1
|
Stickler K, Kearns G. Spinal manipulation and adverse event reporting in the pregnant patient limits estimation of relative risk: a narrative review. J Man Manip Ther 2023; 31:162-173. [PMID: 36047253 PMCID: PMC10288923 DOI: 10.1080/10669817.2022.2118653] [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] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE To describe variability in spinal manipulation technique details and adverse event (AE) documentation of spinal manipulation during pregnancy. METHODS Five databases were searched for peer-reviewed investigations of spinal manipulation during pregnancy. Criteria for inclusion was as follows: high velocity, low amplitude thrust manipulation performed, subjects pregnant during manipulation, and English language. Studies were excluded when participants were not currently pregnant, and when the manipulation performed was not high-velocity, low-amplitude thrust. Data extraction included study design, number of participants, gestational age, spinal region, number of manipulations, manipulation technique details, profession of manipulator, AE reporting (Yes vs. No), type, and number of AE. RESULTS Out of 18 studies included in the review, only three provide details of the spinal manipulation technique. The reported variables include patient position, practitioner position, and direction of thrust. Fourteen studies documented AE; however, only seven provide AE details. DISCUSSION Reporting of spinal manipulation techniques and AE during pregnancy were inconsistent. Replication of methods in future investigations is limited without more detailed documentation of manipulation techniques performed. Furthermore, determining the relative risk and safety of spinal manipulation during pregnancy is not possible without more detailed reporting of AE. Due to these inconsistencies, a checklist is proposed for standardized reporting of spinal manipulation techniques and AE. With more consistent reporting of these parameters, results of future investigations may allow for more definitive and generalizable safety recommendations on spinal manipulation during pregnancy.
Collapse
Affiliation(s)
- Kellie Stickler
- Cerner Corporation, Workforce Health Services, Overland Park, Kansas, USA
| | - Gary Kearns
- Texas Tech University Health Sciences Center, DPT Program, Lubbock, Texas, USA
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
Fiat F, Merghes PE, Scurtu AD, Almajan Guta B, Dehelean CA, Varan N, Bernad E. The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain. Medicina (B Aires) 2022; 58:medicina58081115. [PMID: 36013582 PMCID: PMC9414568 DOI: 10.3390/medicina58081115] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.
Collapse
Affiliation(s)
- Felicia Fiat
- Department of Obstetrics-Gynecology II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Petru Eugen Merghes
- Department of Physical Education and Sport, Banat’s University of Agricultural Sciences and Veterinary Medicine “King Mihai I of Romania” from Timisoara, Calea Aradului 119, 300645 Timisoara, Romania
| | - Alexandra Denisa Scurtu
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Correspondence: (A.D.S.); (B.A.G.)
| | - Bogdan Almajan Guta
- Department of Physical Therapy and Special Motor Skills, Faculty of Physical Education and Sport, West University of Timisoara, Vasile Parvan Boulevard, No. 4, 300223 Timisoara, Romania
- Correspondence: (A.D.S.); (B.A.G.)
| | - Cristina Adriana Dehelean
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Narcis Varan
- Department of Physical Education and Sport, Banat’s University of Agricultural Sciences and Veterinary Medicine “King Mihai I of Romania” from Timisoara, Calea Aradului 119, 300645 Timisoara, Romania
| | - Elena Bernad
- Department of Obstetrics-Gynecology II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| |
Collapse
|
4
|
Monari F, Busani S, Imbrogno MG, Neri I, Girardis M, Ghirardini A, Cavalleri F, Facchinetti F. Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature. J Med Case Rep 2021; 15:530. [PMID: 34670622 PMCID: PMC8527659 DOI: 10.1186/s13256-021-03090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. CASE PRESENTATION A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. CONCLUSION Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.
Collapse
Affiliation(s)
- Francesca Monari
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy.
| | - Stefano Busani
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Maria Giovanna Imbrogno
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Isabella Neri
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Massimo Girardis
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Annamaria Ghirardini
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Francesca Cavalleri
- Department of Neuroradiology, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy
| |
Collapse
|
5
|
Chiropractic Care for the Pregnant Body. Clin Obstet Gynecol 2021; 64:602-610. [PMID: 33882524 DOI: 10.1097/grf.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chiropractic care is a commonly used treatment modality for musculoskeletal pain in pregnancy. Low back pain, pelvic pain, and other neuromuscular complaints are prevalent in pregnancy and contribute to significant maternal discomfort in many women. Nonpharmacologic therapies to relieve pain are increasingly important during pregnancy because of the opioid epidemic. Chiropractic treatment is one of the potential therapies that offers intervention without medications. This article provides an evidence-based review of the epidemiology of chiropractic use in obstetrics, commonly treated conditions, related physiology of pregnancy, and safety of spinal manipulation.
