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PubMed2005

Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study.

STUDY DESIGN: Observational study conducted within a randomized clinical trial. OBJECTIVES: The objective of this study is to estimate the effects of patient satisfaction on subsequent changes in pain and disability among low back pain patients randomized to chiropractic or medical care in a managed-care practice setting. SUMMARY OF BACKGROUND DATA: Recent studies of low back pain treatments have shown chiropractic patients to be more satisfied with their care than medical patients. However, little is known about the relation between patient satisfaction and clinical outcomes. METHODS: A total of 681 low back pain patients presenting to three southern California healthcare clinics and screened for serious spinal pathology and contraindications were randomized to medical care with and without physical therapy, and chiropractic care with and without physical modalities, and followed for 18 months. Satisfaction with back care was measured on a 40-point scale and observed at 4 weeks following randomization. The primary outcome variables, observed between 6 weeks and 18 months of follow-up, are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire, and remission from clinically meaningful pain and disability. Perceived change in low back symptoms was a secondary outcome. RESULTS: Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction = 1.61, 95% confidence interval [CI] = 0.99, 2.68), but not at 6, 12, or 18 months (6 months: adjusted OR = 1.05, 95% CI = 0.73, 1.52; 12 months: adjusted OR = 0.94, 95% CI = 0.67, 1.32; 18 months: adjusted OR = 1.07; 95% CI = 0.76, 1.50). Perception of improvement was greater among highly satisfied than less satisfied patients throughout the 18-month follow-up period. The estimated effects of satisfaction on clinical outcomes were similar for medical and chiropractic patients. CONCLUSIONS: Patient satisfaction may confer small short-term clinical benefits for low back pain patients. Long-term perceived improvement may reflect, in part, perceived past improvement as measured by satisfaction.

Adult↗
PubMed1983

The physician visit patterns of chiropractic users: health-seeking behavior of the elderly in Manitoba, Canada.

To assess the effect of chiropractic use on overall health care utilization patterns, the volume and pattern of ambulatory physician visits by elderly persons having contact with chiropractors are compared with those having contact with physicians only. This analysis is based on data representative of the Canadian Province of Manitoba's entire elderly population; they are drawn from interviews and from claims filed routinely as part of Manitoba's universally insured health care services. The results show that chiropractic services do not substitute for physician services among the elderly in a province which fully insures medical services and a limited number of chiropractic visits. The data suggest that, under these conditions, some elderly chiropractic users consume more physician services than other elderly of equal health status, in addition to visiting chiropractors.

Aged↗
PubMed1991

A community-based study of the use of chiropractic services.

BACKGROUND: Little population-based information is available on the use of chiropractic services. METHODS: We analyzed data from the RAND Health Insurance Experiment (HIE), a community-based study of the use of health services. Insurance claim forms for all fee-for-service patients who completed the study were examined for all visits coded as being seen by a chiropractor. Services provided and patient-specified symptoms were taken from these forms. Population-based use rates were calculated for each HIE site. Use rates and services were calculated separately for first visits and repeat visits. RESULTS: There were 5,279 persons who contributed 19,021 person-years of exposure during the study; 395 different persons used 7,873 chiropractic services for a visit rate of 41 per 100 person-years and rate of use of 7.5 percent. Forty-two percent of all visits were for pain in the back. Spinal manipulation accounted for 61 percent of all services provided. Compared to non-users, users tended to be White, middle-aged, married, and high school educated. Seven-fold geographic variations in the use of chiropractic services were seen. CONCLUSIONS: Chiropractors deliver a substantial amount of health care to the US population, and there are significant geographic variations in the rate and intensity of use of chiropractic services.

Adolescent↗
PubMed1998

Use of chiropractic services from 1985 through 1991 in the United States and Canada.

