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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  [2969 journals]
  • Sensorimotor Control Impairment in Young Adults With Idiopathic Scoliosis
           Compared With Healthy Controls
    • Abstract: Publication date: Available online 17 August 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jean-Philippe Pialasse, Pierre Mercier, Martin Descarreaux, Martin Simoneau
      Objective It has been hypothesized that the impaired sensorimotor control observed in adolescents with idiopathic scoliosis (IS) may be related more to the onset of scoliosis than to the maturation of sensory systems or sensorimotor control mechanisms. The objective of this study was to assess sensorimotor control in adults diagnosed with IS in adolescence versus healthy controls. Methods The study included 20 young adults 20 to 24 years of age (10 healthy controls and 10 diagnosed with adolescent IS but not treated for it). Binaural bipolar galvanic vestibular stimulation (GVS) was delivered to assess sensorimotor control. Vertical forces under each foot and upper body kinematics along the frontal plane were measured before GVS (2-second window), during GVS (2-second window), immediately after the cessation of GVS (1-second window), and during the following 2 seconds. Balance control was assessed by calculating the root mean square values of vertical forces and upper body kinematics. Results Compared with healthy controls, the IS group showed greater body sway upon GVS; the amplitude of this sway was even greater immediately after the cessation of GVS—an outcome requiring sensorimotor control. Conclusion Compared with normal controls, adults who had been diagnosed with IS in adolescence showed altered balance control immediately following GVS. This finding suggests that dysfunctional sensorimotor control may be related to the onset of scoliosis rather than to a transient suboptimal development of the sensory systems or sensorimotor control mechanisms.


      PubDate: 2016-08-18T05:48:19Z
       
  • Cross-cultural Adaptation of the Pelvic Girdle Questionnaire for the
           French-Canadian Population
    • Abstract: Publication date: Available online 14 August 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Marie-Pier Girard, Andrée-Anne Marchand, Britt Stuge, Stephanie-May Ruchat, Martin Descarreaux
      Objective The Pelvic Girdle Questionnaire (PGQ) is the only condition-specific tool assessing activity limitations and symptoms for those with pelvic girdle pain (PGP). It is simple to administer and can be used in research and clinical settings during pregnancy and postpartum periods; however, there currently is no version for the French-Canadian population. The aim of this study was to translate and culturally adapt the PGQ for the French-Canadian population. Methods The French-Canadian translation and adaptation of the PGQ was completed following a 4-stage approach: (1) forward translation, (2) synthesis, (3) expert committee review, and (4) testing of the prefinal version of the questionnaire. The testing stage was conducted with a cohort of 34 women, aged 18 to 45 years, who experienced PGP over the span of pregnancy or during the first year postpartum. Results The global understanding of the PGP concept was rated as either “Fair” (41.2%) or “Good” (32.4%) by the majority of participants, which led to the consensual decision to add an illustration of the pelvic girdle region to the final version of the French-Canadian PGQ. Only 1 item (“Has your leg/have your legs given way?”) was reported as unclear by 12 participants (35.3%). The expert committee unanimously agreed to add a brief explanation of the term “given way” to the final version to ensure proper understanding of the question. Conclusions The current study yielded a satisfactory French-Canadian translation of the PGQ.


      PubDate: 2016-08-18T05:48:19Z
       
  • Mapping the Health Care Policy Landscape for Complementary and Alternative
           Medicine Professions Using Expert Panels and Literature Analysis
    • Abstract: Publication date: Available online 14 August 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Patricia M. Herman, Ian D. Coulter
      Objectives The purpose of this project was to examine the policy implications of politically defining complementary and alternative medicine (CAM) professions by their treatment modalities rather than by their full professional scope. Methods This study used a 2-stage exploratory grounded approach. In stage 1, we identified how CAM is represented (if considered as professions vs modalities) across a purposely sampled diverse set of policy topic domains using exemplars to describe and summarize each. In stage 2 we convened 2 stakeholder panels (12 CAM practitioners and 9 health policymaker representatives), and using the results of stage 1 as a starting point and framing mechanism, we engaged panelists in a discussion of how they each see the dichotomy and its impacts. Our discussion focused on 4 licensed CAM professions: acupuncture and Oriental medicine, chiropractic, naturopathic medicine, and massage. Results Workforce policies affected where and how members of CAM professions could practice. Licensure affected whether a CAM profession was recognized in a state and which modalities were allowed. Complementary and alternative medicine research examined the effectiveness of procedures and modalities and only rarely the effectiveness of care from a particular profession. Treatment guidelines are based on research and also focus on procedures and modalities. Health plan reimbursement policies address which professions are covered and for which procedures/modalities and conditions. Conclusions The policy landscape related to CAM professions and modalities is broad, complex, and interrelated. Although health plan reimbursement tends to receive the majority of attention when CAM health care policy is discussed, it is clear, given the results of our study, that coverage policies cannot be addressed in isolation and that a wide range of stakeholders and social institutions will need to be involved.


