1
|
Garrett B, Caulfield T, Murdoch B, Brignall M, Kapur AK, Murphy S, Nelson E, Reardon J, Harrison M, Hislop J, Wilson‐Keates BJ, Anthony J, Loewen PS, Musoke RM, Braun J. A taxonomy of risk-associated alternative health practices: A Delphi study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1163-1181. [PMID: 34041822 PMCID: PMC9291966 DOI: 10.1111/hsc.13386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk-associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.
Collapse
Affiliation(s)
- Bernie Garrett
- School of NursingUniversity of British ColumbiaVancouverBCCanada
| | - Timothy Caulfield
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | - Blake Murdoch
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | | | | | - Susan Murphy
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Erin Nelson
- Faculty of LawHealth Law InstituteUniversity of AlbertaEdmontonABCanada
| | - Jillian Reardon
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Mark Harrison
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
- Centre for Health Evaluation and Outcome Sciences (CHEOS)St. Paul’s HospitalVancouverBCCanada
| | - Jonathan Hislop
- Family MedicineUniversity of British ColumbiaVancouverBCCanada
| | | | - Joseph Anthony
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Peter S. Loewen
- Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverBCCanada
| | - Richard M. Musoke
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | - Joan Braun
- Bora Laskin Faculty of LawLakehead UniversityThunder BayONCanada
| |
Collapse
|
2
|
Engel RM, Wearing J, Gonski P, Vemulpad S. The effect of combining manual therapy with exercise for mild chronic obstructive pulmonary disease: study protocol for a randomised controlled trial. Trials 2017; 18:282. [PMID: 28623944 PMCID: PMC5474053 DOI: 10.1186/s13063-017-2027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/30/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of disability and hospital admission. Current management strategies have not been successful in altering the loss of lung function typically seen as the disease progresses. A recent systematic review into the use of spinal manipulative therapy (SMT) in the management of COPD concluded that there was low level evidence to support the view that a combination of SMT and exercise had the potential to improve lung function more than exercise alone in people with moderate to severe COPD. The aim of this study is to investigate whether the combination of exercise and manual therapy (MT) that includes SMT produces sustainable improvements in lung function and exercise capacity in people with mild COPD. METHODS/DESIGN The study is a randomised controlled trial of 202 people with stable mild COPD. The cohort will be divided into two equal groups matched at baseline. The first group will receive a standardised exercise program. The second group will receive MT that includes SMT plus the same standardised exercise program. Exercise will be administered a total of 36 times over an 18-week period, while MT will be administered in conjunction with exercise a total of 15 times over a 6-week period. The primary outcome measure is lung function (forced expiratory volume in the 1st second: FEV1 and forced vital capacity: FVC). The secondary outcome measures are the 6-minute walking test (6MWT), quality of life questionnaire (St George's Respiratory Questionnaire: SGRQ), anxiety and depression levels (Hospital Anxiety and Depression Scale: HADS), frequency of exacerbations, chest wall expansion measurements (tape measurements) and systemic inflammatory biomarker levels. Outcome measurements will be taken by blinded assessors on seven occasions over a 48-week period. Adverse event data will also be gathered at the beginning of each intervention session. DISCUSSION This randomised controlled trial is designed to investigate whether the combination of MT and exercise delivers any additional benefits to people with mild COPD compared to exercise alone. The study is designed in response to recommendations from a recent systematic review calling for more research into the effect of MT in the management of COPD. TRIAL REGISTRATION ANZCTRN, 12614000766617 . Registered on 18 July 2014.
Collapse
Affiliation(s)
- Roger M. Engel
- Department of Chiropractic, Macquarie University, North Ryde, Sydney, NSW 2109 Australia
| | - Jaxson Wearing
- Department of Chiropractic, Macquarie University, North Ryde, Sydney, NSW 2109 Australia
| | - Peter Gonski
- Southcare, Sutherland Hospital, Sydney, Australia
| | - Subramanyam Vemulpad
- Department of Chiropractic, Macquarie University, North Ryde, Sydney, NSW 2109 Australia
| |
Collapse
|
3
|
Kranenburg HA, Lakke SE, Schmitt MA, Van der Schans CP. Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients. J Man Manip Ther 2017; 25:279-287. [PMID: 29449770 DOI: 10.1080/10669817.2017.1332556] [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] [Indexed: 01/29/2023] Open
Abstract
Objectives To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Methods Design: A three-round Delphi study. Participants: Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure: Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Results Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. Discussion A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.
Collapse
Affiliation(s)
- Hendrikus A Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra E Lakke
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Maarten A Schmitt
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Cees P Van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
4
|
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
|
5
|
Gorrell LM, Engel RM, Lystad RP, Brown BT. Assignment of adverse event indexing terms in randomized clinical trials involving spinal manipulative therapy: an audit of records in MEDLINE and EMBASE databases. BMC Med Res Methodol 2017; 17:41. [PMID: 28292267 PMCID: PMC5351045 DOI: 10.1186/s12874-017-0320-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/08/2017] [Indexed: 11/16/2022] Open
Abstract
Background Reporting of adverse events in randomized clinical trials (RCTs) is encouraged by the authors of The Consolidated Standards of Reporting Trials (CONSORT) statement. With robust methodological design and adequate reporting, RCTs have the potential to provide useful evidence on the incidence of adverse events associated with spinal manipulative therapy (SMT). During a previous investigation, it became apparent that comprehensive search strategies combining text words with indexing terms was not sufficiently sensitive for retrieving records that were known to contain reports on adverse events. The aim of this analysis was to compare the proportion of articles containing data on adverse events associated with SMT that were indexed in MEDLINE and/or EMBASE and the proportion of those that included adverse event-related words in their title or abstract. Methods A sample of 140 RCT articles previously identified as containing data on adverse events associated with SMT was used. Articles were checked to determine if: (1) they had been indexed with relevant terms describing adverse events in the MEDLINE and EMBASE databases; and (2) they mentioned adverse events (or any related terms) in the title or abstract. Results Of the 140 papers, 91% were MEDLINE records, 85% were EMBASE records, 81% were found in both MEDLINE and EMBASE records, and 4% were not in either database. Only 19% mentioned adverse event-related text words in the title or abstract. There was no significant difference between MEDLINE and EMBASE records in the proportion of available papers (p = 0.078). Of the 113 papers that were found in both MEDLINE and EMBASE records, only 3% had adverse event-related indexing terms assigned to them in both databases, while 81% were not assigned an adverse event-related indexing term in either database. Conclusions While there was effective indexing of RCTs involving SMT in the MEDLINE and EMBASE databases, there was a failure of allocation of adverse event indexing terms in both databases. We recommend the development of standardized definitions and reporting tools for adverse events associated with SMT. Adequate reporting of adverse events associated with SMT will facilitate accurate indexing of these types of manuscripts in the databases.
Collapse
Affiliation(s)
- Lindsay M Gorrell
- Human Performance Laboratory, KNB 222, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, T2N 1 N4, Canada.
