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).
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.
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.
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.
The following critique of the Chiropractic Services Pilot Program (SDR #86-09) focuses on two major issues: the terms of reference established for the study and the research constraints that arose from either the terms of reference or their interpretation; the technical design and execution of the research. The review suggests that the constraints invalidated the study and ensured that no comparisons are possible between chiropractic and medical care for VA patients based on these results. The constraints resulted in the use of a nonexperimental design, distinct samples being chosen and nonequivalent care settings being compared. The critique also reveals that in each of the design steps (eligibility criteria, sampling, protocols, data collection, analysis, interpretations) there were serious methodological flaws. These ensured that the two populations being compared (chiropractic patients versus medical patients) were in fact noncomparable. In terms of the economic cost comparisons, the design guaranteed the comparison was unfair, pitting a private, fee-for-service chiropractic practice against a not-for-profit, managed-care, federally regulated and budgeted institution. Furthermore, the allocation of costs to the two groups was done inaccurately. The critique concludes that the results are not valid, they cannot be used for generalizing, they cannot be used for statistical analysis and they should not be used to establish policy. The research design and the methodological flaws meant that the objectives of the study could not be met.
The purpose of this study was to evaluate neck-related physical function in individuals 11 to 14 years after anterior cervical decompression and fusion (ACDF) surgery for degenerative cervical disk disease and to compare the long-term outcome of 2 surgical techniques, including the Cloward procedure and cervical intervertebral fusion cage.
In this cross-sectional study, 51 individuals, 11 years or more after ACDF, underwent testing of cervical active range of motion, hand-grip strength, static and dynamic balance, neck muscle endurance, and completed pain ratings. The participants' values were compared with values of age- and sex-matched healthy individuals to evaluate impairments. Correlations between different test scores and pain were performed. Group differences were analyzed between the 2 surgical techniques.
Sixty-five percent and 82% exhibited impairment in ventral and dorsal neck muscle endurance, respectively. Impairment rates of 18% to 39% for cervical active range of motion, 27% to 43% for hand-grip strength, 37% for standing balance, and 35% for dynamic balance were recorded. Twenty-nine percent of the participants had impairment (>30 mm visual analog scale) in pain. There were no significant differences in physical function between the 2 surgical treatment groups (Cloward procedure or cervical intervertebral fusion cage) (P = .10-.92).
In those studied, a large percentage of patients who had anterior cervical decompression and fusion surgery have impairments in neck-related physical function when compared 11 to 14 years after surgery with age- and sex-matched healthy reference individuals. Neck-specific function, but not balance, was statistically correlated to pain. Neck muscle endurance was most affected, and balance impairments were also present in one-third of the individuals. There were no differences in long-term physical function between the 2 surgical techniques.
The aim of this study is to examine the prevalence of chiropractic and osteopathy use and the profile of chiropractor/osteopath users among middle-aged Australian women.
This article reports on research conducted as part of the Australian Longitudinal Study on Women's Health. The focus of this article is the middle-aged women who responded to Survey 3 in 2001 when they were between the ages of 50 and 55 years. The demographic characteristics, health status, and health service use of chiropractic/osteopathy users and nonusers were compared using chi2 tests for categorical variables and t tests for continuous variables.
We estimate that 16% of middle-aged women consult with a chiropractor or osteopath (after adjustment for the oversampling of rural women). Area of residence, education, and employment status were all statistically significantly associated with chiropractic and osteopath use. Specifically, women who live in nonurban areas were more likely to consult a chiropractor or osteopath, compared with women who live in urban areas. Women are significantly more likely to consult with a chiropractor/osteopath if they have had a major personal injury in the previous year, and women who use chiropractic/osteopathy are also high users of 'conventional' health services.
Chiropractic/osteopathy use among women in Australia is substantial and cannot be ignored by those providing or managing primary health care services for women. It is essential that the interface and communication between chiropractors/osteopaths and other health care providers be highlighted and maximized to establish and maintain effective overall patient coordination and management.
The purpose of this study was to describe the circumstances, clinical features, role, and results of chiropractic management of infants who were referred to a chiropractic clinic for failure to adequately feed at the breast.
Clinical case series of 114 infant cases of hospital-diagnosed or lactation consultant diagnosed feeding problems that were treated with chiropractic therapy in addition to routine care and followed to short-term result.
The most common age of referral was 1 week (mean, 3 weeks; range, 2 days-12 weeks), and the most common physical findings were cervical posterior joint dysfunction (89%), temporomandibular joint imbalance (36%), and inadequate suck reflex (34%). Treatment was chiropractic therapy in addition to any support given elsewhere. All children showed some improvement with 78% (N = 89) being able to exclusively breast feed after 2 to 5 treatments within a 2-week time period.