      PubDate: 2016-08-18T05:48:19Z
       
  • Editorial Board
    • Abstract: Publication date: July–August 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 6




      PubDate: 2016-08-14T05:33:41Z
       
  • Table of Contents
    • Abstract: Publication date: July–August 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 6




      PubDate: 2016-08-14T05:33:41Z
       
  • Information for Readers
    • Abstract: Publication date: July–August 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 6




      PubDate: 2016-08-14T05:33:41Z
       
  • Cervical Facet Joint Imaging-Guided Injections: A Comparison of Outcomes
           in Patients Referred Based on Imaging Findings vs Palpation for Pain
    • Abstract: Publication date: Available online 11 August 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Yann Le Clec’h, Cynthia K. Peterson, Florian Brunner, Christian W.A. Pfirrmann
      Objectives The purpose of this study was to compare outcomes of patients referred for cervical facet joint injections by either a medical doctor (MD) primarily basing the selection of facet levels on structural changes found on imaging vs a doctor of chiropractic (DC) selecting the levels for injection based on palpation for pain. Methods This was a prospective cohort outcome study including 121 consecutive patients receiving cervical facet injections with completed outcomes questionnaires. Medical doctors referred 91 patients and DCs referred 30 patients. Baseline pain numerical rating scale (NRS) data were collected. Outcomes collected at 1 day, 1 week, and 1 month after injection included NRS pain levels and overall “improvement” using the Patient Global Impression of Change scale (primary outcome). The responses “much better” and “better” were considered “improved.” The proportion improved was compared between the 2 groups using the χ2 test. NRS change scores for the 2 groups were compared using the unpaired t test. Results At 1 day, “improvement” was reported in 44.8% of DC-and 29.7% of MD-referred patients (P = .17). At 1 week, 37.9% of DC-and 21.3% of MD-referred patients reported improvement (P = .03). At 1 month, 50.0% of DC-and 31.0% of MD-referred patients reported improvement (P = .1). Conclusions A greater proportion of DC-referred patients (injection level based on palpation for pain) reported “improvement” at all follow-up time points. This finding reached statistical significance at 1 week. These findings may be because DCs use palpation for pain to determine injection level whereas MDs rely more on imaging findings. The results suggest that the reported moderate results of facet injections partially may be due to the inaccurate selection of the spinal level treated.


      PubDate: 2016-08-14T05:33:41Z
       
  • Handheld Tissue Hardness Meters for Assessing the Mechanical Properties of
           Skeletal Muscle: A Feasibility Study
    • Abstract: Publication date: Available online 11 August 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Kentaro Chino, Hideyuki Takahashi
      Objectives The purpose of this study was to examine the feasibility of using handheld tissue hardness meters to assess the mechanical properties of skeletal muscle. Methods This observational study included 33 healthy men (age, 22.4 ± 4.4 years) and 33 healthy women (age, 23.7 ± 4.2 years). Participants were placed in a supine position, and tissue hardness overlying the rectus femoris and the shear modulus of the muscle were measured on the right side of the body at 50% thigh length. In the same position, subcutaneous adipose tissue thickness and muscle thickness were measured using B-mode ultrasonography. To examine the associations of subcutaneous adipose tissue thickness, muscle thickness, and muscle shear modulus with tissue hardness, linear regression using a stepwise bidirectional elimination approach was performed. Results Stepwise linear regression revealed that subcutaneous adipose tissue thickness (r = −0.38, P = .002) and muscle shear modulus (r = 0.27, P = .03) were significantly associated with tissue hardness. Conclusions Significant associations among adipose tissue thickness, muscle shear modulus, and tissue hardness show the limitations and feasibility of handheld tissue hardness meters for assessing the mechanical properties of skeletal muscles.


      PubDate: 2016-08-14T05:33:41Z
       
  • Attitudes and Opinions of Doctors of Chiropractic Specializing in
           Pediatric Care Toward Patient Safety: A Cross-sectional Survey
    • Abstract: Publication date: Available online 13 August 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Katherine A. Pohlman, Linda Carroll, Lisa Hartling, Ross Tsuyuki, Sunita Vohra
      Objective The purpose of this cross-sectional survey was to evaluate attitudes and opinions of doctors of chiropractic (DCs) specializing in pediatric care toward patient safety. Methods The Medical Office Survey on Patient Safety Culture of the Agency for Healthcare Research and Quality was adapted for providers who use spinal manipulation therapy and sent out to 2 US chiropractic organizations’ pediatric council members (n = 400) between February and April 2014. The survey measured 12 patient safety dimensions and included questions on patient safety items and quality issues, information exchange, and overall clinic ratings. Data analyses included a percent composite average and a nonrespondent analysis. Results The response rate was 29.5% (n = 118). Almost one- third of respondents’ patients were pediatric (≤17 years of age). DCs with a pediatric certification were 3 times more likely to respond (P < .001), but little qualitative differences were found in responses. The patient safety dimensions with the highest positive composite percentages were Organizational Learning (both administration and clinical) and Teamwork (>90%). Patient Care Tracking/Follow-up and Work Pressure and Pace were patient safety dimensions that had the lowest positive composite scores (<85%). The responses also indicated that there was concern regarding information exchange with insurance/third-party payors. Two quality issues identified for improvement were (1) updating a patient’s medication list and (2) following up on critically abnormal results from a laboratory or imaging test within 1 day. The average overall patient safety rating score indicated that 83% of respondents rated themselves as “very good” or “excellent.” Conclusions Compared with 2014 Agency for Healthcare Research and Quality physician referent data from medical offices, pediatric DCs appear to have more positive patient safety attitudes and opinions. Future patient safety studies need to prospectively evaluate safety performance with direct feedback from patients and compare results with these self-assessed safety attitudes, as well as make further use of this survey to develop a comparable database for spinal manipulation providers.


