Topics in Integrative Health Care: an International Journal

Topics in Integrative Health Care

Tue, 27 Mar 2012 00:00:00 GMT

Topics in Integrative Health Care welcomes unsolicited manuscripts with original research, Grand Rounds, clinical briefs and “fast facts” collections. All submissions are peer-reviewed. For the June 2012 issue, we have tentatively scheduled a theme focusing on issues in health professions training and education.

Poor Healthcare Coverage and Management of Low Back Pain: Descriptive Analysis of an African American Cohort

Tue, 27 Mar 2012 00:00:00 GMT

Purpose: Low back pain is one of the most common musculoskeletal disorders in the developed world and remains a growing and potentially debilitating condition. Management of this condition for individuals with poor healthcare coverage poses an additional burden. The purpose of this study was to characterize management of low back pain in a cohort of African Americans (AA), a majority of who were determined to have poor or no healthcare coverage.

Methods: Data from the general and AA patient populations with low back pain were extracted from the University of Virginia Medical Center Clinical Data Repository (CDR), which contains 15 years of data on approximately one million patients seen at the University of Virginia Medical Center. Patient demographics, healthcare coverage status, comorbidities, low back pain diagnoses, and procedure codes were extracted from the CDR and analyzed for differences between both groups and among healthcare coverage types within the AA cohort with low back pain.

Results: The largest percentage of completely indigent patients, Medicaid recipients, and the uninsured was found within the AA cohort compared to the general cohort (P < .001). AAs with poor healthcare coverage received less healthcare services than AAs with private insurance in management of low back pain.

Conclusion: Differences in the management of low back pain by healthcare coverage type were observed within a cohort of AA with low back pain. Further investigation into the most appropriate low back pain management options for this and other vulnerable communities is warranted.

Patient Characteristics, Screening Use, and Health Education Advice in a Chiropractic Practice-Based Research Network

Tue, 27 Mar 2012 00:00:00 GMT

Objective: to replicate questions from the National Ambulatory Medical Care Survey (NAMCS) in a sample of Doctors of Chiropractic (DCs) in a practice-based research network (PBRN) to assess the feasibility and appropriateness of the survey instrument for a larger study focusing on prevention and health promotion-related practices.

Methods: The study population consisted of volunteer DCs in the Integrative Chiropractic Outcomes Network (ICON) PBRN. DCs recorded data on each patient who presented in their office during one designated day. Data were collected on chief complaints, screening procedures, diagnosis, and health education advice.

Results: 530 patient visits were captured from 27 DCs in 21 practices. The most common complaint was back pain, and over 80% were established patients. Ordering of screenings on the day of the visit was infrequent, including radiography (4%). Most patients paid with private insurance (61%). Nearly half (49%) presented for a new complaint and only 4% for preventive care. 10.5% of the patients were recorded as tobacco users and over 65% were overweight or obese. Advice on physical activity/exercise was suggested to over 60% of patients. While specific advice on weight management was provided to only 11.5% of obese patients, 74% of obese patients received advice on diet, exercise or weight reduction. Only 9.8% of tobacco users were offered cessation advice that day.

Conclusions: Adaptations of the survey may be necessary to reflect chiropractic practice style, in which patients make multiple visits. Methods to encourage DCs to adopt health promotion and disease prevention advising guidelines may be warranted.

Clinical Brief: Classification of Essential and Parkinson’s Tremors

Tue, 27 Mar 2012 00:00:00 GMT

Essential tremor and Parkinson’s disease are the most common tremors encountered in clinical practice. In addition to the detailed history, the differential diagnosis is mainly clinical and does not typically require use of special tests. In these cases, the role of the chiropractic physician and manual therapist should be to provide early diagnosis, appropriate referral, and provide palliative care aimed at improved patient function and quality of life.

Clinical Brief: Recognition of Benign Joint Hypermobility Syndrome (BJHS)

Tue, 27 Mar 2012 00:00:00 GMT

The first known reference to joint laxity which leads to joint hypermobility is attributed to Hippocrates who, in the 4th century BC, described the Scythians as being "so-loose-limbed that they were unable to draw a bow-string or hurl a javelin."1 The prevalence of generalized joint hypermobility varies from 10 to 30 percent.2-5 This was illustrated in a study of 123 healthy medical students where 22 (18%) had at least one lax joint, and 14 others (11%) had three or more lax joints.6 Joint laxity is more common in the right limb, females, blacks, and in children from families with higher socioeconomic status.7-9

Fast Facts

Tue, 27 Mar 2012 00:00:00 GMT

Readers are welcome to contribute to Fast Facts. Please include the original abstract (with citation) that is the source of your contribution. Contributors’ names will be included along with the item.