Cooperative multidisciplinary care to support breastfeeding was demonstrated in this population. Chiropractic treatment may be a useful adjunct to routine care given by other professionals in cases of diagnosed breastfeeding problems with a biomechanical component.
This editorial reviews the scientific sessions and announces the 4 award-winning scientific articles from the World Federation of Chiropractic 11th Biennial Congress held in Rio de Janeiro from April 6, to 9, 2011, that are published in this issue of the Journal of Manipulative and Physiological Therapeutics.
This case series presents information on diagnosis and treatment of 13 cases of benign infant headache presenting to a chiropractic teaching clinic.
A retrospective search was performed for files of infants presenting with probable headache revealing 13 cases of headache from 350 files.
Thirteen cases (6 females, 7 males) from 2 days old to 8.5 months old were identified by behavioral presentation, parental, or medical diagnosis. In the cohort, historical findings included: birth trauma, assisted birth, familial headache history and feeding difficulty. Examination and behavioral findings were grabbing or holding of the face, ineffective latching, grimacing and positional discomfort, rapping head against the floor, photophobia and anorexia. Posterior joint restrictions of the cervical spine were found in these cases. No cases of malignant headache were found. All infants received a trial of chiropractic care including manual therapy.
This case series offers information about potential signs of benign infant headache. The patients in this study responded favorably to chiropractic management.
To discuss the immediate increment of improvement in vision that occurs when the spine is manipulated.
Two juvenile patients (13-yr-old female cousins) were found to have constricted visual fields and diminished visual acuities.
Spinal manipulation was associated with recovery of normal vision over seven treatment sessions. It was noted that significant improvement in vision occurred immediately after the spinal manipulation treatments. Full recovery of vision was attained by series of these steps. In addition, both patients reported significant constitutional benefits after the treatment in addition to the improved vision.
The change in visual function immediately related to spinal manipulation has been described as the "step phenomenon." The step phenomenon raises questions about the nature of the condition that may be treated by spinal manipulation and the method of action of the treatment. A vascular hypothesis is mentioned that could explain these events. The consistent occurrence of the step phenomenon indicates that spinal manipulation may have an effect on brain function.
To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not.
A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the chi(2) test were used to test for differences between the 2 groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill).
Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.
In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.
The purpose of this study was to evaluate survey data from a national cross-sectional sample of 1427 urban and nonurban Australian women focusing on the relationship between the use of specific complementary and alternative medicine (CAM) practitioner types and the levels of CAM use across urban and nonurban areas.
A cross-sectional survey of 1427 middle-aged participants from the Australian Longitudinal Study on Women's Health conducted in 2009 was performed. The survey was designed to investigate multiple factors affecting the health and well-being of a cohort of women, with a particular emphasis on urban and nonurban residence. Women in 3 age groups ("young" 18-23 years, "mid-age" 45-50 years, and "older" 70-75 years) were randomly selected from the national Medicare database. The survey covered place of residence, measures of health status, rating of health care providers/services, and consultation with CAM practitioners.
The most commonly consulted CAM practitioners for this sample were massage therapists (n = 912; 63.9%), doctors of chiropractic/chiropractors (n = 614; 43.0%), and naturopaths/herbal therapists (n = 327; 22.9%). Statistically significant differences between the areas of residence were found for women who used chiropractors (P = .0165), yoga practitioners (P = .0087), and osteopaths (P < .0001). Women residing in nonurban areas were more likely to consult with a chiropractor compared with women residing in major cities. Women in major cities were more likely to consult with a yoga practitioner or osteopath than women from nonurban areas. Women from nonurban areas who consulted a chiropractor were significantly less satisfied with their access to a medical specialist (P < .0001), access to a female general practitioner (P = .043), the number of general practitioners they have to choose from (P = .001), how long they have to wait for an appointment (0.0146), and the amount of information sharing by their general practitioner (P = .003), compared with urban women.
For the population sample studied, the higher overall consultation rates with CAM therapists by Australian nonurban women were caused by consultations for chiropractic care.
Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented.
To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible.
Prospective, randomized, controlled intervention trial.
One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment.
Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated.
Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems.
Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups.
This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.
This study presents a case series of 157 children with developmental delay syndromes, including the conditions such as dyspraxia, dyslexia, attention-deficit hyperactivity disorder, and learning disabilities who received chiropractic care.
A consecutive sample of 157 children aged 6 to 13 years (86 boys and 71 girls) with difficulties in reading, learning, social interaction, and school performance who met these inclusion criteria were included.
