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OBJECTIVE Reparixin is an inhibitor of CXCR1/2 chemokine receptor shown to be an effective anti-inflammatory adjuvant in a pilot clinical trial in allotransplant recipients. RESEARCH DESIGN AND METHODS A phase 3, multicenter, randomized, double-blind, parallel-assignment study (NCT01817959) was conducted in recipients of islet allotransplants randomized (2:1) to reparixin or placebo in addition to immunosuppression. Primary outcome was the area under the curve (AUC) for C-peptide during the mixed-meal tolerance test at day 75 6 5 after the first and day 365 6 14 after the last transplant. Secondary end points included insulin independence and standard measures of glycemic control. RESULTS The intention-to-treat analysis did not show a significant difference in C-peptide AUC at both day 75 (27 on reparixin vs. 18 on placebo, P 5 0.99) and day 365 (24 on reparixin vs. 15 on placebo, P 5 0.71). There was no statistically significant difference between treatment groups at any time point for any secondary variable. Analysis of patient subsets showed a trend for a higher percentage of subjects retaining insulin independence for 1 year after a single islet infusion in patients receiving reparixin as compared with patients receiving placebo (26.7% vs. 0%, P 5 0.09) when antithymocyte globulin was used as induction immunosuppression. CONCLUSIONS In this first double-blind randomized trial, islet transplantation data obtained with reparixin do not support a role of CXCR1/2 inhibition in preventing islet inflammation-mediated damage.

Importance: Juvenile amyotrophic lateral sclerosis (ALS) is a rare form of ALS characterized by age of symptom onset less than 25 years and a variable presentation. Objective: To identify the genetic variants associated with juvenile ALS. Design, setting, and participants: In this multicenter family-based genetic study, trio whole-exome sequencing was performed to identify the disease-associated gene in a case series of unrelated patients diagnosed with juvenile ALS and severe growth retardation. The patients and their family members were enrolled at academic hospitals and a government research facility between March 1, 2016, and March 13, 2020, and were observed until October 1, 2020. Whole-exome sequencing was also performed in a series of patients with juvenile ALS. A total of 66 patients with juvenile ALS and 6258 adult patients with ALS participated in the study. Patients were selected for the study based on their diagnosis, and all eligible participants were enrolled in the study. None of the participants had a family history of neurological disorders, suggesting de novo variants as the underlying genetic mechanism. Main outcomes and measures: De novo variants present only in the index case and not in unaffected family members. Results: Trio whole-exome sequencing was performed in 3 patients diagnosed with juvenile ALS and their parents. An additional 63 patients with juvenile ALS and 6258 adult patients with ALS were subsequently screened for variants in the SPTLC1 gene. De novo variants in SPTLC1 (p.Ala20Ser in 2 patients and p.Ser331Tyr in 1 patient) were identified in 3 unrelated patients diagnosed with juvenile ALS and failure to thrive. A fourth variant (p.Leu39del) was identified in a patient with juvenile ALS where parental DNA was unavailable. Variants in this gene have been previously shown to be associated with autosomal-dominant hereditary sensory autonomic neuropathy, type 1A, by disrupting an essential enzyme complex in the sphingolipid synthesis

Background Hypothyroidism is a common endocrine condition. There is evidence to suggest that, for a proportion of sufferers, the standard medical treatment does not completely reverse the constitutional and neuropsychiatric symptoms brought about by this condition. The management of hypothyroidism follows a biomedical model with little consideration given to alternative management approaches. There exists anecdotal evidence and case reports supporting the use of a biopsychosocial-based intervention called Neuro-Emotional Technique (NET) for this population. The aim of this study was to explore the potential short-medium term clinical efficacy and safety of NET for individuals with primary hypothyroidism.DesignPlacebo-controlled, blinded, parallel groups, randomized trial. Methods Ninety adults with a diagnosis of primary hypothyroidism were recruited from Sydney, Australia. Blinded participants were randomized to either the NET or placebo group and received ten intervention sessions over a six week period. The primary outcome involved the measurement of states of depression using the DASS-42 questionnaire. Secondary outcomes included thyroid function, thyroid autoimmunity testing, SF-36v2 questionnaire, resting heart rate and temperature measurement. Outcomes were obtained at baseline, seven weeks and six months. Questionnaires were completed at the private clinics, and serum measures were obtained and analysed at commercial pathology company locations. Heart rate and temperature were also measured daily by participants. Linear mixed-effects models were used to analyse the continuous outcomes. Unadjusted odds ratios with 95% confidence intervals were calculated for the binary outcomes. Results Participants were randomly allocated to the NET (n=44) and placebo (n=46) groups. A proportion of the sample displayed neuropsychiatric disturbances and alterations in quality of life measures at baseline. There were no statistically significant or clinically relevant changes

Background Hypothyroidism is a common endocrine condition. There is evidence to suggest that, for a proportion of sufferers, the standard medical treatment does not completely reverse the constitutional and neuropsychiatric symptoms brought about by this condition. The management of hypothyroidism follows a biomedical model with little consideration given to alternative management approaches. There exists anecdotal evidence and case reports supporting the use of a biopsychosocial-based intervention called Neuro-Emotional Technique (NET) for this population. The aim of this study was to explore the potential short-medium term clinical efficacy and safety of NET for individuals with primary hypothyroidism.DesignPlacebo-controlled, blinded, parallel groups, randomized trial. Methods Ninety adults with a diagnosis of primary hypothyroidism were recruited from Sydney, Australia. Blinded participants were randomized to either the NET or placebo group and received ten intervention sessions over a six week period. The primary outcome involved the measurement of states of depression using the DASS-42 questionnaire. Secondary outcomes included thyroid function, thyroid autoimmunity testing, SF-36v2 questionnaire, resting heart rate and temperature measurement. Outcomes were obtained at baseline, seven weeks and six months. Questionnaires were completed at the private clinics, and serum measures were obtained and analysed at commercial pathology company locations. Heart rate and temperature were also measured daily by participants. Linear mixed-effects models were used to analyse the continuous outcomes. Unadjusted odds ratios with 95% confidence intervals were calculated for the binary outcomes. Results Participants were randomly allocated to the NET (n=44) and placebo (n=46) groups. A proportion of the sample displayed neuropsychiatric disturbances and alterations in quality of life measures at baseline. There were no statistically significant or clinically relevant changes