      PubDate: 2016-08-14T05:33:41Z
       
  • Forces of Commonly Used Chiropractic Techniques for Children: A Review of
           the Literature
    • Abstract: Publication date: Available online 23 June 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Angela J. Todd, Matthew T. Carroll, Eleanor K.L. Mitchell
      Objective The purpose of this study is to review the available literature that describes forces of the most commonly used chiropractic techniques for children. Methods Review of the English-language literature using search terms Chiropract* and technique, protocol, or approach in databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine, and Index to Chiropractic Literature and direct contact with authors of articles and book chapters. Results Eleven articles that discussed the 7 most commonly used pediatric chiropractic techniques and the forces applied were identified. Chiropractic techniques reviewed described forces that were modified based on the age of the patient. Force data for mechanically assisted devices were varied, with the minimum force settings for some devices outside the age-specific safe range recommended in the literature when not modified in some way. Conclusion This review found that technique selection and application by chiropractors treating infants and young children are typically modified in force and speed to suit the age and development of the child.


      PubDate: 2016-08-10T05:14:01Z
       
  • Reliability and Reproducibility of Chest Wall Expansion Measurement in
           Young Healthy Adults
    • Abstract: Publication date: Available online 23 June 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Sophie Debouche, Laurent Pitance, Annie Robert, Giuseppe Liistro, Gregory Reychler
      Objective The purposes of this study were to (1) evaluate the reliability and reproducibility of chest expansion (CE) measurement on 2 different levels and (2) observe relationships between upper and lower CE measurements and lung function. Methods Fifty-three healthy subjects aged between 18 and 39 years were recruited. Chest expansion measurements were taken with a cloth tape measure at 2 levels of the rib cage (upper and lower). Reproducibility of the measurement was measured for 2 physiotherapists and on 2 different days. Lung function (ie, forced expiratory volume in 1 second [FEV1], forced vital capacity (FVC), vital capacity and, inspiratory capacity) was measured for all subjects by a spirometer (MEC Pocket-spiro USB100, Medical Electronic Construction, Brussels, Belgium). Results Upper CE was less than lower CE (5.4 cm and 6.4 cm, respectively; P < .001). Intrarater and interrater reliability were good for upper and lower CE. Reproducibility between physiotherapists was verified for both CE measurements. Reproducibility between days was only verified for upper CE. Sex influenced lower CE. Upper and lower CE values were correlated (r = 0.747; P < .01). Lower and upper CE were significantly and positively correlated with all lung function parameters and inspiratory muscle strength (moderately and weakly, respectively) except to inspiratory capacity for upper CE (P = .051) and for FEV1/FVC for both CE measurements. Conclusion Upper and lower CE measurements showed good intra- and interrater reliability and reproducibility in healthy subjects. Although both measurements were correlated with lung functions (ie, FEV1, FVC, and vital capacity), the findings of this study showed that upper CE measurements may be more useful in clinical practice to evaluate chest mobility and to give indirect information on lung volume function and inspiratory muscle strength.


      PubDate: 2016-08-10T05:14:01Z
       
  • The Effect of Phase of Menstrual Cycle on Joint Mobility in the Cervical
           Spine and Extremities in Nulliparous Women: A Cross-sectional Study
    • Abstract: Publication date: Available online 23 June 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Carol Ann Weis, Diane Grondin, Howard Vernon
      Objective The purpose of this study was to investigate the range of motion (ROM) of various joints in women throughout the menstrual cycle to determine whether there would be a difference in the ROM between the luteal and follicular phases during extension at the fifth metacarpophalangeal joint and bilateral rotation of the cervical spine in young adult nulliparous women. Methods Sixteen nulliparous women of childbearing age (mean age, 26 years) were recruited from the academic institution where the study was being performed. Participants were randomized into and tested during either the luteal or follicular phases of the menstrual cycle. In the following month, participants were tested in the opposite phases of the menstrual cycle. All testing was performed by a doctor of chiropractic. Differences in ROM were measured in single joint movements (fifth digit hyperextension) and in multijoint movements (bilateral cervical rotation) using an electromagnetic sensor system. Results No significant effects of phase were found on peak ROM of the fifth digit or during cervical spine rotation (left, right, or bilaterally), irrespective of trial. Conclusion There is no difference in ROM of the cervical spine or the fifth metacarpophalangeal joint, regardless of the phase of menses, suggesting there is likely no hormonal influence on these structures during the follicular or luteal phases.


      PubDate: 2016-08-10T05:14:01Z
       
  • Neck Flexor and Extensor Muscle Endurance in Subclinical Neck Pain:
           Intrarater Reliability, Standard Error of Measurement, Minimal Detectable
           Change, and Comparison With Asymptomatic Participants in a University
           Student Population
    • Abstract: Publication date: Available online 29 June 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ana S. Lourenço, Carina Lameiras, Anabela G. Silva
      Objective The aims of this study were to assess intrarater reliability and to calculate the standard error of measurement (SEM) and minimal detectable change (MDC) for deep neck flexor and neck extensor muscle endurance tests, and compare the results between individuals with and without subclinical neck pain. Methods Participants were students of the University of Aveiro reporting subclinical neck pain and asymptomatic participants matched for sex and age to the neck pain group. Data on endurance capacity of the deep neck flexors and neck extensors were collected by a blinded assessor using the deep neck flexor endurance test and the extensor endurance test, respectively. Intraclass correlation coefficients (ICCs), SEM, and MDC were calculated for measurements taken within a session by the same assessor. Differences between groups for endurance capacity were investigated using a Mann-Whitney U test. Results The deep neck flexor endurance test (ICC = 0.71; SEM = 6.91 seconds; MDC = 19.15 seconds) and neck extensor endurance test (ICC = 0.73; SEM = 9.84 minutes; MDC = 2.34 minutes) are reliable. No significant differences were found between participants with and without neck pain for both tests of muscle endurance (P > .05). Conclusion The endurance capacity of the deep neck flexors and neck extensors can be reliably measured in participants with subclinical neck pain. However, the wide SEM and MDC might limit the sensitivity of these tests.