The following is an excerpt:

The American Cancer Society (ACS) publishes Nutrition and Physical Activity Guidelines every 5 years to serve as a foundation for its communication, policy, and community strategies. Free full text available at: http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/abstract

Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2012;62(1):30-67.

Topics in Integrative Health Care

Fri, 30 Dec 2011 00:00:00 GMT

Each issue of TIHC focuses on a particular theme. Although many of the articles are invited, we also welcome unsolicited manuscripts with original research, Grand Rounds, clinical briefs and “fast facts” collections. All submissions are peer-reviewed. For the spring 2012 issue, the theme “Integrative approaches to chronic disease prevention and management” is tentatively scheduled.

Finding a Common Ground in Chiropractic: The Key to Progression

Fri, 30 Dec 2011 00:00:00 GMT

The chiropractic profession has survived many challenges in its brief lifetime. As a result of its many trials, the profession has a history filled with inner discord and external confusion, carrying over to the present. Conflict among chiropractors with differing opinions in scope of practice, education and the chiropractor’s role has been embedded in the profession. Chiropractors have traditionally vocalized passionately to each other and to each new generation of chiropractic students and patients their positions on these topics, creating an environment of intra-professional disorder and public uncertainty. In order for chiropractic to mature to its highest potential, the profession must connect and present itself as a consistent and united group. If chiropractors hope to unite, a bond must be created with some form of commonality in each area of dispute, overcoming the culture of internal friction. This commentary, from a chiropractic student’s perspective, provides a historical look into how dispute in chiropractic has become so deeply rooted and presents a unifying principle in which chiropractors can relate to and overcome the profession’s divisions and public confusion while advancing chiropractic’s future.

Methodology of a Randomized Controlled Trial of Manipulation and Physical Therapy for Chronic Low Back Pain and Balance Problems in the Geriatric Population.

Fri, 30 Dec 2011 00:00:00 GMT

Introduction: Postural control problems are one of the most common conditions affecting the geriatric population. This paper discusses the design of a prospective randomized controlled trial that examines a mixed modal treatment protocol for geriatric patients with non-vestibular related balance problems with or without chronic low back pain.

Methods: This three-year study will randomly assign a total of 300 consecutive community dwelling subjects between the ages of 65 and 80 years old into treatment groups receiving 6 weeks of either physical therapy or chiropractic care. Primary outcomes for balance include the NeuroCom balance tests, Berg Balance Scale, and POMA. The primary outcomes for low back pain are the VAS and 21-point box scale. Secondary outcomes are the Timed Up and Go Test for mobility and the Falls Efficacy Scale for confidence in performing everyday activities. Participants will be tested prior to randomization, and after 6 weeks of treatment, and again 6 weeks later. The data analysis for this intent-to-treat design will be mixed-model analysis of variance (ANOVA) with an alpha level of 0.05 for statistical significance for each outcome measure.

Conclusion: The methodology and design of a multimodal treatment protocol for balance disorders and low back pain in the geriatric population is described in this paper. By examining geriatric patients in separate cohorts with or without cLBP, we hope to identify effective treatment protocols and further define the relative contribution of cLBP to balance problems.

Chiropractic Students’ Perceptions about Interdisciplinary Collaboration

Fri, 30 Dec 2011 00:00:00 GMT

Objective: To assess the attitudes of chiropractic students toward interdisciplinary collaboration, as well as to compare the attitudes of students at chiropractic-only colleges to those in chiropractic institutions training multiple health professions.

Methods: This was a cross-sectional survey conducted in 4 chiropractic institutions. Two are universities offering training in chiropractic and other CAM health professions, and two are chiropractic colleges offering only chiropractic training. Students were approximately midway in their course of training. The study instrument was the Interdisciplinary Education Perception Scale (IEPS), an 18-item questionnaire comprising 4 factors, with a 6-point Likert response scale. Mean total scores for each group of students were compared using an analysis of variance (ANOVA), with a post-hoc Bonferroni test of multiple comparisons. The mean total score of the two chiropractic-only colleges was compared to the mean total score of the two multiple health professions colleges using a t-test for independent samples.

Results: The survey was conducted in 2011 with 248 students. The mean total scores did not differ significantly among the 4 colleges (p = 0.57), nor did they when comparing the 2 chiropractic-only colleges to the 2 multiple health professions colleges (p = 0.47).

Conclusion: Based on the non-significant differences between the scores at the 4 institutions we surveyed, as well as their overall similarity to the students’ scores in the 2000 study, we feel it is appropriate to aggregate all DC students’ scores in our planned study involving samples from a number of health professions students.

