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Vining R, Onifer SM, Twist E, Ziegler AM, Corber L, Long CR. Thoracolumbar fascia mobility and chronic low back pain: Phase 1 of a pilot and feasibility study assessing repeated measures and the influence of paraspinal muscle contraction. J Bodyw Mov Ther 2023; 34:19-27. [PMID: 37301552 DOI: 10.1016/j.jbmt.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/14/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Differential movement, or shear strain (SS), between layers of thoracolumbar fascia is reduced with chronic low back pain. To provide a foundation for clinical research involving SS, this study assessed temporal stability and the effect of paraspinal muscle contraction on SS in persons with chronic low back pain. METHODS We used ultrasound imaging to measure SS in adults self-reporting low back pain ≥1 year. Images were obtained by placing a transducer 2-3 cm lateral to L2-3 with participants lying prone and relaxed on a table moving the lower extremities downward 15°, for 5 cycles at 0.5 Hz. To assess paraspinal muscle contraction effects, participants raised the head slightly from the table. SS was calculated using 2 computational methods. Method 1 averaged the maximum SS from each side during the third cycle. Method 2 used the maximum SS from any cycle (2-4) on each side, prior to averaging. SS was also assessed after a 4-week no manual therapy period. RESULTS Of 30 participants (n = 14 female), mean age was 40 years; mean BMI 30.1. Mean (SE) SS in females with paraspinal muscle contraction was 66% (7.4) (method 1) and 78% (7.8) (method 2); 54% (6.9) (method 1) and 67% (7.3) (method 2) in males. With muscles relaxed, mean SS in females was 77% (7.6) (method 1) or 87% (6.8) (method 2); 63% (7.1) (method 1) and 78% (6.4) (method 2) in males. Mean SS decreased 8-13% in females and 7-13% in males after 4-weeks CONCLUSION: Mean SS in females was higher than males at each timepoint. Paraspinal muscle contraction temporarily reduced SS. Over a 4-week no-treatment period, mean SS (with paraspinal muscles relaxed) decreased. Methods less likely to induce muscle guarding and enabling assessment with broader populations are needed.
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Affiliation(s)
- Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA.
| | - Stephen M Onifer
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Elissa Twist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Anna-Marie Ziegler
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Lance Corber
- Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA
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Vining R, Onifer SM, Twist E, Ziegler AM, Corber L, Long CR. Thoracolumbar fascia mobility and chronic low back pain: Phase 2 of a pilot and feasibility study including multimodal chiropractic care. Chiropr Man Therap 2022; 30:46. [PMID: 36271428 PMCID: PMC9587561 DOI: 10.1186/s12998-022-00455-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Thoracolumbar fascia mobility observed with ultrasound imaging and calculated as shear strain is lower in persons with chronic low back pain. This pilot and feasibility trial assessed thoracolumbar shear strain in persons with chronic low back pain following spinal manipulation and over an 8-week course of multimodal chiropractic care. METHODS Adults self-reporting chronic low back pain ≥ 1 year participated between September 2019 and April 2021 in a trial using ultrasound imaging to measure thoracolumbar shear strain. Ultrasound imaging occurred 2-3 cm lateral to L2-3 while participants relaxed prone on an automated table moving the lower extremities downward 15 degrees, for 5 cycles at 0.5 Hz. Pain intensity on an 11-point numerical rating scale, disability, pain interference, and global improvement were also collected. Participants received 8-weeks of twice-weekly chiropractic care including spinal manipulation, education, exercise, self-management advice and myofascial therapies. Shear strain was computed using 2 methods. The highest shear strain from movement cycles 2, 3, or 4 was averaged over right and left sides for each participant. Alternately, the highest shear strain from movement cycle 3 was used. All data were analyzed over time using mixed-effects models. Estimated mean changes are reported. RESULTS Of 20 participants completing 8-weeks of chiropractic care (female n = 11), mean (SD) age was 41 years (12.6); mean BMI was 28.5 (6.2). All clinical outcomes improved at 8-weeks. Mean (95% confidence interval) pain intensity decreased 2.7 points (- 4.1 to - 1.4) for females and 2.1 points (- 3.7 to 0.4) for males. Mean Roland-Morris disability score decreased by 5 points (- 7.2 to - 2.8) for females, 2.3 points (- 4.9 to 0.2) for males. Mean PROMIS pain interference T-score decreased by 8.7 points (- 11.8 to - 5.5) for females, 5.6 points (- 9.5 to - 1.6) for males. Mean shear strain at 8-weeks increased in females 5.4% (- 9.9 to 20.8) or 15% (- 0.5 to 30.6), decreasing in males 6.0% (- 24.2 to 12.2) or 2% (- 21.0 to 16.8) depending on computational method. CONCLUSION Spinal manipulation does not likely disrupt adhesions or relax paraspinal muscles enough to immediately affect shear strain. Clinical outcomes improved in both groups, however, shear strain only increased in females following 8-weeks of multimodal chiropractic care. Trial registration ClinicalTrials.gov registration is NCT03916705.
