Posts

Dr. Kevin Haussler

Dr. Haussler graduated from The Ohio State University, College of Veterinary Medicine in 1988 and completed a small animal internship in Sacramento, CA.  To further his training in the conservative management of spinal-related disorders, he pursued human training at Palmer College of Chiropractic-West and completed a veterinary chiropractic certification program in 1993.  He attended the University of California-Davis to attain a PhD focusing on spinal pathology and pelvic biomechanics in Thoroughbred racehorses.   Currently, he is an Associate Professor at the Orthopaedic Research Center at Colorado State University and is involved in teaching, clinical duties, and research into the objective assessment of musculoskeletal pain, spinal dysfunction and the application of physical therapy and rehabilitation. Please comment below if you have any questions for us during the interview. I might choose some of them for our conversation.

I am excited for the opportunity to discuss chiropractic research with Drs. Peterson and Humphreys in the near future. Cynthia Peterson, RN, DC, DACBR, M.Med.Ed. has worked as a chiropractic radiologist, researcher and educator in 4 countries.  She retired from her positions as Professor and researcher, Radiology Department, Orthopaedic University hospital Balgrist and Professor, Chiropractic Medicine Programme, University of Zürich in 2017.  She is currently a Visiting Professor for the Chiropractic Department in the Faculty of Health at the University of Johannesburg, South Africa and is the Quality Assurance Consultant for the European Council on Chiropractic Education.  Barry Kim Humphreys, BSc, DC, PhD, is Professor Emeritus, Faculty of Medicine, University of Zurich. He retired in July 2017, after 9 years as the first Professor for Chiropractic Medicine in Switzerland. During this time, Professor Humphreys was responsible for the development and accreditations of the chiropractic education program, research portfolio and teaching clinic within the university, medical faculty and teaching hospital. He has been active in research including chiropractic clinical outcome studies for back and neck pain, functional MRI studies of chronic pain patients and back pain in various gravitational environments (parabolic flight).  Please comment below if you have any questions for us during the interview. I might choose some of them for our conversation.

Chiropractic care can be complicated for patients because of its specialized terminology for assessment, treatment plans, symptom trajectories, and potential for benign adverse events.  One solution is for chiropractors to adopt functional health literacy, interactive health literacy, and critical health literacy into patient-centered chiropractic care. Health literacy empowers patients of all backgrounds to “read” and “listen” to their bodies, verbally communicate their thoughts and needs during the chiropractic visit, and access print and digital technologies to optimize their health outcomes. See here for our recent poster describing health literacy within the chiropractic profession (https://chiropracticscience.com/advancing-a-framework-for-chiropractic-health-literacy/). 

Based upon several U.S. and international consensus studies (2017), we advocate for chiropractors and D.C. students to use, implement, and practice health literacy competencies developed by Coleman et al. (2013 & 2017). We propose the adoption of a Health Literacy Curriculum (HLC) for chiropractors, because other health and medical professionals are adopting these competencies also.

The top consensus recommendation by the Coleman et al study (2017) was to use a “teach back” or “show me” technique with patients to check for understanding and correct misunderstandings, during the clinical visit and and during the informed consent process. In this regard, patients are asked to demonstrate their level of understanding by repeating back in their own words the information the professional has communicated to them.  To learn more about the other health literacy recommendations, please look at our poster or visit the link below to the Coleman study.

References:

Coleman, C., Hudson, S., & Pederson, B. (2017). Prioritized health literacy and clear communication practices for health care professionals. HLRP: Health Literacy Research and Practice, 1(3): e91-e99 https://doi.org/10.3928/24748307-20170503-01

Coleman, C. A., Hudson, S., & Maine, L.L. (2013). Health literacy practices and educational competencies for health professionals: a consensus study.Journal of Health communication,18 Suppl 1(Suppl 1), 82-102.

Upcoming interview with Dr. Katie de Luca.  Katie de Luca is a post-doctoral research fellow in the Department of Chiropractic at Macquarie University. She is a chiropractor in clinical practice, however her research focuses on the epidemiology and management of musculoskeletal conditions, with expertise in the elderly. In 2016 she was awarded her PhD from the University of Newcastle, School of Medicine and Public Health. Her thesis explored the experience of pain in women with arthritis, and resulted in substantial contributions to fields of rheumatology, pain and ageing research. She has 25 peer-reviewed journal publications and more than 50 conference presentations, which includes several invited keynote presentations on back pain in the elderly. These have been at regional, national and international conferences in gerontology, pain, public health and chiropractic forums. She is on the editorial boards of Chiropractic and Manual Therapies and JMPT, and peer-reviews for another 13 journals.  Please comment below if you have any questions for us during the interview. I might choose some of them for our conversation.

Upcoming interview with Dr. Anthony Lisi.  We will be discussing chiropractic research and the state of chiropractic in the VA. Dr. Lisi is the Chiropractic Program Director for the US Veterans Health Administration, overseeing all national programmatic issues related to the integration of chiropractic clinical services, education and research. He is also an Associate Research Scientist at the Yale Center for Medical Informatics, Yale University School of Medicine. He has authored numerous peer-reviewed publications on topics including low back pain management, spinal manipulation, interprofessional education, and chiropractic services. Dr. Lisi received the American Chiropractic Associations’ 2015 Academician of the Year award, and the 2017 Chiropractor of the Year award.   Please comment below if you have any questions for us during the interview. I might choose some of them for our conversation.

podcast picture of microphonePodcasts are increasingly being used for health professionals’ education. They are utilized by individual practitioners, teaching institutions, and many major journals are adding podcasts to their offerings. To date, there are no evidence-based guidelines for the development of educational podcasts.