Each patient received a multimodal chiropractic treatment protocol, applied kinesiology chiropractic technique. The outcome measures were a series of 8 standardized psychometric tests given to the children by a certified speech therapist pre- and posttreatment, which evaluate 20 separate areas of cognitive function, including patient- or parent-reported improvements in school performance, social interaction, and sporting activities. Individual and group data showed that at the end of treatment, the 157 children showed improvements in the 8 psychometric tests and 20 areas of cognitive function compared with their values before treatment. Their ability to concentrate, maintain focus and attention, and control impulsivity and their performance at home and school improved.
This report suggests that a multimodal chiropractic method that assesses and treats motor dysfunction reduced symptoms and enhanced the cognitive performance in this group of children.
This case report discusses the diagnosis and conservative management of a patient with femoral trochlear dysplasia (FTD) and subacute patellar dislocation. Femoral trochlear dysplasia is characterized by an abnormally shallow trochlear groove. Disengagement of the patella from the shallow femoral trochlea is common in FTD and is a predisposing risk factor to recurrent patellar dislocation and subsequent premature osteoarthrosis. Accurate diagnosis is necessary to prevent recurrent patellar dislocations and damage of the patellofemoral joint cartilage and supporting structures.
A 16-year-old male adolescent presented with pain, ecchymosis, and swelling about the right anterior knee approximately one month after a self-described dislocating event. Clinical and imaging findings, including magnetic resonance imaging and ultrasonography, demonstrated evidence of patellar dislocation with previously undiagnosed FTD.
After drainage of the knee effusion at a local hospital, the patient underwent a chiropractic treatment protocol consisting of stabilization with patellar tracking orthosis, customized orthotic support, and various muscular stabilization and strengthening exercises. After 6 weeks of treatment, the swelling and ecchymosis resolved. The knee ranges of motion were full without pain. Although the hypermobility of the patella demonstrated no interval change, the patient reported improved strength and stability of the right knee.
This case highlights a young athlete with subacute patellar dislocation and FTD who responded successfully to conservative management. Conservative stabilization and strengthening protocols improved patient outcome without surgical repair of the underlying FTD. Conservative management of FTD has not been reported and it makes the current case unique. However, the long-term outcome of conservative management is unknown at this point and further studies are necessary to evaluate treatment protocols.
To present an unusual case of chronic myelogenous leukemia (CML) in an adolescent with a complaint of leg pain. Clinical presentation is highlighted and a brief review of the childhood leukemias and common clinical features are outlined.
A 16-yr-old black male was seen after suffering from leg and knee pains for 7 months. Exquisite tibial pain, normal radiographs and an abnormal CBC led to the diagnosis of leukemia. Subsequent referral for bone marrow examination confirmed the final diagnosis of chronic myelogenous leukemia.
The patient was referred to a pediatric hematologist-oncologist for medical management of his condition. He is currently receiving chemotherapy and the search for a suitable donor for bone marrow transplant is in progress.
This case demonstrates the importance of considering one of the more common pediatric malignancies, such as leukemia, in the differential diagnosis of children with musculoskeletal complaints. Chronic myelogenous leukemia accounts for only 3-5% of cases of childhood onset. Its rare incidence in childhood constitutes the basis for this case report.
This editorial presents a brief description of the Association of Chiropractic Colleges Educational Conference and Research Agenda Conference, the components of the conference, and long range goals of the peer-review committee.
To describe the importance of correlating symptoms with objective clinical findings and appropriate diagnostic imaging in a patient with traumatic wrist pain.
A 17-year-old golfer had persistent left wrist pain of 4 months' duration that began while playing golf. Approximately 1 week after injury, he was diagnosed with a scaphoid fracture and was splinted. He reported that his pain did not decrease with splinting or with subsequent physical therapy, and on dismissal from orthopedic care he could not use the wrist well enough to return to golf.
The patient was found to have marked point tenderness at the hamate. Although plain-film radiography was negative, secondary computed tomography of the wrist showed a fracture to the hook of the hamate. A referral was made to an orthopedic surgeon and surgical excision of the hook of the hamate was recommended because of the failure of union at the fracture site.
This case shows the significance of follow-up diagnostic imaging in a patient who does not respond as expected. In addition, it stresses the importance of the doctor of chiropractic in the diagnostic process, although the patient may have been treated and released by another physician.
Hip osteoarthritis (HOA) affects 30 million Americans or more, and is a leading cause of disability, suffering, and pain. Standard treatments are minimally effective and carry significant risk and expense. This study assessed treatment effects of a chiropractic protocol for HOA.
Eighteen individuals, who did not qualify due to low baseline Western Ontario and McMaster Osteoarthritis Index scores (WOMAC) for other ongoing HOA randomized control trials, were selected. A prospectively planned protocol, consisting of axial manipulation to the affected hip with modified Thomas and active assisted stretch, was combined with full kinetic chain treatment or manipulative therapy to the spine, knee, ankle, or foot and assessed with use of valid and reliable outcome measures.