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Affiliation(s)
- Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, USA.
| | - Stephen M. Onifer
- grid.419969.a0000 0004 1937 0749Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA USA
| | - Elissa Twist
- grid.419969.a0000 0004 1937 0749Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA USA
| | - Anna-Marie Ziegler
- grid.419969.a0000 0004 1937 0749Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA USA
| | - Lance Corber
- grid.419969.a0000 0004 1937 0749Palmer College of Chiropractic, Information Technology, 1000 Brady St, Davenport, IA USA
| | - Cynthia R. Long
- grid.419969.a0000 0004 1937 0749Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 1000 Brady St, Davenport, IA USA
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Long CR, Salsbury SA, Vining RD, Lisi AJ, Corber L, Twist E, Abrams T, Wallace RB, Goertz CM. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain. Pilot Feasibility Stud 2022; 8:54. [PMID: 35256010 PMCID: PMC8900358 DOI: 10.1186/s40814-022-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial. Methods This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10-week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables. Results We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial. Conclusions We demonstrated the feasibility of participant recruitment, retention, and electronic data collection for conducting a pragmatic clinical trial of chiropractic care in a Veterans Health Administration facility. Using the pilot data and lessons learned, we modified and refined a protocol for a full-scale, multisite, pragmatic, National Institutes of Health-funded randomized trial of multimodal chiropractic care for veterans with chronic LBP that began recruitment in February 2021. Trial registration ClinicalTrials.gov NCT03254719 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01008-0.
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Long CR, Lisi AJ, Vining RD, Wallace RB, Salsbury SA, Shannon ZK, Halloran S, Minkalis AL, Corber L, Shekelle PG, Krebs EE, Abrams TE, Lurie JD, Goertz CM. Veteran Response to Dosage in Chiropractic Therapy (VERDICT): Study Protocol of a Pragmatic Randomized Trial for Chronic Low Back Pain. Pain Med 2021; 21:S37-S44. [PMID: 33313732 DOI: 10.1093/pm/pnaa289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low back pain is a leading cause of disability in veterans. Chiropractic care is a well-integrated, nonpharmacological therapy in Veterans Affairs health care facilities, where doctors of chiropractic provide therapeutic interventions focused on the management of low back pain and other musculoskeletal conditions. However, important knowledge gaps remain regarding the effectiveness of chiropractic care in terms of the number and frequency of treatment visits needed for optimal outcomes in veterans with low back pain. DESIGN This pragmatic, parallel-group randomized trial at four Veterans Affairs sites will include 766 veterans with chronic low back pain who are randomly allocated to a course of low-dose (one to five visits) or higher-dose (eight to 12 visits) chiropractic care for 10 weeks (Phase 1). After Phase 1, participants within each treatment arm will again be randomly allocated to receive either monthly chiropractic chronic pain management for 10 months or no scheduled chiropractic visits (Phase 2). Assessments will be collected electronically. The Roland Morris Disability Questionnaire will be the primary outcome for Phase 1 at week 10 and Phase 2 at week 52. SUMMARY This trial will provide evidence to guide the chiropractic dose in an initial course of care and an extended-care approach for veterans with chronic low back pain. Accurate information on the effectiveness of different dosing regimens of chiropractic care can greatly assist health care facilities, including Veterans Affairs, in modeling the number of doctors of chiropractic that will best meet the needs of patients with chronic low back pain.