Clinical Brief: Acromegaly in Adults

Fri, 30 Dec 2011 00:00:00 GMT

Acromegaly is a condition affecting the growth of extremities and facial features, in addition to increasing the risk of life-threatening diseases such as obesity, diabetes, and cardiovascular disease among adults. The National Organization of Rare Disorders classifies acromegaly as an orphan disease due its rare occurrence; however, medical researchers and practitioners suggest that the prevalence is much higher than current estimates. The health risks associated with this condition indicate a need for additional approaches to recognition and clinical diagnosis among healthcare providers.

Fast Facts

Fri, 30 Dec 2011 00:00:00 GMT

The following is an excerpt:

This report describes school health guidelines for promoting healthy eating and physical activity, including coordination of school policies and practices; supportive environments; school nutrition services; physical education and physical activity programs; health education; health, mental health, and social services; family and community involvement; school employee wellness; and professional development for school staff members. It is available free of charge to the public at http://www.cdc.gov/mmwr/pdf/rr/rr6005.pdf

CDC. School health guidelines to promote healthy eating and physical activity. MMWR 2011;60(5).

Topics in Integrative Health Care

Fri, 07 Oct 2011 00:00:00 GMT

Each issue of TIHC focuses on a particular theme. Although many of the articles are invited, we also welcome unsolicited manuscripts with original research, Grand Rounds, clinical briefs and “fast facts” collections. All submissions are peer-reviewed. The following themes are tentatively scheduled:

· Winter 2011: Interdisciplinary education and training

· Spring 2012: Integrative Approaches to Chronic Disease Prevention and Management

Can Healthcare Providers Contribute to the Prevention of Dependent Adult Abuse? Recognizing and Intervening for Caregiver Stress

Fri, 07 Oct 2011 00:00:00 GMT

As Dr. Salsbury describes in her article, dependent adult abuse is an under-recognized issue in the U.S. However, it is one which must be addressed, not only because it currently affects many of our most vulnerable citizens—but also because it is likely to grow. Currently 1 in 7 Americans suffers a disability, and this number is expected to increase.¹ For the disabled who require personal assistance, at least 75% of their caregivers are “informal,” being unpaid family members or friends living either inside or outside the disabled person’s home. Approximately 12% of middle-aged Americans currently are involved in caregiving for a family member,^2,3 and this number is likely to increase as the number of disabled increases.

Opportunities to Integrate Prevention Into the Chiropractic Clinical Encounter: A Practice-based Research Project By the Integrated Chiropractic Outcomes Network (ICON)

Fri, 07 Oct 2011 00:00:00 GMT

Purpose: to collect exploratory data on the characteristics of chiropractic practices participating in a practice-based research network (PBRN), particularly with respect to important health promotion and disease prevention activities, to lay the groundwork for future longitudinal studies.

Methods: This was a cross-sectional descriptive study conducted by the methods of practice-based research in the offices of participating U.S. chiropractors. Data were collected by self-report from practitioners and from all patients presenting for treatment in the participating offices for one week in March 2011.

Results: Data were collected on 1891 patients of 38 Doctors of Chiropractic (DCs) in 30 practices in 17 U.S. states. Forty-seven percent of DCs reported that they routinely gave advice on diet; 26% on weight management; and 21% on tobacco use. Of the 1891 patients, 24.9% were presenting for wellness/maintenance care only. Forty percent of patients’ health concern’s duration was > 1 year. The mean number of annual visits reported by patients was 14. Of the 12.4% of patients who reported using tobacco currently, 29.1% reported that their practitioner discussed quitting with them. About 40% of patients reported being overweight; 19.5% reported that they received information from their DC on weight management. Only 9.2% of patients reported being obese; 31.6% reported receiving information on weight management from their DC.

Conclusion: Chiropractic patients in this sample presented with risk factors amenable to physician counseling. Their DCs reported routinely providing advice on some risk factors, and a substantial proportion of patients with risk factors reported receiving advice from their DC. Chiropractic practices, in which patients with chronic pain have frequent follow-up visits, present an opportunity to advise patients on health risks, which could contribute to improved health outcomes.