Below are some snippets regarding the evidence base for podcasts from the recent literature.

“This study suggests that podcasts and blog posts are useful for extracurricular knowledge acquisition by undergraduate medical students with no significant difference between the two modalities. The usage conditions for each type of media differ.” https://www.ncbi.nlm.nih.gov/pubmed/29552428

“Participants who completed the assessments demonstrated an effect of learning. The top three activities participants were engaged in while listening to the podcasts were driving (46%), completing chores (26%), and exercising (23%).”
https://www.ncbi.nlm.nih.gov/pubmed/29464137

How about speeding up the playback on the podcast to 1.5x?  Does it make a difference? “These findings suggest that, unlike previously published studies that showed subjective improvement in performance with sped-up video-recorded lectures compared to normal speed, objective performance may be worse.”
https://www.ncbi.nlm.nih.gov/pubmed/29383063

“Podcasts are an effective method for medical residents to learn from pharmacy students and may also improve pharmacy students’ confidence in their abilities.”
https://www.ncbi.nlm.nih.gov/pubmed/29233443

“There is limited evidence showing the efficacy of podcasts as teaching tools, or regarding best practices in making podcasts. More rigorous studies evaluating efficacy, changes in behavior, and changes in patient outcomes need to be performed in order to prove podcasts‘ value and to justify production costs.”
https://www.ncbi.nlm.nih.gov/pubmed/29207454

 

 

In this upcoming interview, John M. Mayer, DC, PhD, CCRP, FACSM will discuss his extensive clinical and research experience in occupational health, wellness, and therapeutic exercise. Dr. Mayer has led teams on numerous clinical trials across the country on various aspects of wellness, clinical management, and prevention funded through federal, state, industry, and foundation sources, including the largest single financial commitment by the US Department of Homeland Security on low back injury prevention in firefighters. Please comment below if you have any questions for us during the interview. I might choose some of them for our conversation.

Chiropractic Neck AdjustmentThere is a growing trend of chiropractic use in adults. In a recent survey of US adults who used chiropractic services, back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. Most of the survey respondents reported consulting a chiropractor for general wellness or disease prevention (43.3%), to improve their energy (16.3%), or to improve athletic or sports performance (15.4%). Many reported positive outcomes of chiropractic utilization agreeing that such care had helped them to improve overall health and make them feel better (66.9%), to sleep better (41.9%), and to reduce stress or to relax (40.2%). Almost half of all adults surveyed (47.9%) felt that chiropractic was very important for maintaining health and well-being, and another 30% felt it was somewhat important.

Reference: Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. Spine (Phila Pa 1976). 2017 Dec 1;42(23):1810-1816.

In this update, I will summarize key points from recent scientific literature regarding the practice of chiropractic, patient profiles, utilization rates, chiropractic assessment and care methods.  Much of the information comes from the excellent work of Beliveau et al (2017) who did a scoping review and used 337 articles from across the globe. I have provided references to other key papers also.

Chiropractors practice in over 100 countries.  There are 90 existing national chiropractic associations across the world. Chiropractic has become one of the most commonly used health professions in the United States and Europe. A substantial proportion of US adults utilize chiropractic services and report associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common (1). Chiropractors provide a significant amount of care for patients with many health conditions including low back and neck pain. The profession is a major participant in the health care expenditures of the United States and Denmark. As an example, here in the United States in 2015, chiropractors provided 18.6 million clinical services under Medicare and overall spending for chiropractic services was estimated at USD $12.5 billion (Beliveau et al, 2017).

According to the American Chiropractic Association (2), there are 77,000 chiropractors in the United States with roughly another 3,000 chiropractors that work in academic and management roles. There are approximately 10,000 chiropractic students in 18 nationally accredited, chiropractic doctoral programs across the United States with 2,500 chiropractors entering the work environment each year. Estimates indicate that chiropractors treat more than 35 million Americans (adults and children) annually. Chiropractors are designated as physician-level providers in the vast majority of states and the federal Medicare program. The essential services provided by chiropractors are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs (VA) and Defense, Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs. Chiropractic is currently offered at 75 VA facilities and 66 military hospitals/clinics.

National and international guidelines include chiropractic (spinal manipulation) for low back pain (LBP) and neck pain. A short summary (3-4) of recent guidelines include:

  • For acute and chronic LBP, a review of clinical practice guidelines (CPGs) on the noninvasive management of LBP and 3 national CPGs published since 2016 in the United States (Agency for Healthcare Research and Quality [AHRQ] comparative effectiveness review [CER]), the UK (National Institute for Care Excellence [NICE]), and Denmark (Denmark National Guideline) recommend considering manual therapy, including SMT, mobilization, or soft tissue techniques such as massage
  • An additional CPG, by the American College of Physicians (ACP), recommends clinicians select nonpharmacologic treatment for acute and chronic LBP (superficial heat, massage, acupuncture, and SMT) before pharmacologic treatment options

Chiropractic utilization rates

  • Across the world, 52 studies (Beliveau et al, 2017) have found the median 12-month use of chiropractic services was 9.1% and lifetime utilization was 22.2%
  • In Canada and the United States there has been an increased 12 month utilization rate from 10% to 11.7% and from 7.2% to 10.7% respectively from the 1980’s until 2015

Who delivers spinal manipulation?

