Posts

Hip Osteoarthritis – Improvements in Pain and Disability with Care Provided by a Chiropractor

Hip ArthritisChiropractic care holds potential value for the treatment of a variety of limb conditions.  For patients with osteoarthritis (OA) of the hip, a combined intervention of manual therapy provided by a chiropractor and patient education was more effective than a minimal control intervention.

A recent article by Poulsen et al (2013) contributes to our understanding of the literature regarding chiropractic and lower extremity conditions – particularly hip osteoarthritis. Hip osteoarthritis (OA) is a common joint disease and when symptomatic can have significant impact on regular daily activities.  Recently, hip OA has been linked to higher mortality rates.  In end stage hip OA, joint replacement surgery is an appropriate and cost-effective treatment but a long-term cohort study has documented that only 20% of patients with radiographic hip OA have had surgery 11-28 years after the initial diagnosis.  Therefore, non-surgical interventions with documented effectiveness become essential for patients who do not need, or choose not to have surgery.

Although guidelines recommend patient education (PE) programs as a core intervention, systematic reviews are contradictory in conclusions regarding their effectiveness on pain and function in hip OA. Manual therapy (MT) has been proposed as an adjunct intervention to exercise for patients with hip OA but evidence is based on a single randomized clinical trial (RCT).  The authors of the current study realized this gap in the literature and decided to investigate the effectiveness of a patient education (PE) program with or without the added effect of manual therapy (MT) compared to a minimal control intervention (MCI).

The design of this study was a single-center proof-of-principle three-arm parallel group RCT.  Inclusion criteria were: Unilateral hip pain >3 months’ duration, age 40-80 years, radiographic hip OA defined as minimal joint space width (JSW) measurement <2.00 mm or a side difference in minimal JSW >10%, and, ability to speak and read Danish.  The study took place at the Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark.

During the first 2 months of recruitment, 3 exclusion criteria were added to the original criteria: patients who had had MT within the previous twelve months; patients who rated their pain severity as 1 or 2 on the numerical rating scale (NRS); patients with polyarthritis.

The 3 groups in the study were: 1) MCI; 2) PE; 3) PE + MT.

For the MCI group, a nurse provided written advice on a home stretching program derived from the PE program together with 5-10-min instruction.

The PE group, originally termed ‘Hip School’ was taught by a physiotherapist with 11 years experience. The PE program included two individual sessions and three group sessions.

In the combined PE and MT group, manual therapy was administered by a chiropractor with 20 years of clinical experience. MT was scheduled twice a week for the 6-week intervention period and treatment was individualized to each patient depending on examination findings. MT consisted of: trigger point release therapy (TPPR), muscular stretching by muscle energy technique (MET) and joint manipulation.

The primary outcome was pain severity rated on an 11-box NRS, measured after 6 weeks of intervention. Patients were asked to rate the worst pain experienced during the previous week. Secondary outcome measures were the Hip Disability and Osteoarthritis Outcome Score (HOOS) ranging from 0-100, worst to best; patients’ perceived global effect of interventions, percentage in each group having classified themselves as improved; passive hip range of motion (ROM); use of pain medication at 12 months and hip replacement surgery within the 12 month follow-up period.

Results:

  • A total of 111 patients were included in the analyses at the primary end point at 6 weeks
  • In the combined group (PE + MT), a clinically relevant reduction in pain severity compared to the MCI of 1.90 points was achieved
  • Effect size (Cohen’s d) for the PE + MT minus the MCI was 0.92 (large effect)
  • The number of patients in each group experiencing pain reduction of at least 25% from baseline to 6 weeks was PE = 8, PE +MT = 21 and MCI = 7
  • Number needed to treat for PE + MT was 3
  • No difference was found between the PE and MCI groups
  • At 12 months, not including patients receiving hip surgery the statistically significant difference favoring PE + MT was maintained
  • All HOOS (pain, symptoms, ADLs, Sport/Rec, QOL) subscales demonstrated clinically relevant and statistically significant superiority, p < 0.05 for the PE + MT group when compared to the MCI group
  • Mean differences between PE and MCI were small (range 4 to 1) and not statistically significant, p > 0.05
  • Effect sizes for HOOS subscales for PE + MT minus MCI ranged between 0.75 and 1.08
  • No changes in hip ROM noted between groups

Key Findings:

  • For primary care patients with OA of the hip, a combined intervention of manual therapy provided by a chiropractor and patient education was more effective than a minimal control intervention
  • Note that patient education alone was not superior to the minimal control intervention

So, what does this study tell us?  This trial demonstrated clinical and statistically significant improvements in pain, symptoms and disability for a combined intervention consisting of manual therapy provided by a chiropractor and patient education when compared to a minimal control intervention including home stretching.

 

Reference: Poulsen E, Hartvigsen J, Christensen HW, Roos EM, Vach W, Overgaard S. Patient education with or without manual therapy compared to a control group in patients  with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial. Osteoarthritis Cartilage. 2013 Oct;21(10):1494-503.

, , ,

Chiropractic Adjustments Reduce Fatigue and Increase Neural Drive

ChiropracticOver the last decade, research has demonstrated that spinal manipulation can change various aspects of nervous system function, including muscle reflexes, cognitive processing, reaction time, and the speed at which the brain processes information. One research group from New Zealand (Haavik et al) has hypothesized that the joint dysfunction part of the chiropractic clinical construct, the vertebral subluxation, results in altered afferent input to the central nervous system (CNS) that modifies the way in which the CNS processes and integrates all subsequent sensory input. This processing (i.e., sensorimotor integration) is a central nervous system (CNS) function that appears most vulnerable to altered inputs.