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Affiliation(s)
| | - Anthony J Lisi
- Yale School of Medicine-Center for Medical Informatics, Yale University, New Haven, Connecticut
| | | | - Robert B Wallace
- The University of Iowa, College of Public Health, Iowa City, Iowa
| | | | | | | | | | | | - Paul G Shekelle
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Erin E Krebs
- Minneapolis VA Health Care System, Minneapolis, Minnesota
| | | | - Jon D Lurie
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Vining R, Minkalis A, Long CR, Corber L, Franklin C, Gudavalli MR, Xia T, Goertz CM. Assessment of chiropractic care on strength, balance, and endurance in active-duty U.S. military personnel with low back pain: a protocol for a randomized controlled trial. Trials 2018; 19:671. [PMID: 30518400 PMCID: PMC6280458 DOI: 10.1186/s13063-018-3041-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a common cause of disability among U.S. military personnel. Approximately 20% of all diagnoses resulting in disability discharges are linked to back-related conditions. Because LBP can negatively influence trunk muscle strength, balance, and endurance, the military readiness of active-duty military personnel with LBP is potentially compromised. Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with LBP. This trial will assess the effects of chiropractic care on strength, balance, and endurance for active-duty military personnel with LBP. METHODS/DESIGN This randomized controlled trial will allocate 110 active-duty military service members aged 18-40 with non-surgical acute, subacute, or chronic LBP with pain severity of ≥2/10 within the past 24 h. All study procedures are conducted at a single military treatment facility within the continental United States. Participants are recruited through recruitment materials approved by the institutional review board, such as posters and flyers, as well as through provider referrals. Group assignment occurs through computer-generated random allocation to either the study intervention (chiropractic care) or the control group (waiting list) for a 4-week period. Chiropractic care consists primarily of spinal manipulation at a frequency and duration determined by a chiropractic practitioner. Strength, balance, and endurance outcomes are obtained at baseline and after 4 weeks. The primary outcome is a change between baseline and 4 weeks of peak isometric strength, which is measured by pulling on a bimanual handle in a semi-squat position. Secondary outcomes include balance time during a single-leg standing test and trunk muscle endurance with the Biering-Sorensen test. Patient-reported outcomes include pain severity, disability measured with the Roland Morris Disability Questionnaire, symptom bothersomeness, PROMIS-29, Fear Avoidance Beliefs Questionnaire, expectations of care, physical activity, and global improvement. DISCUSSION This trial may help inform further research on biological mechanisms related to manual therapies employed by chiropractic practitioners. TRIAL REGISTRATION ClinicalTrials.gov, NCT02670148 Registered on 1 February 2016.
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Affiliation(s)
- Robert Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Amy Minkalis
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Cynthia R. Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Lance Corber
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - Crystal Franklin
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA 52803 USA
| | - M. Ram Gudavalli
- College of Chiropractic Medicine, Keiser University, 2081 Vista Parkway, West Palm Beach, FL 33411 USA
| | - Ting Xia
- Mechanical Engineering, Northern Illinois University, 590 Garden Rd, DeKalb, IL 60115 USA
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Vining RD, Salsbury SA, Cooley WC, Gosselin D, Corber L, Goertz CM. Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study. J Multidiscip Healthc 2018; 11:223-231. [PMID: 29760552 PMCID: PMC5937508 DOI: 10.2147/jmdh.s159618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives Individuals rehabilitating from complex neurological injury require a multidisciplinary approach, which typically does not include chiropractic care. This study describes inpatients receiving multidisciplinary rehabilitation including chiropractic care for brain injury, spinal cord injury (SCI), stroke, and other complex neurological conditions. Design Chiropractic services were integrated into Crotched Mountain Specialty Hospital (CMSH) through this project. Patient characteristics and chiropractic care data were collected to describe those receiving care and the interventions during the first 15 months when chiropractic services were available. Setting CMSH, a 62-bed subacute multidisciplinary rehabilitation, skilled nursing facility located in Greenfield, New Hampshire, USA. Results Patient mean (SD) age (n=27) was 42.8 (13) years, ranging from 20 to 64 years. Males (n=18, 67%) and those of white race/ethnicity (n=23, 85%) comprised the majority. Brain injury (n=20) was the most common admitting condition caused by trauma (n=9), hemorrhage (n=7), infarction (n=2), and general anoxia (n=2). Three patients were admitted for cervical SCI, 1 for ankylosing spondylitis, 1 for traumatic polyarthropathy, and 2 for respiratory failure with encephalopathy. Other common comorbid diagnoses potentially complicating the treatment and recovery process included myospasm (n=13), depression (n=11), anxiety (n=10), dysphagia (n=8), substance abuse (n=8), and candidiasis (n=7). Chiropractic procedures employed, by visit (n=641), included manual myofascial therapies (93%), mechanical percussion (83%), manual muscle stretching (75%), and thrust manipulation (65%) to address patients with spinal-related pain (n=15, 54%), joint or regional stiffness (n= 14, 50%), and extremity pain (n=13, 46%). Care often required adapting to participant limitations or conditions. Such adaptations not commonly encountered in outpatient settings where chiropractic care is usually delivered included the need for lift assistance, wheelchair dependence, contractures, impaired speech, quadriplegia/paraplegia, and the presence of feeding tubes and urinary catheters. Conclusion Patients suffered significant functional limitations and comorbidity resulting in modifications to the typical delivery of chiropractic care. Chiropractic services focused on relieving musculoskeletal pain and stiffness.
