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Henderson VK, Brismée JM. Pediatric neck pain of a 10-year-old child with cervical spinal tumor evaluated and managed in direct access physical therapy: a case report. J Man Manip Ther 2024; 32:335-342. [PMID: 38415682 PMCID: PMC11216264 DOI: 10.1080/10669817.2024.2319427] [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: 11/25/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Differential diagnosis of pediatric neck pain requires age-appropriate communication and assessment tools. Recognizing these age-related nuances is critical, emphasizing the role of physical therapists in assessing and managing pediatric patients while ruling out severe pathologies. CASE DESCRIPTION A 10-year-old male presented to physical therapy with a five-week history of increasing neck pain. A thorough history and segmental cervical examination considering the patient's age and development, led to patient referral to the emergency department. This case underscores the significance of comprehensive evaluation in pediatric neck pain management. OUTCOMES The patient was diagnosed with Langerhans Cell Histiocytosis (LCH). LCH primarily affects children and is treated with chemotherapy. Chemotherapy reduced the tumor, revealing C2 vertebral body damage. The patient underwent C1-C3 fusion surgery, a standard procedure for atlanto-occipital region stabilization in children. The patient was advised to restrict motion for 6 months while monitoring for tumor growth. DISCUSSION-CONCLUSION Pediatric neck cancer presents diagnostic challenges due to varied symptoms, but research highlights specific indicators to assist with differential diagnosis. This case emphasizes the need to recognize the complexities of pediatric neck pain and perform a thorough age-appropriate evaluation.
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Affiliation(s)
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Dice JL, Brismee JM, Froment FP, Henricksen J, Sherwin R, Pool J, Milne N, Clewley D, Basson A, Olson KA, Gross AR. Perceived factors and barriers affecting physiotherapists' decision to use spinal manipulation and mobilisation among infants, children, and adolescents: an international survey. J Man Manip Ther 2024; 32:295-303. [PMID: 38940281 PMCID: PMC11216267 DOI: 10.1080/10669817.2024.2363033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/24/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE To identify factors and barriers, which affect the utilisation of spinal manipulation and mobilisation among infants, children, and adolescents. METHODS Twenty-six international expert physiotherapists in manual therapy and paediatrics were invited to participate in a Delphi investigation using QualtricsⓇ. In Round-1 physiotherapists selected from a list of factors and barriers affecting their decision to use spinal manipulation and mobilisation in the paediatric population and had opportunity to add to the list. Round-2 asked respondents to select as many factors and barriers that they agreed with, resulting in a frequency count. The subset of responses to questions around barriers and facilitators are the focus of this study. RESULTS Twelve physiotherapists completed both rounds of the survey. Medical diagnosis, mechanism of injury, patient presentation, tolerance to handling, and therapist's knowledge of techniques were the dominant deciding factors to use spinal manipulation and mobilisation among infants, children, and adolescents across spinal levels. More than 90% of the respondents selected manipulation as inappropriate among infants as their top barrier. Additional dominant barriers to using spinal manipulation among infants and children identified by ≥ 75% of the respondents included fear of injuring the patient, fear of litigation, lack of communication, lack of evidence, lack of guardian consent, and precision of the examination to inform clinical reasoning. CONCLUSION This international survey provides much needed insight regarding the factors and barriers physiotherapists should consider when contemplating the utilisation of spinal mobilisation and manipulation in the paediatric population.