Many studies show that chiropractic adjustments result in changes to sensorimotor integration within the central nervous system. Do these changes correlate with beneficial clinical outcomes?  That is not completely determined yet. It is also not clear whether the changes seen after adjustments are due to the correction of vertebral subluxation, therefore normalizing aberrant afferent input to the CNS, or are they merely due to afferent influx associated with the thrusting into the spine? These questions remain to be answered. The level of CNS involvement and the exact mechanisms underlying these neural adaptations following chiropractic adjustments remain unclear.

This new study reported here sought to investigate possible neural plastic changes with spinal manipulation by measuring H-reflexes and V-waves.  The H-reflex is an electrically evoked response that operates via the same neuronal circuitry as stretch reflexes.  The H (Hoffmann) reflex may be useful to assess motoneuron excitability in vivo while also reflecting presynaptic inhibition of Ia afferent synapses.  The so-called V-wave, which is an electrophysiological variant of the H-reflex, can be recorded during maximal voluntary motor contractions. The elicited V-wave response may be used to reflect the level of efferent neural drive from spinal α-motoneurons during maximal voluntary contraction (MVC).

While several previous studies have shown a decrease in the H-reflex indicating a transient attenuation of motoneuronal activity of the lumbosacral spine in both asymptomatic subjects and low back pain patients, new advances in data collection and processing have occurred since then. The purpose of this study was to take advantage of these recent technical and methodological discoveries related to the H-reflex and V-waves and explore what effect, if any, spinal manipulation of vertebral subluxations will have on them.

Methods:

Two studies were included in the paper.  All participants were men, between the ages of 18 and 40 and were required to have evidence of spinal dysfunction and a previous history of subclinical pain, but absence of degenerative conditions of the spine or known contraindications to spinal manipulation.  Instrumentation included: 1) surface EMG to record the (SEMG) activity of the soleus muscle (SOL) of the right leg; 2) electrical stimulation producing the H-, M-, and V-waves of the SOL muscle by stimulation of the tibial nerve and; 3) force recordings performed using a strain gauge attached to a custom-made ankle brace, while the subject performed maximum voluntary ankle dorsiflexion contractions.

During study one, ten subjects attended two sessions each, the control and the experimental (spinal manipulation) session. A second study was added wherein a group of eight participants attended two more sessions each, where only force was measured. The order of these sessions were randomized and at least 1 week separated the sessions.  All experiments were performed on the right leg, while the volunteers comfortably lay prone on a massage table with their right leg firmly strapped to the table with Velcro.  The following measures were collected pre and post interventions: SEMG signals during MVC; H-and M-recruitment curves; H-reflex area under curve normalized to Mmax (Harea/Mmax), H-reflex threshold, V-wave normalized to Mmax (V/Mmax), M-wave slope, H-reflex slope and the mean power frequency (MPF) of a fast Fourier transform (FFT) of the SEMG during MVC.

The entire spine and sacroiliac joints were assessed for segmental dysfunction (vertebral subluxation) and adjusted where deemed necessary by a registered chiropractor with at least 10-years clinical experience using high-velocity, low-amplitude techniques.  The control condition involved passive and active movements of the subject’s head, spine, and body into the manipulation setup positions but without performing the adjustment.

Results:

  • the threshold to elicit the H-reflex significantly decreased by 8.5% in the spinal manipulation group
  • the SEMGs showed a significant drop in the power spectrum after controls but there was no fatigue demonstrated in the power spectrum after spinal manipulation
  • for study 1: maximal voluntary contraction as determined by SEMG increased significantly by 59.5% after spinal manipulation and decreased significantly by 13.3% after control
  • for study 2: maximal voluntary contraction increased significantly by 16.1% after spinal manipulation and decreased significantly by 11.4% after control
  • the V-wave amplitude (V/Mmax ratio) increased significantly by 45% after spinal manipulation and reduced significantly by 23% after control

Key Points

  • this study is the first to indicate that chiropractic adjustments can induce significant changes in the net excitability for the low-threshold motor units/and or alters the synaptic efficacy of the Ia synapse
  • the improvements in maximal voluntary contraction following spinal manipulation are likely attributed to the increased descending drive and/or modulation in afferents
  • spinal manipulation prevents fatigue
  • these results suggest that spinal manipulation may be indicated as part of the treatment for the patients who have lost tonus of their muscle and/or are recovering from muscle dysfunction such as stroke or orthopedic operations
  • these findings will also be of interest to athletes and perhaps the general public

 

Reference: Niazi IK, Türker KS, Flavel S, Kinget M, Duehr J, Haavik H. Changes in H-reflex and V-waves following spinal manipulation. Exp Brain Res. 2015 Apr;233(4):1165-73. doi: 10.1007/s00221-014-4193-5. Epub 2015 Jan 13. PubMed

 

We’re not ‘just treating’ back and neck pain

WorldSpineChiropracticWe’re not ‘just treating’ back and neck pain!  We are reducing the leading global burden of disease! Low back pain causes more global disability than any other condition.  Neck pain is the 4th leading cause of global disability.

Reference: Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):968-74.

