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Whedon JM, Petersen CL, Schoellkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. The association between cervical artery dissection and spinal manipulation among US adults. Eur Spine J 2023; 32:3497-3504. [PMID: 37422607 PMCID: PMC10591258 DOI: 10.1007/s00586-023-07844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/23/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Cervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). We evaluated the association between CSM and CeAD among US adults. METHODS Through analysis of health claims data, we employed a case-control study with matched controls, a case-control design in which controls were diagnosed with ischemic stroke, and a case-crossover design in which recent exposures were compared to exposures in the same case that occurred 6-7 months earlier. We evaluated the association between CeAD and the 3-level exposure, CSM versus office visit for medical evaluation and management (E&M) versus neither, with E&M set as the referent group. RESULTS We identified 2337 VAD cases and 2916 CAD cases. Compared to population controls, VAD cases were 0.17 (95% CI 0.09 to 0.32) times as likely to have received CSM in the previous week as compared to E&M. In other words, E&M was about 5 times more likely than CSM in the previous week in cases, relative to controls. CSM was 2.53 (95% CI 1.71 to 3.68) times as likely as E&M in the previous week among individuals with VAD than among individuals experiencing a stroke without CeAD. In the case-crossover study, CSM was 0.38 (95% CI 0.15 to 0.91) times as likely as E&M in the week before a VAD, relative to 6 months earlier. In other words, E&M was approximately 3 times more likely than CSM in the previous week in cases, relative to controls. Results for the 14-day and 30-day timeframes were similar to those at one week. CONCLUSION Among privately insured US adults, the overall risk of CeAD is very low. Prior receipt of CSM was more likely than E&M among VAD patients as compared to stroke patients. However, for CAD patients as compared to stroke patients, as well as for both VAD and CAD patients in comparison with population controls and in case-crossover analysis, prior receipt of E&M was more likely than CSM.
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Affiliation(s)
- James M Whedon
- Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Scott Haldeman
- Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA
- Department of Neurology, University of California at Irvine, Irvine, CA, USA
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Jon D Lurie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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Whedon JM, Petersen CL, Li Z, Schoelkopf WJ, Haldeman S, MacKenzie TA, Lurie JD. Association between cervical artery dissection and spinal manipulative therapy -a medicare claims analysis. BMC Geriatr 2022; 22:917. [PMID: 36447166 PMCID: PMC9710172 DOI: 10.1186/s12877-022-03495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation. METHODS We evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-crossover designs in the analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007-2015. The primary exposure was cervical spinal manipulation; the secondary exposure was a clinical encounter for evaluation and management for neck pain or headache. We created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management. The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection. The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. Cases were compared to 3 different control groups: (1) matched population controls having at least one claim in the same year as the case; (2) ischemic stroke controls without cervical artery dissection; and (3) case-crossover analysis comparing cases to themselves in the time period 6-7 months prior to their cervical artery dissection. We made each comparison across three different time frames: up to (1) 7 days; (2) 14 days; and (3) 30 days prior to index event. RESULTS The odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints (ORs 0.84 to 1.88; p > 0.05). Results for carotid artery dissection cases were similar. CONCLUSION Among Medicare beneficiaries aged 65 and older who received cervical spinal manipulation, the risk of cervical artery dissection is no greater than that among control groups.
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Affiliation(s)
- James M Whedon
- Health Services Research, Southern California University of Health Sciences, 16200 Amber Valley Drive, 90604, Whittier, CA, USA.
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Zhongze Li
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Scott Haldeman
- Department of Neurology, University of California at Irvine, Irvine, CA, USA
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Jon D Lurie
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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Russell BS, Keller M, Wynd SE, Hosek RS, Owens EF, Hoiriis KT. Angular Kinematics of Chiropractic Supine Cervical Spine Manipulation: Rotational Measures and Comparisons to Doctor and Recipient Perceptions. J Manipulative Physiol Ther 2022; 45:497-507. [PMID: 36922054 DOI: 10.1016/j.jmpt.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/20/2022] [Accepted: 12/01/2022] [Indexed: 03/17/2023]
Abstract
OBJECTIVES The primary purposes of this study were to measure axial rotation during supine cervical spinal manipulative therapy (cSMT) and to record recipients' and doctors' perceptions of rotational magnitudes. METHODS Experienced doctors of chiropractic (DCs) provided supine cSMT and acted as recipients of cSMT. Participants who received SMT wore inertial measurement units attached to the forehead and sternum for motion capture. Afterward, recipients and DCs completed questionnaires asking about their perceptions of motion. Data were analyzed for magnitudes of axial rotation at peak thrust and correlations with patient and doctor perceptions. Secondary analyses included angular velocity, angular acceleration, and other kinematic variables. RESULTS We recorded 23 SMT events with 14 DCs. Rotation at thrust peaks averaged 32.4° (17.4°). Doctors' and recipients' perceptions of rotation were higher than measured values 45% and 50% of the time, respectively. Maximum angular velocity and acceleration averaged 221.9°/s (124.9) and 4786.5°/s2 (2456.6), respectively. We found no correlation between perceptions and velocity or acceleration; doctors' perceptions had an inverse correlation with measurements. CONCLUSION On average, we found rotation during supine cSMT to be 32°. Both DCs and SMT recipients overestimated rotation compared with actual measurements. These factors should be considered in discussions of rotation and SMT.
