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Biomedical subjects

J C Keating

Publications and source records attributed to J C Keating.

At least 73 records · Page 4Linked to original sources
PubMed1986

A multivariate time-series descriptive case study of chiropractic care in the treatment of cervical pain.

This paper presents a multivariate quantitative description of the temporal course of 13 clinical variables measured before, during and after a multimodal chiropractic treatment package. Clinical measures included total and peak daily cervical pain, unleveling of the pelvis, shoulders and cranium; bilateral grip strength; and cervical ranges of motion. Intervention techniques included heel wedges; cervical, abdominal, and foot exercises; and spinal adjustments (cervical spine and ilium). Data are presented in tabular and graphic formats, and limitations in validity and reliability are reviewed. Interpretive limitations included confounding by multiple and sequential interventions and by lack of experimental control comparisons. However, the study suggests the plausible influence of biomechanical and adjustive care upon mediators and clinical outcomes. Strengths inherent in multivariate time-series research are noted.

Adult↗
PubMed1985

Urobehavioral intervention in the rehabilitation of lower urinary tract dysfunction: a case report.

A case study illustrates the usefulness of behavioral analysis and paradoxical strategy in the treatment of life-long urgency incontinence in a cerebral palsy patient. Volitional increase in diurnal enuresis appeared to result in rapid (within 5 days) acquisition of continence. From pretreatment to 13 month follow-up interview, the weekly wetting frequency decreased from an average of 25 to 0.5 episodes. Symptom rehearsal is believed to have interrupted the typical pathobehavioral sequence between the urge to void and micturition.

Adult↗
PubMed1985

Toward an experimental chiropractic: time-series designs.

If chiropractic is to develop as a clinical science, it must develop an experimental data-base. Despite numerous continuing obstacles, a growing segment of the profession is advocating chiropractic clinical trials. However, the large-scale control-group clinical-experimental designs which have most frequently been recommended are usually beyond the economic means of chiropractic institutions. Moreover, such designs are impractical in many ways for the chiropractic field-doctor who wishes to integrate the roles of scientist and practitioner. Time-series experimental (and case study) designs offer practical and economical alternatives for the DC, whether inter, solo-practitioner, or academic researcher. Several types of time-series designs are described, published examples from related health-care literature are noted, and the role of time-series research in furthering the goals of chiropractic research are reviewed. Ethical considerations in clinical research are briefly noted.

Chiropractic↗
PubMed1983

Dry bed training without a urine alarm: lack of effect of setting and therapist contact with child.

Three variations in the mode of delivery of Dry Bed Training as a treatment for nocturnal enuresis were investigated. Twenty-three children, ranging in age from 4 to 14, received dry bed training without the additional use of a urine alarm. Treatment variations included: (a) in-home training of parents and child, (b) office based training of parents and child, and (c) office based training of parents only. An additional 7 children served as a waiting list control during the first 8 weeks of the study. A wide variety of outcome measures showed improvement for the entire sample regardless of specific mode of delivery. Implications for the treatment of enuresis using dry bed training and a number of critical methodological issues are discussed.

Adolescent↗
PubMedDate not supplied

Interexaminer reliability of activator methods' relative leg-length evaluation in the prone extended position.

OBJECTIVE: To investigate the interexaminer reliability of the prone extended relative leg-length check as described by Activator Methods, Inc. SUBJECTS: Thirty-four subjects were selected from a pool of 52 consecutive patients visiting a private chiropractic office. METHODS: Exclusion criteria included congenital or acquired conditions known to affect lower extremity length and inability to lie prone for a 10-minute period. Two experienced chiropractors who specialize in Activator Methods and are "advanced-proficiency rated" by Activator Methods, Inc. assessed each patient in random order for leg length inequality. Findings were recorded as left short leg, equal leg length, or right short leg. RESULTS: The data for 34 subjects were organized in a 3 x 3 contingency table. Total agreement was 85%. A simple, unweighted kappa value yielded kappa = 0.66. A disproportionately greater number of right short leg findings than left short leg findings were observed by both examiners. In only 2 instances were equal leg lengths observed, and both were detected by the same examiner. Because examiners found only 2 of 34 subjects with equal leg lengths, several secondary analyses involving data reductions were conducted. The resulting kappa values were similar to the 3 x 3 analysis. CONCLUSION: There was good reproducibility between 2 examiners by using the Activator Method to detect leg length inequality in the prone extended position. This study does not address the validity or clinical significance of the measurement method. Future studies should include larger numbers, a wider variety of subjects, and a diversity of examiners.

Adult↗
PubMedDate not supplied

Effectiveness of chiropractic management for patellofemoral pain syndrome's symptomatic control phase: a single subject experiment.