Objective The purpose of this study was to complete a systematic review of manual and manipulative therapy (MMT) for common upper extremity pain and disorders including the temporomandibular joint (TMJ). Methods A literature search was conducted using the Cumulative Index of Nursing Allied Health Literature, PubMed, Manual, Alternative, and Natural Therapy Index System (MANTIS), Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, Google Scholar, and hand search inclusive of literature from January 1983 to March 5, 2012. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, and physical therapies. Inclusion criteria required an extremity peripheral diagnosis (for upper extremity problems including the elbow, wrist, hand, finger and the (upper quadrant) temporomandibular joint) and MMT with or without multimodal therapy. Studies were assessed using the PEDro scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring was complete, evidence grades of “A, B, C and I” were applied. Results Out of 764 citations reviewed, 129 studies were deemed possibly to probably useful and/or relevant to develop expert consensus. Out of 81 randomized controlled or clinical trials, 35 were included. Five controlled or clinical trials were located and 4 were included. Fifty case series, reports and/or single-group pre-test post-test prospective case series were located with 32 included. There is Fair (B) level of evidence for MMT to specific joints and the full kinetic chain combined generally with exercise and/or multimodal therapy for lateral epicondylopathy, carpal tunnel syndrome, and temporomandibular joint disorders, in the short term. Conclusion The information from this study will help guide practitioners in the use of MMT, soft tissue technique, exercise, and/or multimodal therapy for the treatment of a variety of upper

Objective The purpose of this study was to complete a systematic review of manual and manipulative therapy (MMT) for common upper extremity pain and disorders including the temporomandibular joint (TMJ). Methods A literature search was conducted using the Cumulative Index of Nursing Allied Health Literature, PubMed, Manual, Alternative, and Natural Therapy Index System (MANTIS), Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, Google Scholar, and hand search inclusive of literature from January 1983 to March 5, 2012. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, and physical therapies. Inclusion criteria required an extremity peripheral diagnosis (for upper extremity problems including the elbow, wrist, hand, finger and the (upper quadrant) temporomandibular joint) and MMT with or without multimodal therapy. Studies were assessed using the PEDro scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring was complete, evidence grades of “A, B, C and I” were applied. Results Out of 764 citations reviewed, 129 studies were deemed possibly to probably useful and/or relevant to develop expert consensus. Out of 81 randomized controlled or clinical trials, 35 were included. Five controlled or clinical trials were located and 4 were included. Fifty case series, reports and/or single-group pre-test post-test prospective case series were located with 32 included. There is Fair (B) level of evidence for MMT to specific joints and the full kinetic chain combined generally with exercise and/or multimodal therapy for lateral epicondylopathy, carpal tunnel syndrome, and temporomandibular joint disorders, in the short term. Conclusion The information from this study will help guide practitioners in the use of MMT, soft tissue technique, exercise, and/or multimodal therapy for the treatment of a variety of upper

Interindividual variation in mean leukocyte telomere length (LTL) is associated with cancer and several age-associated diseases. We report here a genome-wide meta-analysis of 37,684 individuals with replication of selected variants in an additional 10,739 individuals. We identified seven loci, including five new loci, associated with mean LTL (P < 5 × 10 -8). Five of the loci contain candidate genes (TERC, TERT, NAF1, OBFC1 and RTEL1) that are known to be involved in telomere biology. Lead SNPs at two loci (TERC and TERT) associate with several cancers and other diseases, including idiopathic pulmonary fibrosis. Moreover, a genetic risk score analysis combining lead variants at all 7 loci in 22,233 coronary artery disease cases and 64,762 controls showed an association of the alleles associated with shorter LTL with increased risk of coronary artery disease (21% (95% confidence interval, 5-35%) per standard deviation in LTL, P = 0.014). Our findings support a causal role of telomere-length variation in some age-related diseases.

Objective: To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA). Design: Parallel-group randomized trial with 3-month follow-up. Setting: Two chiropractic outpatient teaching clinics. Participants: Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively. Interventions: Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period. Main Outcome Measures: Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. Results: Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively). Conclusions: There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.

Objective: To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA). Design: Parallel-group randomized trial with 3-month follow-up. Setting: Two chiropractic outpatient teaching clinics. Participants: Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively. Interventions: Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period. Main Outcome Measures: Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. Results: Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively). Conclusions: There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.

Contains fulltext : 98050.pdf (publisher's version ) (Open Access), Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in approximately 2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10(-33); LPA:p<10(-19); 1p13.3:p<10(-17)) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5x10(-7)). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06-1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other approximately 4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular f

Introduction: The literature reveals that two treatments have been validated as effective treatment modalities for pediatric AD/HD: psychosocial treatments, pharmacological treatments and their combination. However, controversy exists over the efficacy and safety of pharmacological therapies. As a result of this controversy, parents have been seeking complementary and alternative medicine (CAM) such as chiropractic for their children with AD/HD. The objective of this study was to determine whether the addition of the emotional component of NET therapy to an existing treatment program could improve clinical outcomes (i.e. reduce inattention, hyperactivity and impulsivity) in pediatric AD/HD. The purpose of this study was to test anecdotal claims of treatment success made by chiropractors using NET therapy for pediatric AD/HD. Methods: An approved clinical trial was conducted in four private clinics in Sydney, Australia. Children aged 5–12 years who met inclusion criteria were randomised into three groups: Group A (Sham n = 37), Group B (NET therapy n = 59) and Group C (Control n = 32). All groups continued with their existing treatment regimens (i.e. pharmacological and/or psychosocial). Groups A and B had sham and NET protocols added respectively to existing regimens. Psychometric outcome measures were chosen from the Conners’ Rating Scales (CRS), which were scored and interpreted by independent registered clinical psychologists. The psychologists, participants, parents and teachers of groups A and B were all blinded to group allocation. An analysis of covariance was conducted comparing the changes between baseline and final results (i.e. after seven months and 14 interventions) between the active group (NET) and placebo group (sham). Results: Forty-one participants (10 sham; 21 NET; 10 Control) completed the protocol. CRS classified changes of five or more subscale points as significant and thus -5 was chosen as the minimally clinically important difference (MCID).