      PubDate: 2016-08-10T05:14:01Z
       
  • Subjective Mental Workload and Its Correlation with Musculoskeletal
           Disorders in Bank Staff
    • Abstract: Publication date: Available online 29 June 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ebrahim Darvishi, Afshin Maleki, Omid Giahi, Arash Akbarzadeh
      Objective The purpose of this study was to evaluate the rate of subjective mental workload (SMWL) and its correlation with musculoskeletal disorders among bank staff members in Kurdistan Province located in western Iran. Methods This cross-sectional study was conducted among 200 bank staff members in Kurdistan Province, Iran. The mental workload was assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) computerized version. NASA-TLX is a multidimensional rating procedure that derives an overall workload score based on a weighted average of ratings on 6 subscales. These subscales include Mental Demands, Physical Demands, Temporal Demands, Performance, Effort, Effectiveness, and Frustration. The musculoskeletal disorders (MSDs) were documented with the Nordic Musculoskeletal Questionnaire and generic body diagram. Results Of the staff members, 78.5% experienced pain at least once during the past year in 1 of their 9 musculoskeletal body regions. The highest frequencies of pain were in the neck and lower back. The NASA-TLX estimated the Effort and Performance scales with mean ± SD of 72.8 ± 25.2 and 36 ± 22.6, respectively, as the maximal and minimal scores among the 6 subscales of SMWL. The statistical analysis of the data revealed that there was a significant correlation between the overall mental workload score and also among the 6 subscales of SMWL separately with MSDs (P < .05). Conclusion SMWL appears to be a risk factor in the incidence of MSDs, so that the odds of MSDs increased by 11% with each additional 1-point increase in SMWL score.


      PubDate: 2016-08-10T05:14:01Z
       
  • Reliability and Comparison of Spinal End-Range Motion Assessment Using a
           Skin-Surface Device in Participants With and Without Low Back Pain
    • Abstract: Publication date: Available online 16 July 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Jason Zafereo, Sharon Wang-Price, Jace Brown, Evan Carson
      Objectives The purposes of this study were to determine the reliability of using a skin-surface device to measure global and segmental thoracic and lumbar spine motion in participants with and without low back pain (LBP) and to compare global thoracic and lumbar motion between the 2 groups. Methods Forty participants were included in the study (20 adults with LBP and 20 age- and sex-matched adults without LBP). On the same day, 2 raters independently measured thoracic and lumbar spine motion by rolling a skin-surface device along the spine from C7 to S3, with participants at their end range of standing flexion and extension. Results In participants with LBP, global thoracic and lumbar flexion and extension end-range motion testing yielded fair-to-high intrarater reliability (intraclass correlation coefficient [ICC] = 0.76-0.96) and good-to-high interrater reliability (ICC = 0.82-0.98). Interrater reliability was fair to high (ICC = 0.77-0.93) for segmental lumbar flexion measurements in participants with LBP. No significant differences were found in global thoracic and lumbar flexion or extension end-range mobility between participants with and without LBP. Conclusions Global thoracic and lumbar end-range motion measurement using a skin-surface device has acceptable reliability for participants with LBP. Reliability for segmental end-range motion measurement was only acceptable for lumbar flexion in participants with LBP.


      PubDate: 2016-08-10T05:14:01Z
       
  • A Comparison of Fourth-Year Health Sciences Students’ Knowledge of
           Gross Lower and Upper Limb Anatomy
    • Abstract: Publication date: Available online 29 June 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Juan-Antonio Díaz-Mancha, José Manuel Castillo-López, Pedro V. Munuera-Martinez, Lourdes María Fernández-Seguín, Juan Polo-Padillo, Alberto Marcos Heredia-Rizo
      Objective The aim of the study was to assess and compare the knowledge of fourth-year medicine, physiotherapy (PT), nursing, and podiatry students in carpal and tarsal bone anatomy. Methods A cross-sectional study was carried out. Based on a nonprobability convenience sampling, 177 fourth-year students (117 women and 60 men, mean age of 23.16 ± 3.82 years) from the podiatry (n = 39), nursing (n = 26), PT (n = 73), and medicine (n = 39) schools at a large Spanish university were included. Measurements were taken of their gross anatomy knowledge by means of the carpal and the tarsal bone tests. Students were asked to identify all carpal and tarsal bones in an illustration of the bony skeleton of both regions and were given a maximum of 5 minutes per test. Results Of a total of 15 bones to be labeled, the PT (11.07 ± 3.30) and podiatry (9.36 ± 2.93) students had the highest rate of correct answers compared with the medicine (6.13 ± 3.27) and nursing (4.04 ± 3.72) undergraduates. When assessing academic degrees and test scores, significant differences were observed between PT and podiatry participants vs those from the medicine and nursing schools (P < .001). Conclusion Fourth-year students from the PT and podiatry programs correctly identified a higher number of carpal and tarsal bones than students from the nursing and medicine schools.


