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Journal Cover Journal of Manipulative and Physiological Therapeutics
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0161-4754
   Published by Elsevier Homepage  [2817 journals]
  • Editorial Board
    • Abstract: Publication date: March–April 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 3




      PubDate: 2016-04-27T18:42:31Z
       
  • Table of Contents
    • Abstract: Publication date: March–April 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 3




      PubDate: 2016-04-27T18:42:31Z
       
  • Information for Readers
    • Abstract: Publication date: March–April 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 3




      PubDate: 2016-04-27T18:42:31Z
       
  • Methods of Muscle Activation Onset Timing Recorded During Spinal
           Manipulation
    • Abstract: Publication date: Available online 9 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Stuart J. Currie, Casey A. Myers, Ashok Krishnamurthy, Brian A. Enebo, Bradley S. Davidson
      Objective The purpose of this study was to determine electromyographic threshold parameters that most reliably characterize the muscular response to spinal manipulation and compare 2 methods that detect muscle activity onset delay: the double-threshold method and cross-correlation method. Methods Surface and indwelling electromyography were recorded during lumbar side-lying manipulations in 17 asymptomatic participants. Muscle activity onset delays in relation to the thrusting force were compared across methods and muscles using a generalized linear model. Results The threshold combinations that resulted in the lowest Detection Failures were the “8 SD–0 milliseconds” threshold (Detection Failures = 8) and the “8 SD–10 milliseconds” threshold (Detection Failures = 9). The average muscle activity onset delay for the double-threshold method across all participants was 149 ± 152 milliseconds for the multifidus and 252 ± 204 milliseconds for the erector spinae. The average onset delay for the cross-correlation method was 26 ± 101 for the multifidus and 67 ± 116 for the erector spinae. There were no statistical interactions, and a main effect of method demonstrated that the delays were higher when using the double-threshold method compared with cross-correlation. Conclusions The threshold parameters that best characterized activity onset delays were an 8-SD amplitude and a 10-millisecond duration threshold. The double-threshold method correlated well with visual supervision of muscle activity. The cross-correlation method provides several advantages in signal processing; however, supervision was required for some results, negating this advantage. These results help standardize methods when recording neuromuscular responses of spinal manipulation and improve comparisons within and across investigations.


      PubDate: 2016-04-27T18:42:31Z
       
  • The Neuromuscular Response to Spinal Manipulation in the Presence of Pain
    • Abstract: Publication date: Available online 6 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Stuart J. Currie, Casey A. Myers, Catherine Durso, Brian A. Enebo, Bradley S. Davidson
      Objective The purpose of this study was to evaluate differences in muscle activity in participants with and without low back pain during a side-lying lumbar diversified spinal manipulation. Methods Surface and indwelling electromyography at eight muscle locations were recorded during lumbar side-lying manipulations in 20 asymptomatic participants and 20 participants with low back pain. The number of muscle responses and muscle activity onset delays in relation to the manipulation impulse were compared in the 2 pain groups using mixed linear regressions. Effect sizes for all comparisons were calculated using Cohen’s d. Results Muscle responses occurred in 61.6% ± 23.6% of the EMG locations in the asymptomatic group and 52.8% ± 26.3% of the symptomatic group. The difference was not statistically significant but there was a small effect of pain (d = 0.350). Muscle activity onset delays were longer for the symptomatic group at every EMG location except the right side indwelling L5 electrode, and a small effect of pain was present at the left L2, quadratus lumborum and trapezius surface electrodes (d = 0.311, 0.278, and 0.265) respectively. The indwelling electrodes demonstrated greater muscle responses (P ≤ .01) and shorter muscle activity onset delays (P < .01) than the surface electrodes. Conclusions The results revealed trends that indicate participants with low back pain have less muscle responses, and when muscle responses are present they occur with longer onset delays following the onset of a manipulation impulse.


      PubDate: 2016-04-09T10:10:08Z
       
  • Effects of Axial Torsion on Disc Height Distribution: An In Vivo Study
    • Abstract: Publication date: Available online 6 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Alejandro A. Espinoza Orías, Nicole M. Mammoser, John J. Triano, Howard S. An, Gunnar B.J. Andersson, Nozomu Inoue
      Objectives Axial rotation of the torso is commonly used during manipulation treatment of low back pain. Little is known about the effect of these positions on disc morphology. Rotation is a three-dimensional event that is inadequately represented with planar images in the clinic. True quantification of the intervertebral gap can be achieved with a disc height distribution. The objective of this study was to analyze disc height distribution patterns during torsion relevant to manipulation in vivo. Methods Eighty-one volunteers were computed tomography–scanned both in supine and in right 50° rotation positions. Virtual models of each intervertebral gap representing the disc were created with the inferior endplate of each “disc” set as the reference surface and separated into 5 anatomical zones: 4 peripheral and 1 central, corresponding to the footprint of the annulus fibrosus and nucleus pulposus, respectively. Whole-disc and individual anatomical zone disc height distributions were calculated in both positions and were compared against each other with analysis of variance, with significance set at P < .05. Results Mean neutral disc height was 7.32 mm (1.59 mm). With 50° rotation, a small but significant increase to 7.44 mm (1.52 mm) (P < .0002) was observed. The right side showed larger separation in most levels, except at L5/S1. The posterior and right zones increased in height upon axial rotation of the spine (P < .0001), whereas the left, anterior, and central decreased. Conclusions This study quantified important tensile/compressive changes disc height during torsion. The implications of these mutually opposing changes on spinal manipulation are still unknown.


      PubDate: 2016-04-09T10:10:08Z
       
  • Changes in Manipulative Peak Force Modulation and Time to Peak Thrust
           among First-Year Chiropractic Students Following a 12-Week Detraining
           Period
    • Abstract: Publication date: Available online 6 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): David J Starmer, Brett P Guist, Taylor R Tuff, Sarah C Warren, Matthew GR Williams
      Objective 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. Methods 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. Results 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). Conclusions 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.


      PubDate: 2016-04-09T10:10:08Z
       
  • Effectiveness of Chiropractic Care to Improve Sensorimotor Function
           
    • Abstract: Publication date: Available online 2 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Kelly R. Holt, Heidi Haavik, Arier Chi Lun Lee, Bernadette Murphy, C. Raina Elley
      Objective This study assessed whether 12 weeks of chiropractic care was effective in improving sensorimotor function associated with fall risk, compared with no intervention, in community-dwelling older adults living in Auckland, New Zealand. Methods Sixty community-dwelling adults older than 65 years were enrolled in the study. Outcome measures were assessed at baseline, 4 weeks, and 12 weeks and included proprioception (ankle joint position sense), postural stability (static posturography), sensorimotor function (choice stepping reaction time), multisensory integration (sound-induced flash illusion), and health-related quality of life (SF-36). Results Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26-212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%-24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°-0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF-36 physical component of quality of life (2.4; 95% CI, 0.04-4.8; P = .04) compared with control. Conclusion Sensorimotor function and multisensory integration associated with fall risk and the physical component of quality of life improved in older adults receiving chiropractic care compared with control. Future research is needed to investigate the mechanisms of action that contributed to the observed changes in this study and whether chiropractic care has an impact on actual falls risk in older adults.


