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.
Podcasts 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%).”
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.”
“Podcasts are an effective method for medical residents to learn from pharmacy students and may also improve pharmacy students’ confidence in their abilities.”
“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.”
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.
There 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)
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.
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.
Shoulder pain is one of the most common musculoskeletal disorders. The lifetime prevalence is estimated to be in the range of 6.7–66.7%. Shoulder pain and stiffness may reduce family life or social life functions as well as reduce productive activities. It also has a strong statistical correlation with somatizing tendency and poor mental health. There are many cases of shoulder pain that have not improved over time, remain persistent, or occur repeatedly. The prognosis becomes poorer the longer the illness is present. A review of the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder was published in the Journal of Manipulative and Physiological Therapeutics in June, 2017. Shoulder conditions addressed in the article were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Eligibility criteria for the scientific studies included randomized controlled trials (RCTs), systematic reviews, or meta-analyses. Treatments included nondrug, nonsurgical procedures. Results indicated low- to moderate-quality evidence supporting the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions.
- Manual therapy is beneficial for common shoulder conditions.
- Low-level laser therapy is beneficial for common shoulder conditions.
- Exercise protocols are beneficial for SIS and AC.
A clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs) was recently developed and replaces existing chiropractic guidelines on these topics (Bussières, Stewart et al, 2016). The Guideline Development Group of the Canadian Chiropractic Guideline Initiative (CCGI) conducted the updated guidelines. They considered recently published systematic reviews on NAD and WAD from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Below is a brief summary of the guidelines. Please refer to the numerous links in this blog post to gain access to the original paper and the full guidelines which are freely available.
Neck pain and its associated disorders (NAD), including headache and radiating pain into the arm and upper back, are common. These disorders often result in significant social, psychological, and economic burden. Neck pain is a common reason for people to seek chiropractic care.
Motor vehicle collisions most commonly are associated with neck pain related to whiplash-associated disorders (WADs). Whiplash-associated disorders also affect the daily functioning of our patients in terms of considerable pain, suffering, disability, and costs. Whiplash-associated disorders are defined as an injury to the neck that occurs with sudden acceleration or deceleration of the head and neck relative to other body parts. Symptoms of WADs commonly include headache, stiffness, shoulder and back pain, numbness, dizziness, sleeping difficulties, fatigue, and cognitive deficits.
The 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders recommended that all types of neck pain, including WADs, be included under the classification of NAD. The 4 grades of NAD are:
- I – No signs or symptoms suggestive of major structural pathology and no or minor interference with activities of daily living
- II – No signs or symptoms of major structural pathology, but major interference with activities of daily living
- III – No signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness or sensory deficits
- IV – Signs or symptoms of major structural pathology (e.g., fracture, tumor, infection)
After searching and synthesizing the latest scientific literature on these topics, the guideline committee provided their recommendations. Below is the summary of the recommendations. The full guideline and accompanying documents are available from the CCGI website at www.chiroguidelines.org. There are excellent resources for practitioners and patients available from this website including exercise videos and forms.
Global summary of recommendations: A multimodal approach including manual therapy, self-management advice and exercise is an effective treatment strategy for both recent onset and persistent neck pain and whiplash associated disorders.
A) Summary of Recommendations for Grades I-III Neck Pain and Associated Disorders (NAD)
- For recent-onset (0-3 months) neck pain grades I-II, based on patient preference and practitioner experience we suggest offering advice with:
- multimodal care;
- manipulation or mobilization;
- Range of motion home exercises or multimodal manual therapy.
- For recent-onset (0-3 months) neck pain grade III, based on patient preference and practitioner experience we suggest offering advice with:
- supervised graded strengthening exercises.
- For persistent (>3 months) neck pain grades I-II, based on patient preference and practitioner experience we suggest offering advice with:
- multimodal care or stress self-management;
- multimodal care or advice alone;
- manipulation in conjunction with soft tissue therapy;
- supervised yoga; supervised group exercise; supervised strengthening exercises or home exercises;
- mixed supervised and unsupervised high-intensity strength training or advice alone for workers with persistent neck and shoulder pain;
- high dose massage.