      PubDate: 2016-08-10T05:14:01Z
       
  • Editorial Board
    • Abstract: Publication date: June 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 5




      PubDate: 2016-06-10T09:11:53Z
       
  • Table of Contents
    • Abstract: Publication date: June 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 5




      PubDate: 2016-06-10T09:11:53Z
       
  • Information for Readers
    • Abstract: Publication date: June 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 5




      PubDate: 2016-06-10T09:11:53Z
       
  • Trends in the Use and Characteristics of Chiropractic Services in the
           Department of Veterans Affairs
    • Abstract: Publication date: June 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 5
      Author(s): Anthony J. Lisi, Cynthia A. Brandt
      Objectives The purpose of this study was to analyze national trends and key features of the Department of Veterans Affairs’ (VA’s) chiropractic service delivery and chiropractic provider workforce since their initial inception. Methods This was a serial cross-sectional analysis of the VA administrative data sampled from the first record of chiropractic services in VA through September 30, 2015. Data were obtained from VA’s Corporate Data Warehouse and analyzed with descriptive statistics. Results From October 1, 2004, through September 30, 2015, the annual number of patients seen in VA chiropractic clinics increased from 4052 to 37349 (821.7%), and the annual number of chiropractic visits increased from 20072 to 159366 (693.9%). The typical VA chiropractic patient is male, is between the ages of 45 and 64, is seen for low back and/or neck conditions, and receives chiropractic spinal manipulation and evaluation and management services. The total number of VA chiropractic clinics grew from 27 to 65 (9.4% annually), and the number of chiropractor employees grew from 13 to 86 (21.3% annually). The typical VA chiropractor employee is a 45.9-year-old man, has worked in VA for 4.5 years, and receives annual compensation of $97860. VA also purchased care from private sector chiropractors starting in 2000, growing to 159533 chiropractic visits for 19435 patients at a cost of $11155654 annually. Conclusions Use of chiropractic services and the chiropractic workforce in VA have grown substantially over more than a decade since their introduction.


      PubDate: 2016-06-10T09:11:53Z
       
  • A Biomechanical Investigation of Selected Lumbopelvic Hip Tests:
           Implications for the Examination of Walking
    • Abstract: Publication date: Available online 27 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Robert Walter Bailey, Jim Richards, James Selfe
      Objectives The purpose of this study was to compare lumbopelvic hip ranges of motion during the Trendelenburg, Single Leg Squat, and Corkscrew Tests to walking and to describe the 3-dimensional lumbopelvic hip motion during the tests. This may help clinicians to select appropriate tests when examining gait. Methods An optoelectronic movement analysis tracking system was used to assess the lumbopelvic hip region of 14 healthy participants while performing Trendelenburg, Single Leg Squat, and Corkscrew Tests and walking. The lumbopelvic hip 3-dimensional ranges of movement for the clinical tests were compared with walking using a repeated-measures analysis of variance with pairwise comparisons. Results No significant differences were found between the pelvic obliquity during the Trendelenburg Test and walking (Trendelenburg Test: L, 11.3° ± 4.8°, R, 10.8° ± 5.0° vs walk: L, 8.3° ± 4.8°, R 8.3° ± 5.1°, L, P = .143, R, P = .068). Significant differences were found between the hip sagittal plane range of movement during the Single Leg Squat and walking (Single Leg Squat: L, 44.2° ±13.7°, R, 41.7° ±10.9° vs walk: 38.6° ±7.0°, R 37.8° ±5.1°, P < .05), the hip coronal plane range of movement (Single Leg Squat: L, 9.1° ±5.8°, R, 9.0° ± 4.6° vs walk: L, 9.4° ± 2.3°, R 9.5° ± 2.0°, P < .05), and the hip coronal plane range of movement during the Corkscrew Test and walking (Corkscrew: L, 5.7° ±3.3°, R, 5.7° ±3.2° vs walk: L, 9.4° ± 2.3°, R 9.5° ± 2.0°, P < .05). Conclusions The results of the present study showed that, in young asymptomatic participants with no known lumbopelvic hip pathology, the pelvic obliquity during the Trendelenburg Test and walking is similar. During the Single Leg Squat, the hip moved more in the sagittal plane and less in the coronal plane when compared with walking. There was more movement in the hip transverse plane movement during the Corkscrew Test than during walking. These results suggest that for the Trendelenburg Test to be interpreted as normal, the pelvis should achieve at least 10° of pelvic obliquity; during the Single Leg Squat, the hip should move through 43° in the sagittal plane and under 10° in the coronal plane; and for the Corkscrew Test to be interpreted as normal, the hip should move through 6° of rotation and the trunk through 27° of rotation.