OBJECTIVES: The purpose of this paper is to describe the demographic and clinical characteristics of chiropractic patients and to document chiropractic visit rates in 6 sites in the United States and Canada. METHODS: Random samples of chiropractors from 5 US sites and 1 Canadian site were selected. A record abstraction system was developed to obtain demographic and clinical data from office charts. RESULTS: Of the 185 eligible chiropractors sampled, 131 (71%) participated. Sixty-eight percent of the selected charts showed that care was sought for low back pain, while 32% recorded care for other reasons. Spinal manipulative therapy was recorded in 83% of all charts. There was a greater than 2-fold difference in the median number of visits related to low back pain per episode of care across sites. The chiropractic visit rates in the US sites and Ontario are estimated to be 101.2 and 140.9 visits per 100 person-years, respectively. CONCLUSIONS: The chiropractic use rate in these sites is twice that of estimates made 15 years ago. The great majority of patients receive care for musculoskeletal conditions of the back and neck. The number of visits per episode varies appreciably by site.

Adult↗
PubMed2000

Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II.

OBJECTIVE: Health promotion and prevention services provided by the chiropractic profession historically have been referred to as maintenance care (MC). The primary objective of this investigation was to obtain information regarding multiple health issues of patients age 65 years and over who have had a long-term regimen of chiropractic health promotion and preventive care. The study also sought to explore the nature of the interventions and methods that were most commonly used by chiropractors when administering MC and to determine whether there were differences between patients who have had long-term exposure to these preventive services versus those who have not. DESIGN: This descriptive study was accomplished by selecting chiropractic patients (age 65 years and over) who had received health-promotion and prevention services for at least 5 years, with a minimum of 4 visits per year. To enhance the probability of securing a more representative patient sample, selection was made through the participation of chiropractors from 6 diverse geographic locations across the United States. Doctors were asked to enroll the first 10 consenting patients who met the inclusion criteria. A battery of diverse assessment instruments were completed by each patient to provide a patient health profile. Information related to each patient included answers to the SF-36D survey, patient health habits, expenditures of health services, frequency of use of health providers, and perceived value of chiropractic prevention and health promotion services. RESULTS: A total of 73 chiropractors participated in this investigation from the 6 study sites. In addition to an average 1.9 manual procedures used per patient, it was common to recommend stretching exercises (68.2%), aerobic exercises (55.6%), dietary advice (45.3%), and a host of other prevention strategies, including vitamins and relaxation. The patients investigated in this study reported making only half the annual number of visits to medical providers (4.76 visits per year) compared with the national average (9 visits per year) for individuals age 65 years and over. CONCLUSIONS: On the basis of the response of participating chiropractors, this study describes the therapeutic components of MC for the elderly patient. For these patients, MC does not simply consist solely of periodic visits for joint manipulation, but it involves an eclectic host of interventions (e.g., exercise, nutrition, relaxation, physical therapy, and manipulation) that are directed at both musculoskeletal and visceral conditions.

Adult↗
PubMed2001

Rating specific chiropractic technique procedures for common low back conditions.

OBJECTIVE: To rate specific chiropractic technique procedures used in the treatment of common low back conditions. DESIGN AND METHODS: A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process. RESULTS: For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain. CONCLUSIONS: The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.

Acute Disease↗
PubMed1993

Birth of the "chiropractic angel": a Caduceus counterpoint.

Use of the winged angel with raised hands as a chiropractic emblem began circa 1928. Although often attributed to the National Chiropractic Association (NCA), the emblem was created prior to the NCA's formation, and was initially "copyrighted ... for the exclusive use of members of the American Society of Chiropractors." The emblem appeared as part of the ASC's advertising in popular national magazines, including American Legion Monthly, Cosmopolitan, Liberty, and Physical Culture. First use of the chiropractic angel to represent the NCA and its ally, the Internatonal Chiropractic Congress (ICC), took place at the NCA and ICC joint national convention in Denver in 1933. The emblem was formally adopted by the NCA at its 1934 convention in Pittsburgh. This paper reviews some of the early history of the emblem and its use by the ASC and the NCA.

