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Faydenko J, Grieve T, Madigan D, Pocius JD, Olsen C, Cramer GD. Comparison of online to face-to-face instruction for anatomy review in a third-year clinical course. J Chiropr Educ 2024; 0:0. [PMID: 38329314 PMCID: PMC11097218 DOI: 10.7899/jce-23-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/18/2023] [Accepted: 11/22/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This project compared student learning and satisfaction of an anatomy review delivered by a face-to-face lecture (F2FL) and an online learning module (OLM) for third-year doctor of chiropractic students. METHODS This cohort study compared student learning and satisfaction of a pediatric spinal anatomy review delivered via F2FL (cohort 1, n = 23) and OLM (cohort 2, n = 18) in 2 successive 2019 (pre-COVID) course offerings. Previously validated pre- and post-tests were given. Students completed a survey assessing delivery, comfort with online learning and online learning technology, and preference of F2FL vs OLM of review material. Pre- and post-test results were assessed using repeated-measures analysis of variance. RESULTS Testing results showed an improvement with both groups (F2FL 53.7%, p < .001 vs OLM 51.8%, p < .001), with no significant difference between the F2FL and OLM groups (p = .53; p = .82). The survey showed: 83.3% of OLM students felt the online method was effective, and 88.9% of the OLM students would prefer online reviews or have no preference between online or face-to-face; meanwhile, 80% of the F2FL group thought the lecture engaging/effective, whereas 60% of the F2FL group would have preferred to have the material presented online. CONCLUSION The OLM was found to be as effective as the F2FL for the content assessed. The majority of students would prefer the online method for future anatomy review content presented in the course. This strategy could be applied to provide review materials in other clinical courses, allowing material to be developed and given by content experts while freeing valuable in-class time.
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Roytman GR, Selby S, Cantu J, Cramer GD. A Novel and Accurate Palpation Method for Identification of the L4 Spinous Process: A Preliminary Study of Accuracy. J Manipulative Physiol Ther 2021; 44:398-407. [PMID: 34429213 DOI: 10.1016/j.jmpt.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/09/2020] [Revised: 09/19/2020] [Accepted: 03/30/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess a novel method of lumbar spinous process (SP) palpation by using magnetic resonance imaging (MRI) high-signal marker reference standards for verification. METHODS Clinicians (doctors of chiropractic) in this study used either: (1) the standard/traditional method of identifying the L4 SP using the supracristal plane (n = 14) or (2) a novel method that manually induced sacral motion to identify the L5 and then the L4 SP (n = 54). The clinicians, blinded to the results of each other, used a grease pencil to mark the location identified as the L4 SP. An MRI high-signal marker then was taped across this location. The MRI scans were assessed by a radiologist, blinded to the palpation method, who extended a line posteriorly from the superior and inferior extent of the L4 SP and determined whether the high-signal marker was within the lines bordering the L4 SP (ie, "on-target"). RESULTS Palpation using the traditional method showed a 35.7% accuracy, with 5 of 14 "on target" and all "off target" being too superior. Palpation using the novel method showed 77.8% accuracy, with 42 of 54 "on target" and 3 "off target" being too superior and 9 "off target" too inferior. CONCLUSIONS The novel method performed better than the traditional method. The novel method shows promise. Additional prospective research should be conducted to fully assess the accuracy of the novel method compared with traditional methods of palpation.
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Affiliation(s)
- Gregory R Roytman
- Research Department, National University of Health Sciences, Lombard, Illinois
| | - Scott Selby
- Research Department, National University of Health Sciences, Lombard, Illinois; Private Practice, Wheaton, Illinois
| | - Joe Cantu
- Research Department, National University of Health Sciences, Lombard, Illinois; Private Practice, Charlottesville, Virginia
| | - Gregory D Cramer
- Research Department, National University of Health Sciences, Lombard, Illinois.
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Little JW, Grieve T, Cantu J, Bogar WC, Heiser R, Miley H, Cramer GD. Reliability of Human Lumbar Facet Joint Degeneration Severity Assessed by Magnetic Resonance Imaging. J Manipulative Physiol Ther 2020; 43:43-49. [PMID: 32081513 DOI: 10.1016/j.jmpt.2018.11.027] [Citation(s) in RCA: 3] [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: 05/03/2018] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the reliability of the assessment of lumbar facet joint degeneration severity by analyzing degeneration subscales using magnetic resonance imaging (MRI) in human participants. METHODS The reliability of articular cartilage degeneration, subchondral bone sclerosis, and osteophyte formation subscales of lumbar facet joint degeneration severity was assessed in MRI images from n = 10 human participants. Each scale was applied to n = 20 lumbar facet joints (L4/5 level). Three examiners were trained. A first assessment of MRI images was provided by the examiners followed by a second assessment 30 days later. Intraobserver and interobserver reliability were determined using percent agreement, the weighted kappa coefficient κw for paired comparisons, and the overall weighted kappa κo. The minimum threshold for reliability was set at moderate levels of agreement, κw > 0.40, based upon previous recommendations. RESULTS The articular cartilage subscale had acceptable intraobserver (κo = 0.51) and interobserver (κo = 0.41) reliability. Scales for subchondral bone sclerosis (intraobserver κo = 0.28; interobserver κo = 0.10) and osteophyte formation (intraobserver κo = 0.26; interobserver κo = 0.20) did not achieve acceptable reliability. CONCLUSION Of the 3 subcategories of lumbar facet joint degeneration, only articular cartilage degeneration demonstrated acceptable reliability. Subscales of lumbar facet joint degeneration should be considered independently for reliability before combining subscales for a global degeneration score. Owing to the inherent difficulty of assessing lumbar facet joint degeneration, the use of multiple examiners independently assessing degeneration with reliable scales and then coming to a consensus score upon any disagreements is recommended for future clinical studies.
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Affiliation(s)
- Joshua W Little
- Department of Surgery, Center for Anatomical Science and Education, School of Medicine, Saint Louis University, St. Louis, Missouri.