Objectives. To collate and appraise incidence and severity data for neck injury in Rugby Union. To report risk factors for neck injury in Rugby Union that are supported by incidence and severity data. Design. Systematic review. Methods. Original journal articles were retrieved from electronic searches of AusportMed, AUSPORT, Scopus, Medline (Ovid), CINAHL, Mantis, and Pubmed databases and relevant bibliographic hand searches. Selection criteria were restricted to: (a) prospective study designs including cohort, case-control, and intervention methodologies; (b) populations of Rugby Union players, either male or female of any age; (c) studies must report on neck injury incidence and/or severity specifically; (d) articles with republished neck injury data were excluded. The STROBE Statement was adapted for the quality assessment of included studies and categorised as either poor, moderate or good. Results. Thirty-three original articles met the selection criteria. Wide variation of injury and exposure definitions and population sampling was identified in the included articles. Neck injury incidence ranged between 0.26 (CI: 0.08, 0.93) and 9.17 (CI: 1.89, 26.81) per 1000 player hours for mixed populations that adopted an all inclusive sports injury definition. There is a paucity of severity data and analytical data which evaluates causal roles of risk factors for neck injury in Rugby Union. Conclusions. Meaningful understanding of neck injury incidence and severity in Rugby Union is restricted to a few studies which adopt comparable methodological construct. This paper provides an index for future neck injury studies in Rugby Union.

Contains fulltext : 98050.pdf (publisher's version ) (Open Access), Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in approximately 2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10(-33); LPA:p<10(-19); 1p13.3:p<10(-17)) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5x10(-7)). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06-1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other approximately 4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular f

Introduction: The literature reveals that two treatments have been validated as effective treatment modalities for pediatric AD/HD: psychosocial treatments, pharmacological treatments and their combination. However, controversy exists over the efficacy and safety of pharmacological therapies. As a result of this controversy, parents have been seeking complementary and alternative medicine (CAM) such as chiropractic for their children with AD/HD. The objective of this study was to determine whether the addition of the emotional component of NET therapy to an existing treatment program could improve clinical outcomes (i.e. reduce inattention, hyperactivity and impulsivity) in pediatric AD/HD. The purpose of this study was to test anecdotal claims of treatment success made by chiropractors using NET therapy for pediatric AD/HD. Methods: An approved clinical trial was conducted in four private clinics in Sydney, Australia. Children aged 5–12 years who met inclusion criteria were randomised into three groups: Group A (Sham n = 37), Group B (NET therapy n = 59) and Group C (Control n = 32). All groups continued with their existing treatment regimens (i.e. pharmacological and/or psychosocial). Groups A and B had sham and NET protocols added respectively to existing regimens. Psychometric outcome measures were chosen from the Conners’ Rating Scales (CRS), which were scored and interpreted by independent registered clinical psychologists. The psychologists, participants, parents and teachers of groups A and B were all blinded to group allocation. An analysis of covariance was conducted comparing the changes between baseline and final results (i.e. after seven months and 14 interventions) between the active group (NET) and placebo group (sham). Results: Forty-one participants (10 sham; 21 NET; 10 Control) completed the protocol. CRS classified changes of five or more subscale points as significant and thus -5 was chosen as the minimally clinically important difference (MCID).

Objectives. To collate and appraise incidence and severity data for neck injury in Rugby Union. To report risk factors for neck injury in Rugby Union that are supported by incidence and severity data. Design. Systematic review. Methods. Original journal articles were retrieved from electronic searches of AusportMed, AUSPORT, Scopus, Medline (Ovid), CINAHL, Mantis, and Pubmed databases and relevant bibliographic hand searches. Selection criteria were restricted to: (a) prospective study designs including cohort, case-control, and intervention methodologies; (b) populations of Rugby Union players, either male or female of any age; (c) studies must report on neck injury incidence and/or severity specifically; (d) articles with republished neck injury data were excluded. The STROBE Statement was adapted for the quality assessment of included studies and categorised as either poor, moderate or good. Results. Thirty-three original articles met the selection criteria. Wide variation of injury and exposure definitions and population sampling was identified in the included articles. Neck injury incidence ranged between 0.26 (CI: 0.08, 0.93) and 9.17 (CI: 1.89, 26.81) per 1000 player hours for mixed populations that adopted an all inclusive sports injury definition. There is a paucity of severity data and analytical data which evaluates causal roles of risk factors for neck injury in Rugby Union. Conclusions. Meaningful understanding of neck injury incidence and severity in Rugby Union is restricted to a few studies which adopt comparable methodological construct. This paper provides an index for future neck injury studies in Rugby Union.

Contains fulltext : 98050.pdf (publisher's version ) (Open Access), Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in approximately 2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p<10(-33); LPA:p<10(-19); 1p13.3:p<10(-17)) as well as three recently discovered loci (COL4A1/COL4A2, ZC3HC1, CYP17A1:p<5x10(-7)). However, we found essentially null results for most previously suggested CAD candidate genes. In our replication study of 24 promising common variants, we identified novel associations of variants in or near LIPA, IL5, TRIB1, and ABCG5/ABCG8, with per-allele odds ratios for CAD risk with each of the novel variants ranging from 1.06-1.09. Associations with variants at LIPA, TRIB1, and ABCG5/ABCG8 were supported by gene expression data or effects on lipid levels. Apart from the previously reported variants in LPA, none of the other approximately 4,500 low frequency and functional variants showed a strong effect. Associations in South Asians did not differ appreciably from those in Europeans, except for 9p21.3 (per-allele odds ratio: 1.14 versus 1.27 respectively; P for heterogeneity = 0.003). This large-scale gene-centric analysis has identified several novel genes for CAD that relate to diverse biochemical and cellular f

Background Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors. Objective The purpose of this systematic review is to discuss the evidence for manipulative methods of management of shoulder pain and chiropractic management techniques used within the literature. Methods A literature search of MEDLINE, CINAHL, MANTIS, the Cochrane Musculoskeletal Group trials register and the Cochrane Controlled Trials Register was conducted. Search terms included chiropractic or manipulative therapy and shoulder pain, impingement, rotator cuff, shoulder instability, shoulder joint, treatment or rehabilitation exercises. Publications were included if they contained shoulder pain or contained a specific clinical diagnosis of a shoulder pain syndrome in the title; a detailed description of the treatment intervention which was typical of the profession; treatment performed by a registered practitioner and outcome measures were included in the studies. Exclusion criteria included the diagnosis of adhesive capsultis or referred/pathological pain. The articles were reviewed and clinical trials ranked on the Physiotherapy Evidence Database scale. Results From a total of 913 retrieved publications, 22 case reports, 4 case series and 4 randomized, controlled trials met the inclusion and exclusion criteria for this review. Conclusions The literature contains 2 articles of reasonably sound methodology. The evidence for chiropractic management of shoulder pain is limited to lo

Objective The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. Methods Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. Conclusions To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.