  • Among the 8.5% of US adults who reported receiving manipulation, 97.6% saw chiropractors according to the 2012 National Health Interview Survey (5)

Reasons for seeing a chiropractor

  • For the general population, the most common reasons for seeking care from a chiropractor included: low back pain (49.7%), neck pain (22.5%), extremity problem (10%), wellness/maintenance (7.5%), hip pain (7%), headache (5.5%)
  • For the pediatric population, the most common reasons for seeking care from a chiropractor included: musculoskeletal conditions (44%), excessive crying (19.8%), neurologic conditions (17.9%), gastrointestinal conditions (17.5%), ear/nose/throat conditions (8.3%) and infection (7%) (Beliveau et al, 2017)

Profile of chiropractic patients

  • People who sought chiropractic care were more likely to be female with a median age of 43.4 years
  • 3% of the chiropractic patient population were employed, and a smaller proportion were either retired, unemployed, or students
  • People with disabilities constituted only 1.4% of chiropractic patients (Beliveau et al, 2017)

Types of chiropractic assessments used in practice

  • The most common assessment methods included: static palpation (89.3%), motion palpation (86.5%), spinal examination (79.5%), orthopedic examination (71.8%), neurological examination (64.6%) (Beliveau et al, 2017)

Types of chiropractic treatment provided

  • Across the globe, spinal manipulation (79.3%), soft-tissue therapy (35.1%), formal patient education (31.3%), nutritional supplements (30.9%), exercise instruction/prescription (26%)
  • Interestingly the NBCE (National Board of Chiropractic Examiners) found that in the US: 98.8% of chiropractors provide ergonomic/postural advice, 98.5% of chiropractors provide physical fitness/exercise promotion and 97% of chiropractors provide nutritional/dietary recommendations (Beliveau et al, 2017)

References:

Main Source: Beliveau PJH, Wong JJ, Sutton DA et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017 Nov 22;25:35.

1. Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. Spine (Phila Pa 1976). 2017 Dec 1;42(23):1810-1816.

2. https://www.acatoday.org/Patients/Why-Choose-Chiropractic/Key-Facts

3. Wong JJ, Côté P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain 2016;21(2):201-16.

4. Bussières AE, Gauthier CA, Fournier G, Descarreaux M. Spinal manipulative therapy for low back pain-time for an update. Can Fam Physician. 2017 Sep;63(9):669-672.

5. Forte ML, Maiers M. Functional Limitations in Adults Who Utilize Chiropractic or Osteopathic Manipulation in the United States: Analysis of the 2012 National Health Interview Survey. J Manipulative Physiol Ther. 2017 Nov -Dec;40(9):668-675.

There was a low recurrence rate (using a stringent definition of recurrence) in a large population of patients with low back pain (LBP) up to 1 year after chiropractic care. However, the vast majority of patients were not pain free after 1 year. This is the conclusion of a recent observational study published in the Journal of Manipulative and Physiological Therapeutics.

Patients in the study were located in Switzerland.  Seven hundred and twenty-two patients with LBP (375 male) completed the Numeric Rating Scale for pain (NRS) and the Oswestry Disability Index (ODI) before chiropractic treatment and 1, 3, 6, and 12 months later (ODI up to 3 months). Patients were then categorized based on pain rating scores into “fast recovery,” “slow recovery,” “recurrent,” “chronic,” and “others.”

Based on these pain ratings, 13.4% of the patients were categorized as recurrent. The recurrent pattern significantly differed from fast recovery in duration of complaint. The duration of complaint before treatment was the main predictor for recurrence. Specifically, a subacute duration, defined in the present study as longer than 14 days, significantly increased the odds for an unfavorable course of LBP, which is of clinical relevance.

Reference: Knecht C, Humphreys BK, Wirth B. An Observational Study on Recurrences of Low
Back Pain During the First 12 Months After Chiropractic Treatment. J Manipulative
Physiol Ther. 2017 Jul – Aug;40(6):427-433.

 

 

Podcast

Dr. Ken Weber

Dr. Ken Weber and I discuss his research pursuits which involve: 1) developing imaging modalities that are more sensitive and specific to the pathology, providing more diagnostic, prognostic, and predictive information; 2) providing more quantitative information to the clinician; and 3) using these measures to better understand the nervous system and how it functions, the neurophysiology of pain, how treatments work, and why certain treatments work for some patients but not for others. Dr. Ken Weber is an Instructor in the Department of Anesthesia, Perioperative and Pain Medicine at Stanford University. He obtained his Doctor of Chiropractic from Palmer College of Chiropractic Florida in 2009 and then completed a PhD in neuroscience at Northwestern University in 2016, specializing in movement and rehabilitation science. Ken’s research intersects clinical pain research and advanced MRI techniques with an emphasis on brain, spinal cord, and musculoskeletal imaging. His research aims to better understand the neural and musculoskeletal changes underlying clinical pain conditions, the mechanisms of treatments, and predictors for recovery. Ken is currently supported by a K23 Mentored Patient-Oriented Research Career Development Award from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. His previous funding has included the National Center for Complementary and Integrative Health, the National Institute on Drug Abuse, and the NCMIC Foundation, Inc.

