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Objective: This purpose of this study was to assess the reliability of measurements made of the zygapophysial (Z) joint space from the magnetic resonance imaging scans of subjects with acute low back pain using new equipment and 2 different methods of statistical analysis. If found to be reliable, the methods of Z joint measurement can be applied to scans taken before and after spinal manipulation in a larger study of acute low back pain subjects., Methods: Three observers measured the central anterior-to-posterior distance of the left and right L4/L5 and L5/S1 Z joint space from 5 subject scans (20 digitizer measurements, rounded to 0.1 mm) on 2 separate occasions separated by 4 weeks. Observers were blinded to each other and their previous work. Intra- and interobserver reliability was calculated by means of intraclass correlation coefficients and also by mean differences using the methods of Bland and Altman (1986). A mean difference of less than +/-0.4 mm was considered clinically acceptable., Results: Intraclass correlation coefficients showed intraobserver reliabilities of 0.95 (95% confidence interval, 0.87-0.98), 0.83 (0.62-0.92), and 0.92 (0.83-0.96) for each of the 3 observers and interobserver reliabilities of 0.90 (0.82-0.95), 0.79 (0.61-0.90), and 0.84 (0.75-0.90) for the first and second measurements and overall reliability, respectively. The mean difference between the first and second measurements was -0.04 mm (+/-1.96 SD = -0.37 to 0.29), 0.23 (-0.48 to 0.94), 0.25 (-0.24 to 0.75), and 0.15 (-0.44 to 0.74) for each of the 3 observers and the overall agreement, respectively., Conclusions: Both statistical methods were found to be useful and complementary and showed the measurements to be highly reliable., (Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to collect preliminary information on the effect of a limited and extended course of chiropractic care on balance, chronic pain, and associated dizziness in a sample of older adults with impaired balance., Methods: The authors conducted a randomized pilot study targeting a sample size of 30, comparing 2 schedules of chiropractic care to a no-treatment group. Group 1 (limited schedule) was treated for 8 weeks, group 2 (extended schedule) was treated for 8 weeks and then once per month for 10 months, and group 3 received no treatment. Assessments were made at baseline and 1, 2, 6, and 12 months later. The primary outcome was changed in the Berg Balance Scale (BBS) from baseline to 1 year. Changes in the Pain Disability Index and Dizziness Handicap Index were also measured., Results: Thirty-four patients were enrolled, 13 in group 1, 15 in group 2, and 6 in group 3. Only 5 had baseline BBS scores less than 45, indicating increased risk for falls. There were no treatment-related adverse events. Nine patients dropped out by 1 year. No significant differences within or between groups in median BBS from baseline to 12 months were observed. Median Pain Disability Index scores improved more from baseline to 1 year in group 2 compared with groups 1 and 3 (P = .06, Kruskal-Wallis test). For the 9 patients with dizziness, a clinically significant improvement in Dizziness Handicap Index scores of groups 1 and 2 was observed at 1 month and remained lower than baseline thereafter; this was not true of group 3., Conclusion: Further investigation of the possible benefit of chiropractic maintenance care (extended schedule) for balance and pain-related disability is feasible and warranted, as well as both limited and extended schedules for patients with idiopathic dizziness.

Objective: Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat., Methods: A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information, (2) whether their chiropractor was their primary care physician, and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients., Results: There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each 'primary care condition' listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly with many conditions showing an affirmative response of higher than 50% especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions., Conclusions: Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions.

Objective: To better understand the experiences and problems encountered by research assistants (RAs) involved in clinical trials to improve the process of RA training for future studies., Design: A 1-time focus group of research assistants was conducted., Setting: A chiropractic college in the United States during a national chiropractic research agenda conference., Subjects: Eight research assistants from 2 teaching institutions, who are directly involved in clinical trials and have patient-centered responsibilities, such as recruiting patients, interviewing patients, and collecting data. Main outcome measures Responses to predetermined questions were qualitatively compiled. Question topics included research assistants' experiences while administering phone screens, questionnaires, and informed consents., Results: Research assistants involved in this focus group expressed they were adequately trained in telephone screening and administering informed consent but felt they required more training in administering self-report questionnaires to patients. The majority of problems they encountered were related to a lack of information. To improve training of future RAs, more detailed study information is necessary, such as how to describe study treatments and how to give questionnaire instructions., Conclusions: The comparability of responses by the members of this focus group was interesting. Members had similar experiences within clinical trials and found that the problems encountered were common across studies.

