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At least 19 recordsLinked to original sources
PubMedDate not supplied

Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession.

PURPOSE: This project was part of a national, federally sponsored effort to create a prioritized research agenda for the chiropractic profession. An overview (and a separate comprehensive annotated bibliography) of recent social sciences, medical, chiropractic and health services research literature regarding chiropractic is presented. Based on this information, key research questions and issues were identified in the areas of health services research, practice environments and account ability/quality management. Research issues were prioritized by a multidisciplinary panel. METHODS: Qualitative review of literature gathered through searches of electronic health care database retrieval systems and citation tracking. Nominal group-process methodology with an expert panel was used to identify research priorities from a comprehensive list of potential health services research questions. RESULTS: Six recommendations for a health services research agenda for the chiropractic profession were made: determine barriers to usage of chiropractic; develop models to explain chiropractic usage; determine cost-effectiveness of different chiropractic procedures; develop valid measures and predictors of quality of chiropractic care; and examine satisfaction with chiropractic services from patients, other providers, purchasers, etc.

Chiropractic↗
PubMed1991

Osteoarthritis, chiropractic, and nutrition: osteoarthritis considered as a natural part of a three stage subluxation complex: its reversibility: its relevance and treatability by chiropractic and nutritional correlates.

It is proposed that chiropractic and nutritional treatment contribute to the amelioration and perhaps reversal of osteoarthritis (OA). It is further proposed that the chiropractic manipulative thrust, is in effect, treating dysfunctional bio-mechanics of joints, affecting positive cartilaginous change. The pathophysiology and multi-factorial causes of OA are reviewed. New interpretations of the literature surrounding OA are discussed which offer arguments for OA's treatment and reversal through chiropractic manipulation and nutrutional support. Presented is a new model of the chiropractic concept of subluxation (abnormal joint complex resulting in fixation or decrease in normal range of motion) and the chiropractic manipulative thrust. The associated histologic correlates are also discussed. A review of the literature of anti-inflammatory and muscle/joint complex supportive nutrients appropriate for OA is presented. Finally, a complete treatment protocol for OA is summarized.

Animals↗
PubMedDate not supplied

Outcomes research in chiropractic: the state of the art and recommendations for the chiropractic research agenda.

OBJECTIVE: To examine and document the state of the art in outcomes research in chiropractic, including the limitations of available data, and to make recommendations for further progress in this area. METHODOLOGY: An extensive search of the literature from 1990 through 1994 was undertaken using electronic databases (Medline, Index to Chiropractic Literature, EMBASE, and ERIC) and hand searches were conducted for relevant studies published in 1995. Publication in English, publication in a peer-reviewed journal, weight of evidence (study design) and measurement of patient-relevant outcomes were primary inclusion criteria. We prepared a draft with recommendation, rationale, actions required, responsible parties and expected outcomes for each seed statement. An outcomes workgroup, convened at the Research Agenda Work shop, added its perspective to the seed recommendations and actions required. Finally, the white paper authors prepared the final recommendations for outcomes research in chiropractic. RESULTS: This white paper presents six recommendations, emphasizing four general areas in which to develop the outcomes research agenda in chiropractic: research culture, infrastructure, opportunities and topics in outcomes research. CONCLUSION: The long-term goals of the chiropractic research agenda must be to advance the profession and to better meet the health needs of the public. Our final recommendations serve as a foundation for the development of proposals for future strategy with outcomes research a priority.

Case-Control Studies↗
PubMed1984

Attitudes of chiropractic patients: a preliminary survey of patients receiving care in a chiropractic teaching clinic.

A survey of 390 patients receiving care in the teaching clinics of the Northwestern College of Chiropractic (NWCC) was conducted to obtain information about patient satisfaction with their chiropractic care and about their prior or subsequent utilization of other types of health care services. Patients were contacted by telephone after a period of at least one month had passed since discharge or discontinuance of care. Of patients surveyed, 92.1% responded that there was improvement in their condition ranging from "slight" to "complete" while 7.9% stated that there was no improvement in their complaint after receiving care. When asked about receiving treatment for their complaint prior to admittance, 58.0% stated that they had not sought previous care while 42.0% received treatment from another doctor first. These data are discussed and compared to other recently published investigations regarding utilization of chiropractic health care services and patient attitudes concerning chiropractic.

Adolescent↗
PubMedDate not supplied

Chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique.

OBJECTIVE: To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator Methods Chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II). CLINICAL FEATURES: A 29-year-old woman had unremitting coccygeal pain of 3 weeks' duration. The problem began after she had moved heavy boxes while at work. The pain was characterized by a continual dull ache in the coccygeal region, accompanied by intermittent sharp pain, particularly upon sitting or rising from a seated position. She had been taking self-prescribed over-the-counter analgesics (aspirin and ibuprofen) for 3 weeks without obtaining relief. INTERVENTION AND OUTCOME: Treatment consisted of mechanical force, manually assisted, short-lever (MFMA) chiropractic adjusting procedures to the coccygeal area, primarily the sacrococcygeal ligament. The AAI II was used to deliver the adjustment according to diagnostic and treatment protocol specified for AMCT. The patient experienced first treatment. CONCLUSION: Chiropractic coccygeal manipulation may be effectively delivered via instrumental adjustment in certain cases of coccygodynia. The use of an AAI II in administering the coccygeal adjustment has the benefit of being a gentle, noninvasive procedure, as well as being comfortably tolerated by the patient. This method of coccygeal adjustment may bear consideration in certain cases of coccygodynia.