I’d also like to point out that Ken was recently selected to be part of the CARL (Chiropractic Academy for Research Leadership) program

View Dr. Weber‘s research at researchgate.net.

Here are some of the papers we discuss in this episode.

1. Machine Learning for the Prediction of Cervical Spondylotic Myelopathy: A Post Hoc Pilot Study of 28 Participants.
  Hopkins BS, Weber KA 2nd, Kesavabhotla K, Paliwal M, Cantrell DR, Smith ZA.
  World Neurosurg. 2019 Jul;127:e436-e442. doi: 10.1016/j.wneu.2019.03.165. Epub 2019 Mar 25.
  PMID: 30922901 [PubMed – indexed for MEDLINE]
  Similar articles
2. Are Magnetic Resonance Imaging Technologies Crucial to Our Understanding of Spinal Conditions?
  Crawford RJ, Fortin M, Weber KA 2nd, Smith A, Elliott JM.
  J Orthop Sports Phys Ther. 2019 May;49(5):320-329. doi: 10.2519/jospt.2019.8793. Epub 2019 Mar 26.
  PMID: 30913967 [PubMed – in process]
  Similar articles
3. Lateral Corticospinal Tract Damage Correlates With Motor Output in Incomplete Spinal Cord Injury.
  Smith AC, Weber KA 2nd, O’Dell DR, Parrish TB, Wasielewski M, Elliott JM.
  Arch Phys Med Rehabil. 2018 Apr;99(4):660-666. doi: 10.1016/j.apmr.2017.10.002. Epub 2017 Oct 26.
  PMID: 29107041 [PubMed – indexed for MEDLINE] Free PMC Article
  Similar articles
4. Evidence for decreased Neurologic Pain Signature activation following thoracic spinal manipulation in healthy volunteers and participants with neck pain.
  Weber Ii KA, Wager TD, Mackey S, Elliott JM, Liu WC, Sparks CL.
  Neuroimage Clin. 2019;24:102042. doi: 10.1016/j.nicl.2019.102042. Epub 2019 Oct 18.
  PMID: 31670070 [PubMed – in process] Free PMC Article
  Similar articles
5. Deep Learning Convolutional Neural Networks for the Automatic Quantification of Muscle Fat Infiltration Following Whiplash Injury.
  Weber KA, Smith AC, Wasielewski M, Eghtesad K, Upadhyayula PA, Wintermark M, Hastie TJ, Parrish TB, Mackey S, Elliott JM.
  Sci Rep. 2019 May 28;9(1):7973. doi: 10.1038/s41598-019-44416-8.
  PMID: 31138878 [PubMed – in process] Free PMC Article
  Similar articles

Dr. William Reed is an Associate Professor in the School of Health Professions, Department of Physical Therapy at University of Alabama at Birmingham. He is the director of the Mechanisms of Spinal Manual Therapy Laboratory. His research is directed towards determining the peripheral and central mechanisms of spinal manipulation (manual therapy) for the treatment of musculoskeletal pain.  He is also the Interim Co-Director of the PhD program in Rehabilitation Science at the University of Alabama at Birmingham. Here we discuss some of Dr. William Reed’s research starting with his introduction to research as a chiropractic student in 1994 then we’ll discuss his work with Dr. Joel Pickar, his K01 award topic, and progressing to his latest line of research on characterization of a rat LBP model and spinal mobilization mechanisms. 

See more of Dr. Reed’s research at researchgate.net.

The articles we discuss in this episode include:

1.
Chiropractic management of primary nocturnal enuresis.
Reed WR, Beavers S, Reddy SK, Kern G.
J Manipulative Physiol Ther. 1994 Nov-Dec;17(9):596-600.
PMID: 7884329 Clinical Trial.
2.
Relationship between Biomechanical Characteristics of Spinal Manipulation and Neural Responses in an Animal Model: Effect of Linear Control of Thrust Displacement versus Force, Thrust Amplitude, Thrust Duration, and Thrust Rate.
Reed WR, Cao DY, Long CR, Kawchuk GN, Pickar JG.
Evid Based Complement Alternat Med. 2013;2013:492039. doi: 10.1155/2013/492039. Epub 2013 Jan 20.
PMID: 23401713 Free PMC article.
3.
Paraspinal Muscle Spindle Response to Intervertebral Fixation and Segmental Thrust Level During Spinal Manipulation in an Animal Model.
Reed WR, Pickar JG.
Spine (Phila Pa 1976). 2015 Jul 1;40(13):E752-9. doi: 10.1097/BRS.0000000000000915.
PMID: 25856263 Free PMC article.
4.
Neural responses to the mechanical characteristics of high velocity, low amplitude spinal manipulation: Effect of specific contact site.
Reed WR, Long CR, Kawchuk GN, Pickar JG.
Man Ther. 2015 Dec;20(6):797-804. doi: 10.1016/j.math.2015.03.008. Epub 2015 Mar 27.
PMID: 25841562 Free PMC article.
5.
Spinal Mobilization Prevents NGF-Induced Trunk Mechanical Hyperalgesia and Attenuates Expression of CGRP.
Reed WR, Little JW, Lima CR, Sorge RE, Yarar-Fisher C, Eraslan M, Hurt CP, Ness TJ, Gu JG, Martins DF, Li P.
Front Neurosci. 2020 Apr 30;14:385. doi: 10.3389/fnins.2020.00385. eCollection 2020.
PMID: 32425750 Free PMC article.