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Building C5C West, Sydney, 2109, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Building C5C West, Sydney, 2109, Australia
| |
Collapse
|
6
|
Engel RM, Beirman R, Grace S. An indication of current views of Australian general practitioners towards chiropractic and osteopathy: a cross-sectional study. Chiropr Man Therap 2016; 24:37. [PMID: 27822360 PMCID: PMC5088656 DOI: 10.1186/s12998-016-0119-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
Background While the role of complementary medicine therapies such as chiropractic and osteopathy is yet to be clearly delineated in the Australian context, demand for these services remains high. The attitudes of general practitioners towards chiropractors and osteopaths may have played a part in producing this outcome. However, this view is based on data that were more than 10 years old. Current anecdotal evidence suggests that the previous level of support may be declining in sections of the Australian medical profession. An assessment of the current views of general practitioners towards chiropractors and osteopaths is called for. The results being reported here represent the first stage of this assessment. Methods This cross-sectional study was designed as a quantitative descriptive study using an anonymous online survey that included closed and open-ended questions with opportunities provided for free text. The target population was Australian general practitioners. Inclusion criteria included current medical registration, membership of the Royal Australian College of General Practitioners and currently practicing as a general practitioner in Australia. The data being reported here were collected between May and December, 2014. Results There were 630 respondents to the online survey during this period representing a response rate of 2.6 %. Results were not uniform for the two professions. More general practitioners believed chiropractic education was not evidence-based compared to osteopathic education (70 % and 50 % respectively) while scope of practice was viewed as similar for both professions. A majority of general practitioners had never referred a patient to either profession (chiropractic: 60 %; osteopathy: 66 %) with approximately two-thirds not interested in learning more about their education (chiropractors: 68 %; osteopaths: 63 %). Conclusions This study provides an indication of the current views of Australian general practitioners towards chiropractors and osteopaths. The findings suggest that attitudes may have become less favourable with a growing intolerance towards both professions. If confirmed, this has the potential to impact health service provision. The results from this cross-sectional study suggest that obtaining representative general practitioner views using online surveys is difficult and another approach is needed to supplement or replace the current recruitment strategy.' Electronic supplementary material The online version of this article (doi:10.1186/s12998-016-0119-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney, NSW 2109 Australia
| | - Robyn Beirman
- School of Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Sandra Grace
- School of Health & Human Sciences, Southern Cross University, Lismore, Australia
| |
Collapse
|
7
|
Gorrell LM, Engel RM, Brown B, Lystad RP. The reporting of adverse events following spinal manipulation in randomized clinical trials-a systematic review. Spine J 2016; 16:1143-51. [PMID: 27241208 DOI: 10.1016/j.spinee.2016.05.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/25/2016] [Accepted: 05/25/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulative therapy (SMT) is commonly used to treat spinal disorders. Although clinical practice guidelines recommend the use of SMT in the treatment of neck and back disorders, concerns exist about the nature and incidence of adverse events associated with the intervention. Comprehensive reporting of adverse events in clinical trials could allow for accurate incidence estimates through meta-analysis. However, it is not clear if randomized clinical trials (RCTs) that involve SMT are currently reporting adverse events adequately. PURPOSE This study aimed to describe the extent of adverse events reporting in published RCTs involving SMT, and to determine whether the quality of reporting has improved since publication of the 2010 Consolidated Standards Of Reporting Trials (CONSORT) statement. STUDY DESIGN This is a systematic literature review. METHODS The Physiotherapy Evidence Database (PEDro) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCTs involving SMT. Domains of interest included classifications of adverse events, completeness of adverse events reporting, nomenclature used to describe the events, methodological quality of the study, and details of the publishing journal. Data were analyzed using descriptive statistics. Frequencies and proportions of trials reporting on each of the specified domains above were calculated. Differences in proportions between pre- and post-CONSORT trials were calculated with 95% confidence intervals using standard methods, and statistical comparisons were analyzed using tests for equality of proportions with continuity correction. There was no funding obtained for this study. The authors declare no conflict of interest. RESULTS Of 7,398 records identified in the electronic searches, 368 articles were eligible for inclusion in this review. Adverse events were reported in 140 (38.0%) articles. There was a significant increase in the reporting of adverse events post-CONSORT (p=.001). There were two major adverse events reported (0.3%). Only 22 articles (15.7%) reported on adverse events in the abstract. There were no differences in reporting of adverse events post-CONSORT for any of the chosen parameters. CONCLUSIONS Although there has been an increase in reporting adverse events since the introduction of the 2010 CONSORT guidelines, the current level should be seen as inadequate and unacceptable. We recommend that authors adhere to the CONSORT statement when reporting adverse events associated with RCTs that involve SMT.
Collapse
Affiliation(s)
- Lindsay M Gorrell
- Department of Chiropractic, Macquarie University, Sydney 2109, Australia; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney 2109, Australia
| | - Benjamin Brown
- Department of Chiropractic, Macquarie University, Sydney 2109, Australia
| | - Reidar P Lystad
- Department of Chiropractic, Macquarie University, Sydney 2109, Australia
| |
Collapse
|
8
|
Rozmovits L, Mior S, Boon H. Exploring approaches to patient safety: the case of spinal manipulation therapy. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:164. [PMID: 27251398 PMCID: PMC4890537 DOI: 10.1186/s12906-016-1149-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/27/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The purpose of this study was to gain insight into the current safety culture around the use of spinal manipulation therapy (SMT) by regulated health professionals in Canada and to explore perceptions of readiness for implementing formal mechanisms for tracking associated adverse events. METHODS Fifty-six semi-structured telephone interviews were conducted with professional leaders and frontline practitioners in chiropractic, physiotherapy, naturopathy and medicine, all professions regulated to perform SMT in the provinces of Alberta and Ontario Canada. Interviews were digitally audio-recorded for verbatim transcription. Transcripts were entered into HyperResearch software for qualitative data analysis and were coded for both anticipated and emergent themes using the constant comparative method. A thematic, descriptive analysis was produced. RESULTS The safety culture around SMT is characterized by substantial disagreement about its actual rather than putative risks. Competing intra- and inter-professional narratives further cloud the safety picture. Participants felt that safety talk is sometimes conflated with competition for business in the context of fee-for-service healthcare delivery by several professions with overlapping scopes of practice. Both professional leaders and frontline practitioners perceived multiple barriers to the implementation of an incident reporting system for SMT. CONCLUSIONS The established 'measure and manage' approach to patient safety is difficult to apply to care which is geographically dispersed and delivered by practitioners in multiple professions with overlapping scopes of practice, primarily in a fee-for-service model. Collaboration across professions on models that allow practitioners to share information anonymously and help practitioners learn from the reported incidents is needed.