Chiropractic management of patellofemoral pain syndrome has not been well documented. A time-series experimental design was employed to assess the effectiveness of chiropractic care during the symptomatic control phase in a patient with bilateral knee pain. Treatment consisted of long axis tibiofemoral adjustment, passive patellofemoral mobilization, and continuous ultrasound. Mediating variables, derived from physical examination findings, were subject to periodic randomized observation sampling by a second observer who was blinded to the first observer, but unblinded to the experimental phases. Strong interexaminer reliability (K = 0.78, p less than .005) was observed for patellar tracking jitter. Poor agreement (K = 0.31, NS) was observed for the patellar grinding test graded on an oridinal scale, but moderate interexaminer agreement (K = 0.52; p less than .01) was obtained with the test on a nominal scale. Clinical outcome measures of pain, patellar tracking, and patellar grinding tests were observed to visually covary throughout the experiment. A reliable 3-4 wk lag was observed between treatment phases and demonstrable changes in the patient's signs and symptoms.

Adult↗
PubMedDate not supplied

"Research" and "science" in the first half of the chiropractic century.

In the first 50 years of the chiropractic profession, a variety of unorthodox meanings for the terms "research," "science" and related words were in evidence. In harmony with popular conceptions of the day, science was constructed as a relatively static body of knowledge and was thought to reflect the will of God. Research was an ill-defined activity, and acquisition of new knowledge did not involve the experimental methodology that increasingly took hold in biology and medicine in the twentieth century. Chiropractors often viewed science and research as marketing strategies. Clinical data collection, when it occurred at all, was not described in sufficient detail to permit replication. Results were enthusiastically interpreted as indisputable proof of investigators' a priori assumptions about the effectiveness of chiropractic methods. A few in the profession recognized the general lack of understanding of the scientific method and sought reform from within. However, the colleges were unwilling to introduce coursework in research methods. At the end of World War II, the broad-scope national association of chiropractors in the United States established a nonprofit foundation for the purpose of raising funds for chiropractic research and education. Research plans were poorly conceived and grandiose: the first major initiative of the Chiropractic Research Foundation involved a nationwide publicity and fund-raising campaign modeled after the March of Dimes. When these efforts failed and the possibility of establishing free-standing research centers collapsed, the Foundation sought to shift responsibility for research to the schools. The poverty-stricken chiropractic colleges lacked the research sophistication for this task. Several more decades would pass before a sustained research effort and interest in clinical experimentation would become evident in chiropractic.

Chiropractic↗
PubMedDate not supplied

Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality: Part II.

OBJECTIVE: The objectives of this study were to assess the interexaminer agreement of palpation for soft tissue and osseous pain along with visual observations in the lumbar spine. Second, the interexaminer agreement of dermothermograph and surface electromyographic (EMG) scans of the lumbar spine were assessed. Third, to perform these evaluations on symptomatic low back patients. Finally, the most reliable measurements were combined in a multidimensional index of segmental lumbar abnormality, which was assessed for interexaminer agreement. DESIGN: This is an interexaminer reliability study of commonly used palpatory and instrumentation procedures used to assess lumbar segmental abnormality. SETTING: This study was conducted at Pain Assessment and Rehabilitation Center (PARC) and the Center for Clinical Studies (CCS) at Northwestern College of Chiropractic. PATIENTS: The patients involved in this study were symptomatic at the time of examination. The patients were recruited from the CCS clinic and PARC. RESULTS: Palpation for osseous pain produced kappa coefficients ranging from .48-.90. Palpation for soft tissue pain produced kappa coefficients that ranged from .40-.79 and the kappas for visual observation ranged from .34-.84. The dermothermograph and surface EMG scanner were also assessed with the kappa coefficient for their reliability in assessing lumbar segmental abnormality. The kappa coefficients ranged from -.13 to .59 for the surface EMG and 0- .63 for the dermothermograph measurements. Intraclass correlation coefficients for the surface EMG measurements ranged from .20-.55 and the dermothermograph measurements ranged from .01-.55. Palpation for pain (osseous and soft tissue) and visual observation were included in the multidimensional index of abnormality. The interexaminer agreement of detecting a manipulable lesion was evaluated by designating a lesion present with a positive two out of three tests. Kappa coefficients for the multidimensional index of lumbar abnormality ranged from a low of .05 to a high of .52. CONCLUSIONS: Palpation for pain (osseous and soft tissue) and visual observation produced good to excellent interexaminer agreement and were included in the multidimensional index of abnormality. The interexaminer agreement of surface EMG scans and dermothermograph measurements were poor and considered to be clinically unacceptable, thus were not included in the multidimensional index. Palpation for pain is the only spinal assessment procedure to show consistent reliability in a number of studies.

Adolescent↗