| | - Thomas Grieve
- Department of Clinical Sciences, National University of Health Sciences, Lombard, Illinois
| | - Joseph Cantu
- Department of Research, National University of Health Sciences, Lombard, Illinois
| | - William C Bogar
- Department of Diagnostic Imaging, National University of Health Sciences, Lombard, Illinois
| | - Rudy Heiser
- Department of Diagnostic Imaging, National University of Health Sciences, Lombard, Illinois
| | - Heather Miley
- Department of Diagnostic Imaging, National University of Health Sciences, Lombard, Illinois
| | - Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, Illinois
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Allison JM, Martin AD, McDowell JA, Merlo JA, Lawson C, Cramer GD, Little JW. Pathological Alterations of the Lumbar Facet Joint Subchondral Bone and Synovial Fold during Hypomobility Induced Cartilage Degeneration. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.644.2] [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: 11/11/2022]
Affiliation(s)
- Jeffrey M. Allison
- Department of SurgeryCenter for Anatomical Science and EducationSaint Louis University School of MedicineSaint LouisMO
| | - August D. Martin
- Department of SurgeryCenter for Anatomical Science and EducationSaint Louis University School of MedicineSaint LouisMO
| | - Jacob A. McDowell
- Department of SurgeryCenter for Anatomical Science and EducationSaint Louis University School of MedicineSaint LouisMO
| | - John A. Merlo
- Department of SurgeryCenter for Anatomical Science and EducationSaint Louis University School of MedicineSaint LouisMO
| | - Craig Lawson
- Department of SurgeryCenter for Anatomical Science and EducationSaint Louis University School of MedicineSaint LouisMO
| | - Gregory D. Cramer
- Department of ResearchNational University of Health SciencesLombardIL
| | - Joshua W. Little
- Department of SurgeryCenter for Anatomical Science and EducationSaint Louis University School of MedicineSaint LouisMO
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Bakkum BW, Cramer GD. Spinal Manipulative Therapies in Visceral Conditions. J Altern Complement Med 2018; 24:104-105. [DOI: 10.1089/acm.2017.0327] [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: 11/12/2022] Open
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Cramer GD, Budavich M, Bora P, Ross K. A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation. J Manipulative Physiol Ther 2017; 40:187-200. [PMID: 28268027 DOI: 10.1016/j.jmpt.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/01/2016] [Accepted: 01/10/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This feasibility study used novel accelerometry (vibration) and microphone (sound) methods to assess crepitus originating from the lumbar spine before and after side-posture spinal manipulative therapy (SMT). METHODS This study included 5 healthy and 5 low back pain (LBP) participants. Nine accelerometers and 1 specialized directional microphone were applied to the lumbar region, allowing assessment of crepitus. Each participant underwent full lumbar ranges of motion (ROM), bilateral lumbar SMT, and repeated full ROM. After full ROMs the participants received side-posture lumbar SMT on both sides by a licensed doctor of chiropractic. Accelerometer and microphone recordings were made during all pre- and post-SMT ROMs. Primary outcome was a descriptive report of crepitus prevalence (average number of crepitus events/participant). Participants were also divided into 3 age groups for comparisons (18-25, 26-45, and 46-65 years). RESULTS Overall, crepitus prevalence decreased pre-post SMT (average pre = 1.4 crepitus/participant vs post = 0.9). Prevalence progressively increased from the youngest to oldest age groups (pre-SMT = 0.0, 1.67, and 2.0, respectively; and post-SMT = 0.5, 0.83, and 1.5). Prevalence was higher in LBP participants compared with healthy (pre-SMT-LBP = 2.0, vs pre-SMT-healthy = 0.8; post-SMT-LBP = 1.0 vs post-SMT-healthy = 0.8), even though healthy participants were older than LBP participants (40.8 years vs 27.8 years); accounting for age: pre-SMT-LBP = 2.0 vs pre-SMT-healthy = 0.0; post-SMT-LBP = 1.0 vs post-SMT-healthy = 0.3. CONCLUSIONS Our findings indicated that a larger study is feasible. Other findings included that crepitus prevalence increased with age, was higher in participants with LBP than in healthy participants, and overall decreased after SMT. This study indicated that crepitus assessment using accelerometers has the potential of being an outcome measure or biomarker for assessing spinal joint (facet/zygapophyseal joint) function during movement and the effects of LBP treatments (eg, SMT) on zygapophyseal joint function.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL.
| | - Matthew Budavich
- Department of Research, National University of Health Sciences, Lombard, IL
| | | | - Kim Ross
- Department of Applied Chiropractic, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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Schneider M, Evans R, Haas M, Leach M, Delagran L, Hawk C, Long C, Cramer GD, Walters O, Vihstadt C, Terhorst L. The effectiveness and feasibility of an online educational program for improving evidence-based practice literacy: an exploratory randomized study of US chiropractors. Chiropr Man Therap 2016; 24:27. [PMID: 27486510 PMCID: PMC4970279 DOI: 10.1186/s12998-016-0109-8] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Online education programs are becoming a popular means to disseminate knowledge about evidence-based practice (EBP) among healthcare practitioners. This mode of delivery also offers a viable and potentially sustainable solution for teaching consistent EBP content to learners over time and across multiple geographical locations. We conducted a study with 3 main aims: 1) develop an online distance-learning program about the principles of evidence-based practice (EBP) for chiropractic providers; 2) test the effectiveness of the online program on the attitudes, skills, and use of EBP in a sample of chiropractors; and 3) determine the feasibility of expanding the program for broader-scale implementation. This study was conducted from January 2013 to September 2014. Methods This was an exploratory randomized trial in which 293 chiropractors were allocated to either an online EBP education intervention or a waitlist control. The online EBP program consisted of 3 courses and 4 booster lessons, and was developed using educational resources created in previous EBP educational programs at 4 chiropractic institutions. Participants were surveyed using a validated EBP instrument (EBASE) with 3 rescaled (0 to 100) subscores: Attitudes, Skills, and Use of EBP. Multiple regression was used to compare groups, adjusting for personal and practice characteristics. Satisfaction and compliance with the program was evaluated to assess feasibility. Results The Training Group showed modest improvement compared to the Waitlist Group in attitudes (Δ =6.2, p < .001) and skills (Δ =10.0, p < .001) subscores, but not the use subscore (Δ = −2.3, p = .470). The majority of participants agreed that the educational program was ‘relevant to their profession’ (84 %) and ‘was worthwhile’ (82 %). Overall, engagement in the online program was less than optimal, with 48 % of the Training Group, and 42 % of the Waitlist Group completing all 3 of the program courses. Conclusions Online EBP training leads to modest improvements in chiropractors’ EBP attitudes and skill, but not their use of EBP. This online program can be delivered to a wide national audience, but requires modification to enable greater individualization and peer-to-peer interaction. Our results indicate that it is feasible to deliver an online EBP education on a broad scale, but that this mode of education alone is not sufficient for making large changes in chiropractors’ use of EBP.
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Affiliation(s)
- Michael Schneider
- School of Health and Rehabilitation Sciences, Department of Physical Therapy, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Roni Evans
- Center for Spirituality and Healing, Integrative Health and Wellbeing Research Program, University of Minnesota, Minneapolis, MN USA
| | | | - Matthew Leach
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA Australia
| | - Louise Delagran
- Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN USA
| | - Cheryl Hawk
- Chair, Scientific Commission, Council on Chiropractic Guidelines and Practice Parameters, Lexington, SC USA
| | - Cynthia Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA USA
| | | | | | - Corrie Vihstadt
- Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN USA
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences, Department of Occupational Therapy, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA
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Little JW, Grieve TJ, Cramer GD, Rich JA, Laptook EE, Stiefel JPD, Linaker K. Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study. J Manipulative Physiol Ther 2015; 38:344-51. [PMID: 26118786 DOI: 10.1016/j.jmpt.2014.12.009] [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: 04/04/2012] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs. METHODS Modifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1-4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intrarater and interrater agreement was determined by weighted κ (κw) from the examination of 79 Z joints (25 packets). RESULTS Using the modified scale and after training, examiners demonstrated a moderate-to-substantial level of interrater agreement (κw = 0.57, 0.60, and 0.68). Intrarater agreement was moderate (κw = 0.42 and 0.54). CONCLUSIONS The modified Kellgren 5-point grading system provides acceptable intrarater and interrater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints.