Collapse
Affiliation(s)
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.
| |
Collapse
|
9
|
[Cauda equina syndrome after chiropractic treatment]. Neurocirugia (Astur) 2016; 27:151-3. [PMID: 27041465 DOI: 10.1016/j.neucir.2016.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/19/2016] [Indexed: 01/31/2023]
|
10
|
Puentedura EJ, O'Grady WH. Safety of thrust joint manipulation in the thoracic spine: a systematic review. J Man Manip Ther 2015; 23:154-61. [PMID: 26309386 DOI: 10.1179/2042618615y.0000000012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There appears to be very little in the research literature on the safety of thrust joint manipulation (TJM) when applied to the thoracic spine. PURPOSE To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AE) after receiving TJM to their thoracic spine. DATA SOURCES Case reports published in peer reviewed journals were searched in Medline (using Ovid Technologies, Inc.), Science Direct, Web of Science, PEDro (Physiotherapy Evidence Database), Index of Chiropractic literature, AMED (Allied and Alternative Medicine Database), PubMed and the Cumulative Index to Nursing and Allied Health (CINHAL) from January 1950 to February 2015. STUDY SELECTION Case reports were included if they: (1) were peer-reviewed; (2) were published between 1950 and 2015; (3) provided case reports or case series; and (4) had TJM as an intervention. Articles were excluded if: (1) the AE occurred without TJM (e.g. spontaneous); (2) the article was a systematic or literature review; or (3) it was written in a language other than English or Spanish. DATA EXTRACTION Data extracted from each case report included: gender; age; who performed the TJM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the TJM; as well as type of severe AE that resulted. RESULTS Ten cases, reported in 7 case reports, were reviewed. Cases involved females (8) more than males (2), with mean age being 43.5 years (SD=18.73, Range = 17 -71). The most frequent AE reported was injury (mechanical or vascular) to the spinal cord (7/10), with pneumothorax and hematothorax (2/10) and CSF leak secondary to dural sleeve injury (1/10). LIMITATIONS There were only a small number of case reports published in the literature and there may have been discrepancies between what was reported and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the TJM, published the cases. CONCLUSIONS Serious AE do occur in the thoracic spine, most commonly, trauma to the spinal cord, followed by pneumothorax. This suggests that excessive peak forces may have been applied to thoracic spine, and it should serve as a cautionary note for clinicians to decrease these peak forces.
Collapse
Affiliation(s)
- Emilio J Puentedura
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, NV, USA
| | - William H O'Grady
- University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, NV, USA
| |
Collapse
|
11
|
Han L, Zhao P, Guo W, Wei J, Wang F, Fan Y, Li Y, Min Y. Short-term study on risk-benefit outcomes of two spinal manipulative therapies in the treatment of acute radiculopathy caused by lumbar disc herniation: study protocol for a randomized controlled trial. Trials 2015; 16:122. [PMID: 25872929 PMCID: PMC4380109 DOI: 10.1186/s13063-015-0634-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND That patients with acute radiculopathy caused by lumbar disc herniation (LDH) will benefit from spinal manipulation (SM) treatment has been taken for granted, despite no solid evidence to support that claim. There is a demand for a win-win SM treatment that is both effective and less risky, and we attempt to use this trial to demonstrate such a treatment. In this study, Feng's Spinal Manipulative Therapy (FSM) is selected as the observational SM. FSM can be performed with either manipulation or mobilization, and also can be easily mimicked as a sham SM. METHODS/DESIGN Two hundred and sixteen qualified hospitalized participants will be randomly allocated to one of the three following groups: sham SM, mobilization, or manipulation, according to a ratio of 1:1:1. Participants in each group will receive specific FSM treatments four times, along with basic therapies over a course of 2 weeks. Two days after each SM appointment, risk outcomes will be assessed using a questionnaire developed to identify accompanying unpleasant reactions (AUR). The pain pressure threshold (PPT) will be measured paraspinally on the tender spot beside the involved joint before and immediately after each SM treatment. Relative risk (RR) of AUR, number needed to harm (NNH) and the 95% confidence intervals of each group will be calculated and compared. Benefit outcomes will be assessed by analyzing the following data recordings: the Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), and Global Perceived Effect (GPE) before enrollment and at the 7th, and 15th day after the treatment. Analyses will include comparisons of NRS, ODI and changes at the different visit times among the three groups by Repeated Measures Data ANOVA, an evaluation of reduced scores of NRS and ODI after the therapy to determine if they meet the minimum acceptable outcome (MAO), and the determination of the minimal clinically important difference (MCID) by the average improvement in NRS and ODI scores of all participants who have been allocated to the category 'improved' on the GPE assessment. TRIAL REGISTRATION This trial is registered in Chinese Clinical Trial Register (ChiCTR) on 19 August 2013 ( ChiCTR-TRC-13003496 ).
Collapse
Affiliation(s)
- Lei Han
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Ping Zhao
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Wei Guo
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Jie Wei
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Fei Wang
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Yu Fan
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Yi Li
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| | - Yaqing Min
- PLA Spine Center of TCM Manipulative Orthopedics, Air Force General Hospital of PLA, No. 30, Fu Cheng Street, Hai Dian District, Beijing, 100142, China.
| |
Collapse
|
12
|
Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976) 2015; 40:264-70. [PMID: 25494315 PMCID: PMC4326543 DOI: 10.1097/brs.0000000000000725] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE In older adults with a neuromusculoskeletal complaint, to evaluate risk of injury to the head, neck, or trunk after an office visit for chiropractic spinal manipulation compared with office visit for evaluation by primary care physician. SUMMARY OF BACKGROUND DATA The risk of physical injury due to spinal manipulation has not been rigorously evaluated for older adults, a population particularly vulnerable to traumatic injury in general. METHODS We analyzed Medicare administrative data on Medicare B beneficiaries aged 66 to 99 years with an office visit in 2007 for a neuromusculoskeletal complaint. Using a Cox proportional hazards model, we evaluated for adjusted risk of injury within 7 days, comparing 2 cohorts: those treated by chiropractic spinal manipulation versus those evaluated by a primary care physician. We used direct adjusted survival curves to estimate the cumulative probability of injury. In the chiropractic cohort only, we used logistic regression to evaluate the effect of specific chronic conditions on likelihood of injury. RESULTS The adjusted risk of injury in the chiropractic cohort was lower than that of the primary care cohort (hazard ratio, 0.24; 95% confidence interval, 0.23-0.25). The cumulative probability of injury in the chiropractic cohort was 40 injury incidents per 100,000 subjects compared with 153 incidents per 100,000 subjects in the primary care cohort. Among subjects who saw a chiropractic physician, the likelihood of injury was increased in those with a chronic coagulation defect, inflammatory spondylopathy, osteoporosis, aortic aneurysm and dissection, or long-term use of anticoagulant therapy. CONCLUSION Among Medicare beneficiaries aged 66 to 99 years with an office visit risk for a neuromusculoskeletal problem, risk of injury to the head, neck, or trunk within 7 days was 76% lower among subjects with a chiropractic office visit than among those who saw a primary care physician. LEVEL OF EVIDENCE 3.
Collapse
|
13
|
Whedon JM, Song Y, Mackenzie TA, Phillips RB, Lukovits TG, Lurie JD. Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain. J Manipulative Physiol Ther 2015; 38:93-101. [PMID: 25596875 DOI: 10.1016/j.jmpt.2014.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. METHODS This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts. RESULTS The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19). CONCLUSIONS Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.