Objective: There are fundamental differences between the administration of medications and the application of manual procedures, such as those used by chiropractors. The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite, randomized placebo-controlled trial of chiropractic care for women with chronic pelvic pain (CPP)., Design: Pilot study for a multisite, randomized, placebo-controlled clinical trial., Setting: Three chiropractic research clinics in the midwest United States., Subjects: Thirty-nine (39) women with CPP of at least 6 months' duration, diagnosed by board-certified gynecologists., Interventions: The active intervention consisted of the chiropractic technique, lumbar spine flexion-distraction, combined with manual Trigger Point Therapy. The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage (light massage)., Outcome Measures: The primary outcome measure was the change in the Pain Disability Index (PDI) from baseline to the end of treatment (6 weeks), assessed by group and site. If the change score was in the same direction at all sites, the results were to be combined to estimate treatment effect size., Results: Patient characteristics were similar to those of patients with CPP in other studies. Recruitment methods, particularly in respect to the eligibility criteria and screening protocols, would require modification in order to recruit an adequate sample for the planned randomized controlled trial. Clinicians followed standardized procedures with apparently minimal deviation, patients in both groups were satisfied with their care and blinding appeared to be successful. PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated., Conclusions: The technical and personnel resources required to achieve adequate standardization of procedures at multiple sites may make a placebo-controlled trial unfeasible, given our current lack of knowledge about the active agent in manual chiropractic procedures.

Objective: This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking. Methods: All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study. Results: The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was "very important." Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%). Conclusion: Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking. [ABSTRACT FROM AUTHOR]

Objectives To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain compared with no treatment. Design Randomized controlled trial. Setting Integrative medicine teaching clinic at a university. Participants Adult subjects (N=225) with symptomatic low back pain of ≥3 months were recruited from a volunteer sample. Interventions Subjects were randomized into 1 of 3 treatment groups (shoe orthotic, plus, and waitlist groups). The shoe orthotic group received custom-made shoe orthotics. The plus group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The waitlist group received no care. Main Outcome Measures The primary outcome measures were change in perceived back pain (numerical pain rating scale) and functional health status (Oswestry Disability Index) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months. Results After 6 weeks, all 3 groups demonstrated significant within-group improvement in average back pain, but only the shoe orthotic and plus groups had significant within-group improvement in function. When compared with the waitlist group, the shoe orthotic group demonstrated significantly greater improvements in pain ( P <.0001) and function ( P =.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function ( P =.0278) when compared with orthotics alone, but no significant difference in pain ( P =.3431). Group differences at 12 weeks and later were not significant. Conclusions Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared with no treatment. The addition of chiropractic care led to higher improvements in function. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to explore potential baseline physical examination and demographic predictors of clinical outcomes in patients with lumbar spinal stenosis. Methods This was a secondary analysis of data obtained from a pilot randomized controlled trial. Primary and secondary outcome measures were the Swiss Spinal Stenosis (SSS) Questionnaire and visual analog scale (VAS) for leg pain. Multiple regression models were used to assess 2 different outcomes: SSS at completion of care and VAS at completion of care. Separate regression models were built for each of the 2 outcomes to identify the best subset of variables that predicted improvement. Predictors with a significant contribution were retained in a final “best” model. Results Three variables were identified as having an association with SSS score at completion of care: baseline SSS score, qualitative description of leg pain, and age (adjusted R 2 = 33.2). Four variables were identified as having an association with VAS score at completion of care: baseline VAS score, qualitative description of leg pain, body mass index, and age (adjusted R 2 = 38.3). Conclusion This study provides preliminary evidence supporting an association between certain baseline characteristics and nonsurgical clinical outcomes in patients with lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]

Background: The literature pertaining to chiropractic students' opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America. Objective: The purpose of this study is to investigate North American chiropractic students' opinions concerning professional identity, role and future. Methods: A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed. Results: A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments. Conclusion: The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation. Methods: This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function. Results: The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies. Conclusion: This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials. [ABSTRACT FROM AUTHOR]

