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Keating G, Hawk C, Amorin-Woods L, Amorin-Woods D, Vallone S, Farabaugh R, Todd A, Ferrance R, Young J, O'Neill Bhogal S, Sexton H, Alevaki H, Miller J, Parkin-Smith G, Schielke A, Robinson A, Thompson R. Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:216-232. [PMID: 37902954 PMCID: PMC10954607 DOI: 10.1089/jicm.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
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Affiliation(s)
- Genevieve Keating
- Fielding Graduate University, Santa Barbara, CA, USA
- Private Practice, Melbourne, Australia
| | - Cheryl Hawk
- US-Clinical Compass, Lexington SC, USA
- Texas Chiropractic College, TX, USA
| | - Lyndon Amorin-Woods
- School of Allied Health, Murdoch University, Murdoch, Australia
- Private Practice, Perth, Australia
| | - Deisy Amorin-Woods
- Edith Cowan University, Joondalup, Australia
- Private Practice, Insight Counselling, Perth, Australia
| | | | - Ronald Farabaugh
- Advanced Medicine Integration Group, Columbus, OH, USA
- Clinical Compass, Columbus, OH, USA
| | - Angela Todd
- Private Practice, Sale, Australia
- Aus-ACA, Sale, Australia
| | | | | | | | | | | | - Joyce Miller
- Anglo European College of Chiropractic, Bournemouth, United Kingdom
| | - Gregory Parkin-Smith
- Private Practice, Perth, Australia
- School of Allied Health, Murdoch University, Murdoch, Australia
| | | | | | - Robyn Thompson
- Private Practice, The Thompson Method Breastfeeding, Melbourne, Australia
- Australian Catholic University, Fitzroy, Australia
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Hayes R, Imbeau C, Pohlman KA, Blanchette MA, Doucet C. Chiropractic care and research priorities for the pediatric population: a cross-sectional survey of Quebec chiropractors. Chiropr Man Therap 2023; 31:42. [PMID: 37752493 PMCID: PMC10523689 DOI: 10.1186/s12998-023-00514-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Chiropractors commonly treat pediatric patients within their private practices. The objectives of this study were (1) to identify the treatment techniques and health advice used by Quebec chiropractors with pediatric patients; (2) to explore the research priorities of Quebec chiropractors for the pediatric population; and (3) to identify Quebec chiropractors' training in the field of pediatric chiropractics. METHODS A web-based cross-sectional survey was conducted among all licensed Quebec chiropractors (Qc, Canada). Descriptive statistics were used to analyze all quantitative variables. RESULTS The results showed that among the 245 respondents (22.8% response rate), practitioners adapted their treatment techniques based on their patients' age group, thus using softer techniques with younger pediatric patients and slowly gravitating toward techniques used with adults when patients reached the age of six. In terms of continuing education, chiropractors reported an average of 7.87 h of training on the subject per year, which mostly came from either Quebec's College of Chiropractors (OCQ) (54.7%), written articles (46.9%) or seminars and conferences (43.7%). Both musculoskeletal (MSK) and viscerosomatic conditions were identified as high research priorities by the clinicians. CONCLUSIONS Quebec chiropractors adapt their treatment techniques to pediatric patients. In light of limited sources of continuing education in the field of pediatric chiropractics, practitioners mostly rely on the training provided by their provincial college and scientific publications. According to practitioners, future research priorities for pediatric care should focus on both MSK conditions and non-MSK conditions.
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Affiliation(s)
- Rebecca Hayes
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
| | - Camille Imbeau
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | | | - Marc-André Blanchette
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Chantale Doucet
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
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Fisher M. The John A. Sweaney Lecture: Berlin, Germany, March 2019, Given by Dr. Matthew Fisher: Becoming a Trusted Advisor in Health or Does Ego Get in the Way? An Australian Story. JOURNAL OF CHIROPRACTIC HUMANITIES 2019; 26:75-81. [PMID: 33935607 PMCID: PMC8076910 DOI: 10.1016/j.echu.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/21/2019] [Indexed: 06/12/2023]
Abstract
The following is The John A. Sweaney Lecture delivered by Dr. Matthew Fisher at the biannual meeting of the World Federation of Chiropractic in Berlin, Germany, on March 19, 2019.
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Affiliation(s)
- Matthew Fisher
- Corresponding author: Matthew Fisher, PhD, Chief Executive Officer, Australian Chiropractors Association, PO Box 255, Parramatta NSW 2124 Australia.
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Miller JE, Hanson HA, Hiew M, Lo Tiap Kwong DS, Mok Z, Tee YH. Maternal Report of Outcomes of Chiropractic Care for Infants. J Manipulative Physiol Ther 2019; 42:167-176. [PMID: 31029467 DOI: 10.1016/j.jmpt.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/11/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom. METHODS This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate. RESULTS In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events. CONCLUSION In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.