Collapse
Affiliation(s)
- James M Whedon
- Instructor, The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Grantham, NH.
| | - Yunjie Song
- Research Associate, The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Grantham, NH
| | - Todd A Mackenzie
- Associate Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Grantham, NH
| | - Reed B Phillips
- President Emeritus, Southern California University of Health Sciences, Whittier, CA
| | - Timothy G Lukovits
- Associate Professor of Neurology, Geisel School of Medicine, Dartmouth College, Grantham, NH
| | - Jon D Lurie
- Associate Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Grantham, NH
| |
Collapse
|
14
|
Tissue damage markers after a spinal manipulation in healthy subjects: a preliminary report of a randomized controlled trial. DISEASE MARKERS 2014; 2014:815379. [PMID: 25609853 PMCID: PMC4291009 DOI: 10.1155/2014/815379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/10/2014] [Indexed: 01/30/2023]
Abstract
Spinal manipulation (SM) is a manual therapy technique frequently applied to treat musculoskeletal disorders because of its analgesic effects. It is defined by a manual procedure involving a directed impulse to move a joint past its physiologic range of movement (ROM). In this sense, to exceed the physiologic ROM of a joint could trigger tissue damage, which might represent an adverse effect associated with spinal manipulation. The present work tries to explore the presence of tissue damage associated with SM through the damage markers analysis. Thirty healthy subjects recruited at the University of Jaén were submitted to a placebo SM (control group; n = 10), a single lower cervical manipulation (cervical group; n = 10), and a thoracic manipulation (n = 10). Before the intervention, blood samples were extracted and centrifuged to obtain plasma and serum. The procedure was repeated right after the intervention and two hours after the intervention. Tissue damage markers creatine phosphokinase (CPK), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin-I, myoglobin, neuron-specific enolase (NSE), and aldolase were determined in samples. Statistical analysis was performed through a 3 × 3 mixed-model ANOVA. Neither cervical manipulation nor thoracic manipulation did produce significant changes in the CPK, LDH, CRP, troponin-I, myoglobin, NSE, or aldolase blood levels. Our data suggest that the mechanical strain produced by SM seems to be innocuous to the joints and surrounding tissues in healthy subjects.
Collapse
|
15
|
Casanova-Méndez A, Oliva-Pascual-Vaca Á, Rodriguez-Blanco C, Heredia-Rizo AM, Gogorza-Arroitaonandia K, Almazán-Campos G. Comparative short-term effects of two thoracic spinal manipulation techniques in subjects with chronic mechanical neck pain: A randomized controlled trial. ACTA ACUST UNITED AC 2014; 19:331-7. [DOI: 10.1016/j.math.2014.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 03/01/2014] [Accepted: 03/05/2014] [Indexed: 01/17/2023]
|
16
|
Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials. J Manipulative Physiol Ther 2014; 37:343-62. [DOI: 10.1016/j.jmpt.2014.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/30/2014] [Accepted: 05/01/2014] [Indexed: 11/20/2022]
|
17
|
Martin VT, Neilson D. Joint Hypermobility and Headache: The Glue That Binds the Two Together - Part 2. Headache 2014; 54:1403-11. [DOI: 10.1111/head.12417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Vincent T. Martin
- Department of Internal Medicine; University of Cincinnati; Cincinnati OH USA
| | - Derek Neilson
- Department of Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| |
Collapse
|
18
|
von Heymann W, Terrier B. Leitlinien über die Grundlagen der Aus- und Weiterbildung und der Sicherheit in manueller/muskuloskeletaler Medizin. MANUELLE MEDIZIN 2014. [DOI: 10.1007/s00337-014-1105-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskelet Disord 2014; 15:77. [PMID: 24618345 PMCID: PMC3995636 DOI: 10.1186/1471-2474-15-77] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/25/2014] [Indexed: 11/15/2022] Open
Abstract
Background The safety of the manual treatment techniques such as spinal manipulation has been discussed and there is a need for more information about potential adverse events after manual therapy. The aim of this randomized controlled trial was to investigate differences in occurrence of adverse events between three different combinations of manual treatment techniques used by manual therapists (i.e. chiropractors, naprapaths, osteopaths, physicians and physiotherapists) for patients seeking care for back and/or neck pain. In addition women and men were compared regarding the occurrence of adverse events. Methods Participants were recruited among patients, ages 18–65, seeking care at the educational clinic of the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 767) were randomized to one of three treatment arms 1) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage) (n = 249), 2) manual therapy excluding spinal manipulation (n = 258) and 3) manual therapy excluding stretching (n = 260). Treatments were provided by students in the seventh semester of total eight. Adverse events were measured with a questionnaire after each return visit and categorized in to five levels; 1) short minor, 2) long minor, 3) short moderate, 4) long moderate and 5) serious adverse events, based on the duration and/or severity of the event. Generalized estimating equations were used to examine the association between adverse event and treatments arms. Results The most common adverse events were soreness in muscles, increased pain and stiffness. No differences were found between the treatment arms concerning the occurrence of adverse event. Fifty-one percent of patients, who received at least three treatments, experienced at least one adverse event after one or more visits. Women more often had short moderate adverse events (OR = 2.19 (95% CI: 1.52-3.15)), and long moderate adverse events (OR = 2.49 (95% CI: 1.77-3.52)) compared to men. Conclusion Adverse events after manual therapy are common and transient. Excluding spinal manipulation or stretching do not affect the occurrence of adverse events. The most common adverse event is soreness in the muscles. Women reports more adverse events than men. Trial registration This trial was registered in a public registry (Current Controlled Trials) (ISRCTN92249294).
Collapse
|
20
|
Abstract
BACKGROUND Intracranial hypotension (IH) is caused by a leakage of cerebrospinal fluid (often from a tear in the dura) which commonly produces an orthostatic headache. It has been reported to occur after trivial cervical spine trauma including spinal manipulation. Some authors have recommended specifically questioning patients regarding any chiropractic spinal manipulation therapy (CSMT). Therefore, it is important to review the literature regarding chiropractic and IH. OBJECTIVE To identify key factors that may increase the possibility of IH after CSMT. METHOD A systematic search of the Medline, Embase, Mantis and PubMed databases (from 1991 to 2011) was conducted for studies using the keywords chiropractic and IH. Each paper was reviewed to examine any description of the key factors for IH, the relationship or characteristics of treatment, and the significance of CSMT to IH. In addition, other items that were assessed included the presence of any risk factors, neck pain and headache. RESULTS The search of the databases identified 39 papers that fulfilled initial search criteria, from which only eight case reports were relevant for review (after removal of duplicate papers or papers excluded after the abstract was reviewed). The key factors for IH (identified from the existing literature) were recent trauma, connective tissue disorders, or otherwise cases were reported as spontaneous. A detailed critique of these cases demonstrated that five of eight cases (63%) had non-chiropractic SMT (i.e. SMT technique typically used by medical practitioners). In addition, most cases (88%) had minimal or no discussion of the onset of the presenting symptoms prior to SMT and whether the onset may have indicated any contraindications to SMT. No case reports included information on recent trauma, changes in headache patterns or connective tissue disorders. DISCUSSION Even though type of SMT often indicates that a chiropractor was not the practitioner that delivered the treatment, chiropractic is specifically cited as either the cause of IH or an important factor. There are so much missing data in the case reports that one cannot determine whether the practitioner was negligent (in clinical history taking) or whether the SMT procedure itself was poorly administered. CONCLUSIONS This systematic review revealed that case reports on IH and SMT have very limited clinical details and therefore cannot exclude other theories or plausible alternatives to explain the IH. To date, the evidence that CSMT is not a cause of IH is inconclusive. Further research is required before making any conclusions that CSMT is a cause of IH. Chiropractors and other health practitioners should be vigilant in recording established risk factors for IH in all cases. It is possible that the published cases of CSMT and IH may have missed important confounding risk factors (e.g. a new headache, or minor neck trauma in young or middle-aged adults).