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Affiliation(s)
- Joshua W Little
- Assistant Professor, Center for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, St Louis, MO
| | - Thomas J Grieve
- Instructor, Department of Clinical Sciences, National University of Health Sciences, Lombard, IL
| | - Gregory D Cramer
- Professor and Dean of Research, Research Department, National University of Health Sciences, Lombard, IL.
| | - Jeffrey A Rich
- Radiologist, Northwestern Health Sciences University, Bloomington, MN
| | - Evelyn E Laptook
- Assistant Professor, National University of Health Sciences, Lombard, IL
| | | | - Kathleen Linaker
- Dean, Center for Life and Health Sciences, Mohawk Valley Community College, Utica, NY
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Schneider MJ, Evans R, Haas M, Leach M, Hawk C, Long C, Cramer GD, Walters O, Vihstadt C, Terhorst L. US chiropractors' attitudes, skills and use of evidence-based practice: A cross-sectional national survey. Chiropr Man Therap 2015; 23:16. [PMID: 25949800 PMCID: PMC4422535 DOI: 10.1186/s12998-015-0060-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 12/05/2014] [Accepted: 04/07/2015] [Indexed: 01/24/2023] Open
Abstract
Background Evidence based practice (EBP) is being increasingly utilized by health care professionals as a means of improving the quality of health care. The introduction of EBP principles into the chiropractic profession is a relatively recent phenomenon. There is currently a lack of information about the EBP literacy level of US chiropractors and the barriers/facilitators to the use of EBP in the chiropractic profession. Methods A nationwide EBP survey of US chiropractors was administered online (Nov 2012-Mar 2013) utilizing a validated self-report instrument (EBASE) in which three sub-scores are reported: attitudes, skills and use. Means, medians, and frequency distributions for each of the sub-scores were generated. Descriptive statistics were used to analyze the demographic characteristics of the sample. Means and proportions were calculated for all of the responses to each of the questions in the survey. Results A total of 1,314 US chiropractors completed the EBASE survey; the sample appeared to be representative of the US chiropractic profession. Respondents were predominantly white (94.3%), male (75%), 47 (+/− 11.6) years of age, and in practice for more than 10 years (60%). EBASE sub-score means (possible ranges) were: attitudes, 31.4 (8–40); skills, 44.3 (13–65); and use, 10.3 (0–24). Survey participants generally held favorable attitudes toward EBP, but reported less use of EBP. A minority of participants indicated that EBP coursework (17%) and critical thinking (29%) were a major part of their chiropractic education. The most commonly reported barrier to the use of EBP was “lack of time”. Almost 90% of the sample indicated that they were interested in improving their EBP skills. Conclusion American chiropractors appear similar to chiropractors in other countries, and other health professionals regarding their favorable attitudes towards EBP, while expressing barriers related to EBP skills such as research relevance and lack of time. This suggests that the design of future EBP educational interventions should capitalize on the growing body of EBP implementation research developing in other health disciplines. This will likely include broadening the approach beyond a sole focus on EBP education, and taking a multilevel approach that also targets professional, organizational and health policy domains. Electronic supplementary material The online version of this article (doi:10.1186/s12998-015-0060-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael J Schneider
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Roni Evans
- Center for Spirituality and Healing, Integrative Health and Wellbeing Research Program, University of Minnesota, Minneapolis, MN USA
| | | | - Matthew Leach
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA Australia
| | - Cheryl Hawk
- Logan College of Chiropractic, Chesterfield, MO USA
| | - Cynthia Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA USA
| | | | | | - Corrie Vihstadt
- Center for Spirituality and Healing, Integrative Health and Wellbeing Research Program, University of Minnesota, Minneapolis, MN USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
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Sullivan BM, Furner SE, Cramer GD. Development of a student-mentored research program between a complementary and alternative medicine university and a traditional, research-intensive university. Acad Med 2014; 89:1220-1226. [PMID: 24988423 PMCID: PMC4174269 DOI: 10.1097/acm.0000000000000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The global need to develop clinician-scientists capable of using research in clinical practice, translating research knowledge into practice, and carrying out research that affects the quality, efficacy, and efficiency of health care is well documented. The complementary and alternative medicine (CAM) professions embrace the call to develop physician-researchers to carry out translational and applied research for CAM modalities. CAM universities face unique challenges when implementing research training compared with traditional, research-intensive (TRI) universities and medical centers where the majority of medical research is carried out.The authors present the development and outcomes of a mentored research program (MRP) between a CAM and a TRI institution, the National University of Health Sciences and the University of Illinois at Chicago School of Public Health, between 2006 and 2012. CAM predoctoral students engaged in a full-immersion semester at the TRI, including didactic courses and active research with a TRI faculty research mentor. Half of the participating doctor of chiropractic (DC) students continued on to PhD programs, and half established integrative medicine, primary care clinical careers.Establishing rigorous criteria for mentors and mentees, communicating expectations, developing solid relationships between the mentor, mentee, and home school advisor, responding quickly to impediments, and providing adequate support from CAM and TRI investigators were key to the MRP's success. To sustain research opportunities, coordinated degree programs for the DC and master of public health and master of clinical and translational research were established.
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Affiliation(s)
- Barbara M Sullivan
- Dr. Sullivan is assistant professor, Department of Research, National University of Health Sciences, Lombard, Illinois. Dr. Furner is associate professor, emerita, of epidemiology, School of Public Health, University of Illinois at Chicago, Chicago, Illinois. Dr. Cramer is professor and dean, Department of Research, National University of Health Sciences, Lombard, Illinois
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Cambron JA, Schneider M, Dexheimer JM, Iannelli G, Chang M, Terhorst L, Cramer GD. A pilot randomized controlled trial of flexion-distraction dosage for chiropractic treatment of lumbar spinal stenosis. J Manipulative Physiol Ther 2014; 37:396-406. [PMID: 25108751 DOI: 10.1016/j.jmpt.2014.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/20/2014] [Accepted: 05/21/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation. METHODS This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function. RESULTS The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies. CONCLUSION This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials.
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Affiliation(s)
- Jerrilyn A Cambron
- Professor, Department of Research, National University of Health Sciences, Lombard, IL.
| | - Michael Schneider
- Assistant Professor, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer M Dexheimer
- Clinical Research Coordinator, Department of Research, National University of Health Sciences, Lombard, IL
| | - Grant Iannelli
- Professor of Anatomy and Physiology, ATS Institute of Technology, Chicago, IL
| | - Mabel Chang
- Assistant Professor, Department of Clinical Sciences, National University of Health Sciences, St. Petersburg, FL
| | - Lauren Terhorst
- Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Gregory D Cramer
- Dean and Professor, Department of Research, National University of Health Sciences, Lombard, IL
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Cramer GD, Smith DL. Correctly identify practitioners and put adverse events of spinal manipulation into perspective. Orthop Rev (Pavia) 2014; 6:5248. [PMID: 24744843 PMCID: PMC3980159 DOI: 10.4081/or.2014.5248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/10/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Dean L. Smith
- Department of Kinesiology and Health, Miami University, Oxford, OH, USA
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Smith DL, Pohlman KA, Cramer GD. Chiropractors respond. Can Fam Physician 2013; 59:1265-1268. [PMID: 24336534 PMCID: PMC3860918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Cramer GD, Ross K. In reply. J Manipulative Physiol Ther 2013; 36:259-60. [PMID: 23769264 DOI: 10.1016/j.jmpt.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Indexed: 11/28/2022]
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Cramer GD, Cambron J, Cantu JA, Dexheimer JM, Pocius JD, Gregerson D, Fergus M, McKinnis R, Grieve TJ. Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding. J Manipulative Physiol Ther 2013; 36:203-17. [PMID: 23648055 DOI: 10.1016/j.jmpt.2013.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 02/22/2013] [Accepted: 03/25/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). METHODS This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint "gapping difference." Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. RESULTS Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001). CONCLUSIONS Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL 60148, USA.
