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Cost analysis related to dose-response of spinal manipulative therapy for chronic low back pain: outcomes from a randomized controlled trial. J Manipulative Physiol Ther 2015; 37:300-11. [PMID: 24928639 DOI: 10.1016/j.jmpt.2014.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/04/2014] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP). METHODS We randomized 400 patients with chronic LBP to receive a dose of 0, 6, 12, or 18 sessions of SMT. Participants were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a doctor of chiropractic. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days. Multiple regression was performed on outcomes and log-transformed cost data. RESULTS Lost productivity accounts for most societal costs of chronic LBP. Cost of treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age (P = .03), greater disability (P = .01), lower quality-adjusted life year scores (P = .01), and higher costs in the period preceding enrollment (P < .01). Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days (P = .03) and 19.8 disability-free days (P = .04). No statistically significant group differences in quality-adjusted life years were noted. CONCLUSIONS A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.
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Abstract
Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.
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Affiliation(s)
- Richard A Deyo
- Departments of Family Medicine, Internal Medicine, and Public Health and Preventive Medicine and Oregon Institute for Occupational Health Sciences, Oregon Health and Science University, Portland, OR 97239, USA Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Otoo SKW, Hendrick P, Ribeiro DC. The comparative effectiveness of advice/education compared to active physiotherapy (manual therapy and exercise) in the management of chronic non-specific low back pain. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x14y.0000000164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pillastrini P, Vanti C, Curti S, Mattioli S, Ferrari S, Violante FS, Guccione A. Using PubMed search strings for efficient retrieval of manual therapy research literature. J Manipulative Physiol Ther 2014; 38:159-66. [PMID: 25499192 DOI: 10.1016/j.jmpt.2014.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 03/04/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to construct PubMed search strings that could efficiently retrieve studies on manual therapy (MT), especially for time-constrained clinicians. METHODS Our experts chose 11 Medical Subject Heading terms describing MT along with 84 additional potential terms. For each term that was able to retrieve more than 100 abstracts, we systematically extracted a sample of abstracts from which we estimated the proportion of studies potentially relevant to MT. We then constructed 2 search strings: 1 narrow (threshold of pertinent articles ≥40%) and 1 expanded (including all terms for which a proportion had been calculated). We tested these search strings against articles on 2 conditions relevant to MT (thoracic and temporomandibular pain). We calculated the number of abstracts needed to read (NNR) to identify 1 potentially pertinent article in the context of these conditions. Finally, we evaluated the efficiency of the proposed PubMed search strings to identify relevant articles included in a systematic review on spinal manipulative therapy for chronic low back pain. RESULTS Fifty-five search terms were able to extract more than 100 citations. The NNR to find 1 potentially pertinent article using the narrow string was 1.2 for thoracic pain and 1.3 for temporomandibular pain, and the NNR for the expanded string was 1.9 and 1.6, respectively. The narrow search strategy retrieved all the randomized controlled trials included in the systematic review selected for comparison. CONCLUSION The proposed PubMed search strings may help health care professionals locate potentially pertinent articles and review a large number of MT studies efficiently to better implement evidence-based practice.
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Affiliation(s)
- Paolo Pillastrini
- Associate Professor, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Carla Vanti
- Adjunct Professor Manual Therapy, Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Stefania Curti
- Research Fellow, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Stefano Mattioli
- Associate Professor, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Silvano Ferrari
- Adjunct Professor Manual Therapy, Department of Biomedical Sciences, University of Padova, Italy
| | | | - Andrew Guccione
- Professor and Chair, Department of Rehabilitation Science, College of Health and Human Services, George Mason University, Fairfax, VA
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Dougherty PE, Karuza J, Savino D, Katz P. Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial. Chiropr Man Therap 2014; 22:41. [PMID: 25426289 PMCID: PMC4243318 DOI: 10.1186/s12998-014-0041-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 10/31/2014] [Indexed: 12/19/2022] Open
Abstract
Background Spinal Manipulative Therapy (SMT) and Active Exercise Therapy (AET) have both demonstrated efficacy in the treatment of Chronic Lower Back Pain (CLBP). A Clinical Prediction Rule (CPR) for responsiveness to SMT has been validated in a heterogeneous lower back pain population; however there is a need to evaluate this CPR specifically for patients with CLBP, which is a significant source of disability. Methods We conducted a randomized controlled trial (RCT) in Veteran Affairs and civilian outpatient clinics evaluating a modification of the original CPR (mCPR) in CLBP, eliminating acute low back pain and altering the specific types of SMT to improve generalizability. We enrolled and followed 181 patients with CLBP from 2007 to 2010. Patients were randomized by status on the mCPR to undergo either SMT or AET twice a week for four weeks. Providers and statisticians were blinded as to mCPR status. We collected outcome measures at 5, 12 and 24-weeks post baseline. We tested our study hypotheses by a general linear model repeated measures procedure following a univariate analysis of covariance approach. Outcome measures included, Visual Analogue Scale, Bodily pain subscale of SF-36 and the Oswestry Disability Index, Patient Satisfaction and Patient Expectation. Results Of the 89 AET patients, 69 (78%) completed the study and of the 92 SMT patients, 76 (83%) completed the study. As hypothesized, we found main effects of time where the SMT and AET groups showed significant improvements in pain and disability from baseline. There were no differences in treatment outcomes between groups in response to the treatment, given the lack of significant treatment x time interactions. The mCPR x treatment x time interactions were not significant. The differences in outcomes between treatment groups were the same for positive and negative on the mCPR groups, thus our second hypothesis was not supported. Conclusions We found no evidence that a modification of the original CPR can be used to discriminate CLBP patients that would benefit more from SMT. Further studies are needed to further clarify the patient characteristics that moderate treatment responsiveness to specific interventions for CLBP. Trial registration ISRCTN30511490
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Affiliation(s)
- Paul E Dougherty
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY USA ; New York Chiropractic College, Seneca Falls, NY USA ; University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Jurgis Karuza
- New York Chiropractic College, Seneca Falls, NY USA ; University of Rochester, Rochester, NY USA ; State University of New York College at Buffalo, Buffalo, NY USA
| | - Dorian Savino
- Canandaigua Veterans Affairs Medical Center, Canandaigua, NY USA
| | - Paul Katz
- University of Toronto, Toronto, ON Canada ; Medical Affairs, Baycrest Geriatric Centre, Toronto, Canada
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Gay CW, Robinson ME, George SZ, Perlstein WM, Bishop MD. Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. J Manipulative Physiol Ther 2014; 37:614-27. [PMID: 25284739 DOI: 10.1016/j.jmpt.2014.09.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/18/2014] [Accepted: 09/01/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purposes of this study were to use functional magnetic resonance imaging to investigate the immediate changes in functional connectivity (FC) between brain regions that process and modulate the pain experience after 3 different types of manual therapies (MT) and to identify reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity. METHODS Twenty-four participants (17 men; mean age ± SD, 21.6 ± 4.2 years) who completed an exercise-injury protocol to induce low back pain were randomized into 3 groups: chiropractic spinal manipulation (n = 6), spinal mobilization (n = 8), or therapeutic touch (n = 10). The primary outcome was the immediate change in FC as measured on functional magnetic resonance imaging between the following brain regions: somatosensory cortex, secondary somatosensory cortex, thalamus, anterior and posterior cingulate cortices, anterior and poster insula, and periaqueductal gray. Secondary outcomes were immediate changes in pain intensity, measured with a 101-point numeric rating scale, and pain sensitivity, measured with a handheld dynamometer. Repeated-measures analysis of variance models and correlation analyses were conducted to examine treatment effects and the relationship between within-person changes across outcome measures. RESULTS Changes in FC were found between several brain regions that were common to all 3 MT interventions. Treatment-dependent changes in FC were also observed between several brain regions. Improvement was seen in pain intensity after all interventions (P < .05) with no difference between groups (P > .05). There were no observed changes in pain sensitivity, or an association between primary and secondary outcome measures. CONCLUSION These results suggest that MTs (chiropractic spinal manipulation, spinal mobilization, and therapeutic touch) have an immediate effect on the FC between brain regions involved in processing and modulating the pain experience. This suggests that neurophysiologic changes after MT may be an underlying mechanism of pain relief.