Chiropractic↗
PubMed1994

Chiropractic goes to Washington: with Dr. Emmett J. Murphy, 1938-1964.

Articulate, urbane, naturally companionable, and always prepared, Dr. Emmett J. Murphy was perfectly suited to the office he created as chiropractic's first full-time national lobbyist. As labor relations director of the National Chiropractic Association from 1938 to 1964, he worked diligently to increase awareness of chiropractic among legislators, the federal bureaucracy, veterans organizations, labor and other groups equally concerned about the affairs of government. Many of his accomplishments, especially for chiropractic students, were pioneering efforts.

Chiropractic↗
PubMed1995

Kansas coconuts: legalizing chiropractic in the first state, 1910-1915.

When the Kansas Supreme Court averred that, under existing law, chiropractic was the practice of medicine, the matter was settled. The beleaguered chiropractic profession of that state had two choices: it could risk continued harassment by the medical establishment or seek legislation. In a small frontier town in western Kansas, a benchmark trial would clearly demonstrate the public's feeling about chiropractic's right to exist on its own merits, separate and distinct from medicine. That coveted goal seemed to have been achieved by passage of the Chiropractic Act of 1913, the world's first such law. However, a board of examiners could not be legally seated. It would be a combination of brilliant legal strategy on the part of the chiropractors and the medical board's own negligence that would end the dilemma, allowing licensure in Kansas by 1915.

Chiropractic↗
PubMed1995

Buckeye chiropractic: turbulence in a limited branch of medicine, 1915-1975.

In Ohio in 1915, the Platt-Ellis Law was enacted, a compromise between medical and chiropractic forces that defined chiropractic as a "limited branch of medicine or surgery." Practitioners of chiropractic, naprapathy, spondylotherapy, mechanotherapy, magnetic healing, and other "minor" healing arts excluding osteopathy and midwifery were all examined by the State Medical Board. The two disparate definitions created six decades of turmoil for chiropractic in Ohio. The 1920's were marked by the civil disobedience employed successfully in other states, with hundreds of unlicensed chiropractors choosing jail over fines. Multiple state organizations were formed, representing "straights, mixers, straight-mixers, mixing straights, minglers" and every other possible combination. The public accepted licensed and unlicensed practitioners, and doctors included their licensing status in their advertisements.

Chiropractic↗
PubMed1996

The sixteen major events in chiropractic history.

A centennial is the time for chiropractic to take stock, review its past, and plan for the future. "Major events" are those that define what chiropractic has become, turning points or obstacles overcome, without which chiropractic would not be what it is today. I identify what I consider the sixteen most important events in the chiropractic history, note relevant names and dates, place each event in its historical context, and discuss its significance. I discuss the events chronologically rather than in order of their importance.

Chiropractic↗
PubMed1996

The role of the encyclopedic Howard System in the professionalization of chiropractic National College, 1906-1981.

D.D. Palmer, chiropractic's discoverer and nomenclator, lost his Palmer School to his son, B.J., in 1906. That same year, a Palmer graduate, John Fitz Alan Howard, founded the National School of Chiropractic in the Ryan Building in Davenport. In 1908, he moved National to Chicago to secure the clinical, laboratory, dissection, hospital, facilities, licensure and other advantages in Illinois. Within two years, Howard's commonsensical, science-based lectures encompassed virtually every major characteristic of the chiropractic profession as it stands today. Dr. Howard called it the "Howard System" of Chiropractic. National's presidents (Dr.s. Schulze and Janse) led faculty who continued to raise educational standards. Gradually, other surviving colleges embraced most of NCC's first seventy-five years of philosophic, scientific and artistic educational innovations, and thus the profession emerged.

Chiropractic↗
PubMed2002

Attitudes toward vaccination: a survey of Canadian chiropractic students.

