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PubMed2002

Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study.

OBJECTIVE: To determine the feasibility of conducting a randomized clinical trial in the private practice setting examining short- and long-term effects of chiropractic adjustments for subjects with essential hypertension compared with a brief soft tissue massage, as well as a nontreatment control group. DESIGN: Randomized controlled-comparison trial with 3 parallel groups. SETTING: Private practice outpatient chiropractic clinic. PATIENTS: Twenty-three subjects, aged 24 to 50 years with systolic or diastolic essential hypertension. INTERVENTIONS: Two months of full-spine chiropractic care (ie, Gonstead) consisting primarily of specific-contact, short-lever-arm adjustments delivered at motion segments exhibiting signs of subluxation. The massage group had a brief effleurage procedure delivered at localized regions of the spine believed to be exhibiting signs of subluxation. The nontreatment control group rested alone for a period of approximately 5 minutes in an adjustment room. MAIN OUTCOME MEASURES: Cost per enrolled subject, as well as systolic and diastolic blood pressure (BP) measured with a random-0 sphygmomanometer and patient reported health status (SF-36). Pilot study outcome measures also included an assessment of cooperation of subjects to randomization procedures and drop-out rates, recruitment effectiveness, analysis of temporal stability of BPs at the beginning of care, and the effects of inclusion/exclusion criteria on the subject pool. RESULTS: Thirty subjects enrolled, yielding a cost of $161 per enrolled subject. One subject was later determined to be ineligible, and 6 others dropped out. In both the chiropractic and massage therapy groups, all subjects were classified as either overweight or obese; in the control group there were only 2 classified as such. SF-36 profiles for the groups were similar to that of a normal population. The mean change in diastolic BP was -4 (95% confidence interval [CI]: -8.6, 0.5) in the chiropractic care group, 0.5 (95% CI: -3.5, 4.5) in the brief massage treatment group, and -4.9 (95% CI: -9.7, -0.1) in the no treatment control group. At the end of the study period, this change was -6.3 (95% CI: 13.1, 0.4), -1.0 (95% CI: -7.5, 15.6), -7.2 (95% CI: -13.3, -1.1) in the 3 study groups. The mean improvements in the chiropractic care and no treatment control groups remained consistent over the follow-up period. CONCLUSIONS: This pilot study elucidated several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments in patients with essential hypertension. A multidisciplinary approach to recruitment may need to be used in any future efforts because of the limited subject pool of patients who have hypertensive disease but are not taking medications for its control. Measures need to be used to assure comparable groups regarding prognostic variables such as weight. Studies such as these demonstrate the feasibility of conducting a full-scale 3-group randomized clinical trial in the private practice setting.

Adult↗
PubMed1995

A patient-centered paradigm: a model for chiropractic education and research.

Within the chiropractic profession there is concern over both the appropriate paradigm for educating the student and the appropriate research model for investigating health care and promotion. The purpose of this study was to identify, interpret, and describe a paradigm for chiropractic education and research. Chiropractic first principles and existing health care paradigms were identified and integrated with the characteristics of chiropractic practice described in sociological studies of the chiropractic profession. A patient-centered paradigm emerged, incorporating the principles of vitalism, holism, humanism, conservatism, naturalism, and rationalism. Characteristics of a patient-centered paradigm that were identified were then subjected to an eight-member consensus panel with representatives drawn from chiropractic education, research, and sociology. The characteristics of a patient-centered paradigm agreed upon include self-healing, recognition of the patient as a unified whole, respect for the patient's values, beliefs, and dignity, involvement of the patient as a partner in health promotion, and a natural and conservative approach to evidence based care. Patient-centered research must reach beyond the randomized controlled trial, involving designs where clinicians apply their own patient-centered therapy in a "real world" assessment. A pluralism of methods, including both qualitative and quantitative studies, needs to be designed and implemented. Patient-centered research is a process that is pragmatic, realistic, and grounded in the day-to-day experiences of both patients and chiropractors. A patient-centered paradigm offers a useful model to critically study what benefits patients and to prepare chiropractic students to practice in the patient's interest.

Chiropractic↗
PubMed2004

Chiropractic care: is it substitution care or add-on care in corporate medical plans?