- For persistent (>3 months) neck pain grade III, based on patient preference and practitioner experience we suggest offering advice with:
- multimodal care or advice alone;
- mixed supervised and unsupervised high-intensity strength training or advice alone for workers with persistent neck and shoulder pain.
B) Summary of Recommendations for Grade I-III Whiplash and Associated Disorders (WAD)
- For recent onset (0-3 months) whiplash grades I-III, based on patient preference and practitioner experience we suggest offering advice with:
- multimodal care.
- For persistent (>3 months) whiplash grades I-II, based on patient preference and practitioner experience we suggest offering advice with:
- supervised exercise or advice alone.
Source: Bussières AE, Stewart G, Al-Zoubi F et al. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline. J Manipulative Physiol Ther. 2016 Oct;39(8):523-564.
Chiropractic care is commonly thought to have a beneficial effect on the functioning of the human body by affecting the nervous system. Evidence indicates that chiropractic adjustments result in plastic changes in sensorimotor integration within the central nervous system in human participants, particularly within the prefrontal cortex. Adjustments appear to alter the net excitability of the low-threshold motor units, increase cortical drive, and prevent fatigue (see this blog). This same group of researchers have more recently found an increase cortical drive to upper and lower extremity muscles following manipulation as measured by motor evoked potential. The researchers suggested the effects were due to descending cortical drive and could not be explained by changes at the level of the spinal cord (although they can’t rule that out completely). Two experiments were conducted. In experiment one, transcranial magnetic stimulation input–output (TMS I/O) curves for an upper limb muscle (abductor pollicus brevis; APB) were recorded, along with F waves prior to and after either spinal manipulation or a control intervention for the same subjects on two different days. During these two separate days, lower limb TMS I/O curves and movement related cortical potentials (MRCPs) were recorded from tibialis anterior muscle (TA) before and after spinal manipulation. Spinal manipulation resulted in a 54.5% ± 93.1% increase in maximum motor evoked potential (MEPmax) for APB and a 44.6% ± 69.6% increase in MEPmax for TA. They conclude that “Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations. These results may also be of interest to sports performers. We suggest these findings should be followed up in the relevant populations.”
Reference: Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sci. 2016 Dec 23;7(1).
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]|
|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]|
|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]|
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]|
|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]|
|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]|
|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]|
|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]|
Geoffrey Bove, DC, PhD, and I discuss his research regarding inflammation within peripheral nerves, chiropractic principles, manual therapies, repetitive motion disorders and much more. Dr. Bove is a graduate of Hampshire College, Canadian Memorial Chiropractic College, and the University of North Carolina, Chapel Hill. He is currently a professor at the University of New England, in Biddeford Maine (USA). Dr. Bove’s research has focused on the effect of inflammation on small diameter axons within peripheral nerves, a topic directed by founding chiropractic principles. He also studies the effects of manual therapies on common painful conditions, such as repetitive motion disorders and postoperative visceral adhesions.
Visit Dr. Bove’s research gate profile.
