Neck Solutions

Satisfaction with low back pain care

Satisfaction with low back pain care

From: Spine J. 2008 May-Jun;8(3):510-21. Epub 2007 May 25

By using a unique, prospective study of occupational back pain claims, they examined health care satisfaction by provider type and its effect on return to work. They estimated satisfaction differentials by provider type, decomposing overall satisfaction into two components: bedside manner and effectiveness of care. They also examined how health care satisfaction affects the duration of jobless claims. The Arizona State University Healthy Back Study is a prospective study of work related back pain; 1,831 workers completed a baseline interview, with follow-up interviews at 1 month, 6 months, and 1 year. The Arizona State University Healthy Back Study merged demographic and claim characteristics from the workers’ compensation claim files with self-reported severity measures, measures of satisfaction, and postonset employment from worker interviews.

Overall and detailed satisfaction with treatment and workers’ compensation claim duration. They performed a nonparametric descriptive analysis of satisfaction by provider type and used multivariate regressions to decompose overall satisfaction into component parts. The duration analysis links differentials in health care satisfaction to differences in claim durations. Workers treated by surgeons, chiropractors (DCs), or physical therapists are more satisfied with their health care than those treated by MDs. Workers are more concerned with the effectiveness of care than with the bedside manner of their provider. A one standard deviation improvement in satisfaction with the health care provider reduces claim duration by about 25%.

Chiropractic and pain clinic management for chronic low back pain

A comparison between chiropractic management and pain clinic management for chronic low back pain in a national health service outpatient clinic

From: J Altern Complement Med. 2008 Jun;14(5):465-73

To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low back pain when managed in a hospital by either a regional pain clinic or a chiropractor. Design: The study was a pragmatic, randomized, controlled trial. The trial was performed at a National Health Service hospital outpatient clinic (pain clinic) in the United Kingdom. Subjects and interventions: Patients with chronic low back pain (i.e., symptom duration of >12 weeks) referred to a regional pain clinic (outpatient hospital clinic) were assessed and randomized to either chiropractic or pain-clinic management for a period of 8 weeks. The study was pragmatic, allowing for normal treatment protocols to be used. Treatment was administered in an National Health Service hospital setting. Outcome measures: The Roland-Morris Disability Questionnaire (RMDQ) and Numerical Rating Scale were used to assess changes in perceived disability and pain. Mean values at weeks 0, 2, 4, 6, and 8 were calculated. The mean differences between week 0 and week 8 were compared across the two treatment groups using Student’s t-tests. Ninety-five percent (95%) confidence intervals (CIs) for the differences between groups were calculated.

Randomization placed 12 patients in the pain clinic and 18 in the chiropractic group, of which 11 and 16, respectively, completed the trial. At 8 weeks, the mean improvement in RMDQ was 5.5 points greater for the chiropractic group (decrease in disability by 5.9) than for the pain-clinic group (0.36) (95% CI 2.0 points to 9.0 points; p = 0.004). Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group (p = 0.023).

This study suggests that chiropractic management administered in an National Health Service setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a subpopulation of patients with chronic low back pain.

Case management of chiropractic patients with low back pain

Case management of chiropractic patients with low back pain: The Nordic Maintenance Care program - A survey of Swedish chiropractors

From: Chiropractic & Osteopathy journal. 2008 Jun 18;16(1):6 [Epub ahead of print]

Chiropractic treatment for low back pain can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and “maintenance care”, during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of low back pain-scenarios, with a special emphasis on maintenance care.

The design was a mailed questionnaire survey. Members of the Swedish Chiropractors’ Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one’s own alternative, resulting in a “nine-by-seven” table. The research team defined its own pre hoc choice of “clinically logical” answers based on the team’s clinical experience. The frequency of findings was compared to the suggestions of the research team.

A pattern of self-reported clinical management strategies emerged, largely corresponding to the “clinically logical” answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care.

To a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of low back pain.

Continue reading Case management of chiropractic patients with low back pain…

Predictors of a favorable outcome in chiropractic neck pain treatment

Predictors of a favorable outcome in patients treated by chiropractors for neck pain

From: Spine. 2008 Jun 1;33(13):1451-1458

Study to examine which clinical and sociodemographic baseline variables can predict a favorable outcome in subjects with neck pain treated by chiropractors. Relatively little is known on predictors of neck pain, particularly for those subjects undergoing chiropractic care. No previous study has examined predictors of outcome for subjects with neck pain by modeling the trajectories of subjects in a longitudinal design.

