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Chiropractic Rehabilitation of a Scoliosis Family: Results from a 9-Year Follow-Up  [PDF]
Mark W. Morningstar, Aatif Siddiqui, Clayton Stitzel, Brian Dovorany
Open Journal of Therapy and Rehabilitation (OJTR) , 2017, DOI: 10.4236/ojtr.2017.51003
Abstract: Scoliosis bracing is typically prescribed when the curvature reaches to between 30° - 50°. Although there has been a vast amount of bracing literature published, the results remain equivocal. Many patients face issues of compliance, comfort, and decreased self-esteem due to social stigmas with bracing. This has caused many patients to seek non-bracing options. Although these treatments are plausible, they lack the research background that bracing has. Therefore, many physicians are reluctant to prescribe exercise-based rehabilitation for their scoliosis patients. This study reports on 3 patients who sought non-bracing, exercise-based chiropractic rehabilitation for their scoliosis. Their results before, after, and at long term follow up are included.
Radiographic, Pain, and Functional Outcomes in an Adult Post-Fusion Patient Using a Scoliosis Activity Suit: Comparative Results after 8 Months  [PDF]
Mark W. Morningstar, Brian Dovorany, Clayton J. Stitzel, Aatif Siddiqui
International Journal of Clinical Medicine (IJCM) , 2016, DOI: 10.4236/ijcm.2016.74028
Abstract: There are few conservative treatment options for adult patients with idiopathic scoliosis who are status post-fusion surgery. These typically include pharmacologic pain management, epidural injections, and generalized CAM treatments such as massage and chiropractic manipulation in the non-fused areas of the spine. The purpose of this study was to compare the post-treatment results in an adult post-fusion patient who wore a scoliosis activity suit for 8 months. Pain was evaluated using a quadruple visual analog scale (QVAS), while function was measured using an SRS-22r questionnaire. After 8 months of wearing the scoliosis activity suit, her pain scores improved, here SRS-22r improved, and a significant correction in radiographic Cobb angle was observed. This case report is the first to document a Cobb angle change in an adult patient wearing a scoliosis activity suit who is status post-fusion. Given that pain and dysfunction are primary reasons for scoliosis treatment in the adult population, more studies need to address the disparity between available treatments for adult scoliosis and the incidence of adult scoliosis, especially in the post-meno-pausal population. Future prospective studies should consider evaluating treatment effects of this suit using intent-to-treat methodology.
Resolution of Amenorrhea and Chronic Constipation in an Adult Patient with Idiopathic Scoliosis Wearing a Scoliosis Activity Suit for 6 Months: A Case Report  [PDF]
Mark W. Morningstar
Open Journal of Therapy and Rehabilitation (OJTR) , 2018, DOI: 10.4236/ojtr.2018.62007
Abstract: Objective: To report the symptomatic and radiographic changes in an adult scoliosis patient with a history of amenorrhea and chronic constipation. Clinical Features: Patient presented for treatment with an 8-year history of amenorrhea and chronic constipation. Radiographic study showed a right thoracic/left lumbar double major scoliosis. Intervention and Outcome: Patient was fitted for a scoliosis activity suit and given instructions for continued home use, building up to 3 - 4 hours total daily. After 6 months of use, her amenorrhea and chronic constipation had resolved, and both scoliosis Cobb angles also improved. Scores on before and after SRS-22r questionnaires, as well as a quadruple numerical pain rating scale, also improved. Conclusion: A patient wearing a scoliosis activity suit for 6 months reported symptomatic changes as well as radiographic, pain, and quality of life improvements. The results of this case cannot be generalized. More investigation into the association of scoliosis and other organic symptoms is warranted.
Using Clinical Case Studies to Teach Biochemistry in a Doctoral Program: A Descriptive Paper  [PDF]
Marc P. McRae
Creative Education (CE) , 2012, DOI: 10.4236/ce.2012.37174
Abstract: Introduction: Biochemistry has traditionally been taught through lectures and rote memorization paying little attention to nurturing key problem solving skills. The literature on clinical case studies utilized in health education indicates that case studies facilitate and promote active learning, help clinical problem solving and encourage the development of critical thinking skills. Methods: This paper describes a method of using clinical case studies to deepen and solidify the students understanding of biochemical facts and concepts as related to clinical medicine. Discussion: Clinical case studies can be a helpful adjunct for teaching the content of human biochemistry that complements the traditional approach of lecture, textbook and laboratory. The learning issues presented to the students required them to reformulate biochemical concepts in their own words, integrate diverse principles and decide what information was important and what was superfluous. Limitations include a small subset of students riding the coat tails of their more ambitious peers, and biochemistry professors not having the confidence to take the students through a clinical case study because they may feel like they do not have sufficient “clinical expertise”. Conclusion: Clinical case studies are a valuable addition to the traditional methods of lecture, textbook reading and laboratory for teaching biochemistry. More importantly clinical case studies help remind students that what they are learning has relevance in the real world, and may help motivate students to pay more attention to the numerous facts faced in biochemistry.