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Affiliation(s)
- Jenifer L. Dice
- School of Physical Therapy, Texas Woman’s University, Houston, TX, USA
| | - Jean-Michel Brismee
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Frédéric P. Froment
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- International Academy of Musculoskeletal Physiotherapy, Paris, France
| | - Janis Henricksen
- School of Physical Therapy, University of St. Augustine, Dallas, TX, USA
| | - Rebecca Sherwin
- NELA Rehabilitation, Physical Therapy Department, West Monroe, Louisiana, USA
- Hauser School of Physical Therapy, University of the Cumberlands, Williamsburg, KY, USA
| | - Jan Pool
- Institute of Movement Studies, University of Applied Sciences, Utrecht, The Netherlands
| | - Nikki Milne
- THINK Paediatrics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- International Organisation of Physiotherapists in Paediatrics (IOPTP)
| | - Derek Clewley
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Annalie Basson
- Faculty of Health Sciences, Physiotherapy Department, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Anita R. Gross
- Rehabilitation Sciences, McMaster University, Hamilton, Canada
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Henderson VK, Brismée JM. New clinical decision tool to assist physical therapists with joint mobilization application to the pediatric population. J Man Manip Ther 2024; 32:304-309. [PMID: 38426695 PMCID: PMC11216253 DOI: 10.1080/10669817.2024.2322213] [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: 11/25/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
Joint mobilizations are well-established and extensively researched treatment modality for adults. However, it remains largely unexplored in the pediatric population. Physical therapists hesitate to perform joint mobilization on children because of lack of knowledge, concern for the developing skeletal system, and the paucity of research on the topic. The aim of this article is to present a decision tool created for a continuing education course with the purpose to instruct pediatric therapists in the safe and effective use of joint mobilizations in children. It is based on the pediatric paradigm of developmental and functional assessment to best address the concerns and preferences of physical therapists (PTs). To advance research in pediatric joint mobilization, PTs should listen to the concerns of pediatric therapists and respond to those concerns with effective, evidence-supported training. This decision tree will serve as a resource for the education of pediatric therapists in the safe and effective use of joint mobilizations.
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Affiliation(s)
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, USA
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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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Vining R, Smith J, Anderson B, Almquist Z, Wong D. Developing an initial set of quality indicators for chiropractic care: a scoping review. BMC Health Serv Res 2024; 24:65. [PMID: 38216977 PMCID: PMC10785553 DOI: 10.1186/s12913-024-10561-8] [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: 06/05/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Quality indicators are standardized, evidence-based measures of health care quality. Currently, there is no basic set of quality indicators for chiropractic care published in peer-reviewed literature. The goal of this research is to develop a preliminary set of quality indicators, measurable with administrative data. METHODS We conducted a scoping review searching PubMed/MEDLINE, CINAHL, and Index to Chiropractic Literature databases. Eligible articles were published after 2011, in English, developing/reporting best practices and clinical guidelines specifically developed for, or directly applicable to, chiropractic care. Eligible non-peer-reviewed sources such as quality measures published by the Centers for Medicare and Medicaid Services and the Royal College of Chiropractors quality standards were also included. Following a stepwise eligibility determination process, data abstraction identified specific statements from included sources that can conceivably be measured with administrative data. Once identified, statements were transformed into potential indicators by: 1) Generating a brief title and description; 2) Documenting a source; 3) Developing a metric; and 4) Assigning a Donabedian category (structure, process, outcome). Draft indicators then traversed a 5-step assessment: 1) Describes a narrowly defined structure, process, or outcome; 2) Quantitative data can conceivably be available; 3) Performance is achievable; 4) Metric is relevant; 5) Data are obtainable within reasonable time limits. Indicators meeting all criteria were included in the final set. RESULTS Literature searching revealed 2562 articles. After removing duplicates and conducting eligibility determination, 18 remained. Most were clinical guidelines (n = 10) and best practice recommendations (n = 6), with 1 consensus and 1 clinical standards development study. Data abstraction and transformation produced 204 draft quality indicators. Of those, 57 did not meet 1 or more assessment criteria. After removing duplicates, 70 distinct indicators remained. Most indicators matched the Donabedian category of process (n = 35), with 31 structure and 4 outcome indicators. No sources were identified to support indicator development from patient perspectives. CONCLUSIONS This article proposes a preliminary set of 70 quality indicators for chiropractic care, theoretically measurable with administrative data and largely obtained from electronic health records. Future research should assess feasibility, achieve stakeholder consensus, develop additional indicators including those considering patient perspectives, and study relationships with clinical outcomes. TRIAL REGISTRATION Open Science Framework, https://osf.io/t7kgm.