Objectives Studies investigating the efficacy of intra-oral myofascial therapies (IMT) for chronic temporomandibular disorder (TMD) are rare. The objective of this randomized, controlled pilot study was to compare the effects of IMT and the addition of self-care and education over 6 months on four common TMD outcome measures: inter-incisal opening range, jaw pain at rest, jaw pain upon opening, and jaw pain upon clenching. Participants Thirty myogenous TMD participants between the ages of 18 and 50 years, experiencing chronic jaw pain of longer than 3-month duration, were recruited for the present study. Intervention Included patients were randomized into one of three groups: (1) IMT consisting of two treatment interventions per week for 5 weeks; (2) IMT plus ‘self-care’ involving education and exercises; and (3) wait list control. Main outcome measures Range of motion findings were measured in millimetres by vernier callipers and pain scores were quantified using an 11-point self-reported graded chronic pain scale. Measurements were taken at baseline, 6 weeks post-treatment, and 6 months post-treatment. Results The results showed statistically significant differences in resting, opening, and clenching pain and opening range scores (P<0.05) in both treatment groups compared to control at 6 months. No significant differences were observed between the two treatment groups during the course of the trial. Conclusions This study suggests that IMT alone or with the addition of self-care may be of some benefit in the management of chronic TMD over the short-medium term. A larger scale study over a longer term (1–2 years) may be of further value.

Background Hypothyroidism is a prevalent endocrine condition. Individuals with this disease are commonly managed through supplementation with synthetic thyroid hormone, with the aim of alleviating symptoms and restoring normal thyroid stimulating hormone levels. Generally this management strategy is effective and well tolerated. However, there is research to suggest that a significant proportion of hypothyroid sufferers are being inadequately managed. Furthermore, hypothyroid patients are more likely to have a decreased sense of well-being and more commonly experience constitutional and neuropsychiatric complaints, even with pharmacological intervention. The current management of hypothyroidism follows a biomedical model. Little consideration has been given to a biopsychosocial approach to this condition. Within the chiropractic profession there is growing support for the use of a biopsychosocial-based intervention called Neuro-Emotional Technique (NET) for this population. Methods/Design A placebo-controlled, single-blinded, randomised clinical pilot-trial has been designed to assess the influence of Neuro-Emotional Technique on a population with primary overt hypothyroidism. A sample of 102 adults (≥18 years) who meet the inclusion criteria will be randomised to either a treatment group or a placebo group. Each group will receive ten treatments (NET or placebo) over a six week period, and will be monitored for six months. The primary outcome will involve the measurement of depression using the Depression, Anxiety and Stress Scale (DASS). The secondary outcome measures to be used are; serum thyroid stimulating hormone, serum free-thyroxine, serum free-triiodothyronine, serum thyroid peroxidase auto-antibodies, serum thyroglobulin auto-antibodies as well as the measurement of functional health and well-being using the Short-Form-36 Version 2. The emotional states of anxiety and stress will be measured using the DASS. Self-measurement of basal heart rate and basal te

Background Psychostimulants are first line of therapy for paediatric and adolescent AD/HD. The evidence suggests that up to 30% of those prescribed stimulant medications do not show clinically significant outcomes. In addition, many children and adolescents experience side-effects from these medications. As a result, parents are seeking alternate interventions for their children. Complementary and alternative medicine therapies for behavioural disorders such as AD/HD are increasing with as many as 68% of parents having sought help from alternative practitioners, including chiropractors. Objective The purpose of this systematic review is to discuss the evidence for manipulative methods of management of shoulder pain and chiropractic management techniques used within the literature. Methods A literature search of MEDLINE, CINAHL, MANTIS, the Cochrane Musculoskeletal Group trials register and the Cochrane Controlled Trials Register was conducted. Search terms included chiropractic or manipulative therapy and shoulder pain, impingement, rotator cuff, shoulder instability, shoulder joint, treatment or rehabilitation exercises. Publications were included if they contained shoulder pain or contained a specific clinical diagnosis of a shoulder pain syndrome in the title; a detailed description of the treatment intervention which was typical of the profession; treatment performed by a registered practitioner and outcome measures were included in the studies. Exclusion criteria included the diagnosis of adhesive capsultis or referred/pathological pain. The articles were reviewed and clinical trials ranked on the Physiotherapy Evidence Database scale. Results From a total of 913 retrieved publications, 22 case reports, 4 case series and 4 randomized, controlled trials met the inclusion and exclusion criteria for this review. Conclusions The literature contains 2 articles of reasonably sound methodology. The evidence for chiropractic management of shoulder pain is limited to lo

Objectives Studies investigating the efficacy of intra-oral myofascial therapies (IMT) for chronic temporomandibular disorder (TMD) are rare. The objective of this randomized, controlled pilot study was to compare the effects of IMT and the addition of self-care and education over 6 months on four common TMD outcome measures: inter-incisal opening range, jaw pain at rest, jaw pain upon opening, and jaw pain upon clenching. Participants Thirty myogenous TMD participants between the ages of 18 and 50 years, experiencing chronic jaw pain of longer than 3-month duration, were recruited for the present study. Intervention Included patients were randomized into one of three groups: (1) IMT consisting of two treatment interventions per week for 5 weeks; (2) IMT plus ‘self-care’ involving education and exercises; and (3) wait list control. Main outcome measures Range of motion findings were measured in millimetres by vernier callipers and pain scores were quantified using an 11-point self-reported graded chronic pain scale. Measurements were taken at baseline, 6 weeks post-treatment, and 6 months post-treatment. Results The results showed statistically significant differences in resting, opening, and clenching pain and opening range scores (P<0.05) in both treatment groups compared to control at 6 months. No significant differences were observed between the two treatment groups during the course of the trial. Conclusions This study suggests that IMT alone or with the addition of self-care may be of some benefit in the management of chronic TMD over the short-medium term. A larger scale study over a longer term (1–2 years) may be of further value.