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Cramer GD, Ross K, Raju PK, Cambron J, Cantu JA, Bora P, Dexheimer JM, McKinnis R, Habeck AR, Selby S, Pocius JD, Gregerson D. Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy. J Manipulative Physiol Ther 2012; 35:614-21. [PMID: 22902194 DOI: 10.1016/j.jmpt.2012.06.007] [Citation(s) in RCA: 11] [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] [Received: 01/31/2012] [Revised: 05/24/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. METHODS This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. RESULTS Upside SMT and SPP joints gapped more than downside joints (0.69 vs -0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone (P = .43). CONCLUSIONS Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL 60148, USA.
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Cramer GD, Cambron JA, Cantu JA, Dexheimer J, Pocius JD, Gregerson D, Fergus M, McKinnis RA. Zygapophyseal joint space gapping following spinal manipulation in low back pain patients. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.729.3] [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: 11/11/2022]
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Cramer GD, Bora P, Ross K, Selby S. Sound and vibration recordings during normal motion and spinal manipulation. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.lb42] [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: 11/11/2022]
Affiliation(s)
| | | | - Kim Ross
- Canadian Memorial Chiropractic CollegeTorontoONCanada
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Cramer GD, Ross JK, Raju PK, Cambron JA, Dexheimer JM, Bora P, McKinnis R, Selby S, Habeck AR. Distribution of cavitations as identified with accelerometry during lumbar spinal manipulation. J Manipulative Physiol Ther 2011; 34:572-83. [PMID: 21986305 DOI: 10.1016/j.jmpt.2011.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/14/2011] [Accepted: 05/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT). METHODS This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (7 on spinous processes/sacral tubercles of L1-S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (groups 1 and 2) and SMT (group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using χ(2) or McNemar test were made between number of joints cavitating from group 1 vs group 2, upside (contact side for SMT) vs downside, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs outside the target area (L1/L2, L2/L3, sacroiliac). RESULTS Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than group 2 joints (P < .0001), upside joints cavitated more than downside joints (P < .0001), and joints inside the target area cavitated more than those outside the target area (P < .01). CONCLUSIONS Most cavitations (93.5%) occurred on the upside of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than did subjects with side-posture positioning only (96.7% vs 30%). Multiple cavitations from the same Z joints had not been previously reported.
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Affiliation(s)
- Gregory D Cramer
- Dean of Research, Department of Research, National University of Health Sciences, Lombard, IL, USA.
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Cramer GD, Ross K, Pocius J, Cantu JA, Laptook E, Fergus M, Gregerson D, Selby S, Raju PK. Evaluating the relationship among cavitation, zygapophyseal joint gapping, and spinal manipulation: an exploratory case series. J Manipulative Physiol Ther 2011; 34:2-14. [PMID: 21237402 DOI: 10.1016/j.jmpt.2010.11.008] [Citation(s) in RCA: 17] [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] [Received: 08/06/2010] [Revised: 09/25/2010] [Accepted: 10/27/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This project determined the feasibility of conducting larger studies assessing the relationship between cavitation and zygapophyseal (Z) joint gapping following spinal manipulative therapy (SMT). METHODS Five healthy volunteers (average age, 25.4 years) were screened and examined against inclusion and exclusion criteria. High-signal magnetic resonance imaging (MRI) markers were fixed to T12, L3, and S1 spinous processes. Scout images were taken to verify the location of the markers. Axial images of the L4/L5 and L5/S1 levels were obtained in the neutral supine position. Following the first MRI, accelerometers were placed over the same spinous processes; and recordings were made from them during side-posture positioning and SMT. The accelerometers were removed, and each subject was scanned in side-posture. The greatest central anterior to posterior Z joint spaces (gap) were measured from the first and second MRI scans. Values obtained from the first scan were subtracted from those of the second, with a positive result indicating an increase in gapping following SMT (positive gapping difference). Gapping difference was compared between the up-side (SMT) joints vs the down-side (non-SMT) joints and between up-side cavitation vs up-side noncavitation joints. RESULTS Greater gapping was found in Z joints that received SMT (0.5 ± 0.6 mm) vs non-SMT joints (-0.2 ± 0.6 mm), and vertebral segments that cavitated gapped more than those that did not cavitate (0.8 ± 0.7 vs 0.4 ± 0.5 mm). CONCLUSIONS A future clinical study is quite feasible. Forty subjects (30 in an SMT group and 10 in a control group) would be needed for appropriate power (0.90).
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Cramer GD, Henderson CNR, Little JW, Daley C, Grieve TJ. Zygapophyseal joint adhesions after induced hypomobility. J Manipulative Physiol Ther 2011; 33:508-18. [PMID: 20937429 DOI: 10.1016/j.jmpt.2010.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 06/07/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Adhesions (ADH) have been previously identified in many hypomobile joints, but not in the zygapophyseal (Z) joints of the spine. The objective of this study was to determine if connective tissue ADH developed in lumbar Z joints after induced intervertebral hypomobility (segmental fixation). METHODS Using an established rat model, 3 contiguous segments (L4, L5, L6) were fixed with specially engineered, surgically implanted, vertebral fixation devices. Z joints of experimental rats (17 rats, 64 Z joints) with 4, 8, 12, or 16 weeks of induced hypomobility were compared with Z joints of age-matched control rats (23 rats, 86 Z joints). Tissue was prepared for brightfield microscopy, examined, and photomicrographed. A standardized grading system identified small, medium, and large ADH and the average numbers of each per joint were calculated. RESULTS Connective tissue ADH were characterized and their location within Z joints described. Small and medium ADH were found in rats from all study groups. However, large ADH were found only in rats with 8, 12, or 16 weeks of experimentally induced intervertebral hypomobility. Significant differences among study groups were found for small (P < .003), medium (P < .000), and large (P < .000) ADH. The average number of medium and large ADH per joint increased with the length of experimentally induced hypomobility in rats with 8 and 16 weeks of induced hypomobility. CONCLUSIONS We conclude that hypomobility results in time-dependent ADH development within the Z joints. Such ADH development may have relevance to spinal manipulation, which could theoretically break up Z joint intra-articular ADHs.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, IL 60510, USA.