      PubDate: 2016-04-05T22:55:01Z
       
  • The Effect of Chronic Pain Intensity on Sit-to-Stand Strategy in Patients
           With Herniated Lumbar Disks
    • Abstract: Publication date: Available online 31 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Tomasz Sipko, Edmund Glibowski, Katarzyna Barczyk-Pawelec, Michał Kuczyński
      Objective Recurrent symptoms of low back pain and its transition to a chronic state are associated with specific motor strategies used by people to avoid pain. The aim of the study was to determine the impact of chronic pain intensity on sit-to-stand (STS) strategy in chronic low back pain (CLBP) patients with herniated disks. Method Vertical ground reaction forces (counter, peak, and postpeak rebound) and their respective times of occurrence were measured on 2 Kistler force plates. Thirty-two healthy persons served as a control group. People with CLBP (n = 40) were divided into 2 subgroups according to the reported pain intensity at rest as measured by the numeric pain rating scale (NRS): low pain (NRS ≤ 3) and high pain (HP; NRS > 3). Results Both CLBP subgroups achieved shorter time to counter force but longer time to postpeak rebound force (P < .01). The time to peak force was extended in HP on the right side (P < .01). HP presented lower peak force on the right and lower postpeak rebound force on the left side (P < .001) compared with controls. Conclusion Patients with CLBP were characterized by an individual, compensatory STS movement strategy with shorter preparation and longer stabilization times. Avoidance behavior in STS execution was presented in HP individuals only, indicating that intensity of chronic pain was a significant factor in decreasing ground reaction peak force and increasing time to peak force.


      PubDate: 2016-04-02T01:14:23Z
       
  • Symptomatic, Magnetic Resonance Imaging–Confirmed Cervical Disk
           Herniation Patients: A Comparative-Effectiveness Prospective Observational
           Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided
           Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy
    • Abstract: Publication date: Available online 31 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Cynthia K. Peterson, Christian W.A. Pfirrmann, Jürg Hodler, Serafin Leemann, Christof Schmid, Bernard Anklin, B. Kim Humphreys
      Objective The purpose of this study was to compare the outcomes of overall improvement, pain reduction, and treatment costs in matched patients with symptomatic, magnetic resonance imaging–confirmed cervical disk herniations treated with either spinal manipulative therapy (SMT) or imaging-guided cervical nerve root injection blocks (CNRI). Methods This prospective cohort comparative-effectiveness study included 104 patients with magnetic resonance imaging–confirmed symptomatic cervical disk herniation. Fifty-two patients treated with CNRI were age and sex matched with 52 patients treated with SMT. Baseline numerical rating scale (NRS) pain data were collected. Three months after treatment, NRS pain levels were recorded and overall “improvement” was assessed using the Patient Global Impression of Change scale. Only responses “much better” or “better” were considered “improved.” The proportion of patients “improved” was calculated for each treatment method and compared using the χ 2 test. The NRS and NRS change scores for the 2 groups were compared at baseline and 3 months using the unpaired t test. Acute and subacute/chronic patients in the 2 groups were compared for “improvement” using the χ 2 test. Results “Improvement” was reported in 86.5% of SMT patients and 49.0% of CNRI patients (P = .0001). Significantly more CNRI patients were in the subacute/chronic category (77%) compared with SMT patients (46%). A significant difference between the proportion of subacute/chronic CNRI patients (37.5%) and SMT patients (78.3%) reporting “improvement” was noted (P = .002). Conclusion Subacute/chronic patients treated with SMT were significantly more likely to report relevant “improvement” compared with CNRI patients. There was no difference in outcomes when comparing acute patients only.


      PubDate: 2016-04-02T01:14:23Z
       
  • Best Practices for Chiropractic Care of Children: A Consensus Update
    • Abstract: Publication date: Available online 31 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Cheryl Hawk, Michael J. Schneider, Sharon Vallone, Elise G. Hewitt
      Objective 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. Methods 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. Results 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. Conclusions 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.


      PubDate: 2016-04-02T01:14:23Z
       
  • Comparison of Outcomes in MRI Confirmed Lumbar Disc Herniation Patients
           With and Without Modic Changes Treated With High Velocity, Low Amplitude
           Spinal Manipulation
    • Abstract: Publication date: Available online 1 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Michelé Annen, Cynthia Peterson, Serafin Leemann, Christof Schmid, Bernard Anklin, B. Kim Humphreys
      Objective The purpose of this study was to determine if there is a difference in outcomes between Modic positive and negative lumbar disc herniation (LDH) patients treated with spinal manipulative therapy (SMT). Methods This prospective outcomes study includes 72 MRI confirmed symptomatic LDH patients treated with SMT. Numerical rating scale (NRS) pain and Oswestry disability data were collected at baseline. NRS, patient global impression of change to assess overall improvement, and Oswestry data were collected at 2 weeks, 1, 3, 6 months and 1 year. MRI scans were analyzed for Modic change present/absent and classified as Modic I or II when present. Chi-squared test compared the proportion of patients reporting relevant 'improvement' between patients with and without Modic changes and those with Modic I vs. II. NRS and Oswestry scores were compared at baseline and change scores at all follow-up time points using the unpaired Student t test. Results 76.5% of Modic positive patients reported ‘improvement’ compared to 53.3% of Modic negative patients (P = .09) at 2 weeks. Modic positive patients had larger decreases in leg pain (P = .02) and disability scores (P = .012) at 2 weeks. Modic positive patients had larger reductions in disability levels at 3 (P = .049) and 6 months (P = .001). A significant difference (P = .001) between patients with Modic I vs. Modic II was found at 1 year, where Modic II patients did significantly better. Conclusion Modic positive patients reported higher levels of clinically relevant improvement 2 weeks, 3 and 6 months compared to Modic negative patients. However, at 1 year Modic I patients were significantly less likely to report ‘improvement’, suggesting they may be prone to relapse.