, ,

Is Chiropractic Useful For Dizziness and Balance?

42184199_sDizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. A recent study explored the role of chiropractic in the treatment of dizziness/balance disorders through analysis of data from the 2008 National Health Interview Survey (the only year that included a subset of questions about balance and dizziness).  Questions were asked about dizziness, balance and  accompanying health conditions as well as their perceived causes and effects of the dizziness or balance problem. The survey data queried whether people were helped by a variety of practitioners, including chiropractors.   Balance or dizziness problems were reported by 11% of all respondents.  The reported prevalence was 35% for those aged 65 or older.  The authors found that although a small proportion (4.2%) sought chiropractic care for balance and dizziness, those who did were very likely to report that it had helped (OR, 1.73). For those in whom the cause of their balance or dizziness problem was head or neck trauma, the odds ratio for perceiving that they had been helped by a chiropractor was 9.5, compared with OR 0.53 for medical physicians. For those respondents aged 65 years and older, and for those reporting the cause of their balance and dizziness were trauma or neurological or musculoskeletal issues, the OR was even higher (OR, 13.78).

Reference:
Ndetan H, Hawk C, Sekhon VK, Chiusano M. The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data. J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42. doi: 10.1177/2156587215604974. Epub 2015 Sep 11. PubMed PMID: 26362851.

, ,

Chiropractic and Midwifery Improve Breastfeeding Rates

A recent study incorporated a clinic of midwives and chiropractors to care for suboptimal feeding through a multidisciplinary approach. Suboptimal breastfeeding is a recognized problem among mothers and health care professionals worldwide. The aim was to assess the impact of care and education on breastfeeding and maternal satisfaction after attending the multidisciplinary clinic. On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. The relative risk ratio for exclusive breastfeeding after attending the multidisciplinary clinic was 3.6  The results from this study demonstrate high maternal satisfaction and improved breastfeeding rates associated with attending the chiropractic and midwifery clinic.

http://www.ncbi.nlm.nih.gov/pubmed/26763046

 

Happy 120th Birthday Chiropractic!

chiropractic birthday DDCelebrate the founder of chiropractic today, Sept. 18.  Chiropractic’s first adjustment is recognized each year as Chiropractic Founder’s Day. On this day in 1895 (120 years ago), Dr. Daniel David Palmer gave the first chiropractic adjustment. Chiropractic focuses on the relationship between the body’s main structures – the skeleton, the muscles and the nerves – and the patient’s health.  There is substantial evidence supporting the safety and effectiveness of chiropractic treatment for patients seen in chiropractic practice.  Share the word of chiropractic today.

Chiropractic Manipulation Versus Usual Medical Care for Acute and Subacute Low Back Pain

33609004_sLow back pain (LBP) is an extremely common presenting complaint that occurs in greater than 80% of people. Chiropractors care for patients who have no symptoms and those who have symptoms.   Research has demonstrated that chiropractic care in addition to standard medical care improves pain and disability scores, and in another study a subgroup of patients with acute nonspecific LBP – spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo (Spine 2013; 38:540-548).  The study reviewed here sought to compare the effectiveness of manual thrust manipulation (MTM) and manual assisted manipulation (MAM), to usual medical care (UMC) for the treatment of acute and subacute LBP.

This study was a prospective, randomized controlled trial evaluating the comparative effectiveness of manual and mechanical spinal manipulation to usual medical care for the treatment of acute and subacute LBP.  Participants were at least 18 years old and had a new LBP episode within the previous 3 months.  They also were required to have a minimum level of self-rated pain of 3 out of 10 and minimum disability rating of 20 out of 100. Exclusions included: chronic LBP (greater than 3 months duration), previous treatment for the current episode, radicular signs/symptoms, contraindications to SMT, current use of prescription pain medicine.

Participants and treating clinicians were not blinded to treatment allocation but the principal investigator was blinded to treatment assignment and had no interaction with participants.

The study interventions consisted of:

  1. Manual thrust manipulation (MTM) – high velocity low amplitude thrust delivered by a chiropractor to the lower thoracic, lumbar and SI joints in the side posture position as deemed necessary
  1. Mechanical-assisted manipulation (MAM) – certified Activator Methods chiropractor delivered MAM in the prone position to the lower thoracic, lumbar and SI joints as deemed necessary
  1. Usual medical care (UMC) – participants were seen by a board certified physical medicine and rehabilitation medical doctor and prescribed over the counter analgesic and NSAID medications, given advice to stay active and avoid bed rest

All groups had a 4 week course of care.  All groups received an educational booklet describing proper posture and movements during activities of daily living. Both manipulation groups had 8 visits (2 per week x 4 wks).  The UMC group had 3 visits (initial, at 2 weeks and at 4 weeks).  Following the 4 week assessment, participants were free to pursue rehabilitation or manipulation.

The primary outcome was the Oswestry LBP Disability Index (OSW).  Pain intensity ratings were also collected. Outcomes were assessed at baseline, 4 weeks, 3 months and 6 months.  Participants with at least 30% or 50% reductions in an outcome measure were considered to be ‘responders’ and had moderate or substantial improvement respectively.