An analysis of claims data from a managed care health plan was performed to evaluate whether patients use chiropractic care as a substitution for medical care or in addition to medical care. Rates of neuromusculoskeletal complaints in 9e diagnostic categories were compared between groups with and without chiropractic coverage. For the 4-year study period, there were 3,129,752 insured member years in the groups with chiropractic coverage and 5,197,686 insured member years in the groups without chiropractic coverage. Expressed in terms of unique patients with neuromusculoskeletal complaints, the cohort with chiropractic coverage experienced a rate of 162.0 complaints per 1000 member years compared with 171.3 complaints in the cohort without chiropractic coverage. These results indicate that patients use chiropractic care as a direct substitution for medical care.

Adult↗
PubMed1999

Factors affecting use of chiropractic services in seven midwestern states of the United State.

Although chiropractic is used by approximately 10 percent of the U.S. population, predictors of its use have not been definitively described. Previous studies have suggested that chiropractic users differ from nonusers in a number of sociodemographic characteristics, but their findings are inconsistent, perhaps because of differences in populations sampled and dates of data collection, most of which are prior to 1990. Regional studies have been conducted in rural areas based on the premise that rural residents are more likely than non-rural residents to use chiropractice; however, this premise has not been definitively documented. The purpose of this study was to provide clarification of these sociodemographic predictors of chiropractic use in Illinois, Iowa, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin by characterizing chiropractic users and nonusers in terms of sociodemographics, including rural or non-rural residence, and presence of low back pain. Data from 1,511 respondents to a 1994 population-based survey, conducted by the University of Iowa Social Science Institute, were analyzed. Unconditional logistic regression was used to derive odds ratios and 95 percent confidence intervals for univariate and multiple regression models. Overall, 15.1 percent of respondents had used chiropractic within the last year, most often for low back pain (57 percent). Chiropractic use was less likely in African Americans, Hispanics and Asians than whites, less likely by non-rural than rural residents, and less likely in Catholics than Protestants in states other than Iowa and South Dakota. Overall, 42.7 percent of workers with low back pain reported using chiropractic, and use increased with age but remained significantly related to race, rural or non-rural residence, state of residence and religious preference. Race, rural or non-rural residence, state of residence and religious preference, independently of low back pain, affect use of chiropractice in seven Midwestern states.

Adult↗
PubMed1995

Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up.

OBJECTIVE: To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain. DESIGN: Randomised allocation of patients to chiropractic or hospital outpatient management. SETTING: Chiropractic clinics and hospital outpatient departments within reasonable travelling distance of each other in 11 centres. SUBJECTS: 741 men and women aged 18-64 years with low back pain in whom manipulation was not contraindicated. OUTCOME MEASURES: Change in total Oswestry questionnaire score and in score for pain and patient satisfaction with allocated treatment. RESULTS: According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear. Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment. Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management. CONCLUSIONS: At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.

Adult↗
PubMedDate not supplied

Epilepsy and seizure disorders: a review of literature relative to chiropractic care of children.

OBJECTIVE: To review the currently available literature regarding chiropractic care relative to patients with epilepsy, particular emphasis being placed on those who have epilepsy as children. DATA SOURCES: The Index to Chiropractic Literature was searched for the years 1980 through 1998 through use of the keywords epilepsy and seizure. The MANTIS database was searched for the years 1970 through 2000 through use of the Medical Subject Heading (MeSH) keywords chiropractic, epilepsy, seizure, and child/children. In addition, a MEDLINE search of the literature was performed for the years 1966 through 2000 through use of the same subject headings. RESULTS: The present study reviews 17 reports of pediatric epileptic patients receiving chiropractic care. Fourteen of the 17 patients were receiving anticonvulsive medications, which had proven unsuccessful in the management of the condition. Upper cervical care to correct vertebral subluxation was administered to 15 patients, and all reported positive outcomes as a result of chiropractic care. CONCLUSIONS: Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.

Child↗
PubMed2001

Pain, disability, and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians.

BACKGROUND: Few studies exist on the prognostic value of demographic, clinical, or psychosocial factors on long-term outcomes for patients with chronic low back pain. OBJECTIVE: This study reports on long-term pain and disability outcomes for patients with chronic low back pain, evaluates predictors of long-term outcomes, and assesses the influence of doctor type on clinical outcome. METHODS: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in data collection for a prospective, longitudinal, practice-based, observational study of ambulatory low back pain of mechanical origin. The primary outcomes, measured at 6 months and 12 months, were pain (by using the Visual Analog Scale), and functional disability (by using the Revised Oswestry Disability Questionnaire). Satisfaction was a secondary outcome. RESULTS: Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P <.002). A greater proportion of chiropractic patients were satisfied with all aspects of their care (P =.0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study. CONCLUSION: Chiropractic care compared favorably to medical care with respect to long-term pain and disability outcomes. Further study is required to explore the advantage seen for chiropractic care in patients with leg pain below the knee and in the area of patient satisfaction. Identification of patient and treatment characteristics associated with better or worse outcomes may foster changes in physicians' practice activities that better serve these patients' needs.