      PubDate: 2016-04-02T01:14:23Z
       
  • Evidence on the Ability of A Pneumatic Decompression Belt to Restore
           Spinal Height Following an Acute Bout of Exercise
    • Abstract: Publication date: Available online 1 April 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jordan Cannon, David Emond, Stuart M. McGill
      Objective The purpose of this study was to evaluate the ability of a pneumatic decompression belt to restore spinal height lost following an acute bout of exercise that induced compression. Methods This study implemented a test-retest repeated measures design in which twelve participants (male = 10, female = 2) age, 21.5 ± 1.0 years; height, 179.0 ± 7.70 cm; weight, 84.0 ±11.5 kg; were recruited from a university population and acted as their own control. All participants were healthy with no previous history of disabling back pain, and were frequent weight trainers. A stadiometer was used to measure spinal height at baseline, then following an acute bout of exercise and then again following the intervention (use of a pneumatic decompression belt for 20 minutes) or control (lying supine for 20 minutes). A 2-way repeated measures ANOVA was performed on the change in spinal height in order to evaluate differences between measurement phases and intervention conditions. Results The use of the decompression belt increased spinal height gain (4.3 ± 3.0 mm) significantly more than the control condition (1.8 ± 1.2 mm) following an acute bout of weightlifting exercises known to elicit high compressive loads on the lumbar spine. Conclusion The pneumatic decompression belt restored spinal height faster than a non-belt wearing condition in young healthy asymptomatic participants.


      PubDate: 2016-04-02T01:14:23Z
       
  • Symptomatic, MRI Confirmed, Lumbar Disc Herniations: A Comparison of
           Outcomes Depending on the Type and Anatomical Axial Location of the Hernia
           
    • Abstract: Publication date: Available online 28 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Marco Ehrler, Cynthia Peterson, Serafin Leemann, Christof Schmid, Bernard Anklin, B. Kim Humphreys
      Objective The purpose of this study was to evaluate whether specific MRI features, such as axial location and type of herniation, are associated with outcomes of symptomatic lumbar disc herniation patients treated with spinal manipulation therapy (SMT). Methods MRI and treatment outcome data from 68 patients were included in this prospective outcomes study. Pain numerical rating scale (NRS) and Oswestry physical disability questionnaire (OPDQ) levels were measured at baseline. The Patients Global Impression of Change scale, the NRS and the OPDQ were collected at 2 weeks, 1, 3, 6 months and 1 year. One radiologist and 2 chiropractic medicine master’s degree students analyzed the MRI scans blinded to treatment outcomes. κ statistics assessed inter-rater reliability of MRI diagnosis. The proportion of patients reporting relevant improvement at each time point was compared based on MRI findings using the chi-square test. The t test and ANOVA compared the NRS and OPDQ change scores between patients with various MRI abnormalities. Results A higher proportion of patients with disc sequestration reported relevant improvement at each time point but this did not quite reach statistical significance. Patients with disc sequestration had significantly higher reduction in leg pain at 1 month compared to those with extrusion (P = .02). Reliability of MRI diagnosis ranged from substantial to perfect (K = .733-1.0). Conclusions Patients with sequestered herniations treated with SMT to the level of herniation reported significantly higher levels of leg pain reduction at 1 month and a higher proportion reported improvement at all data collection time points but this did not reach statistical significance.


      PubDate: 2016-03-29T00:46:38Z
       
  • Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic
           and Opioid Use in Younger Medicare Beneficiaries
    • Abstract: Publication date: Available online 28 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): William B Weeks, Christine M Goertz
      Objective 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. Methods 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. Results 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. Conclusions 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.


      PubDate: 2016-03-29T00:46:38Z
       
  • Exploring the Definition of Acute Low Back Pain: A Prospective
           Observational Cohort Study Comparing Outcomes of Chiropractic Patients
           With 0-2, 2-4, and 4-12 Weeks of Symptoms
    • Abstract: Publication date: Available online 28 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Karin E. Mantel, Cynthia K. Peterson, B. Kim Humphreys
      Objective The purpose of this study was to compare improvement rates in patients with low back pain (LBP) undergoing chiropractic treatment with 0-2 weeks vs 2-4 and 4-12 weeks of symptoms. Methods This was a prospective cohort outcome study with 1-year follow-up including adult acute (symptoms 0-4 weeks) LBP patients. The numerical rating scale for pain (NRS) and Oswestry questionnaire were completed at baseline, 1 week, 1 month, and 3 months after starting treatment. The Patient Global Impression of Change (PGIC) scale was completed at all follow-up time points. At 6 months and 1 year, NRS and PGIC data were collected. The proportion of patients reporting relevant “improvement” (PGIC scale) was compared between patients having 0-2 and 2-4 weeks of symptoms using the χ 2 test at all data collection time points. The unpaired t test compared NRS and Oswestry change scores between these 2 groups. Results Patients with 0-2 weeks of symptoms were significantly more likely to “improve” at 1 week, 1 month, and 6 months compared with those with 2-4 weeks of symptoms (P < .015). Patients with 0-2 weeks of symptoms reported significantly higher NRS and Oswestry change scores at all data collection time points. Outcomes for patients with 2-4 weeks of symptoms were similar to patients having 4-12 weeks of symptoms. Conclusion The time period 0-4 weeks as the definition of “acute” should be challenged. Patients with 2-4 weeks of symptoms had outcomes similar to patients with subacute (4-12 weeks) symptoms and not with patients reporting 0-2 weeks of symptoms.


      PubDate: 2016-03-29T00:46:38Z
       
  • Development of a Linked Segment Model to Derive Patient Low Back Reaction
           
    • Abstract: Publication date: Available online 28 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Samuel J Howarth, Kevin D’Angelo, John J Triano
      Objective The purpose of this paper is to present the experimental setup, the development, and implementation of a new scalable model capable of efficiently handling data required to determine low back kinetics during high-velocity low-amplitude spinal manipulation (HVLA-SM). Methods The model was implemented in Visual3D software. All contact forces and moments between the patient and the external environment (2 clinician hand contact forces, 1 contact force between the patient and the treatment table), the patient upper body kinematics, and inertial properties were used as input. Spine kinetics and kinematics were determined from a single HVLA-SM applied to one healthy participant in a right side-lying posture to demonstrate the model’s utility. The net applied force was used to separate the spine kinetic and kinematic time-series data from the HVLA-SM into preload as well as early and late impulse phases. Results Time-series data obtained from the HVLA-SM procedure showed that the participant’s spine underwent left axial rotation, combined with extension, and a reduction in left lateral bending during the procedure. All components of the reaction force, as well as the axial twist and flexion/extension reaction moments demonstrated a sinusoidal pattern during the early and late impulse phases. During the early impulse phase, the participant’s spine experienced a leftward axial twisting moment of 37.0 Nm followed by a rightward moment of −45.8 Nm. The lateral bend reaction moment exhibited a bimodal pattern during the early and late impulse phases. Conclusion This model was the first attempt to directly measure all contact forces acting on the participant/patient’s upper body, and integrate them with spine kinematic data to determine patient low back reaction forces and moments during HVLA-SM in a side-lying posture. Advantages of this model include the brevity of data collection (<1 hour), and adaptability for different patient anthropometries and clinician-patient contacts.