Collapse
Affiliation(s)
- P Tuchin
- Department of Chiropractic, Macquarie University, NorthRyde, NSW, Australia
| |
Collapse
|
21
|
River Y, Aharony S, Bracha J, Levital T, Gerwin R. Three-dimensional computerized mobilization of the cervical spine for the treatment of chronic neck pain: a pilot study. PAIN MEDICINE 2014; 15:1091-9. [PMID: 24400987 DOI: 10.1111/pme.12329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Manual therapies for chronic neck pain are imprecise, inconsistent, and brief due to therapist fatigue. A previous study showed that computerized mobilization of the cervical spine in the sagittal plane is a safe and potentially effective treatment of chronic neck pain. OBJECTIVE To investigate the safety and efficacy of computerized mobilization of the cervical spine in a three-dimensional space for the treatment of chronic neck pain. DESIGN Pilot, open trial. SETTING Physical therapy outpatient department. PARTICIPANTS Nine patients with chronic neck pain. INTERVENTIONS A computerized cradle capable of three-dimensional neck mobilizations was used. Treatment sessions lasted 20 minutes, biweekly, for six weeks. MAIN OUTCOME MEASURES Visual analog scale (VAS) for pain, cervical range of motion (CROM), neck disability index (NDI), joint position error (JPE), and muscle algometry. RESULTS Comparing baseline at week one with week six (end of treatment), the VAS scores dropped by 2.9 points (P < 0.01). The six directions of movement studied by the CROM showed a combined increase of 11% (P = 0.01). The NDI decreased significantly from 16 to 10 (P = 0.03), and the JPE decreased significantly from 3.7° to 1.9° (P = 0.047). There was no change in the pressure pain threshold in any muscle tested. There were no significant adverse effects. CONCLUSIONS These preliminary results demonstrate that this novel, computerized, three-dimensional cervical mobilization device is probably safe. The data also suggest that this method is effective in alleviating neck pain and associated headache, and in increasing the CROM, although the sample size was small in this open trial.
Collapse
Affiliation(s)
- Yaron River
- Department of Neurology, Hillel Yaffe Medical Center, Hadera, Israel
| | | | | | | | | |
Collapse
|
22
|
|
23
|
Fawkes CA, Leach CMJ, Mathias S, Moore AP. A profile of osteopathic care in private practices in the United Kingdom: a national pilot using standardised data collection. ACTA ACUST UNITED AC 2013; 19:125-30. [PMID: 24139392 DOI: 10.1016/j.math.2013.09.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/02/2013] [Accepted: 09/05/2013] [Indexed: 11/15/2022]
Abstract
Increasing interest is being shown in osteopathy on a national and international basis. Since little prospective data had been available concerning the day-to-day practice of the profession, a standardised data collection tool was developed to try and address this issue. The tool development process has been described in an earlier paper. The standardised data collection (SDC) tool underwent national piloting between April and July 2009 in United Kingdom private practices. Osteopaths volunteered to participate and collected data on consecutive new patients or patients presenting with a new symptom episode for a period of one month; follow-up data were collected for a further two months. A total of 1630 completed datasets from the SDC pilot were analysed by the project team. Data generated from the national pilot showed that lumbar symptoms were the most commonly presented in patients (36%), followed by cervical spine (15%), sacroiliac/pelvic/groin (7.9%), head/facial area (7%), shoulder (6.8%), and thoracic spine (6%). A total of 48.8% of patients reported comorbidities, the most common being hypertension (11.7%), followed by asthma (6.6%), and arthritis (5.7%). Outcome data were collected looking at the patients' response to treatment, and any form of treatment reactions. The profiling information collected using the SDC tool provides a contemporary picture of osteopathic practice in the United Kingdom.
Collapse
Affiliation(s)
- C A Fawkes
- Clinical Research Centre, Aldro Building, University of Brighton, 49, Darley Road, Eastbourne, East Sussex, BN20 7UR, England, UK.
| | - C M J Leach
- Clinical Research Centre, Aldro Building, University of Brighton, 49, Darley Road, Eastbourne, East Sussex, BN20 7UR, England, UK
| | - S Mathias
- Clinical Research Centre, Aldro Building, University of Brighton, 49, Darley Road, Eastbourne, East Sussex, BN20 7UR, England, UK
| | - A P Moore
- Clinical Research Centre, Aldro Building, University of Brighton, 49, Darley Road, Eastbourne, East Sussex, BN20 7UR, England, UK
| |
Collapse
|
24
|
Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, Tong V, Korporaal C. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Physiol Ther 2013; 36:143-201. [PMID: 23697915 DOI: 10.1016/j.jmpt.2013.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 02/09/2013] [Accepted: 02/20/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to complete a systematic review of manual and manipulative therapy (MMT) for common upper extremity pain and disorders including the temporomandibular joint (TMJ). METHODS A literature search was conducted using the Cumulative Index of Nursing Allied Health Literature, PubMed, Manual, Alternative, and Natural Therapy Index System (MANTIS), Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, Google Scholar, and hand search inclusive of literature from January 1983 to March 5, 2012. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, and physical therapies. Inclusion criteria required an extremity peripheral diagnosis (for upper extremity problems including the elbow, wrist, hand, finger and the (upper quadrant) temporomandibular joint) and MMT with or without multimodal therapy. Studies were assessed using the PEDro scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring was complete, evidence grades of "A, B, C and I" were applied. RESULTS Out of 764 citations reviewed, 129 studies were deemed possibly to probably useful and/or relevant to develop expert consensus. Out of 81 randomized controlled or clinical trials, 35 were included. Five controlled or clinical trials were located and 4 were included. Fifty case series, reports and/or single-group pre-test post-test prospective case series were located with 32 included. There is Fair (B) level of evidence for MMT to specific joints and the full kinetic chain combined generally with exercise and/or multimodal therapy for lateral epicondylopathy, carpal tunnel syndrome, and temporomandibular joint disorders, in the short term. CONCLUSION The information from this study will help guide practitioners in the use of MMT, soft tissue technique, exercise, and/or multimodal therapy for the treatment of a variety of upper extremity complaints in the context of the hierarchy of published and available evidence.