Collapse
|
6
|
Weis CA, Stuber K, Murnaghan K, Wynd S. Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:32-49. [PMID: 34035539 PMCID: PMC8128327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study is to update a previous critical review of adverse events in pregnant and postpartum populations. METHODS The following databases were searched: PubMed, CINAHL, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews/Cochrane Central Register of Controlled Trials and MEDLINE. We included all study design types as it was determined a priori that there would not be enough high-quality research on spinal manipulative therapy (SMT) in these populations to make any determinations. The Scottish Intercollegiate Guidelines Network (SIGN) and CARE (CAse REport) checklists were used for quality rating. RESULTS This update found one case study that demonstrated a serious adverse event in the cervical spine following SMT and a handful of minor and transient adverse events in the low back following SMT. CONCLUSIONS There was limited evidence of adverse events following SMT in these populations. Although we are calling for improved reporting of such events in future studies, it may be that such injuries are rare.
Collapse
|
7
|
Gausel AM, Dalen I, Kjærmann I, Malmqvist S, Andersen K, Larsen JP, Økland I. Adding Chiropractic Treatment to Individual Rehabilitation for Persistent Pelvic Girdle Pain 3 to 6 Months After Delivery: A Pilot Randomized Trial. J Manipulative Physiol Ther 2019; 42:601-607. [PMID: 31864519 DOI: 10.1016/j.jmpt.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/05/2018] [Accepted: 12/19/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the feasibility of conducting a study examining the influence of individualized rehabilitation and chiropractic treatment, compared with individualized rehabilitation alone, in women with persistent dominating 1-sided pelvic girdle pain (PGP) 3 to 6 months after delivery. METHODS Women were recruited from an outpatient clinic at Stavanger University Hospital, Norway and in a private chiropractic clinic in Stavanger. Those with persistent, dominating 1-sided PGP were included in this pilot study. Those who met inclusion criteria were randomized into 2 groups, one group received individualized rehabilitation and chiropractic treatment and the other group women received individualized rehabilitation alone. Treatment was measured for 20 weeks. RESULTS Of 330 consenting women who were recruited who reported pelvic pain during pregnancy, 68 reported PGP or low back pain, and 63 consented to fill in a questionnaire. Forty-seven women underwent a clinical examination 3 to 6 months after delivery. During the examination, the women were diagnosed into subgroups for PGP. After exclusion of the women with low back pain only, a total of 13 women were diagnosed with dominating 1-sided PGP and thus included in this study. Six were randomized to the individualized rehabilitation and chiropractic treatment group and 5 to the individualized rehabilitation alone group. After 20 weeks of intervention, both groups reported improvement in disability and pain, but not in general health status. No serious or long-lasting adverse events were registered after treatment or training. CONCLUSION We found that a study of this nature is feasible. However, the conditions of patient recruitment need to be considered carefully. We learned that a trial to investigate the effect of chiropractic treatment for PGP pain should include all subgroups of PGP to reach an acceptable sample size.
Collapse
Affiliation(s)
- Anne M Gausel
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway.
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Inger Kjærmann
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Stefan Malmqvist
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Knut Andersen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
8
|
Reyhan AÇ, Dereli EE, Çolak TK. Low back pain during pregnancy and Kinesio tape application. J Back Musculoskelet Rehabil 2017; 30:609-613. [PMID: 28035911 DOI: 10.3233/bmr-160584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Low back pain is a common problem during pregnancy. Although the pain usually occurs in the third trimester, it might be seen in the first trimester, too. There are various types of applications for the treatment of low back pain during pregnancy. However, there is a lack of evidence for the effectiveness of each method. If there is not an obvious deficit, bed rest, exercise, conventional physiotherapy, using protective principles for the lumbar area are recommended, since the main and the only complaint is low back pain. It is aimed in the current review to investigate the use of Kinesio tape in the low back pain seen during pregnancy and to review the literature related to this subject. CONCLUSION There are only a few studies investigating the effect of Kinesio tape during pregnancy in the literature and they mostly did not aim to study the low back pain, further evidence and studies are needed to investigate the use of Kinesio tape for the low back pain seen during pregnancy as there is not evidence strong enough. Kinesiotape application aims to increase circulation and mobility, and regarding these gains decreased pain and increased performance are expected.