Results and Conclusions:

  • Manual thrust manipulation by a chiropractor led to greater short term reductions in self-reported pain and disability than manual assisted manipulation (Activator) or usual medical care by a physical medicine and rehabilitation specialist
  • The benefits seen at the end of 4 weeks of care were no longer statistically significant at 3 or 6 months
  • MTM should be considered as an effective short term treatment option for patients with acute and subacute LBP
  • Significantly more patients in the MTM group achieved moderate or substantial reductions in disability and pain scores
  • These results contradict assumptions of therapeutic similarity between manual thrust and mechanical-assisted manipulation

Reference: Schneider M, Haas M, Glick R, Stevans J, Landsittel D. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine (Phila Pa 1976). 2015 Feb 15;40(4):209-17.

, , , , ,

Chiropractic Has Lowest Total Costs for Low Back Problems in a Major Self-Insured Workforce

Low Back PainStatistics tell us that up to 84% of the general population will report low back pain (LBP) symptoms at some point during their lifetime.  This leads employers seeking to maximize the ratio of outcomes achieved relative to costs incurred (ie, value) for the investments that they are making in their employees. Previous research has found that patients receiving chiropractic care have been found to record lower associations of probability of disability recurrence than patients of physicians and physical therapists.  Given these findings, the authors of this newly published article sought to assess the cost outcomes of treatment approaches to care for back problems in a major self-insured workforce, using published guidelines to focus on low back pain. Results of the study were that care congruent with 10 of 11 guidelines was linked to lower total costs. Of the five patterns of care, complex medical management reported the highest guideline-incongruent use of imaging, surgeries, and medications and had the highest health care costs.  On the other hand, chiropractic reported the lowest rates of guideline-incongruent use of imaging, surgeries, and medications and had the lowest health care costs.

http://www.ncbi.nlm.nih.gov/pubmed/24854253

Podcast

017- Chiropractic and Response Time, EMG and TMD with James DeVocht, DC, PhD

DeVocht (061205)James DeVocht, DC, PhD and I discuss research regarding the effect of chiropractic care on special operations forces reaction and response times, the biomechanical aspects of chiropractic care on patients, the cervical flexion-relaxation phenomenon and chiropractic treatment of temporomandibular disorders.

Dr. James DeVocht is an associate professor in the Palmer Center for Chiropractic Research at Palmer College of Chiropractic. He has a BS in physics (Brigham Young University, 1972), a DC (Palmer College of Chiropractic, 1983), a MS in mechanical engineering, with emphasis in biomedical engineering (Michigan Technological University, 1992), and a PhD in biomedical engineering (University of Iowa, 1996). He was in private practice in New Mexico (1984-1985). He has spent 11 years on active duty as an officer in the US Army, including 2 years as a research physicist. For the last 19 years he has been a research scientist at Palmer and is going to retire this year.

He has been a peer reviewer for several journals including Clinical Biomechanics, Journal of Electromyography and Kinesiology, and Journal of Manipulative and Physiological Therapeutics (JMPT). He has also been an examiner of the PhD thesis of a research student at Macquarie University, Australia. His research interests include the use of electromyography (EMG) to quantify the effect of chiropractic treatment, descriptive studies of chiropractic adjustments, and chiropractic treatment of temporomandibular disorders.

Here is a link to Dr. DeVocht’s publications on researchgate.

Articles Discussed in the Podcast:

1. Novel Electromyographic Protocols Using Axial Rotation and Cervical Flexion-Relaxation for the Assessment of Subjects With Neck Pain: A Feasibility Study.
DeVocht JW, Gudavalli K, Gudavalli MR, Xia T.
J Chiropr Med. 2016 Jun;15(2):102-11. doi: 10.1016/j.jcm.2016.04.013.
PMID: 27330512 [PubMed] Free PMC Article
Similar articles
2. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder.
DeVocht JW, Goertz CM, Hondras MA, Long CR, Schaeffer W, Thomann L, Spector M, Stanford CM.
J Am Dent Assoc. 2013;144(10):1154-63.
PMID: 24080932 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
3. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol.
DeVocht JW, Schaeffer W, Lawrence DJ.
Altern Ther Health Med. 2005 Nov-Dec;11(6):70-3.
PMID: 16320863 [PubMed – indexed for MEDLINE]
Similar articles
4. Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study.
DeVocht JW, Pickar JG, Wilder DG.
J Manipulative Physiol Ther. 2005 Sep;28(7):465-71.
PMID: 16182019 [PubMed – indexed for MEDLINE]
Similar articles
5. Experimental validation of a finite element model of the temporomandibular joint.
Devocht JW, Goel VK, Zeitler DL, Lew D.
J Oral Maxillofac Surg. 2001 Jul;59(7):775-8.
PMID: 11429739 [PubMed – indexed for MEDLINE]
Similar articles

 

015- Chiropractic and Value in Spine Care with William Weeks, MD, PhD, MBA

weeks_dr. william_thumbnailWilliam Weeks MD, PhD, MBA and I discuss topics such as: how doctors of chiropractic supply health care services, how patients use such services, and how best to integrate chiropractic with other health care providers; health care delivery science; value in spine care and; opioid overuse in back pain. Dr. Weeks is Professor of Psychiatry and of Community and Family Medicine at The Geisel School of Medicine at Dartmouth. There, he works at The Dartmouth Institute for Health Policy and Clinical Practice as a Senior Research Scientist, where he teaches in Masters programs and conducts research on health economics, healthcare value, the complementary and alternative medicine market, and geographic variation in health services utilization in France.  Dr. Weeks has published over 150 peer-reviewed manuscripts examining economic and business aspects of health care services utilization and delivery, physicians’ return on educational investment, health care delivery science, and healthcare value. He received his MD from the University of Texas Medical Branch at Galveston, his MBA from Columbia University, and his PhD in Economics from the Aix-Marseille School of Economics and Management. Dr. Weeks has been honored with the 2009 National Rural Health Association Outstanding Researcher Award and the 2016 Jerome F McAndrews award for excellence in research from the National Chiropractic Mutual Insurance Corporation Group. During 2016, Dr. Weeks holds the Fulbright-Toqueville Distinguished Chair at Aix-Marseille University.