      PubDate: 2016-03-29T00:46:38Z
       
  • Systematic Augmented Feedback and Dependency in Spinal Manipulation
           Learning: a Randomized Comparative Study
    • Abstract: Publication date: Available online 22 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Arnaud Lardon, Charlène Cheron, Isabelle Pagé, Claude Dugas, Martin Descarreaux
      Objective The purpose of the study was to evaluate if systematic augmented feedback during short sessions of spinal manipulation (SM) training creates a dependency compared with short training session characterized by progressive withdrawal of augmented feedback. Methods Forty fourth- and fifth-year chiropractic students enrolled in a 5-year chiropractic program were randomized into 2 groups. The 2 groups performed the same number of SM with a 300-N peak force target on an instrumented device. Baseline assessment consisted of 10 trials without feedback. Three training blocks of 10 SMs were then performed with visual and verbal feedback. For the control group, feedback was always provided. For the experimental group, augmented feedback was provided for each trial of the first training block, 50% of the second block, and 20% of the last training block. A postintervention assessment of 10 trials without feedback was performed, and a retention assessment was conducted 20 minutes later. Results No group main effect was found on biomechanical parameters and error variables. A main effect of learning for the absolute error was observed, suggesting that short sessions of feedback training improve participants’ accuracy. Conclusion The results of the study suggest that feedback scheduling does not influence SM motor performance and learning in clinically experienced students.


      PubDate: 2016-03-24T00:31:46Z
       
  • Editorial Board
    • Abstract: Publication date: February 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 2




      PubDate: 2016-03-11T23:01:00Z
       
  • Table of Contents
    • Abstract: Publication date: February 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 2




      PubDate: 2016-03-11T23:01:00Z
       
  • Information for Readers
    • Abstract: Publication date: February 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 2




      PubDate: 2016-03-11T23:01:00Z
       
  • The Effectiveness of Multimodal Care for Soft Tissue Injuries of the Lower
           Extremity: A Systematic Review by the Ontario Protocol for Traffic Injury
           Management (OPTIMa) Collaboration
    • Abstract: Publication date: February 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 2
      Author(s): Deborah A. Sutton, Margareta Nordin, Pierre Côté, Kristi Randhawa, Hainan Yu, Jessica J. Wong, Paula Stern, Sharanya Varatharajan, Danielle Southerst, Heather M. Shearer, Maja Stupar, Chadwick Chung, Rachel Goldgrub, Linda J. Carroll, Anne Taylor-Vaisey
      Objective The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the lower extremity. Methods We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Random pairs of independent reviewers screened studies for relevance and critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. Results We screened 6794 articles. Six studies had a low risk of bias and addressed the following: plantar heel pain (n = 2), adductor-related groin pain (n = 1), and patellofemoral pain (n = 3). The evidence suggests that multimodal care for the management of persistent plantar heel pain may include mobilization and stretching exercise. An intensive, clinic-based, group exercise program (strengthening, stretching, balance, agility) is more effective than multimodal care for the management of adductor-related groin pain in male athletes. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain. Our search did not identify any low risk of bias studies examining multimodal care for the management of other soft tissue injuries of the lower extremity. Conclusion A multimodal program of care for the management of persistent plantar heel pain may include mobilization and stretching exercise. Multimodal care for adductor-related groin pain is not recommended based on the current evidence. There is inconclusive evidence to support the use of multimodal care for the management of persistent patellofemoral pain.


      PubDate: 2016-03-11T23:01:00Z
       
  • The Effectiveness of Multimodal Care for the Management of Soft Tissue
           Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for
           Traffic Injury Management (OPTIMa) Collaboration
    • Abstract: Publication date: February 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 2
      Author(s): Rachel Goldgrub, Pierre Côté, Deborah Sutton, Jessica J. Wong, Hainan Yu, Kristi Randhawa, Sharanya Varatharajan, Danielle Southerst, Silvano Mior, Heather M. Shearer, Craig Jacobs, Maja Stupar, Chadwick L. Chung, Sean Abdulla, Robert Balogh, Shilpa Dogra, Margareta Nordin, Anne Taylor-Vaisey
      Objective The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder. Methods We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias. Results We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections. Conclusions The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.


      PubDate: 2016-03-11T23:01:00Z
       
  • The Effectiveness of Exercise on Recovery and Clinical Outcomes in
           Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A
           Systematic Review by the Ontario Protocol for Traffic Injury Management
           (OPTIMa) Collaboration
    • Abstract: Publication date: February 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 2
      Author(s): Courtney K. Brown, Danielle Southerst, Pierre Côté, Heather M. Shearer, Kristi Randhawa, Jessica J. Wong, Hainan Yu, Sharanya Varatharajan, Deborah Sutton, Paula J. Stern, Kevin D’Angelo, Sarah Dion, Jocelyn Cox, Rachel Goldgrub, Maja Stupar, Linda J. Carroll, Anne Taylor-Vaisey
      Objective The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee. Methods We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used. Results We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a “wait and see” approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain. Conclusion We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.


      PubDate: 2016-03-11T23:01:00Z
       
  • Characteristics of US Adults Who Have Positive and Negative Perceptions of
           Doctors of Chiropractic and Chiropractic Care
    • Abstract: Publication date: Available online 3 March 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): William B. Weeks, Christine M. Goertz, William C. Meeker, Dennis M. Marchiori
      Objective 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. Methods 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. Results 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. Conclusion 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.


      PubDate: 2016-03-06T22:32:30Z
       
  • Patients’ Experiences With Vehicle Collision to Inform the
           Development of Clinical Practice Guidelines: A Narrative Inquiry
    • Abstract: Publication date: Available online 28 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Gail M. Lindsay, Silvano A. Mior, Pierre Côté, Linda J. Carroll, Heather M. Shearer
      Objective The purpose of this narrative inquiry was to explore the experiences of persons who were injured in traffic collisions and seek their recommendations for the development of clinical practice guideline (CPG) for the management of minor traffic injuries. Methods Patients receiving care for traffic injuries were recruited from 4 clinics in Ontario, Canada resulting in 11 adult participants (5 men, 6 women). Eight were injured while driving cars, 1 was injured on a motorcycle, 2 were pedestrians, and none caused the collision. Using narrative inquiry methodology, initial interviews were audiotaped, and follow-up interviews were held within 2 weeks to extend the story of experience created from the first interview. Narrative plotlines across the 11 stories were identified, and a composite story inclusive of all recommendations was developed by the authors. The research findings and composite narrative were used to inform the CPG Expert Panel in the development of new CPGs. Results Four recommended directions were identified from the narrative inquiry process and applied. First, terminology that caused stigma was a concern. This resulted in modified language (“injured persons”) being adopted by the Expert Panel, and a new nomenclature categorizing layers of injury was identified. Second, participants valued being engaged as partners with health care practitioners. This resulted in inclusion of shared decision-making as a foundational recommendation connecting CPGs and care planning. Third, emotional distress was recognized as a factor in recovery. Therefore, the importance of early detection and the ongoing evaluation of risk factors for delayed recovery were included in all CPGs. Fourth, participants shared that they were unfamiliar with the health care system and insurance industry before their accident. Thus, repeatedly orienting injured persons to the system was advised. Conclusion A narrative inquiry of 11 patients’ experiences with traffic collision and their recommendations for clinical guidelines informed the Ontario Protocol for Traffic Injury Management Collaboration in the development of new Minor Injury Guidelines. The values and findings of the qualitative inquiry were interwoven into each clinical pathway and embedded within the final guideline report submitted to government.