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Cramer GD, Ross K, Pocius J, Cantu J, Laptook E, Fergus M, Gregerson D, Selby S, Raju PK. Assessing joint vibration during spinal manipulation. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.635.2] [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: 11/11/2022]
Affiliation(s)
| | - Kim Ross
- Canadian Memorial Chiropractic CollegeTorontoONCanada
| | - Judy Pocius
- National University of Health SciencesLombardIL
| | - Joe Cantu
- National University of Health SciencesLombardIL
| | | | | | | | - Scott Selby
- National University of Health SciencesLombardIL
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Grieve TJ, Cramer GD, Cantu JA, McKinnis RA, Bogar WC, Miley HL, Heiser RN, Little JW. Reliability of grading zygapophysial (Z) joint degeneration from MRIs of subjects with acute low back pain. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.lb38] [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: 11/11/2022]
Affiliation(s)
| | | | - Joe A Cantu
- ResearchNational University of Health SciencesLombardIL
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Cramer GD, Henderson CN, Pocius JD, Grieve TJ, Daley C. Grading system for articular surface degeneration of zygapophysial (Z) joints following induced segmental hypomobility in the rat. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.649.8] [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: 11/11/2022]
Affiliation(s)
| | | | | | | | - Clover Daley
- Palmer Center for Chiropractic ResearchDavenportIA
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Cramer GD, Cantu JA, Pocius JD, Balester F, Simpson DR, Horner TB, Healy J, McKinnis RA. Reliability of zygapophysial (Z) joint measurements taken from MRIs of subjects with acute low back pain. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.649.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Joe A. Cantu
- ResearchNational University of Health SciencesLombardIL
| | | | | | | | | | - Joshua Healy
- ResearchNational University of Health SciencesLombardIL
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Cramer GD, Henderson CN, Pocius JD, Little JW, Grieve TJ, Daley CJ. Grading system for osteophytic changes in zygapophysial (Z) joints following induced segmental hypomobility in the rat. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.773.2] [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: 11/11/2022]
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Cramer GD, Little JW, Henderson CN, Daley CJ. Changes in zygapophysial (Z) joint synovial folds following induced segmental hypomobility in the rat. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.773.3] [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: 11/11/2022]
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Bakkum BW, Henderson CNR, Hong SP, Cramer GD. Preliminary morphological evidence that vertebral hypomobility induces synaptic plasticity in the spinal cord. J Manipulative Physiol Ther 2007; 30:336-42. [PMID: 17574950 DOI: 10.1016/j.jmpt.2007.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 03/20/2007] [Accepted: 03/26/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A widely accepted theoretical model suggests that vertebral hypomobility can cause pain and abnormal spinal mechanics because of changes in sensory input from spinal and paraspinal tissues. The purpose of this pilot study was 3-fold: (1) to make a preliminary determination if chronic vertebral hypomobility at L4 through L6 in the rat would affect synaptic density and/or morphology in the superficial dorsal horn of the L2 spinal cord level, (2) to identify relevant outcome variables for future studies, and (3) to obtain preliminary data that would permit estimating an appropriate sample size for future studies. METHODS Using an established rat model, we fixed 3 contiguous lumbar segments (L4-L6) for 8 weeks with a specially engineered vertebral fixation device. Electron micrographs were obtained from 2 animals from the experimental (fixed) group and each of 3 control groups (no surgery, surgery but no devices implanted, and devices implanted but not fixed). Synapses were randomly selected using a stereological approach and were analyzed for symmetry, curvature, type of postsynaptic profile, and perforations. The synaptic density was also estimated. RESULTS There was increased synaptic density and percentage of positively curved synapses in the dorsal horn of experimental animals as compared with controls. Experimental animals had a lower percentage of axospinous synapses, with a concomitant increase in the percentage of synapses on dendritic shafts. CONCLUSIONS These preliminary data suggest for the first time that chronic vertebral hypomobility at L4 through L6 in the rat affects synaptic density and morphology in the superficial dorsal horn of the L2 spinal cord level. More definitive studies are warranted, and the biologic significance of these finding should be investigated.
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Affiliation(s)
- Barclay W Bakkum
- Department of Basic and Health Sciences, Illinois College of Optometry, Chicago, Ill 60616, USA.
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Henderson CN, Cramer GD, Zhang Q, DeVocht JW, Fournier JT. Introducing the External Link Model for Studying Spine Fixation and Misalignment: Part 2, Biomechanical Features. J Manipulative Physiol Ther 2007; 30:279-94. [DOI: 10.1016/j.jmpt.2007.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 09/26/2006] [Accepted: 12/09/2006] [Indexed: 10/23/2022]
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Henderson CNR, Cramer GD, Zhang Q, DeVocht JW, Fournier JT. Introducing the External Link Model for Studying Spine Fixation and Misalignment. J Manipulative Physiol Ther 2007; 30:239-45. [PMID: 17416279 DOI: 10.1016/j.jmpt.2007.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 08/08/2006] [Accepted: 11/25/2006] [Indexed: 11/24/2022]
Abstract
This is the first article in a series introducing a new animal model, the External Link Model that we propose will allow researchers to produce and study spine lesions with the cardinal biomechanical features of the chiropractic subluxation: fixation (hypomobility) and misalignment.
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Cambron JA, Cramer GD, Winterstein J. Patient perceptions of chiropractic treatment for primary care disorders. J Manipulative Physiol Ther 2007; 30:11-6. [PMID: 17224350 DOI: 10.1016/j.jmpt.2006.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 07/28/2006] [Accepted: 08/24/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat. METHODS A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information, (2) whether their chiropractor was their primary care physician, and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients. RESULTS There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each 'primary care condition' listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly with many conditions showing an affirmative response of higher than 50% especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions. CONCLUSIONS Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions.
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Affiliation(s)
- Jerrilyn A Cambron
- Department of Research, National University of Health Sciences, Lombard, Illinois 60148, USA.
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Abstract
OBJECTIVE The objective of this study was to evaluate changes of the lumbar vertebral column following fixation. DESIGN Using an established small animal (rat) model of spinal fixation (hypomobility), 3 contiguous lumbar segments (L4, L5, L6) were fixed with a specially engineered vertebral fixation device. Spinal segments of control rats were compared with those of animals with 1, 4, or 8 weeks of fixation. Subgroups of these fixation animals subsequently had the fixation device removed for 1, 2, 4, 8, or 12 weeks to evaluate the effects of attempting to reestablish normal forces to the vertebral segments following hypomobility. SETTING This Institutional Animal Care and Use Committee (IACUC) approved study was conducted in a university animal facility. ANIMALS Eighty-seven animals (23 controls animals and 64 fixation animals) were used in this study. Main Outcome Measures Outcome measures were degenerative changes of the vertebral bodies (VBs) and intervertebral disks (IVDs), zygapophysial (Z) joint osteophyte formation, and Z joint articular surface degeneration (ASD). Changes found in vertebral segments that were fixed (hypomobile) were compared with changes in adjacent nonfixed vertebral segments, and changes among fixation animals were compared with nonfixed controls. Main Results Very few degenerative changes were identified on the VBs and IVDs. Z joint changes were significant, both for osteophyte formation (analysis of variance [ANOVA], P <.0001) and ASD (ANOVA, P <.0001). Fixed segments had more degenerative changes than nonfixed segments for all Z joint parameters (ANOVA, P <.0001). Osteophyte formation and ASD were directly dependent on duration of fixation. CONCLUSIONS These findings indicate that fixation (hypomobility) results in time-dependent degenerative changes of the Z joints.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, 200 E Roosevelt Road, Lombard, IL 60148, USA.