Here are the links to Dr. Bove’s articles we discuss in this interview:
|1.||Time course of ongoing activity during neuritis and following axonal transport disruption.|
|Satkeviciute I, Goodwin G, Bove GM, Dilley A.|
|J Neurophysiol. 2018 May 1;119(5):1993-2000. doi: 10.1152/jn.00882.2017. Epub 2018 Feb 21.|
|PMID: 29465329 [PubMed – in process]|
|2.||Group IV nociceptors develop axonal chemical sensitivity during neuritis and following treatment of the sciatic nerve with vinblastine.|
|Govea RM, Barbe MF, Bove GM.|
|J Neurophysiol. 2017 Oct 1;118(4):2103-2109. doi: 10.1152/jn.00395.2017. Epub 2017 Jul 12.|
|PMID: 28701542 [PubMed – indexed for MEDLINE] Free PMC Article|
|3.||Attenuation of postoperative adhesions using a modeled manual therapy.|
|Bove GM, Chapelle SL, Hanlon KE, Diamond MP, Mokler DJ.|
|PLoS One. 2017 Jun 2;12(6):e0178407. doi: 10.1371/journal.pone.0178407. eCollection 2017.|
|PMID: 28574997 [PubMed – indexed for MEDLINE] Free PMC Article|
|4.||A model for radiating leg pain of endometriosis.|
|J Bodyw Mov Ther. 2016 Oct;20(4):931-936. doi: 10.1016/j.jbmt.2016.04.013. Epub 2016 Apr 14.|
|PMID: 27814877 [PubMed – indexed for MEDLINE] Free PMC Article|
|5.||A Novel Method for Evaluating Postoperative Adhesions in Rats.|
|Bove GM, Chapelle SL, Boyle E, Mokler DJ, Hartvigsen J.|
|J Invest Surg. 2017 Apr;30(2):88-94. doi: 10.1080/08941939.2016.1229367. Epub 2016 Oct 3.|
|PMID: 27690703 [PubMed – indexed for MEDLINE]|
|6.||Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury.|
|Bove GM, Harris MY, Zhao H, Barbe MF.|
|J Neurol Sci. 2016 Feb 15;361:168-80. doi: 10.1016/j.jns.2015.12.029. Epub 2015 Dec 24.|
|PMID: 26810536 [PubMed – indexed for MEDLINE] Free PMC Article|
|7.||Disruption of fast axonal transport in the rat induces behavioral changes consistent with neuropathic pain.|
|Dilley A, Richards N, Pulman KG, Bove GM.|
|J Pain. 2013 Nov;14(11):1437-49. doi: 10.1016/j.jpain.2013.07.005. Epub 2013 Sep 12.|
|PMID: 24035352 [PubMed – indexed for MEDLINE]|
|8.||Focal nerve inflammation induces neuronal signs consistent with symptoms of early complex regional pain syndromes.|
|Exp Neurol. 2009 Sep;219(1):223-7. doi: 10.1016/j.expneurol.2009.05.
|PMID: 19477176 [PubMed – indexed for MEDLINE]|
|9.||Inflammation induces ectopic mechanical sensitivity in axons of nociceptors innervating deep tissues.|
|Bove GM, Ransil BJ, Lin HC, Leem JG.|
|J Neurophysiol. 2003 Sep;90(3):1949-55. Epub 2003 Apr 30.|
|PMID: 12724363 [PubMed – indexed for MEDLINE] Free Article|
|10.||Disruption of axoplasmic transport induces mechanical sensitivity in intact rat C-fibre nociceptor axons.|
|Dilley A, Bove GM.|
|J Physiol. 2008 Jan 15;586(2):593-604. Epub 2007 Nov 15.|
|PMID: 18006580 [PubMed – indexed for MEDLINE] Free PMC Article|
In this episode, Dr. James Whedon and I discuss his research on chiropractic, opioids, adverse events, risk of injury, medicare, and much more. For instance, his research found the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with nonrecipients. Dr. Jim Whedon is Director of Health Services Research at Southern California University of Health Sciences and adjunct instructor at The Dartmouth Institute for Health Policy and Clinical Practice. He holds a DC degree from Logan College and an MS from Dartmouth College. He has authored 33 peer reviewed publications. He is advisor to the Project for Integrative Health and the Triple Aim, co-chair of the research working group of The Academic Consortium for Integrative Health, charter member of the Academy of Integrative Health & Medicine, and recipient of the Jerome F. McAndrews DC Memorial Research Fund Award from NCMIC Foundation.
Dr. Jim Whedon is a national award-winning, NIH-funded clinical and health services investigator with interests in trauma, integrative medicine, spinal disorders and Medicare health policy. Experience in clinical database development and medical editing. IRB and editorial advisory board member. Licensed chiropractic physician with 25 years clinical experience. Faculty appointment with Geisel School of Medicine at Dartmouth.
Much of his research has focused upon geographic variations in access to chiropractic services under Medicare. He conducts observational research using claims and registry data.
Dr. Whedon’s long-term research goals are to improve access to health services that people need and want, and to improve quality through systematic care of acute problems and conservative upstream care of chronic problems. He has a particular interest in helping to improve access to care for vulnerable populations.
He is also a member of the Advisory Team, Project for Integrative Health and the Triple Aim, and of the Research Working Group, Academic Consortium for Complementary and Alternative Health Care (ACCAHC).