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Affiliation(s)
- Charles W Gay
- Postdoctoral Research Fellow, Rehabilitation Science, College of Public and Health and Health Professions, University of Florida, Gainesville, Fla.
| | - Michael E Robinson
- Professor, Department of Clinical and Health Psychology, College of Public and Health and Health Professions, University of Florida, Gainesville, FL
| | - Steven Z George
- Associate Professor and Assistant Department Chair, Department of Physical Therapy, College of Public and Health and Health Professions, University of Florida, Gainesville, FL
| | - William M Perlstein
- Associate Professor, Department of Clinical and Health Psychology, College of Public and Health and Health Professions, University of Florida, Gainesville, FL; Research Health Scientist, VA RR&D Brain Rehabilitation Research Center of Excellence (151A), Malcom Randall Veterans Administration Medical Center, Gainesville, FL
| | - Mark D Bishop
- Associate Professor, Department of Physical Therapy, College of Public and Health and Health Professions, University of Florida, Gainesville, FL
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Dugailly PM, Beyer B, Sobczak S, Salvia P, Rooze M, Feipel V. Kinematics of the upper cervical spine during high velocity-low amplitude manipulation. Analysis of intra- and inter-operator reliability for pre-manipulation positioning and impulse displacements. J Electromyogr Kinesiol 2014; 24:621-7. [DOI: 10.1016/j.jelekin.2014.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 11/29/2022] Open
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Global and regional kinematics of the cervical spine during upper cervical spine manipulation: A reliability analysis of 3D motion data. ACTA ACUST UNITED AC 2014; 19:472-7. [DOI: 10.1016/j.math.2014.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/22/2014] [Accepted: 04/28/2014] [Indexed: 11/22/2022]
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Kizhakkeveettil A, Rose K, Kadar GE. Integrative therapies for low back pain that include complementary and alternative medicine care: a systematic review. Glob Adv Health Med 2014; 3:49-64. [PMID: 25568825 PMCID: PMC4268606 DOI: 10.7453/gahmj.2014.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
STUDY DESIGN Systematic review of the literature. OBJECTIVE To evaluate whether an integrated approach that includes different Complementary and Alternative Medicine (CAM) therapies combined or CAM therapies combined with conventional medical care is more effective for the management of low back pain (LBP) than single modalities alone. SUMMARY OF BACKGROUND DATA LBP is one of the leading causes of disability worldwide, yet its optimal management is still unresolved. METHODS The PRISMA Statement guidelines were followed. The Cochrane Back Review Group scale was used to rate the quality of the studies found. RESULTS Twenty-one studies were found that met the inclusion criteria. The CAM modalities used in the studies included spinal manipulative therapy, acupuncture, exercise therapy, physiotherapy, massage therapy, and a topical ointment. Twenty studies included acupuncture and/or spinal manipulative therapy. Nine high quality studies showed that integrative care was clinically effective for the management of LBP. Spinal manipulative therapy combined with exercise therapy and acupuncture combined with conventional medical care or with exercise therapy appears to be promising approaches to the management of chronic cases of LBP. CONCLUSIONS There is support in the literature for integrated CAM and conventional medical therapy for the management of chronic LBP. Further research into the integrated management of LBP is clearly needed to provide better guidance for patients and clinicians.
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Affiliation(s)
| | - Kevin Rose
- Southern California University of Health Sciences, Whittier, United States
| | - Gena E Kadar
- Southern California University of Health Sciences, Whittier, United States
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Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2014; 15:286. [PMID: 25175885 PMCID: PMC4159549 DOI: 10.1186/1471-2474-15-286] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/25/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nonspecific back pain is common, disabling, and costly. Therefore, we assessed effectiveness of osteopathic manipulative treatment (OMT) in the management of nonspecific low back pain (LBP) regarding pain and functional status. METHODS A systematic literature search unrestricted by language was performed in October 2013 in electronic and ongoing trials databases. Searches of reference lists and personal communications identified additional studies. Only randomized clinical trials were included; specific back pain or single treatment techniques studies were excluded. Outcomes were pain and functional status. Studies were independently reviewed using a standardized form. The mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) and overall effect size were calculated at 3 months posttreatment. GRADE was used to assess quality of evidence. RESULTS We identified 307 studies. Thirty-one were evaluated and 16 excluded. Of the 15 studies reviewed, 10 investigated effectiveness of OMT for nonspecific LBP, 3 effect of OMT for LBP in pregnant women, and 2 effect of OMT for LBP in postpartum women. Twelve had a low risk of bias. Moderate-quality evidence suggested OMT had a significant effect on pain relief (MD, -12.91; 95% CI, -20.00 to -5.82) and functional status (SMD, -0.36; 95% CI, -0.58 to -0.14) in acute and chronic nonspecific LBP. In chronic nonspecific LBP, moderate-quality evidence suggested a significant difference in favour of OMT regarding pain (MD, -14.93; 95% CI, -25.18 to -4.68) and functional status (SMD, -0.32; 95% CI, -0.58 to -0.07). For nonspecific LBP in pregnancy, low-quality evidence suggested a significant difference in favour of OMT for pain (MD, -23.01; 95% CI, -44.13 to -1.88) and functional status (SMD, -0.80; 95% CI, -1.36 to -0.23), whereas moderate-quality evidence suggested a significant difference in favour of OMT for pain (MD, -41.85; 95% CI, -49.43 to -34.27) and functional status (SMD, -1.78; 95% CI, -2.21 to -1.35) in nonspecific LBP postpartum. CONCLUSION Clinically relevant effects of OMT were found for reducing pain and improving functional status in patients with acute and chronic nonspecific LBP and for LBP in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.