 

Check out related chiropractic science podcasts on neurophysiology and the brain.

Dr. Kevin Haussler, DVM, DC, PhD

Kevin Haussler, DVM, DC, PhD and I discuss his research regarding chiropractic and horses.  In particular we discuss four themes in this interview: 1) How chiropractic techniques can be applied to horses; 2) How do you know you are making a difference (objective outcome measures)?; 3) Effects of mobilization versus manipulation in horses; 4)Controlled clinical trials in horses with acute versus chronic back pain.

Dr. Haussler graduated from The Ohio State University, College of Veterinary Medicine in 1988 and completed a small animal internship in Sacramento, CA.  To further his training in the conservative management of spinal-related disorders, he pursued human training at Palmer College of Chiropractic-West and completed a veterinary chiropractic certification program in 1993.  He attended the University of California-Davis to attain a PhD focusing on spinal pathology and pelvic biomechanics in Thoroughbred racehorses.  Post-doctorate training involved evaluation of in-vivo spinal kinematics in horses at Cornell University.  While at Cornell, he directed the newly formed Integrative Medicine Service which provided chiropractic, acupuncture and physical therapy services to both small and large animals.  Currently, he is an Associate Professor at the Orthopaedic Research Center at Colorado State University and is involved in teaching, clinical duties, and research into the objective assessment of musculoskeletal pain, spinal dysfunction and the application of physical therapy and rehabilitation. Dr. Haussler is a charter diplomate of the American College of Veterinary Sports Medicine and Rehabilitation and is currently a course instructor for the Equine Rehabilitation Certification course co-branded by the University of Tennessee and Colorado State University.

View Dr. Haussler’s research at researchgate.net

Below are the articles we discuss in this interview.

1. Haussler KK. Review of Manual Therapy Techniques in Equine Practice. Journal of Equine Veterinary Science. 2009;29(12):849-69.
2. Haussler KK, Erb HN. Pressure algometry for the detection of induced back pain in horses: a preliminary study. Equine Vet J. 2006;38(1):76-81.
3. Haussler KK, Hill AE, Puttlitz CM, McIlwraith CW. Effects of vertebral mobilization and manipulation on kinematics of the thoracolumbar region. Am J Vet Res. 2007;68(5):508-16.
4. Haussler KK, Manchon PT, Donnell JR, Frisbie DD. Effects of Low-Level Laser Therapy and Chiropractic Care on Back Pain in Quarter Horses. Journal of Equine Veterinary Science. 2020;86:102891.
5. Sullivan KA, Hill AE, Haussler KK. The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs. Equine Vet J. 2008;40(1):14-20.

To see other chiropractic research on mobilization and manipulation here.

Drs. Imran Niazi and Kelly Holt

Drs. Imran Niazi and Kelly Holt discuss with me their research on chiropractic, falls risk, and neuroplasticity in various populations. Imran Khan Niazi received his B.Sc. degree in Electrical engineering (specialisation: Biomedical Engineering) from the Riphah International University, Islamabad, Pakistan, in 2005, and his  Masters in biomedical engineering from University & FH Luebeck, Luebeck, Germany in 2009. Later he got his PhD under the supervision of Prof. Dario Farina from Center of sensory-motor interaction, Health Science Technology Department, University of Aalborg, Aalborg, Denmark in 2012. After working as a postdoc for a year, he moved to New Zealand in 2013, where he is currently working as Senior Research Fellow at New Zealand College of Chiropractic. He has an adjunct position in Aalborg University, Denmark and Auckland University of Technology, New Zealand.

Dr. Niazi is interested in studying and understanding the altered mechanism of motor control and learning in neurological disorder to develop various technologies that can enhance the QOL of these patients. He has successfully co-supervised 4 PhD and 31 master thesis and currently has 4 active PhD students. He has authored 46 peer-reviewed journal papers and 82 conference papers (proceedings and extended abstracts including). His work has been cited more than 1100 times, and have an h-index of 16 according to google scholar. Over the last ten year, he has received funding worth around US $ 1.5 million from various sources. He is currently working as a review editor for Frontiers in Robotics and AI (Biomedical Robotics) and reviewer for more than 25 engineering/neuroscience journals.

Dr. Kelly Holt was a member of the 1998 inaugural graduating class of the New Zealand College of Chiropractic. Besides his chiropractic degree he also holds a Bachelor of Science majoring in physiology and a PhD in Health Science from the University of Auckland. His PhD focused on the effects of chiropractic care on sensorimotor function and falls risk in older adults. He has published work in a number of peer reviewed journals that investigated the effects of chiropractic care on nervous system function and the reliability of vertebral subluxation indicators and has won a number of international research awards. Kelly worked in private practice as a chiropractor for 10 years following graduation and has taught at the New Zealand College of Chiropractic since 2000 and is currently the Dean of Research at the College.   Kelly was named ‘Chiropractor of the Year’ by the New Zealand College of Chiropractic Alumni Association in 2012 and by the New Zealand Chiropractors’ Association in 2014.

View Dr. Imran Niazi’s research at researchgate.net and Dr. Kelly Holt’s research at researchgate.net.

In addition to Drs. Imran Niazi and Kelly Holt, you might also be interested in listening to the previous episode with Dr. Heidi Haavik, also from New Zealand College of Chiropractic discussing “brain adjustments”.

Below are the studies that we discuss in this interview.