The primary outcome measure, the Overall Therapy Effectiveness Tool, was assessed with chi(2) and demonstrated that 83.33% of participants were improved after the ninth visit, P = .005, and 78% improved at the 3-month follow-up, P = .018. Using the paired t test, WOMAC was improved 64% at the ninth visit, P = .000, and 47% at follow-up, P = .016.
In HOA patients with lower WOMAC scores, a highly organized HOA treatment appears to have resulted in statistically and clinically meaningful intragroup changes in the Overall Effectiveness Therapy Tool, WOMAC, Harris Hip Scale, and range of motion, all with P <or= .05. Although the directionality and strength of the findings are encouraging, fully powered clinical trials are necessary to report generalizable findings.
This case study presents the delayed diagnosis, surgical management, and postsurgical follow-up of an intra-articular osteoid osteoma of the left femoral neck in an 18-year-old male patient with special emphasis on discussing the confusing clinical and imaging characteristics of the lesion often associated with delayed diagnosis and increased morbidity.
The patient initially complained of left knee and hip pain at which time conventional radiographs were reported as normal. In magnetic resonance imaging studies, the diagnosis of intra-articular osteoid osteoma of the femoral neck was suggested; however, working diagnoses also included old posttraumatic injury, hip infection, juvenile chronic arthritis, and posttraumatic arthritis. The correct diagnosis was made 31 months after presentation based on computed tomography depiction of the lesion.
Pain associated with the tumor was alleviated after surgical removal with minimal loss of motion and muscle atrophy 19 months after tumor excision.
Clinicians and radiologists should be aware of the potentially confusing clinical and imaging findings associated with intra-articular osteoid osteoma of the hip. Early correlation between juvenile joint pain and imaging abnormalities as well as the use of thin slice computed tomography imaging could reduce the time to diagnose the lesion and prevent unnecessary morbidity.
The purpose of this study was to use digital videofluoroscopy to identify motion patterns of the lumbar spine during coronal movement in asymptomatic (normal) subjects and patients with herniated nucleus pulposus (HNP).
Videofluoroscopic lumbar coronal motion was recorded in 18 asymptomatic volunteers and 9 patients with HNP. Measurements were made while patients bent laterally and rotated toward the right and left from a sitting position and then returned to their original position. Direction and degree of extension in the coronal plane at each motion segment and sacral descent were measured. Through the motion analysis software, the coupled pattern with lateral bending and rotation was analyzed in the asymptomatic subjects and patients with HNP.
Lateral flexion movement was coupled with contralateral extension and ipsilateral sacral descent but with a different rotation pattern. Rotation movement was coupled with ipsilateral extension, ipsilateral sacral descent, and ipsilateral spinous process rotation. Patients with HNP and asymptomatic subjects had similar coupled patterns but differences in amount of motion.
Digital videofluoroscopy showed coupled patterns during the lateral bending and rotation movements.
The purpose of this prospective case series was to examine the combined effects of soft tissue mobilization and nerve slider neurodynamic technique on pain and pressure sensitivity in women with chronic carpal tunnel syndrome (CTS).
Eighteen women with a clinical and electromyographic diagnosis of CTS participated. Patients completed the numerical pain rating scale (NPRS) for current, worst, and lowest pain intensity and underwent pain pressure threshold (PPT) testing over the median, radial, and ulnar nerves; the C5-C6 zygapophyseal joint; the carpal tunnel; and the tibialis anterior muscle. Pain was assessed at baseline and 1-week follow-up, whereas PPT were assessed at baseline and immediately after and 1-week after intervention. Each received soft tissue mobilization and nerve slider neurodynamic technique directed at different anatomical sites of potential entrapment of the median nerve.
A decrease in the mean current intensity and worst level of hand pain (P < .01) was found 1 week after the treatment session (mean changes, 2.2 ± 1.1 points). A treatment effect for PPT levels over the C5-C6 zygapophyseal joint (P < .001) was found: PPT increased bilaterally 1 week after the intervention. No other significant changes in PPT levels were found (P > .195).
The application of soft tissue mobilization and neurodynamic technique decreased the intensity of pain but did not change pressure pain sensitivity in this group of women with chronic CTS.