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Cramer GD, Cantu JA, Dorsett RD, Greenstein JS, McGregor M, Howe JE, Glenn WV. Dimensions of the lumbar intervertebral foramina as determined from the sagittal plane magnetic resonance imaging scans of 95 normal subjects. J Manipulative Physiol Ther 2003; 26:160-70. [PMID: 12704308 DOI: 10.1016/s0161-4754(02)54109-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This was a 2-part study. Part 1 evaluated the reliability of measurements of the intervertebral foramina (IVF) from magnetic resonance imaging (MRI) scans, and part 2 developed a morphometric database of IVF dimensions from normal living subjects. DESIGN Part 1 was a blinded reliability study using 7 observers, and part 2 developed a morphometric database using 2 teams of 3 observers, all blinded to the results of each other. SUBJECTS Ninety-five normal subjects (46 women, 49 men) were stratified by age (range 14-84 years, average 38.8 years). OUTCOME MEASURES Part 1: Interclass correlation coefficients (ICCs) were calculated for intraobserver and interobserver reliability for 3 dimensions of the lumbar IVFs. Part 2: A database was developed using the same measures. In addition, the relationships between IVF dimensions and age, height, weight, sex, and left versus right sides of subjects were evaluated. RESULTS Part 1: All ICCs were very high (> 0.94). Part 2: 8550 measurements were made, and a morphometric database of 95 subjects, stratified by age and sex, was completed. Differences in IVF size associated with age, height, weight, sex, and side were described. CONCLUSIONS Measurements taken from MRI scans of IVFs were performed reliably. The morphometric database and IVF relationships should aid clinicians and researchers in evaluating patients with suspected foraminal stenosis and help further investigate IVF pathology and treatment of such pathology.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, 200 E. Roosevelt Road, Lombard, IL 60148, USA.
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Abstract
The connective tissue attachments to the cervical spinal dura mater originating from the ligamentum nuchae (LN) and rectus capitis posterior minor (RCPM) muscle were evaluated in 30 cadaveric spines. Magnetic resonance images (MRIs) were correlated with the attachments in four cadaveric specimens. Attachments from the LN to the RCPM were also identified. The LN and the RCPM to dura attachments were found in all 30 specimens. Our results indicate that: 1) the attachments between the LN and RCPM and the dura occur between vertebrae C1-C2 and the occipital bone and C1, respectively, and that they are substantial normal anatomic attachments, 2) attachments between the LN and RCPM are usually present, and 3) the attachments between the LN and dura mater can be identified on MRI. These latter attachments may play a role in neck pain, making their MRI appearance clinically important.
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Affiliation(s)
- B K Humphreys
- Anglo-European College of Chiropractic, Bournemouth, England
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Cramer GD, Gregerson DM, Knudsen JT, Hubbard BB, Ustas LM, Cantu JA. The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Spine (Phila Pa 1976) 2002; 27:2459-66. [PMID: 12435975 DOI: 10.1097/00007632-200211150-00008] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A blinded, randomized controlled trial was conducted. OBJECTIVE To test the hypothesis that chiropractic side-posture manipulation (adjusting) of the lumbar spine separates (gaps) the zygapophysial (Z) joints. SUMMARY OF BACKGROUND DATA Spinal adjusting is thought to gap the Z joints, yet no studies have conclusively validated this hypothesis, and some investigators have reported that the lumbar Z joints do not gap during rotation. METHODS For this study, 64 healthy student volunteers (32 men and 32 women) ages 22 to 30 years with no history of significant low back pain were randomized into four groups of 8 men and 8 women each. Interventions included lumbar side-posture spinal adjusting (manipulation) and side-posture positioning. Anterior to posterior measurements of the Z joints from MRI scans taken before and after side-posture spinal adjusting and before and after side-posture positioning were compared. RESULTS Observers performing the measurements were blinded as to group and first and second scans. Reliability of the measurements was established. Differences were found between the groups (F = 24.15; P < 0.000, analysis of variance). Side-posture positioning showed greater gapping than the control condition (mean difference, 1.18; P < 0.000); side-posture adjusting showed greater gapping than the control condition (mean difference, 1.89; P < 0.000), and side-posture adjusting showed greater gapping than side-posture positioning (mean difference, 0.71; P = 0.047). CONCLUSIONS Spinal adjusting produced increased separation (gapping) of the Z joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. This study helps to increase understanding about the mechanism of action for spinal manipulation.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, Lombard, Illinois 60148, USA.
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Cramer GD, Skogsbergh DR, Bakkum BW, Winterstein JF, Yu S, Tuck NR. Evaluation of transforaminal ligaments by magnetic resonance imaging. J Manipulative Physiol Ther 2002; 25:199-208. [PMID: 12021738 DOI: 10.1067/mmt.2002.123174] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Three-part study to (1) identify and describe transforaminal ligaments (TFLs), (2) determine the best low-field-strength magnetic resonance imaging (MRI) technique for TFLs, and (3) determine the ability of low-field-strength MRI to obtain images of TFLs. DESIGN Part I-descriptive anatomic study; part II-descriptive MRI study; part III-blinded comparison of diagnostic test against gold standard (MRI vs anatomic dissection). SETTING Chiropractic college gross anatomy laboratory and MRI facilities. SPECIMENS Three anatomic specimens of male cadavers age 60 to 85 years; a fourth specimen was used for training radiologists in part III. MAIN OUTCOME MEASURES Part I-number and size of TFLs; part II-subjective grading of highest quality MRI images; part III-specificity, sensitivity, positive predictive value, negative predictive value, percent agreement, and accuracy of identifying TFLs from MRI scans. MAIN RESULTS Part I-19 TFLs identified in 30 intervertebral foramina (IVFs) (60% of IVFs had TFLs), thick = 4 (21%), medium thickness = 12 (63.2%), thin = 3 (15.8%); part II-TFLs demonstrated to best advantage with pure sagittal plane, T(1)-weighted MRI; part III-average: specificity = 88.9%, sensitivity = 45.6%, positive predictive value = 86.7%, negative predictive value = 50.8%, percent agreement = 78%, and accuracy = 62.4%. CONCLUSIONS The number of TFLs was in general agreement with previous research. Images of TFLs can be successfully imaged with low-field-strength MRI. If a trained radiologist identifies a TFL, there is an 87% chance that one is present, and if a trained radiologist does not identify a TFL in an intervertebral foramen, there remains a 51% chance that one is present.
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Affiliation(s)
- Gregory D Cramer
- Department of Research, National University of Health Sciences, 200 E Roosevelt Road, Lombard, IL 60148, USA.