1. The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients.
  Holt K, Niazi IK, Nedergaard RW, Duehr J, Amjad I, Shafique M, Anwar MN, Ndetan H, Turker KS, Haavik H.
  Sci Rep. 2019 Feb 25;9(1):2673. doi: 10.1038/s41598-019-39577-5.
  PMID: 30804399 [PubMed – in process] Free PMC Article
  Similar articles
2. The effects of a single session of spinal manipulation on strength and cortical drive in athletes.
  Christiansen TL, Niazi IK, Holt K, Nedergaard RW, Duehr J, Allen K, Marshall P, Türker KS, Hartvigsen J, Haavik H.
  Eur J Appl Physiol. 2018 Apr;118(4):737-749. doi: 10.1007/s00421-018-3799-x. Epub 2018 Jan 11.
  PMID: 29327170 [PubMed – indexed for MEDLINE] Free PMC Article
  Similar articles
3. Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial.
  Holt KR, Haavik H, Lee AC, Murphy B, Elley CR.
  J Manipulative Physiol Ther. 2016 May;39(4):267-78. doi: 10.1016/j.jmpt.2016.02.003. Epub 2016 Apr 2.
  PMID: 27050038 [PubMed – indexed for MEDLINE]
  Similar articles
4. Changes in H-reflex and V-waves following spinal manipulation.
  Niazi IK, Türker KS, Flavel S, Kinget M, Duehr J, Haavik H.
  Exp Brain Res. 2015 Apr;233(4):1165-73. doi: 10.1007/s00221-014-4193-5. Epub 2015 Jan 13.
  PMID: 25579661 [PubMed – indexed for MEDLINE]
  Similar articles

In this episode, Dr. Jeff Hebert discusses back pain in young people, the link between back pain, health behavior and cardiovascular disease & sport participation as a health intervention. Jeff Hebert, DC, PhD is a Professor and the CCRF/NBHRF Chair of Musculoskeletal Health Research at the University of New Brunswick, as well as an Adjunct Professor at Murdoch University in Australia. Jeff’s career to date includes 18 years of experience in faculty, clinical, and administrative positions in Canada, the United States, and Australia.  Most recently, he was the Associate Dean (Research) in Murdoch University’s School of Psychology and Exercise Science. Previous appointments include positions as a Senior Lecturer of Rehabilitation Science (Murdoch University) and Assistant Professor of Neurosurgery (University of Utah). He has earned a Bachelor’s degree in Psychology (University of Denver) as well as a Doctorate in Chiropractic (Palmer College) and PhD in Exercise Science (University of Utah). He serves as an Associate Editor for the journal Chiropractic & Manual Therapies. Before pursuing an academic career, Jeff worked as an outpatient and hospital-based clinician in multidisciplinary environments including as pain medicine, sports medicine, and spine surgery.

View Dr. Hebert’s research publications at researchgate.net.

Here are the articles that we discussed in this episode of the chiropractic science podcast.

1. Pubertal development and growth are prospectively associated with spinal pain in young people (CHAMPS study-DK).
  Hebert JJ, Leboeuf-Yde C, Franz C, Lardon A, Hestbæk L, Manson N, Wedderkopp N.
  Eur Spine J. 2019 Feb 11. doi: 10.1007/s00586-019-05905-6. [Epub ahead of print]
  PMID: 30740638 [PubMed – as supplied by publisher]
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2. The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain: a 9-year population-based prospective cohort study.
  Hebert JJ, Kjaer P, Fritz JM, Walker BF.
  Spine (Phila Pa 1976). 2014 Aug 1;39(17):1417-25. doi: 10.1097/BRS.0000000000000424.
  PMID: 24859576 [PubMed – indexed for MEDLINE]
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3. Physical activity is prospectively associated with spinal pain in children (CHAMPS Study-DK).
  Franz C, Møller NC, Korsholm L, Jespersen E, Hebert JJ, Wedderkopp N.
  Sci Rep. 2017 Sep 14;7(1):11598. doi: 10.1038/s41598-017-11762-4.
  PMID: 28912463 [PubMed – in process] Free PMC Article
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4. The Prospective Association of Organized Sports Participation With Cardiovascular Disease Risk in Children (the CHAMPS Study-DK).
  Hebert JJ, Klakk H, Møller NC, Grøntved A, Andersen LB, Wedderkopp N.
  Mayo Clin Proc. 2017 Jan;92(1):57-65. doi: 10.1016/j.mayocp.2016.08.013. Epub 2016 Nov 16.
  PMID: 27865444 [PubMed – indexed for MEDLINE]
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Martha Funabashi, is a PhD currently working as a clinical research scientist at CMCC. She is also a CARL fellow and the co-lead study coordinator of SafetyNET – an international and multidisciplinary research team to support patient safety among spinal manipulative therapy (SMT) providers. Martha has a Bachelor’s Degree in Physiotherapy and a Master’s Degree in Neuroscience from the University of Sao Paulo – Brazil. She completed her PhD in Rehabilitation Sciences at the University of Alberta under the supervision of Dr. Greg Kawchuk and her post-doctoral fellowship also at the University of Alberta with Dr. Sunita Vohra. Martha’s research interests and passion are on the SMT’s biomechanics, underlying mechanisms, force-time characterization and its safety aspects. Martha has 26 peer-reviewed scientific journal publications, over 40 conference presentations and is on the editorial boards for peer review journals, such as Chiropractic and Manual Therapies. Martha has won research prizes, including the New Investigator Award at the World Federation of Chiropractic Conference 2017 and works in collaboration with emerging and well-known researchers around the world.