BACKGROUND: Although the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiropractic students. METHODS: An 11-item questionnaire about attitudes toward vaccination was distributed to students enrolled at CMCC during the 1999/2000 academic year. The responses for the 11 items were then summed to arrive at a total score ranging from 0 (most negative attitude toward vaccination) to 22 (most positive attitude toward vaccination). Respondents' perceptions of sources of vaccine information were also investigated. RESULTS: Over 75% of the students (467 of 621) completed the questionnaire. Most students (53.3%) reported that in general they agreed with vaccination. This was especially true among first-year students (60.7%). However, among fourth year students, only 39.5% agreed with vaccination. The proportion of respondents who stated that they were against vaccination in general was 5 (4.5%) of 112 first-year students, 10 (8.3%) of 121 second-year students, 16 (13.9%) of 115 third-year students and 35 (29.4%) of 119 fourth-year students. The mean scores on the questionnaire were progressively lower with each higher year of study at the College. The mean survey scores for each year of study were first year, 15.9 (95% confidence interval [CI] 15.2-16.6); second year, 16.1 (95% CI 15.3-1 7.0); third year, 14.5 (95% CI 13.5-15.4); and fourth year, 12.8 (95% CI 11.7-13.9). The mean scores varied among year of study and were statistically significant using one-way ANOVA (p < 0.0001). Among students who relied primarily on informal sources of vaccine information, such as the chiropractic literature and informal talks at CMCC, anti-vaccination attitudes were more prevalent in later years. INTERPRETATION: Most CMCC students reported pro-vaccination attitudes, but there appeared to be an increase in anti-vaccination attitudes as students progressed through the CMCC program. This pattern was seen almost exclusively among students who relied primarily on informal sources of vaccine information rather than on core CMCC lectures or prior lectures at university.

Analysis of Variance↗
PubMed1992

Line drawing analyses of static cervical X ray used in chiropractic.

OBJECTIVE: This review article identifies the chiropractic techniques used to assess the structure of the cervical spine as seen on the static cervical radiograph. DATA SOURCES: On-line search of MEDLINE, key words, radiograph and X ray in combination with cervical spine (vertebrae); the Chiropractic Research Archives Collection (CRAC); indexes published in the Journal of Chiropractic Research; conference proceedings from Annual Biomechanics Conference of the Spine, FCER sponsored conferences and Annual Upper Cervical Spine Conference; references identified from bibliographies of pertinent articles; a telephone poll of radiography/technique instructors at chiropractic colleges. STUDY SELECTION: Techniques that quantitatively assess relative alignment of skeletal structures or distortion of the spinal column. DATA EXTRACTION: Techniques were grouped according to the structures analyzed and the views used. DATA SYNTHESIS: Variables and artifacts that limit the reliability or validity of static cervical X ray line drawing analysis were identified and the techniques assessed for their reported reliability and validity. CONCLUSIONS: Reliability studies exist showing that inter- and intraexaminer reliability are sufficient to measure lateral and rotational displacements of C1 to within +/- 1 degree. This amount of error allows objective analysis of upper cervical X rays to detect changes in the angular positional relationships of radiographic images on the order of those already seen clinically. Methods of cervical analysis that use relative angular measures of skeletal positioning are best able to control the effects of radiographic distortion. The accuracy of the analysis methods has not been ascertained to establish the extent to which angular measurement of vertebral relationships actually reflect three-dimensional movement. It is not known how much of the changes that are seen in pre/post-radiograph sets are due to positioning changes of the patient between radiographic procedure, and how much are due to actual changes of skeletal relationships brought about by adjustment.

Cervical Vertebrae↗
PubMed2003

Chiropractic manipulation for non-spinal pain--a systematic review.