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Affiliation(s)
| | | | - Gary Fryer
- College of Health & Biomedicine; ISEAL, Victoria University, Melbourne, Australia.
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Xia T, Wilder DG, Gudavalli MR, DeVocht JW, Vining RD, Pohlman KA, Kawchuk GN, Long CR, Goertz CM. Study protocol for patient response to spinal manipulation - a prospective observational clinical trial on physiological and patient-centered outcomes in patients with chronic low back pain. Altern Ther Health Med 2014; 14:292. [PMID: 25106673 PMCID: PMC4139615 DOI: 10.1186/1472-6882-14-292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/31/2014] [Indexed: 02/22/2023]
Abstract
Background Low back pain (LBP) is a major health issue due to its high prevalence rate and socioeconomic cost. While spinal manipulation (SM) is recommended for LBP treatment by recently published clinical guidelines, the underlying therapeutic mechanisms remain unclear. Spinal stiffness is routinely examined and used in clinical decisions for SM delivery. It has also been explored as a predictor for clinical improvement. Flexion-relaxation phenomenon has been demonstrated to distinguish between LBP and healthy populations. The primary objective of the current study is to collect preliminary estimates of variability and effect size for the associations of these two physiological measures with patient-centered outcomes in chronic LBP patients. Additionally biomechanical characteristics of SM delivery are collected with the intention to explore the potential dose–response relationship between SM and LBP improvement. Methods/Design This is a prospective, observational study applying side-lying, high velocity, low amplitude SM as treatment for patients with LBP over a course of 6 weeks. Approximately 80 participants will be enrolled if they present with chronic LBP of 1, 2 or 3 in Quebec Task Force Classification for spinal disorders, a Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6, and persistent LBP ≥ 2 with a maximum ≥ 4 using numerical rating scale. Patient-centered outcomes include LBP using visual analog scale, RMDQ, and PROMIS-29. Lumbar spine stiffness is assessed using palpation, a hand-held instrumented device, and an automated device. Flexion-relaxation is assessed using surface electromyography at the third level of the lumbar spine. Biomechanical characteristics of SM are assessed using a self-reported, itemized description system, as well as advanced kinetic measures that will be applied to estimate forces and moments at the lumbar segment level targeted by SM. Discussion Beside alterations in material properties of the passive components of the spine, increased neuromuscular activity may also contribute to a stiffened spine. Examining changes in both spinal stiffness and flexion-relaxation along the course of the treatment provides an opportunity to understand if the therapeutic effect of SM is associated with its action on active and/or passive components of the spine. Trial registration NCT01670292 on clinicaltrials.gov.
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Haas M, Vavrek D, Peterson D, Polissar N, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine J 2014; 14:1106-16. [PMID: 24139233 PMCID: PMC3989479 DOI: 10.1016/j.spinee.2013.07.468] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. PURPOSE To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control. STUDY DESIGN/SETTING Practice-based randomized controlled trial. PATIENT SAMPLE Four hundred participants with cLBP. OUTCOME MEASURES The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status. METHODS One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks. RESULTS For the primary outcomes, mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (p<.025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, p<.025). CONCLUSIONS The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.
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Affiliation(s)
- Mitchell Haas
- Center for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA.
| | - Darcy Vavrek
- Center for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR, USA
| | - David Peterson
- Division of Chiropractic Sciences, University of Western States, 2700 NE 132nd Ave., Portland, OR, USA
| | - Nayak Polissar
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA, USA
| | - Moni B. Neradilek
- The Mountain-Whisper-Light Statistics, 1827 23rd Ave. East, Seattle, WA, USA
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Short-term effect of spinal manipulation on pain perception, spinal mobility, and full height recovery in male subjects with degenerative disk disease: a randomized controlled trial. Arch Phys Med Rehabil 2014; 95:1613-9. [PMID: 24862763 DOI: 10.1016/j.apmr.2014.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 04/15/2014] [Accepted: 05/01/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the short-term effect on spinal mobility, pain perception, neural mechanosensitivity, and full height recovery after high-velocity, low-amplitude (HVLA) spinal manipulation (SM) in the lumbosacral joint (L5-S1). DESIGN Randomized, double-blind, controlled clinical trial with evaluations at baseline and after intervention. SETTING University-based physical therapy research clinic. PARTICIPANTS Men (N=40; mean age ± SD, 38 ± 9.14 y) with diagnosed degenerative lumbar disease at L5-S1 were randomly divided into 2 groups: a treatment group (TG) (n=20; mean age ± SD, 39 ± 9.12 y) and a control group (CG) (n=20; mean age ± SD, 37 ± 9.31 y). All participants completed the intervention and follow-up evaluations. INTERVENTIONS A single L5-S1 SM technique (pull-move) was performed in the TG, whereas the CG received a single placebo intervention. MAIN OUTCOME MEASURES Measures included assessing the subject's height using a stadiometer. The secondary outcome measures included perceived low back pain, evaluated using a visual analog scale; neural mechanosensitivity, as assessed using the passive straight-leg raise (SLR) test; and amount of spinal mobility in flexion, as measured using the finger-to-floor distance (FFD) test. RESULTS The intragroup comparison indicated a significant improvement in all variables in the TG (P<.001). There were no changes in the CG, except for the FFD test (P=.008). In the between-group comparison of the mean differences from pre- to postintervention, there was statistical significance for all cases (P<.001). CONCLUSIONS An HVLA SM in the lumbosacral joint performed on men with degenerative disk disease immediately improves self-perceived pain, spinal mobility in flexion, hip flexion during the passive SLR test, and subjects' full height. Future studies should include women and should evaluate the long-term results.