Adult↗
PubMed1990

Addressing the issue of cataloging and making chiropractic literature accessible: Part I: Defining the problem.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A review of the literature shows there is a trend toward database management for cataloging and accessibility of other, nonchiropractic, literature. Most notable of these is an endeavor by National Technical Information Service, commonly referred to as MEDLARS (Medline). It is interesting to note that a computer-assisted library database program does not exist on any chiropractic campus. This is in contrast with the trend on campuses of other health care fields. Manual search strategies within the chiropractic literature are time consuming, subject to a high failure rate, and even if the search produces citations, there is no assurance the journal can be accessed unless a chiropractic campus is nearby. Furthermore, difficulties exist when a chiropractic literature search is attempted in any computerized database, e.g., MEDLARS (Medline). Journals/articles that are unique to chiropractic (national, international or on the state level) are not specifically included in these computerized databases. Aside from these difficulties, there exists the problem of finding those articles that contain valid and relevant information from among those that are less valid or informative.

Cataloging↗
PubMed1984

Educational preparation for chiropractic clinical research.

Chiropractic is severely criticized by organized medicine for its lack of scientific proof and publications. The official stance is that the onus for demonstrating the scientific validity of chiropractic rests with the chiropractic profession rather than the health care system. It is therefore desirable that chiropractic practitioners gain a practical comprehension of research methodology during their undergraduate course. This paper theorizes on how the teaching of research methodology may be implemented so as to facilitate clinical chiropractic research. By linking research and diagnosis in the form of case studies it is suggested that a significant contribution to chiropractic clinical research publications can be made by field practitioners. Changes in the undergraduate chiropractic program and at the Phillip Institute of Technology are examined in the light of the above proposal.

Chiropractic↗
PubMed1995

Preliminary findings of analysis of chiropractic utilization and cost in the workers' compensation system of New South Wales, Australia.

OBJECTIVE: To review the literature and test a new methodology of assessing chiropractic utilization and cost-effectiveness on workers' compensation claimants. DESIGN: A retrospective analysis of data from the WorkCover Authority (WCA) of New South Wales, Australia. MAIN OUTCOME MEASURES: Average chiropractic treatment cost per case, average medical treatment cost per case, comparisons with total compensation payments, assessments of related indirect costs (e.g., pathology tests). RESULTS: From the total number of employment injuries (n = 51,077) in NSW for 1991-92, 1,289 cases met selection criteria. Approximately 30% of the total injuries were described as back problems. The total utilization rate for chiropractic intervention in spinal injuries for workers' compensation claimants was 12%. Payments for physiotherapy and chiropractic treatment totalled over $25.2 million and represented 2.4% of total payments for all cases. Average chiropractic treatment cost for a sample of 20 randomly selected cases was $299.65; average medical treatment cost per case was $647.20. Further analysis of the 20 selected cases seemed to show an average cost per claim that was significantly different from WCA database figures. CONCLUSION: The methodology used was found to be able to provide a basis for comparison of costs for care apportioned to chiropractic and other interventions. An analysis of 20 randomly selected cases from the WCA suggested that chiropractic intervention for certain conditions may be more cost-effective than other forms of intervention.

Chiropractic↗
PubMed1996

The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling.

OBJECTIVE: To determine the effectiveness of chiropractic treatment for patients with low back pain by means of a systematic review of the literature. DATA SOURCES: Randomized clinical trials (RCTs) on chiropractic were identified with a Medline and Embase search (1966-1995), by citation tracking, and by hand searching of the relevant chiropractic reference systems (CRAC and Index to Chiropractic Literature). STUDY SELECTION: All RCTs on low back pain that involved chiropractors as therapists. DATA EXTRACTION: Methodological quality was assessed independently by two reviewers on 14 items covering internal validity, informativeness and study size. Data were extracted on: patients (initial referral, duration of complaints, radiation of pain); outcomes (four different types); and timing of follow-up (short-term, intermediate and long-term). Statistical pooling was intended, according to a preset analysis plan, to include subgroup analysis. DATA SYNTHESIS: Eight RCTs were identified. All RCTs had serious flaws in their design, execution and reporting. Because of the great variety of outcome measures and follow-up timing, there was insufficient data to enable statistical pooling of the RCTs. A narrative review, however, did not provide convincing evidence for the effectiveness of chiropractic for acute or chronic low back pain. CONCLUSIONS: There is certainly a need for correctly executed trials. In future research on the effectiveness of chiropractic, guidelines for uniform execution and reporting of RCTs should first be established to enable subsequent statistical pooling in systematic reviews of chiropractic trials.