AIMS: Chiropractic manipulation is mostly used for spinal problems but, in an increasing number of cases, also for non-spinal conditions. This systematic review is aimed at critically evaluating the evidence for or against the effectiveness of this approach. METHODS: Five electronic databases were searched for all randomised clinical trials of chiropractic manipulation as a treatment of non-spinal pain. They were evaluated according to standardised criteria. RESULTS: Eight such studies were identified. They related to the following conditions: fibromyalgia, carpal tunnel syndrome, infantile colic, otitis media, dysmenorrhoea and chronic pelvic pain. Their methodological quality ranged from mostly poor to excellent. Their findings do not demonstrate that chiropractic manipulation is an effective therapy for any of these conditions. CONCLUSIONS: Only very few randomised clinical trials of chiropractic manipulation as a treatment of non-spinal conditions exist. The claim that this approach is effective for such conditions is not based on data from rigorous clinical trials.

Humans↗
PubMed2000

Roots of the NCMIC: Loran M. Rogers and the National Chiropractic Association, 1930-1946.

Today's National Chiropractic Mutual Insurance Company (NCMIC) evolved from the legal protective services offered initially by the Universal Chiropractors' Association, and subsequently, by the National Chiropractic Association (NCA). At first these services focused on the criminal defence of chiropractors charged with unlicensed practice. However, as an increasing number of jurisdictions enacted chiropractic statutes, the NCA's legal program became ever more involved in civil litigation: suits for malpractice and negligence. Steering the NCA throughout its tumultuous voyage was its longtime secretary-treasurer, Loran M. Rogers, D.C. When the NCA spun off its legal services division in 1946, forming the National Chiropractic Insurance Company (predecessor of the NCMIC), Rogers continued his work as executive secretary-treasurer of the malpractice insurer.

Chiropractic↗
PubMedDate not supplied

Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol.

OBJECTIVE: To describe the chiropractic management of a 30-year-old woman with temporomandibular joint (TMJ) pain and to discuss the general etiology and management of TMJ conditions. CLINICAL FEATURES: The patient suffered from daily unremitting jaw pain for 7 years, which was the apparent sequela of a series of 8 root canals on the same tooth. Pain radiated from her TMJ into her shoulder and was accompanied by headache, tinnitus, decreased hearing, and a feeling of congestion in her right ear. Symptoms were not reduced by medication or other dental treatments. OUTCOME AND INTERVENTION: The patient underwent a series of chiropractic treatments using the instrument and protocol of Activator Methods, International. During the first 5 months, her VAS rating of jaw pain decreased from 60 (on a scale of 0 to 100) to 9, her ability to eat solid foods increased, headache intensity and frequency diminished, and her maximum mouth opening without pain measurement increased from 22 to 28 mm. Overall, 20 months of chiropractic treatment along with 2 concurrent months of massage therapy yielded slow but continual progress that finally resulted in total resolution of all symptoms except some fullness of the right cheek. CONCLUSION: Use of the Activator Methods protocol of chiropractic treatment was beneficial for this patient and merits further study in similar cases.

Adult↗
PubMed1992

The evolution and importance of spinal and chiropractic research.

From its discovery in 1895 to its current status, in which the World Federation of Chiropractic Meeting may be considered a prestigious international scientific conference, the evaluation of chiropractic can be viewed as a compression of the phases which medical and scientific evolution have followed over a much longer period. Chiropractic theory started primarily as a vitalistic philosophy justifying its treatment while the medical scientific community was rejecting vitalism. Both chiropractic and medical spine specialists went through a period of speculative theory in the first half of this century based upon either perceived neurological or pathological observations. There was a period of single-theory preoccupation by chiropractors (the subluxation) and medical specialists (disc herniation) which brought these professions into conflict. The past decade has led to greater scientific exploration by both professions, with more national scientific discussion of the causes and treatment of spinal problems. The next decade, however, appears likely to require greater emphasis on social research into clinical effectiveness of treatments, prevention of back pain, patient satisfaction and quality assurance. This evolution should be considered the normal maturation of a health care profession.

Chiropractic↗