Collapse
|
25
|
Puentedura EJ, March J, Anders J, Perez A, Landers MR, Wallmann HW, Cleland JA. Safety of cervical spine manipulation: are adverse events preventable and are manipulations being performed appropriately? A review of 134 case reports. J Man Manip Ther 2013; 20:66-74. [PMID: 23633885 DOI: 10.1179/2042618611y.0000000022] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cervical spine manipulation (CSM) is a commonly utilized intervention, but its use remains controversial. PURPOSE To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AEs) after receiving CSM to determine if the CSM was used appropriately, and if these types of AEs could have been prevented using sound clinical reasoning on the part of the clinician. DATA SOURCES PubMed and the Cumulative Index to Nursing and Allied Health were systematically searched for case reports between 1950 and 2010 of AEs following CSM. STUDY SELECTION Case reports were included if they were peer-reviewed; published between 1950 and 2010; case reports or case series; and had CSM as an intervention. Articles were excluded if the AE occurred without CSM (e.g. spontaneous); they were systematic or literature reviews. Data extracted from each case report included: gender; age; who performed the CSM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the CSM; and type of resultant AE. DATA SYNTHESIS Based on the information gathered, CSMs were categorized as appropriate or inappropriate, and AEs were categorized as preventable, unpreventable, or unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if there was a difference in proportion between six categories: appropriate/preventable, appropriate/unpreventable, appropriate/unknown, inappropriate/preventable, inappropriate/unpreventable, and inappropriate/unknown. RESULTS One hundred thirty four cases, reported in 93 case reports, were reviewed. There was no significant difference in proportions between appropriateness and preventability, P = .46. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n = 7) of the cases, mostly caused by arterial dissection. LIMITATIONS There may have been discrepancies between what was reported in the cases and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the CSM, published many of the cases. CONCLUSIONS This review showed that, if all contraindications and red flags were ruled out, there was potential for a clinician to prevent 44.8% of AEs associated with CSM. Additionally, 10.4% of the events were unpreventable, suggesting some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning.
Collapse
Affiliation(s)
- Emilio J Puentedura
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Dissection asymptomatique de l’artère carotide interne après un traumatisme grave : intérêt de l’angioscanner systématique des troncs supra-aortiques. ANNALES FRANCAISES DE MEDECINE D URGENCE 2013. [DOI: 10.1007/s13341-013-0286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
27
|
Miller MC. Complementary and integrative treatments: expanding the continuum of care. Otolaryngol Clin North Am 2013; 46:261-76. [PMID: 23764808 DOI: 10.1016/j.otc.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article is an introduction to the concepts of complementary, alternative, and integrative medicine. It discusses the scope and prevalence of complementary and integrative medicine (CIM) use among otolaryngology patients. Specific types of CIM are characterized in the context of their origins, philosophic and historical bases, scientific evidence, and applicability to the practice of otolaryngology. The author's intent is to provide a framework for discussing CIM with patients and integrating it into treatment paradigms in an evidence-based manner.
Collapse
Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology-Head and Neck Surgery, Rochester, NY 14642, USA.
| |
Collapse
|
28
|
Ferreira LAB, Santos LCF, Pereira WM, Neto HP, Grecco LAC, Christovão TCL, Oliveira CS. Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Luiz Alfredo Braun Ferreira
- Department of Physical Therapy, Guairacá College
- Doctoral Program in Rehabilitation Sciences, Nove de Julho University
| | | | | | - Hugo Pasini Neto
- Doctoral Program in Rehabilitation Sciences, Nove de Julho University
| | | | | | - Claudia Santos Oliveira
- Master’s Program in Rehabilitation Sciences, Nove de Julho University: São Paulo, SP, Brazil
| |
Collapse
|
29
|
Posadzki P, Alotaibi A, Ernst E. Prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK: a systematic review of surveys. Clin Med (Lond) 2012; 12:505-12. [PMID: 23342401 PMCID: PMC5922587 DOI: 10.7861/clinmedicine.12-6-505] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This systematic review aims to estimate the prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK. Five databases were searched for surveys monitoring the prevalence of use of CAM, which were published between 1 January 1995 and 7 December 2011. In total, 14 papers that reported 13 separate surveys met our inclusion criteria. Most were of poor methodological quality. The average prevalence of use of CAM across all surveys was 20.6% (range 12.1-32%). The average referral rate to CAM was 39% (range 24.6-86%), and CAM was recommended by 46% of physicians (range 38-55%). The average percentage of physicians who had received training in CAM was 10.3% (range 4.8-21%). The three most commonly used methods of CAM were acupuncture, homeopathy and relaxation therapy. A sizable proportion of physicians in the UK seem to employ some type of CAM, yet many have not received any training in CAM. This raises issues related to medical ethics, professional competence and education of physicians.
Collapse
Affiliation(s)
- Paul Posadzki
- Amani Alotaibi, Complementary Medicine, Peninsula Medical School, Exeter.
| | | | | |
Collapse
|
30
|
Tuchin P. A replication of the study 'Adverse effects of spinal manipulation: a systematic review'. Chiropr Man Therap 2012; 20:30. [PMID: 22998971 PMCID: PMC3502141 DOI: 10.1186/2045-709x-20-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/12/2012] [Indexed: 01/10/2023] Open
Abstract
Objective To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernst (J Roy Soc Med 100:330–338, 2007). Method Replication of a 2007 Ernst paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine. Results The review of the 32 papers discussed by Ernst found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulation therapy (SMT) as chiropractic treatment when it had been reported in the original paper as delivered by a non-chiropractic provider (e.g. Physician). The original case reports often omitted to record the time lapse between treatment and the adverse event, and other significant clinical or risk factors. The country of origin of the original paper was also overlooked, which is significant as chiropractic is not legislated in many countries. In 21 of the cases reported by Ernst to be chiropractic treatment, 11 were from countries where chiropractic is not legislated. Conclusion The number of errors or omissions in the 2007 Ernst paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects.