Background Hypothyroidism is a prevalent endocrine condition. Individuals with this disease are commonly managed through supplementation with synthetic thyroid hormone, with the aim of alleviating symptoms and restoring normal thyroid stimulating hormone levels. Generally this management strategy is effective and well tolerated. However, there is research to suggest that a significant proportion of hypothyroid sufferers are being inadequately managed. Furthermore, hypothyroid patients are more likely to have a decreased sense of well-being and more commonly experience constitutional and neuropsychiatric complaints, even with pharmacological intervention. The current management of hypothyroidism follows a biomedical model. Little consideration has been given to a biopsychosocial approach to this condition. Within the chiropractic profession there is growing support for the use of a biopsychosocial-based intervention called Neuro-Emotional Technique (NET) for this population. Methods/Design A placebo-controlled, single-blinded, randomised clinical pilot-trial has been designed to assess the influence of Neuro-Emotional Technique on a population with primary overt hypothyroidism. A sample of 102 adults (≥18 years) who meet the inclusion criteria will be randomised to either a treatment group or a placebo group. Each group will receive ten treatments (NET or placebo) over a six week period, and will be monitored for six months. The primary outcome will involve the measurement of depression using the Depression, Anxiety and Stress Scale (DASS). The secondary outcome measures to be used are; serum thyroid stimulating hormone, serum free-thyroxine, serum free-triiodothyronine, serum thyroid peroxidase auto-antibodies, serum thyroglobulin auto-antibodies as well as the measurement of functional health and well-being using the Short-Form-36 Version 2. The emotional states of anxiety and stress will be measured using the DASS. Self-measurement of basal heart rate and basal te

Objective The review seeks to answer the question of whether chiropractic care can reduce symptoms of inattention, impulsivity and hyperactivity for paediatric and adolescent AD/HD. Methods Electronic databases (Cochrane CENTRAL register of Controlled Trials, Cochrane Database of Systematic reviews, MEDLINE, PsycINFO, CINAHL, Scopus, ISI Web of Science, Index to Chiropractic Literature) were searched from inception until July 2009 for English language studies for chiropractic care and AD/HD. Inclusion and exclusion criteria were applied to select studies. All randomised controlled trials were evaluated using the Jadad score and a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for paediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. Conclusions To date there is insufficient evidence to evaluate the efficacy of chiropractic care for paediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.

Background An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM). The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60–65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET. Design/methods A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD. Children aged 5–12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months. The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity. Calcula

Objective This survey investigated the demographic characteristics of the responding practitioners, the prevalence of shoulder pain symptoms seen in weekly chiropractic practice, the sources of shoulder pain, the chiropractor-diagnosed prevalence of shoulder clinical syndromes, and the management strategies for Australian chiropractors. Methods A survey was created by the authors consisting of questions seeking demographic information from the respondents, shoulder syndrome, and shoulder management information. The survey was mailed to every chiropractic practitioner based in the Australian state of New South Wales (general population 6.8 million in 2005). Contact details were derived from Yellow Pages online listings. Results One thousand thirty-seven surveys were mailed to New South Wales–based chiropractors, with 192 (21%) returning a completed survey. The prevalence of shoulder pain symptoms as reported by the practitioners was 12% of the total weekly patients, with the major cause of symptoms related to overuse (32%). The most prevalent working diagnosis of shoulder pain was shoulder impingement syndrome (13%), followed by impingement syndrome with rotator cuff tendinosis (17%), impingement syndrome without rotator cuff tendinosis (14%), and chiropractic shoulder subluxation (12%). Shoulder pain is managed with a combination of manipulation, mainly diversified technique (81%), peripheral joint manipulation (82%), and various soft tissue strategies used by 92% of practitioners. Rehabilitation strategies were also used by 89% of practitioners with a main emphasis placed on rotator cuff strengthening. Conclusion The results suggest a moderate prevalence of shoulder pain in clinical practice with the most prevalent structure involved being the rotator cuff tendon. Most practitioners use a multimodal therapeutic treatment approach in managing disorders of the shoulder.

Purpose To describe the profile of patients presenting to a private chiropractic clinic specialising in Neuro Emotional Technique (NET) and to identify trends in the presentation of symptoms from these patients. Methods 761 consecutive new patients presented to a large, multi-doctor chiropractic clinic in which practitioners all adopt a similar philosophical paradigm and practice NET From January 2005 to December 2005, self-referred patients completed a new patient questionnaire, in which they self-reported one primary complaint for why they were visiting the practitioner. Predetermined patient information was entered manually into a database and basic descriptive statistics extracted. Results 67.3% of participants were female and 32.6% of the participants were between the ages of 31 and 40. 54.8% of patients presented with a primary musculoskeletal complaint and 36.0% a non-musculoskeletal complaint. Of the musculoskeletal complaints, 40.8% of patients presented with back pain, 20.9% with neck pain and 11.5% with shoulder pain. The most common form of non-musculoskeletal complaint was immune and recurrent infections (13.9%), stress and anxiety (12.8%) and depression (10.9%). 41.4% of participants reported a first time complaint, however, of the patients who had had the presenting complaint before 60.7% reported as having the complaint for greater than 1 year. Musculoskeletal and non-musculoskeletal participants had similar pain profiles. Conclusion This retrospective analysis is the first comprehensive description of the scope of NET patients and their presenting complaints. The patient profile of this NET clinic has a higher degree of non-musculoskeletal patients than that usually reported in non-NET chiropractic offices, and other forms of chiropractic previously described in the literature. Further cross sectional research is required to determine if this particular clinic is indicative of all NET practices and whether the presenting symptoms, especially the non

Objectives: The authors of this manuscript seek to define the role, and scientific backing for the inclusion of Traditional Chinese Medicine (TCM) principles in the chiropractic techniques know as Applied Kinesiology (AK) and Neuro-Emotional Technique (NET). A discussion of the suitability of TCM principles within the chiropractic profession is also presented. Data Sources: A search through the electronic databases Medline, Meditext, Pubmed, OVID, CINAHL, and the Cochrane Library was performed for the period of 1900 – 2007 using the key words Traditional Chinese Medicine, Meridian, five-element, five-phase, acupuncture, chiropractic, Applied Kinesiology, and Neuro-Emotional Technique. The results were limited to works published in English appearing in peer-reviewed journals. A hand search was then performed within the reference lists of the articles retrieved. Study Selection: Based on their relevance to the subject, 196 references were obtained. Data Extraction and Synthesis: Only those historical principles and current research findings that pertain specifically to the TCM concepts used in AK and NET have been included. Conclusions: Principles and philosophies from TCM are incorporated into the diagnostic and treatment of protocols of the chiropractic techniques AK and NET. The scientific backing for this inclusion is still evolving and it is clear that further research is required to support the placement of TCM principles and practices within these chiropractic techniques. The welcoming of TCM principles into chiropractic practice may broaden the scope of the chiropractic profession and allow chiropractors to more faithfully adhere to the biopsychosocial model of healthcare.