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Affiliation(s)
- Brent S Russell
- Life University Center for Chiropractic Research, Atlanta, Georgia.
| | - Mackenzie Keller
- Life University Center for Chiropractic Research, Atlanta, Georgia
| | - Shari E Wynd
- Department of Foundational Sciences, Texas Chiropractic College, Pasadena, Texas
| | - Ronald S Hosek
- Life University Center for Chiropractic Research, Atlanta, Georgia
| | - Edward F Owens
- Life University Center for Chiropractic Research, Atlanta, Georgia
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Bernetti A, La Russa R, de Sire A, Agostini F, De Simone S, Farì G, Lacasella GV, Santilli G, De Trane S, Karaboue M, Ruiu P, Mangone M, Leigheb M, Santilli V, Fiore P. Cervical Spine Manipulations: Role of Diagnostic Procedures, Effectiveness, and Safety from a Rehabilitation and Forensic Medicine Perspective: A Systematic Review. Diagnostics (Basel) 2022; 12:1056. [PMID: 35626212 PMCID: PMC9139983 DOI: 10.3390/diagnostics12051056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background: Cervical spine manipulations (CSM) have been performed for centuries and are a widely practiced intervention to manage cervical spine musculoskeletal disorders. We aimed to perform an overview of the literature concerning the effects and the adverse events of CSM in the Physical and Rehabilitation Medicine (PRM) field with a forensic medicine perspective. Methods: A search in the scientific literature (PubMed, Google Scholar, PEDro and Cochrane) was carried out from inception until October 2020. Results: Fourteen articles were included in this narrative summary. The possible development of side effects requires a careful mandatory balance of benefits and risks even when there is an indication for this approach. Moreover, a qualified professional is essential to perform CSM–a non-invasive therapeutic procedure that can be potentially harmful. Conclusions: In conclusion, it is essential to perform the diagnosis, to treat, and to manage complications within the PRM field, both for the reduction of malpractice claims and, most importantly, for the safety of the patient.
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de Best RF, Coppieters MW, van Trijffel E, Compter A, Uyttenboogaart M, Bot JC, Castien R, Pool JJM, Cagnie B, Scholten-Peeters GGM. Interexaminer Agreement and Reliability of an Internationally Endorsed Screening Framework for Cervical Vascular Risks Following Manual Therapy and Exercise: The Go4Safe Project. Phys Ther 2021; 101:6309589. [PMID: 34174073 PMCID: PMC8494014 DOI: 10.1093/ptj/pzab166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 03/25/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care. METHODS Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated. RESULTS Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21-0.57) and varied considerably between pairs of physical therapists (κ = 0.14-1.00). CONCLUSION The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. IMPACT The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework.
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Affiliation(s)
- Rogier F de Best
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands,Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Emie van Trijffel
- SOMT University of Physiotherapy, Amersfoort, The Netherlands,Department of Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annette Compter
- Department of Neuro-Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost C Bot
- Department of Radiology, Amsterdam University Medical Center, The Netherlands
| | - Rene Castien
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Jan J M Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands,Address all correspondence to Dr Scholten-Peeters at:
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Hu A, Motyka T, Gish E, Dogbey G. Teaching and use of cervical high-velocity, low-amplitude manipulation at colleges of osteopathic medicine. J Osteopath Med 2021; 121:265-270. [PMID: 33635957 DOI: 10.1515/jom-2020-0120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Despite the documented effectiveness of high-velocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians. Objectives To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine. Methods A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6 weeks at 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, board-certified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment. Results Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0-25% of their school's medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51-75% of their class could perform cervical HVLA. Conclusions A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.
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Affiliation(s)
- Annette Hu
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | - Thomas Motyka
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | - Eric Gish
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | - Godwin Dogbey
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
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Pool J, Maissan F, de Waele N, Wittink H, Ostelo R. Completeness of the description of manipulation and mobilisation techniques in randomized controlled trials in neck pain; A review using the TiDieR checklist. Musculoskelet Sci Pract 2020; 45:102098. [PMID: 32056823 DOI: 10.1016/j.msksp.2019.102098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/24/2019] [Accepted: 11/29/2019] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN A secondary analysis of a systematic review. BACKGROUND Manipulations or mobilizations are commonly used interventions in patients with mechanical neck pain. The treatment effects have often been studied in randomized controlled trials (RCT) which are generally considered the gold standard in evaluating the treatment effects, mainly due to its high internal validity. External validity is defined as the extent to which the effects can be generalised to clinical practice. An important prerequisite for this is that interventions used in clinical trials can be replicated in clinical practice. It can be questioned if interventions utilized in randomized controlled trials can be translated into clinical practice. OBJECTIVES The overall aim of this study is to examine whether the quality of the description of manipulation and mobilization interventions is sufficient for to replication of these interventions in clinical practice. METHODS A comprehensive literature search was performed. Two independent researchers used the Template for Intervention Description and Replication (TIDieR) which is a 12-item checklist for describing the completeness of the interventions. RESULTS Sixty-seven articles were included that used manipulation and/or mobilization interventions for patients with mechanical neck pain. None of the articles describe the intervention e.g. all the items on the TIDieR list. Considering item 8 (a-f) of the TIDieR checklist only one article described the used techniques completely. CONCLUSION Manipulation or a mobilization interventions are poorly reported in RCTs, which jeopardize the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions.
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Affiliation(s)
- Jan Pool
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, the Netherlands.
| | - Francois Maissan
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | | | - Harriet Wittink
- Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, the Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije University Amsterdam, Amsterdam Movement Sciences, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Location VUMC, the Netherlands
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Myers BJ, Davey D, Cook CE. Factors associated with cervical arterial dysfunction: a survey of physical therapist educators in the United States. J Man Manip Ther 2020; 29:33-39. [PMID: 31975642 DOI: 10.1080/10669817.2020.1719300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: The purpose of this study was to identify the key constructs associated with symptom description and behavior, natural history of complaints, and previous medical history of cervical arterial dysfunction (CAD) according to a panel of physical therapist (PT) educators. Methods: An electronic survey was conducted of licensed PT educators currently involved in musculoskeletal physical therapy education within a credentialed program. Survey prompts queried educators to list the subjective and objective items associated with CAD, in open-text format. Responses were coded to identify unique themes (constructs). Principal axis factor analysis with Varimax rotation was performed to identify underlying constructs associated with CAD according to the panel of educators. Results: Seventy-two educators completed the survey (24.2% response rate) resulting in 50 identified unique items through thematic coding. Factor analysis (Kaiser-Meyer-Olkin measure of sampling adequacy = .679, Bartlett's test of sphericity (x 2(351) = 1129.06. p < .001), resulted in a four-factor solution: '5Ds and 3 Ns,' 'Other Neurological Findings,' 'Signs & Symptoms in Rotation and/or Extension,' and 'General Health.' Discussion: According to the PT educators in this study, the factors associated with CAD appear to reflect the IFOMPT guidelines. The responses and subsequent factor analysis demonstrate the lack of any one clinical finding for the identification of CAD in a patient with neck pain. Level of Evidence: V.