A brief historical review of the discovery of X-ray by Wilhelm Konrad Roentgen on November 9, 1895, is presented. This synopsis discusses the evolution of X-ray imaging from the primitive Crookes x-ray tube to the state-of-the-art high-frequency generators. Technological advancements from fluoroscopy to plain films, nuclear medicine, computed tomography and magnetic resonance imaging, along with changes in X-ray film and intensifying screens, are also provided. A concise overview of chiropractic radiology and the introduction of X-ray into the chiropractic curriculum, first at Palmer College and then at other colleges is presented. Historical recognition of the development of the American Chiropractic Board of Radiology (ACBR), its founding fathers and its certification program for training chiropractic radiologists is reviewed. General comments pointing to computerized digital imaging as the filmless imaging of the future are offered.
The Los Angeles College of Chiropractic (LACC) can trace its history from D. D. Palmer through Thomas H. Storey, D.C. to Charles A. Cale, D.C., N.D., the LACC's founder. The formation and early history of the College is intimately intertwined with the naturopathic movement and to a lesser extent the osteopathic profession in southern California during the first two decades of this century. Although the school would eventually become the largest producer of chiropractors in the densest chiropractic jurisdiction in the world, its early survival was not always certain, and its later status as a bellwether for the rest of the profession was not yet in evidence. Organized by Charles Cale in 1910 and chartered in 1911, the school would suspend operations for several years (1914-6) while Charles and Linnie Cale acquired osteopathic credentials. The school's rebirth in 1916 marked the beginning of the final push for the initiative act of 1922 that licensed chiropractors and ended some of the most intensive legal persecutions by organized medicine that chiropractors would ever experience. This initial phase of LACC's history (through 1922) set the stage for at least 12 subsequent mergers and reorganizations to form today's LACC. The College would later lead the state's and the profession's efforts to broaden and deepen the chiropractic curriculum during the middle ages of chiropractic.
Empiricism plagued the Kansas Territory even as it entered into statehood and was caused by numerous dabblers into the health care field. They were 'wannabe' doctors of all kinds: pure charlatans, fakers of all type, faith healers and even osteopaths and chiropractors, all practicing in violation of Kansas law from 1854-1914. This was not an unusual finding in any of the western territories, before or since. This article describes the chiropractic struggle for licensure from 1906-1915. Numerous chiropractors suffered the indignity of arrest, trial, fines or even jail while pursuing the ultimate goal of an independent chiropractic act. The enacted Kansas chiropractic act of 1913 became the focal point of the battle for a board of examiners to issue licenses. The specific language therein set forth a requirement for the first appointed board members; it mandated practice of a stipulated number of years before licensure. Only in Kansas, and later California, would this language cause dire consequences.
Although the Cleveland family is well known in the profession for the two colleges that carry its name, relatively few of the details of the early activities of these chiropractic pioneers are recalled. This paper traces the early lives and careers of Ruth Ashworth and Carl S. Cleveland, Sr. from their education and marriage at the Palmer School in 1917 through their college operations and national professional activities before the start of the National Chiropractic Association's educational reform initiatives in the mid-1930s. The pair was active in Missouri chiropractors' struggles for licensure in the 1920s and fought to prevent the enactment of basic science legislation later on. The Clevelands remained allied to B. J. Palmer and the Chiropractic Health Bureau (today's International Chiropractors' Association) after the introduction of the neurocalometer (NCM) in 1924. However, they followed a less strident and less extreme course within straight chiropractic than did their Davenport mentor. The Cleveland College perpetuated a full-spine approach to chiropractic technique and always included diagnostic instruction. In the late 1920s and early 1930s, Carl Cleveland's more moderate stance found favor within the unification efforts centered in the International Chiropractic Congress, and he served during 1931-1933 as president of the Congress' division of school leaders. The Cleveland Chiropractic College's battle for economic survival during the lean days of the nation's economic depression is a testimony to its founders' vision and commitment to chiropractic education.
Dr. Raymond L. Nimmo (1904-86) was the definitive chiropractic pioneer in the now widely accepted field of soft tissue and trigger point therapy. This article explores how Nimmo was able to make the radical conceptual leap from moving bones to working with muscles that move the bones. Also discussed are the neurophysiological explanations that Nimmo evolved in the 1950s for the trigger point phenomenon, formulations that are still regarded as highly sophisticated half a century later. Finally, the article describes how Nimmo, with a basic chiropractic education absent much of the background in the biological and physical sciences of today's preparation, was able to combine his clinical experiences and intellectual formulation to arrive at a theory that became widely accepted.
The purpose of this article is to relate the story of the Bakkum Chiropractic Clinic and Hospital and offer evidence regarding the lost days of chiropractic hospitalization and inpatient care.