Background An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM). The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60–65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET. Design/methods A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD. Children aged 5–12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months. The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity. Calcula

Objectives: The authors of this manuscript seek to define the role, and scientific backing for the inclusion of Traditional Chinese Medicine (TCM) principles in the chiropractic techniques know as Applied Kinesiology (AK) and Neuro-Emotional Technique (NET). A discussion of the suitability of TCM principles within the chiropractic profession is also presented. Data Sources: A search through the electronic databases Medline, Meditext, Pubmed, OVID, CINAHL, and the Cochrane Library was performed for the period of 1900 – 2007 using the key words Traditional Chinese Medicine, Meridian, five-element, five-phase, acupuncture, chiropractic, Applied Kinesiology, and Neuro-Emotional Technique. The results were limited to works published in English appearing in peer-reviewed journals. A hand search was then performed within the reference lists of the articles retrieved. Study Selection: Based on their relevance to the subject, 196 references were obtained. Data Extraction and Synthesis: Only those historical principles and current research findings that pertain specifically to the TCM concepts used in AK and NET have been included. Conclusions: Principles and philosophies from TCM are incorporated into the diagnostic and treatment of protocols of the chiropractic techniques AK and NET. The scientific backing for this inclusion is still evolving and it is clear that further research is required to support the placement of TCM principles and practices within these chiropractic techniques. The welcoming of TCM principles into chiropractic practice may broaden the scope of the chiropractic profession and allow chiropractors to more faithfully adhere to the biopsychosocial model of healthcare.

Purpose To describe the profile of patients presenting to a private chiropractic clinic specialising in Neuro Emotional Technique (NET) and to identify trends in the presentation of symptoms from these patients. Methods 761 consecutive new patients presented to a large, multi-doctor chiropractic clinic in which practitioners all adopt a similar philosophical paradigm and practice NET From January 2005 to December 2005, self-referred patients completed a new patient questionnaire, in which they self-reported one primary complaint for why they were visiting the practitioner. Predetermined patient information was entered manually into a database and basic descriptive statistics extracted. Results 67.3% of participants were female and 32.6% of the participants were between the ages of 31 and 40. 54.8% of patients presented with a primary musculoskeletal complaint and 36.0% a non-musculoskeletal complaint. Of the musculoskeletal complaints, 40.8% of patients presented with back pain, 20.9% with neck pain and 11.5% with shoulder pain. The most common form of non-musculoskeletal complaint was immune and recurrent infections (13.9%), stress and anxiety (12.8%) and depression (10.9%). 41.4% of participants reported a first time complaint, however, of the patients who had had the presenting complaint before 60.7% reported as having the complaint for greater than 1 year. Musculoskeletal and non-musculoskeletal participants had similar pain profiles. Conclusion This retrospective analysis is the first comprehensive description of the scope of NET patients and their presenting complaints. The patient profile of this NET clinic has a higher degree of non-musculoskeletal patients than that usually reported in non-NET chiropractic offices, and other forms of chiropractic previously described in the literature. Further cross sectional research is required to determine if this particular clinic is indicative of all NET practices and whether the presenting symptoms, especially the non

Objective This survey investigated the demographic characteristics of the responding practitioners, the prevalence of shoulder pain symptoms seen in weekly chiropractic practice, the sources of shoulder pain, the chiropractor-diagnosed prevalence of shoulder clinical syndromes, and the management strategies for Australian chiropractors. Methods A survey was created by the authors consisting of questions seeking demographic information from the respondents, shoulder syndrome, and shoulder management information. The survey was mailed to every chiropractic practitioner based in the Australian state of New South Wales (general population 6.8 million in 2005). Contact details were derived from Yellow Pages online listings. Results One thousand thirty-seven surveys were mailed to New South Wales–based chiropractors, with 192 (21%) returning a completed survey. The prevalence of shoulder pain symptoms as reported by the practitioners was 12% of the total weekly patients, with the major cause of symptoms related to overuse (32%). The most prevalent working diagnosis of shoulder pain was shoulder impingement syndrome (13%), followed by impingement syndrome with rotator cuff tendinosis (17%), impingement syndrome without rotator cuff tendinosis (14%), and chiropractic shoulder subluxation (12%). Shoulder pain is managed with a combination of manipulation, mainly diversified technique (81%), peripheral joint manipulation (82%), and various soft tissue strategies used by 92% of practitioners. Rehabilitation strategies were also used by 89% of practitioners with a main emphasis placed on rotator cuff strengthening. Conclusion The results suggest a moderate prevalence of shoulder pain in clinical practice with the most prevalent structure involved being the rotator cuff tendon. Most practitioners use a multimodal therapeutic treatment approach in managing disorders of the shoulder.

OBJECTIVE: To describe a case of an adolescent with separation anxiety disorder (SAD) presenting to a chiropractor for treatment. CLINICAL FEATURES: The patient was a 13-year-old boy who had consulted with a clinical psychologist and had been diagnosed with SAD using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The patient was unable to attend school camps or sleep at friends' homes because of anxiety. INTERVENTION/OUTCOME: The patient underwent 8 sessions with a chiropractor certified in the Neuro Emotional Technique (NET). Two days after his last NET treatment, he attended his first school camp without incident. He also slept away from home at a friend's home for the first time without incident. Six months postintervention, he returned to his clinical psychologist, where she independently reevaluated him stating that he no longer met the criteria for SAD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. CONCLUSION: This single case report cannot provide a causal relationship between the clinical outcome and NET without further investigations. Neuro Emotional Technique is a unique therapy that does not take the place of psychotherapy; however, it may be used as an adjunct to it. It is possible that, with valid and reliable follow-up research, the biopsychosocial principles that NET addresses may be of value to children and adolescents with SAD.