      PubDate: 2016-05-31T08:28:31Z
       
  • The Accuracy of Locating Lumbar Vertebrae When Using Palpation Versus
           Ultrasonography
    • Abstract: Publication date: Available online 26 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Rune Mygind Mieritz, Gregory Neil Kawchuk
      Objectives The purpose of this study was to determine the accuracy of locating lumbar vertebrae using palpation vs ultrasonography. Methods In this study, ultrasonic imaging was used by 2 experienced clinicians to identify the third lumbar spinous process (target) of a female participant. The target was then located by 16 undergraduate chiropractic students using clinical palpation techniques learned in their academic program (with participant seated and prone) and ultrasonic imaging learned through a 5-minute training video. Presumed target locations identified by students were recorded by infrared motion capture equipment. The coordinates of the presumed target site were then compared statistically. Results There was no significant difference between the presumed target position identified by the students using sitting and prone palpation (P = .346). These positions were significantly different from the target location identified by expert clinicians using ultrasonic imaging (P < .0001 in both cases). The vertebra identified by ultrasonic imaging by the students was the same vertebra identified by the expert clinicians using ultrasound. This position error in the vertebra identified by palpation resulted in the students mistakenly identifying the L4 spinous process as the target vertebra. Conclusions This study found that ultrasonography provided more accurate identification of a lumbar spinal landmark when compared with palpation. In addition, our data suggest that ultrasonic imaging to identify spinal landmarks can be learned easily and can improve accuracy of landmark detection. Although the time to use ultrasonic imaging was greater than with palpation, these results suggest that this procedure could potentially be used in clinical practice to identify spinal landmarks.


      PubDate: 2016-05-26T08:00:48Z
       
  • Manual and Instrument Applied Cervical Manipulation for Mechanical Neck
           Pain: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 12 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Lindsay M Gorrell, Kenneth Beath, Roger M Engel
      Objective The purpose of this study was to compare the effects of 2 different cervical manipulation techniques for mechanical neck pain (MNP). Methods Participants with MNP of at least 1 month’s duration (n = 65) were randomly allocated to 3 groups: (1) stretching (control), (2) stretching plus manually applied manipulation (MAM), and (3) stretching plus instrument-applied manipulation (IAM). MAM consisted of a single high-velocity, low-amplitude cervical chiropractic manipulation, whereas IAM involved the application of a single cervical manipulation using an (Activator IV) adjusting instrument. Preintervention and postintervention measurements were taken of all outcomes measures. Pain was the primary outcome and was measured using visual analogue scale and pressure pain thresholds. Secondary outcomes included cervical range of motion, hand grip-strength, and wrist blood pressure. Follow-up subjective pain scores were obtained via telephone text message 7 days postintervention. Results Subjective pain scores decreased at 7-day follow-up in the MAM group compared with control (P = .015). Cervical rotation bilaterally (ipsilateral: P = .002; contralateral: P = .015) and lateral flexion on the contralateral side to manipulation (P = .001) increased following MAM. Hand grip-strength on the contralateral side to manipulation (P = .013) increased following IAM. No moderate or severe adverse events were reported. Mild adverse events were reported on 6 occasions (control, 4; MAM, 1; IAM, 1). Conclusion This study demonstrates that a single cervical manipulation is capable of producing immediate and short-term benefits for MNP. The study also demonstrates that not all manipulative techniques have the same effect and that the differences may be mediated by neurological or biomechanical factors inherent to each technique.


      PubDate: 2016-05-15T19:59:38Z
       
  • The Relationship Between Clinical Instability and Endurance Tests, Pain,
           and Disability in Nonspecific Low Back Pain
    • Abstract: Publication date: Available online 7 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Carla Vanti, Cristina Conti, Federica Faresin, Silvano Ferrari, Raffaella Piccarreta
      Objective The aims of this study were (1) to investigate the relationship between clinical tests detecting spinal instability and the perceived pain and disability in nonspecific low back pain and (2) to investigate the relationship between endurance and instability tests. Methods Four instability tests (aberrant movements, active straight leg raising, prone instability test, and passive lumbar extension test) and 2 endurance tests (prone bridge test [PBT] and supine bridge test [SBT]) were performed on 101 participants. Their results were compared with the Numerical Rating Scale and the Oswestry Disability Index evaluating pain and disability, respectively. Results A low to moderate significant relationship between pain, disability, and all tests with the exception of PBT was observed. A low to moderate significant relationship between endurance tests and instability tests was also shown. The results of PBT and SBT were significantly related to the duration of symptoms (P = .0014 and P = .0203, respectively). Conclusion The results of endurance and instability tests appear to be related to the amount of pain and the disability in nonspecific low back pain. The persistence of pain significantly reduces anterior and posterior core muscle endurance.


      PubDate: 2016-05-10T19:33:34Z
       
  • Variations in Patterns of Utilization and Charges for the Care of Low Back
           Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data
           Analysis
    • Abstract: Publication date: May 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4
      Author(s): Eric L. Hurwitz, Dongmei Li, Jenni Guillen, Michael J. Schneider, Joel M. Stevans, Reed B. Phillips, Shawn P. Phelan, Eugene A. Lewis, Richard C. Armstrong, Maria Vassilaki
      Objectives The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by patterns of care for the treatment of low back pain in North Carolina. Methods This was an analysis of low-back-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, 9th Revision diagnostic codes for uncomplicated low back pain (ULBP) and complicated low back pain (CLBP). Results Care patterns with single-provider types and no referrals incurred the least charges on average for both ULBP and CLBP. When care did not include referral providers or services, for ULBP, MD and DC care was on average $465 less than MD and PT care. For CLBP, MD and DC care averaged $965 more than MD and PT care. However, when care involved referral providers or services, MD and DC care was on average $1600 less when compared to MD and PT care for ULBP and $1885 less for CLBP. Risk-adjusted charges (available 2006-2009) for patients in the middle quintile of risk were significantly less for DC care patterns. Conclusions Chiropractic care alone or DC with MD care incurred appreciably fewer charges for ULBP than MD care with or without PT care. This finding was reversed for CLBP. Adjusted charges for both ULBP and CLBP patients were significantly lower for DC patients.