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Changes in biochemical markers of pain perception and stress response after spinal manipulation. J Orthop Sports Phys Ther 2014; 44:231-9. [PMID: 24450367 DOI: 10.2519/jospt.2014.4996] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled, repeated-measures, single-blind randomized study. OBJECTIVES To determine the effect of cervical or thoracic manipulation on neurotensin, oxytocin, orexin A, and cortisol levels. BACKGROUND Previous studies have researched the effect of spinal manipulation on pain modulation and/or range of movement. However, there is little knowledge of the biochemical process that supports the antinociceptive effect of spinal manipulation. METHODS Thirty asymptomatic subjects were randomly divided into 3 groups: cervical manipulation (n = 10), thoracic manipulation (n = 10), and nonmanipulation (control) (n = 10). Blood samples were extracted before, immediately after, and 2 hours after each intervention. Neurotensin, oxytocin, and orexin A were determined in plasma using enzyme-linked immuno assay. Cortisol was measured by microparticulate enzyme immuno assay in serum samples. RESULTS Immediately after the intervention, significantly higher values of neurotensin (P<.05) and oxytocin (P<.001) levels were observed with both cervical and thoracic manipulation, whereas cortisol concentration was increased only in the cervical manipulation group (P<.05). No changes were detected for orexin A levels. Two hours after the intervention, no significant differences were observed in between-group analysis. CONCLUSION The mechanical stimulus provided by spinal manipulation triggers an increase in neurotensin, oxytocin, and cortisol blood levels. Data suggest that the initial capability of the tissues to tolerate mechanical deformation affects the capacity of these tissues to produce an induction of neuropeptide expression. J
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Weigel PA, Hockenberry J, Bentler SE, Wolinsky FD. The comparative effect of episodes of chiropractic and medical treatment on the health of older adults. J Manipulative Physiol Ther 2014; 37:143-54. [PMID: 24636108 DOI: 10.1016/j.jmpt.2013.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/05/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated. METHODS Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants' Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models. RESULTS Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms. CONCLUSION The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.
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Affiliation(s)
- Paula A Weigel
- Candidate for PhD, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA.
| | - Jason Hockenberry
- Assistant Professor, Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Suzanne E Bentler
- Candidate for PhD, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA
| | - Fredric D Wolinsky
- Professor, John W. Colloton Chair of Health Management and Policy, Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA
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Pettit J, Glickman-Simon R. Osteopathy and low back pain, acupuncture and in vitro fertilization, Tai Chi and osteoarthritis, Andrographis paniculata and ulcerative colitis, and acupressure and vertigo. Explore (NY) 2014; 10:62-6. [PMID: 24439098 DOI: 10.1016/j.explore.2013.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ming L, Al-Worafi YA, Kamaruddin K, Sejari N. A narrative review of massage and spinal manipulation in the treatment of low back pain. ARCHIVES OF PHARMACY PRACTICE 2014. [DOI: 10.4103/2045-080x.142047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
This article on physiotherapy presents some current evidence stating the strengths and weaknesses of the physiotherapeutic procedures. In the area of physiotherapy empirical data obtained during decades were overtaken by evidence from current studies. The author points out the great problem of physiotherapy, namely the heterogeneity of the applied parameters. Knowledge of current evidence may be very important and helpful for the physicians, but the author proposes, from the practical point of view, that physiotherapeutical procedures based on exprience and used for many years should not be entirely neglected. Nowadays physiotherapy plays an important role in the treament of locomotor diseases but its use is increasing in other fields of medicine, as well.
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Affiliation(s)
- Tamás Bender
- Budai Irgalmasrendi Kórház Központi Fizioterápiás Osztály Budapest Árpád fejedelem u. 7. 1023
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No relationship between body mass index and changes in pain and disability after exercise rehabilitation for patients with mild to moderate chronic low back pain. Spine (Phila Pa 1976) 2013; 38:2190-5. [PMID: 24296481 DOI: 10.1097/brs.0000000000000002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter study. OBJECTIVE To investigate the relationship between body mass index (BMI) and changes in pain and disability resulting from exercise-based chronic low back pain (cLBP) treatment. SUMMARY OF BACKGROUND DATA Past research has shown evidence of a relationship between BMI, a measurement of obesity, and cLBP. Exercise is a known beneficial treatment for cLBP. However, it is unclear if exercise-induced changes in pain and disability are related to baseline levels of, or changes in, BMI. METHODS One hundred and twenty-eight (n = 128) males and females with cLBP performed 8 weeks of exercise, consisting of 3 to 5 exercise sessions (minimum of 1 supervised session) per week. Outcome measures included BMI and self-reported pain and disability. BMI was calculated as weight divided by height squared (kg/m). Pain was measured using the visual analogue scale and disability was measured using the Oswestry Disability Index. Correlation, regression, covariance and likelihood ratios analyses were used to examine the relationship between BMI and self-reported pain and disability changes. RESULTS No baseline relationships between BMI and self-reported pain (r = -0.083, P = 0.349) and disability (r = 0.090, P = 0.314) were observed. There was no relationship observed between baseline BMI (P = 0.938, P = 0.873), or changes in BMI (P = 0.402, P = 0.854), with exercise-related changes in pain and disability, respectively. No relationships between baseline BMI or BMI changes with pain and disability at baseline or after exercise were observed on the basis of pain and disability subgroups. BMI was not a predictor of exercise-based pain and disability changes. CONCLUSION There was no significant relationship between BMI and self-reported pain and disability in cLBP participants. BMI was not a predictor of exercise-induced changes in pain and disability. The reliance on BMI as a sole measurement of obesity in cLBP research may be unwarranted.
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Abstract
STUDY DESIGN Parallel-group randomized controlled trial. OBJECTIVE Establish the short-term effectiveness of chiropractic therapy for spinal pain compared with a sham intervention and explore the predictors of chiropractic treatment satisfaction. SUMMARY OF BACKGROUND DATA Chiropractic treatment is widely used for spinal pain. However, a lack of sound evidence precludes conclusions about the effectiveness of chiropractic for spinal pain. METHODS Participants were adults experiencing spinal pain, randomized to receive 2 treatments of chiropractic or sham therapy. Participants and outcome assessors were blinded to group allocation. Primary outcomes at 2 weeks were pain intensity (0-10 scale) and function (0-40 Functional Rating Index). Secondary outcomes were global change, minimum acceptable outcome, and treatment satisfaction. Treatment effects were estimated with linear mixed models for the primary outcomes. We used logistic regression to identify differences in the secondary outcomes and explore for predictors of treatment satisfaction. RESULTS One hundred eighty three participants (chiropractic, n = 92; sham, n = 91) were recruited and included in the analyses. Participants receiving chiropractic therapy reported greater improvements in pain (mean difference, 95% confidence interval [CI] = 0.5 [0.1-0.9]), physical function (mean difference [95% CI] = 2.1 [0.3-4.0]), and were more likely to experience global improvement (48% vs. 24%, P = 0.01) and treatment satisfaction (78% vs. 56%, P < 0.01). There was no between-group difference in achieving a minimally acceptable outcome (34% sham vs. 29% chiropractic, P = 0.42). Awareness of treatment assignment and achieving minimally important improvement in pain intensity were associated with chiropractic treatment satisfaction. CONCLUSION Short-term chiropractic treatment was superior to sham; however, treatment effects were not clinically important. Awareness of treatment assignment and clinically important reductions in pain were associated with chiropractic treatment satisfaction. LEVEL OF EVIDENCE 2.