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Affiliation(s)
- Bradley J Myers
- Doctor of Physical Therapy Program, Campbell University , Buies Creek, NC, USA.,Orthopaedic Manual Physical Therapy Fellowship, Regis University , Denver, CO, USA
| | - Deborah Davey
- Doctor of Physical Therapy Program, University of Illinois at Chicago , Chicago, IL, USA
| | - Chad E Cook
- Doctor of Physical Therapy Program, Duke University , Durham, NC, USA
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Afana HB, Abuhadrous NMM, Elsharkawy AE. Bithalamic Infarction (Artery of Percheron Occlusion) after Anterior Cervical Discectomy and Fusion. Case Rep Neurol Med. 2019;2019:9438089. [PMID: 31011457 DOI: 10.1155/2019/9438089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/05/2019] [Indexed: 01/04/2023] Open
Abstract
Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended. The intraoperative procedure was uneventful. During surgery, blood pressure ranged around 110 mmHg∖50 mmHg. At the end of surgery, the patient's recovery from general anesthesia was normal with no delaying or complication; on next the day, patient developed a sudden loss of consciousness. Urgent brain computed tomography (CT) was normal; two days later, follow-up CT and CT Angiography (CTA) revealed bilateral thalamic infarction with right vertebral artery occlusion from its origin. Intraoperative surgical manipulation, hypotensive anesthesia, and prolonged neck hyperextension might have contributed to stroke in this patient. ACDF carries a potential risk for posterior circulation stroke. Artery of Percheron infarction should be considered in the differential diagnosis of patients developing a sudden loss of consciousness after ACDF. Vertebral artery thrombosis should be taken into account as an important possible cause of embolism.
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Mushinskiy AA, Aminovа EV, Korotkova AM. Evaluation of tolerance of tubers Solanum tuberosum to silicа nanoparticles. Environ Sci Pollut Res Int 2018; 25:34559-34569. [PMID: 30315529 DOI: 10.1007/s11356-018-3268-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/17/2018] [Indexed: 05/23/2023]
Abstract
In recent years, researches on the impact of nanometals on the state of soil ecosystems, including silicon, which is known to have a positive effect on plants under stressful conditions, have become relevant. The aim of this study was to assess the biological effects of nanoparticles (NP) of SiO2 on the plant Solanum tuberosum. Testing of biological activity of NP SiO2 on potato tubers was carried out on the example of five concentrations of metal increasing exponentially (0.03, 0.09, 0.18, 0.21, and 0.36 g/kg of potatoes) and control (without processing of NP SiO2). We have shown that on the 21st day of the experiment after tuber treatment, the average mass of tuber in concentrations 0.18 and 0.21 g/kg of NP SiO2 increased by 6.6% and 2.2%, respectively; stimulation of root length by 27.8-21.0%, the length of sprouts increased to 55.3%, and at a concentration of 0.36 g/kg on the 14th and 45th days, there was a maximum accumulation of Si in different parts of the plants. Analysis of chlorophyll content in the sprouts Solanum tuberosum showed that concentrations of nanoform SiO2 0.03-0.21 g/kg chlorophyll were higher than control by 48.8% and content of carotenoids by 29.7%. According to the results of field studies, the maximum mass of potato stems and tubers was observed at concentrations of 0.09 g/kg and 0.18 g/kg NP SiO2, which confirmed the absence of toxic properties of NP SiO2. The absence of the toxic effect of the investigated range of concentrations of NP SiO2 from 0.03 to 0.36 g/kg was also confirmed by electrophoretic mobility of plant DNA molecules after incubation with silicon nanoparticles in vitro.
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Affiliation(s)
- Alexandr Alekseevich Mushinskiy
- Federal Scientific Centre of Biological Systems and Agrotechnologies of Russian Academy of Sciences, 29, 9 Yanvarya street, Orenburg, Russia, 460000
| | - Evgeniya Vladimirovna Aminovа
- Federal Scientific Centre of Biological Systems and Agrotechnologies of Russian Academy of Sciences, 29, 9 Yanvarya street, Orenburg, Russia, 460000.
| | - Anastasia Mikhailovna Korotkova
- Federal Scientific Centre of Biological Systems and Agrotechnologies of Russian Academy of Sciences, 29, 9 Yanvarya street, Orenburg, Russia, 460000
- Orenburg State University, Prospect Pobedy 13, Orenburg, Russia, 460016
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Moore P, Le T, Blakley B, Beiko J, Meen E. Hemorrhagic stroke after Epley maneuver: a case report. J Otolaryngol Head Neck Surg 2018; 47:25. [PMID: 29631624 PMCID: PMC5891963 DOI: 10.1186/s40463-018-0268-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the first case to our knowledge of a serious adverse event following the Epley maneuver, which is the treatment of choice for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder in adults. CASE PRESENTATION A 77 year old female presented for outpatient evaluation of vertigo at a tertiary otolaryngology clinic. She was found to have BPPV clinically, and elected to have a particle repositioning maneuver (Epley maneuver) performed in clinic. Immediately following Epley maneuver, she had severe nausea and vomiting, with evolving visual changes. A CT angiogram of the brain was performed urgently through the emergency department and demonstrated an acute intraparenchymal hemorrhage in the occipital lobe. After medical stabilization and rehabilitation, the patient continues to have a permanent visual field deficit. CONCLUSION The Epley maneuver is safe and effective, and there are no prior reports of serious adverse events associated with its use. This case, in which a patient experienced a hemorrhagic stroke after undergoing the Epley maneuver, is the first and sole case in the medical literature of an Epley-associated serious adverse event. The indirect causation and extreme rarity of this event do not warrant any change to patterns of practice.