      PubDate: 2016-05-10T19:33:34Z
       
  • Axillary Ultrasound and Laser Combined with Postisometric Facilitation in
           Treatment of Shoulder Adhesive Capsulitis: A Randomized Clinical Trial
    • Abstract: Publication date: Available online 7 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Haytham M. Elhafez, Salam M. Elhafez
      Objectives The purpose of this study was to compare axillary ultrasound, laser, and postisometric facilitation technique with standard care in the management of shoulder adhesive capsulitis. Methods This is a randomized clinical trial study. Fifty-nine participants with shoulder adhesive capsulitis were selected and randomly assigned for eligibility. Forty-five participants were assigned into 3 equal groups of 15, and 14 participants were excluded from the study. The participants were blinded to their group allocation. Standard care group (A) received traditional physical therapy treatment in the form of pulsed ultrasound, scanning laser, supervised exercise program, and home exercise program; group B received the same physical therapy program as group A, except that the ultrasound and scanning laser were applied to the axillary region of the painful shoulder; and group C received the same modified physical therapy program as group B plus postisometric facilitation technique to the painful shoulder. All dependent variables were measured by the second author, who was blinded to the participant's intervention group. The first author administered treatment to all 3 groups. All participants received 12 sessions (3 times/wk for 4 weeks). Pain level and shoulder range of motion (ROM; flexion, abduction, and external rotation) were recorded 3 times (pretreatment, immediately posttreatment, and 4 weeks of treatment). Results Mixed-design multivariate analysis of variance indicated significant pain reduction with significant ROM increase in all groups posttreatment and after 4 weeks. Post hoc analysis for within groups revealed that shoulder ROM and pain levels improved significantly posttreatment compared with pretreatment ROM in all groups, with the greatest improvement in group C. Between-group analysis revealed that pain-free shoulder flexion, abduction, external rotation, and pain level improved significantly in group C compared with groups A and B immediately after treatment and after 4 weeks of follow-up (P < .05). Improvements reported in group B is more than in group A, and C is more than in groups A and B. Conclusions Combining axillary ultrasound and laser with postisometric facilitation had a greater effect in reducing pain and improving shoulder ROM in patients with shoulder adhesive capsulitis compared with axillary ultrasound and laser with traditional exercise.


      PubDate: 2016-05-10T19:33:34Z
       
  • Effect of Dry Needling on Spasticity, Shoulder Range of Motion, and
           Pressure Pain Sensitivity in Patients With Stroke: A Crossover Study
    • Abstract: Publication date: Available online 7 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Ana Mendigutia-Gómez, Carolina Martín-Hernández, Jaime Salom-Moreno, César Fernández-de-las-Peñas
      Objective The purpose of this study was to determine the effects of the inclusion of deep dry needling (DDN) in spastic shoulder muscles into a rehabilitation program on spasticity, pressure pain sensitivity, and shoulder range of motion in subjects who had experienced a stroke. Methods A controlled, repeated-measures, crossover, double-blinded, randomized trial was conducted. Twenty patients who have had a stroke were randomly assigned to receive rehabilitation alone or rehabilitation combined with DDN over the upper trapezius, infraspinatus, subscapularis, and pectoralis mayor muscles on the spastic shoulder. Subjects received both interventions separated at least 15 days apart. Each intervention was applied once per week over 3 weeks. Spasticity (Modified Ashworth Scale), pressure pain thresholds over the deltoid and infraspinatus muscles and C5-C6 zygapophyseal joint, and shoulder range of motion were collected 1 week before and 1 week after each intervention by a blinded assessor. Results Reduction in spasticity was similar after both conditions for the upper trapezius, pectoralis major, and subscapularis muscles. A greater number of individuals receiving DDN exhibited decreased spasticity within the infraspinatus muscle. The analysis of covariance showed that all pressure pain thresholds, shoulder abduction, and external rotation of the shoulder increased significantly more after DNN intervention (P < .05). Shoulder flexion showed similar changes after both conditions. Conclusions Our results suggest that inclusion of DDN into a multimodal rehabilitation program was effective for decreasing localized pressure sensitivity and improving shoulder range of motion in individuals who had experienced stroke; however, we did not observe significant differences in muscle spasticity.


      PubDate: 2016-05-10T19:33:34Z
       
  • Variations in Patterns of Utilization and Charges for the Care of Neck
           Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data
           Analysis
    • Abstract: Publication date: May 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4
      Author(s): Eric L. Hurwitz, Dongmei Li, Jenni Guillen, Michael J. Schneider, Joel M. Stevans, Reed B. Phillips, Shawn P. Phelan, Eugene A. Lewis, Richard C. Armstrong, Maria Vassilaki
      Objectives The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by provider patterns of care for the treatment of neck pain in North Carolina. Methods This was an analysis of neck-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees (NCSHP) from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the NCSHP using ICD-9 diagnostic codes for uncomplicated neck pain (UNP) and complicated neck pain (CNP). Results Care patterns with single-provider types and no referrals incurred the least average charges for both UNP and CNP. When care did not include referral providers or services, for either UNP or CNP, MD care with PT was generally less expensive than MD care with DC care. However, when care involved referral providers or services, MD and PT care was on average more expensive than MD and DC care for either UNP or CNP. Risk-adjusted charges for patients in the middle quintile of risk (available 2006-2009) were lower for chiropractic patients with or without medical care or referral care to other providers. Conclusions Chiropractic care alone or DC with MD care incurred appreciably fewer charges for UNP or CNP compared to MD care with or without PT care, when care included referral providers or services. This finding was reversed when care did not include referral providers or services. Risk-adjusted charges for UNP and CNP patients were lower for DC care patterns.


