Back pain sufferers' attitudes toward consultations with CAM practitioners and self- prescribed CAM products: A study of a nationally representative sample of 1310 Australian women aged 60-65 years

Rotation-traction manipulation induced intradiskal pressure changes in cervical spine-an in vitro study

Objective: Evaluate the effect of rotation-traction manipulation on intradiskal pressure in human cervical spine specimen with different force and duration parameters, and compare the intradiskal pressure changes between rotation-traction manipulation and traction. Methods: Seven human cervical spine specimens were included in this study. The intradiskal pressure was measured by miniature pressure sensor implanting in the nucleus pulposus. rotation-traction manipulation and cervical spine traction were simulated using the MTS biomechanical machine. Varied thrust forces (50N, 150N, and 250N) and durations (0.05 s, 0.1 s, and 0.15 s) were applied during rotation-traction manipulation with Intradiscal pressure recorded in the neutral position, rotation-anteflexion position, preloading, and thrusting phases. Futuremore, we documented changes in intradiscal pressure during cervical spine traction with different loading forces (50N, 150N, and 250N). And a comparative analysis was performed to discern the impact on intradiscal pressure between manipulation and traction. Results: Manipulation application induced a significant reduction in intradiscal pressure during preloading and thrusting phases for each cervical intervertebral disc (p < 0.05). When adjusting thrust parameters, a discernible decrease in intradiscal pressure was observed with increasing thrust force, and the variations between different thrust forces were statistically significant (p < 0.05). Conversely, changes in duration did not yield a significant impact on intradiscal pressure (p > 0.05). Additionally, after traction with varying loading forces (50N, 150N, 250N), a noteworthy decrease in intradiscal pressure was observed (p < 0.05). And a comparative analysis revealed that rotation-traction manipulation more markedly reduced intradiscal pressure compared to traction alone (p < 0.05). Conclusion: Both rotation-traction manipulation and cervical spine traction can reduce intradiscal pressure, exhibiting a positive correlation with force. Notably, manipulation elicits more pronounced and immediate decompression effect, contributing a potential biomechanical rationale for its therapeutic efficacy.

Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review

OBJECTIVES

To determine similarities and differences in the reasons for using or not using complementary and alternative medicine (CAM) amongst general and condition-specific populations, and amongst populations in each region of the globe.

METHODS

A literature search was performed on Pubmed, ScienceDirect and EMBASE.

KEYWORDS

'herbal medicine' OR 'herbal and dietary supplement' OR 'complementary and alternative medicine' AND 'reason' OR 'attitude'. Quantitative or qualitative original articles in English, published between 2003 and 2018 were reviewed. Conference proceedings, pilot studies, protocols, letters, and reviews were excluded. Papers were appraised using valid tools and a 'risk of bias' assessment was also performed. Thematic analysis was conducted. Reasons were coded in each paper, then codes were grouped into categories. If several categories reported similar reasons, these were combined into a theme. Themes were then analysed using χ2 tests to identify the main factors related to reasons for CAM usage.

RESULTS

231 publications were included. Reasons for CAM use amongst general and condition-specific populations were similar. The top three reasons for CAM use were: (1) having an expectation of benefits of CAM (84% of publications), (2) dissatisfaction with conventional medicine (37%) and (3) the perceived safety of CAM (37%). Internal health locus of control as an influencing factor was more likely to be reported in Western populations, whereas the social networks was a common factor amongst Asian populations (p < 0.05). Affordability, easy access to CAM and tradition were significant factors amongst African populations (p < 0.05). Negative attitudes towards CAM and satisfaction with conventional medicine (CM) were the main reasons for non-use (p < 0.05).

CONCLUSIONS

Dissatisfaction with CM and positive attitudes toward CAM, motivate people to use CAM. In contrast, satisfaction with CM and negative attitudes towards CAM are the main reasons for non-use.

Using a behavioral model to identify factors associated with choice of provider for neck and low back pain: A systematic review

BACKGROUND

It remains unclear as to what factors influence a patient's choice to seek care from a specific healthcare provider for low back and neck pain.

OBJECTIVE

Utilize Andersen's Behavioral Model of Health Service Utilization as a conceptual framework to identify the predisposing, enabling and need factors associated with choice of healthcare provider for back and/or neck pain.

METHODS

PubMed, CINAHL, EMBASE, and SCOPUS databases were searched for studies that included 1) patients seeking care for acute or chronic low back or neck pain; 2) patients at least 18 years of age; 3) reported any healthcare provider type chosen to be seen. Significant factors addressing a patient's choice of provider seen for back pain, neck pain, or both were extracted from studies and analyzed under the Behavioral Model of Health Service Utilization.

RESULTS

20 studies were included in this review: 17 quantitative studies and 3 qualitative studies. Provider types identified were medical physicians, chiropractors, physical therapists, acupuncturists and CAM providers. Age and sex were the most commonly reported predisposing factors; financial and personal factors were the most common enabling factors; patients' duration of pain and self-reported level of functioning were the most commonly reported need factors.

CONCLUSIONS

While predisposing and need factors are important, enabling factors also have an influence in choice of healthcare provider for back and/or neck pain.

Unraveling the Mechanisms of Manual Therapy: Modeling an Approach

Synopsis Manual therapy interventions are popular among individual health care providers and their patients; however, systematic reviews do not strongly support their effectiveness. Small treatment effect sizes of manual therapy interventions may result from a "one-size-fits-all" approach to treatment. Mechanistic-based treatment approaches to manual therapy offer an intriguing alternative for identifying patients likely to respond to manual therapy. However, the current lack of knowledge of the mechanisms through which manual therapy interventions inhibit pain limits such an approach. The nature of manual therapy interventions further confounds such an approach, as the related mechanisms are likely a complex interaction of factors related to the patient, the provider, and the environment in which the intervention occurs. Therefore, a model to guide both study design and the interpretation of findings is necessary. We have previously proposed a model suggesting that the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, we provide a narrative appraisal of the model and recommendations to advance the study of manual therapy mechanisms. J Orthop Sports Phys Ther 2018;48(1):8-18. doi:10.2519/jospt.2018.7476.