      PubDate: 2016-02-29T22:13:09Z
       
  • Editorial Board
    • Abstract: Publication date: January 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 1




      PubDate: 2016-02-24T21:55:32Z
       
  • Table of Contents
    • Abstract: Publication date: January 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 1




      PubDate: 2016-02-24T21:55:32Z
       
  • Information for Readers
    • Abstract: Publication date: January 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 1




      PubDate: 2016-02-24T21:55:32Z
       
  • Clinical Practice Guideline: Chiropractic Care for Low Back Pain
    • Abstract: Publication date: January 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 1
      Author(s): Gary Globe, Ronald J. Farabaugh, Cheryl Hawk, Craig E. Morris, Greg Baker, Wayne M. Whalen, Sheryl Walters, Martha Kaeser, Mark Dehen, Thomas Augat
      Objective The purpose of this article is to provide an update of a previously published evidence-based practice guideline on chiropractic management of low back pain. Methods This project updated and combined 3 previous guidelines. A systematic review of articles published between October 2009 through February 2014 was conducted to update the literature published since the previous Council on Chiropractic Guidelines and Practice Parameters (CCGPP) guideline was developed. Articles with new relevant information were summarized and provided to the Delphi panel as background information along with the previous CCGPP guidelines. Delphi panelists who served on previous consensus projects and represented a broad sampling of jurisdictions and practice experience related to low back pain management were invited to participate. Thirty-seven panelists participated; 33 were doctors of chiropractic (DCs). In addition, public comment was sought by posting the consensus statements on the CCGPP Web site. The RAND-UCLA methodology was used to reach formal consensus. Results Consensus was reached after 1 round of revisions, with an additional round conducted to reach consensus on the changes that resulted from the public comment period. Most recommendations made in the original guidelines were unchanged after going through the consensus process. Conclusions The evidence supports that doctors of chiropractic are well suited to diagnose, treat, co-manage, and manage the treatment of patients with low back pain disorders.


      PubDate: 2016-02-24T21:55:32Z
       
  • Exploratory Analysis of Clinical Predictors of Outcomes of Nonsurgical
           Treatment in Patients With Lumbar Spinal Stenosis
    • Abstract: Publication date: Available online 19 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Michael J Schneider, Lauren Terhorst, Donald Murphy, Joel M. Stevans, Rachel Hoffman, Jerrilyn A Cambron
      Objective The purpose of this study was to explore potential baseline physical examination and demographic predictors of clinical outcomes in patients with lumbar spinal stenosis. Methods This was a secondary analysis of data obtained from a pilot randomized controlled trial. Primary and secondary outcome measures were the Swiss Spinal Stenosis (SSS) Questionnaire and visual analog scale (VAS) for leg pain. Multiple regression models were used to assess 2 different outcomes: SSS at completion of care and VAS at completion of care. Separate regression models were built for each of the 2 outcomes to identify the best subset of variables that predicted improvement. Predictors with a significant contribution were retained in a final “best” model. Results Three variables were identified as having an association with SSS score at completion of care: baseline SSS score, qualitative description of leg pain, and age (adjusted R 2 = 33.2). Four variables were identified as having an association with VAS score at completion of care: baseline VAS score, qualitative description of leg pain, body mass index, and age (adjusted R2 = 38.3). Conclusion This study provides preliminary evidence supporting an association between certain baseline characteristics and nonsurgical clinical outcomes in patients with lumbar spinal stenosis.


      PubDate: 2016-02-20T21:29:34Z
       
  • The Association Between Use of Chiropractic Care and Costs of Care Among
           Older Medicare Patients With Chronic Low Back Pain and Multiple
           Comorbidities
    • Abstract: Publication date: Available online 19 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): William B Weeks, Brent Leininger, James M Whedon, Jon D Lurie, Tor D Tosteson, Rand Swenson, Alistair J O’Malley, Christine M Goertz
      Objective The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiply-comorbid Medicare beneficiaries with an episode of chronic low back pain (cLBP). Methods We conducted an observational, retrospective study of 2006 to 2012 Medicare fee-for-service reimbursements for 72326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures: chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. We used propensity score weighting to address selection bias. Results After propensity score weighting, total and per-episode day Part A, Part B, and Part D Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; these patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode. Expenditures were greatest for patients receiving medical care alone; order was irrelevant when both CMT and medical treatment were provided. Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. While patients who used only CMT had the lowest Part A and Part B expenditures per episode day, we found no indication of lower psychiatric or pain medication expenditures associated with CMT. Conclusions This study found that older multiply-comorbid patients who used only CMT during their cLBP episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode day than patients in the other treatment groups. Further, costs of care for the episode and per episode day were lower for patients who used a combination of CMT and conventional medical care than for patients who did not use any CMT. These findings support initial CMT use in the treatment of, and possibly broader chiropractic management of, older multiply-comorbid cLBP patients.


      PubDate: 2016-02-20T21:29:34Z
       
  • Validity of Commonly Used Clinical Tests to Diagnose and Screen for Spinal
           Pain in Adolescents: A School-Based Cohort Study in 1300 Danes Aged
           11–15 Years
    • Abstract: Publication date: Available online 17 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ellen Aartun, Jan Hartvigsen, Lise Hestbaek
      Objective The overall aim of this study was to determine the ability of 2 selected clinical tests to detect or predict neck pain, mid back pain, and low back pain in a school-based cohort of Danish 11- to 15-year-olds. Methods A school-based 2-year prospective cohort study was conducted. Data were collected at the age of 11 to 13 (n = 1224) and 2 years later (n = 963). Spinal pain (neck pain, mid back pain, and low back pain) was assessed by an electronic survey completed during school time, and reference standard was defined as both lifetime prevalence and frequent pain as a proxy of severity. The tests included assessments of scoliosis, hypermobility, global mobility, intersegmental mobility, end range pain, and isometric endurance of back extensors. Sensitivity, specificity, negative and positive predictive values, and odds ratios were calculated for each test individually, and area under the receiver operating characteristic curve was calculated for evaluation of all tests combined. Results The sensitivity was low, and specificity was high for all tests at both baseline (age, 11-13 years) and follow-up (age, 13-15 years). When all tests were evaluated collectively in 1 model, the area under the receiver operating characteristic curve ranged from 0.60 to 0.65. None of the selected tests could predict incidence cases of neck pain, mid back pain, or low back pain. Conclusion Clinical tests commonly used in spinal screening in adolescents could not detect present spinal pain or predict future spinal pain. However, some statistically significant associations between spinal pain and tests involving a pain response from the participant were found.


