Abstract P4-08-01: Not presented

This abstract was not presented at the symposium.

Spinal manipulation: a systematic review of sham-controlled, double-blind, randomized clinical trials

For many years, spinal manipulation has been a popular form of treatment. Yet the debate about its clinical efficacy continues. The research question remains: Does spinal manipulation convey more than a placebo effect? To summarize the evidence from sham-controlled clinical trials of spinal manipulation as a treatment of various conditions, and to assess the methodological quality of these studies, a comprehensive search strategy was designed to locate all sham-controlled, double-blind, randomized trials of spinal manipulation as a treatment of any medical condition. Data were extracted from these trials and validated by two independent reviewers in a standardized fashion. All trials were critically analyzed and their methodological quality evaluated. Eight studies fulfilled the pre-defined inclusion/exclusion criteria. Three trials (two on back pain and one on enuresis) were judged to be burdened with serious methodological flaws. The results of the three most rigorous studies (two on asthma and one on primary dysmenorrhea) do not suggest that spinal manipulation leads to therapeutic responses which differ from an inactive sham-treatment. This analysis demonstrates that sham-controlled trials of spinal manipulation are sparse but feasible. The most rigorous of these studies suggest that spinal manipulation is not associated with clinically-relevant specific therapeutic effects.

Influence of context effects on health outcomes: a systematic review

BACKGROUND

Throughout history, doctor-patient relationships have been acknowledged as having an important therapeutic effect, irrespective of any prescribed drug or treatment. We did a systematic review to determine whether there was any empirical evidence to support this theory.

METHODS

A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. The quality of eligible trials was objectively assessed by two reviewers, and the type of non-treatment care given in each trial was categorised as cognitive or emotional. Cognitive care aims to influence patients' expectations about the illness or the treatment, whereas emotional care refers to the style of the consultation (eg, warm, empathic), and aims to reduce negative feelings such as anxiety and fear.

FINDINGS

We identified 25 eligible randomised controlled trials. 19 examined the effects of influencing patients' expectations about treatment, half of which found significant effects. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients' expectations through positive information about the treatment or the illness, while providing support or reassurance, significantly influenced health outcomes.

INTERPRETATION

There is much inconsistency regarding emotional and cognitive care, although one relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.

The efficacy of "distant healing": a systematic review of randomized trials

PURPOSE

To conduct a systematic review of the available data on the efficacy of any form of "distant healing" (prayer, mental healing, Therapeutic Touch, or spiritual healing) as treatment for any medical condition.

DATA SOURCES

Studies were identified by an electronic search of the MEDLINE, PsychLIT, EMBASE, CISCOM, and Cochrane Library databases from their inception to the end of 1999 and by contact with researchers in the field.

STUDY SELECTION

Studies with the following features were included: random assignment, placebo or other adequate control, publication in peer-reviewed journals, clinical (rather than experimental) investigations, and use of human participants.

DATA EXTRACTION

Two investigators independently extracted data on study design, sample size, type of intervention, type of control, direction of effect (supporting or refuting the hypothesis), and nature of the outcomes.

DATA SYNTHESIS

A total of 23 trials involving 2774 patients met the inclusion criteria and were analyzed. Heterogeneity of the studies precluded a formal meta-analysis. Of the trials, 5 examined prayer as the distant healing intervention, 11 assessed noncontact Therapeutic Touch, and 7 examined other forms of distant healing. Of the 23 studies, 13 (57%) yielded statistically significant treatment effects, 9 showed no effect over control interventions, and 1 showed a negative effect.

CONCLUSIONS

The methodologic limitations of several studies make it difficult to draw definitive conclusions about the efficacy of distant healing. However, given that approximately 57% of trials showed a positive treatment effect, the evidence thus far merits further study.

Residual Effect of CO2 on Bacterial Counts and Surface pH of Channel Catfish

Channel catfish fillet strips were packaged under aerobic atmosphere (AIR) and under 90% CO₂, 7.5% N₂, and 2.5% O ₂modified atmosphere packaging (MAP). Half of the samples from the MAP treatment were repacked under aerobic conditions after 6 d storage (COM). Packaged fish were stored at 0 and 10°C for 20 d. Aerobic plate counts reached 8 log CFU/g by the eighth day for AIR packs and by day 20 for COM packs. Fish in MAP or COM held at 0°C did not reach above 8 log CFU/g for 20 d, whereas those at 10°C reached 8 log CFU/g after 4 d. Facultative anaerobic counts were similar in trend to aerobic plate counts but lower in numbers. Fish pH was not affected by temperature but changed slightly over time with treatment. The pH of fish packed in AIR did not change, whereas that of MAP treatment decreased from 6.40 to 6.17 by day 12. Holding channel catfish fillet strips at 0°C under MAP for 6 d and transferring to aerobic conditions for the remainder of storage, will result in 8 d shelf-life extension.