Collapse
Affiliation(s)
- Aycan Çakmak Reyhan
- Department of Ergotherapy, Faculty of Health Sciences, İstanbul Bilgi University, Istanbul, Turkey
| | - Elif Elçin Dereli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İstanbul Bilgi University, Istanbul, Turkey
| | - Tuğba Kuru Çolak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Turkey
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Gausel AM, Kjærmann I, Malmqvist S, Andersen K, Dalen I, Larsen JP, Økland I. Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial. BMC Pregnancy Childbirth 2017; 17:331. [PMID: 28962596 PMCID: PMC5622492 DOI: 10.1186/s12884-017-1528-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate the outcome of chiropractic management for a subgroup of pregnant women with dominating one-sided pelvic girdle pain (PGP). Methods The study population was recruited from a prospective longitudinal cohort study of pregnant women. Women reporting pelvic pain (PP), and who were diagnosed with dominating one-sided PGP after a clinical examination, were invited to participate in the intervention study. Recruitment took place either at 18 weeks, or after an SMS-tracking up to week 29. The women were randomized into a treatment group or a control group. The treatment group received chiropractic treatment individualized to each woman with regards to treatment modality and number of treatments. The control group was asked to return to conventional primary health care. The primary outcome measure was new occurrence of full time and/or graded sick leave due to PP and/or low back pain. Secondary outcome measures were self-reported PP, physical disability and general health status. Proportion of women reporting new occurrence of sick leave were compared using Chi squared tests. Differences in secondary outcome measures were estimated using linear regression analyses. Results Fifty-Six women were recruited, and 28 of them were randomized into the treatment group, and 28 into the control group. There was no statistically significant difference in sick leave, PP, disability or general health status between the two groups during pregnancy or after delivery. Conclusion The study did not demonstrate superiority of chiropractic management over conventional care for dominating one-sided PGP during pregnancy. However, the analyses revealed wide confidence intervals containing both positive and negative clinically relevant effects. Trial registration The study was registered in ClinicalTrials.gov (NCT01098136; 22/03/2010).
Collapse
Affiliation(s)
- Anne Marie Gausel
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
| | - Inger Kjærmann
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Stefan Malmqvist
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Sundbybergskliniken, Sundbyberg, Sweden
| | - Knut Andersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Jan Petter Larsen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Inger Økland
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
11
|
Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev 2017; 6:64. [PMID: 28340595 PMCID: PMC5366149 DOI: 10.1186/s13643-017-0458-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT. METHODS We searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated. RESULTS We identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe. CONCLUSIONS It is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015030068 .
Collapse
Affiliation(s)
- Sabrina Mai Nielsen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Simon Tarp
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Henning Bliddal
- Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Marius Henriksen
- Physiotherapy and Biomechanics Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark.
| |
Collapse
|
12
|
Weis CA, Grondin D, Vernon H. The Effect of Phase of Menstrual Cycle on Joint Mobility in the Cervical Spine and Extremities in Nulliparous Women: A Cross-Sectional Study. J Manipulative Physiol Ther 2016; 39:393-400. [PMID: 27346859 DOI: 10.1016/j.jmpt.2016.05.002] [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: 06/02/2014] [Revised: 07/01/2015] [Accepted: 10/30/2015] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Carol Ann Weis
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, Toronto, Canada.
| | - Diane Grondin
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Howard Vernon
- Graduate Education and Research Program, Canadian Memorial Chiropractic College, Toronto, Canada
| |
Collapse
|
13
|
Bernard M, Tuchin P. Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study. J Chiropr Med 2016; 15:129-33. [PMID: 27330515 DOI: 10.1016/j.jcm.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe chiropractic management of a patient with pregnancy-related lumbopelvic pain. CLINICAL FEATURES A pregnant 35-year-old woman experienced insidious moderate to severe pregnancy-related lumbopelvic pain and leg pain at 32 weeks' gestation. Pain limited her endurance capacity for walking and sitting. Clinical testing revealed a left sacroiliac joint functional disturbance and myofascial trigger points reproducing back and leg pain. INTERVENTION AND OUTCOME A diagnosis of pregnancy-related low back pain and pregnancy-related pelvic girdle pain was made. The patient was treated with chiropractic spinal manipulation, soft tissue therapy, exercises, and ergonomic advice in 13 visits over 6 weeks. She consulted her obstetrician for her weekly obstetric visits. At the end of treatment, her low back pain reduced from 7 to 2 on a 0-10 numeric pain scale rating. Functional activities reported such as walking, sitting, and traveling comfortably in a car had improved. CONCLUSION This patient with pregnancy-related lumbopelvic pain improved in pain and function after chiropractic treatment and usual obstetric management.