Dr. Funabashi’s email is: MFunabashi@cmcc.ca

See Dr. Funabashi’s publications at researchgate.net.

Here is a list of the articles Dr. Funabashi and I discussed on the podcast.

1. SafetyNET Community-based patient safety initiatives: development and application of a Patient Safety and Quality Improvement Survey.
  Funabashi M, Pohlman KA, Mior S, O’Beirne M, Westaway M, De Carvalho D, El-Bayoumi M, Haig B, Wade DJ, Thiel HW, Cassidy JD, Hurwitz E, Kawchuk GN, Vohra S.
  J Can Chiropr Assoc. 2018 Dec;62(3):130-142.
  PMID: 30662067 [PubMed] Free PMC Article
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2. Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements.
  Funabashi M, Kawchuk GN, Vette AH, Goldsmith P, Prasad N.
  Sci Rep. 2016 Dec 1;6:38107. doi: 10.1038/srep38107.
  PMID: 27905508 [PubMed – indexed for MEDLINE] Free PMC Article
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3. Does the application site of spinal manipulative therapy alter spinal tissues loading?
  Funabashi M, Nougarou F, Descarreaux M, Prasad N, Kawchuk GN.
  Spine J. 2018 Jun;18(6):1041-1052. doi: 10.1016/j.spinee.2018.01.008. Epub 2018 Jan 31.
  PMID: 29355792 [PubMed – indexed for MEDLINE]
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Dr. Rubinstein and I discuss his latest paper that will appear soon in the British Medical Journal regarding his systematic review of spinal manipulative therapy and chronic low back pain. Sidney Rubinstein is an associate professor at the VU University, Amsterdam and adjunct research professor at Southern California University of Health Sciences (SCUHS). He is also a registered epidemiologist in the Netherlands. He has more than 60 publications in international peer-reviewed journals, including three systematic reviews in the Cochrane Library.

His research focuses on effectiveness and cost-effectiveness of interventions in musculoskeletal disorders. His broader goals are to lessen the burden of neck and low-back pain to society by providing high-quality scientific evidence. The projects that he currently supervises are strongly embedded in clinical practice, including the PTED trial, Warrior Trial, an IPD (individual patient data) meta-analysis on spinal manipulative therapy for chronic low-back pain and a large, international observational study in chiropractic care in the elderly (BACE-C cohort study).

One of his passions lies in systematic reviews and meta-analysis as these types of overviews represent a crucial link in the practice of evidence-based health care. He is actively involved in conducting and supervising these reviews, including a position on the Associate Editorial Board of the Cochrane Back and Neck Review Group.  His reviews are quite diverse. One of the more recent Cochrane reviews focused on complications of trocar types for laparoscopic surgery, while another has examined the effectiveness of exercise for acute low back pain. An update of the Cochrane review on the effect of spinal manipulative therapy for chronic low-back has been accepted by the BMJ and should be published soon.

Dr. Rubinstein currently supervises 5 PhD students as well as MSc students, and teaches methodology of systematic reviews and meta-analyses at various levels, including BSc, MSc and PhD students. One chiropractor has received his PhD under Sidney’s supervision, while others are completing theirs.

Here is a link to Dr. Rubinstein’s research at researchgate.net.

Here is a link to Dr. Rubinstein’s page at Vrije Universiteit Amsterdam

The article we discuss in this episode is available now at https://www.bmj.com/content/364/bmj.l689

Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l689 (Published 13 March 2019) Cite this as: BMJ 2019;364:l689

Listen as Dr. Cassidy and I discuss his career in chiropractic, research, and hear his thoughts on a variety of important issues including the powerful role of psychosocial factors on health.  Dr. Cassidy is a Professor of Epidemiology and Health Policy at the Dalla Lana School of Public Health at the University of Toronto. He is also an Adjunct Globalization Professor at the Faculty of Health at the University of Southern Denmark. He began his career as a chiropractor (CMCC 1975) and later obtained graduate degrees in Surgery (MSc University of Saskatchewan), Pathology (PhD University of Saskatchewan) and Injury Epidemiology (DrMedSc Karolinska Institute, Sweden). His past appointments include Assistant Professor of Surgery and Rehabilitation Medicine at the University of Saskatchewan (1994-1999), Associate Professor of Public Health and Medicine at the University of Alberta (2000-2003), Senior Scientist at the Toronto Western Hospital Research Institute (2003-2017) and Professor of Sport Science and Clinical Biomechanics at the University of Southern Denmark (2011-2016).

His research focus is injury epidemiology, neurotrauma, musculoskeletal disorders and evidence-based health care and policy. He has published over 300 research papers and chapters in textbooks over his career, including papers in the New England Journal of Medicine, the British Medical Journal, Annals of Internal Medicine, JAMA Psychiatry and the Archives of Physical and Rehabilitation Medicine to name a few. He is particularly interested in the psychosocial determinants of injury recovery and long-term consequences of injury.

View Dr. Cassidy’s research at researchgate.net.

We talked about a lot of research articles, too many to list in the show notes.  You can see a listing of Dr. Cassidy’s research at pubmed.com.