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Affiliation(s)
- Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA.
| | - Jennifer Smith
- Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Brian Anderson
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Zachary Almquist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Danveshka Wong
- Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
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Doucet C, Dubuc É, Imbeau C, Pohlman KA, Blanchette MA. Chiropractic pediatric patient management and interdisciplinary collaboration: a descriptive cross-sectional study of chiropractors in Quebec. Chiropr Man Therap 2022; 30:54. [PMID: 36514117 PMCID: PMC9746577 DOI: 10.1186/s12998-022-00464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Worldwide, many patients, including minors, seek chiropractic care. The purpose of this study was to investigate the practice characteristics of chiropractors who treat pediatric patients in Quebec, Canada. METHODS We conducted a web-based cross-sectional survey of all licensed chiropractors working in Quebec (Canada). Data were collected using an adapted questionnaire. Descriptive statistics were produced for all the variables collected. RESULTS Among our 245 participants (response rate: 21%), 63% were women, and half defined themselves as general musculoskeletal (MSK) health care practitioners. Nearly all participants reported seeing 0-5 new pediatric patients/week, and the most common pediatric age group was 6-12 years old (57%). Pediatric patients were most commonly referred by family members and "word of mouth". The respondents most frequently indicated that they strongly agreed with statements affirming their confidence in their own diagnostic capacities regarding MSK disorders with respect to all age groups as well as non-MSK disorders with regard to young teens. They reported a moderate level of agreement with similar statements concerning the diagnosis of non-MSK disorders in newborns, preschoolers, and children. Chiropractors rarely referred their pediatric patients to a nurse/family doctor or a pediatrician. When presented with potential pediatric red flags, the respondents commonly indicated that they would refer the patient to a physician in an emergency situation or for comanagement. CONCLUSION Chiropractors in Quebec are confident in their diagnoses of pediatric MSK conditions and refer patients to physicians in the rare event of a worrisome presentation. However, some chiropractors may have expectations that are unsupported by evidence regarding the diagnosis and management of non-MSK complaints.
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Affiliation(s)
- 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.
| | - Élisa Dubuc
- 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
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7
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Weis CA, Pohlman K, Barrett J, Clinton S, da Silva-Oolup S, Draper C, Lee J, Kumar R, O'Beirne M, Stuber K, Hawk C. Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process. J Manipulative Physiol Ther 2022; 45:469-489. [PMID: 34836673 DOI: 10.1016/j.jmpt.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination. METHODS A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale. RESULTS Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included. CONCLUSION An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.
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Affiliation(s)
- Carol Ann Weis
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | | | | | - Susan Clinton
- Embody Physiotherapy & Wellness (Private Practice), Andrews University, Sewickley, Pennsylvania
| | - Sophia da Silva-Oolup
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Crystal Draper
- Undergraduate Department, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Joyce Lee
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Rupali Kumar
- Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas Texas
| | - Maeve O'Beirne
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Calgary, AB, Canada
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Leach RA. Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs. JOURNAL OF CHIROPRACTIC HUMANITIES 2020; 27:29-36. [PMID: 33324134 PMCID: PMC7729103 DOI: 10.1016/j.echu.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this article is to discuss evidence that supports the resolution of inequities for Medicare beneficiaries who receive chiropractic care. DISCUSSION Medicare covers necessary examinations, imaging, exercise instruction, and treatments for beneficiaries with back pain when provided by medical doctors, osteopaths, and their associated support staff such as nurse practitioners, physician assistants, clinical nurse specialists, and physical therapists. However, if the same patient with back pain presents to a chiropractor, then the only service that is covered by Medicare is manipulation of the spine. Current evidence does not support this inequity in Medicare beneficiary service coverage. There is no evidence to show an increase in serious risks associated with chiropractic treatment of neck or back pain in Medicare beneficiaries. Chiropractors support national public health goals and endorse safe, evidence-based practices. Chiropractic care for Medicare beneficiaries has been associated with enhanced clinical outcomes such as faster recovery, fewer back surgeries a year later, reduced opioid-associated disability, fewer traumatic injuries and falls, and slower declines in activities of daily living and disability over time. Further evidence points to lower costs, fewer medical physician visits for low back pain, less opioid-related expense, and less back-surgery expense with chiropractic utilization. Use is lower among vulnerable populations: seniors, lower income women, and black and Hispanic beneficiaries who may be most affected by current inequities associated with the limited coverage. In this era of evidence-based and patient-centered care, beneficiaries who receive chiropractic care are very satisfied with the care they receive. CONCLUSION The current evidence suggests a need for change in US policy toward chiropractic in Medicare and support for HR 3654. Ending inequities by providing patients full coverage for chiropractic services has the potential to enhance care outcomes and reduce health disparities without increasing program costs.