Objective: We sought to identify the percentage of nonmusculoskeletal and musculoskeletal conditions treated by interns in the National University of Health Sciences (NUHS) Student Clinic compared to chiropractic and allopathic health care professionals. Methods: The information gathered was taken from the charts of patients treated in the fall trimester, dated September 12, 2011 through December 9, 2011. The data collected included ICD-9 codes for the conditions treated, the number of patient visits, age, and gender, and was evaluated using Microsoft Excel. Results: Over half of the 113 eligible patients were women with a mean patient age of 28 years, an average of three treated diagnoses, and a mean of seven treatments. Those treated only for musculoskeletal conditions totaled 52% of the patients; 48% of the patients were treated for nonmusculoskeletal conditions, or musculoskeletal plus nonmusculoskeletal conditions. Conclusion: The NUHS Student Clinic interns are treating a greater percentage of nonmusculoskeletal conditions and a lesser percentage of musculoskeletal conditions than practicing chiropractic physicians. The student interns also treat a lesser percentage of nonmusculoskeletal and a greater percentage of musculoskeletal conditions than allopathic practitioners. This comparison would suggest that NUHS is nearing its institutional goal of training its student interns as primary care practitioners. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to quantify lumbar zygapophyseal (Z) joint space separation (gapping) in low back pain (LBP) subjects after spinal manipulative therapy (SMT) or side-posture positioning (SPP). Methods: This was a controlled mechanisms trial with randomization and blinding. Acute LBP subjects (N = 112; four n = 28 magnetic resonance imaging [MRI] protocol groups) had 2 MRI appointments (initial enrollment and after 2 weeks of chiropractic treatment, receiving 2 MRI scans of the L4/L5 and L5/S1 Z joints at each MRI appointment. After the first MRI scan of each appointment, subjects were randomized (initial enrollment appointment) or assigned (after 2 weeks of chiropractic treatment appointment) into SPP (nonmanipulation), SMT (manipulation), or control MRI protocol groups. After SPP or SMT, a second MRI was taken. The central anterior-posterior joint space was measured. Difference between most painful side anterior-posterior measurements taken postintervention and preintervention was the Z joint “gapping difference.” Gapping differences were compared (analysis of variance) among protocol groups. Secondary measures of pain (visual analog scale, verbal numeric pain rating scale) and function (Bournemouth questionnaire) were assessed. Results: Gapping differences were significant at the first (adjusted, P = .009; SPP, 0.66 ± 0.48 mm; SMT, 0.23 ± 0.86; control, 0.18 ± 0.71) and second (adjusted, P = .0005; SPP, 0.65 ± 0.92 mm; SMT, 0.89 ± 0.71; control, 0.35 ± 0.32) MRI appointments. Verbal numeric pain rating scale differences were significant at first MRI appointment (P = .04) with SMT showing the greatest improvement. Visual analog scale and Bournemouth questionnaire improved after 2 weeks of care in all groups (both P < .0001). Conclusions: Side-posture positioning showed greatest gapping at baseline. After 2 weeks, SMT resulted in greatest gapping. Side-posture positioning appeared to have additive therapeutic benefit to SMT. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. Methods: This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. Results: Upside SMT and SPP joints gapped more than downside joints (0.69 vs −0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone (P = .43). Conclusions: Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped. [Copyright &y& Elsevier]

Abstract: Objective: This project determined the location and distribution of cavitations (producing vibrations and audible sounds) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT). Methods: This randomized, controlled, clinical study assessed 40 healthy subjects (20 men, 20 women) 18 to 30 years of age who were block randomized into SMT (group 1, n = 30) or side-posture positioning only (group 2; control, n = 10) groups. Nine accelerometers were placed on each patient (7 on spinous processes/sacral tubercles of L1-S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (groups 1 and 2) and SMT (group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using χ 2 or McNemar test were made between number of joints cavitating from group 1 vs group 2, upside (contact side for SMT) vs downside, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs outside the target area (L1/L2, L2/L3, sacroiliac). Results: Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than group 2 joints (P < .0001), upside joints cavitated more than downside joints (P < .0001), and joints inside the target area cavitated more than those outside the target area (P < .01). Conclusions: Most cavitations (93.5%) occurred on the upside of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than did subjects with side-posture positioning only (96.7% vs 30%). Multiple cavitations from the same Z joints had not been previously reported. [Copyright &y& Elsevier]