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Affiliation(s)
- Paige Moore
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
| | - Trung Le
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Blakley
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
| | - Jason Beiko
- Department of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Meen
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, GB421 - 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada
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12
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Hagley GW, Mills PD, Shiner B, Hemphill RR. An Analysis of Adverse Events in the Rehabilitation Department: Using the Veterans Affairs Root Cause Analysis System. Phys Ther 2018; 98:223-230. [PMID: 29325162 DOI: 10.1093/ptj/pzy003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 01/08/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Root cause analyses (RCA) are often completed in health care settings to determine causes of adverse events (AEs). RCAs result in action plans designed to mitigate future patient harm. National reviews of RCA reports have assessed the safety of numerous health care settings and suggested opportunities for improvement. However, few studies have assessed the safety of receiving care from physical therapists, occupational therapists, or speech and language pathology pathologists. OBJECTIVE The objective of this study was to determine the types of AEs, root causes, and action plans for risk mitigation that exist within the disciplines of rehabilitation medicine. DESIGN This study is a retrospective, cross-sectional review. METHODS A national search of the Veterans Health Administration RCA database was conducted to identify reports describing AEs associated with physical therapy, occupational therapy, or speech and language pathology services between 2009 and May 2016. Twenty-five reports met the inclusion requirements. The reports were classified by the event type, root cause, action plans, and strength of action plans. RESULTS Delays in care (32.0%) and falls (28.0%) were the most common type of AE. Three AEs resulted in death. RCA teams identified deficits regarding policy and procedures as the most common root cause. Eighty-eight percent of RCA reports included strong or intermediate action plans to mitigate risk. Strong action plans included standardizing emergency terminology and implementing a dedicated line to call for an emergency response. LIMITATIONS These data are self-reported and only AEs that are scored as a safety assessment code 3 in the system receive a full RCA, so there are likely AEs that were not captured in this study. In addition, the RCA reports are deidentified and so do not include all patient characteristics. As the Veterans Health Administration system services mostly men, the data might not generalize to non-Veterans Health Administration systems with a different patient mix. CONCLUSIONS Care provided by rehabilitation professionals is generally safe, but AEs do occur. Based on this RCA review, the safety of rehabilitation services can be improved by implementing strong practices to mitigate risk to patients. Checklists should be considered to aid timely decision making when initiating an emergency response.
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Affiliation(s)
- Gregory W Hagley
- White River Junction VA Medical Center, White River Junction, Vermont, and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Peter D Mills
- National Center for Patient Safety, White River Junction Field Office, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Brian Shiner
- White River Junction VA Medical Center and Geisel School of Medicine at Dartmouth
| | - Robin R Hemphill
- Quality and Safety, VCU Health, and School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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13
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Abstract
Background Communicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research. Method A methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points. Results Two hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events.Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes.Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk. Conclusion Existing literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.
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Affiliation(s)
- Gabrielle Swait
- The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK
| | - Rob Finch
- The Royal College of Chiropractors, Chiltern Chambers, St. Peters Avenue, Reading, RG4 7DH UK
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14
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Yunoki M, Kanda T, Suzuki K, Uneda A, Hirashita K, Yoshino K. Vertebral artery occlusion after anterior cervical discectomy with fusion. Iran J Neurol 2017; 16:221-222. [PMID: 29736229 PMCID: PMC5937009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Galindez-Ibarbengoetxea X, Setuain I, Andersen LL, Ramírez-Velez R, González-Izal M, Jauregi A, Izquierdo M. Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review. J Altern Complement Med 2017; 23:667-675. [PMID: 28731832 DOI: 10.1089/acm.2017.0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cervical high-velocity low-amplitude (HVLA) manipulation technique is among the oldest and most frequently used chiropractic manual therapy, but the physiologic and biomechanics effects were not completely clear. OBJECTIVE This review aims to describe the effects of cervical HVLA manipulation techniques on range of motion, strength, and cardiovascular performance. METHODS/DESIGN A systematic search was conducted of the electronic databases from January 2000 to August 2016: PubMed (n = 131), ScienceDirect (n = 101), Scopus (n = 991), PEDro (n = 33), CINAHL (n = 884), and SciELO (n = 5). Two independent reviewers conducted the screening process to determine article eligibility. The intervention that included randomized controlled trials was thrust, or HVLA, manipulative therapy directed to the cervical spine. Methodological quality was assessed using the Cochrane risk-of-bias tool. The initial search rendered 2145 articles. After screening titles and abstracts, 11 articles remained for full-text review. RESULTS The review shows that cervical HVLA manipulation treatment results in a large effect size (d > 0.80) on increasing cervical range of motion and mouth opening. In patients with lateral epicondylalgia, cervical HVLA manipulation resulted in increased pain-free handgrip strength, with large effect sizes (1.44 and 0.78, respectively). Finally, in subjects with hypertension the blood pressure seemed to decrease after cervical HVLA manipulation. Higher quality studies are needed to develop a stronger evidence-based foundation for HVLA manipulation techniques as a treatment for cervical conditions.