Collapse
Affiliation(s)
| | - Peter Tuchin
- Associate Professor, Department of Chiropractic Faculty Science, Macquarie University, Sydney, NSW, Australia
| |
Collapse
|
14
|
Weis CA, Stuber K, Barrett J, Greco A, Kipershlak A, Glenn T, Desjardins R, Nash J, Busse J. Attitudes Toward Chiropractic. J Evid Based Complementary Altern Med 2015; 21:92-104. [DOI: 10.1177/2156587215604073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/02/2015] [Indexed: 11/17/2022] Open
Abstract
We assessed the attitudes of Canadian obstetricians toward chiropractic with a 38-item cross-sectional survey. Ninety-one obstetricians completed the survey, for a response rate of 14% (91 of 659). Overall, 30% of respondents held positive views toward chiropractic, 37% were neutral, and 33% reported negative views. Most (77%) reported that chiropractic care was effective for some musculoskeletal complaints, but 74% disagreed that chiropractic had a role in treatment of non-musculoskeletal conditions. Forty percent of respondents referred at least some patients for chiropractic care each year, and 56% were interested in learning more about chiropractic care. Written comments from respondents revealed concerns regarding safety of spinal manipulation and variability among chiropractors. Canadian obstetricians’ attitudes toward chiropractic are diverse and referrals to chiropractic care for their patients who suffer from pregnancy-related low back pain are limited. Improved interprofessional relations may help optimize care of pregnant patients suffering from low back pain.
Collapse
Affiliation(s)
- Carol Ann Weis
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Jon Barrett
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexandra Greco
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | | | - Tierney Glenn
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Ryan Desjardins
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | | | - Jason Busse
- McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
15
|
Holden SC, Gardiner P, Birdee G, Davis RB, Yeh GY. Complementary and Alternative Medicine Use Among Women During Pregnancy and Childbearing Years. Birth 2015; 42:261-9. [PMID: 26111221 PMCID: PMC4537684 DOI: 10.1111/birt.12177] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Little is known regarding complementary and alternative medicine (CAM) use during pregnancy and the preconception period. Since half of all pregnancies in the United States are unintended, understanding the patterns of CAM use among women of childbearing age has implications for fetal and maternal health. METHODS Descriptive statistics were generated from the 2012 National Health Interview Study (NHIS) to estimate weighted prevalence and patterns of CAM use by women of childbearing age. Comparisons were made between pregnant and nonpregnant respondents. RESULTS In this sample of 10,002 women, 7 percent (n = 727) were recently pregnant. Over one-third of all the women used CAM during the previous year (34/38%, pregnant/nonpregnant, respectively) and only half disclosed CAM use to conventional providers (50/49%). In the adjusted model, taking multivitamins (OR 2.52 [CI 2.22-2.86]) and moderate to heavy alcohol use (OR 1.92 [CI 1.53-2.41]) were more likely associated with CAM use. The two most commonly used modalities were herbs (14/17%) and yoga (13/16%). The top reasons for CAM use were to improve general wellness or to prevent disease (33/35%) and to treat back pain (16/18%). When examining all pregnancy-related symptoms treated with CAM, no difference was found in the rates of CAM use between pregnant and nonpregnant users. CONCLUSIONS CAM use by women of childbearing age in the United States is common, with over a third of the population using one or more therapies. However, only half disclosed their use to conventional providers despite limited evidence on safety and effectiveness. This study highlights the important need for further research in this area.
Collapse
Affiliation(s)
- Selma C Holden
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | | | - Gurjeet Birdee
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Gloria Y Yeh
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Brookline, MA, USA
| |
Collapse
|
16
|
Steel A, Adams J, Sibbritt D, Broom A. The Outcomes of Complementary and Alternative Medicine Use among Pregnant and Birthing Women: Current Trends and Future Directions. WOMENS HEALTH 2015; 11:309-23. [DOI: 10.2217/whe.14.84] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.