Abstract: Objective: Although chiropractic manipulation is commonly used for low back pain, applying this procedure to the patient with postlumbar spine surgery has not been adequately studied. The purpose of this retrospective chart review is to report on the results of chiropractic management (including Cox flexion distraction technique) of patients with postsurgical lumbar spine pain to determine the change in reported pain based on surgical type. Methods: Ten years of patient files from one chiropractic practice were electronically screened for lumbar spine surgery occurring before presenting for chiropractic care. Of the 58 patients with a postsurgical diagnosis, 32 files contained all pertinent components for this study including treatment with Cox flexion distraction manipulation (in addition to adjunct procedures) for at least 2 weeks and pretreatment and posttreatment pain measures using the Numeric Pain Scale (NPS) that ranged from 0 (no pain) to 10 (worst pain imaginable). Results: A change was observed in the mean pretreatment and posttreatment NPS pain scores of 6.4 to 2.3, a reduction of 4.1 of 10. The mean number of treatments was 14, with a range of 6 to 31. When stratified by surgical type, the mean change in pain was most remarkable in patients who underwent a surgery that combined lumbar discectomy, fusion, and/or laminectomy, with an average NPS pain reduction of 5.7 of 10. No adverse events were reported for any of these postsurgical patients. Conclusions: The results of this study showed improvement for patients with low back pain subsequent to lumbar spine surgery who were managed with chiropractic care. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this pilot study was to investigate the feasibility of a randomized clinical trial of shoe orthotics for chronic low back pain. Methods: The study recruited 50 patients with chronic low back pain through media advertising in a midwestern suburban area. Medical history and a low back examination were completed at a chiropractic clinic. Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After 6 weeks, the wait-list control group also received custom-made orthotics. This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of 6 weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment. Results: This study showed changes in back pain and disability with the use of shoe orthotics for 6 weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects did not continue to improve during this time. Conclusions: This pilot study showed that the measurement of shoe orthotics to reduce low back pain and discomfort after 6 weeks of use is feasible. A larger clinical trial is needed to verify these results. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this article is to describe the methods for recruitment in a clinical trial on chiropractic care for lumbar spinal stenosis. Methods: This randomized, placebo-controlled pilot study investigated the efficacy of different amounts of total treatment dosage over 6 weeks in 60 volunteer subjects with lumbar spinal stenosis. Subjects were recruited for this study through several media venues, focusing on successful and cost-effective strategies. Included in our efforts were radio advertising, newspaper advertising, direct mail, and various other low-cost initiatives. Results: Of the 1211 telephone screens, 60 responders (5.0%) were randomized into the study. The most successful recruitment method was radio advertising, generating more than 64% of the calls (776 subjects). Newspaper and magazine advertising generated approximately 9% of all calls (108 subjects), and direct mail generated less than 7% (79 subjects). The total direct cost for recruitment was $40 740 or $679 per randomized patient. The costs per randomization were highest for direct mail ($995 per randomization) and lowest for newspaper/magazine advertising ($558 per randomization). Conclusions: Success of recruitment methods may vary based on target population and location. Planning of recruitment efforts is essential to the success of any clinical trial. [Copyright &y& Elsevier]

Abstract: Objective: The initiation of multiple clinical programs within a previously single-purpose health care institution brings multiple health care providers together under one roof. A baseline cross-sectional survey was undertaken to measure the development of integrative care communication patterns and cross-disciplinary knowledge at a health sciences university clinic. Methods: This study was conducted by means of 3 separate surveys administered to all complementary and alternative medicine (CAM) faculty clinicians, CAM student interns, and patients attending CAM therapy at a university clinic (National University of Health Sciences, Lombard, Ill). The CAM therapies included acupuncture and Oriental medicine, chiropractic medicine/doctor of chiropractic, massage therapy, and naturopathic medicine/naturopathic doctor. Results: Consultations between practitioners, including clinicians and interns, of different professions were predominantly informal in nature. The highest level of familiarity was with chiropractic philosophy; the lowest level was with naturopathic philosophy. Clinicians were very familiar with the philosophies of the other professions, with interns and patients being variably familiar with the other professions'' philosophies. Less than 20% of patients reported being referred to another care provider. Clinicians, interns, and patients indicated that they would like additional opportunities to take advantage of multiple professions working together. Conclusions: This study is an initial assessment of the knowledge, communication patterns, and actions within the clinic during these early stages of integration. Recommendations for integrating both clinical care and educational processes within a multiple professions university are considered. [Copyright &y& Elsevier]