Collapse
Affiliation(s)
- Peter Tuchin
- Macquarie University, Bld E5A Rm 355, Waterloo Rd, North Ryde, Sydney, NSW, 2109, Australia.
| |
Collapse
|
31
|
Malo-Urriés M, Tricás-Moreno JM, Lucha-López O, Estébanez-de-Miguel E, Hidalgo-García C, Pérez-Guillén S. Vertebral and internal carotid artery flow during vascular premanipulative testing using duplex Doppler ultrasound measurements: A systematic review. INT J OSTEOPATH MED 2012. [DOI: 10.1016/j.ijosm.2012.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Jatuzis D, Valaikiene J. Migraine-like presentation of vertebral artery dissection after cervical manipulative therapy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
33
|
Posadzki P. Is Spinal Manipulation Effective for Pain? An Overview of Systematic Reviews. PAIN MEDICINE 2012; 13:754-61. [DOI: 10.1111/j.1526-4637.2012.01397.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
34
|
Wang M. Death due to extensive cervicomedullary infarction following iatrogenic vertebral artery occlusion. Forensic Sci Med Pathol 2012; 8:334-7. [PMID: 22350824 DOI: 10.1007/s12024-012-9321-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Marian Wang
- Forensic Medicine Division, Health Sciences Authority, 11 Outram Road, Singapore 169078, Singapore.
| |
Collapse
|
35
|
Learning lumbar spine mobilization: the effects of frequency and self-control of feedback. J Orthop Sports Phys Ther 2012; 42:114-24. [PMID: 22030595 DOI: 10.2519/jospt.2012.3691] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study, longitudinal. OBJECTIVES To investigate the effects of frequency and self-control of feedback on physiotherapy students learning lumbar spinal mobilization. BACKGROUND Posterior-to-anterior mobilization is included in most physiotherapy curricula. However, force application varies between therapists and the optimal feedback for learning is unknown. METHODS Sixty-two physiotherapy students were randomized to 3 feedback groups: constant (100% of practice trials), intermittent (33%), and self-controlled (varied according to student choice) feedback. Students performed 12 practice trials of grade II posterior-to-anterior mobilization to the third lumbar vertebra while receiving real-time feedback. The differences between students' force parameters (mean peak force [N], force amplitude [N], and oscillation frequency [Hz]) and those of a physiotherapist expert were compared between groups posttest and at a follow-up of 5 to 7 days using analysis of covariance. Students completed a survey regarding their perceptions of feedback. RESULTS Students in the self-controlled group applied mean peak force (mean difference between student and expert, 6.7 N; 95% confidence interval [CI]: 4.4, 9.0) and force amplitude (6.3 N; 95% CI: 4.2, 8.4) that more closely matched the expert's than those applied by the constant group (13.7 N; 95% CI: 8.7, 18.6; P = .021, and 13.1 N; 95% CI: 8.9, 17.4; P = .028) at posttest, with similar results at follow-up for force amplitude only (self-controlled, 9.5 N; 95% CI: 5.8, 18.1; constant, 21.0 N; 95% CI: 13.3, 28.7; P = .018). There were no other significant differences. All students reported a better understanding of manual force application, but feedback preferences varied. CONCLUSION Self-controlled feedback appears to be more beneficial than constant feedback for students learning to apply forces during lumbar mobilization.
Collapse
|
36
|
Pilkington K, Boshnakova A. Complementary medicine and safety: a systematic investigation of design and reporting of systematic reviews. Complement Ther Med 2011; 20:73-82. [PMID: 22305252 DOI: 10.1016/j.ctim.2011.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objective of this study was to examine the methods used in systematic reviews of safety across a range of complementary therapies to assess the variation in approach and the potential for developing guidance on conduct and reporting. DESIGN Systematic reviews focusing on safety were retrieved from NHS Evidence and searches of major databases. A pre-prepared template was used for data extraction. Information extracted included details of search strategies, sources, participants, interventions, reported adverse event/effect(s) and causality assessment. Data extraction was carried out by one researcher and a check for accuracy by a second researcher. Methods were assessed against criteria based on guidance provided by the Cochrane Adverse Effects Methods Group. RESULTS A total of 2563 citations were screened and 88 systematic reviews were selected for inclusion. The majority focused on the safety of herbs and nutritional supplements. Approximately half the reviews covered all aspects of safety; other reviews addressed specific adverse effects or interactions. Types of data included in the reviews did not always reflect the focus of the review. Search strategies, sources used, quality assessment and assessment of causality also varied. CONCLUSIONS Detailed examination and comparison of the methods has highlighted several areas in which there is potential for development of guidelines and consensus on standards. These include search strategies, sources of information, data extraction and assessment of causality. The value of systematic reviews in relation to large outcome studies requires further consideration.
Collapse
Affiliation(s)
- Karen Pilkington
- School of Life Sciences, University of Westminster, 115 New Cavendish Street, London W1W 6UW, UK.
| | | |
Collapse
|
37
|
Brantingham JW, Cassa TK, Bonnefin D, Jensen M, Globe G, Hicks M, Korporaal C. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manipulative Physiol Ther 2011; 34:314-46. [PMID: 21640255 DOI: 10.1016/j.jmpt.2011.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to conduct a systematic review on manual and manipulative therapy (MMT) for common shoulder pain and disorders. METHODS A search of the literature was conducted using the Cumulative Index of Nursing Allied Health Literature; PubMed; Manual, Alternative, and Natural Therapy Index System; Physiotherapy Evidence Database; and Index to Chiropractic Literature dating from January 1983 to July 7, 2010. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, musculoskeletal, physical therapies, shoulder, etc. Inclusion criteria required a shoulder peripheral diagnosis and MMT with/without multimodal therapy. Exclusion criteria included pain referred from spinal sites without a peripheral shoulder diagnosis. Articles were assessed primarily using the Physiotherapy Evidence Database scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring were complete, with subsequent participant review and agreement, evidence grades of A, B, C, and I were applied. RESULTS A total of 211 citations were retrieved, and 35 articles were deemed useful. There is fair evidence (B) for the treatment of a variety of common rotator cuff disorders, shoulder disorders, adhesive capsulitis, and soft tissue disorders using MMT to the shoulder, shoulder girdle, and/or the full kinetic chain (FKC) combined with or without exercise and/or multimodal therapy. There is limited (C) and insufficient (I) evidence for MMT treatment of minor neurogenic shoulder pain and shoulder osteoarthritis, respectively. CONCLUSIONS This study found a level of B or fair evidence for MMT of the shoulder, shoulder girdle, and/or the FKC combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction. There is a fair or B level of evidence for MMT of the shoulder/shoulder girdle and FKC combined with a multimodal treatment approach for shoulder complaints, dysfunction, disorders, and/or pain.
