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Choosing Outcome Assessments for Back Pain

Patient-reported outcome measures quantify patients’ subjective symptoms and are often more in line with accomplishing patient-centered goals. Patient-reported outcomes can give valuable information to evaluate the success of a treatment plan and aid in determining a prognosis based on past response. They are also used by insurance companies for re-imbursement purposes, such as determining medical necessity. Chiarotto et al. developed a core outcome set for use in clinical practice with accompanying suggested measures for patients with low back pain.

Author: Zac Shannon
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Research Review: Chiropractic Care and Risk for Acute Lumbar Disc Herniation: a Population-based Self-controlled Case Series Study

The objective of this study was to compare the associations between primary care physician and chiropractic care in relation to acute lumbar disc herniation (LDH) with early surgery. The clinical picture of LDH in the early stages (i.e. the prodromal phase), in which low back pain progresses to radicular leg pain and possible neurologic signs, is often uncertain and can be a confusing time for both patients and clinicians. Thus, making a diagnosis of LDH during the early course of symptoms is often very difficult. The study's hypothesis was that chiropractic care could only be thought to increase the risk for acute LDH if the measured association between chiropractic visits and acute LDH exceeded the association between PCP visits and acute LDH.

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Research Review: Manipulation and Mobilization for Treating Chronic Low Back Pain: a Systematic Review and Meta-analysis

Spinal manipulation and mobilization for the treatment of back and neck pain have been the topic of several systematic reviews, with some suggesting that the evidence in support of the view that spinal manipulative therapy is superior to other standard treatments for chronic low back pain is sparse. On the other hand, more recent systematic reviews have reported that spinal manipulation and mobilization are “viable” options for treating pain. Despite this degree of variability among studies, manipulation and mobilization are still considered to be effective treatments when compared with other therapies. The purpose of this systematic review was to unravel these differences and inconsistent findings. 

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WHO Collaboration Presents Public Health Opportunities for Chiropractic

The World Health Organization (WHO) held its 71st Assembly May 21-26, 2018 at the United Nations headquarters in Geneva. WHO is the directing and coordinating authority on international health, and uses the annual Assembly to set norms and standards for ethical and evidence-based healthcare policy. I had the honor of attending the Assembly this year as part of the World Federation of Chiropractic (WFC) delegation. Over four days of plenary sessions, committee meetings, and technical briefings, I observed an impressive breadth and depth of operations at WHO—and a chiropractic profession that is primed for more meaningful engagement with the broader public health community.

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Research Review: Spinal Manipulation vs. NSAID (Diclofenac) for Acute Low Back Pain

The purpose of this randomized, double-blinded, placebo-controlled, parallel trial was to compare high-velocity low-amplitude spinal manipulation with chemical treatment. In this case, the chemical treatment was diclofenac, a nonsteroidal anti-inflammatory. The trial also included comparison with placebo. Considering the staggering impact of low back pain, the authors of this trial felt there were too few studies comparing spinal manipulation to nonsteroidal anti-inflammatory drugs or placebo. They aimed to test patient satisfaction and function, time off from work, and rescue medication, specifically.

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Evidence-based Diagnosis for Low Back Pain

Health professionals from different disciplines use diverse diagnostic methods to inform clinical management for patients with low back pain. One person may diagnose someone as suffering from sacroiliac joint pain while another might classify the same patient with a movement disorder caused by poor muscle coordination. In a given circumstance, either or both individuals could be right or wrong. However, we can’t realistically discern this until we understand the underlying strength of the diagnostic tests we use.

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Research Review: Clinical Practice Guideline: Chiropractic Care for Low Back Pain

It is now well known that low back pain (LBP) is the leading cause of disability worldwide and that chiropractors can play a pivotal role in the management of this condition. However, the chiropractic profession can achieve wider acceptance and improved cultural authority, particularly within integrated health care delivery systems, by embracing and integrating current scientific research into our approach to evidence-based health care. It is in this context that this Clinical Practice Guideline (CPG) was developed. The aim of this systematic review was to update and combine three previously published clinical guidelines, while answering this question: “What is the effectiveness of chiropractic care, including spinal manipulation (SMT), for nonspecific low back pain?” 

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Does Spinal Manipulation Affect Central Nervous System Pain Mechanisms?

Part of the Evidence in Action series by Palmer College of Chiropractic

Clinical guidelines for adults with acute, subacute, and chronic low back pain support conservative management with spinal manipulative therapy (SMT). Research shows SMT is comparable to other noninvasive treatments in reducing low back pain and disability with relatively low risk for adverse events. However, the mechanisms leading to pain relief from SMT are poorly understood. Identifying therapeutic mechanisms of SMT can inform treatment strategies and lead to more effective care. 

Author: Zac Shannon
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Go “Back to Basics” During National Chiropractic Health Month: Here’s How!

Back pain remains a persistent and debilitating problem for many people in the United States and around the world. News that the opioid crisis in America has been fueled in part by the overprescribing of pain medications for low back pain amplifies the need for the chiropractic profession to continue spreading its message about the value of a conservative approach to back pain treatment. To this end, National Chiropractic Health Month (NCHM) goes “Back to Basics” this year by focusing on overall health and injury prevention as key strategies in maintaining spinal health throughout a lifetime—and highlighting the growing body of research supporting a conservative approach to back pain treatment.

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Research Review: Biological Mechanisms May Provide Insight into Effectiveness of Spinal Manipulation

One of the most complex and misinterpreted lines of research in chiropractic and manual medicine is the immuno-physiological-endocrine (I made up that term, but you know what I mean!) effects of spinal manipulation and other manual interventions.  The research group out of the Canadian Memorial Chiropractic College (CMCC) in Toronto, Canada has done the bulk of the work in this area.  This Research Review discusses their latest publication, which had some very interesting results...enjoy!
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