Chiropractic↗
PubMedDate not supplied

Three-dimensional spinal coupling mechanics: Part II. Implications for chiropractic theories and practice.

OBJECTIVE: To compare the current knowledge of 3-D spinal mechanics and abnormal equilibrium states with chiropractic motion theories, chiropractic vertebral letter listing theories, and chiropractic technique theories. DATA COLLECTION: A manual search of available reference texts and a computer search of literature from Index Medicus were collected with an emphasis on 3-D studies of human spinal movements, segmental instability, Euler buckling of the spine, and chiropractic theories concerning vertebral movements. RESULTS: Previous spinal coupling results based upon two-dimensional radiographic studies are inadequate and inaccurate. Therefore, the validity of any chiropractic technique procedure, listing, motion analysis or adjusting style based on the two-dimensional radiograph and coupling studies must be questioned. We have identified four types of spinal subluxations (displacements) in the biomechanical literature: (a) posture main motion and associated segmental coupling, (b) Euler buckling viewed in the anteroposterior view, (c) snap through viewed in the lateral view and (d) segmental instability. CONCLUSIONS: Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Previous chiropractic letter listings (e.g., PRI, PLS, etc.) of spinal displacements are inadequate and invalid. Only one of the four types of biomechanical displacements, segmental instability, is consistent with the traditional chiropractic theory of segmental spinal displacements; in general, this does not respond well to care. In general, vertebrae displacement must be viewed in the context of equilibrium configurations and one vertebra can not be displaced as an individual misalignment. Validity questions arise for any technique methods that use letter listings of displacement taken from motion palpation or two-dimensional radiographic analysis.

Biomechanical Phenomena↗
PubMed1998

A cervical manikin procedure for chiropractic skills development.

OBJECTIVE: To determine whether chiropractic students can effectively acquire adjustive skills for the cervical spine by utilizing a Thrust in Motion Cervical (TMC) manikin and to evaluate its value as a teaching aid. A pilot study was formulated and incorporated into the skills tutorial program at Macquarie University. Centre for Chiropractic in Sydney, Australia. DESIGN AND SETTING: A prospective study was performed on chiropractic students with no prior experience in performing spinal adjustments. SUBJECTS: Twenty subjects were selected randomly from a population of 75 students about to commence their 4th-yr Master's of Chiropractic program. INTERVENTION: Students who formed the experimental group (n = 6) did not perform any thrusting maneuvers on human subjects while practicing Diversified chiropractic cervical spinal techniques. They practiced the adjustive thrust only on the TMC manikin. The control group (n = 14) learned in the established "hands-on" approach, performing thrusting maneuvers on fellow student subjects. Both groups were supervised, taught and examined in an otherwise identical fashion. RESULTS: The data indicate there is no significant difference between the examination scores of the student group that practiced on the TMC manikin (average, 2.17 points) compared with the controls (2.13 points), with a confidence interval at p = .985, assuming that 0.5 marks is clinically important in these examination results. Interexam reliability was acceptable (Pearson's r = .73) for both experimental and control examination performances. CONCLUSION: The null hypothesis is accepted, and no significant difference in student examination performance was found between those who learned thrusting on the manikin alone and those who learned on fellow students. Further, for the first time, a manikin has been shown to be effective in teaching chiropractic skills. The implications of the TMC manikin procedure will revolutionize the acquisition of motor learning skills that are essential for chiropractic skills training.

Cervical Vertebrae↗
PubMedDate not supplied

Chiropractic radiologists: a survey of demographics, abilities, educational attitudes and practice trends.