See Dr. Whedon’s list of publications on researchgate.net.
How to cite this episode:
Smith DL. Chiropractic Science: Chiropractic, Opioids, Adverse Drug Events, and Medicare with Dr. James Whedon [internet]. Eaton, Ohio; Aug 23, 2018. Podcast: 1:05:21. Available from: https://chiropracticscience.com/podcast/drjameswhedon/
Below is a list of the articles Dr. Whedon discusses in this episode:
|1.||Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events.|
|Whedon JM, Toler AWJ, Goehl JM, Kazal LA.|
|J Manipulative Physiol Ther. 2018 Jun;41(5):383-388. doi: 10.1016/j.jmpt.2018.01.004. Epub 2018 May 26.|
|PMID: 29843912 [PubMed – in process]|
|2.||Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids.|
|Whedon JM, Toler AWJ, Goehl JM, Kazal LA.|
|J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22.|
|PMID: 29470104 [PubMed – indexed for MEDLINE]|
|3.||Relevance of Quality Measurement to Integrative Healthcare in the United States.|
|Whedon JM, Punzo M, Dehen R, Menard MB, Fogel D, Olejownik J.|
|J Altern Complement Med. 2016 Nov;22(11):853-858. Epub 2016 Sep 23.|
|PMID: 27660896 [PubMed – indexed for MEDLINE]|
|4.||The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.|
|Weeks WB, Leininger B, Whedon JM, Lurie JD, Tosteson TD, Swenson R, O’Malley AJ, Goertz CM.|
|J Manipulative Physiol Ther. 2016 Feb;39(2):63-75.e1-2. doi: 10.1016/j.jmpt.2016.01.006. Epub 2016 Feb 19.|
|PMID: 26907615 [PubMed – indexed for MEDLINE] Free PMC Article|
|5.||Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years.|
|Whedon JM, Mackenzie TA, Phillips RB, Lurie JD.|
|Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. doi: 10.1097/BRS.0000000000000725.|
|PMID: 25494315 [PubMed – indexed for MEDLINE] Free PMC Article|
|6.||Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain.|
|Whedon JM, Song Y, Mackenzie TA, Phillips RB, Lukovits TG, Lurie JD.|
|J Manipulative Physiol Ther. 2015 Feb;38(2):93-101. doi: 10.1016/j.jmpt.2014.12.001. Epub 2015 Jan 14.|
|PMID: 25596875 [PubMed – indexed for MEDLINE] Free PMC Article|
|7.||Comparing Propensity Score Methods for Creating Comparable Cohorts of Chiropractic Users and Nonusers in Older, Multiply Comorbid Medicare Patients With Chronic Low Back Pain.|
|Weeks WB, Tosteson TD, Whedon JM, Leininger B, Lurie JD, Swenson R, Goertz CM, O’Malley AJ.|
|J Manipulative Physiol Ther. 2015 Nov-Dec;38(9):620-8. doi: 10.1016/j.jmpt.2015.10.005. Epub 2015 Nov 5.|
|PMID: 26547763 [PubMed – indexed for MEDLINE] Free PMC Article|
In this episode, Dr. Robert Vining and I discuss his involvement in chiropractic research at a specialty hospital in New Hampshire, low back pain classification and strategies on how to implement evidence into practice. Dr. Vining is an Associate Professor and Research Clinic Director at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic. Beginning in private practice in Pennsylvania, he eventually transitioned to the role of clinician/educator, teaching courses in clinical biomechanics at Cleveland Chiropractic College (now Cleveland University), and serving as a teaching clinic director at Logan College of Chiropractic. More recently, Dr. Robert Vining has taken on the role of clinician/scientist, serving as a co-investigator on 11 federally funded clinical studies including those conducted within Veterans Affairs and the US Department of Defense health systems. He was also co-principal investigator on a series of privately funded research projects focused on integrating chiropractic care into a rehabilitation specialty hospital. Dr. Vining is a lead or co-author on over 30 peer reviewed scientific journal articles, 2 book chapters, and numerous other publications related to chiropractic care, musculoskeletal diagnosis, and translating research evidence into clinical practice.