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Affiliation(s)
| | - Igor Setuain
- 2 Department of Health Sciences, Public University of Navarra , Navarra, Spain .,3 Clinical Research Department , TDN, Orthopaedic Surgery and Advanced Rehabilitation Centre, Pamplona, Spain
| | - Lars L Andersen
- 4 National Research Centre for the Working Environment , Copenhagen, Denmark .,5 Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University , Aalborg, Denmark
| | - Robinson Ramírez-Velez
- 6 Centre for Studies on Measurement of Physical Activity, School of Medicine and Health Sciences , Universidad del Rosario, Bogotá, Colombia
| | | | - Andoni Jauregi
- 1 International School of Osteopathy , Bilbao, Spain .,7 University of Deusto , Bilbao, Spain
| | - Mikel Izquierdo
- 2 Department of Health Sciences, Public University of Navarra , Navarra, Spain
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16
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Kranenburg HA, Lakke SE, Schmitt MA, Van der Schans CP. Adverse events following cervical manipulative therapy: consensus on classification among Dutch medical specialists, manual therapists, and patients. J Man Manip Ther 2017; 25:279-287. [PMID: 29449770 DOI: 10.1080/10669817.2017.1332556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objectives To obtain consensus-based agreement on a classification system of adverse events (AE) following cervical spinal manipulation. The classification system should be comprised of clear definitions, include patients' and clinicians' perspectives, and have an acceptable number of categories. Methods Design: A three-round Delphi study. Participants: Thirty Dutch participants (medical specialists, manual therapists, and patients) participated in an online survey. Procedure: Participants inventoried AE and were asked about their preferences for either a three- or a four-category classification system. The identified AE were classified by two analysts following the International Classification of Functioning, Disability and Health (ICF), and the International Classification of Diseases and Related Health Problems (ICD-10). Participants were asked to classify the severity for all AE in relation to the time duration. Results Consensus occurred in a three-category classification system. There was strong consensus for 16 AE in all severities (no, minor, and major AE) and all three time durations [hours, days, weeks]. The 16 AE included anxiety, flushing, skin rash, fainting, dizziness, coma, altered sensation, muscle tenderness, pain, increased pain during movement, radiating pain, dislocation, fracture, transient ischemic attack, stroke, and death. Mild to strong consensus was reached for 13 AE. Discussion A consensus-based classification system of AE is established which includes patients' and clinicians' perspectives and has three categories. The classification comprises a precise description of potential AE in accordance with internationally accepted classifications. After international validation, clinicians and researchers may use this AE classification system to report AE in clinical practice and research.
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Affiliation(s)
- Hendrikus A Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra E Lakke
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Maarten A Schmitt
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Cees P Van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev 2017; 6:64. [PMID: 28340595 PMCID: PMC5366149 DOI: 10.1186/s13643-017-0458-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT. METHODS We searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated. RESULTS We identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe. CONCLUSIONS It is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015030068 .
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Affiliation(s)
- Sabrina Mai Nielsen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Simon Tarp
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Henning Bliddal
- Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Marius Henriksen
- Physiotherapy and Biomechanics Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark.
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Bronson MA, Perle SM, Tuchin P. Issues with vertebral artery dissections. Interv Neuroradiol 2017; 23:154-155. [PMID: 28304208 DOI: 10.1177/1591019916680111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Peter Tuchin
- 3 Department of Chiropractic, Macquarie University, Australia
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19
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Marcon AR, Klostermann P, Caulfield T. Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates. JMIR Public Health Surveill 2016; 2:e153. [PMID: 27637456 PMCID: PMC5045521 DOI: 10.2196/publichealth.5739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/04/2016] [Accepted: 08/21/2016] [Indexed: 12/18/2022] Open
Abstract
Background Spinal manipulation therapy (SMT) is a popular though controversial practice. The debates surrounding efficacy and risk of SMT are only partially evident in popular discourse. Objective This study aims to investigate the presence of critiques and debates surrounding efficacy and risk of SMT on the social media platform Twitter. The study examines whether there is presence of debate and whether critical information is being widely disseminated. Methods An initial corpus of 31,339 tweets was compiled through Twitter’s Search Application Programming Interface using the query terms “chiropractic,” “chiropractor,” and “spinal manipulation therapy.” Tweets were collected for the month of December 2015. Post removal of tweets made by bots and spam, the corpus totaled 20,695 tweets, of which a sample (n=1267) was analyzed for skeptical or critical tweets. Additional criteria were also assessed. Results There were 34 tweets explicitly containing skepticism or critique of SMT, representing 2.68% of the sample (n=1267). As such, there is a presence of 2.68% of tweets in the total corpus, 95% CI 0-6.58% displaying explicitly skeptical or critical perspectives of SMT. In addition, there are numerous tweets highlighting the health benefits of SMT for health issues such as attention deficit hyperactivity disorder (ADHD), immune system, and blood pressure that receive scant critical attention. The presence of tweets in the corpus highlighting the risks of “stroke” and “vertebral artery dissection” is also minute (0.1%). Conclusions In the abundance of tweets substantiating and promoting chiropractic and SMT as sound health practices and valuable business endeavors, the debates surrounding the efficacy and risks of SMT on Twitter are almost completely absent. Although there are some critical voices of SMT proving to be influential, issues persist regarding how widely this information is being disseminated.
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Affiliation(s)
- Alessandro R Marcon
- Health Law Institute, Department of Law, University of Alberta, Edmonton, AB, Canada
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20
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Vaughan B, Moran R, Tehan P, Fryer G, Holmes M, Vogel S, Taylor A. Manual therapy and cervical artery dysfunction: Identification of potential risk factors in clinical encounters. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Stason WB, Ritter GA, Martin T, Prottas J, Tompkins C, Shepard DS. Effects of Expanded Coverage for Chiropractic Services on Medicare Costs in a CMS Demonstration. PLoS One 2016; 11:e0147959. [PMID: 26928221 DOI: 10.1371/journal.pone.0147959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/11/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head. METHODS The demonstration was conducted in 2005-2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework. RESULTS Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa. CONCLUSION The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.
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Mikkelsen R, Dalby RB, Hjort N, Simonsen CZ, Karabegovic S. Endovascular Treatment of Basilar Artery Thrombosis Secondary to Bilateral Vertebral Artery Dissection with Symptom Onset Following Cervical Spine Manipulation Therapy. Am J Case Rep 2015; 16:868-71. [PMID: 26647210 PMCID: PMC4678923 DOI: 10.12659/ajcr.895273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Female, 37 Final Diagnosis: Vertebral artery dissection Symptoms: Neck pain and focal neurological deficits Medication: No previous Clinical Procedure: Endovascular thrombectomy Specialty: Neurology
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Affiliation(s)
- Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Beese Dalby
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Hjort
- Danish Stroke Center, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sanja Karabegovic
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
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Futch D, Schneider MJ, Murphy D, Grayev A. Vertebral artery dissection in evolution found during chiropractic examination. BMJ Case Rep 2015; 2015:bcr-2015-212568. [PMID: 26564115 DOI: 10.1136/bcr-2015-212568] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 30-year-old woman presented to an emergency department with sudden onset of transient loss of left peripheral vision. Owing to a history of migraine headaches, she was released with a diagnosis of ocular migraine. Two days later, she sought chiropractic care for the chief symptom of severe neck pain. The chiropractor suspected the possibility of vertebral artery dissection (VAD). No manipulation was performed; instead, MR angiography (MRA) of the neck was obtained, which revealed an acute left VAD with early thrombus formation. The patient was placed on aspirin therapy. Repeat MRA of the neck 3 months later revealed resolution of the thrombus, without progression to stroke. This case illustrates the importance for all healthcare providers who see patients with neck pain and headache to be attentive to the symptomatic presentation of possible VAD in progress.