Adult↗
PubMed1996

Chiropractic biophysics technique: a linear algebra approach to posture in chiropractic.

OBJECTIVE: This paper discusses linear algebra as applied to human posture in chiropractic, specifically chiropractic biophysics technique (CBP). MATHEMATICAL ANALYSIS: 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. CONCLUSION: 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.

Biomechanical Phenomena↗
PubMed1990

Nutritional intervention in chiropractic clinical practice: the chiropractic student's perspective.

A survey of chiropractic students reveals that they regard chiropractors as a knowledgeable source of information about nutrition. While the dissonance produced by the use of nutrients in clinical practice may be overcome by denying that this constitutes drug therapy, the controversies of appropriate use need to be addressed. The challenge faced by chiropractic undergraduate nutrition education involves identification of justifiable nutritional interventions, selection of effective doses and an awareness of the potential side effects. By resolving to match or better the medical profession as a source of nutritional health care, the future chiropractor has unwittingly embraced the cost-benefit paradigm of medical drug therapy.

Chiropractic↗
PubMed1992

The efficacy of chiropractic manipulation for back pain: blinded review of relevant randomized clinical trials.

OBJECTIVE: To assess the efficacy of chiropractic for patients with back pain. DATA SOURCES: Randomized clinical trials (RCTs) on spinal manipulation were identified with a Medline search (1966-1990), by citration tracking, and by manual examination of the relevant chiropractic reference systems [Chiropractic Research Archives Collection and Index to Chiropractic Literature]. [Indexing terms, Medline; backache, musculoskeletal diseases, manipulation, osteopathy or chiropractic in combination with evaluation studies, outcome and process assessment, prospective studies, comparative studies, clinical trials or double blind method. Indexing terms, Chiropractic Research Archives Collection: backache therapy-chiropractic clinical trials, cost benefit analysis, evaluation studies--chiropractic, manipulation--spinal, prospective studies, sciatica-therapy. Indexing terms, Index to Chiropractic Literature, backache therapy, clinical trials, cost benefit analysis, intervertebral disc displacement-therapy.] STUDY SELECTION: All RCTs involving chiropractors as therapists. To find additional evidence from nonchiropractic RCTs, chiropractic standards similar to the type of treatment used in nonchiropractic trials were determined by a panel of blinded chiropractors. DATA EXTRACTION: Review by two blinded reviewers independently, using a list of methodological criteria, each of which was attached to a weight. The maximum was set at 100 points. DATA SYNTHESIS: We identified five chiropractic RCTs. No similarity to chiropractic standards could be detected in any of the nonchiropractic RCTs. No chiropractic RCT had a methodological score of more than 50 points. The authors of four of the trials report favorable results for chiropractic, while one refrains from drawing conclusions. The results of the chiropractic RCTs differed on the timing of maximal effect as well as on the subgroups showing the best treatment results. CONCLUSIONS: Although the small number of chiropractic RCTs and the poor general methodological quality precludes the drawing of strong conclusions, chiropractic seems to be an effective treatment of back pain. However, more studies with a better research methodology are clearly still needed.

Back Pain↗
PubMed1995

Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic.