      PubDate: 2016-02-20T21:29:34Z
       
  • An Electronic Patient-Reported Outcome Measures System in UK Chiropractic
           Practices: A Feasibility Study of Routine Collection of Outcomes and Costs
           
    • Abstract: Publication date: Available online 1 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Dave Newell, Emily Diment, Jenni E Bolton
      Objective 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. Methods 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. Results 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. Conclusion 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.


      PubDate: 2016-02-01T19:56:53Z
       
  • Influence of Subclinical Neck Pain on the Ability to Perform a Mental
           Rotation Task: A 4-Week Longitudinal Study With a Healthy Control Group
           Comparison
    • Abstract: Publication date: Available online 1 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Julianne K. Baarbé, Michael W.R. Holmes, Heather E. Murphy, Heidi Haavik, Bernadette A. Murphy
      Objective Mental rotation of objects and the frame of reference of those objects are critical for executing correct and skillful movements and are important for object recognition, spatial navigation, and movement planning. The purpose of this longitudinal study was to compare the mental rotation ability of those with subclinical neck pain (SCNP) to healthy controls at baseline and after 4 weeks. Methods Twenty-six volunteers (13 SCNP and 12 healthy controls) were recruited from a university student population. Subclinical neck pain participants had scores of mild to moderate on the Chronic Pain Grade Scale, and controls had minimal or no pain. For the mental rotation task, participants were presented with an object (letter “R”) on a computer screen presented randomly in either normal or backwards parity at various orientations (0°, 45°, 90°, 135°, 180°, 225°, 270°, and 315°). Participants indicated the object's parity by pressing “N” for normal or “B” for backwards. Each orientation for normal and backward parities was presented 5 times, and the average response time for all letter presentations was calculated for each participant, at baseline and 4 weeks later. Results Both groups had overall improved response times from baseline to 4 weeks. Healthy participants had significantly improved response times compared to SCNP, both at baseline (P < .05) and 4 weeks (P < .05). Conclusions Healthy participants performed better than the SCNP group at both time points. Subclinical neck pain may impair the ability to perform a complex mental rotation task involving cerebellar connections, possibly due to altered body schema.


      PubDate: 2016-02-01T19:56:53Z
       
  • Clinical Outcomes in a Large Cohort of Musculoskeletal Patients Undergoing
           Chiropractic Care in the United Kingdom: A Comparison of Self- and
           National Health Service–Referred Routes
    • Abstract: Publication date: Available online 1 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jonathan R Field, Dave Newell
      Objective 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. Methods 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. Results 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. Conclusions 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.


      PubDate: 2016-02-01T19:56:53Z
       
  • Attenuation Effect of Spinal Manipulation on Neuropathic and Postoperative
           Pain Through Activating Endogenous Anti-Inflammatory Cytokine Interleukin
           10 in Rat Spinal Cord
    • Abstract: Publication date: Available online 1 February 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Xue-Jun Song, Zhi-Jiang Huang, William B. Song, Xue-Song Song, Arlan F. Fuhr, Anthony L. Rosner, Harrison Ndtan, Ronald L. Rupert
      Objectives The purpose of this study was to investigate roles of the anti-inflammatory cytokine interleukin (IL) 10 and the proinflammatory cytokines IL-1β and tumor necrosis factor α (TNF-α) in spinal manipulation–induced analgesic effects of neuropathic and postoperative pain. Methods Neuropathic and postoperative pain were mimicked by chronic compression of dorsal root ganglion (DRG) (CCD) and decompression (de-CCD) in adult, male, Sprague-Dawley rats. Behavioral pain after CCD and de-CCD was determined by the increased thermal and mechanical hypersensitivity of the affected hindpaw. Hematoxylin and eosin staining, whole-cell patch clamp electrophysiological recordings, immunohistochemistry, and enzyme-linked immunosorbent assay were used to examine the neural inflammation, neural excitability, and expression of c-Fos and PKC as well as levels of IL-1β, TNF-α, and IL-10 in blood plasma, DRG, or the spinal cord. We used the activator adjusting instrument, a chiropractic spinal manipulative therapy tool, to deliver force to the spinous processes of L5 and L6. Results After CCD and de-CCD treatments, the animals exhibited behavioral and neurochemical signs of neuropathic pain manifested as mechanical allodynia and thermal hyperalgesia, DRG inflammation, DRG neuron hyperexcitability, induction of c-Fos, and the increased expression of PKCγ in the spinal cord as well as increased level of IL-1β and TNF-α in DRG and the spinal cord. Repetitive Activator-assisted spinal manipulative therapy significantly reduced simulated neuropathic and postoperative pain, inhibited or reversed the neurochemical alterations, and increased the anti-inflammatory IL-10 in the spinal cord. Conclusion These findings show that spinal manipulation may activate the endogenous anti-inflammatory cytokine IL-10 in the spinal cord and thus has the potential to alleviate neuropathic and postoperative pain.


      PubDate: 2016-02-01T19:56:53Z
       
  • A Literature Review of Pediatric Spinal Manipulation and Chiropractic
           Manipulative Therapy: Evaluation of Consistent Use of Safety Terminology
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9
      Author(s): Aurélie M. Marchand
      Objective The purpose of this study was to perform a literature search to identify relevant studies on pediatric spinal manipulation and chiropractic manipulative therapy and to assess if safety terminology was consistent with the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). Methods A literature search was performed in PubMed using the following terms: spinal manipulation pediatric, chiropractic safety pediatric, and manual therapy safety pediatric. PubMed was searched from inception to April 2012 with no language limitations. The international standards included the terminology of the World Health Organization on side effects, adverse reactions, adverse events and the ICH guideline templates that were adapted for manual therapy for this study. Results Of the 9 relevant articles identified in this study, 3 reported methodology for classifying safety incidents, and all 9 used safety terminology (adverse effects or adverse events). However, terminology was not used consistently. Conclusion Most of the articles identified in this literature review did not use terminology consistent with the standards established by the ICH when reporting on safety incidents following pediatric spinal manipulation or chiropractic manipulative therapy. More efforts should be taken to include consistent terminology for studies of spinal manipulation and chiropractic manipulative therapy for children.