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Affiliation(s)
- Dan Futch
- Department of Chiropractic Medicine, Group Health Cooperative of South Central Wisconsin, Madison, Wisconsin, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Donald Murphy
- Department of Family Medicine, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA
| | - Allison Grayev
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Tarola G, Phillips RB. Chiropractic Response to a Spontaneous Vertebral Artery Dissection. J Chiropr Med 2015; 14:183-90. [PMID: 26778932 DOI: 10.1016/j.jcm.2015.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The purpose of this case report is to describe a case in which early detection and proper follow-up of spontaneous vertebral artery dissection led to satisfactory outcomes. CLINICAL FEATURES A 34-year old white woman reported to a chiropractic clinic with a constant burning pain at the right side of her neck and shoulder with a limited ability to turn her head from side to side, periods of blurred vision, and muffled hearing. Dizziness, visual and auditory disturbances, and balance difficulty abated within 1 hour of onset and were not present at the time of evaluation. A pain drawing indicated burning pain in the suboccipital area, neck, and upper shoulder on the right and a pins and needles sensation on the dorsal surface of both forearms. Turning her head from side-to-side aggravated the pain, and the application of heat brought temporary relief. The Neck Disability Index score of 44 placed the patient's pain in the most severe category. INTERVENTION AND OUTCOME The patient was not treated on the initial visit but was advised of the possibility of a vertebral artery or carotid artery dissection and was recommended to the emergency department for immediate evaluation. The patient declined but later was convinced by her chiropractor to present to the emergency department. A magnetic resonance angiogram of the neck and carotid arteries was performed showing that the left vertebral artery was hypoplastic and appeared to terminate at the left posterior inferior cerebellar artery. There was an abrupt moderately long segment of narrowing involving the right vertebral artery beginning near the junction of the V1 and V2 segments. The radiologist noted a concern regarding right vertebral artery dissection. Symptoms resolved and the patient was cleared of any medications but advised that if symptoms reoccurred she was to go for emergency care immediately. CONCLUSION Recognition and rapid response by the chiropractic physician provided the optimum outcome for this particular patient.
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Affiliation(s)
- Gary Tarola
- Private Practice, Lehigh Valley Medical Network, Allentown, PA
| | - Reed B Phillips
- Adjunct Faculty, Southern California University of Health Sciences, Whittier, CA
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Abstract
The use of complementary, alternative, and traditional therapies is increasing in the United States, and patients and their families are bringing these practices into the acute care setting. Acute and critical care nurses are in a unique and trusted position to advocate for their patients and to promote safe incorporation of complementary, alternative, and traditional therapies into the plan of care.
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Affiliation(s)
- Debra Kramlich
- Debra Kramlich is an assistant professor of nursing, University of New England, Portland, Maine.
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Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, Faber-Dobrescu M, Andres C, Graham N, Goldsmith CH, Brønfort G, Hoving JL, LeBlanc F. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev 2015; 2015:CD004249. [PMID: 26397370 PMCID: PMC10883412 DOI: 10.1002/14651858.cd004249.pub4] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Manipulation and mobilisation are commonly used to treat neck pain. This is an update of a Cochrane review first published in 2003, and previously updated in 2010. OBJECTIVES To assess the effects of manipulation or mobilisation alone compared wiith those of an inactive control or another active treatment on pain, function, disability, patient satisfaction, quality of life and global perceived effect in adults experiencing neck pain with or without radicular symptoms and cervicogenic headache (CGH) at immediate- to long-term follow-up. When appropriate, to assess the influence of treatment characteristics (i.e. technique, dosage), methodological quality, symptom duration and subtypes of neck disorder on treatment outcomes. SEARCH METHODS Review authors searched the following computerised databases to November 2014 to identify additional studies: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched ClinicalTrials.gov, checked references, searched citations and contacted study authors to find relevant studies. We updated this search in June 2015, but these results have not yet been incorporated. SELECTION CRITERIA Randomised controlled trials (RCTs) undertaken to assess whether manipulation or mobilisation improves clinical outcomes for adults with acute/subacute/chronic neck pain. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, abstracted data, assessed risk of bias and applied Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods (very low, low, moderate, high quality). We calculated pooled risk ratios (RRs) and standardised mean differences (SMDs). MAIN RESULTS We included 51 trials (2920 participants, 18 trials of manipulation/mobilisation versus control; 34 trials of manipulation/mobilisation versus another treatment, 1 trial had two comparisons). Cervical manipulation versus inactive control: For subacute and chronic neck pain, a single manipulation (three trials, no meta-analysis, 154 participants, ranged from very low to low quality) relieved pain at immediate- but not short-term follow-up. Cervical manipulation versus another active treatment: For acute and chronic neck pain, multiple sessions of cervical manipulation (two trials, 446 participants, ranged from moderate to high quality) produced similar changes in pain, function, quality of life (QoL), global perceived effect (GPE) and patient satisfaction when compared with multiple sessions of cervical mobilisation at immediate-, short- and intermediate-term follow-up. For acute and subacute neck pain, multiple sessions of cervical manipulation were more effective than certain medications in improving pain and function at immediate- (one trial, 182 participants, moderate quality) and long-term follow-up (one trial, 181 participants, moderate quality). These findings are consistent for function at intermediate-term follow-up (one trial, 182 participants, moderate quality). For chronic CGH, multiple sessions of cervical manipulation (two trials, 125 participants, low quality) may be more