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Affiliation(s)
- Joyce E Miller
- Outpatient Teaching Clinic, AECC University College, Bournemouth, Dorset, UK.
| | | | - Mandy Hiew
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | | | - Zicheng Mok
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | - Yun-Han Tee
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
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Hawk C, Minkalis A, Webb C, Hogan O, Vallone S. Manual Interventions for Musculoskeletal Factors in Infants With Suboptimal Breastfeeding: A Scoping Review. J Evid Based Integr Med 2018. [PMCID: PMC6299335 DOI: 10.1177/2515690x18816971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Exclusive breastfeeding for the first 6 months, and continuing for at least the first year of life, is strongly recommended. Suboptimal breastfeeding, which is breastfeeding that does not meet these recommendations, is a multifactorial issue. Some authorities, particularly in the nursing and lactation counseling professions, have identified musculoskeletal issues that may interfere with successful breastfeeding. The purpose of this project was to survey the literature on manual treatments to correct musculoskeletal dysfunctions in infants with suboptimal breastfeeding. Our research question was, “Have manual interventions been used to correct infants’ musculoskeletal dysfunctions thought to be linked to suboptimal breastfeeding?” We searched PubMed and Index to Chiropractic Literature, from inception through July 2018, as well as relevant gray literature. We assessed quality of randomized controlled trials (RCTs) and cohort studies using modified SIGN checklists, and the overall strength of evidence using GRADE. The search yielded 461 articles, with a final inclusion of 27 articles: 7 expert commentaries, 1 high-quality RCT, 1 low-quality cohort, 1 pilot study, 2 cross-sectional surveys, 5 narrative reviews, and 10 case series or case reports. Combining the 10 case series and reports in our search with 18 discussed in narrative reviews included in our review yielded 201 infants who received manual therapy for nursing dysfunction. No serious adverse events were reported and improvement in nursing ability was observed using various outcome measures, usually maternal report. Based on the GRADE criteria, there is moderate positive evidence for the effect of manual therapy on suboptimal breastfeeding.
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Affiliation(s)
- Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
| | - Amy Minkalis
- Palmer Center for Chiropractic Research, Davenport, IA, USA
| | - Carol Webb
- Texas Chiropractic College, Pasadena, TX, USA
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Saedt ERIC, Driehuis F, Hoogeboom TJ, van der Woude BH, de Bie RA, Nijhuis-van der Sanden MWG. Common Manual Therapy Practices in the Netherlands for Infants With Upper Cervical Dysfunction: A Prospective Cohort Study. J Manipulative Physiol Ther 2017; 41:52-61. [PMID: 29254625 DOI: 10.1016/j.jmpt.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/01/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to describe common clinical practices of manual therapists (MTs) in the Netherlands for infants with indications of upper cervical dysfunction (UCD). METHODS A prospective observational cohort study was conducted to gain insight into characteristics, reasons for seeking care, and common clinical practice for infants (<27 weeks) with indications of UCD, referred to MTs. Pre- and posttreatment self-reported questionnaires were used to collect data from parents and MTs. Parents reported on infant characteristics and perceived effect of treatment. Manual therapists reported on diagnostics, therapeutic procedures, and outcomes. RESULTS Between 2006 and 2007, data regarding 307 referred infants (mean age: 11.2 weeks) were collected by parents and 42 MTs. The most frequent reasons for seeking care were positional preference, restlessness, and/or abnormal head position. Manual therapists observed active, spontaneous, and provoked mobility and passive upper cervical mobility. Of the 307 infants, 295 were diagnosed with UCD based on positive outcomes on the flexion-rotation test and/or lateral flexion test. After treatment with mobilization techniques, positive outcomes on the flexion-rotation test decreased from 78.8% to 6.8%. For the lateral flexion test, the positive outcomes decreased from 91.5% to 6.2%. All parents perceived positive treatment effects. No serious adverse events were reported during this study. CONCLUSIONS This is the first study to describe common clinical practice for infants referred for manual therapy. Infants with UCD were treated mainly with upper cervical mobilization techniques, and the greatest perceived effect was observed after approximately 2 treatment sessions.