How to cite this episode:
Smith DL. Chiropractic Science: Interdisciplinary Care and Strategies to Incorporate Evidence Into Practice With Dr. Robert Vining [internet]. Eaton, Ohio; Aug 7, 2018. Podcast: 1:21:13. Available from: https://chiropracticscience.com/podcast/drrobertvining/
|1.||“Be good, communicate, and collaborate”: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team.|
|Salsbury SA, Vining RD, Gosselin D, Goertz CM.|
|Chiropr Man Therap. 2018 Jun 22;26:29. doi: 10.1186/s12998-018-0200-4. eCollection 2018.|
|PMID: 29977521 [PubMed – in process] Free PMC Article|
|2.||Patients receiving chiropractic care in a neurorehabilitation hospital: a descriptive study.|
|Vining RD, Salsbury SA, Cooley WC, Gosselin D, Corber L, Goertz CM.|
|J Multidiscip Healthc. 2018 May 3;11:223-231. doi: 10.2147/JMDH.S159618. eCollection 2018.|
|PMID: 29760552 [PubMed] Free PMC Article|
|3.||Interdisciplinary rehabilitation for a patient with incomplete cervical spinal cord injury and multimorbidity: A case report.|
|Vining RD, Gosselin DM, Thurmond J, Case K, Bruch FR.|
|Medicine (Baltimore). 2017 Aug;96(34):e7837. doi: 10.1097/MD.0000000000007837.|
|PMID: 28834891 [PubMed – indexed for MEDLINE] Free PMC Article|
|4.||An evidence-based diagnostic classification system for low back pain.|
|Vining R, Potocki E, Seidman M, Morgenthal AP.|
|J Can Chiropr Assoc. 2013 Sep;57(3):189-204.|
|PMID: 23997245 [PubMed] Free PMC Article|
Dr. Peter McCarthy and I discuss his varied research in the profession from spine function to dysfunction and multidisciplinary teamwork. Professor Peter McCarthy PhD (Full Professor of clinical technology, University of South Wales, UK) has been involved in the education of chiropractors for 30 years. He obtained his PhD in neurophysiology from the University of St Andrews (1986) and worked in various institutes around the world. He first joined the AECC in 1989, moving in 1998 to the University of Glamorgan to help Susan King create and consolidate the first University based chiropractic course in the UK: later becoming the Welsh Institute of Chiropractic. Holding a couple of patents, Peter has been awarded honorary fellowships, from the BCA, RCC and EAC, and research awards from the National Back Pain Association and British Association for Sport and Exercise Medicine, amongst others; even being part of a team that won a National design award. He has successfully supervised PhD students from a wide range of professions across medicine, including 4 chiropractors. Although his research publication profile appears eclectic, it is tied together by his overarching interest in sensory neurophysiology. He has studied the innervation of spinal structures, factors that affect cervical spine function and also performed RCTs of therapies on chronic back pain. More recently, he has been looking at measuring the sensory factors that can help predict relative discomfort when sitting or lying as well as developing a multidisciplinary team interested in studying neck function changes in sport and developing ways of reducing the impact these changes can have.
How to cite this episode:
Smith DL. Chiropractic Science: From Spine Function to Dysfunction and Multidisciplinary Teamwork With Dr. Peter McCarthy [internet]. Eaton, Ohio; Aug 1, 2018. Podcast: 59:14. Available from: https://chiropracticscience.com/podcast/drpetermccarthy/
Below is a list of some of the articles we discuss in this interview.