STUDY DESIGN: Controlled comparison of radiographic interpretive performance based on training and experience. OBJECTIVES: This study compared each of these groups in medicine and chiropractic by testing abilities to interpret abnormal plain film radiographs of the lumbosacral spine and pelvis. SUMMARY OF BACKGROUND DATA: Low back pain is a common and costly problem that is evaluated and treated primarily by medical physicians, orthopedists, and chiropractors. Although radiology is used extensively in patients with low back pain, the radiographic interpretations of students, clinicians, radiology residents, and radiologists have never been compared. METHODS: Four hundred ninety-six eligible volunteers from nine target groups completed a test of radiographic interpretation consisting of nineteen cases with clinically important radiographic findings. The nine groups included 22 medical students, 183 chiropractic students, 27 medical radiology residents, 13 chiropractic radiology residents, 66 medical clinicians (including 12 general practice physicians, 25 orthopedic surgeons, 21 orthopedic residents, and 8 rheumatologists), 46 chiropractic clinicians, 48 general medical radiologists, 55 chiropractic radiologists, and 36 skeletal radiologists and fellows. RESULTS: The test established a high level of internal consistency reliability (0.880) and revealed that, in the interpretation of abnormal plain film radiographs of the lumbosacral spine and pelvis, significant differences were found among professional groups (P < 0.0001). Post hoc tests (P < 0.05) revealed that skeletal radiologists achieved significantly higher test results than did all other medical groups; that the test results of general medical radiologists and medical radiology residents was significantly higher than those of medical clinicians; that test results of medical students was significantly poorer than that of all other medical groups; that the performance of chiropractic radiologists and chiropractic radiology residents was significantly higher than that of chiropractic clinicians and chiropractic students; that no significant differences was revealed in the mean values of performance of chiropractic clinicians and chiropractic students; that the test results of chiropractic radiologists, chiropractic radiology residents, and chiropractic students was significantly higher than that of the corresponding medical categories (general medical radiologists, medical radiology residents, and medical students, respectively); that no significant difference in test results was identified between chiropractic radiologists and skeletal radiologists or between chiropractic and medical clinicians; and that the length of time in practice for clinicians and radiologists was not a significant factor in the test results. CONCLUSIONS: These data demonstrate a substantial increase in test results of all radiologists and radiology residents when compared to students and clinicians in both medicine and chiropractic related to the interpretation of abnormal radiographs of the lumbosacral spine and pelvis. Furthermore, the study reinforces the need for radiologic specialists to reduce missed diagnoses, misdiagnoses, and medicolegal complications.

Chiropractic↗
PubMed1996

The effect of cost sharing on the use of chiropractic services.

OBJECTIVES: Chiropractic care is increasing in the United States, and there are few data about the effect of cost sharing on the use of chiropractic services. This study calculates the effect of cost sharing on chiropractic use. METHODS: The authors analyzed data from the RAND Health Insurance Experiment, a randomized controlled trial of the effect of cost sharing on the use of health services. Families in six US sites were randomized to receive fee-for-service care that was free or required one of several levels of cost sharing, or to receive care from a health maintenance organization (HMO). Enrollees were followed for 3 or 5 years. All fee-for-service plans covered chiropractic services. Persons assigned to the HMO experimental group received free fee-for-service chiropractic care; persons in the HMO control group had 95% cost sharing for chiropractic services. The authors calculated the mean annual chiropractic expense per person in each of the fee-for-service plans, and also predicted their chiropractic expenditures using a two-equation model. Chiropractic use among persons receiving HMO and fee-for-service care were compared. RESULTS: Chiropractic care is very sensitive to price, with any level of coinsurance of 25% or greater decreasing chiropractic expenditures by approximately half. Access to free chiropractic care among HMO enrollees increased chiropractic use ninefold, whereas access to free medical care decreased fee-for-service chiropractic care by 80%. CONCLUSIONS: Chiropractic care is more sensitive to price than general medical care, outpatient medical care, or dental care, or and nearly as sensitive as outpatient mental health care. A substantial cross-price effect with medical care may exist.

Adult↗
PubMed1996

Research attitudes among chiropractic college students.

OBJECTIVE: To explore the attitudes of chiropractic students toward research and factors influencing it. DESIGN: This study was conducted through the use of a survey questionnaire. Students were given a questionnaire with no prior knowledge of the survey to ensure that their responses were spontaneous and to increase the possibility that the responses reflected their true feelings. SETTING: This study was conducted at a small southern chiropractic college. PARTICIPANTS: Students were selected from all quarters (1st-13th) to determine the effect of educational level on research attitude. RESULTS: Seventy students (51 men and 19 women, representing 40% of college student population) completed the questionnaire. Of those students, 51.62% indicated they were interested in research in general; 70.96% thought chiropractic research was important; 35.65% were interested in conducting research before coming to chiropractic college; 90.32% had experienced something interesting in chiropractic and wanted to know more about it; 64.52% had at some time thought about a chiropractic research topic; 35.48% had thought about other research topics; 67.75% agreed that there are many things that need to be researched in chiropractic; 25.81% had research experience in some setting; 45.16% thought basic research technique and statistics should be taught in chiropractic college; 19.36% thought research training should be a requirement in chiropractic college; and 61.29% would participate in chiropractic research if given the opportunity while in chiropractic college. Age and gender had very little effect on the research attitude of students in this study. The level of education in chiropractic college affected the students' general interest in research. Middle quarter-level students who had not taken the required research and chiropractic courses showed greater willingness to participate in research than senior students did. Students with previous research training and experience showed significant positive attitudes toward research in almost all questions. However, providing research training in school did not change students' attitudes toward research significantly in a short period of time. Lack of research experience and family concerns were the major factors affecting the students' interest in participating in research while in school. CONCLUSIONS: Most students completing the survey indicated an interest in research but were reluctant to take extra courses in research. A majority indicated an interest in participating in research. Students interested in doing research were most likely to be students who had some previous research experience or a personal interest as a result of some personal experience. Reasons given for the students' lack of desire to participate in research included family responsibilities, heavy study workload and lack of personal interest and/or previous experience. The overwhelming concern to the students in terms of participating in research was the additional time requirement.

Adult↗