The number of chiropractic facilities offering inpatient care peaked in the period between World Wars I and II. Little information is available about the vast majority of these facilities. One of them was the Bakkum Chiropractic Clinic and Hospital in Waukon, Iowa. The proprietor was Roy C. Bakkum, DC; he and his wife, Jessie H. Bakkum, DC, opened their 30-bed facility in 1936. Patients received hole-in-one chiropractic adjustments, rest, and nursing care at this facility. Dr Roy Bakkum not only envisioned chiropractors as true primary caregivers but also implemented that vision to the best of his ability. He saw chiropractic as the principal type of health care that the vast majority of people should receive, even as inpatients; instead of being the usual and customary type of hospital care, pharmaceutical and surgical intervention would be called on only as needed. Mainly because of economic pressures, the Bakkums' facility closed in 1950.
The Bakkum Chiropractic Clinic and Hospital may have been fairly typical of small chiropractic facilities offering inpatient care. Like many private hospitals of various kinds, the Bakkums' facility closed in the post-World War II period, primarily because of economic and political losses. This article traces the history of one chiropractic facility to add historical context to chiropractors' long struggle to own and operate chiropractic hospitals.
Little is known about changes in the chiropractic patient population over time.
To compare 2 surveys describing the Danish chiropractic patient population.
Data concerning location of primary complaint and its duration for patients in Danish chiropractic offices between 1962 and 1999 were compared.
Private chiropractic practice and nonprofit research institution.
Location of primary diagnosis/complaint, duration of complaint.
In 1962, data for 1118 patients were collected, with a participation rate of 93%. In 1999, data for 1897 patients were collected. Of all Danish chiropractic clinics, 88% participated in the study, and 94% of all eligible patients filled out a questionnaire. In both 1962 and 1999, the most frequent complaints were pain in the lower back or neck either alone or with radiation to the extremities (roughly 70% of patients). In 1962, almost 4 times as many patients complained of headache as in 1999 (11% vs 4%). Although there were significant differences, less that 10% of patients presented with a nonmusculoskeletal disorder in both 1962 and 1999 (7% vs 3%). In 1962, almost half of the patients had had their complaint for more than 1 year; in 1999, approximately 80% of patients had had their complaint for less than 1 year.
In both 1962 and 1999, Danish chiropractors primarily treated patients with pain syndromes related to the lower back and neck. Patients presenting with type O disorders comprised less than 10% of the total patient population in both surveys.
Problems in ascertaining cases and in determining the total number of treatments have made it difficult to establish the rate of cerebrovascular accidents (CVA) after spinal manipulative therapy.
To estimate the occurrence of cerebrovascular accidents after chiropractic treatment to the cervical spine.
Information was sought on cases of CVA in Denmark during the period 1978-1988 inclusive, through several sources and through a survey of the Danish Chiropractors' Association. Information was sought also on proportion of consultations consisting of cervical treatment and preferred type of therapy. The incidence rate of CVA was calculated for several denominators.
Targeted sample in survey 1: all 226 practicing members of the Danish Chiropractors' Association in 1989 [i.e., 99% of the chiropractors in Denmark at that time (response rate 54%)]. In survey 2, a random sample of 40 chiropractors (response rate 72.5%) was used.
The number of CVAs in relation to the number of chiropractor-years, number of consultations, consultations including neck treatment, upper and lower neck treatment, and type of technique used.
Five cases of CVA were identified; one resulted in death and the others in permanent neurological sequelae of varying severity. One case of CVA appeared for every estimated 1.3 million cervical treatment sessions and 1 for every 0.9 million upper cervical treatment sessions. Rotation techniques were over-represented in relation to their estimated frequency of use.
Although the incidence of CVA after chiropractic SMT was confirmed to be low, there seems to be sufficient evidence to justify a firm policy statement cautioning against upper cervical rotation as a technique of first choice.
Applied Kinesiology (AK) is a diagnostic and therapeutic approach used by a large number of chiropractors. AK seminars are conducted worldwide; during these seminars mention is frequently made of the presence of supportive research. A review was undertaken of the type and scientific quality of 50 papers which had been published between 1981 and 1987 by the International College of Applied Kinesiology, 20 of which were classified as research papers. These were subjected to further scrutiny relating to criteria considered crucial in research methodology, namely, a clear identification of sample size, inclusion criteria, blind and naive subjects and statistical analysis. Although some papers satisfied several of these criteria, none satisfied all seven of them. As none of the papers included adequate statistical analyses, no valid conclusions could be drawn concerning their report of findings.
Forty-six data reports which appeared in the Journal of Manipulative and Physiological Therapeutics from 1986 to 1988 were reviewed according to specific methodological criteria. There appears to be a need for improved study design in contemporary chiropractic research. Experimental and quasi-experimental studies were most commonly deficient in the areas of reliable methods of measurement, the use of blind assessors and blind, or at least naive, study subjects. Common flaws in surveys were: failure to test the survey instrument prior to the study, not stating the response rate, and omitting discussion of the question of confidentiality. The results confirmed findings obtained in a similar study of data reports of an Australian peer-reviewed chiropractic journal. The use of various types of checklists is recommended for authors and reviewers of chiropractic scientific material.