All new, consecutive patients, between 18 and 65 years of age with neck pain of any duration, who had not undergone chiropractic or manual therapy in the prior 3 months, were recruited. Questionnaires were administered at the first 3 visits, and at 3 and 12 months. In all, 29 putative prognostic baseline variables were evaluated. Multivariate multilevel longitudinal regression analyses were conducted using neck pain, neck disability, and perceived recovery as outcomes.

In total, 529 patients fulfilled the inclusion criteria. The response rate at 12-months was 92%. In the multivariate analyses, 14 (48%) of the prognostic variables examined were retained in at least one of the models. Shorter duration of neck pain at the first visit was the only variable retained in all 3 final regression models. The following were predictive of a favorable outcome for any 2 of the 3 outcome measures examined: intermittent neck pain, those not on sick-leave or receiving workers compensation at baseline, a higher level of education, less tiredness, higher expectations that the treatment would be beneficial, lack of morning pain, and worse perceived general health.

On the basis of the patient’s history, the clinician can identify a number of determinants, which are predictive of a favorable outcome. Shorter duration of neck pain at the first visit was the only variable consistently found to be predictive of a favorable outcome for all 3 outcome measures examined.

Chiropractic and exercise for seniors with low back pain or neck pain

Chiropractic and exercise for seniors with low back pain or neck pain: the design of two randomized clinical trials

From: BMC Musculoskeletal Disorders 2007, 8:94

Low back pain and neck pain are major public health problems throughout the western world. These conditions can begin early in life and persist through adulthood and into old age. This places low back pain and neck pain among the most common health complaints experienced over a lifetime. Most research pertaining to low back pain and neck pain has been aimed at the working and middle aged segments of the population. However, it is estimated that, by the year 2025, approximately one third of individuals in developed countries will be over 60 years of age. Anticipating the impact of population projections, interest in low back pain and neck pain among seniors has increased.

Low back pain and neck pain, either alone or in conjunction, affect over 30% of the population 70 years of age and older on a monthly basis. These conditions have important impact, since approximately 15% of this population indicate that they have subsequently altered or diminished their physical activity during the past year due to low back pain or neck pain. Roughly the same proportion have sought some kind of treatment. Furthermore, low back pain has been rated as the third most important condition affecting the physical health status of older Americans, after heart and lung disease. Neck pain has also been found to substantially impact function and well-being in this age group. Thus, while low back pain and neck pain are not life threatening conditions, they may lead to reduced functional ability and decreased independence, resulting in serious socio-economic consequences for elderly individuals, their families, and society. Therefore, research aimed at identifying effective prevention and treatment strategies is a high priority.

Continue reading Chiropractic and exercise for seniors with low back pain or neck pain…

Maintenance care in chiropractic

Maintenance care in chiropractic - what do we know?

From: Chiropractic & Osteopathy. 2008 May 8;16(1):3 [Epub ahead of print]

Back problems are often recurring or chronic. It is therefore not surprising that chiropractors wish to prevent their return or reduce their impact. This is often attempted with a long-term treatment strategy, commonly called maintenance care. However, some aspects of maintenance care are considered controversial. It is therefore relevant to investigate the scientific evidence forming the basis for its use.

A review of the literature was performed in order to obtain answers to the following questions: What is the exact definition of maintenance care, what are its indications for use, and how is it practised? How common is it that chiropractors support the concept of maintenance care, and how well accepted is it by patients? How frequently is maintenance care used, and what factors are associated with its use? Is maintenance care a clinically valid method of approach, and is it cost-effective for the patient?

Thirteen original studies were found, in which maintenance care was investigated. The relative paucity of studies, the obvious bias in many of these, the lack of exhaustive information, and the diversity of findings made it impossible to answer any of the questions.

There is no evidence-based definition of maintenance care and the indications for and nature of its use remain to be clearly stated. It is likely that many chiropractors believe in the usefulness of maintenance care but it seems to be less well accepted by their patients. The prevalence with which maintenance care is used has not been established. Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown. Therefore, our conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial.