Areas of Expertise:

Healthcare delivery science; healthcare value; health economics; physician incomes; the complementary and alternative medicine market

Awards:

2015-16 Fulbright-Tocqueville Distinguished Chair 2015-2016 at Aix-Marseille University
2009 Researcher of the Year, National Rural Health Association

Professional Achievements:

Consulting
•Provided strategic consultative services, partnering opportunities, to a variety of healthcare organizations
•Reviewed operations and provided strategic advice to Maine Medical Center, Dupont/Nemours Children’s Hospital, and Christiana Care around enhancing value, leveraging research efforts, and moving toward becoming an Accountable Care Organization
•Conducted analytics and provided strategic advice to Community Health Network of Washington around performance variation, identification of best practices, and the development of a comprehensive plan to improve quality and reduce costs.
•Provided consulting services and policy updates to Amerinet, a group purchasing organization around accountable care and organization of healthcare services.
•Provided on-site and distance quality improvement and research education followed by ongoing coaching teams at Eastern Maine Medical Center and Central Maine Medical Center.

Professor and Senior Research Scientist
•Wrote research proposals, obtained grant funding, conducted original research, and published findings
•For The High Value Healthcare Collaborative, a CMMI ($26.1 million) and member funded (approximately $2.5 million per year) effort to examine and leverage variation in care quantity, understand and reduce healthcare costs, and enhance value of care delivered across 15 US healthcare systems, with considerable work focused on bundled payments.
•On the performance of physician practices and medical groups in the United States, funded by Commonwealth Fund and Kaiser Foundation ($536,254)
•Examining the association between public reporting of quality of care on care quality in Wisconsin, funded by Commonwealth Fund ($295,889)
•On chiropractic and alternative medicine care markets in the US, funded by NIH, Bernard Osher Foundation, and National Chiropractic Medicine Insurance Corporation ($1,170,451).
•In an effort to examine and select patient safety indicators for emerging and developing countries, funded by WHO ($35,000)
•Between 1992 – 2008 obtained over $10 million in grant funding as PI or Co-PI while working within the VA system.

Core Faculty and Course Director
•Designed, developed, directed, and taught masters level courses
•Leveraging Data to Inform Decision Making, Dartmouth’s Master in Healthcare Delivery Science program. Provides methods for examining, understanding, and using data from a variety of sources to inform managerial decision-making. 50 students per year.
•Critical Issues in Health and Health Care, Geisel School of Medicine’s MS and MPH programs. Required survey course designed to provide a foundation in and overview of current healthcare issues. 60-70 students per year.
•Strategic and Financial Management of Health Care Organizations, Geisel School of Medicine’s MS and MPH programs. Provided an overview of managerial and financial accounting practices and strategic frameworks in order to prepare students for managerial roles in healthcare environments. 50-60 students per year. Required course for MPH.
•Financial Management for Non-Financial Managers, TDI’s Office for Professional Education and Outreach. Online course providing basic financial and managerial accounting practices in healthcare settings.

http://tdi.dartmouth.edu/faculty/william-weeks-md-mba

Discover more of Dr. Hartvigsen’s publications on researchgate.

Links to articles mentioned in the podcast:

1. Multistakeholder recommendations for improving value of spine care: Key themes from a roundtable discussion at the 2015 NASS Annual Meeting.
Weeks WB, Ventura J, Justice B, Hsu E, Milstein A.
Spine J. 2016 Jul;16(7):801-4. doi: 10.1016/j.spinee.2016.02.031. No abstract available.
PMID: 27045250 [PubMed – in process]
Similar articles
2. Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries.
Weeks WB, Goertz CM.
J Manipulative Physiol Ther. 2016 May;39(4):263-6. doi: 10.1016/j.jmpt.2016.02.016.
PMID: 27034107 [PubMed – in process] Free Article
Similar articles
3. Characteristics of US Adults Who Have Positive and Negative Perceptions of Doctors of Chiropractic and Chiropractic Care.
Weeks WB, Goertz CM, Meeker WC, Marchiori DM.
J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):150-7. doi: 10.1016/j.jmpt.2016.02.001.
PMID: 26948180 [PubMed – in process] Free Article
Similar articles
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.
PMID: 26907615 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles

014- Evidence Based Practice with Jan Hartvigsen, DC, PhD

Dr. Hartvigsen and I discuss some important issues facing the profession including: 1) What is Evidence Based Practice?; 2) How do we build chiropractic’s academic capacity (and what are the barriers)?; 3) The Chiropractic Profession in the Mainstream; 4) How can we get the research out to chiropractors and the public?; 5) Musculoskeletal health in the context of general health; 6) The current situation in Australia (pediatric chiropractic).