      PubDate: 2015-12-12T23:00:36Z
       
  • Serious Adverse Events and Spinal Manipulative Therapy of the Low Back
           Region: A Systematic Review of Cases
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9
      Author(s): Jeffrey J. Hebert, Norman J. Stomski, Simon D. French, Sidney M. Rubinstein
      Objective The purpose of this study was to systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details. Methods A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 12, 2012, by an experienced reference librarian. Study selection was performed by 2 independent reviewers using predefined criteria. We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis by any type of provider (eg, chiropractic, medical, physical therapy, osteopathic, layperson). A serious adverse event was defined as an untoward occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. We included studies published in English, German, Dutch, and Swedish. Results A total of 2046 studies were screened, and 41 studies reporting on 77 cases were included. Important case details were frequently unreported, such as descriptions of SMT technique, the pre-SMT presentation of the patient, the specific details of the adverse event, time from SMT to the adverse event, factors contributing to the adverse event, and clinical outcome. Adverse events consisted of cauda equina syndrome (29 cases, 38% of total); lumbar disk herniation (23 cases, 30%); fracture (7 cases, 9%); hematoma or hemorrhagic cyst (6 cases, 8%); or other serious adverse events (12 cases, 16%) such as neurologic or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing, and esophageal rupture. Conclusions This systematic review describes case details from published articles that describe serious adverse events that have been reported to occur following SMT of the lumbopelvic region. The anecdotal nature of these cases does not allow for causal inferences between SMT and the events identified in this review. Recommendations regarding future case reporting and research aimed at furthering the understanding of the safety profile of SMT are discussed.


      PubDate: 2015-12-12T23:00:36Z
       
  • The Association Between Cervical Spine Manipulation and Carotid Artery
           Dissection: A Systematic Review of the Literature
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9
      Author(s): Chadwick L.R. Chung, Pierre Côté, Paula Stern, Georges L'Espérance
      Objective Controversy surrounds the safety of cervical spine manipulation. Ischemic stroke secondary to cervical spine manipulation is a hypothesized adverse event. In Canada, the seriousness of these events and their perceived association to cervical spine manipulation has led some members of the public to call for a ban of the procedure. The primary objective of this study was to determine the incidence of internal carotid artery (ICA) dissection after cervical spine manipulation in patients who experience neck pain and its associated disorders. The secondary objective was to determine whether cervical spine manipulation is associated with an increased risk of ICA dissection in patients with neck pain, upper back pain, or headaches. Methods We systematically searched MEDLINE, CINAHL, Alternative Health, AMED, Index to Chiropractic Literature, and EMBASE from 1970 to November 2012. Two independent reviewers used standardized criteria to screen the eligibility of articles. We considered cohort studies, case-control studies, and randomized clinical trials that addressed our objectives. We planned to critically appraise eligible articles using the Scottish Intercollegiate Guideline Network methodology. Results We did not find any epidemiologic studies that measured the incidence of cervical spine manipulation and ICA dissection. Similarly, we did not find any studies that determined whether cervical spine manipulation is associated with ICA dissection. Conclusions The incidence of ICA dissection after cervical spine manipulation is unknown. The relative risk of ICA dissection after cervical spine manipulation compared with other health care interventions for neck pain, back pain, or headache is also unknown. Although several case reports and case series raise the hypothesis of an association, we found no epidemiologic studies that validate this hypothesis.


      PubDate: 2015-12-12T23:00:36Z
       
  • Editorial Board
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9




      PubDate: 2015-12-12T23:00:36Z
       
  • Table of Contents
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9




      PubDate: 2015-12-12T23:00:36Z
       
  • Information for Readers
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9




      PubDate: 2015-12-12T23:00:36Z
       
  • Internal Carotid Artery Strains During High-Speed, Low-Amplitude Spinal
           Manipulations of the Neck
    • Abstract: Publication date: November–December 2015
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 38, Issue 9
      Author(s): Walter Herzog, Conrad Tang, Tim Leonard
      Objective The primary objective of this study was to quantify the strains applied to the internal carotid artery (ICA) during neck spinal manipulative treatments and range of motion (ROM)/diagnostic testing of the head and neck. Methods Strains of the ICA (n = 12) were measured in 6 fresh, unembalmed cadaveric specimens using sonomicrometry. Peak and average strains of the ICA obtained during cervical spinal manipulations given by experienced doctors of chiropractic were compared with the corresponding strains obtained during ROM and diagnostic testing of the head and neck. Results Peak and average strains of the ICA for cervical spinal manipulative treatments were significantly smaller (P < .001) than the corresponding strains obtained for the ROM and diagnostic testing. All strains during ROM and treatment testing were dramatically smaller than the initial failure strains of the ICA. Conclusions This study showed that maximal ICA strains imparted by cervical spinal manipulative treatments were well within the normal ROM. Chiropractic manipulation of the neck did not cause strains to the ICA in excess of those experienced during normal everyday movements. Therefore, cervical spinal manipulative therapy as performed by the trained clinicians in this study, did not appear to place undue strain on the ICA and thus does not seem to be a factor in ICA injuries.


      PubDate: 2015-12-12T23:00:36Z
       
  • Thank You to JMPT Peer Reviewers for 2014
    • Abstract: Publication date: Available online 11 November 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Claire Johnson
      This article recognizes editorial board members and peer reviewers who completed manuscript reviews for the Journal of Manipulative and Physiological Therapeutics in the year 2014 and provides a summary of international representation of peer reviewers.


      PubDate: 2015-11-11T21:07:11Z
       
  • A Test-Retest Reliability Study of the Whiplash Disability Questionnaire
           in Patients With Acute Whiplash-Associated Disorders
    • Abstract: Publication date: Available online 11 November 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Maja Stupar, Pierre Côté, Dorcas E. Beaton, Eleanor Boyle, J David Cassidy
      Objective The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). Methods We performed a test-retest reliability study. We included insurance claimants from Ontario who were at least 18years of age, within 21days of their motor vehicle collision and diagnosed as having acute WAD grades I to III. The WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability), was administered to all participants at baseline and by telephone 3days later. We computed the intraclass correlation coefficient (model 2,1) and the MDC with 95% confidence intervals (CIs; MDC95). Results The mean (SD) age of the 66 participants was 41.6 (12.7) years and 71.2% were female. Twenty-nine percent had WAD I and 71.2% had WAD II. Time since injury ranged from 0 to 19 days. The mean (SD) baseline WDQ score was 49.3 (28.8) and 46.5 (29.8) 3days later. The intraclass correlation coefficient for the WDQ total score was 0.89 (95% CI, 0.85-0.92) in the entire sample and 0.83 (95% CI, 0.69-0.93) for the 15 participants reporting no change in neck pain. The MDC95 of the WDQ was 21.4 (SD = 14.9) for participants reporting no change. Conclusion The WDQ was reliable in individuals with acute WAD. There is 95% confidence that a change of approximately one-sixth of the total score is beyond the daily variation of a stable condition. This level of measurement error must be taken into consideration when interpreting change in WDQ scores.