A Survey of Alabama Chiropractors Regarding Health Promotion, Primary Prevention, and Primary Care

Fri, 07 Oct 2011 00:00:00 GMT

Doctors of Chiropractic (DCs) perform health promotion as part of routine practice. In addition, the regulating body for chiropractic educational institutions has a standard in place on the teaching of this subject matter in all accredited colleges. The largest chiropractic professional organization in the U.S. (the American Chiropractic Association) and the Association of Chiropractic Colleges also have position statements supportive of prevention and health promotion as part of practice. However, very little is known as to whether practicing chiropractors have the aptitude, willingness, competence or the infrastructure to appropriately address primary preventive issues with patients. Additionally, little is known regarding attitudes and beliefs among DC’s in different regions of the country and whether demographic and cultural norms will affect the ability to meet the accrediting agency’s charge.

This study applies the Ecological Theory of health promotion to design a survey of attitudes, beliefs and practices of chiropractors in Alabama. Results indicate that although some health promotion practices are performed, many recommended screenings or procedures are not. In addition, though most clinicians agreed that public health measures should be a part of practice, in many cases they reported they did not perform them routinely. Further education and investigation are needed as to how chiropractors can be more involved in prevention and promotion of health as part of routine practice, including removal of actual and perceived barriers to this practice.

Management of Non-cardiac Chest Pain With Chiropractic Care: A Case Report and Brief Review

Fri, 07 Oct 2011 00:00:00 GMT

Objective: The purpose of this report is to discuss the outcome of a patient with non-cardiac chest pain treated with chiropractic spinal manipulation combined with instrument-assisted soft tissue mobilization.

Introduction: Chest pain is the fourth most common presentation in emergency rooms in the United States. The direct and indirect costs of chest pain are high in terms of disability, medication, repeated hospital admissions and physician visits, and costly diagnostic procedures.

Clinical features: The case of a 45 year-old male presenting to a chiropractic clinic with complaints of chest pain is discussed. Although the source of this chest pain was likely non-cardiac, cardiac risk factors were present and were addressed as well.

Intervention and outcome: The patient was treated with manual thoracic spinal manipulation and instrument-assisted soft tissue mobilization with complete resolution of chest pain at 3 weeks and no chest pain at 1 month and 3 month follow-up visits. Conservative cardiac prevention approaches were encouraged with good outcome.

Conclusion: This case points out the promising role the combination of chiropractic manipulation and instrument-assisted soft tissue mobilization may have in the management of non-cardiac chest pain arising from musculoskeletal dysfunction.

Chiropractic Management of Post-concussion Headache and Neck Pain In a Young Athlete and Implications For Return-To-Play

Fri, 07 Oct 2011 00:00:00 GMT

Objective: Each year there are an estimated 1.6-3.8 million sports-related brain injuries; 136,000 of which occur in young athletes in the course of high school sports. The purpose of this article is to discuss the management and outcome of a post-concussive headache and neck pain in a young athlete and implications for return to play.

Clinical Features: A 16-year-old male athlete presented to a chiropractic clinic complaining of neck pain and daily headaches from a concussion while playing football 5 weeks previously.

Intervention and Outcome: A short course of diversified-type cervical and thoracic manipulation was applied with significant relief after the second treatment and resolution of symptoms after 5 visits performed over 2 weeks. The athlete was able to participate in a graduated return to play. Three months post-SRC the athlete was able to return to full game play symptom free.

Conclusion: Chiropractors who see athletes in their practices should be aware of SRC and return to play guidelines.

Clinical Brief: Challenges with the Differential Diagnosis of Fibromyalgia

Fri, 07 Oct 2011 00:00:00 GMT

Fibromyalgia (FM) is a diagnosis of exclusion used to describe patients with a cluster of symptoms that are not attributed to a recognized disease process. The hallmark symptom of FM is chronic widespread pain which is bilateral, above and below the waist, and involving the axial skeleton and/or torso. The symptom cluster also includes unrefreshing sleep, fatigue, cognitive difficulties, and a number of somatic complaints. Unfortunately, FM is often misdiagnosed because these symptoms may also be found associated with latent pathology or disease, metabolic/functional disorders, or chronic musculoskeletal disorders. All clinicians who treat chronic pain patients should learn how to differentiate between FM and other causes of widespread pain and fatigue.

Clinical Brief: Recognizing, Reporting and Responding to Dependent Adult Abuse

Fri, 07 Oct 2011 00:00:00 GMT

Dependent adult abuse is an under-recognized problem affecting many disabled adults and older persons living in their homes or in institutional settings. Elder abuse, the most common form of dependent adult abuse, may present as physical, emotional/psychological, or sexual abuse; financial exploitation; and neglect, abandonment, or self-neglect. Health care professionals should be aware of the signs and symptoms of dependent adult abuse, and know how to report suspected cases accordingly. Manual therapists may need to modify treatment approaches for patients with a history of dependent adult abuse.