Collapse
Affiliation(s)
- Amie Steel
- Office of Research, Endeavour College of Natural Health, Fortitude Valley, Queensland, Australia
- Australian Research Centre in Complementary & Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jon Adams
- Australian Research Centre in Complementary & Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David Sibbritt
- Australian Research Centre in Complementary & Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Alex Broom
- School of Social Sciences, University of New South Wales, Kensington, New South Wales, Australia
| |
Collapse
|
17
|
Peterson CK, Mühlemann D, Humphreys BK. Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1 year follow-up. Chiropr Man Therap 2014; 22:15. [PMID: 24690125 PMCID: PMC3994225 DOI: 10.1186/2045-709x-22-15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 02/25/2014] [Indexed: 12/13/2022] Open
Abstract
Background Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome. Methods Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited. Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded. The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better’ or ‘much better’ were categorized as ‘improved’. The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed. Results 52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ,improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013). Conclusions Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of, improvement’ in the logistic regression model.
Collapse
Affiliation(s)
- Cynthia K Peterson
- Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, Zürich, Switzerland.
| | | | | |
Collapse
|
18
|
Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap 2014; 22:12. [PMID: 24679336 PMCID: PMC3997823 DOI: 10.1186/2045-709x-22-12] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/24/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This systematic review updated and extended the "UK evidence report" by Bronfort et al. (Chiropr Osteopath 18:3, 2010) with respect to conditions/interventions that received an 'inconclusive' or 'negative' evidence rating or were not covered in the report. METHODS A literature search of more than 10 general medical and specialised databases was conducted in August 2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new categories not assessed by Bronfort were added. RESULTS 25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic reviews, 96 were randomised controlled trials, and 10 were non-randomised primary studies. Most 'inconclusive' or 'moderate' evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive direction from inconclusive to moderate evidence ratings in only three cases (manipulation/mobilisation [with exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions not previously considered; most of this evidence was rated as inconclusive. CONCLUSIONS Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity. Areas requiring further research are highlighted.
Collapse
Affiliation(s)
- Christine Clar
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Alexander Tsertsvadze
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Rachel Court
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Gillian Lewando Hundt
- Social Science and Systems in Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Aileen Clarke
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| | - Paul Sutcliffe
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
| |
Collapse
|
19
|
In a 36-year-old woman with neck pain, will manipulation and mobilization be beneficial for reducing her reports of neck pain? Phys Ther 2014; 94:179-84. [PMID: 24009344 DOI: 10.2522/ptj.20120402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
20
|
Smith DL, Pohlman KA, Cramer GD. Chiropractors respond. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:1265-1268. [PMID: 24336534 PMCID: PMC3860918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
21
|
Steel A, Frawley J, Sibbritt D, Adams J. A preliminary profile of Australian women accessing doula care: findings from the Australian Longitudinal Study on Women's Health. Aust N Z J Obstet Gynaecol 2013; 53:589-92. [PMID: 23919571 DOI: 10.1111/ajo.12123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/24/2013] [Indexed: 01/16/2023]
Abstract
Despite growing interest and controversy regarding the value of doulas in contemporary maternity care, little is known about the profile of women who choose to involve a doula in their care team. This preliminary analysis indicates that women's attitudes towards maternity care may influence their use of a doula more so than demographic factors. Further research examining these issues in more detail is needed for all those involved in maternity care to ensure safe maternal and fetal outcomes.
Collapse
Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | | | | | | |
Collapse
|
22
|
Oswald C, Higgins CC, Assimakopoulos D. Optimizing pain relief during pregnancy using manual therapy. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:841-842. [PMID: 23946024 PMCID: PMC3743693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
QUESTION Many of my pregnant patients have muscle and joint aches, and are reluctant to use analgesics. What is known about chiropractic care during pregnancy? ANSWER As pregnant women move into their second and third trimesters, their centres of mass shift anteriorly, causing an increase in lumbar lordosis, which causes low back and pelvic girdle pain. Increasing recent evidence attests to the effectiveness and safety of treating this pain using manual therapy. Massage therapy and chiropractic care, including spinal manipulation, are highly safe and effective evidence-based options for pregnant women suffering from mechanical low back and pelvic pain.