|1.||A pilot study assessing patient-centred care in patients with chronic health conditions attending chiropractic practice.|
|Stuber KJ, Langweiler M, Mior S, McCarthy PW.|
|Complement Ther Med. 2018 Aug;39:1-7. doi: 10.1016/j.ctim.2018.05.006. Epub 2018 May 18.|
|PMID: 30012379 [PubMed – in process]|
|2.||Modelling the effect of electrode displacement on transcranial direct current stimulation (tDCS).|
|Ramaraju S, Roula MA, McCarthy PW.|
|J Neural Eng. 2018 Feb;15(1):016019. doi: 10.1088/1741-2552/aa8d8a.|
|PMID: 28925375 [PubMed – in process]|
|3.||Effect of Anodal-tDCS on Event-Related Potentials: A Controlled Study.|
|Izzidien A, Ramaraju S, Roula MA, McCarthy PW.|
|Biomed Res Int. 2016;2016:1584947. Epub 2016 Nov 10.|
|PMID: 27957487 [PubMed – indexed for MEDLINE] Free PMC Article|
|4.||The factors and motivations behind United Kingdom chiropractic professional association membership: a survey of the Welsh Institute of Chiropractic Alumni.|
|Wotherspoon SE, McCarthy PW.|
|Chiropr Man Therap. 2016 Sep 12;24(1):35. doi: 10.1186/s12998-016-0115-x. eCollection 2016.|
|PMID: 27621800 [PubMed] Free PMC Article|
|5.||Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study.|
|Stuber KJ, Langweiler M, Mior S, McCarthy PW.|
|Chiropr Man Therap. 2016 May 9;24:15. doi: 10.1186/s12998-016-0095-x. eCollection 2016.|
|PMID: 27162609 [PubMed] Free PMC Article|
|6.||Wearing American Football helmets increases cervicocephalic kinaesthetic awareness in “elite” American Football players but not controls.|
|McCarthy PW, Hume PJ, Heusch AI, Lark SD.|
|Chiropr Man Therap. 2015 Nov 16;23:32. doi: 10.1186/s12998-015-0077-4. eCollection 2015.|
|PMID: 26576266 [PubMed] Free PMC Article|
|7.||Survey based investigation into general practitioner referral patterns for spinal manipulative therapy.|
|Kier A, George M, McCarthy PW.|
|Chiropr Man Therap. 2013 May 29;21:16. doi: 10.1186/2045-709X-21-16. eCollection 2013.|
|PMID: 23718217 [PubMed] Free PMC Article|
Ian Coulter, PhD, is a senior health policy analyst at the RAND Corporation, where he holds the Samueli Institute Chair in Policy for Integrative Medicine. He is a full professor in the School of Dentistry, UCLA, in the Division of Public Health and Community Dentistry; a professor at the Pardee RAND Graduate School; and a research professor at the Southern California University of Health Sciences.
Dr. Coulter has published over 200 articles, chapters and books. He is the past Vice President for Integrative Medicine at the Samueli Institute. He has had numerous grants from NIH and the DoD. For the past 20 years he has taught ethics and research ethics at UCLA and to various professional bodies throughout the United States. He currently teaches Professional Ethics/Research Ethics in the Pediatric Dentist Residency Program at the UCLA School of Dentistry.
Dr. Coulter was born in New Zealand and holds degrees in sociology from the University of Canterbury (B.A., M.A. Honors) and the London School of Economics & Political Science (Ph.D.) and an honorary doctorate in humanities from the Southern California University of Health Sciences. He was a Pew Fellow at the RAND/ University of California at Los Angeles, Center for Health Policy Study from which he received a certificate in health policy analysis. Additional qualifications include a diploma in educational management from the Institute of Educational Management, Harvard University. He is also a past President of the Canadian Memorial Chiropractic College.
And…more specifically regarding his research that relates to this interview, Dr. Coulter was an author of the recent JAMA article on adding chiropractic care to usual medical care, and lead author on the recent Spine Journal systematic review on spinal manipulation and chronic LBP. In addition, he is currently lead investigator of the CERC project (funded at over $8 million) to investigate chiropractors and their patients for Clinician Based Appropriateness, Outcomes Based Appropriateness, Patient Preferences Appropriateness and Resource Utilization Based Appropriateness.
View Dr. Coulter’s RAND page here.
How to cite this episode:
Smith DL. Chiropractic Science: Dr. Ian Coulter Discusses Research in JAMA, Appropriateness and Contextual Factors in Chiropractic Care [internet]. Eaton, Ohio; July 10, 2018. Podcast: 1:19:47. Available from: https://chiropracticscience.
Research discussed in this episode with Dr. Coulter include:
Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back PainA Comparative Effectiveness Clinical Trial. JAMA Network Open. 2018;1(1):e180105.
Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, Herman PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018 May;18(5):866-879.