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Affiliation(s)
- Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - W Carl Cooley
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Lance Corber
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Christine M Goertz
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
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DeVocht JW, Smith DL, Long CR, Corber L, Kane B, Jones TM, Goertz CM. The effect of chiropractic treatment on the reaction and response times of special operation forces military personnel: study protocol for a randomized controlled trial. Trials 2016; 17:457. [PMID: 27645465 PMCID: PMC5029007 DOI: 10.1186/s13063-016-1580-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background Chiropractic care is commonly used to treat musculoskeletal conditions and has been endorsed by clinical practice guidelines as being evidence-based and cost-effective for the treatment of patients with low back pain. Gaps in the literature exist regarding the physiological outcomes of chiropractic treatment. Previous pilot work has indicated the possibility of improvements in response time following the application of chiropractic treatment. However, it is unknown whether or not chiropractic treatment is able to improve reaction and response times in specific populations of interest. One such population is the U.S. military special operation forces’ (SOF) personnel. Methods This study is a randomized controlled trial of 120 asymptomatic volunteer SOF personnel. All participants are examined by a study doctor of chiropractic (DC) for eligibility prior to randomization. The participants are randomly allocated to either a treatment group receiving four treatments of chiropractic manipulative therapy (CMT) over 2 weeks or to a wait-list control group. The wait-list group does not receive any treatment but has assessments at the same time interval as the treatment group. The outcome measures are simple reaction times for dominant hand and dominant foot, choice reaction time with prompts calling for either hand or either foot, response time using Fitts’ law tasks for small movements involving eye-hand coordination, and brief whole body movements using the t-wall, a commercially available product. At the first visit, all five tests are completed so that participants can familiarize themselves with the equipment and protocol. Assessments at the second and the final visits are used for data analysis. Discussion SOF personnel are highly motivated and extremely physically fit individuals whose occupation requires reaction times that are as quick as possible during the course of their assigned duties. A goal of CMT is to maximize the functionality and integration of the neuromusculoskeletal systems. Therefore, chiropractic treatment may be able to optimize the capacity of the numerous components of those systems, resulting in improved reaction time. The objective of this study is to test the hypothesis that CMT improves reaction and response times in asymptomatic SOF personnel. Trial registration ClinicalTrials.gov, NCT02168153. Registered on 12 June 2014.
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Affiliation(s)
- James W DeVocht
- Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA, 52803, USA.