Continue reading Maintenance care in chiropractic…

Manual therapies for neck pain

Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews

From: Europa Medicophysica. 2007 Mar;43(1):91-118

Manual therapy for neck pain enjoys a long history, with increasing popularity in recent times. The evidence base for manual therapies for neck pain consists of a reasonably large body of clinical trials, an even greater number of systematic reviews and, more recently, a number of practice guidelines. We have conducted several systematic reviews pertaining to the evidence base for both acute and chronic neck pain as well as for the outcome of control groups of chronic neck pain subjects in clinical trials of conservative therapies. In this review, we first provide background material on the definition and characterization of manual therapies as well as on the epidemiology of neck pain. We then review our recent systematic reviews on manual therapies for acute and chronic neck pain without whiplash. Finally, we provide brief, original reviews of, first, the literature on the treatment of whiplash injury by manual therapies followed by the current practice guidelines pertaining to manual therapies for neck pain. While there are several publications, especially those registered with the Cochrane Collaboration, that are currently the authoritative evaluations of the use of manual therapies for neck pain, the present review is designed to present a broad overview of the topic with a distinctive approach emphasizing the analysis of change scores in the clinical trials. It is hoped that this will benefit researchers and clinicians alike in their management of neck pain patients.

Continue reading Manual therapies for neck pain…

Exercise and manipulative therapy for cervicogenic headache and neck pain

A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache

From: Spine. 2002 Sep 1;27(17):1835-43

A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months. To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache (neck related headache) when used alone and in combination, as compared with a control group.

Headaches related to the neck and arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache.

In patients with cervicogenic headache, manipulative therapy and a low load exercise regimen each reduced headache frequency and intensity more than no physical therapy. A combination of manipulative therapy and exercise was not better than each individual therapy for these outcomes.

200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture. The therapeutic exercise used low load endurance exercises to train muscle control of the neck and scapular region.

Continue reading Exercise and manipulative therapy for cervicogenic headache and neck pain…

Neck manipulation and sensorimotor integration

Altered sensorimotor integration with cervical spine manipulation

From: Journal of Manipulative and Physiological Therapeutics. 2008 Feb;31(2):115-26

Investigating changes in the intrinsic inhibitory and facilitatory interactions within the sensorimotor cortex subsequent to a single session of neck manipulation of the cervical spine using single and paired pulse transcranial magnetic stimulation protocols.

Twelve subjects with a history of reoccurring neck pain participated in this study. Short interval intracortical inhibition, short interval intracortical facilitation, motor evoked potentials, and cortical silent periods were recorded from the abductor pollicis brevis and the extensor indices proprios muscles of the dominant limb after single and paired pulse transcranial magnetic stimulation of the contralateral motor cortex. The experimental measures were recorded before and after spinal manipulation of dysfunctional cervical joints, and on a different day after passive head movement. To assess spinal excitability, F wave persistence and amplitudes were recorded after median nerve stimulation at the wrist.

After neck manipulations, there was an increase in short interval intracortical facilitation, a decrease in short interval intracortical inhibition, and a shortening of the cortical silent periods in abductor pollicis brevis. The opposite effect was observed in extensor indices proprios, with a decrease in short interval intracortical facilitation and a lengthening of the cortical silent periods. No motor evoked potentials or F wave response alterations were observed, and no changes were observed after the control condition.

Spinal manipulation of dysfunctional cervical joints in the neck may alter specific central corticomotor facilitatory and inhibitory neural processing and cortical motor control of 2 upper limb muscles in a muscle specific manner. This suggests that spinal manipulation may alter sensorimotor integration. These findings may help elucidate mechanisms responsible for the effective relief of pain and restoration of functional ability documented after spinal manipulation.

Neck injury in a rugby football player

Cervical stenosis in a professional rugby league football player

From: Chiropractic & Osteopathy 2005, 13:15

Recommendations from the available literature at the present time suggest that conservative management of cervical discogenic pain and disc protrusion, including chiropractic manipulation and ancillary therapies, can be successful in the absence of progressive neurological deficit. The current case highlights the initial successful management of a football athlete, and the later unsuccessful management. This case highlights the issues involvement in the management of a collision sport athlete with a serious neck injury.

This case outlines a series of cervical traumas producing neck, arm and head pain. The series of injuries involved forced flexion, compression and lateral deviation away from the painful side. This mechanism is in contrast to the mechanism of extension with lateral deviation towards the painful side as described in the majority of studies of neck injuries in American football and rugby. The clinical signs suggest a disc herniation following repeated trauma resulting in compression of the C7 nerve root.

Continue reading Neck injury in a rugby football player…