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Abstract
Stratified care for back pain involves targeting treatment to subgroups of patients based on their key characteristics such as prognostic factors, likely response to treatment and underlying mechanisms. It aims to tailor therapeutic decisions in ways that maximise treatment benefit, reduce harm and increase health-care efficiency by offering the right treatment to the right patient at the right time. From being called the 'Holy Grail' of back pain research over a decade ago, stratified care is becoming the zeitgeist in research and clinical practice. In this chapter, we introduce and evaluate the quality and underpinning evidence for three examples of stratified care for back pain to highlight their general principles, research design issues and clinical practice implications. We include consideration of their merits for implementation in practice. We conclude with a set of remaining, key research questions.
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Scholten-Peeters GGM, Thoomes E, Konings S, Beijer M, Verkerk K, Koes BW, Verhagen AP. Is manipulative therapy more effective than sham manipulation in adults : a systematic review and meta-analysis. Chiropr Man Therap 2013; 21:34. [PMID: 24274314 PMCID: PMC3850908 DOI: 10.1186/2045-709x-21-34] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/28/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Manipulative therapy is widely used in the treatment of spinal disorders. Manipulative techniques are under debate because of the possibility of adverse events. To date, the efficacy of manipulations compared to sham manipulations is unclear. The purpose of the study is: to assess the efficacy of manipulative therapy compared to sham in adults with a variety of complaints. STUDY DESIGN Systematic review and meta-analysis. METHODS Bibliographic databases (PubMed, EMBASE, CINAHL, PEDro, Central) along with a hand search of selected bibliographies were searched from inception up to April 2012. RESULTS In total 965 references were screened for eligibility and 19 RCTs (n = 1080) met the selection criteria. Eight studies were considered of low risk of bias. There is moderate level of evidence that manipulative therapy has a significant effect in adults on pain relief immediately after treatment (standardized mean difference [SMD] - 0.68, 95% confidence interval (-1.06 to -0.31). There is low level of evidence that manipulative therapy has a significant effect in adults on pain relief (SMD - 0.37, -0.69 to -0.04) at short- term follow-up. In patients with musculoskeletal disorders, we found moderate level of evidence for pain relief (SMD - 0.73, -1.21 to -0.25) immediate after treatment and low level of evidence for pain relief (SMD - 0.52, -0.87 to -0.17) at short term-follow-up. We found very low level of evidence that manipulative therapy has no statistically significant effect on disability and perceived (asthma) recovery. Sensitivity analyses did not change the main findings. No serious adverse events were reported in the manipulative therapy or sham group. CONCLUSIONS Manipulative therapy has a clinical relevant effect on pain, but not on disability or perceived (asthma) recovery. Clinicians can refer patients for manipulative therapy to reduce pain.
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Affiliation(s)
- Gwendolijne GM Scholten-Peeters
- University of Applied Sciences AVANS, Research Group Diagnostics, PO Box 90116, Breda, RA 4800, The Netherlands
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Erik Thoomes
- University of Applied Sciences AVANS, Research Group Diagnostics, PO Box 90116, Breda, RA 4800, The Netherlands
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Sophie Konings
- Rotterdam University of Applied Sciences, Rotterdam, Department physical therapy, Museumpark 40, Rotterdam, CX 3015, The Netherlands
| | - Michelle Beijer
- Rotterdam University of Applied Sciences, Rotterdam, Department physical therapy, Museumpark 40, Rotterdam, CX 3015, The Netherlands
| | - Karin Verkerk
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
- Rotterdam University of Applied Sciences, Rotterdam, Department physical therapy, Museumpark 40, Rotterdam, CX 3015, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Arianne P Verhagen
- University of Applied Sciences AVANS, Research Group Diagnostics, PO Box 90116, Breda, RA 4800, The Netherlands
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
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Mansell G, Kamper SJ, Kent P. Why and how back pain interventions work: What can we do to find out? Best Pract Res Clin Rheumatol 2013; 27:685-97. [DOI: 10.1016/j.berh.2013.10.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Eirikstoft H, Kongsted A. Patient characteristics in low back pain subgroups based on an existing classification system. A descriptive cohort study in chiropractic practice. ACTA ACUST UNITED AC 2013; 19:65-71. [PMID: 23932099 DOI: 10.1016/j.math.2013.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 07/04/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
Sub-grouping of low back pain (LBP) is believed to improve prediction of prognosis and treatment effects. The objectives of this study were: (1) to examine whether chiropractic patients could be sub-grouped according to an existing pathoanatomically-based classification system, (2) to describe patient characteristics within each subgroup, and (3) to determine the proportion of patients in whom clinicians considered the classification to be unchanged after approximately 10 days. A cohort of 923 LBP patients was included during their first consultation. Patients completed an extensive questionnaire and were examined according to a standardised protocol. Based on the clinical examination, patients were classified into diagnostic subgroups. After approximately 10 days, chiropractors reported whether they considered the subgroup had changed. The most frequent subgroups were reducible and partly reducible disc syndromes followed by facet joint pain, dysfunction and sacroiliac (SI)-joint pain. Classification was inconclusive in 5% of the patients. Differences in pain, activity limitation, and psychological factors were small across subgroups. Within 10 days, 82% were reported to belong to the same subgroup as at the first visit. In conclusion, LBP patients could be classified according to a standardised protocol, and chiropractors considered most patient classifications to be unchanged within 10 days. Differences in patient characteristics between subgroups were very small, and the clinical relevance of the classification system should be investigated by testing its value as a prognostic factor or a treatment effect modifier. It is recommended that this classification system be combined with psychological and social factors if it is to be useful.
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Affiliation(s)
- Heidi Eirikstoft
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Alice Kongsted
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark.
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Licciardone JC, Kearns CM, Minotti DE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. ACTA ACUST UNITED AC 2013; 18:533-40. [PMID: 23759340 DOI: 10.1016/j.math.2013.05.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess response to osteopathic manual treatment (OMT) according to baseline severity of chronic low back pain (LBP). METHODS The OSTEOPATHIC Trial used a randomized, double-blind, sham-controlled, 2×2 factorial design to study OMT for chronic LBP. A total of 269 (59%) patients reported low baseline pain severity (LBPS) (<50 mm/100 mm), whereas 186 (41%) patients reported high baseline pain severity (HBPS) (≥50 mm/100 mm). Six OMT sessions were provided over eight weeks and outcomes were assessed at week 12. The primary outcome was substantial LBP improvement (≥50% pain reduction). The Roland-Morris Disability Questionnaire (RMDQ) and eight other secondary outcomes were also studied. Response ratios (RRs) and 95% confidence intervals (CIs) were used in conjunction with Cochrane Back Review Group criteria to determine OMT effects. RESULTS There was a large effect size for OMT in providing substantial LBP improvement in patients with HBPS (RR, 2.04; 95% CI, 1.36-3.05; P<0.001). This was accompanied by clinically important improvement in back-specific functioning on the RMDQ (RR, 1.80; 95% CI, 1.08-3.01; P=0.02). Both RRs were significantly greater than those observed in patients with LBPS. Osteopathic manual treatment was consistently associated with benefits in all other secondary outcomes in patients with HBPS, although the statistical significance and clinical relevance of results varied. CONCLUSIONS The large effect size for OMT in providing substantial pain reduction in patients with chronic LBP of high severity was associated with clinically important improvement in back-specific functioning. Thus, OMT may be an attractive option in such patients before proceeding to more invasive and costly treatments.