Professor Hartvigsen is Full Professor and Head of Research at the Department of Sports Science and Clinical Biomechanics at the Faculty of Health, University of Southern Denmark (SDU). He is also leading the Graduate Program for Physical Activity and Musculoskeletal Health and is co-founder of the Center for Muscle and Joint Health. He has published 136 scientific publications (67 in the past five years) including 26 systematic reviews, 13 editorials and commentaries and 10 book chapters and commissioned reports. His h-index is 26 and his work has received 1806 citations in the past five years. He has published as lead and senior author in leading general and musculoskeletal specialty journals such as BMJ, Spine, Pain, Osteoarthritis and Cartilage and Archives of Physical Medicine and Rehabilitation.

Invited Keynote Presentations:

Jan Hartvigsen has given 104 keynotes or invited presentations at meetings and multidisciplinary conferences in the fields of chiropractic, physiotherapy, back pain, and orthopaedics. Noticeably he has been invited to speak at the Forum for Research on Back Pain in Primary Care, World Congress on Low Back and Pelvic Pain (2x), World federation of Chiropractic Biennial Conference (4x), Forum on Manual Medicine, and The Nordic Congress on Musculoskeletal Physiotherapy and Musculoskeletal Medicine.

Research:

Jan Hartvigsen has received research support from numerous sources including from The Danish Regions 2001-2015, European Chiropractors Union 2012, Ontario Neurotrauma Foundation 2012, IMK General Foundation 2006-2015, Danish League Against Rheumatism 2011, Danish Agency for Science, Technology, and Innovation 2008, Danish Enterprise and Construction Authority 2008, Danish Board of Health 2005, Health Ressources and Service Administration (USA) 2009-2012. In total he has received over 50 million DKK in research support as lead or co-applicant since 2005.

Jan Hartvigsen has supervised 70+ MSc students during thesis work. He has completed supervision of 13 PhD students and is currently supervising 6 PhD students.

Prof Hartvigsen has peer reviewed 200+ manuscripts for 38 scientific journals including BMJ, Annals of Internal Medicine, Pain, Brain, and Annals of Rheumatic Diseases. He has reviewed submissions for 17 international conferences since 2007. He has reviewed grant applications from 13 agencies since 2005 including Canadian Institutes for Health Research, National Institutes for Health Research (UK), Arthritis Research UK, The BUPA Foundation (UK), WorkSafe BC (Canada), and The Wellcome Trust (UK). He has been examiner on 13 PhD theses in Denmark, Norway, Sweden, UK, Canada, Holland and Australia. Jan Hartvigsen has evaluated candidates for scientific positions at University of Sydney (AU), MacQuarie University (AU), Curtin University (AU), Keele University (UK), University of Toronto (Canada), University of Alberta (Canada), and all major Danish universities.

Teaching:

He has extensive teaching experience in the areas of research methodology, biostatistics, clinical examination and treatment of spine problems, and epidemiology. He has been responsible for establishing and coordinating courses in all of these areas.

www.sdu.dk/staff/jhartvigsen

Discover more of Dr. Hartvigsen’s publications on researchgate.

Links to Articles mentioned in the podcast:

1. Beyond the spine: a new clinical research priority.
Donovan J, Cassidy JD, Cancelliere C, Poulsen E, Stochkendahl MJ, Kilsgaard J, Blanchette MA, Hartvigsen J.
J Can Chiropr Assoc. 2015 Mar;59(1):6-12.
PMID: 25729080 [PubMed] Free PMC Article
Similar articles
2. Is it all about a pain in the back?
Hartvigsen J, Natvig B, Ferreira M.
Best Pract Res Clin Rheumatol. 2013 Oct;27(5):613-23. doi: 10.1016/j.berh.2013.09.008. Review.
PMID: 24315143 [PubMed – indexed for MEDLINE]
Similar articles
3. Musculoskeletal disorders and work disability.
Hartvigsen J.
Pain. 2013 Oct;154(10):1904-5. doi: 10.1016/j.pain.2013.06.036. Review. No abstract available.
PMID: 23810853 [PubMed – indexed for MEDLINE]
Similar articles

 

013- Patient Centered Chiropractic Care with Dr. Kent Stuber

Dr. Kent StuberDr. Kent Stuber discusses his research interests, his role as editor of the Journal of the Canadian Chiropractic Association and how chiropractors can get involved in research. Kent Stuber has been in practice in Calgary, Alberta, Canada for nearly 14 years. He did his chiropractic training at CMCC. He completed a Master of Science degree in Health and Social Care Research from the University of Sheffield in 2008. He is currently a MPhil/PhD student at the University of South Wales, studying patient-centeredness in chiropractic.

Kent is an Adjunct Professor in CMCC’s Division of Graduate Education and Research. He has published over 30 articles in over a dozen different peer-reviewed scientific journals. His research interests include patient-centered care, sports injuries, spinal stenosis, the psychometric properties and use of orthopaedic testing, as well as the treatment of pregnancy-related musculoskeletal conditions.

Kent is a member of the International Task Force on Diagnosis and Management of Lumbar Spinal Stenosis as well as the Guideline Implementation Group (GIG) of the Canadian Chiropractic Association’s Clinical Practice Guideline Initiative. In July 2015, Kent became the fifth Editor-in-Chief of the Journal of the Canadian Chiropractic Association, a peer-reviewed journal now in its 60th year of publication.