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Affiliation(s)
- Robert A. Leach
- Corresponding author: Robert A. Leach, DC, MS, Food Science, Nutrition and Health Promotion, Mississippi State University, 214 Russell Street, Starkville, MS 39759
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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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Parnell Prevost C, Gleberzon B, Carleo B, Anderson K, Cark M, Pohlman KA. Manual therapy for the pediatric population: a systematic review. Altern Ther Health Med 2019; 19:60. [PMID: 30866915 PMCID: PMC6417069 DOI: 10.1186/s12906-019-2447-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022]
Abstract
Background This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report. Methods Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study. Results Of the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity. Conclusions Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed. Trial registration PROSPERA registration number: CRD42018091835
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Maiers M, Agaoglu M, Brown R, Cassirer C, DaSilva K, Lystad RP, Mohammad S, Wong JJ. Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap 2018; 26:26. [PMID: 30026909 PMCID: PMC6048707 DOI: 10.1186/s12998-018-0194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Abstract
The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women's, children's, and adolescents' health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve.
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Affiliation(s)
- Michele Maiers
- Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431 USA
| | - Mustafa Agaoglu
- Bahçeşehir University Health Sciences School of Chiropractic, No:10, Gayrettepe, 34353 Beşiktaş, Istanbul, Turkey
| | - Richard Brown
- World Federation of Chiropractic, 160 Eglinton Avenue East Suite 601, Toronto, ON M4P 3B5 Canada
| | - Christopher Cassirer
- Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431 USA
| | - Kendrah DaSilva
- Chiropractic Association of South Africa, Crossway Office Park, 240 Lenchen Ave, Centurion, Pretoria, 0157 South Africa
| | - Reidar P. Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarkaw Mohammad
- Hillcrest Spinal Centre, 174 Cambridge Road Hillcrest Hamilton, Hamilton, 3216 New Zealand
| | - Jessica J. Wong
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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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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Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap 2017; 25:37. [PMID: 29234493 PMCID: PMC5719861 DOI: 10.1186/s12998-017-0168-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/08/2017] [Indexed: 12/20/2022] Open
Abstract
Background Communicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research. Method A methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points. Results Two hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events.Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes.Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk. Conclusion Existing literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.
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Affiliation(s)
- Gabrielle Swait
- The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK
| | - Rob Finch
- The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK
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Puhl AA, Reinhart CJ, Injeyan HS, Tibbles A. Description of the case mix experienced by chiropractic students during a clinical internship. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 31:132-139. [PMID: 28657811 PMCID: PMC5656149 DOI: 10.7899/jce-16-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The primary objective of this study was to describe the case mix experienced by chiropractic students during their clinical internship at the Canadian Memorial Chiropractic College. Secondary objectives were to characterize teaching clinic patient populations, assess the similarity to previously published data for practicing chiropractors, and describe the treatment plans being recommended by interns. METHODS A prospective, observational study was conducted using a convenience sample of 24 chiropractic interns. Data were collected by interns using a standardized form that was completed for each new patient and each new complaint examined during the 1-year internship. Standardized forms included data regarding patient demographics, complaint characteristics, and treatment recommendations. RESULTS Data were included for 23 of 24 participating interns, who described 828 patients and a total of 948 unique complaint presentations. Overall, 60% of patients were female, 86% were 18 to 64 years old, and 23% were naive to chiropractic care. Of all presenting complaints, 93% were pain-based, 67% were chronic, 65% included spinal complaints, and 7% presented with red flags; individual interns' experiences were variable and are described. On average, treatment recommendations called for 9.4 visits and often included multimodal treatment approaches, most commonly soft-tissue therapies (91%), home-based active care (84%), and spine manipulation (70%). CONCLUSIONS The findings of this study suggest that patients presenting to CMCC teaching clinics are similar to those reported previously to attend private chiropractic clinics. While all participating interns encountered multiple complex clinical cases, very few had experience with pediatric populations. This study adds to the few that detail the characteristics of patients attending chiropractic teaching clinics; to our knowledge it is the first to describe average case loads of chiropractic interns.
