The JMPT is the premier scientific journal of the chiropractic profession, dedicated to the advancement of chiropractic health care.
Aging Baby Boomers and the Rising Cost of Chronic Back Pain
Monica Smith, DC, PhD, et al.
Objectives: The purposes of this study were to analyze data from the longitudinal Medical Expenditures Panel Survey (MEPS) to evaluate the impact of an aging population on secular trends in back pain and chronicity, and to provide estimates of treatment costs for patients who used only ambulatory services.
Methods: Using the MEPS two-year longitudinal data for years 2000 to 2007, we analyzed data from all adult respondents. Of the total number of MEPS respondent records analyzed (N = 71 838), we identified 12,104 respondents with back pain and further categorized 3,842 as chronic cases and 8,262 as nonchronic cases.
Results: Secular trends from the MEPS data indicate that the prevalence of back pain has increased by 29%, whereas chronic back pain increased by 64%. The average age among all adults with back pain increased from 45.9 to 48.2 years; the average age among adults with chronic back pain increased from 48.5 to 52.2 years. Inflation-adjusted (to 2010 dollars) biennial expenditures on ambulatory services for chronic back pain increased by 129% over the same period, from $15.6 billion in 2000 to 2001 to $35.7 billion in 2006 to 2007.
Conclusion: The prevalence of back pain, especially chronic back pain, is increasing. To the extent that the growth in chronic back pain is caused, in part, by an aging population, the growth will likely continue or accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for prioritizing health policy, clinical practice, and research efforts to improve care outcomes, costs, and cost-effectiveness, and for health work-force planning.
Kinematic Differences Between Two Cervical Manipulation Techniques
Jonathan Williams, PhD, et al.
Objective: The purpose of this study was to quantify the kinematics of the premanipulative position, the angular displacement, and velocity of thrust of two commonly used cervical spine manipulative procedures using inertial sensor technology.
Methods: Thirteen asymptomatic subjects (seven females; mean age, 25.3 years; mean height, 170.9 cm; mean weight, 65.3 kg) received a right-handed and left-handed downslope and upslope manipulation, aimed at C4/5 while cervical kinematics were measured using an inertial sensor mounted on the forehead of the subject. One therapist used the upslope, and another therapist, the downslope, as was their preferred method; t tests were used to compare techniques and handiness.
Results: The results demonstrated differences in the kinematics between the two techniques. The downslope manipulation was associated with a mean premanipulative position of 24.8° side bending and 2.7° rotation, thrust displacement magnitude comprising of 4.5° side bending and 5.4° rotation with thrust velocity comprising, on average, of 57.5°/s side bending and 74.8°/s rotation. Upslope premanipulation was on average comprised of 30.1° side bending and 8.4° rotation, thrust displacement comprised of 4.5° side bending and 12.7° rotation with thrust velocity comprising of 75.9°/s side bending and 194.7°/s rotation.
Conclusion: The results of this study demonstrate that there are different kinematic patterns for these two manipulative techniques.
Intrasubject Reliability of Radiographic Craniocervical Posture
Inae Gadotti, PhD, et al.
Objective: The objective of this study was to measure the reproducibility of the craniocervical posture (intrasubject reliability) of asymptomatic female subjects.
Methods: Two radiographs of the craniocervical posture of 22 female subjects (mean ± SD: age, 28 ± 4.37 years; body mass index, 22.3 ± 3.24 kg/m2) in the sagittal view were taken one week apart and at the same time of day. Their posture was standardized in the self-balance position. Seven angles were measured in the digitalized radiographs and analyzed using the Alcimage software (Uberlândia, Minas Gerais, Brazil). Intraclass correlation coefficient (ICC), SEM, and 95% confidence intervals were analyzed.
Results: Good-to-excellent ICC (ICC, 0.90-0.98) and small SEM (SEM, 0.25-0.70) were found.
Conclusion: The craniocervical posture of the subjects included in this study was reproducible (i.e., intrasubject reliability) when measured a week apart using radiographs.
