort raise concerns about manipulation. This paper will focus on noninformational nudges that operate by changing the salience of various options. It will survey two approaches to understanding manipulation, one which sees manipulation as a kind of pressure, and one that sees it as a kind of trickery. On the pressure view, salience nudges do not appear to be manipulative. However, on the trickery view (which the author favors), salience nudges will be manipulative if they increase the salience so that it is disproportionate to that fact's true relevance and importance for the decision at hand. By contrast, salience nudges will not be manipulative if they merely highlight some fact that is true and important for the decision at hand. The paper concludes by providing examples of both manipulative and nonmanipulative salience nudges. © 2017 John Wiley & Sons Ltd.
Uneventful upper cervical manipulation in the presence of a damaged vertebral artery.
Michaud, Thomas C
2002-09-01
To discuss a case in which a patient with a previously injured vertebral artery underwent manipulation in the upper cervical spine without alteration of her symptom pattern. The literature concerning the relative safety of specific upper cervical manipulative techniques is reviewed. A 42-year-old woman had a 3-week history of unilateral suboccipital pain that she related to a sudden twisting of her head and neck that occurred while she was putting sheets of drywall on top of her car. Subsequent examination by a neurologist 2 weeks later was unremarkable, and a tension-type headache was diagnosed. Approximately 10 days later (3 weeks after injury), a single high-velocity upper-cervical manipulation (incorporating slight rotation and full lateral flexion) was performed with no change in her symptom pattern. Two weeks after that, the patient had development of a lateral medullary syndrome (also known as Wallenberg syndrome) after she briefly extended and rotated her upper cervical spine while painting a ceiling. The patient was treated with anticoagulant therapy, and the lateral medullary infarct healed without incident. The spinocerebellar and subtle motor symptoms also resolved, but the ipsilateral suboccipital headache and the loss of temperature sensation associated with the spinothalamic tract lesion were still present 9 months later. This case report demonstrates that vigorous manipulation of the upper cervical spine is possible without injuring an already damaged vertebral artery. It is suggested that the line of drive used during the single manipulation, almost pure lateral flexion with slight rotation, was responsible for the apparent innocuous response. Guidelines for the evaluation and management of vertebral artery dissection are reviewed. Because it is currently impossible to identify patients at risk of having a dissected vertebral artery with standard in-office examination procedures, rotational manipulation of the upper cervical spine should be
Visualizing Motion Patterns in Acupuncture Manipulation.
Lee, Ye-Seul; Jung, Won-Mo; Lee, In-Seon; Lee, Hyangsook; Park, Hi-Joon; Chae, Younbyoung
2016-07-16
Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture manipulation techniques skillfully. The Acupuncture Manipulation Education System (AMES) is an open source software system designed to enhance acupuncture manipulation skills using visual feedback. Using a phantom acupoint and motion sensor, our method for acupuncture manipulation training provides visual feedback regarding the actual movement of the student's acupuncture manipulation in addition to the optimal or intended movement, regardless of whether the manipulation skill is lifting, thrusting, or rotating. Our results show that students could enhance their manipulation skills by training using this method. This video shows the process of manufacturing phantom acupoints and discusses several issues that may require the attention of individuals interested in creating phantom acupoints or operating this system.
Cell manipulation in microfluidics.
Yun, Hoyoung; Kim, Kisoo; Lee, Won Gu
2013-06-01
Recent advances in the lab-on-a-chip field in association with nano/microfluidics have been made for new applications and functionalities to the fields of molecular biology, genetic analysis and proteomics, enabling the expansion of the cell biology field. Specifically, microfluidics has provided promising tools for enhancing cell biological research, since it has the ability to precisely control the cellular environment, to easily mimic heterogeneous cellular environment by multiplexing, and to analyze sub-cellular information by high-contents screening assays at the single-cell level. Various cell manipulation techniques in microfluidics have been developed in accordance with specific objectives and applications. In this review, we examine the latest achievements of cell manipulation techniques in microfluidics by categorizing externally applied forces for manipulation: (i) optical, (ii) magnetic, (iii) electrical, (iv) mechanical and (v) other manipulations. We furthermore focus on history where the manipulation techniques originate and also discuss future perspectives with key examples where available.
Update: Biochemistry of Genetic Manipulation.
ERIC Educational Resources Information Center
Barker, G. R.
1983-01-01
Various topics on the biochemistry of genetic manipulation are discussed. These include genetic transformation and DNA; genetic expression; DNA replication, repair, and mutation; technology of genetic manipulation; and applications of genetic manipulation. Other techniques employed are also considered. (JN)
Treatment of atlantoaxial rotatory fixation with botulinum toxin muscle block and manipulation.