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Young MD, Young JL. Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases. J Chiropr Med 2017; 16:252-256. [PMID: 29097957 DOI: 10.1016/j.jcm.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 01/19/2023] Open
Abstract
Objective The purpose of this case report is to describe the conservative management of 2 cases of acquired torticollis in children under 3 years of age. Clinical Features Both patients awoke with painful, stiff, twisted necks the day after play in a bouncy house. Range of motion was limited, and hypertonic muscles were palpated. Their neurologic and physical evaluation was consistent with a diagnosis of acquired torticollis of musculoskeletal origin. Intervention and Outcomes Both children were treated with chiropractic care that consisted of light myofascial release, use of an Activator instrument, and home stretching. Patients improved in pain and range of motion immediately posttreatment and returned to normal ranges in 1 or 2 visits. Conclusion Chiropractic care provided relief for these 2 young patients with acquired torticollis.
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Affiliation(s)
- Morgan D Young
- Research Department, Palmer College of Chiropractic West, San Jose, California
| | - Jessie L Young
- Los Gatos Chiropractic and Wellness Center, Los Gatos, California
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Théroux J, Stomski N, Losco CD, Khadra C, Labelle H, Le May S. Spinal Manipulative Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review. J Manipulative Physiol Ther 2017; 40:452-458. [PMID: 28822477 DOI: 10.1016/j.jmpt.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/09/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to perform a systematic review of clinical trials of spinal manipulative therapy for adolescent idiopathic scoliosis. METHODS Search strategies were developed for PubMed, CINHAL, and CENTRAL databases. Studies were included through June 2016 if they were prospective trials that evaluated spinal manipulative therapy (eg, chiropractic, osteopathic, physical therapy) for adolescent idiopathic scoliosis. Data were extracted and assessed by 2 independent reviewers. Cochrane risk of bias tools were used to assess the quality of the included studies. Data were reported qualitatively because heterogeneity prevented statistical pooling. RESULTS Four studies satisfied the inclusion criteria and were critically appraised. The findings of the included studies indicated that spinal manipulative therapy might be effective for preventing curve progression or reducing Cobb angle. However, the lack of controls and small sample sizes precluded robust estimation of the interventions' effect sizes. CONCLUSION There is currently insufficient evidence to establish whether spinal manipulative therapy may be beneficial for adolescent idiopathic scoliosis. The results of the included studies suggest that spinal manipulative therapy may be a promising treatment, but these studies were all at substantial risk of bias. Further high-quality studies are warranted to conclusively determine if spinal manipulative therapy may be effective in the management of adolescent idiopathic scoliosis.
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Affiliation(s)
- Jean Théroux
- Chiropractic Discipline, School of Health Profession, Murdoch University, Murdoch, Western Australia, Australia.
| | - Norman Stomski
- School of Health Profession, Murdoch University, Murdoch, Western Australia, Australia
| | | | - Christelle Khadra
- Faculty of Nursing, University of Montréal, Montréal, Québec, Canada
| | - Hubert Labelle
- Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Sylvie Le May
- Faculty of Nursing, University of Montréal, Montréal, Québec, Canada
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Hawk C, Schneider MJ, Haas M, Katz P, Dougherty P, Gleberzon B, Killinger LZ, Weeks J. Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update. J Manipulative Physiol Ther 2017; 40:217-229. [DOI: 10.1016/j.jmpt.2017.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/10/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022]
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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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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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Hawk C, Ramcharan M, Kruger CL. Training chiropractic students in weight management counseling using standardized patients. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 32:23-31. [PMID: 29227718 PMCID: PMC5834297 DOI: 10.7899/jce-17-9r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to describe and assess an activity that trained chiropractic students to counsel patients on weight management through the use of standardized patients. METHODS This was a descriptive study using mixed methods. Students were trained to apply health behavior theory and the transtheoretical model. Standardized patients were given a case to portray with the students. Students had 15 minutes for the encounter. The encounters were assessed in 2 ways: (1) standardized patients answered a brief questionnaire about the students' performance, and (2) students answered a questionnaire about the utility of the intervention. Numerical data were extracted from the audiovisual management platform, and statistics were computed for each question. Comments made by students and patients were transferred verbatim for content analysis. RESULTS A total of 102 students took part in the activity. Students' performance in the encounter was uniformly high, with over 90% "yes" responses to all questions except "gave me printed information material" and "discussed the printed material with me." The key issue identified in the comments by standardized patients was that students tended not to connect weight management with their chief complaint (low back pain). Nearly all students (97%) thought the activity would be useful to their future practice, and 97% felt it had increased their confidence in providing weight management counseling. CONCLUSION This experiential activity was assessed to be useful to students' future practice and appeared to provide them with skills to successfully communicate with patients on weight management.