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Cramer GD, Tuck NR, Knudsen JT, Fonda SD, Schliesser JS, Fournier JT, Patel P. Effects of side-posture positioning and side-posture adjusting on the lumbar zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with randomization. J Manipulative Physiol Ther 2000; 23:380-94. [PMID: 10951308 DOI: 10.1067/mmt.2000.108145] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the a priori hypothesis that one of the positive mechanisms of action of chiropractic side-posture manipulation (adjusting) of the lumbar spine is to separate, or gap, the zygapophysial (Z) joints. DESIGN Before and after study with randomization. SETTING Chiropractic college clinic and magnetic resonance imaging (MRI) facility. PARTICIPANTS Sixteen healthy student volunteers (8 men and 8 women) ages 22 to 29 years with no history of significant low back pain. Nineteen volunteers were screened, with 3 disqualified from the study. Subjects were randomized into 4 groups, each with 2 men and 2 women. INTERVENTIONS Lumbar side-posture spinal adjusting (manipulation) and side-posture positioning. MAIN OUTCOME MEASURES Comparison of anterior to posterior measurements of the Z joints from MRI scans taken before and after side-posture spinal adjusting and before and after side-posture positioning, and a rigorous subjective evaluation protocol of the Z joints by 3 radiologists blinded to the randomized groups. MAIN RESULTS Observers making measurements were blinded to what group subjects were placed in and whether they were measuring first or second scans; radiologists were blinded to what group subjects were assigned. Differences were found between the groups. Those receiving side-posture spinal adjusting and remaining in side posture showed the greatest increase in gapping (0.7 mm vs 0.0 mm for controls). CONCLUSIONS Lumbar side-posture spinal adjusting produced increased separation (gapping) of the zygapophysial joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. A larger clinical trial should be performed to further define the results of this study.
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Affiliation(s)
- G D Cramer
- Department of Research, the National College of Chiropractic, Lombard, IL 60148, USA
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Cramer GD, Scott CY, Tuck NR. The holey spine: a summary of the history of scientific investigation of the intervertebral foramina. Chiropr Hist 1998; 18:13-24. [PMID: 11623679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The intervertebral foramina (IVFs) are important to all individuals who treat disorders of the spine, but this region is of special historic significance to chiropractors. This is because some of the earliest descriptions of the mechanism of action of chiropratic were related to the IVFs. The history of investigation of the IVFs is very rich spanning time from the fifth century B.C. to the present. Several professions were based upon theories related to the IVFs or upon serious investigations of the IVFs, and the results of other investigations were reported out of proper context in order to criticize chiropractic and other professions. The history of investigation of the IVFs can be divided into three time periods: 1) very early descriptions of neural foramina and the IVFs; )2 discussions of IVFs by developing professions and the studies of the IVFs by Swanberg in the early twentieth century; and 3) studies of the IVFs in the middle and late twentieth century. This paper discusses the major activities of each of these time periods.
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Affiliation(s)
- G D Cramer
- The National College of Chiropractic, Lombard, Illinois
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Brennan PC, Cramer GD, Kirstukas SJ, Cullum ME. Basic science research in chiropractic: the state of the art and recommendations for a research agenda. J Manipulative Physiol Ther 1997; 20:150-68. [PMID: 9127254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A position paper was prepared as background information for participants in the National Workshop to Develop the Chiropractic Workshop Agenda conducted by the Palmer Center for Chiropractic Research, Davenport, Iowa. The paper was revised in light of comments and suggestions at the workshop by participants and by a workgroup composed of basic scientists from within and outside of chiropractic. This final article documents the history of basic science research in chiropractic, and the current state of the art of basic science research conducted since 1975 by chiropractors or investigators at chiropractic institutions in North America. Seed recommendations contained in the working paper for the development of an adequate infrastructure needed to conduct future research and seed recommendations for a future basic science research agenda were also modified and revised by the workgroup participants through a modified nominal group process. The final recommendations contained in this article represent a synthesis of these recommendations and those of the authors.
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Affiliation(s)
- P C Brennan
- Department of Research, National College of Chiropractic, Lombard, IL 60148, USA
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Greenstein J, Cramer GD, Howe J, Glenn WV, Johnson S, Huntoon R, Cantu J, McGregor M. Comparison of 1.5 Tesla and 0.35 Tesla field strength magnetic resonance imaging scans in the morphometric evaluation of the lumbar intervertebral foramina. J Manipulative Physiol Ther 1995; 18:195-202. [PMID: 7636408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare magnetic resonance imaging (MRI) scans obtained from 1.5 Tesla (T) MRI units with scans obtained from 0.35T MRI units in the morphometric evaluation of the lumbar intervertebral foramina (IVF). DESIGN Three dimensions of lumbar IVFs were measured on a cadaveric lumbar spine by using Vernier calipers. The spine was embedded in gelatin to simulate soft tissue and scanned twice in a 1.5T MRI unit (3-mm and 5-mm slice thicknesses) and once in a 0.35T MRI unit (5-mm slice thickness). Measurements from the scans were made independently by three observers. The results obtained from the two units were compared to the actual IVF size (as measured by calipers) and to one another. RESULTS The greatest superior-to-inferior distance had the strongest statistically significant correlation to the actual cadaver measurements for both the 0.35T and 1.5T imaging units [r = 0.986 (0.35T); r = 0.985 (1.5T at 3 mm) and r = 0.981 (1.5T at 5 mm); p < .0001 in all cases]. Mean differences and standard errors were minimal between measurements made from MRI scans of both 1.5T and 0.35T units and measurements made directly from the cadaveric spine. CONCLUSION Both imaging units produced images that accurately depicted the actual size of the IVF. The MRI units of 0.35T field strength produced images of high morphometric accuracy. In addition, the potential for side effects and the operating costs are less with 0.35T units. Therefore, 0.35T MRI units may be a prudent choice as a clinical and research imaging tool in the evaluation of the lumbar IVF.
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Affiliation(s)
- J Greenstein
- Department of Anatomy, National College of Chiropractic, Lombard, Illinois 60148-4583, USA
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Cramer GD, Howe J, Glenn WV, Greenstein J, Potvin W. Morphometric comparison of computed tomography to magnetic resonance imaging in the evaluation of the lumbar intervertebral foramina. Clin Anat 1994. [DOI: 10.1002/ca.980070402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Triano JJ, McGregor M, Cramer GD, Emde DL. A comparison of outcome measures for use with back pain patients: results of a feasibility study. J Manipulative Physiol Ther 1993; 16:67-73. [PMID: 8445356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the reliability, validity and change in patient clinical status over time with treatment for six potential outcome questionnaires in a defined population of patients. SETTING Physician based, multidoctor teaching practice. PATIENTS Three hundred thirty-five consecutive patients presenting with new complaints were solicited. One hundred eighty-six agreed to participate. INTERVENTIONS The six questionnaires being studied were administered to each of the participants on three separate occasions. They were: a) prior to clinical evaluation for their chief complaint, b) immediately after clinical evaluation and before treatment and c) 6 wk later. MEASUREMENTS Each instrument was scored following the prescribed methods of interpretation from the original literature describing it. Results were submitted for analysis by Pearson correlation and two-way analysis of variance as appropriate. MAIN RESULTS Differences were found in the mean value of the modified Zung with respect to both gender and time. An unexpected drop in patients' somatic perceptions in association with the process of clinical evaluation was found for the Modified Somatic Pain Questionnaire. Overall, the Oswestry and Visual Analogue Pain Scale were the most reliable and responsive to clinical change for musculoskeletal disorders. CONCLUSIONS This investigation demonstrated substantial differences in the validity and reliability of commonly referenced self-administered instruments for quantifying patient perceptions of pain and disability. The Oswestry and Visual Analogue Pain Scale were both more reliable and valid than other instruments.