Collapse
|
23
|
Yuen T, Wells K, Benoit S, Yohanathan S, Capelletti L, Stuber K. Therapeutic interventions employed by Greater Toronto Area chiropractors on pregnant patients: results of a cross-sectional online survey. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2013; 57:132-142. [PMID: 23754858 PMCID: PMC3661180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Due to different biomechanical, nutritional, and hormonal considerations, it is possible that chiropractors may employ different therapeutic interventions and recommendations for pregnant patients than non-pregnant ones. The objective of this study was to determine the therapeutic interventions that chiropractors who are members of the Ontario Chiropractic Association in the Greater Toronto Area most commonly provide to pregnant patients. METHODS An introductory e-mail was sent in October 2011 to 755 members of the Ontario Chiropractic Association within the Greater Toronto Area five days prior to a 15 question survey being distributed via e-mail. Reminder e-mails were sent 13 days and 27 days later. Using descriptive statistics, demographic information was reported along with reported use of different treatments and recommendations for pregnant patients. RESULTS A response rate of 23% was obtained. The majority of the respondents (90%) reported using the Diversified technique on pregnant patients, followed by soft tissue therapy (62%) and Activator (42%). The most common adjunctive therapy recommended to pregnant patients was referral to massage therapy (90%). Most of the respondents (92%) indicated that they prescribe stretching exercises to pregnant patients and recommend a multivitamin (84%) or folic acid (81%) to pregnant patients. CONCLUSION In agreement with previous research on chiropractic technique usage on non-pregnant patients, the majority of respondents indicated treating pregnant patients with the Diversified technique, with other chiropractic techniques being utilized at varying rates on pregnant patients. Most respondents indicated prescribing exercise, and making adjunctive and nutritional recommendations frequently for their pregnant patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Kent Stuber
- Division of Graduate Education & Research, Canadian Memorial Chiropractic College
| |
Collapse
|
24
|
Morton A. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus. Chiropr Man Therap 2012; 20:38. [PMID: 23254252 PMCID: PMC3554425 DOI: 10.1186/2045-709x-20-38] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/23/2012] [Indexed: 12/17/2022] Open
Abstract
A case of internal carotid artery dissection in a pregnant woman with Systemic Lupus Erythematosus (SLE) immediately following chiropractic treatment is presented. The literature regarding complications of neck manipulation during pregnancy, spontaneous dissection of craniocervical arteries in pregnancy and the postpartum period, and dissection of craniocervical arteries in SLE are reviewed. To the best of the author’s knowledge, this is the first case of carotid artery dissection following chiropractic treatment in a pregnant woman published in the literature.
Collapse
Affiliation(s)
- Adam Morton
- QLD Diabetes Centre Mater Health Services Raymond Terrace, South Brisbane, QLD, 4101, Australia.
| |
Collapse
|
25
|
Sadr S, Pourkiani-Allah-Abad N, Stuber KJ. The treatment experience of patients with low back pain during pregnancy and their chiropractors: a qualitative study. Chiropr Man Therap 2012; 20:32. [PMID: 23046615 PMCID: PMC3502160 DOI: 10.1186/2045-709x-20-32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/12/2012] [Indexed: 11/30/2022] Open
Abstract
Background Chiropractors regularly treat pregnant patients for low back pain during their pregnancy. An increasing amount of literature on this topic supports this form of treatment; however the experience of the pregnant patient with low back pain and their chiropractor has not yet been explored. The objective of this study is to explore the experience of chiropractic treatment for pregnant women with low back pain, and their chiropractors. Methods This qualitative study employed semi-structured interviews of pregnant patients in their second or third trimester, with low back pain during their pregnancy, and their treating chiropractors in separate interviews. Participants consisted of 11 patients and 12 chiropractors. The interviews consisted of 10 open-ended questions for patients, and eight open-ended questions for chiropractors, asking about their treatment experience or impressions of treating pregnant patients with LBP, respectively. All interviews were audio-recorded, transcribed verbatim, and reviewed independently by the investigators to develop codes, super-codes and themes. Thematic saturation was reached after the eleventh chiropractor and ninth patient interviews. All interviews were analyzed using the qualitative analysis software N-Vivo 9. Results Five themes emerged out of the chiropractor and patient interviews. The themes consisted of Treatment and Effectiveness; Chiropractor-Patient Communication; Pregnant Patient Presentation and the Chiropractic Approach to Pregnancy Care; Safety Considerations; and Self-Care. Conclusions Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.
Collapse
Affiliation(s)
- Shabnam Sadr
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1, Canada.
| | | | | |
Collapse
|