Editor's note: This is a special issue of JMPT dedicated to public health.
Health Status and Modifiable Risk Behavior Among U.S. Adults Using Chiropractic vs. Medical Care
Harrison Ndetan, MSc, MPH, Sejong Bae, PhD, et al.
Objective: The causes of death in the United States have moved from infectious to chronic diseases with modifiable behavioral risk factors. Simultaneously, there has been a paradigm shift in health care provisions with increased emphasis on prevention and health promotion. Use of professional complementary and alternative medicine, such as chiropractic care, has increased. The purpose of this study was to characterize typical conditions, modifiable risk behaviors, and perceived changes in overall general health of patients seeing chiropractors as compared with general medical doctors in the United States.
Methods: Secondary analyses of the National Health Interview Survey 2005 adult sample (n = 31 248) were performed. Multiple logistic regression models were applied to assess associations of health conditions/risk behaviors of patients with the doctors (chiropractors vs medical doctors) they saw within the past 12 months.
Results: Respondents who saw/talked to chiropractors were 9.3%. Among these, 21.4% did not see a medical doctor. Comparing chiropractor-only with medical doctor-only patients, we found no significant difference in smoking/alcohol consumption status, but chiropractor-only patients were more likely to be physically active (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2-1.8) and less likely to be obese (OR, 0.7; 95% CI, 0.6-0.9). Respondents reporting acute neck (OR, 2.7; 95% CI, 2.2-3.2) and low back pain (OR, 2.4; 95% CI, 2.0-2.8) were more likely to have seen a chiropractor.
Conclusions: Based on these analyses, Americans seem to be using chiropractic care for acute neck and low back pain more so than for other health conditions. However, there is no marked difference in their overall health promotion habits and changes in overall general health based on health care provider types.
Chiropractic Care for Older Adults: Effects on Balance, Dizziness and Chronic Pain
Cheryl Hawk, DC, PhD, and Jerrilyn Cambron, DC, PhD
Objective: This study is part of an avenue of research exploring the effect of chiropractic care on balance in older adults. The purpose of this study was to (1) assess the use of the seven-item version of the Berg Balance Scale; (2) explore possible effects of an eight-week course of chiropractic care on balance as measured by the seven-item Short-Form Berg Balance Scale (SF-BBS) in adults 65 years or older with impaired balance; and (3) collect preliminary information on the possible relationships of dizziness and/or chronic pain to poor balance.
Methods: This was a single-group, pretest/posttest design intervention study. Patients 65 years and older who could stand on one leg for less than five seconds were eligible. They received pragmatic chiropractic care for 16 visits for an eight-week period. Outcomes were assessed at baseline, visit eight and visit 16 in terms of balance SF-BBS, dizziness (Dizziness Handicap Inventory [DHI]), chronic pain (Pain Disability Index), and depression (Geriatric Depression Scale).
Results: Sixteen patients were enrolled; 14 completed the study. There was one mild and transient adverse effect, muscle soreness, which self-resolved. One patient was depressed, and his Geriatric Depression Scale score improved significantly during the study. Of the six patients with significant dizziness at baseline, three had scores of 0 (no dizziness) on the DHI at visit 16. Patients with dizziness tended to have greater chronic pain and show greater reductions in that pain than non-dizzy patients. No clinically important effects on balance as measured by the SF-BBS were apparent for the group as a whole, although 3 individual patients improved by four to six points.
Conclusion: The SF-BBS did not show a great deal of clinical responsiveness in this study population. The outcome measures used for chronic pain (Pain Disability Index) and dizziness (DHI) appear to be appropriate for assessing patients in future larger studies for longer periods.
Reliability and Validity of Photogrammetry for Scoliosis Evaluation
Karen Ruggeri Saad, MA, Alexandra Colombo, and Silvia Amado Joao, PhD
Objective: The purpose of this study was to investigate the reliability and validity of photogrammetry in measuring lateral spinal inclination angles.
Methods: Forty subjects (32 female and 8 males) with a mean age of 23.4 +/- 11.2 years had their scoliosis evaluated by radiographs of their trunk, determined by the Cobb angle method, and by photogrammetry. The statistical methods used included Cronbach a, Pearson/Spearman correlation coefficients, and regression analyses.
Results: The Cronbach a values showed that the photogrammetric measures showed high internal consistency, which indicated that the sample was bias free. The radiograph method showed to be more precise with intrarater reliabilities of 0.936, 0.975, and 0.945 for the thoracic, lumbar, and thoracolumbar curves, respectively, and interrater reliabilities of 0.942 and 0.879 for the angular measures of the thoracic and thoracolumbar segments, respectively. The regression analyses revealed a high determination coefficient, although limited to the adjusted linear model between the radiographic and photographic measures. It was found that with more severe scoliosis, the lateral curve measures obtained with photogrammetry were for the thoracic and lumbar regions (R = 0.619 and 0.551).
Conclusions: The photogrammetric measures were found to be reproducible in this study and could be used as supplementary information to decrease the number of radiographs necessary for the monitoring of scoliosis.
Personal and Professional Immunization Behavior Among Alberta Chiropractors
Emily Medd, BScH, and Margaret Russell, MD, PhD
Objectives: This study examined the relationship [between] chiropractors' personal immunization decisions, the vaccination status of their children, and their interest in referring patients for immunization.
Methods: This was a secondary analysis of data collected in a 2002 postal survey of Alberta chiropractors (response rate, 78.2%). Analysis was restricted to chiropractors with children (n = 325). Chiropractors indicated their own vaccination status, that of their children, and their interest in referring patients for immunization. Data analysis included frequencies, cross tabulations, and logistic regression models (a = .05).
Results: Most respondents were male (83.4%), had more than one child (71.8%), and had graduated from chiropractic college a median of 13 years before the survey. Of the chiropractors, 92.6% had ever been immunized, but only 35.7% would accept immunization for themselves in the future. Further, 66.8% had at least one immunized child, and 21.8% indicated interest in referring patients for immunization. Chiropractors who would accept immunization for self in the future, compared with those who would not, were more likely to indicate interest in patient referral for immunization (odds ratio, 11.4; 95% confidence interval, 5.4-24.0; P<.001). Chiropractors who have at least one immunized child, compared with those with none immunized, were 6.2 times more likely to indicate interest in referring patients for immunization (odds ratio, 6.2; 95% confidence interval, 1.4-28.4; P = .018).
Conclusions: Alberta chiropractors are consistent in their personal and professional behaviors. Chiropractors who accept vaccinations for themselves or their children are more likely to refer patients to public health for immunizations.
A Model Framework for Patient Safety Training in Chiropractic: A Literature Synthesis
Beatrice Zaugg, DC, MME, and Martin Wangler, DC, MME
Objective: The objective of this review is to develop an evidence-focused and work-based model framework for patient safety training; that is, reporting and learning from adverse events in chiropractic care. This article will not debate specific issues of adverse events from spinal manipulation. The main focus is on education for patient safety.
Methods: We conducted a systematic search and synthesized 196 articles on patient safety to provide guidance. The review was carried out by the two authors independently in three ways: research type, relevancy with respect to patient safety, safety culture or climate, and distinct description of one or more of the adapted Bland's characteristics.
Results: Fifty-five articles were included. Their review provided knowledge acquisition and practice behavior regarding patient safety issues and excellent baseline data on reporting and learning of adverse events for training purpose.
Conclusions: Leadership, commitment, and communication together with trust and openness to build a culture of patient safety are prerequisites for successful reporting and learning.
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