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Affiliation(s)
- John C Licciardone
- The Osteopathic Research Center, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107, USA; Department of Medical Education, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107, USA.
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Fryer G, Pearce AJ. The effect of muscle energy technique on corticospinal and spinal reflex excitability in asymptomatic participants. J Bodyw Mov Ther 2013; 17:440-7. [PMID: 24139001 DOI: 10.1016/j.jbmt.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/29/2013] [Accepted: 05/04/2013] [Indexed: 11/27/2022]
Abstract
The aim of the current study was to investigate, using a controlled, repeated measure design, the neurophysiological responses following an acute bout of muscle energy technique (MET). Transcranial magnetic stimulation elicited motor evoked potentials using a 110 mm double cone coil placed over the motor area of the brain, while Hoffman reflexes (H-reflex) were measured from the posterior tibial nerve using electrical stimulation. Responses were measured using surface electromyography electrodes placed over the lateral head of the gastrocnemius muscle in 12 asymptomatic volunteers. An MET aimed at the lumbosacral joint was performed bilaterally. Data were collected pre-intervention, after a control intervention, and after the MET intervention. A significant increase was found in evoked potential silent period (SP) duration (F2,22 = 7.64; p = 0.03) over time following MET, but not the control intervention. A significant decrease was found in H-reflex (F1.3,14.4 = 13.8; p = 0.01) over time following the MET intervention. MET applied to the lumbosacral joint produced a significant decrease in corticospinal and spinal reflex excitability, suggesting overall decreased motor excitability.
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Affiliation(s)
- Gary Fryer
- College of Health & Biomedicine, Victoria University, Melbourne, Australia; Institute of Sport, Exercise & Active Living, Victoria University, Melbourne, Australia; A.T. Still Research Institute, Kirksville, MO, USA.
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Salzberg LD, Manusov EG. Management options for patients with chronic back pain without an etiology. Health Serv Insights 2013; 6:33-8. [PMID: 25114558 PMCID: PMC4089831 DOI: 10.4137/hsi.s10469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The treatment and management of low back pain is complex when there is no specific etiology such as cancer, fracture, or herniated disc. An organized approach to management that follows evidence based guidelines will facilitate care in a problem that reflects a lifetime prevalence of over 70 percent. The purpose of this review is to present a guideline to care for a common disabling process with a very heterogeneous etiology.
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Affiliation(s)
- Lenny D Salzberg
- Faculty Development Fellowship, Duke/SR-AHEC Family Medicine Residency, 1601 Owen Drive, Fayetteville NC 28304
| | - Eron G Manusov
- Vice President CEAS, Program Director, Duke/SR-AHEC Family Medicine Residency, 1601 Owen Drive, Fayetteville NC 28304
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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: 3.0] [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.
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Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013; 11:122-9. [PMID: 23508598 PMCID: PMC3601389 DOI: 10.1370/afm.1468] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain. METHODS A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12 (30% or greater and 50% or greater pain reductions from baseline, respectively). Five secondary outcomes, safety, and treatment adherence were also assessed. RESULTS There was no statistical interaction between OMT and UST. Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate (response ratio [RR] = 1.38; 95% CI, 1.16-1.64; P <.001) and substantial (RR = 1.41, 95% CI, 1.13-1.76; P = .002) improvements in low back pain at week 12. These improvements met the Cochrane Back Review Group criterion for a medium effect size. Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT. Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study (P <.001). Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group (use ratio = 0.66, 95% CI, 0.43-1.00; P = .048). Ultrasound therapy was not efficacious. CONCLUSIONS The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.
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Affiliation(s)
- John C Licciardone
- The Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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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: 0.3] [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.
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Affiliation(s)
- Matthew C Miller
- Department of Otolaryngology-Head and Neck Surgery, Rochester, NY 14642, USA.
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Manchikanti L, Singh V, Cash KA, Pampati V, Falco FJE. The role of fluoroscopic interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind trial. Pain Pract 2012; 13:547-58. [PMID: 23279452 DOI: 10.1111/papr.12023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 11/06/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is continued debate on the effectiveness, indications, and medical necessity of epidural injections in managing pain and disability from lumbar disc herniation, despite extensive utilization. There is paucity of literature on interlaminar epidural injections in managing lumbar disc herniation or radiculitis in contemporary interventional pain management settings utilizing fluoroscopy. METHODS A randomized, double-blind, active-control trial was undertaken to assess the effectiveness of lumbar interlaminar epidural injections with or without steroids for disc herniation and radiculitis. The primary outcome was defined as pain relief and functional status improvement of ≥ 50%. One hundred twenty patients were randomly assigned to 1 of the 2 groups. Group I patients received lumbar interlaminar injections containing a local anesthetic (lidocaine 0.5%, 6 mL), whereas Group II patients received lumbar interlaminar epidural injections of 0.5% lidocaine, 5 mL, mixed with 1 mL of non-particulate betamethasone. RESULTS In the patients who responded with initial 2 procedures with at least 3 weeks of relief, significant improvement was seen in 80% of the patients in the local anesthetic group and 86% of the patients in the local anesthetic and steroid group. The overall average procedures per year were 3.6 in the local anesthetic group and 4.1 in the local anesthetic and steroid group, with an average relief of 33.7 ± 18.1 weeks in the local anesthetic group and 39.1 ± 12.2 weeks in the local anesthetic and steroid group over a period of 52 weeks in the overall population. CONCLUSIONS Lumbar interlaminar epidural injections of local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis, with potential superiority of steroids compared with local anesthetic alone at 1 year follow-up.