| | - Dean L Smith
- Department of Kinesiology and Health, 26E Phillips Hall, Miami University, Oxford, OH, 45056, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA, 52803, USA
| | - Lance Corber
- Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA, 52803, USA
| | - Bridget Kane
- Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA, 52803, USA
| | - Thomas M Jones
- Chiropractic Clinic, Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY, 42223-5349, USA
| | - Christine M Goertz
- Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA, 52803, USA
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Gudavalli MR, Salsbury SA, Vining RD, Long CR, Corber L, Patwardhan AG, Goertz CM. Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain. Trials 2015; 16:259. [PMID: 26044576 PMCID: PMC4460764 DOI: 10.1186/s13063-015-0770-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/20/2015] [Indexed: 12/16/2022] Open
Abstract
Background Manual cervical distraction (MCD) is a traction-based therapy performed with a manual contact over the cervical region producing repeating cycles while patients lie prone. This study evaluated a traction force-based minimal intervention for use as an attention-touch control in clinical trials of MCD for patients with chronic neck pain. Methods We conducted a mixed-methods, pilot randomized clinical trial in adults with chronic neck pain. Participants were allocated to three traction force ranges of MCD: low force/minimal intervention (0-20 N), medium force (21-50 N), or high force (51-100 N). Clinicians delivered five treatments over two weeks consisting of three sets of five cycles of MCD at the C5 vertebra and occiput. Traction forces were measured at each treatment. Patient-reported outcomes included a pain visual analogue scale (VAS), Neck Disability Index (NDI), Credibility and Expectancy Questionnaire (CEQ), and adverse effects. A qualitative interview evaluated treatment group allocation perceptions. Results We randomized 48 participants, allocating an average of five each month. Forty-five participants completed the trial with three participants lost to follow-up. Most participants were women (65 %) and white (92 %) with a mean (SD) age of 46.8 (12.5) years. Mean traction force values were within the prescribed force ranges for each group at the C5 and occiput levels. Neck pain VAS demonstrated a benefit for high traction force MCD compared to the low force group [adjusted mean difference 15.6; 95 % confidence interval (CI) 1.6 to 29.7]. Participants in the medium traction force group demonstrated improvements in NDI compared to the low force group (adjusted mean difference 3.0; 95 % CI 0.1 to 5.9), as did participants in the high traction force group (adjusted mean difference 2.7; 95 % CI -0.1 to 5.6). CEQ favored the high force group. Most low force participants correctly identified their treatment allocation in the qualitative interview. No serious adverse events were documented. Conclusions This pilot study demonstrated the feasibility of a clinical trial protocol and the utility of a traction-based, minimal intervention as an attention-touch control for future efficacy trials of MCD for patients with neck pain. Trial registration ClinicalTrials.gov NCT01765751 (Registration Date 30 May 2012)
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Affiliation(s)
- M Ram Gudavalli
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Lance Corber
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL and Department of Orthopedic Surgery & Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA.
| | - Christine M Goertz
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, 52803, Davenport, IA, USA.
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Gudavalli MR, Vining RD, Salsbury SA, Corber L, Long CR, Patwardhan AG, Goertz CM. Clinician proficiency in delivering manual treatment for neck pain within specified force ranges. Spine J 2015; 15:570-6. [PMID: 25452013 PMCID: PMC4375060 DOI: 10.1016/j.spinee.2014.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/23/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose. PURPOSE To assess clinicians' proficiency in delivering manually applied traction forces within specified ranges to neck pain patients. STUDY DESIGN An observational study nested within a randomized clinical trial. SAMPLE Two research clinicians provided study interventions to 48 participants with neck pain. OUTCOME MEASURES Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21-50 N; and high force 51-100 N). METHODS Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over 2 weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces according to treatment groups. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback. Peak traction force data were extracted and descriptively analyzed. RESULTS Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback. CONCLUSIONS This study demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force-based dose response clinical studies.
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Affiliation(s)
- Maruti Ram Gudavalli
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
| | | | | | - Lance Corber
- Palmer Center for Chiropractic Research, Davenport, IA, USA
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Gudavalli MR, Vining RD, Salsbury SA, Corber L, Long CR, Patwardhan AG, Goertz CM. Doctors of Chiropractic Proficiency in Delivering Prescribed Traction Forces During Manual Cervical Distraction of Neck Pain Patients. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5126.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maruti Ram Gudavalli
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Robert D Vining
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Stacie A Salsbury
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Lance Corber
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Cynthia R Long
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Avinash G Patwardhan
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Christine M Goertz
- (1) Palmer Center for Chiropractic Research, Davenport, IA, USA
- (2) Loyola University Stritch School of Medicine, Maywood, IL, USA
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Pohlman K, Carber L, Vining R, Devlin T, Rice R, Salsbury S, Corber L, Hondras M, Long C, Goertz C. P02.39. Leveraging grant awards to enhance the research infrastructure at a CAM institution. Altern Ther Health Med 2012. [PMCID: PMC3373852 DOI: 10.1186/1472-6882-12-s1-p95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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