Research Abstracts From the Journal of Manipulative and Physiological Therapeutics
February Abstracts Volume 34, Issue 2
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Subclinical Neck Pain: Effects of Cervical Manipulation on Elbow Joint Position Sense
Heidi Haavik, PhD, BSc (Chiro), Bernadette Murphy, PhD, DC
Objective: The objectives of this study were to investigate whether elbow joint position sense (JPS) accuracy differs between participants with a history of subclinical neck pain (SCNP) and those with no neck complaints and to determine whether adjusting dysfunctional cervical segments in the SCNP group improves their JPS accuracy.
Method: Twenty-five SCNP participants and 18 control participants took part in this pre-post experimental study. Elbow JPS was measured using an electrogoniometer (MLTS700, ADInstruments, New Zealand). Participants reproduced a previously presented angle of the elbow joint with their neck in four positions: neutral, flexion, rotation, and combined flexion/rotation. The experimental intervention was high-velocity, low-amplitude cervical adjustments, and the control intervention was a five-minute rest period. Group JPS data were compared, and it was assessed pre- and post-interventions using three parameters: absolute, constant, and variable errors.
Results: At baseline, the control group was significantly better at reproducing the elbow target angle. The SCNP group's absolute error significantly improved after the cervical adjustments when the participants' heads were in the neutral and left-rotation positions. They displayed a significant overall decrease in variable error after the cervical adjustments. The control group participants' JPS accuracy was worse after the control intervention, with a significant overall effect in absolute and variable errors. No other significant effects were detected.
Conclusion: These results suggest that asymptomatic people with a history of SCNP have reduced elbow JPS accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper-limb JPS accuracy.
A Hospital-Based Standardized Spine Care Pathway: Quality and Value of Care
Ian Paskowski, DC, et al.
Objective: A health care facility (Jordan Hospital) implemented a multidimensional spine care pathway (SCP) using the National Center for Quality Assurance (NCQA) Back Pain Recognition Program (BPRP) as its foundation. The purpose of this report is to describe the implementation and results of a multidisciplinary, evidence-based, standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.
Methods: A standardized SCP was developed to improve the quality of back pain care. The NCQA BPRP provided the framework for the SCP to determine the standard of quality care delivered. Patients were triaged, and suitable patients were categorized into one of five classifications based upon history and examination, directional exercise flexion or "extension biases," spinal manipulation, traction, or spinal stabilization exercises.
Results: The findings for 518 consecutive patients were included. One hundred sixteen patients were seen once and triaged to specialty care; 7% of patients received magnetic resonance imagings. Four hundred thirty-two patients (83%) were classified and treated by doctors of chiropractic and/or physical therapists. Results for the patients treated by doctors of chiropractic were mean of 5.2 visits, mean cost per case of $302, mean intake pain rating score of 6.2 of 10, and mean discharge score of 1.9 of 10; 95% of patients rated their care as "excellent."
Conclusions: By adopting the NCQA BPRP as an SCP, training physicians in this SCP, and using a back pain classification, Jordan Hospital Spine Care demonstrated the quality and value of care rendered to a population of patients. This was accomplished with a relatively low cost and with high patient satisfaction.
Comparison of Neck Movement in the Soft Cervical Collar and Rigid Cervical Brace
Katherine Whitcroft, BSc, et al.
Objective: The soft cervical collar has been prescribed for whiplash injury, but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis.
Methods: Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range-of-motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under three conditions: no collar, a soft collar, and a rigid cervical brace.
Results: The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks.
Conclusion: Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.
Upper Cervical Mobilization and Mobilization for Atlantoaxial Osteoarthritis
Hong Yu, MD, et al.
Objective: This study presents the outcomes of patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis who were treated with upper cervical manipulation in combination with mobilization device therapy.
Clinical Features: A retrospective case review of 10 patients who were diagnosed with either degenerative or posttraumatic atlantoaxial arthritis based on histories, clinical symptoms, physical examination, and radiographic presentations was conducted at a multidisciplinary integrated clinic that used both chiropractic and orthopedic services. All 10 patients selected for this series were treated with a combination of upper cervical manipulation and mechanical mobilization device therapy. Outcome measures were collected at baseline and at the end of the treatment period. Assessments were measured using patients' self-report of pain using a numeric pain scale (NPS), physical examination, and radiologic changes. Average premanipulative NPS was 8.6 (range, 7-10), which was improved to a mean NPS of 2.6 (range, 0-7) at posttreatment follow-up. Mean rotation of C1-C2 at the end of treatment was improved from 28° (±3.1) to 52° (±4.5). Restoration of joint space was observed in 6 patients. Overall clinical improvement was described as "good" or "excellent" in about 80% of patients. Clinical improvements in pain and range of motion were seen in 80% and 90% of patients, respectively.
Conclusion: Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients.
Fall Risk Profile and Quality-of-Life Status of Older Chiropractic Patients
Kelly Holt, BSc (Chiro), PGDipHSc, et al.
Objectives: The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status.
Methods: A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.
Results: One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least one fall in the previous 12 months. Of those who had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community-dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04).
Conclusions: A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified.
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