Paraspinal Cutaneous Temperature in Subjects With and Without Chronic LBP
Richard Roy, DC, PhD, FICC, et al.
Objective: The purpose of this study was to evaluate the effects of chiropractic manipulative treatment on paraspinal cutaneous temperature (PCT) for subjects with chronic low back pain and compare these PCT findings to subjects without chronic low back pain.
Methods: Two groups were created, a symptomatic treatment group (subjects with chronic low back pain, n = 11; seven males, four females) and an asymptomatic, nontreatment group (asymptomatic subjects, n = 10; six males, four females). Outcomes included the modified Oswestry questionnaire and PCT measurements in the prone position after an eight-minute acclimation period. The treatment group received nine chiropractic spinal instrument-based manipulative treatments over two weeks. Re-evaluation was done two weeks after the initial evaluation for both groups.
Results: The preintervention Oswestry results (29.8% ± 11.8%) for the treatment group were higher than the asymptomatic group (10.2% ± 10.6%). The postintervention Oswestry results for the treatment group were 14.20% ± 11.5%. The resulting Cohen’s effect size of the spinal manipulation on the Oswestry evaluation is 0.58. The preintervention PCT showed higher temperature for the nontreatment group compared with the treatment group. Comparing the levels associated with low back pain, the nontreatment group PCT was stable, varying from 0.01°C to 0.02°C, whereas the treatment group PCT varied from 0.10°C to 0.18°C. The treatment group postintervention PCT showed an increase in temperature after the nine visits; however, this did not reach the values of the asymptomatic group.
Conclusion: The PCT readings for subjects with chronic low back pain were lower than the asymptomatic, nontreatment group. The PCT temperature of the treatment group increased after nine treatments.
Manual Therapy for Childhood Respiratory Disease: Literature Review
Vanessa Carina Pepino, et al.
Objective: This study reviewed the scientific evidence available on the effects of manipulative techniques on children with respiratory diseases.
Method: Three databases (SciELO, PEDro, and MEDLINE) were searched for clinical trials on the effects of manual therapy techniques on children and adolescents with respiratory diseases. The relevant studies were chosen by two independent researchers who assessed their abstracts and selected the studies that met the criteria for a complete and structured review.
Results: Of the 1,147 relevant titles, 103 titles were selected for abstract assessment, and of these, 24 were selected for a full-text review. After critical analysis, eight studies were included in the review and 16 were excluded for the following reasons: one covered only conventional therapy, seven were not about the studied theme, and eight included adults. Of the eight studies included in the present review, five consisted of asthmatic children and the others of children with the following conditions: cystic fibrosis, bronchiolitis, recurrent respiratory infections, among others. Only two studies did not identify positive results with the use of manual therapy. The other six studies found some benefit, specifically in spirometric parameters, immunologic tests, anxiety questionnaire, or level of salivary cortisol.
Conclusion: The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.
Collateral Meridian Therapy for Knee Osteoarthritis Pain Relief
Huei-Chi Horng, MD, et al.
Objective: The purpose of this preliminary study was to examine whether collateral meridian (CM) therapy was feasible in treating knee osteoarthritis (OA) pain.
Methods: Twenty-eight patients with knee OA and knee pain were randomly allocated to two groups. The CM group patients received CM therapy, whereas the control patients received placebo treatment for knee pain relief. Patients in the CM group received two CM treatments weekly for three weeks. The outcome measures were pain intensity on a visual analog scale, and knee function was determined using the Western Ontario and McMaster Universities Osteoarthritis Index.
Results: In the CM group, the posttreatment visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were lower than those of the control group; a significant reduction in pain intensity (P = .02, P = .01, respectively) and improvement in knee function (P = .04, P = .03, respectively) were shown in the CM group at the second and third week.
Conclusion: Collateral meridian therapy may be feasible and effective for knee OA pain relief and knee function recovery. Therefore, additional randomized control trials are warranted.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete January 2013 issue of JMPT.