Abstract: Objective: This study is part of an avenue of research exploring the effect of chiropractic care on balance in older adults. The purpose of this study was to (1) assess the use of the 7-item version of the Berg Balance Scale, (2) explore possible effects of an 8-week course of chiropractic care on balance as measured by the 7-item Short-Form Berg Balance Scale (SF-BBS) in adults 65 years or older with impaired balance, and (3) collect preliminary information on the possible relationships of dizziness and/or chronic pain to poor balance. Methods: This was a single-group, pretest/posttest design intervention study. Patients 65 years and older who could stand on one leg for less than 5 seconds were eligible. They received pragmatic chiropractic care for 16 visits for an 8-week period. Outcomes were assessed at baseline, visit 8 and visit 16 in terms of balance SF-BBS, dizziness (Dizziness Handicap Inventory [DHI]), chronic pain (Pain Disability Index), and depression (Geriatric Depression Scale). Results: Sixteen patients were enrolled; 14 completed the study. There was one mild and transient adverse effect, muscle soreness, which self-resolved. One patient was depressed, and his Geriatric Depression Scale score improved significantly during the study. Of the 6 patients with significant dizziness at baseline, 3 had scores of 0 (no dizziness) on the DHI at visit 16. Patients with dizziness tended to have greater chronic pain and show greater reductions in that pain than nondizzy patients. No clinically important effects on balance as measured by the SF-BBS were apparent for the group as a whole, although 3 individual patients improved by 4 to 6 points. Conclusion: The Short-Form Berg Balance Scale (SF-BBS) did not show a great deal of clinical responsiveness in this study population. The outcome measures used for chronic pain (Pain Disability Index) and dizziness (DHI) appear to be appropriate for assessing patients in future larger studies for longer periods. [Copyright &y& Elsevier]

Objective: This study surveyed and interviewed faculty and staff at chiropractic colleges to investigate issues related to conducting clinical research in teaching clinics. Methods: This was a descriptive study using qualitative research methods. It was conducted from May to August 2007 by means of an electronically administered survey using purposive sampling of faculty and administrators at North American chiropractic colleges. Results: A total of 58 surveys were e-mailed to research directors, faculty, and staff at 16 colleges; 2 surveys were returned as undeliverable. Of the 56 successfully delivered surveys, 34 (61%) completed surveys were returned, representing 13 colleges. Not having a separate research clinic was seen by some respondents as positive and by others as negative. Of the 34 respondents, 32 felt there were advantages associated with conducting research within the college's teaching clinics rather than exclusively in a separate research clinic; 33 respondents described challenges to implementing the integration of research into their institution's clinics. The primary themes that emerged as challenges to conducting research in the institutions' teaching clinics were related to administration and policy, resources/facilities, faculty issues, and student issues. Respondents described strategies they had developed to address these challenges, primarily focusing on the challenges related to faculty and students rather than administration and resources. Conclusion: In most chiropractic institutions, the challenges of integrating research into teaching clinics are primarily being addressed by individuals using focused, situation-specific strategies rather than at the level of institutional policy. [ABSTRACT FROM AUTHOR]

Objectives: Chiropractic in the United States exhibits characteristics of both mainstream health care and complementary and alternative medicine (CAM). The purpose of this project was to investigate the opinions of a sample of chiropractic faculty and practitioners on the appropriate classification of their profession, in terms of CAM versus mainstream. Design: This was a descriptive study conducted by means of an electronically administered survey to a sample of chiropractic college faculty and practicing chiropractors. Sample population: The faculty sample consisted of all faculty members holding Doctor of Chiropractic (D.C.) degrees at 4 chiropractic colleges, 2 in the Midwest and 2 in southern California. The practitioner sample consisted of all 108 participants, located in 32 states in the United States, in a chiropractic practice-based research network. Survey instrument: The survey instrument was based on one used with permission from its authors, who had developed and used it to gather information about respondents' concepts and definitions of health and disease, in order to compare the broad categories of practitioners—mainstream medicine, integrated medicine (IM), and CAM. Results: Of 191 D.C. faculty invited to participate, 71 (37%) completed the survey. Of the 108 practicing D.C.s invited to participate, 61 (57%) completed the survey. Of the total sample of 132, 69% did not agree that chiropractic should be categorized as CAM. Twenty-seven percent (27%) of 132 thought that chiropractors should be classified as IM; 20% of practitioners and 6% of faculty considered chiropractic mainstream medicine. Conclusions: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%). [ABSTRACT FROM AUTHOR]