effective than massage in improving pain and function at short/intermediate-term follow-up. Multiple sessions of cervical manipulation (one trial, 65 participants, very low quality) may be favoured over transcutaneous electrical nerve stimulation (TENS) for pain reduction at short-term follow-up. For acute neck pain, multiple sessions of cervical manipulation (one trial, 20 participants, very low quality) may be more effective than thoracic manipulation in improving pain and function at short/intermediate-term follow-up. Thoracic manipulation versus inactive control: Three trials (150 participants) using a single session were assessed at immediate-, short- and intermediate-term follow-up. At short-term follow-up, manipulation improved pain in participants with acute and subacute neck pain (five trials, 346 participants, moderate quality, pooled SMD -1.26, 95% confidence interval (CI) -1.86 to -0.66) and improved function (four trials, 258 participants, moderate quality, pooled SMD -1.40, 95% CI -2.24 to -0.55) in participants with acute and chronic neck pain. A funnel plot of these data suggests publication bias. These findings were consistent at intermediate follow-up for pain/function/quality of life (one trial, 111 participants, low quality). Thoracic manipulation versus another active treatment: No studies provided sufficient data for statistical analyses. A single session of thoracic manipulation (one trial, 100 participants, moderate quality) was comparable with thoracic mobilisation for pain relief at immediate-term follow-up for chronic neck pain. Mobilisation versus inactive control: Mobilisation as a stand-alone intervention (two trials, 57 participants, ranged from very low to low quality) may not reduce pain more than an inactive control. Mobilisation versus another active treatment: For acute and subacute neck pain, anterior-posterior mobilisation (one trial, 95 participants, very low quality) may favour pain reduction over rotatory or transverse mobilisations at immediate-term follow-up. For chronic CGH with temporomandibular joint (TMJ) dysfunction, multiple sessions of TMJ manual therapy (one trial, 38 participants, very low quality) may be more effective than cervical mobilisation in improving pain/function at immediate- and intermediate-term follow-up. For subacute and chronic neck pain, cervical mobilisation alone (four trials, 165 participants, ranged from low to very low quality) may not be different from ultrasound, TENS, acupuncture and massage in improving pain, function, QoL and participant satisfaction at immediate- and intermediate-term follow-up. Additionally, combining laser with manipulation may be superior to using manipulation or laser alone (one trial, 56 participants, very low quality). AUTHORS' CONCLUSIONS Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.
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Affiliation(s)
- Anita Gross
- School of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics, McMaster University, 1400 Main Street West, Hamilton, ON, Canada, L8S 1C7
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Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap 2015; 23:19. [PMID: 26085925 PMCID: PMC4470078 DOI: 10.1186/s12998-015-0063-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/28/2015] [Indexed: 12/19/2022] Open
Abstract
Background There is controversy surrounding the risk of manipulation, which is often used by chiropractors, with respect to its association with vertebrobasilar artery system (VBA) stroke. The objective of this study was to compare the associations between chiropractic care and VBA stroke with recent primary care physician (PCP) care and VBA stroke. Methods The study design was a case–control study of commercially insured and Medicare Advantage (MA) health plan members in the U.S. population between January 1, 2011 and December 31, 2013. Administrative data were used to identify exposures to chiropractic and PCP care. Separate analyses using conditional logistic regression were conducted for the commercially insured and the MA populations. The analysis of the commercial population was further stratified by age (<45 years; ≥45 years). Odds ratios were calculated to measure associations for different hazard periods. A secondary descriptive analysis was conducted to determine the relevance of using chiropractic visits as a proxy for exposure to manipulative treatment. Results There were a total of 1,829 VBA stroke cases (1,159 – commercial; 670 – MA). The findings showed no significant association between chiropractic visits and VBA stroke for either population or for samples stratified by age. In both commercial and MA populations, there was a significant association between PCP visits and VBA stroke incidence regardless of length of hazard period. The results were similar for age-stratified samples. The findings of the secondary analysis showed that chiropractic visits did not report the inclusion of manipulation in almost one third of stroke cases in the commercial population and in only 1 of 2 cases of the MA cohort. Conclusions We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.
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Affiliation(s)
- Thomas M Kosloff
- Optum Health - Clinical Programs at United Health Group, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - David Elton
- Optum Health - Clinical Programs at United Health Group, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Jiang Tao
- Optum Health - Clinical Analytics at United Health Group, 11000 Optum Circle, Eden Prairie, MN 55344 USA
| | - Wade M Bannister
- Optum Health - Clinical Analytics at United Health Group, 11000 Optum Circle, Eden Prairie, MN 55344 USA
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Green BN, Browske LKM, Rosenthal CMD. Elongated styloid processes and calcified stylohyoid ligaments in a patient with neck pain: implications for manual therapy practice. J Chiropr Med 2015; 13:128-33. [PMID: 25685122 DOI: 10.1016/j.jcm.2014.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/11/2013] [Accepted: 01/14/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection. CLINICAL FEATURES A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally. INTERVENTION AND OUTCOME Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient's symptoms improved but plateaued by the fifth visit. CONCLUSION Neck pain in the presence of ESPs and CSLs can be associated with Eagle syndrome, which can include ipsilateral head and neck pain, odynophagia, dysphagia, and cerebrovascular symptoms. This case, initially thought to be Eagle syndrome, highlights proper diagnostic workup for this condition and presents potential contraindications to consider with regard to cervical spine manipulation in such patients. Manual therapy precautions pertaining to cervical spine manipulation may be appropriate in cases involving ESPs and calcified stylohyoid ligaments.