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Affiliation(s)
- J J Triano
- Spinal Ergonomics Laboratory, National College of Chiropractic, Lombard, IL 60148-4583
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Cramer GD, Humphreys CR, Hondras MA, McGregor M, Triano JJ. The Hmax/Mmax ratio as an outcome measure for acute low back pain. J Manipulative Physiol Ther 1993; 16:7-13. [PMID: 8423429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the use of the Hmax/Mmax (H/M) ratio as an outcome measure for acute low back pain and to determine the change of this ratio in acute low back pain patients treated with spinal manipulation. DESIGN Randomized clinical trial. SETTING Chiropractic college teaching clinic. PATIENTS Thirty-six patients with acute low back pain (pain of less than 2 wk duration) were referred by clinicians of the teaching clinic. Eligibility criteria for inclusion into the study consisted of the following: a score of eight or more on the Oswestry questionnaire, 33 mm or greater on a 100-mm visual analog scale, no involvement in litigation related to the low back pain complaint, patient not pregnant and no physical or electrodiagnostic signs of nerve root entrapment. INTERVENTIONS The patients were randomly assigned to either a treatment or control group. The treatment group (n = 17) received treatment deemed appropriate by the clinician as long as it included a side-lying manipulation to the appropriate level. The control group (n = 19) received detuned ultrasound, application of a cold pack and 15-30 sec of very gentle soft tissue massage. Patients were treated three to five times over a period of 10 days and were subsequently reevaluated. MEASUREMENTS The Hmax/Mmax ratio was calculated from the results of electrodiagnostic testing of the posterior tibial nerve. Extension/flexion ratio of the trunk musculature, Oswestry score and Visual Analog Scale score were also measured. MAIN RESULTS The mean difference between H/M ratios pre- and postintervention for the group treated by chiropractic methods was -0.101 on the left and -0.117 on the right. The mean difference for the control group was 0.038 on the left and 0.036 on the right. Although not statistically significant, trends suggest that at the time of final assessment, the group receiving chiropractic care had improved more than the control group. CONCLUSIONS The H/M ratio was found to be within normal limits in subjects with acute low back pain. The H/M ratio showed greater change in the group which received spinal manipulation, but the change was subtle. The results indicate that the H/M ratio may be of limited value in clinical practice.
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Affiliation(s)
- G D Cramer
- Department of Anatomy, National College of Chiropractic, Lombard, IL 60148-4583
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Cramer GD, Allen DJ, DiDio LJ, Potvin W, Brinker R. Evaluation of encephalic ventricular volume from the magnetic resonance imaging scans of thirty-eight human subjects. Surg Radiol Anat 1990; 12:287-90. [PMID: 2096464 DOI: 10.1007/bf01623707] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Accurate volume determination of the encephalic ventricles is of importance in several clinical conditions, including Alzheimer's presenile dementia, schizophrenia, and benign intracranial hypertension. Previous studies have investigated the accuracy with which magnetic resonance imaging (MRI) can be used in clinical practice to evaluate the encephalic ventricles. However, adequate evaluation of pathological conditions depends on a sufficient amount of morphometric data from normal subjects. To begin establishing this data base for "normal" subjects, we evaluated the MRI scans of 38 subjects found to have no apparent pathology and calculated the ventricular volume in each case by using methods previously developed in our laboratory. The results were then compared with published volumes determined from studies that used either ventricular casts or computerized tomographic scans. The average total ventricular volume for all 38 subjects was 17.4 cm3, while that for males was 16.3 cm3 and that for females was 18.0 cm3. A small but significant correlation was found between age of subject and ventricular volume, with ventricular size increasing with age.
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Affiliation(s)
- G D Cramer
- National College of Chiropractic, Lombard, Illinois 60148
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Cramer GD, Allen DJ, DiDio LJ, Potvin W, Brinker R. Comparison of computerized tomography with magnetic resonance imaging (MRI) in the evaluation of encephalic ventricular volume. Surg Radiol Anat 1990; 12:135-41. [PMID: 2396179 DOI: 10.1007/bf01623340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The volume of the encephalic ventricles was determined from computerized tomographic (CT) and magnetic resonance imaging (MRI) scans of seven subjects without apparent pathology and three subjects with enlarged ventricles. Since there are many conditions in which the encephalic ventricles become enlarged such as Alzheimer's disease and hydrocephalus, accurate measurement of these structures provides (1) a valuable and safe means of aiding in the diagnosis of such conditions and (2) important follow-up information on affected patients. This paper presents the data obtained from the second phase of a three phase study. The first phase demonstrated the possibility of measuring fluid filled spaces by MRI in three phantom preparations (small, medium, and large "ventricles"). The results were compared with those obtained from the computerized tomography (CT) scans of the same preparations. This phase of the study compares the volumes obtained from CT scans with those obtained from MRI scans of the same individuals. The volumetric calculations were done with the aid of a Calcomp 9000 digital analyser programmed to compensate for the scale factor and slice thickness of the images. The results obtained from the MRI scans correlated closely with those obtained from the CT scans of the same subjects. The third and final phase of the project is the development of an MRI volumetric data base for the encephalic ventricles using a larger number of subjects.
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Affiliation(s)
- G D Cramer
- National College of Chiropractic, Lombard, Illinois 60148
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Abstract
The volume of the encephalic ventricles was determined from magnetic resonance imaging (MRI) scans. Since there are many conditions in which the encephalic ventricles become enlarged such as Alzheimer's disease and hydrocephalus, accurate measurement of the ventricles provides a valuable and safe means of aiding the diagnosis of such conditions and also provides important follow-up information in affected patients. The objective was pursued in a three phase study. This paper presents the data obtained from the first phase. This first phase demonstrated the possibility of measuring fluid filled spaces by MRI in three phantom preparations (small, medium, and large "ventricles"). The results were compared with those obtained from computerized tomography (CT) scans of the same preparations. These volumetric calculations were done with the aid of a Calcomp 9,000 digital analyzer programmed to compensate for the scale factor and slice thickness of the images. The phantom study showed that the results obtained from the MRI scans were better than those obtained from the CT scans in measuring the volume of water-filled cavities (ventricles) in gelatin phantoms. The average percent difference between volumes obtained by an imaging procedure compared to the actual volume as determined by water displacement was 15.8% for CT scanning and a more impressive 8.3% for MRI.
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Affiliation(s)
- G D Cramer
- National College of Chiropractic, Lombard, Illinois 60148
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