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Affiliation(s)
- Eric R I C Saedt
- Practice for physical and manual therapy, Saedt and Daanen, Ravenstein, The Netherlands
| | - Femke Driehuis
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - Thomas J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Bé H van der Woude
- Practice for manual therapy and (pediatric) physical therapy, Boxmeer, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Caphri research school, Maastricht University, Maastricht, The Netherlands
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Todd AJ, Carroll MT, Mitchell E. Response to Letter to the Editor on "Forces of Commonly Applied Chiropractic Pediatric Techniques: A Review of the Literature". J Manipulative Physiol Ther 2017; 40:215-216. [PMID: 28283316 DOI: 10.1016/j.jmpt.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Matthew T Carroll
- School of Rural Health-Churchill, Monash University, Churchill, Victoria, Australia
| | - Eleanor Mitchell
- School of Rural Health-Churchill, Monash University, Churchill, Victoria, Australia
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Triano JJ, Lester S, Starmer D, Hewitt EG. Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators. J Manipulative Physiol Ther 2017; 40:139-146. [PMID: 28274487 DOI: 10.1016/j.jmpt.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/25/2016] [Accepted: 01/10/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose-response and safety studies on therapeutic benefit. METHODS The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature. RESULTS Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies. CONCLUSIONS The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.
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Affiliation(s)
- John J Triano
- Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | - Steven Lester
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - David Starmer
- Simulation Lab, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Elise G Hewitt
- Adjunct Faculty, University of Western States, Portland, OR
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9
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Lopes MA, Plaugher G. Response to "Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature". J Manipulative Physiol Ther 2017; 40:214-215. [PMID: 28259494 DOI: 10.1016/j.jmpt.2016.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Mark A Lopes
- Private Practice, Chico, CA; Private Practice, San Francisco, CA
| | - Gregory Plaugher
- Private Practice, Chico, CA; Private Practice, San Francisco, CA
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10
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Kayser R, Harke G. Manuelle Medizin und osteopathische Verfahren an der wachsenden Wirbelsäule. MANUELLE MEDIZIN 2016. [DOI: 10.1007/s00337-016-0171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Todd AJ, Carroll MT, Mitchell EKL. Forces of Commonly Used Chiropractic Techniques for Children: A Review of the Literature. J Manipulative Physiol Ther 2016; 39:401-410. [PMID: 27346861 DOI: 10.1016/j.jmpt.2016.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
| | - Matthew T Carroll
- School of Rural Health-Churchill, Monash University, Churchill, Australia
| | - Eleanor K L Mitchell
- Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Australia; School of Rural Health-East Gippsland, Monash University, Bairnsdale, Australia
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12
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Kayser R, Harke G. [Manual medicine and osteopathic methods on the growing spine]. DER ORTHOPADE 2016; 45:527-33. [PMID: 27255905 DOI: 10.1007/s00132-016-3276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The application of various techniques in manual medicine on infants, toddlers and adolescents enjoys widespread acknowledgement not only in the musculoskeletal field but also beyond that. For a long time, the seminars of the DGMM have been trying to structure the advanced training of doctors and the vocational training of physiotherapists and to adjust it according to the latest clinical and scientific findings (in this subject matter). Considering the controversial debates, this seems particularly necessary and meaningful. This article aims to identify the current state of discussion and the consensus between medical associations but it also means to provide assistance in daily routine.
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Affiliation(s)
- R Kayser
- Abt. Orthopädie, MEDIAN-Klinik Wismar, Ernst-Scheel-Str. 28, 23986, Wismar, Deutschland. .,Universitätsmedizin Greifswald, Fleischmannstr. 8, 17489, Greifswald, Deutschland. .,Ärztevereinigung für Manuelle Medizin, Ärzteseminar Berlin (ÄMM), Deutsche Gesellschaft für Manuelle Medizin (DGMM), Köpenicker Str. 48/49, 10179, Berlin, Deutschland.
| | - G Harke
- Manuelle Medizin und Osteopathie, Praxis für Physikalische und Rehabilitative Medizin, Schlossstr. 26, 12163, Berlin, Deutschland.,Ärztevereinigung für Manuelle Medizin, Ärzteseminar Berlin (ÄMM), Deutsche Gesellschaft für Manuelle Medizin (DGMM), Köpenicker Str. 48/49, 10179, Berlin, Deutschland
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Starmer DJ, Guist BP, Tuff TR, Warren SC, Williams MGR. Changes in Manipulative Peak Force Modulation and Time to Peak Thrust among First-Year Chiropractic Students Following a 12-Week Detraining Period. J Manipulative Physiol Ther 2016; 39:311-7. [PMID: 27059248 DOI: 10.1016/j.jmpt.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 09/05/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- David J Starmer
- Education Coordinator, Simulation Lab, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Chair, Faculty Council, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Brett P Guist
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | - Taylor R Tuff
- Sports Science Resident, Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Sarah C Warren
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Matthew G R Williams
- Research Assistant, Canadian Memorial Chiropractic College, Toronto, ON, Canada; Research Assistant, University of New Brunswick, Fredericton, NB, Canada
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Best Practices for Chiropractic Care of Children: A Consensus Update. J Manipulative Physiol Ther 2016; 39:158-68. [PMID: 27040034 DOI: 10.1016/j.jmpt.2016.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/22/2016] [Accepted: 02/23/2016] [Indexed: 12/16/2022]
Abstract
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.
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