Dr. Stuber was born and raised in Calgary. He obtained a Bachelor of Science degree in Cellular, Molecular & Microbial Biology from the University of Calgary before moving to Toronto where he graduated Magna Cum Laude with Clinic Honours from the Canadian Memorial Chiropractic College (CMCC) in 2002.  Dr. Stuber’s post graduate education courses have included Graston Technique®, Active Release Techniques®, Kinesiotaping, Low-Tech Lumbar Spinal Stabilization Training, Managing Neck Pain Conditions, Evaluation and Management of Neck and Arm Pain, courses from the Titleist Performance Institute, and Taping and Support Techniques for Sports Practitioners.  You can visit Dr. Stuber’s practice at: http://www.momentumhealth.ca.

Visit the Journal of the Canadian Chiropractic Association.  The Journal of the Canadian Chiropractic Association (JCCA) is the official, peer reviewed, quarterly research publication of the Canadian Chiropractic Association (CCA). Published since 1957 and searchable from 1986 on this site and from 1978 in PubMed, the JCCA publishes research papers, commentaries and editorials relevant to the practice of chiropractic.

View Dr. Stuber’s publications on researchgate.com.

Here are the articles we discuss during the interview:

1. 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.
PMID: 27162609 [PubMed] Free PMC Article
Similar articles
2. ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study.
Tomkins-Lane C, Melloh M, Lurie J, Smuck M, Battié MC, Freeman B, Samartzis D, Hu R, Barz T, Stuber K, Schneider M, Haig A, Schizas C, Cheung JP, Mannion AF, Staub L, Comer C, Macedo L, Ahn SH, Takahashi K, Sandella D.
Spine (Phila Pa 1976). 2016 Aug 1;41(15):1239-46. doi: 10.1097/BRS.0000000000001476.
PMID: 26839989 [PubMed – in process]
Similar articles
3. Chiropractic treatment of lumbar spinal stenosis: a review of the literature.
Stuber K, Sajko S, Kristmanson K.
J Chiropr Med. 2009 Jun;8(2):77-85. doi: 10.1016/j.jcm.2009.02.001.
PMID: 19646390 [PubMed] Free PMC Article
Similar articles
4. Core stability exercises for low back pain in athletes: a systematic review of the literature.
Stuber KJ, Bruno P, Sajko S, Hayden JA.
Clin J Sport Med. 2014 Nov;24(6):448-56. doi: 10.1097/JSM.0000000000000081. Review.
PMID: 24662572 [PubMed – indexed for MEDLINE]
Similar articles
5. Chiropractic treatment of pregnancy-related low back pain: a systematic review of the evidence.
Stuber KJ, Smith DL.
J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):447-54. doi: 10.1016/j.jmpt.2008.06.009. Review.
PMID: 18722200 [PubMed – indexed for MEDLINE]
Similar articles
6. The treatment experience of patients with low back pain during pregnancy and their chiropractors: a qualitative study.
Sadr S, Pourkiani-Allah-Abad N, Stuber KJ.
Chiropr Man Therap. 2012 Oct 9;20(1):32. doi: 10.1186/2045-709X-20-32.
PMID: 23046615 [PubMed] Free PMC Article
Similar articles

011- Health Promotion, Wellness and Chiropractic Guidelines with Dr. Cheryl Hawk

Cheryl-Hawk-thumbnailIn this episode Cheryl Hawk, DC, PhD, CHES discusses chiropractic maintenance vs. wellness care, various chiropractic guidelines on low back pain, health promotion and pediatric care as well as her two new books. Dr. Cheryl Hawk is an author of over 100 publications in peer-reviewed scientific journals. She has designed and taught courses on wellness and health promotion to health professions students and in post-graduate education. She has also collaborated on the design and implementation of an online wellness certification program for health professionals, with Will Evans, DC, PhD, MCHES, and Michael Perko, PhD, CHES, FAAHE, offered by the National Wellness Institute. She received her Doctor of Chiropractic degree in 1976 from the National University of Health Sciences and practiced full-time for 12 years. In 1991, she earned a PhD in Preventive Medicine from the University of Iowa and also became a Certified Health Education Specialist (CHES). She is the author, with Will Evans, DC, PhD, MCHES, of Health Promotion and Wellness: An Evidence-Based Guide to Clinical Preventive Services. She is currently co-chair of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care. She has been named “Researcher of the Year” by both the American Chiropractic Association (2003) and the Foundation for Chiropractic Education and Research (2005). Her areas of interest are health promotion and prevention, practice-based research and health services research.

And…Dr. Hawk is also working on two upcoming books, Evidence-based Chiropractic Practice and Careers in Chiropractic. Although they won’t be published until 2017, there’s never been anything like it for chiropractic. This will be 2 entire volumes written NOT for chiropractors, but for potential patients, other providers, and potential chiropractic students!

As mentioned in the interview,  please find a link to the link to the CCGPP/Clinical Compass website and materials at http://clinicalcompass.org/

After CCGPP teams with specific skills review and rate all information gathered from multiple databases (synthesis), this information is then translated into easily usable tools (the “Chiropractic Clinical Compass©”). The synthesis is not the Compass©, it is merely an evidence stratification for the most common conditions seen by chiropractic doctors. CCGPP recognizes that information in this format is difficult to digest and implement. To assist comprehension and ease of application, the synthesis will be translated for use in the treatment room via a DIER (Dissemination, Implementation, Evaluation, and Revision) process (see Powerpoint presentation on the Introduction page of this website for more details on this process). This process will ultimately produce the Chiropractic Clinical Compass©. In addition, in today’s ever-changing health care environment, the literature synthesis can be used for many purposes and CCGPP is flexible and responsive to rapidly changing trends and needs.