OBJECTIVE: To assess the education, abilities, practices and opinions of chiropractic radiologists. DESIGN: Eight-page survey with two mailings. PARTICIPANTS: One hundred seventy-five diplomates of the American Chiropractic Board of Radiology listed with the American Chiropractic College of Radiology office. RESULTS: Of the surveys mailed, 111 of the 175 were returned from the individuals listed with the American Chiropractic College of Radiology office. After excluding the deceased and those with a self-reported retired status, the response rate was calculated as 66%. Of those who responded, 81% were male; the mean age was 46.4 +/- 11.2 yr (mean +/- standard deviation). Most respondents were residents of California, followed by Canada and Illinois. Thirty-six percent taught at chiropractic colleges. They felt most confident in interpreting plain film studies of the musculoskeletal system. Many have undergone advanced training in specialized imaging. They felt topics related to patient positioning, plain film physics, arthritides, trauma, avascular necrosis and tumors are most important to a chiropractic curriculum. Most respondents felt the use of plain film radiology was most appropriate when the clinical presentation of the patient suggests the strong possibility of underlying disease. CONCLUSIONS: Radiology is an important topic to the education of students and the practice of chiropractic. The results of this survey will assist future decision-making regarding student education and clinical use of radiology.

Adult↗
PubMed2006

An educational campaign to increase chiropractic intern advising roles on patient smoking cessation.

BACKGROUND: Tobacco use, particularly smoking, is the most preventable cause of death in the United States. More than 400,000 premature deaths are associated with its use and the health care costs are in the billions. All health care provider groups should be concerned with patients who continue to smoke and use tobacco. The US Preventive Services Taskforce and Health People 2010 guidelines encourage providers to counsel smokers on cessation. Current studies, though limited regarding chiropractic advising practices indicate a low engagement rate when it comes to providing cessation information. OBJECTIVE: To test a campaign regarding initial impact aimed at increasing chiropractic interns advising on cessation and delivery of information to smokers on cessation. DISCUSSION: Chiropractic interns do engage patients on smoking status and can be encouraged to provide more cessation messages and information to patients. The initial impact assessment of this campaign increased the provision of information to patients by about 25%. The prevalence of smoking among chiropractic patients, particularly at teaching clinics may be lower than the national averages. CONCLUSION: Chiropractic interns can and should be encouraged to advise smokers about cessation. A systematic method of intake information on smoking status is needed and a standardized education protocol for chiropractic colleges is needed. Chiropractic colleges should assess the adequacy of their advising roles and implement changes to increase cessation messages to their patients as soon as possible.

Journal Article↗
PubMed1998

Chiropractic: origins, controversies, and contributions.

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↗
PubMed1985

Chiropractic and the clinical art.

Chiropractic is the largest 'unorthodox' health profession in the U.S.A. It is licensed in all 50 states and its services are covered by governmental and private health insurance. Yet chiropractic remains, in the opinion of medical commentators, an unscientific healing cult. Chiropractic holds that much illness is caused, directly or indirectly, by derangements in homeostasis that result from subtle vertebral malalignments called 'subluxations'. Only a minority of 'straight' chiropractors continue to provide spinal manipulation as their only modality, while the majority 'mixers' have embraced physical therapy, vitamin supplements and a wide variety of drugless treatments. Clinical trials suggest that spinal manipulation itself has short-term benefit in back pain, but the success of chiropractic is not fully explained by that effect. The clinical art, though, as manifested in the chiropractor-patient interaction contributes greatly to chiropractic healing. This process promotes patient acceptance and validation, fulfills expectations, provides explanations and engages the patient's commitment. The same process lies at the core of the 'art of medicine'. Seeing the clinical art as it functions in chiropractic can help us to understand its independent power in medicine.

Back Pain↗
PubMed2006

The effect of chiropractic adjustments on movement time: a pilot study using Fitts Law.

OBJECTIVE: To investigate the effect of chiropractic adjustments on movement time using Fitts Law. METHODS: This was a prospective, randomized controlled trial. Ten patients from a private chiropractic practice participated. Participants in the treatment group received high-velocity, low-amplitude chiropractic adjustments to areas of joint dysfunction (chiropractic subluxation). A nonintervention group was used to control for improvement resulting from time and practice effects. Movement time was measured as participants moved a cursor onto a target appearing on a computer screen. A range of target widths and target distances were used to vary the index of difficulty. RESULTS: All participants in the experimental group had significantly improved movement times following spinal adjustments compared with only 1 participant in the control group. The average improvement in movement time for the experimental group was 183 ms, a 9.2% improvement, whereas the average improvement in movement time for the control group was 29 ms, a 1.7% improvement. The difference (improvement) scores after the intervention were significantly greater for the chiropractic group compared with the control group as measured by a 2-tailed independent samples t test (P < .05). CONCLUSION: The results of this study demonstrated a significant improvement in movement time with chiropractic care. These results suggest that spinal adjustments may influence motor behavior.

Adult↗