Two previous reports have summarized the content, institutional affiliations, academic training and funding sources for articles published in the Journal of Manipulative and Physiological Therapeutics (JMPT) from 1978-1986 and 1987-1988.
(a) to quantitatively assess the types of articles published in the JMPT from 1989-1996; (b) to identify the affiliations of contributors to the JMPT during this period; (c) to identify the academic backgrounds of contributors to the JMPT from 1989-1996; (d) to identify funding sources for scholarly works published in the JMPT during this period; (e) to identify the proportionate contributions of female authors; (f) to assess the proportion of articles contributed, i.e., foreign vs. domestic sources; and (g) to compare findings for the JMPT from 1989-1996 with similar data for 1978-1988.
Survey of the contents of the JMPT from 1989-1996.
The contents of the 69 issues of the JMPT from 1989-1996 were reviewed by all authors. Characteristics extracted included category of the article, academic backgrounds of authors, institutional affiliations of authors, funding sources, gender of authors and nation(s) of origin of articles.
The annual rate of published contributions to the Journal has more than doubled compared with its first 11 yr of publication, and the proportion of original data reports has grown slightly. Controlled and quasicontrolled clinical trials were 7 times more numerous (n = 28 articles) during the past 8 yr. Chiropractic colleges were the most frequently mentioned affiliation of authors, followed by private practice and nonchiropractic colleges. Collaborative articles submitted by authors at two or more chiropractic colleges grew from only 4 articles from 1978-1988 to 31 articles from 1989-1996. As in previous years, the National College of Chiropractic continued to be the most frequently mentioned academic affiliation of authors. The numbers of articles contributed by those holding scientific (e.g., PhD) and medical degrees have grown substantially. The number of articles mentioning financial support grew from 78 from 1978-1988 to 179 from 1989-1996, and 58 new funding sources were identified. The Foundation for Chiropractic Education and Research continues to be the most frequently mentioned source of funding. Of all articles published in the JMPT from 1989-1996, 21% were authored or coauthored by women. Of 1050 articles, 286 (27%) were authored or coauthored by individuals residing outside the United States of America.
Substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical. Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline.
The organization and finance of health care in the United States are likely to change dramatically during the 1990s. During the first half of the decade, pro-competition strategies, which characterized the 1980s, are likely to continue. However, by the end of the decade, the country will probably adopt some form of national health care. After briefly discussing both possibilities, this paper investigates their likely impact on the future practice of chiropractic in the United States, and concludes with some policy recommendations.
Published in 1991, the Neck Disability Index (NDI) was the first instrument designed to assess self-rated disability in patients with neck pain. This article reviews the history of the NDI and the current state of the research into its psychometric properties--reliability, validity, and responsiveness--as well as its translations. Focused reviews are presented into its use in studies of the prognosis of whiplash-injured patients as well as its use in clinical trials of conservative therapies for neck pain.
The NDI is a relatively short, paper-pencil instrument that is easy to apply in both clinical and research settings. It has strong psychometric characteristics and has proven to be highly responsive in clinical trials. As of late 2007, it has been used in approximately 300 publications; it has been translated into 22 languages, and it is endorsed for use by a number of clinical guidelines.
The NDI is the most widely used and most strongly validated instrument for assessing self-rated disability in patients with neck pain. It has been used effectively in both clinical and research settings in the treatment of this very common problem.
To determine on a state by state, province by province basis what diagnostic and treatment procedures are allowed by statute in the various practice acts.
A survey administered by mail.
All state and provincial licensing boards.
The response rate to the survey was 90%. More than 50% of the responding licensing boards allow chiropractors to order or perform clinical lab procedures, conduct components of a routine physical exam, examine the female pelvis, perform rectal exams, and conduct electromyographic, electrocardiographic and nerve conduction studies. More than 80% can perform a variety of X-ray procedures, use thermography, administer a vascularizer (Doppler) and order CT or MRI studies. More than 90% of the respondents permit chiropractors to employ some form of physiotherapy, adjust soft tissue or extremities, supplement with vitamins and conduct impairment ratings.
These findings demonstrate that the chiropractic profession offers a broad range of diagnostic and treatment procedures.
To provide a literature review of the etiologic breakdown of cervical artery dissections.
A literature search of the MEDLINE database was conducted for English-language articles published from 1994 to 2003 using the search terms cervical artery dissection (CAD), vertebral artery dissection, and internal carotid artery dissection. Articles were selected for inclusion only if they incorporated a minimum of 5 case reports of CAD and contained sufficient information to ascertain a plausible etiology.