      PubDate: 2016-05-10T19:33:34Z
       
  • Editorial Board
    • Abstract: Publication date: May 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4




      PubDate: 2016-05-10T19:33:34Z
       
  • Table of Contents
    • Abstract: Publication date: May 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4




      PubDate: 2016-05-10T19:33:34Z
       
  • Information for Readers
    • Abstract: Publication date: May 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4




      PubDate: 2016-05-10T19:33:34Z
       
  • Variations in Patterns of Utilization and Charges for the Care of Headache
           in North Carolina, 2000-2009: A Statewide Claims’ Data Analysis
    • Abstract: Publication date: May 2016
      Source:Journal of Manipulative and Physiological Therapeutics, Volume 39, Issue 4
      Author(s): Eric L. Hurwitz, Maria Vassilaki, Dongmei Li, Michael J. Schneider, Joel M. Stevans, Reed B. Phillips, Shawn P. Phelan, Eugene A. Lewis, Richard C. Armstrong
      Objectives The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina. Methods Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns. Results The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care. Conclusions Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care.


      PubDate: 2016-05-10T19:33:34Z
       
  • Effect of Spinal Manipulation of Upper Cervical Vertebrae on Blood
           Pressure: Results of a Pilot Sham-Controlled Trial
    • Abstract: Publication date: Available online 9 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Christine M. Goertz, Stacie A. Salsbury, Robert D. Vining, Cynthia R. Long, Katherine A. Pohlman, William B. Weeks, Gervasio A. Lamas
      Objective The purpose of this pilot sham-controlled clinical trial was to estimate the treatment effect and safety of toggle recoil spinal manipulation for blood pressure management. Methods Fifty-one participants with prehypertension or stage 1 hypertension (systolic blood pressure ranging from 135 to 159 mm Hg or diastolic blood pressure ranging from 85 to 99 mm Hg) were allocated by an adaptive design to 2 treatments: toggle recoil spinal manipulation or a sham procedure. Participants were seen by a doctor of chiropractic twice weekly for 6 weeks and remained on their antihypertensive medications, as prescribed, throughout the trial. Blood pressure was assessed at baseline and after study visits 1, 6 (week 3), and 12 (week 6), with the primary end point at week 6. Analysis of covariance was used to compare mean blood pressure changes from baseline between groups at each end point, controlling for sex, age, body mass index, and baseline blood pressure. Results Adjusted mean change from baseline to week 6 was greater in the sham group (systolic, −4.2 mm Hg; diastolic, −1.6 mm Hg) than in the spinal manipulation group (systolic, 0.6 mm Hg; diastolic, 0.7 mm Hg), but the difference was not statistically significant. No serious and few adverse events were noted. Conclusions Six weeks of toggle recoil spinal manipulation did not lower systolic or diastolic blood pressure when compared with a sham procedure. No serious adverse events from either treatment were reported. Our results do not support a larger clinical trial. Further research to understand the potential mechanisms of action involving upper cervical manipulation on blood pressure is warranted before additional clinical investigations are conducted.


      PubDate: 2016-05-10T19:33:34Z
       
  • Effect of Spinal Manipulation on Pelvic Floor Functional Changes in
           Pregnant and Nonpregnant Women: A Preliminary Study
    • Abstract: Publication date: Available online 6 May 2016
      Source:Journal of Manipulative and Physiological Therapeutics
      Author(s): Heidi Haavik, Bernadette A. Murphy, Jennifer Kruger
      Objective The aim of this study was to investigate whether a single session of spinal manipulation of pregnant women can alter pelvic floor muscle function as measured using ultrasonographic imaging. Methods In this preliminary, prospective, comparative study, transperineal ultrasonographic imaging was used to assess pelvic floor anatomy and function in 11 primigravid women in their second trimester recruited via notice boards at obstetric caregivers, pregnancy keep-fit classes, and word of mouth and 15 nulliparous women recruited from a convenience sample of female students at the New Zealand College of Chiropractic. Following bladder voiding, 3-/4-dimensional transperineal ultrasonography was performed on all participants in the supine position. Levator hiatal area measurements at rest, on maximal pelvic floor contraction, and during maximum Valsalva maneuver were collected before and after either spinal manipulation or a control intervention. Results Levator hiatal area at rest increased significantly (P < .05) after spinal manipulation in the pregnant women, with no change postmanipulation in the nonpregnant women at rest or in any of the other measured parameters. Conclusion Spinal manipulation of pregnant women in their second trimester increased the levator hiatal area at rest and thus appears to relax the pelvic floor muscles. This did not occur in the nonpregnant control participants, suggesting that it may be pregnancy related.


      PubDate: 2016-05-06T19:25:49Z
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
  • 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
       
 
 
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