INTRODUCTION: Chronic low-back pain (CLBP) is a complex, multi-factorial phenomenon with physical and biopsychosocial components. The biopsychosocial model of pain acknowledges the biological, psychological, and social dimensions of the pain experience. Chiropractors have begun to embrace the concept of “mind–body” treatments and attempt to integrate the function of the mind with the body in both assessment and therapy. Very few “mind–body” treatments have been scrutinized under controlled conditions. The objective of this study is to investigate if Neuro Emotional Technique (NET) can alter the status of LBP in a group of chronic LBP patients, in a randomized controlled trial setting. METHODS: 17 CLBP participants with _3 months pain duration were randomised into NET treatment or NET sham protocol groups. Both groups were prescribed a frequency of 2 sessions/wk for 1 month. Outcome measures included the McGill pain questionnaire (MPQ), a numerical pain rating scale (VAS) and the Oswestry disability questionnaire (obtained at baseline and at 1 month). This study received ethics approval: HE26SEPT2003-RO2600, and is registered with the ANZCTR Registration number: ACTRN12607000650493 RESULTS: A strongly significant difference was detected between the two time profiles for Oswestry scores (Exp: _1.9 SE 1.0, Control: _0.05, SE: 0.7); a significant difference was detected between the two time profiles for the VAS Q1 (Exp: _2.6 SE 0.25, Control: _1.0, SE:0.3), and between the two time profiles for the MSPQ scores (Exp: _3.4 SE 7.8, Control: 2.0., SE: 6.6); and a significant difference was almost detected between the two time profiles for the SF-MPQ Q1 scores (Exp: _20 SE 26.5, Control: 2, SE: 0.36). Due to the small numbers, this study was generally a low power study (30% for all measures except the Oswestry which was 81%). The disability score especially demonstrated a large effect size and provides evidence for a larger scale RCT. CONCLUSION: The disability score demonst

No abstract available

No abstract available

s Third International Congress on Complementary Medicine Research 2008. Sydney Convention Centre, Darling Habor, March 29 - 31, 2008.

Background Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S); levator scapulae region (LS); sternocleidomastoid region (SCM) and temporomandibular region (TMJ). For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables) using forward stepwise General Linear Model. Results The visual analog scale (0 to 10) had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P < 0.001). Conclusion After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when compar

No abstract available

INTRODUCTION: Chronic low-back pain (CLBP) is a complex, multi-factorial phenomenon with physical and biopsychosocial components. The biopsychosocial model of pain acknowledges the biological, psychological, and social dimensions of the pain experience. Chiropractors have begun to embrace the concept of “mind–body” treatments and attempt to integrate the function of the mind with the body in both assessment and therapy. Very few “mind–body” treatments have been scrutinized under controlled conditions. The objective of this study is to investigate if Neuro Emotional Technique (NET) can alter the status of LBP in a group of chronic LBP patients, in a randomized controlled trial setting. METHODS: 17 CLBP participants with _3 months pain duration were randomised into NET treatment or NET sham protocol groups. Both groups were prescribed a frequency of 2 sessions/wk for 1 month. Outcome measures included the McGill pain questionnaire (MPQ), a numerical pain rating scale (VAS) and the Oswestry disability questionnaire (obtained at baseline and at 1 month). This study received ethics approval: HE26SEPT2003-RO2600, and is registered with the ANZCTR Registration number: ACTRN12607000650493 RESULTS: A strongly significant difference was detected between the two time profiles for Oswestry scores (Exp: _1.9 SE 1.0, Control: _0.05, SE: 0.7); a significant difference was detected between the two time profiles for the VAS Q1 (Exp: _2.6 SE 0.25, Control: _1.0, SE:0.3), and between the two time profiles for the MSPQ scores (Exp: _3.4 SE 7.8, Control: 2.0., SE: 6.6); and a significant difference was almost detected between the two time profiles for the SF-MPQ Q1 scores (Exp: _20 SE 26.5, Control: 2, SE: 0.36). Due to the small numbers, this study was generally a low power study (30% for all measures except the Oswestry which was 81%). The disability score especially demonstrated a large effect size and provides evidence for a larger scale RCT. CONCLUSION: The disability score demonst

s Third International Congress on Complementary Medicine Research 2008. Sydney Convention Centre, Darling Habor, March 29 - 31, 2008.

Background Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S); levator scapulae region (LS); sternocleidomastoid region (SCM) and temporomandibular region (TMJ). For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables) using forward stepwise General Linear Model. Results The visual analog scale (0 to 10) had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P < 0.001). Conclusion After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when compar

OBJECTIVE: To describe a case of an adolescent with separation anxiety disorder (SAD) presenting to a chiropractor for treatment. CLINICAL FEATURES: The patient was a 13-year-old boy who had consulted with a clinical psychologist and had been diagnosed with SAD using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The patient was unable to attend school camps or sleep at friends' homes because of anxiety. INTERVENTION/OUTCOME: The patient underwent 8 sessions with a chiropractor certified in the Neuro Emotional Technique (NET). Two days after his last NET treatment, he attended his first school camp without incident. He also slept away from home at a friend's home for the first time without incident. Six months postintervention, he returned to his clinical psychologist, where she independently reevaluated him stating that he no longer met the criteria for SAD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. CONCLUSION: This single case report cannot provide a causal relationship between the clinical outcome and NET without further investigations. Neuro Emotional Technique is a unique therapy that does not take the place of psychotherapy; however, it may be used as an adjunct to it. It is possible that, with valid and reliable follow-up research, the biopsychosocial principles that NET addresses may be of value to children and adolescents with SAD.

No abstract available

Objective To examine the phenomenon of bruxism and assess the current state of the literature regarding its role in temporomandibular disorder (TMD). Data sources A review of the literature contained in the CINAHL; Pubmed; COCHRANE; MANTIS and MEDLINE (ovid) database searches as well as hand searches was conducted between September 2005 and March 2006. Study selection Studies using the keywords bruxism, temporomandibular, jaw, randomised controlled trial, survey, epidemiological, longitudinal, were screened. Uncontrolled studies, case studies, case series and reviews were ignored. A total of 172 studies were identified and compared in terms of their definition of bruxism, TMD, and conclusions regarding the role of bruxism. Conclusion The majority of studies found a relationship between bruxism and TMD. However, inconsistency and equivocation of different parafunctional activities are common within the literature. The subject is further complicated by the lack of a universally accepted definition of both TMD and bruxism and an additional failure to standardise investigative variables such as frequency, duration and intensity of episodes. The role of bruxism as it is currently described can therefore be considered a controversial and unresolved issue. The authors suggest that the term bruxism be abandoned in favour of a set of diagnostically more appropriate descriptors.