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Affiliation(s)
- Bart N Green
- Chiropractor, Department of Physical and Occupational Therapy, Naval Medical Center, San Diego, CA ; Associate Editor, Publications Department, National University of Health Sciences, Lombard, IL
| | | | - Capt Michael D Rosenthal
- Physical Therapist, Department of Physical and Occupational Therapy, Naval Medical Center, San Diego
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Whedon JM, Song Y, Mackenzie TA, Phillips RB, Lukovits TG, Lurie JD. Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain. J Manipulative Physiol Ther 2015; 38:93-101. [PMID: 25596875 DOI: 10.1016/j.jmpt.2014.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. METHODS This is a retrospective cohort analysis of a 100% sample of annualized Medicare claims data on 1 157 475 beneficiaries aged 66 to 99 years with an office visit to either a chiropractor or primary care physician for neck pain. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a Cox proportional hazards model. We used direct adjusted survival curves to estimate cumulative probability of stroke up to 30 days for the 2 cohorts. RESULTS The proportion of subjects with stroke of any type in the chiropractic cohort was 1.2 per 1000 at 7 days and 5.1 per 1000 at 30 days. In the primary care cohort, the proportion of subjects with stroke of any type was 1.4 per 1000 at 7 days and 2.8 per 1000 at 30 days. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort (hazard ratio, 0.39; 95% confidence interval, 0.33-0.45), but at 30 days, a slight elevation in risk was observed for the chiropractic cohort (hazard ratio, 1.10; 95% confidence interval, 1.01-1.19). CONCLUSIONS Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.
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Affiliation(s)
- James M Whedon
- Instructor, The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Grantham, NH.
| | - Yunjie Song
- Research Associate, The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Grantham, NH
| | - Todd A Mackenzie
- Associate Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Grantham, NH
| | - Reed B Phillips
- President Emeritus, Southern California University of Health Sciences, Whittier, CA
| | - Timothy G Lukovits
- Associate Professor of Neurology, Geisel School of Medicine, Dartmouth College, Grantham, NH
| | - Jon D Lurie
- Associate Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Grantham, NH
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Jevne J, Hartvigsen J, Christensen HW. Compensation claims for chiropractic in Denmark and Norway 2004-2012. Chiropr Man Therap 2014; 22:37. [PMID: 25389462 PMCID: PMC4226888 DOI: 10.1186/s12998-014-0037-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/21/2014] [Indexed: 01/30/2023] Open
Abstract
Background Adverse events are commonly observed in all parts of health care and have been reported extensively following manual therapy, including chiropractic. The majority of reported adverse events following chiropractic care are mild, transitory and self-limiting. However, little is known about patient filed compensation claims related to the chiropractic consultation process. The aim of this study was to describe claims reported to the Danish Patient Compensation Association and the Norwegian System of Compensation to Patients related to chiropractic from 2004 to 2012. Methods All finalized compensation claims involving chiropractors reported to one of the two associations between 2004 and 2012 were assessed for age, gender, type of complaint, decisions and appeals. Descriptive statistics were used to describe the study population. Results 338 claims were registered in Denmark and Norway between 2004 and 2012 of which 300 were included in the analysis. 41 (13.7%) were approved for financial compensation. The most frequent complaints were worsening of symptoms following treatment (n = 91, 30.3%), alleged disk herniations (n = 57, 19%) and cases with delayed referral (n = 46, 15.3%). A total financial payment of €2,305,757 (median payment €7,730) were distributed among the forty-one cases with complaints relating to a few cases of cervical artery dissection (n = 11, 5.7%) accounting for 88.7% of the total amount. Conclusion Chiropractors in Denmark and Norway received approximately one compensation claim per 100.000 consultations. The approval rate was low across the majority of complaint categories and lower than the approval rates for general practioners and physiotherapists. Many claims can probably be prevented if chiropractors would prioritize informing patients about the normal course of their complaint and normal benign reactions to treatment.
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Affiliation(s)
- Jørgen Jevne
- Hønefoss Kiropraktikk og Rehabilitering, Torvgata 2, 3513 Hønefoss, Norway
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark ; Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark
| | - Henrik Wulff Christensen
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark
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Maiers M, Evans R, Hartvigsen J, Schulz C, Bronfort G. Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. ACTA ACUST UNITED AC 2015; 20:335-41. [PMID: 25454683 DOI: 10.1016/j.math.2014.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022]
Abstract
Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making. This paper provides a detailed report of AE experienced by elderly participants in a randomized comparative effectiveness trial of SMT and exercise for chronic NP. AE data, consistent with CONSORT recommendations, were collected on elderly participants who received 12 weeks of SMT with home exercise, supervised plus home exercise, or home exercise alone. Standardized questions were asked at each treatment; participants were additionally encouraged to report AE as they occurred. Qualitative interviews documented participants' experiences with AE. Descriptive statistics and content analysis were used to categorize and report these data. Compliance was high among the 241 randomized participants. Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred. Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.
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Safain MG, Talan J, Malek AM, Hwang SW. Spontaneous atraumatic vertebral artery occlusion due to physiological cervical extension: case report. J Neurosurg Spine 2014; 20:278-82. [PMID: 24438424 DOI: 10.3171/2013.12.spine13653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Vertebral artery (VA) occlusion is a serious and potentially life-threatening occurrence. Bow hunter's syndrome, a mechanical occlusion of the VA due to physiological head rotation, has been well described in the medical literature. However, mechanical VA compression due to routine flexion or extension of the neck has not been previously reported. The authors present the unique case of a woman without any history of trauma who had multiple posterior fossa strokes and was found to have dynamic occlusion of her right VA visualized via cerebral angiogram upon extension of her neck. This occlusion was attributed to instability at the occipitocervical junction in a patient with a previously unknown congenital fusion of both the occiput to C-1 and C-2 to C-3. An occiput to C-3 fusion was performed to stabilize her cervical spine and minimize the dynamic vascular compression. A postoperative angiogram showed no evidence of restricted flow with flexion or extension of the neck. This case emphasizes the importance of considering symptoms of vertebrobasilar insufficiency as a result of physiological head movement. The authors also review the literature on VA compression resulting from physiological head movement as well as strategies for clinical diagnosis and treatment.
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Affiliation(s)
- Mina G Safain
- Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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Symons B, Herzog W. Cervical artery dissection: a biomechanical perspective. J Can Chiropr Assoc 2013; 57:276-278. [PMID: 24302772 PMCID: PMC3845472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Bruce Symons
- Research Associate, Human Performance Lab. Faculty of Kinesiology, University of Calgary
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