Objective: This study explores the implementation of consent procedures in a sample of chiropractors in the United Kingdom (UK) and the United States (US) and how well they satisfy the core ethical principles of autonomy, veracity, justice, nonmaleficence, and beneficence. Methods: A precoded questionnaire was sent to 500 geographically stratified, randomly selected chiropractors in the UK and 500 similarly selected chiropractors within 10 states (50 from each) across the US. Questionnaires were dispatched 100 per month over a 5-month period. Nonresponders were followed up twice. Quantitative data were analyzed descriptively. Qualitative data were charted and examined for emergent themes. Results: The overall response rate was 35% (346 of 1000), equating to 23% (n = 117) of the US and 46% (n = 231) of the UK cohort. Results suggest chiropractors view consent as an event rather than a process and revealed important omissions in key areas. Reasons specified for the nondisclosure of risk have important negative implications on the principles of autonomy, veracity, and justice, whereas paternalistic tendencies are indicative of tension between beneficence and paternalism. Conclusion: Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Practitioners felt that a serious adverse event occurred so infrequently that this, coupled with a lack of convincing evidence regarding the risk associated with certain treatment, rendered the routine discussion of major risk unnecessary. [ABSTRACT FROM AUTHOR]

Objective: Our initial report analyzed clinical and cost utilization data from tile years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 and includes first-time comparisons in data points among PCPs of different licensures who were oriented toward complementary and alternative medicine (CAM). Methods: Independent physician association-incurred claims and stratified random patient surveys were descriptively analyzed for clinical utilization, cost offsets, and member satisfaction compared with conventional medical IPA normative values. Comparisons to our original publication's comparative blinded data, using nonrandom matched comparison groups, were descriptively analyzed for differences in age/sex demographics and disease profiles to examine sample bias. Results: Clinical and cost utilization based on 70274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame. Conclusion: During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population. [ABSTRACT FROM AUTHOR]

Background: Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program) or a form of chiropractic care (Flexion Distraction) for chronic low back pain. Methods: In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD) or a form of physical therapy (EP). Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain. Results: Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p < 0.05). No group differences were noted in the number of visits to a chiropractor or physical therapist. Self-care was initiated by nearly every participant in both groups. Conclusion: During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care. [ABSTRACT FROM AUTHOR]

Objective: To investigate the accrual rates and recruitment processes among 3 Midwestern sites during a pilot study on manual therapy for chronic pelvic pain. Design: Multisite pilot study for a randomized, placebo-controlled clinical trial. Setting: Three chiropractic institutions in or near major metropolitan cities in the Midwestern United States. Subjects: Thirty-nine women aged 18 to 45 with chronic pelvic pain of at least 6 months duration, diagnosed by a board certified gynecologist. Main Outcome Measures: The method of recruitment was collected for each individual who responded to an advertisement and completed an interviewer-administered telephone screen. Participants who were willing and eligible after 3 baseline visits were entered into a randomized clinical trial. The number of responses and accrual rates were determined for the overall study, each of the 3 treatment sites, and each of the 5 recruitment efforts. Results: In this study, 355 women were screened over the telephone and 39 were randomized, making the rate of randomization approximately 10%. The most effective recruitment methods leading to randomization were direct mail (38%) and radio advertisements (34%). However, success of the recruitment process differed by site. Conclusions: Based on the accrual of this multisite pilot study, a full-scale trial would not be feasible using this study's parameters. However, useful information was gained on recruitment effectiveness, eligibility criteria, and screening protocols among the 3 metropolitan sites. [ABSTRACT FROM AUTHOR]

The article focuses on the success of the United States Bone and Joint Decade, a multidisciplinary and collaborative effort to improve prevention of bone and joint disorders and to improve the quality of life for those affected. The success has been due to the collaboration of more than 90 patient and professional health organizations and more than 100 medical schools and colleges of medicine. Some of the organizations affiliated include the American Chiropractic Association, the Arthritis Foundation and the Foundation for Chiropractic Education and Research.