Collapse
Affiliation(s)
- James W Brantingham
- Department of Research, Cleveland Chiropractic College, Los Angeles, CA, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
Spinal Manipulative Therapy for Elderly Patients With Chronic Obstructive Pulmonary Disease: A Case Series. J Manipulative Physiol Ther 2011; 34:413-7. [DOI: 10.1016/j.jmpt.2011.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/21/2011] [Accepted: 04/04/2011] [Indexed: 11/18/2022]
|
39
|
Posadzki P, Ernst E. Spinal Manipulations for Cervicogenic Headaches: A Systematic Review of Randomized Clinical Trials. Headache 2011; 51:1132-9. [DOI: 10.1111/j.1526-4610.2011.01932.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
40
|
Hughes C, Quinn F, Baxter G. Complementary and alternative medicine: Perception and use by physiotherapists in the management of low back pain. Complement Ther Med 2011; 19:149-54. [DOI: 10.1016/j.ctim.2011.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 03/04/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022] Open
|
41
|
|
42
|
Christe G, Balthazard P. Episode of fainting and tetany after an evaluation technique of the upper cervical region: a case report. MANUAL THERAPY 2011; 16:94-96. [PMID: 20724209 DOI: 10.1016/j.math.2010.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/29/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Affiliation(s)
- Guillaume Christe
- Department of physiotherapy, HECVSante, HES-SO University of Applied Sciences Western Switzerland, Avenue Beaumont 21, CH-1011 Lausanne, Switzerland
| | | |
Collapse
|
43
|
Bowler N, Shamley D, Davies R. The effect of a simulated manipulation position on internal carotid and vertebral artery blood flow in healthy individuals. ACTA ACUST UNITED AC 2011; 16:87-93. [DOI: 10.1016/j.math.2010.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 07/08/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
|
44
|
Aluko A, DeSouza L, Peacock J. Evaluation of trunk acceleration in healthy individuals and those with low back pain. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.1.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Augustine Aluko
- School of Health Sciences and Social Care, Brunel University
| | - Lorraine DeSouza
- Rehabilitation, School of Health Sciences and Social Care, Brunel University, London
| | - Janet Peacock
- Public Health Sciences & Medical Statistics, University of Southampton, Southampton General Hospital, Southampton, UK
| |
Collapse
|
45
|
Funk MF, Cantito AA. Laboratory pre-participation screening examination in a chiropractic college: development, implementation, and results. THE JOURNAL OF CHIROPRACTIC EDUCATION 2011; 25:16-29. [PMID: 21677869 PMCID: PMC3113620 DOI: 10.7899/1042-5055-25.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 08/11/2010] [Accepted: 09/06/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Chiropractic students often serve as subjects in laboratories where they and their classmates practice examinations, various soft tissue techniques, physiological therapeutic modalities, and active rehabilitation. There are contraindications and risks associated with these procedures. This article describes how a procedure was developed to identify potential health concerns and risks that students may face while serving as subjects or performing procedures in clinical skills laboratories. METHODS Screening questions and examination procedures were developed through a consensus process. Findings from the screening process determine whether students may engage in full participation or limited participation (precautions) or are prohibited from receiving certain procedures (contraindications). Skills laboratory students and their instructors are informed of any identifiable precautions or contraindications to participation. RESULTS Since its implementation, precautions regarding delivery of manual therapies were found in 4% of those examined and precautions regarding receiving manual therapies in 11.5%. Contraindications to receiving specified manual therapies were found in 8%, and 4% had contraindications to certain physiological therapeutic modalities. DISCUSSION Further work is necessary to improve compliance with follow-up regarding diagnosis of conditions revealed or suspected. Future efforts should address how well students adhered to precautions and contraindications, the nature and frequency of injuries sustained within the laboratories, and what specific measures were taken by faculty to help students with special needs. CONCLUSION This chiropractic college now has a method to describe potential risks, explain rules of laboratory participation, and obtain consent from each student.
Collapse
Affiliation(s)
- Matthew F. Funk
- Address correspondence to Matthew Funk, University of Bridgeport College of Chiropractic, 60 Lafayette Street, Bridgeport, CT 06604 (e-mail: )
| | | |
Collapse
|
46
|
Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Phys Med Rehabil Clin N Am 2010; 22:105-25. [PMID: 21292148 DOI: 10.1016/j.pmr.2010.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions.
Collapse
Affiliation(s)
- Brent Leininger
- Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 West 84th Street, Bloomington, MN 55431, USA.
| | | | | | | |
Collapse
|
47
|
Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong. Soc Sci Med 2010; 72:247-55. [PMID: 21145150 DOI: 10.1016/j.socscimed.2010.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 09/10/2010] [Accepted: 10/18/2010] [Indexed: 11/20/2022]
Abstract
Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.
Collapse
|
48
|
Murphy DR. Current understanding of the relationship between cervical manipulation and stroke: what does it mean for the chiropractic profession? CHIROPRACTIC & OSTEOPATHY 2010; 18:22. [PMID: 20682039 PMCID: PMC2922298 DOI: 10.1186/1746-1340-18-22] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 08/03/2010] [Indexed: 11/10/2022]
Abstract
The understanding of the relationship between cervical manipulative therapy (CMT) and vertebral artery dissection and stroke (VADS) has evolved considerably over the years. In the beginning the relationship was seen as simple cause-effect, in which CMT was seen to cause VADS in certain susceptible individuals. This was perceived as extremely rare by chiropractic physicians, but as far more common by neurologists and others. Recent evidence has clarified the relationship considerably, and suggests that the relationship is not causal, but that patients with VADS often have initial symptoms which cause them to seek care from a chiropractic physician and have a stroke some time after, independent of the chiropractic visit.This new understanding has shifted the focus for the chiropractic physician from one of attempting to "screen" for "risk of complication to manipulation" to one of recognizing the patient who may be having VADS so that early diagnosis and intervention can be pursued. In addition, this new understanding presents the chiropractic profession with an opportunity to change the conversation about CMT and VADS by taking a proactive, public health approach to this uncommon but potentially devastating disorder.
Collapse
Affiliation(s)
- Donald R Murphy
- Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860, USA.
| |
Collapse
|
49
|
Zusman M. There’s something about passive movement…. Med Hypotheses 2010; 75:106-10. [DOI: 10.1016/j.mehy.2010.01.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 01/31/2010] [Indexed: 12/20/2022]
|
50
|
Acute paraplegia after chiropraxis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20 Suppl 2:S143-6. [PMID: 20556441 DOI: 10.1007/s00586-010-1443-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 09/20/2009] [Accepted: 05/09/2010] [Indexed: 10/19/2022]
Abstract
Spinal manipulation is a form of back and other musculoskeletal pain treatment that often involves a high-velocity thrust, a technique in which the joints are adjusted rapidly. The main objective of chiropractors is to correct spinal malalignment and relieve the nerves, allowing them to function optimally (Ernst In: Expert Rev Neurother 7:1451-1452, 2007; Oppenheim et al. In: Spine J 5:660-666, 2005). The evidence for the effectiveness of this treatment based on randomized clinical trials still remains uncertain (Cassidy et al. In: Spine 33(4 suppl): S176-S183, 2008; Dupeyron et al. In: Ann Readapt Med Phys 46:33-40, 2003; Ernst et al. In: Expert Rev Neurother 7:1451-1452, 2007; Hurwitz et al. In: J Manipulative Physiol Ther 27:16-25, 2007; Thiel et al. In: Spine 32: 2375-2378, 2007). Several case reports and series have been focusing on the risks of chiropraxis, especially on the cervical spine, although the risk/benefit ratio for certain selected patients could be acceptable (Powell et al.In: Neurosurgery 33:73-78, 1993). We describe the case of a 45-year-old woman who suffered complete paraplegia shortly after a chiropractic maneuver in the thoracic spine. Dorsal CT showed a calcified disc herniation at the T8-T9 level and MRI revealed a diffuse spinal cord ischemia from T6 to the conus medullaris without spinal cord compression at the level of herniation. Despite a normal arteriography, authors suggest a vascular injury as the cause of the deficit.
Collapse
|