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Rosner AL. Chiropractic Identity: A Neurological, Professional, and Political Assessment. JOURNAL OF CHIROPRACTIC HUMANITIES 2016; 23:35-45. [PMID: 27920617 PMCID: PMC5127978 DOI: 10.1016/j.echu.2016.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/08/2016] [Accepted: 05/17/2016] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this article is to propose a focused assessment of the identity of chiropractic and its profession, triangulating multiple viewpoints converging upon various aspects and definitions of neurology, manual medicine, and alternative or mainstream medicine. DISCUSSION Over 120 years since its inception, chiropractic has struggled to achieve an identity for which its foundations could provide optimal health care. Despite recognition of the benefits of spinal manipulation in various government guidelines, advances in US military and Veterans Administration, and persistently high levels of patient satisfaction, the chiropractic profession remains underrepresented in most discussions of health care delivery. Distinguishing characteristics of doctors of chiropractic include the following: (1) they embrace a model of holistic, preventive medicine (wellness); (2) they embrace a concept of neurological imbalance in which form follows function, disease follows disturbed biochemistry, and phenomenology follows physiology; (3) they diagnose, and their institutions of training are accredited by a body recognized by the US Department of Education; (4) they manage patients on a first-contact basis, often as primary care providers in geographical areas that are underserved; (5) the spine is their primary-but not exclusive-area of interaction; (6) they deliver high-velocity, low-amplitude adjustments with a superior safety record compared with other professions; and (7) they use a network of institutions worldwide that have shown increasing commitments to research. CONCLUSION This article provides an overview of chiropractic identity from 6 points of view: (1) concepts of manual medicine; (2) areas of interest beyond the spine; (3) concepts of the chiropractic subluxation; (4) concepts of neurology; (5) concepts of mainstream or alternative health care; and (6) concepts of primary care, first-contact provider, or specialist.
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Affiliation(s)
- Anthony L. Rosner
- Corresponding author: Anthony L. Rosner, PhD, LLD (Hon), 156 School St, Watertown, MA 02472-4149. Tel.: + 1 617 794 1372156 School StWatertownMA02472-4149
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Changes in Muscle Spasticity in Patients With Cerebral Palsy After Spinal Manipulation: Case Series. J Chiropr Med 2016; 15:299-304. [PMID: 27857638 DOI: 10.1016/j.jcm.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/24/2016] [Accepted: 07/31/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of this case series was to report quantitative changes in wrist muscle spasticity in children with cerebral palsy after 1 spinal manipulation (SM) and a 2-week course of treatment. METHODS Twenty-nine patients, aged 7 to 18 years, with spastic forms of cerebral palsy and without fixed contracture of the wrist, were evaluated before initiation of treatment, after 1 SM, and at the end of a 2-week course of treatment. Along with daily SM, the program included physical therapy, massage, reflexotherapy, extremity joint mobilization, mechanotherapy, and rehabilitation computer games for 3 to 4 hours' duration. Spasticity of the wrist flexor was measured quantitatively using a Neuroflexor device, which calculates the neural component (NC) of muscle tone, representing true spasticity, and excluding nonneural components, caused by altered muscle properties: elasticity and viscosity. RESULTS Substantial decrease in spasticity was noted in all patient groups after SM. The average NC values decreased by 1.65 newtons (from 7.6 ± 6.2 to 5.9 ± 6.5) after 1 SM. Another slight decrease of 0.5 newtons was noted after a 2-week course of treatment. In the group of patients with minimal spasticity, the decrease in NC after the first SM was almost twofold-from 3.93 ± 2.9 to 2.01 ± 1.0. In cases of moderate spasticity, NC reduction was noted only after the 2-week course of intensive treatment. CONCLUSIONS In this sample of patients with cerebral palsy, a decrease in wrist muscle spasticity was noted after SM. Spasticity reduction was potentiated during the 2-week course of treatment.
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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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