Lin, Chia-Hung; Chen, Chun-Jung; Chen, Chuan-Mu; Liao, Su-Lan; Raung, Shue-Ling; Tsai, Sen-Wei
2010-04-01
Slippage after reduction of atlantoaxial rotatory fixation (AARF) is usually treated with repeated cervical traction and brace immobilization. To date, no data have been published on the management of muscle spasm during treatment. Here, we describe the case of a 7-year-old girl with AARF for 1 month who visited our hospital for treatment. During physical examination, spasm of the sternocleidomastoid muscle was noted. The patient was treated with manipulative reduction, and slippage after reduction was managed with botulinum spasticity block of the sternocleidomastoid and splenius capitis muscles, and repeated manipulation. Cervical orthosis immobilization with a rehabilitation program of isometric contract-relax exercise for the neck was conducted for 3 months. The subject had full recovery from AARF at 1-year follow-up. This report demonstrates that, in selected cases of slippage after reduction from AARF, conservative management with manipulation under anesthesia is a good method, and the muscle components may play a crucial role in AARF. Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.
Macdermid, Joy C.; Santaguida, P. Lina; Thabane, Lehana; Giulekas, Kevin; Larocque, Leo; Millard, James; Williams, Caitlin; Miller, Jack; Chesworth, Bert M.
2013-01-01
ABSTRACT Purpose: This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation. Methods: A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed. Results: The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; β, 95% CI=1.37, 0.89–1.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine. Conclusion: The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events. PMID:24403681
Contextually Aided Recovery (CARe): a scientific theory for innate healing.
Newell, Dave; Lothe, Lise R; Raven, Timothy J L
2017-01-01
The chiropractic profession emerged when scientific explanations for causes of health and disease were still in infancy and the co-existence of notions such as innate healing and vitalism were perhaps admissible within such a historical context. Notwithstanding, within the scientific culture of the 21 st Century all healthcare paradigms require evidential support which in regard these early concepts are in large part, absent. Nevertheless, a large body of emerging scientific evidence supports the existence of innate healing phenomena that may explain a plethora of clinical outcomes observed during chiropractic care. However, in contrast to the notion that removing the putative subluxation constitutes the mechanism by which this healing is initiated, the evidentially supported explanation is one that invokes the impact of contextual factors inherent in the skilful care and authority of the healthcare provider. This perspective is presented here as the scientific model of Contextually Aided Recovery (CARe). This paper contends that;Contextual effects are powerful and desirable and are triggered by contextual factors present in all therapeutic encounters including those encountered in chiropractic practice.These factors can elicit large clinical effects with substantive evidence supporting pain, immune and motor modulation.The compartmentalisation of specific and non-specific effects is a biologically and scientifically false dichotomy, erroneously invoked to de-legitimise treatment approaches that expertly construct contextual healing scenarios.The use of factors to construct contextual healing scenarios that maximise positive (placebo) and minimize negative (nocebo) effects is a skilful clinical art within the multimodal approach that describes modern chiropractic care and should be presented and defended as a legitimate component of orthodox healthcare Clinical improvement during chiropractic care, beyond any biologically specific treatment effects of manipulation
MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER
CELIK, HALUK; SECKIN, MUSTAFA FAIK; AKCAL, MEHMET AKIF; KARA, ADNAN; KILINC, BEKIR ERAY; AKMAN, SENOL
2017-01-01
ABSTRACT Objective: Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. Methods: A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Results: Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients’ values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Conclusion: Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series. PMID:29375258
MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER.
Celik, Haluk; Seckin, Mustafa Faik; Akcal, Mehmet Akif; Kara, Adnan; Kilinc, Bekir Eray; Akman, Senol
2017-01-01
Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients' values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series.
Adaptive control of robotic manipulators
NASA Technical Reports Server (NTRS)
Seraji, H.
1987-01-01
The author presents a novel approach to adaptive control of manipulators to achieve trajectory tracking by the joint angles. The central concept in this approach is the utilization of the manipulator inverse as a feedforward controller. The desired trajectory is applied as an input to the feedforward controller which behaves as the inverse of the manipulator at any operating point; the controller output is used as the driving torque for the manipulator. The controller gains are then updated by an adaptation algorithm derived from MRAC (model reference adaptive control) theory to cope with variations in the manipulator inverse due to changes of the operating point. An adaptive feedback controller and an auxiliary signal are also used to enhance closed-loop stability and to achieve faster adaptation. The proposed control scheme is computationally fast and does not require a priori knowledge of the complex dynamic model or the parameter values of the manipulator or the payload.