      PubDate: 2015-11-11T21:07:11Z
       
  • A Randomized Pragmatic Clinical Trial of Chiropractic Care for Headaches
           With and Without a Self-Acupressure Pillow
    • Abstract: Publication date: Available online 6 November 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Howard Vernon, Cam Borody, Glen Harris, Brad Muir, Jarrod Goldin, Maricelle Dinulos
      Objective The purpose of this study was to determine if the addition of a self-acupressure pillow (SAP) to typical chiropractic treatment results in significantly greater improvement in tension-type and cervicogenic headache sufferers. Methods A pragmatic randomized clinical trial was conducted in a chiropractic college teaching clinic. Thirty-four subjects, including tension-type and cervicogenic headache sufferers, 21 to 60 years of age, male or female, completed the study. Group A (n = 15) received typical chiropractic care only (manual therapy and exercises), and group B (n = 19) received typical chiropractic care with daily home use of the SAP. The intervention period was 4 weeks. The main outcome measure was headache frequency. Satisfaction and relief scores were obtained from subjects in the SAP group. Analysis of variance was used to analyze the intergroup comparisons. Results Owing to failure of randomization to produce group equivalence on weekly headache frequency, analysis of covariance was performed showing a trend (P = .07) favoring the chiropractic-only group; however, this was not statistically significant. Group A obtained a 46% reduction of weekly headache frequency (t = 3.1, P = .002; d = 1.22). The number of subjects in group A achieving a reduction in headaches greater than 40% was 71%, while for group B, this was 28%. The mean benefit score (0-3) in group B of the use of the SAP was 1.2 (.86). The mean satisfaction rating of users of the SAP was 10.4 (2.7) out of 15 (63%). Conclusion This study suggests that chiropractic care may reduce frequency of headaches in patients with chronic tension-type and cervicogenic headache. The use of a self-acupressure pillow (Dr Zaxx device) may help those with headache and headache pain relief as well as producing moderately high satisfaction with use.


      PubDate: 2015-11-07T20:53:56Z
       
  • Comparing Propensity Score Methods for Creating Comparable Cohorts of
           Chiropractic Users and Nonusers in Older, Multiply Comorbid Medicare
           Patients With Chronic Low Back Pain
    • Abstract: Publication date: Available online 5 November 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): William B. Weeks, Tor D. Tosteson, James M. Whedon, Brent Leininger, Jon D. Lurie, Rand Swenson, Christine M. Goertz, Alistair J. O'Malley
      Objective Patients who use complementary and integrative health services like chiropractic manipulative treatment (CMT) often have different characteristics than do patients who do not, and these differences can confound attempts to compare outcomes across treatment groups, particularly in observational studies when selection bias may occur. The purposes of this study were to provide an overview on how propensity scoring methods can be used to address selection bias by balancing treatment groups on key variables and to use Medicare data to compare different methods for doing so. Methods We described 2 propensity score methods (matching and weighting). Then we used Medicare data from 2006 to 2012 on older, multiply comorbid patients who had a chronic low back pain episode to demonstrate the impact of applying methods on the balance of demographics of patients between 2 treatment groups (those who received only CMT and those who received no CMT during their episodes). Results Before application of propensity score methods, patients who used only CMT had different characteristics from those who did not. Propensity score matching diminished observed differences across the treatment groups at the expense of reduced sample size. However, propensity score weighting achieved balance in patient characteristics between the groups and allowed us to keep the entire sample. Conclusions Although propensity score matching and weighting have similar effects in terms of balancing covariates, weighting has the advantage of maintaining sample size, preserving external validity, and generalizing more naturally to comparisons of 3 or more treatment groups. Researchers should carefully consider which propensity score method to use, as using different methods can generate different results.


      PubDate: 2015-11-07T20:53:56Z
       
  • Fiber Typing of the Erector Spinae and Multifidus Muscles in Healthy
           Controls and Back Pain Patients: A Systematic Literature Review
    • Abstract: Publication date: Available online 5 November 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Barbara Cagnie, Famke Dhooge, Charline Schumacher, Kayleigh De Meulemeester, Mirko Petrovic, Jessica van Oosterwijck, Lieven Danneels
      Objective Understanding the changes in muscle fiber typing is relevant in the context of muscle disorders because it provides information on the metabolic profile and functional capacity. The aim of this study was to systematically review the literature comparing muscle fiber typing in the back muscles of healthy subjects with low back pain (LBP) patients. Methods Predefined keywords regarding muscle fiber typing and back muscles were combined in PubMed and Web of Science electronic search engines from inception to August 2014. Full-text articles were independently screened by 2 independent, blinded researchers. Full texts fulfilling the predefined inclusion criteria were assessed on risk of bias by 2 independent researchers, and relative data were extracted. Data were not pooled because of heterogeneity in biopsy locations and population. Results From the 214 articles that were identified, 18 met the inclusion criteria. These articles evaluated the muscle fiber type distribution or proportional fiber type area between muscles, muscle layers, men, and women or healthy subjects and LBP patients. Regarding muscle fiber type distribution, findings in healthy subjects and LBP patients show no or inconclusive evidence for intermuscular and interindividual differentiation. Studies evaluating the proportional fiber type area also suggest little intermuscular differentiation but provide plausible evidence that the proportional area occupied by type I fibers is higher in women compared to men. The evidence for differentiation based on the presence of low back pain is conflicting. Conclusion This study found that the evidence regarding muscle fiber typing in back muscles is either inconclusive or shows little differences. The most plausible evidence exists for differentiation in proportional fiber type area depending on sex.


      PubDate: 2015-11-07T20:53:56Z
       
  • Comparison of Hypoalgesic Effects of Neural Stretching vs Neural Gliding:
           A Randomized Controlled Trial
    • Abstract: Publication date: Available online 21 October 2015
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Hector Beltran-Alacreu, Laura Jiménez-Sanz, Josue Fernández Carnero, Roy La Touche
      Objective The purpose of this study was to evaluate the immediate mechanical hypoalgesic effect of neural mobilization in asymptomatic subjects. We also compared neural gliding vs neural stretching to see which produced greater hypoalgesic effects in asymptomatic subjects. Methods Forty-five asymptomatic subjects (20 men and 25 women; mean ± SD age, 20.8 ± 2.83 years) were randomly allocated into 3 groups: the neural glide group, the neural stretch group, and the placebo group. Each subject received 1 treatment session. Outcome measures included bilateral pressure pain threshold measured at the trigeminal, cervical, and tibialis anterior points, assessed pre-treatment and immediately post-treatment by a blinded assessor. Three-way repeated-measures analysis of variance was used to evaluate changes in pressure pain threshold, with group (experimental or control) as the between-subjects variable and time (pre-, post-treatment) or side (dominant, nondominant) as the within-subjects variable. Results Group differences were identified between neural mobilization groups and the placebo group. Changes occurred in all of the pressure pain threshold measures for neural gliding, and in all but the trigeminal point for neural stretch. No changes in the pressure pain threshold measures occurred in the placebo group. Conclusions This research provides new experimental evidence that neural mobilization produces an immediate widespread hypoalgesic effect vs placebo but neural gliding produces hypoalgesic effects in more body sites than neural stretching.


      PubDate: 2015-10-31T20:33:31Z
       
 
 
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