One thousand fourteen citations were identified; 20 met the selection criteria. There were 606 CAD cases reported in these studies; 321 (54%) were internal carotid artery dissection and 253 (46%) were vertebral artery dissection, not including cases with both. Three hundred seventy-one (61%) were classified as spontaneous, 178 (30%) were associated with trauma/trivial trauma, and 53 (9%) were associated with cervical spinal manipulation. If one apparently biased study is dropped from the data pool, the percentage of CADs related to cervical spinal manipulation drops to approximately 6%.
The case series that were reviewed in this article indicated that most CADs reported in the previous decade were spontaneous but that some were associated with trauma/trivial trauma, and a minority with cervical spine manipulation. This etiologic breakdown of CAD does not differ significantly from what has been portrayed by most other authors.
The purpose of this study was to conduct a bibliographic analysis and assessment of the literature published in the Journal of Clinical Chiropractic Pediatrics (JCCP).
The content of the 13 existing issues of the JCCP (1996-2007) were assessed. Articles were categorized by type, and information concerning author affiliation, academic/professional background and gender were tabulated. A second-level analysis applied specific criteria checklists to applicable articles to determine the quality rating of each paper.
There were 72 articles included in the analysis, of which 46% were case reports, 17% editorials, 13% case series, 10% narrative literature reviews, 10% commentaries, 4% "other," and 1% cross-sectional studies. Seventy-five percent of the authors were "private practitioners." A certification in chiropractic pediatrics was held by 43% of the authors; 65% of the authors were females, and 83% of the articles had a single author. After applying the checklist to specific articles, 13 articles (18%) scored 40% or better (range of 40%-67%), whereas 59 articles (82%) scored less than 40%.
The findings of this analysis suggest there is room for improvement in article type and publication quality of papers in the JCCP.
The objective of this study was to examine the volume and rate of Medicare Part B claims for chiropractic spinal manipulation longitudinally from 1998 to 2004.
A descriptive retrospective analysis was performed on Medicare part B claims from 1998 to 2004 using the Medicare Part B Standard Analytical Variable Length File. Using a 5% random sample of Medicare part B claims, the total number of claims were determined for chiropractic spinal manipulation procedures, and the rate of chiropractic spinal manipulation procedures per 1000 beneficiaries.
From 1998 through 2003, the number of chiropractic spinal manipulation claims increased by 38% (from 824,249 total claims in 1998 to 1,133,872 in 2003) followed by a 24% decline from 2003 to 2004. The rate of total chiropractic spinal manipulation claims rose 29% from 649 claims per 1000 beneficiaries per year in 1998 to a high of 839 claims per 1000 beneficiaries per year in 2003 and then declined by 25% to 632 claims per 1000 beneficiaries per year in 2004.
Medicare Part B claims for chiropractic spinal manipulation increased significantly from 1998 to 2003 and then abruptly declined from 2003 to 2004. Estimates for 2004 are at variance with earlier published estimates.
The purpose of this study is to provide an expanded description of Danish chiropractic patients and to compare characteristics seen in a survey from 1999 with those seen in 2002.
All chiropractic clinics in Denmark were asked to collect information on new patients during 1 randomly assigned week in 2002 using a survey questionnaire. All 52 weeks of the year 2002 were represented with an even dispersion of weeks (182 clinics participated). Outcome measures included age, sex, education, occupation, location and duration of chief complaint, pain intensity, limitation of activities of daily living, mode of referral, duration of sick leave, previous treatments, comorbidity, SF-12, smoking habits, and use of x-ray.
Eighty-five percent of all chiropractic clinics in Denmark participated in the study, and 1595 patients (81%) filled out a self-administered questionnaire. As in 1999, the most frequent area of complaint was pain related to the lower back and pelvis (49%). Contrary to the 1999 survey, most of the patients (64%) had complaints of less than 4 weeks of duration. Twenty-nine percent of the patients had been off work because of their symptoms; most of these for less than 1 week. Fifty-one percent of all patients were referred to chiropractors in 2002 (doubling since 1999). Referrals from general medical practitioners rose from 11% in 1999 to 17% in 2002. Sixty percent of all patients had similar symptoms in the past, and approximately half had previously received treatment of the same or a similar problem. Thirty percent of first-time chiropractic patients were x-rayed. Compared with general population measures, Danish chiropractic patients had significantly worse physical health status measured by the SF-12.
Most Danish chiropractic patients complain of pain related to the spine, especially the lower back, with duration of symptoms of less than 4 weeks, and many with recurrent back pain. Referrals from general medical practitioners have increased since 1999.