Background Current evidence on electrotherapies for the management of chronic neck pain is either lacking or conflicting. New therapeutic devices being introduced to the market should be investigated for their effectiveness and efficacy. The ENAR® (Electro Neuro Adaptive Regulator) therapy device combines Western biofeedback with Eastern energy medicine. Methods A small, preliminary randomised and controlled single-blinded trial was conducted on 24 participants (ten males, 14 females) between the ages of 18 to 50 years (median age of 40.5) Consent was obtained and participants were randomly allocated to one of three groups – ENAR, Transcutaneous Electrical Nerve Stimulation (TENS), or control therapy – to test the hypothesis that ENAR therapy would result in superior pain reduction/disability and improvements in neck function compared with TENS or control intervention. The treatment regimen included twelve 15-minute treatment sessions over a six week period, followed by two assessment periods. Visual Analogue Scale (VAS) pain scores, Neck Disability Index (NDI) scores, Patient Specific Functional Scale (PSFS) scores and Short Form 36v1 (SF-36) quality of life scores reported by participants were collected at each of the assessments points throughout the trial (0, 6, 12, 18 and 24 weeks). Results Eligible participants (n = 30) were recruited and attended clinic visits for 6 months from the time of randomisation. Final trial sample (n = 24) comprised 9 within the ENAR group, 7 within the TENS group and 8 within the control group. With an overall study power of 0.92, the ENAR group showed a decrease in mean pain score from measurement at time zero (5.0 ± 0.79 95%CI) to the first follow-up measurement at six weeks (1.4 ± 0.83 95%CI). Improvement was maintained until week 24 (1.75 ± 0.9 95%CI). The TENS and control groups showed consistent pain levels throughout the trial (3.4 ± 0.96 95%CI and 4.1 ± 0.9 95%CI respectively). Wald analysis for pain intensity was significan

The contemporary biopsychosocial health paradigm emphasizes a reversible and conservative approach to chronic pain management. Manual therapy for temporomandibular disorders (TMDs) claims to fulfil these criteria. An assessment of the utilization and efficacy of manual therapy for this condition is therefore required. A review of the literature pertaining to manual therapy for TMDs was undertaken between September and December 2005. Keywords used in the search were: TMD, manual therapy, massage, manipulation, mobilization, adjustment, chiropractic, osteopathy, physiotherapy, exercise. The four member reviewer panel identified eight (n=8) randomized controlled trials of sufficiently reliable power to be suitable for inclusion in the review, of which only three included manipulative treatment of the temporomandibular joint. The results of manual therapy trials for this condition suggest that manual therapy is a viable and useful approach in the management of TMD. Manual therapy has also been shown to be more cost effective and less prone to side effects than dental treatment. Some manipulative techniques for the TMJ are described.

Sports chiropractic within Australia has a chequered historical background of unorthodox individualistic displays of egocentric treatment approaches that emphasise specific technique preference and individual prowess rather than standardised evidence based management. This situation has changed in recent years with the acceptance of many within sports chiropractic to operate under an evidence informed banner and to embrace a research culture. Despite recent developments within the sports chiropractic movement, the profession is still plagued by a minority of practitioners continuing to espouse certain marginal and outlandish technique systems that beleaguer the mainstream core of sports chiropractic as a cohesive and homogeneous group. Modern chiropractic management is frequently multimodal in nature and incorporates components of passive and active care. Such management typically incorporates spinal and peripheral manipulation, mobilisation, soft tissue techniques, rehabilitation and therapeutic exercises. Externally, sports chiropractic has faced hurdles too, with a lack of recognition and acceptance by organized and orthodox sports medical groups. Whilst some arguments against the inclusion of chiropractic may be legitimate due to its historical baggage, much of the argument appears to be anti-competitive, insecure and driven by a closed-shop mentality.sequently, chiropractic as a profession still remains a pariah to the organised sports medicine world. Add to this an uncertain continuing education system, a lack of protection for the title 'sports chiropractor', a lack of a recognized specialist status and a lack of support from traditional chiropractic, the challenges for the growth and acceptance of the sports chiropractor are considerable. This article outlines the historical and current challenges, both internal and external, faced by sports chiropractic within Australia and proposes positive changes that will assist in recognition and inclusion of sports ch

Background Current evidence on electrotherapies for the management of chronic neck pain is either lacking or conflicting. New therapeutic devices being introduced to the market should be investigated for their effectiveness and efficacy. The ENAR® (Electro Neuro Adaptive Regulator) therapy device combines Western biofeedback with Eastern energy medicine. Methods A small, preliminary randomised and controlled single-blinded trial was conducted on 24 participants (ten males, 14 females) between the ages of 18 to 50 years (median age of 40.5) Consent was obtained and participants were randomly allocated to one of three groups – ENAR, Transcutaneous Electrical Nerve Stimulation (TENS), or control therapy – to test the hypothesis that ENAR therapy would result in superior pain reduction/disability and improvements in neck function compared with TENS or control intervention. The treatment regimen included twelve 15-minute treatment sessions over a six week period, followed by two assessment periods. Visual Analogue Scale (VAS) pain scores, Neck Disability Index (NDI) scores, Patient Specific Functional Scale (PSFS) scores and Short Form 36v1 (SF-36) quality of life scores reported by participants were collected at each of the assessments points throughout the trial (0, 6, 12, 18 and 24 weeks). Results Eligible participants (n = 30) were recruited and attended clinic visits for 6 months from the time of randomisation. Final trial sample (n = 24) comprised 9 within the ENAR group, 7 within the TENS group and 8 within the control group. With an overall study power of 0.92, the ENAR group showed a decrease in mean pain score from measurement at time zero (5.0 ± 0.79 95%CI) to the first follow-up measurement at six weeks (1.4 ± 0.83 95%CI). Improvement was maintained until week 24 (1.75 ± 0.9 95%CI). The TENS and control groups showed consistent pain levels throughout the trial (3.4 ± 0.96 95%CI and 4.1 ± 0.9 95%CI respectively). Wald analysis for pain intensity was significan

To report a case of cluster-tic syndrome (CTS), a rare chronic head pain syndrome recognised by the International Headache Society (IHS). This report describes utilisation of chiropractic in a multi-modal management plan for CTS. The case illustrates a cervical association with head pain, a feature that has not previously been reported. The confluence of nociceptive afferents through the trigenminocervical nucleus and trigeminovascular system has been hypothesised to be responsible for the change. Clinical Features: This case involves a 61-year-old Caucasian male who has suffered typical cluster headaches for more than 30 years. He recently developed a tic-like pain that overlapped his typical cluster headaches. Cervical spine flexion relieved the headaches and the tic-like pains. Intervention and Outcome: The condition was managed with a multi-modal approach that integrated a traditional pharmacological approach and chiropractic, which included cervical and thoracic spinal manipulation therapy (SMT). This approach provided great relief when the pharmacological approach alone did not. Conclusions: This paper describes a new form of management for alleviation of cluster-tic syndrome. Further case studies are required to outline the utility of this approach. Future research should investigate the role of the cervical spine in head pain syndromes. Use of allied health professions may provide new opportunities in the management of chronic pain syndromes.