Join Dr. John Mayer and I as we discuss his extensive clinical and research experience in therapeutic exercise, wellness, chiropractic and first responders. John M. Mayer, DC, PhD, CCRP, FACSM is the Lincoln Endowed Chair in Biomechanical & Chiropractic Research, Executive Director of the Center for Neuromusculoskeletal Research, and Professor of the School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida. He is Director of Research and Innovation for U.S. Spine & Sport Foundation, Chief Scientific Officer of Excellcior LLC, and Co-Founder of Pillar of Health LLC
Dr. Mayer obtained a Doctor of Chiropractic (DC) degree from the National College of Chiropractic (currently known as National University of Health Sciences) and a PhD degree in Exercise Science/Science Education from Syracuse University. He is a licensed Chiropractic Physician in the state of Florida, a Fellow of the American College of Sports Medicine (FACSM), and a Certified Clinical Research Professional (CCRP) from the Society of Clinical Research Associates. He has 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. He serves on the Scientific Secretariat for the Global Spine Care Initiative and Clinical and the Scientific Advisory Board for World Spine Care. Dr. Mayer received the 2012 Safety Award from Tampa Fire Rescue, 2014 “Researcher of the Year” Award by the American Chiropractic Association, and 2015 “Outstanding Research Achievement Award” by USF.
View Dr. Mayer’s research publications on Research Gate.
Here is a listing of the articles we discussed today:
|1.||Effect of Lumbar Progressive Resistance Exercise on Lumbar Muscular Strength and Core Muscular Endurance in Soldiers.|
|Mayer JM, Childs JD, Neilson BD, Chen H, Koppenhaver SL, Quillen WS.|
|Mil Med. 2016 Nov;181(11):e1615-e1622.|
|PMID: 27849497 [PubMed – indexed for MEDLINE]|
|2.||Impact of a supervised worksite exercise program on back and core muscular endurance in firefighters.|
|Mayer JM, Quillen WS, Verna JL, Chen R, Lunseth P, Dagenais S.|
|Am J Health Promot. 2015 Jan-Feb;29(3):165-72. doi: 10.4278/ajhp.130228-QUAN-89.|
|PMID: 24524384 [PubMed – indexed for MEDLINE]|
|3.||Worksite back and core exercise in firefighters: Effect on development of lumbar multifidus muscle size.|
|Mayer JM, Nuzzo JL.|
|Work. 2015;50(4):621-7. doi: 10.3233/WOR-141831.|
|PMID: 24448017 [PubMed – indexed for MEDLINE]|
|4.||Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises.|
|Mayer J, Mooney V, Dagenais S.|
|Spine J. 2008 Jan-Feb;8(1):96-113. doi: 10.1016/j.spinee.2007.09.008. Review.|
|PMID: 18164458 [PubMed – indexed for MEDLINE]|
- 044- Dr. Sidney Rubinstein Discusses Chronic Low Back Pain, Spinal Manipulation and Systematic Reviews February 24, 2019
- 043- Dr. Geoff Outerbridge Discusses World Spine Care and the Global Spine Care Initiative January 22, 2019
- 042- J. David Cassidy, DC, PhD, DrMedSc Discusses Stroke, Concussion, Neck Pain, Whiplash and Epidemiology December 4, 2018
- 041- Spinal Pain in the Elderly and Chiropractic with Dr. Katie de Luca November 15, 2018
- 040- Dr. Anthony Lisi Discusses Chiropractic Practice and Research in the VA October 18, 2018
- 039- Inflammation of Peripheral Nerves, Chiropractic Principles, Manual Therapies and More with Dr. Geoffrey Bove October 4, 2018
- 038- Chiropractic, Opioids, Adverse Drug Events, and Medicare with Dr. James Whedon August 23, 2018
- 037- Interdisciplinary Care and Strategies to Incorporate Evidence Into Practice With Dr. Robert Vining August 7, 2018
Security – SSL Certificate
Chiropractic Science is a Miami University Digital Health Literacy Partner. Health literacy is the ability to read, write, and talk about health habits in a variety of life situations and environments. Our interprofessional partnership promotes the use and dissemination of electronic materials for evidence-based EHealth.