The goals of CCGPP/Clinical Compass are:

  • To promote the improvement of the quality of chiropractic services and of the professional reputation of doctors of chiropractic
  • To promote the intellectual, academic, and clinical integrity of chiropractic practice
  • To promote the intellectual, academic, and clinical integrity of practice guidelines and PR

Please support CCGPP/Clinical Compass by donations at http://clinicalcompass.org/donate

For a list of Dr. Hawk’s scientific publications please click here.

Here is a list of the publications we discuss during this interview:

1. The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders: Analysis of National Health Interview Survey Data.
Ndetan H, Hawk C, Sekhon VK, Chiusano M.
J Evid Based Complementary Altern Med. 2016 Apr;21(2):138-42. doi: 10.1177/2156587215604974.
PMID: 26362851 [PubMed – indexed for MEDLINE]
Similar articles
2. Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness.
Hawk C, Schneider M, Evans MW Jr, Redwood D.
J Manipulative Physiol Ther. 2012 Sep;35(7):556-67. doi: 10.1016/j.jmpt.2012.05.002.
PMID: 22742964 [PubMed – indexed for MEDLINE]
Similar articles
3. Chiropractic and public health: current state and future vision.
Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, Hawk C, Injeyan HS, Killinger L, Kopansky-Giles D, Lisi AJ, Mior SA, Smith M.
J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):397-410. doi: 10.1016/j.jmpt.2008.07.001.
PMID: 18722194 [PubMed – indexed for MEDLINE]
Similar articles
4. A framework for chiropractic training in clinical preventive services.
Hawk C, Evans MW Jr.
Chiropr Man Therap. 2013 Aug 20;21(1):28. doi: 10.1186/2045-709X-21-28.
PMID: 23962353 [PubMed] Free PMC Article
Similar articles
5. Clinical Practice Guideline: Chiropractic Care for Low Back Pain.
Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, Walters S, Kaeser M, Dehen M, Augat T.
J Manipulative Physiol Ther. 2016 Jan;39(1):1-22. doi: 10.1016/j.jmpt.2015.10.006.
PMID: 26804581 [PubMed – indexed for MEDLINE]
Similar articles
6. Best Practices for Chiropractic Care of Children: A Consensus Update.
Hawk C, Schneider MJ, Vallone S, Hewitt EG.
J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):158-68. doi: 10.1016/j.jmpt.2016.02.015.
PMID: 27040034 [PubMed – in process] Free Article
Similar articles

 

005- Human Performance with Dr. Steven Passmore

Passmore Headshot 2012

Subscribe: RSS | iTunes

Listen to Dr. Dean Smith interview Dr. Passmore regarding the science relating chiropractic to human performance. Dr. Passmore is Assistant Professor in the Faculty of Kinesiology & Recreation Management at the University of Manitoba.  He also holds adjunct appointments in the College of Rehabilitation Sciences at the University of Manitoba, the Research Department at New York Chiropractic College, and the University of Ontario Institute of Technology.  His expertise deals with human perceptual learning and motor control.  Dr. Passmore utilizes his theoretical and applied background in perceptual motor behaviour to explore performance-based outcome measures in an attempt to objectively determine population characteristics, movement outcomes and sustainability of interventions.  Dr. Passmore practiced as a chiropractor in the Buffalo Veterans Affairs Medical Center (2007-09), and is currently in practice in Manitoba. He has held competitive grants from the Canadian Institutes for Health Research (CIHR), the Worker’s Compensation Board of Manitoba (WCB), Research Manitoba (RM), the Manitoba Medical Service Foundation (MMSF), and the Alexander Gibson Fund.

004- Myofascial and Chiropractic Research with Dr. Srbely

Dr. John Srbely
Subscribe: RSS | iTunes

Listen to this great interview with Dr. John Srbely as we talk about his research interests in chiropractic, myofascial pain, myofascial trigger points and central sensitization.  Dr. Srbely is a researcher and Assistant Professor at the University of Guelph in the Department of Human Health and Nutritional Sciences.  He studies the physiologic mechanisms of myofascial trigger points and their role in the clinical expression and treatment of pain and joint/muscle dysfunction in chronic disease. A core theme to his research is the study of central sensitization which is a fundamental neuradaptive process associated with the pathophysiology of pain and disease.

Dr. Srbely’s research expertise and interests lie in the fields of clinical biomechanics and neurophysiology. He has a specific interest in the study of pain and joint function associated with aging and chronic disease such as osteoarthritis, myofascial pain and fibromyalgia. To this extent, he studies the physiologic mechanisms of myofascial trigger points and their role in the clinical expression and treatment of pain and joint/muscle dysfunction in chronic disease. A core theme to his research is the study of central sensitization. Central sensitization is a fundamental neuradaptive process associated with the pathophysiology of pain and disease, however, the impact of central sensitization on the physiologic expression of chronic myofascial pain and human mechanics/pathomechanics in chronic degenerative diseases such as osteoarthritis is poorly understood. Dr. Srbely’s research initiatives aim to develop novel/enhance existing treatment approaches in clinical pain management (diagnosis and treatment) and musculoskeletal biomechanics/pathomechanics associated with chronic diseases and aging.