Dr. de Luca and I discuss her research on spinal pain in the elderly and chiropractic. Katie de Luca is a post-doctoral research fellow in the Department of Chiropractic at Macquarie University. She is a chiropractor in clinical practice, however her research focuses on the epidemiology and management of musculoskeletal conditions, with expertise in the elderly. In 2016 she was awarded her PhD from the University of Newcastle, School of Medicine and Public Health. Her thesis explored the experience of pain in women with arthritis, and resulted in substantial contributions to the fields of rheumatology, pain and ageing research. She has 25 peer-reviewed journal publications and more than 50 conference presentations, which includes several invited keynote presentations on back pain in the elderly. These have been at regional, national and international conferences in gerontology, pain, public health and chiropractic forums. She is on the editorial boards of Chiropractic and Manual Therapies and JMPT, and peer-reviews for another 13 journals. She has received several large competitive grants, most recently being awarded in excess of $400,00 in an industry led grant from the Australia Chiropractors Association to perform a longitudinal study on back pain in older Australians who present to a chiropractor for treatment of their low back pain. She has won many research prizes, including 1st prize at the World Federation of Chiropractic Biennial Conference in Washington DC (March, 2017). She is actively on the board for the Chiropractic Australia Research Foundation, and is the Research Chair for Sports Chiropractic Australia. She is one of only 13 CARL Fellows, a group which she is privileged to be a part of. She hopes to be a leading chiropractic researcher on spinal pain in the elderly.

View Dr. de Luca’s research at researchgate.net.

 

Here are the articles we discuss in this interview:

1. Qualitative insights into the experience of pain in older Australian women with arthritis.
de Luca K, Parkinson L, Hunter S, Byles JE.
Australas J Ageing. 2018 Sep;37(3):210-216. doi: 10.1111/ajag.12557. Epub 2018 Jun 26.
PMID: 29947165 [PubMed – in process]
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2. The Relationship Between Spinal Pain and Comorbidity: A Cross-sectional Analysis of 579 Community-Dwelling, Older Australian Women.
de Luca KE, Parkinson L, Haldeman S, Byles JE, Blyth F.
J Manipulative Physiol Ther. 2017 Sep;40(7):459-466. doi: 10.1016/j.jmpt.2017.06.004. Epub 2017 Oct 13.
PMID: 29037787 [PubMed – indexed for MEDLINE]
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3. Three subgroups of pain profiles identified in 227 women with arthritis: a latent class analysis.
de Luca K, Parkinson L, Downie A, Blyth F, Byles J.
Clin Rheumatol. 2017 Mar;36(3):625-634. doi: 10.1007/s10067-016-3343-5. Epub 2016 Jul 6.
PMID: 27383742 [PubMed – indexed for MEDLINE]
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In this episode, Dr. Anthony Lisi and I discuss the state of chiropractic practice and research in the US Veterans Health Administration. Dr. Anthony Lisi is the Chiropractic Program Director for the US Veterans Health Administration, overseeing all national programmatic issues related to the integration of chiropractic clinical services, education and research. He is also an Associate Research Scientist at the Yale Center for Medical Informatics, Yale University School of Medicine.

He has authored numerous peer-reviewed publications on topics including low back pain management, spinal manipulation, interprofessional education, and chiropractic services. Dr. Lisi received the American Chiropractic Associations’ 2015 Academician of the Year award, and the 2017 Chiropractor of the Year award.

See Dr. Lisi’s research profile at researchgate.net.

 

 

Below are the articles we discuss in this episode:

1. Opioid Use Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care.
Lisi AJ, Corcoran KL, DeRycke EC, Bastian LA, Becker WC, Edmond SN, Goertz CM, Goulet JL, Haskell SG, Higgins DM, Kawecki T, Kerns RD, Mattocks K, Ramsey C, Ruser CB, Brandt CA.
Pain Med. 2018 Sep 1;19(suppl_1):S54-S60. doi: 10.1093/pm/pny114.
PMID: 30203014 [PubMed – in process]
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2. Trends in the Use and Characteristics of Chiropractic Services in the Department of Veterans Affairs.
Lisi AJ, Brandt CA.
J Manipulative Physiol Ther. 2016 Jun;39(5):381-6. doi: 10.1016/j.jmpt.2016.04.005.
PMID: 27288324 [PubMed – indexed for MEDLINE]
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3. Chiropractic Integration into Private Sector Medical Facilities: A Multisite Qualitative Case Study.
Lisi AJ, Salsbury SA, Twist EJ, Goertz CM.
J Altern Complement Med. 2018 Aug;24(8):792-800. doi: 10.1089/acm.2018.0218. Epub 2018 Jul 17.
PMID: 30016118 [PubMed – indexed for MEDLINE]
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4. Variations in the implementation and characteristics of chiropractic services in VA.
Lisi AJ, Khorsan R, Smith MM, Mittman BS.
Med Care. 2014 Dec;52(12 Suppl 5):S97-104. doi: 10.1097/MLR.0000000000000235.
PMID: 25397831 [PubMed – indexed for MEDLINE]
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5. Use of Department of Veterans Affairs administrative data to identify veterans with acute low back pain: a pilot study.
Lisi AJ, Burgo-Black AL, Kawecki T, Brandt CA, Goulet JL.
Spine (Phila Pa 1976). 2014 Jun 15;39(14):1151-6. doi: 10.1097/BRS.0000000000000350.
PMID: 24732845 [PubMed – indexed for MEDLINE]
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