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Kongsted A, Kent P, Albert H, Jensen TS, Manniche C. Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement - a cross-sectional study. BMC Musculoskelet Disord 2012. [PMID: 23190800 PMCID: PMC3585913 DOI: 10.1186/1471-2474-13-236] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF) subgroups of: 1) LBP only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement. Methods Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups and described according to the domains of pain, activity limitation, work participation, psychology, general health and clinical examination findings. Results A total of 2,673 patients aged 18–95 years (median 47) who were referred for assessment of LBP were included. Increasing severity was consistently observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile on almost all measures compared with other patients with back-related leg pain. Conclusion LBP patients with pain referral to the legs were more severely affected than those with local LBP, and patients with signs of nerve root involvement were the ones most severily affected. These findings underpin the concurrent validity of the Quebec Task Force Classification. However, the small size of many between-subgroup differences amid the large variability in this sample of cross-sectional data also underlines that the heterogeneity of patients with LBP is more complex than that which can be explained by leg pain patterns alone. The implications of the observed differences also require investigation in longitudinal studies.
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Affiliation(s)
- Alice Kongsted
- Research Department, The Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Services Research, University of Southern Denmark, Clinical Locomotion Science Network, Middelfart, Denmark.
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Abstract
Osteoarthritis of the spine develops as a consequence of the natural aging process and is associated with significant morbidity and health care expenditures. Effective diagnosis and treatment of the resultant pathologic conditions can be clinically challenging. Recent evidence has emerged to aid the investigating clinician in formulating an accurate diagnosis and in implementing a successful treatment algorithm. This article details the degenerative cascade that results in the osteoarthritic spine, reviews prevalence data for common painful spinal disorders, and discusses evidence-based treatment options for management of zygapophysial and sacroiliac joint arthrosis.
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135
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Goertz C, Pohlman K, Vining R, Brantingham J, Long C. Patient-centered outcomes of high-velocity, low-amplitude spinal manipulation for low back pain: A systematic review. J Electromyogr Kinesiol 2012; 22:670-91. [DOI: 10.1016/j.jelekin.2012.03.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 02/20/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022] Open
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136
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Lefebvre R, Peterson D, Haas M. Evidence-Based Practice and Chiropractic Care. J Evid Based Complementary Altern Med 2012; 18:75-79. [PMID: 23875117 DOI: 10.1177/2156587212458435] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.
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137
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Johnson C, Rubinstein SM, Côté P, Hestbaek L, Injeyan HS, Puhl A, Green B, Napuli JG, Dunn AS, Dougherty P, Killinger LZ, Page SA, Stites JS, Ramcharan M, Leach RA, Byrd LD, Redwood D, Kopansky-Giles DR. Chiropractic Care and Public Health: Answering Difficult Questions About Safety, Care Through the Lifespan, and Community Action. J Manipulative Physiol Ther 2012; 35:493-513. [DOI: 10.1016/j.jmpt.2012.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/06/2012] [Indexed: 11/28/2022]
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Millan M, Leboeuf-Yde C, Budgell B, Descarreaux M, Amorim MA. The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review. Chiropr Man Therap 2012; 20:23. [PMID: 22866816 PMCID: PMC3487906 DOI: 10.1186/2045-709x-20-23] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 07/18/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) has been shown to have an effect on spine-related pain, both clinically and in experimentally induced pain. However, it is unclear if it has an immediate noticeable biomechanical effect on spinal motion that can be measured in terms of an increased range of motion (ROM). OBJECTIVE To assess the quality of the literature and to determine whether or not SMT is associated with an immediate increase in ROM. DESIGN A systematic critical literature review. METHOD Systematic searches were performed in Pubmed, the Cochrane Library and EMBASE using terms relating to manipulation, movement and the spine. Selection of articles was made according to specific criteria by two independent reviewers. Two checklists were created based on the needs of the present review. Articles were independently reviewed by two reviewers. Articles were given quality scores and the data synthesized for each region treated in the literature. Findings were summarized in tables and reported in a narrative fashion. RESULTS Fifteen articles were retained reporting on experiments on the neck, lumbar spine, hip and jaw. The mean quality score was 71/100 (ranges 33/100 - 92/100). A positive effect of SMT was reported in both studies where mouth opening was assessed after cervical manipulation. In five of the nine studies on cervical ROM a positive effect was reported, whereas the remaining four studies did not show improvement. None of the three studies of the lumbar spine showed an effect of SMT on lumbar ROMs and one study of sacroiliac manipulation reported no effect on the ROM of the hip joint.In relation to the quality score, the seven highest ranked studies, showed significant positive effects of SMT on ROM. Continuing down the list, the other studies reported no significant differences in the outcomes between groups. CONCLUSION SMT seems sometimes to have a small effect on ROM, at least in the cervical spine. Further research should concentrate on areas of the spine that have the potential of actually improving to such a degree that a change can be easily uncovered.
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Affiliation(s)
- Mario Millan
- EA 4532 CIAMS, UFR STAPS, Univ Paris-Sud, Orsay, France
- The Research Department, The Spine Centre of Southern Denmark, Hospital Lillebælt, Odense, Denmark
- Institut Franco-Européen de Chiropratique, Paris, France
| | - Charlotte Leboeuf-Yde
- EA 4532 CIAMS, UFR STAPS, Univ Paris-Sud, Orsay, France
- The Research Department, The Spine Centre of Southern Denmark, Hospital Lillebælt, Odense, Denmark
- Institut Franco-Européen de Chiropratique, Paris, France
- Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Brian Budgell
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Martin Descarreaux
- Département de Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Michel-Ange Amorim
- EA 4532 CIAMS, UFR STAPS, Univ Paris-Sud, Orsay, France
- Institut Universitaire de France, Paris, France
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139
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Understanding inhibitory mechanisms of lumbar spinal manipulation using H-reflex and F-wave responses: a methodological approach. J Neurosci Methods 2012; 210:169-77. [PMID: 22878176 DOI: 10.1016/j.jneumeth.2012.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 07/13/2012] [Accepted: 07/23/2012] [Indexed: 12/18/2022]
Abstract
The purpose of this research was to characterize unique neurophysiologic events following a high velocity, low amplitude (HVLA) spinal manipulation (SM) procedure. Descriptive time series analysis techniques of time plots, outlier detection and autocorrelation functions were applied to time series of tibial nerve H-reflexes that were evoked at 10-s intervals from 100 s before the event until 100 s after three distinct events L5-S1 HVLA SM, or a L5-S1 joint pre-loading procedure, or the control condition. Sixty-six subjects were randomly assigned to three procedures, i.e., 22 time series per group. If the detection of outliers and correlograms revealed a pattern of non-randomness that was only time-locked to a single, specific event in the normalized time series, then an experimental effect would be inferred beyond the inherent variability of H-reflex responses. Tibial nerve F-wave responses were included to determine if any new information about central nervous function following a HVLA SM procedure could be ascertained. Time series analyses of H(max)/M(max) ratios, pre-post L5-S1 HVLA SM, substantiated the hypothesis that the specific aspects of the manipulative thrust lead to a greater attenuation of the H(max)/M(max) ratio as compared to the non-specific aspects related to the postural perturbation and joint pre-loading. The attenuation of the H(max)/M(max) ratio following the HVLA SM procedure was reliable and may hold promise as a translational tool to measure the consistency and accuracy of protocol implementation involving SM in clinical trials research. F-wave responses were not sensitive to mechanical perturbations of the lumbar spine.
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Transcranial Direct Current Stimulation for the Reduction of Clinical and Experimentally Induced Pain. Clin J Pain 2012; 28:452-61. [DOI: 10.1097/ajp.0b013e31823853e3] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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141
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Fryer G, Pearce AJ. The Effect of Lumbosacral Manipulation on Corticospinal and Spinal Reflex Excitability on Asymptomatic Participants. J Manipulative Physiol Ther 2012; 35:86-93. [DOI: 10.1016/j.jmpt.2011.09.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 07/21/2011] [Accepted: 08/19/2011] [Indexed: 12/01/2022]
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142
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Brantingham JW, Bonnefin D, Perle SM, Cassa TK, Globe G, Pribicevic M, Hicks M, Korporaal C. Manipulative Therapy for Lower Extremity Conditions: Update of a Literature Review. J Manipulative Physiol Ther 2012; 35:127-66. [DOI: 10.1016/j.jmpt.2012.01.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/18/2011] [Accepted: 11/18/2011] [Indexed: 12/26/2022]
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143
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Coronado RA, Gay CW, Bialosky JE, Carnaby GD, Bishop MD, George SZ. Changes in pain sensitivity following spinal manipulation: a systematic review and meta-analysis. J Electromyogr Kinesiol 2012; 22:752-67. [PMID: 22296867 DOI: 10.1016/j.jelekin.2011.12.013] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 12/02/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022] Open
Abstract
Spinal manipulation (SMT) is commonly used for treating individuals experiencing musculoskeletal pain. The mechanisms of SMT remain unclear; however, pain sensitivity testing may provide insight into these mechanisms. The purpose of this systematic review is to examine the literature on the hypoalgesic effects of SMT on pain sensitivity measures and to quantify these effects using meta-analysis. We performed a systematic search of articles using CINAHL, MEDLINE, PsycINFO, and SPORTDiscus from each databases' inception until May 2011. We examined methodological quality of each study and generated pooled effect size estimates using meta-analysis software. Of 997 articles identified, 20 met inclusion criteria for this review. Pain sensitivity testing used in these studies included chemical, electrical, mechanical, and thermal stimuli applied to various anatomical locations. Meta-analysis was appropriate for studies examining the immediate effect of SMT on mechanical pressure pain threshold (PPT). SMT demonstrated a favorable effect over other interventions on increasing PPT. Subgroup analysis showed a significant effect of SMT on increasing PPT at the remote sites of stimulus application supporting a potential central nervous system mechanism. Future studies of SMT related hypoalgesia should include multiple experimental stimuli and test at multiple anatomical sites.
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Affiliation(s)
- Rogelio A Coronado
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
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144
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Woodman JP, Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. Int J Clin Pract 2012; 66:98-112. [PMID: 22171910 DOI: 10.1111/j.1742-1241.2011.02817.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Complementary medicine and alternative approaches to chronic and intractable health conditions are increasingly being used, and require critical evaluation. OBJECTIVE The aim of this review was to systematically evaluate available evidence for the effectiveness and safety of instruction in the Alexander Technique in health-related conditions. METHODS PUBMED, EMBASE, PSYCHINFO, ISI Web-of-Knowledge, AMED, CINHAL-plus, Cochrane library and Evidence-based Medicine Reviews were searched to July 2011. Inclusion criteria were prospective studies evaluating Alexander Technique instruction (individual lessons or group delivery) as an intervention for any medical indication/health-related condition. Studies were categorised and data extracted on study population, randomisation method, nature of intervention and control, practitioner characteristics, validity and reliability of outcome measures, completeness of follow-up and statistical analyses. RESULTS Of 271 publications identified, 18 were selected: three randomised, controlled trials (RCTs), two controlled non-randomised studies, eight non-controlled studies, four qualitative analyses and one health economic analysis. One well-designed, well-conducted RCT demonstrated that, compared with usual GP care, Alexander Technique lessons led to significant long-term reductions in back pain and incapacity caused by chronic back pain. The results were broadly supported by a smaller, earlier RCT in chronic back pain. The third RCT, a small, well-designed, well-conducted study in individuals with Parkinson's disease, showed a sustained increased ability to carry out everyday activities following Alexander lessons, compared with usual care. The 15 non-RCT studies are also reviewed. CONCLUSIONS Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson's-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas.
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Affiliation(s)
- J P Woodman
- Department of Health Sciences, University of York, York, UK.
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Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. Fluoroscopic caudal epidural injections in managing post lumbar surgery syndrome: two-year results of a randomized, double-blind, active-control trial. Int J Med Sci 2012; 9:582-91. [PMID: 23028241 PMCID: PMC3461763 DOI: 10.7150/ijms.4672] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 09/04/2012] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN A randomized, active control, double-blind trial. OBJECTIVE To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome. SUMMARY OF BACKGROUND DATA There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome. METHODS This active control randomized study included 140 patients with 70 patients in each group. Group I received 0.5% lidocaine, 10 mL; Group II received 9 mL of 0.5% lidocaine mixed with 1 mL of 6 mg of nonparticulate betamethasone. The multiple outcome measures included the numeric rating scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as at least 50% improvement in pain and Oswestry Disability Index scores. Patients with a positive response to the first 2 procedures with at least 3 weeks of relief were considered to be successful. All others were considered as failures. RESULTS Overall in Group I, 53% and 47% of the patients and in Group II, 59% and 58% of the patients, showed significant improvement with reduction in pain scores and disability index at 12 months and 24 months. In contrast, in the successful groups, significant pain relief and improvement in function were observed in 70% and 62% of Group I at one and 2 years; in 75% and 69% of Group II at one and 2 years. The results in the successful group showed that at the end of the first year patients experienced approximately 38 weeks of relief and at the end of 2 years Group I had 62 weeks and Group II had 68 weeks of relief. Overall total relief for 2 years was 48 weeks in Group I and 54 weeks in Group II. The average procedures in the successful groups were at 4 in one year and 6 at the end of 2 years. CONCLUSION Caudal epidural injections of local anesthetic with or without steroid might be effective in patients with chronic persistent low back and/or lower extremity pain in patients with post lumbar surgery syndrome.
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Weichteilbehandlung bei Tennisellenbogen. MANUELLE MEDIZIN 2011. [DOI: 10.1007/s00337-011-0852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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