Burnout among chiropractic practitioners: real or imagined an exploratory study protocol
Shawn Williams, Stanley Innes
Chiropractic & Manual Therapies , 2012, DOI: 10.1186/2045-709x-20-4
Abstract: Past research has sought to explore and quantify the elevated levels of stress and susceptibility to burnout found in the helping professions. This has been demonstrated in professionals that share many similar characteristics to chiropractic such as medical practitioners [1,2], dentists [3-5], nurses [6-9], physical therapists [10-15], and occupational therapists [16-18]. However, this subject has never been studied in the chiropractic profession.Factors that have been identified which increase levels of stress and susceptibility to burnout include constantly focusing on the needs of others, which may lead to fatigue, feelings of frustration and anger, a sense of ineffectiveness and failure, and the onset of depression and associated co-morbidities [2,19-22]. Other factors include physical workload, quality of recipient contact, physical environment, type of patient feedback, financial pressures and supervisor support [22]. These factors have been shown to vary across geographic locations [10-13,23].With this body of evidence available for comparison it would seem logical to explore those significant factors already identified. Therefore, the objective of this paper is to demonstrate the need to explore burnout in chiropractic practice and to propose a research protocol for a potential study. Thus we would seek to question a representative selection of chiropractors from varying locations on their perceptions of the impact of these factors using an established and validated questionnaire.In 2008 there were 49,100 registered chiropractors in the U.S.; of these approximately 44% were self-employed [24]. While there is a trend of increasing numbers of chiropractors there is counter pattern of declining use of chiropractic. In the U.S., 9.9% of U.S. adults reported having seen a chiropractor in 1997 vs. 7.4% in 2002. This was the largest relative decrease among CAM professions, which overall had a stable use rate [25].Against this backdrop is the unfavourable public pe
New Proposal of Evaluation of the Thoracic Outlet  [PDF]
Bordoni Bruno, Marelli Fabiola, Morabito Bruno, Sacconi Beatrice
Open Journal of Therapy and Rehabilitation (OJTR) , 2018, DOI: 10.4236/ojtr.2018.62003
Abstract: The present article comprehensively reviews the thoracic outlet syndrome (TOS), its etiology and assessment, with reference to the usual conservative treatment and surgical therapy, highlighting new definitions and reporting obsolete tests. The syndrome affects about 8% of the population, with higher prevalence in females, and rarely affects the children. Conservative, non-surgical treatment produces good results, and it becomes important to know which specific areas need to be treated. Currently, there is no rehabilitation scheme, either osteopathic or chiropractic, considered as a valid tool for a precise localization of the pathologic condition, probably due to the lack of a manual assessment process to evaluate bones and muscular components of the thoracic outlet. In this situation, the manual treatment performed is usually generic. The present article proposes a manual evaluation that can be used to identify the anatomical area which needs to be treated. This hypothesis of assessment should be carried out after the clinician has ruled out the necessity of surgery with instrumental examinations.
A health care system in transformation: making the case for chiropractic
Richard Brown
Chiropractic & Manual Therapies , 2012, DOI: 10.1186/2045-709x-20-37
Abstract: This commentary explores the present day healthcare crisis and looks at the opportunities for chiropractors as pressure intensifies on politicians and leaders in healthcare to seek innovative solutions to a failing model. Amidst these opportunities, it questions whether the chiropractic profession is ready to accept the challenges that integration into mainstream healthcare will bring and identifies both pathways and potential obstacles to acceptance.A need for transformation in healthcare systems throughout the globe has long been recognised [1-3]. Social reform, improvements in living conditions and the positive impact of public health initiatives have all conspired to enhance quantity and quality of life [4]. As the baby boomers of the post World War Two era move into their twilight years enjoying a range of activities that would have left their ancestors aghast [5], western societies have experienced a steady increase in the size of the ageing population as communities dance, jog, cycle and gyrate their way into their eighties and nineties [6].But while we celebrate the achievements of medical science in prolonging and sustaining life, health care systems have been buckling under the pressure [7]. Advances in health technologies have brought about highly sophisticated systems of investigation, surgery and medical care [8,9]. In nations where health is delivered free at the point of service and where an informed public demands access to the most advanced available care, costs of health provision have rapidly escalated [10]. At the same time, fiscal deficits and global economic crises have resulted in budgets being dramatically reduced as governments struggle to balance the pressures on the public purse [11,12] whilst at the same time demanding added value. In nations which have seen the cost of healthcare as a proportion of the nation’s GDP rise steeply, in some cases by over seventy per cent [13], it is clear that within such an environment traditional models of
Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow-up
B Kim Humphreys, Cynthia Peterson
Chiropractic & Manual Therapies , 2013, DOI: 10.1186/2045-709x-21-3
Abstract: This prospective cohort study compares adult neck pain patients with dizziness (n = 177) to neck pain patients without dizziness (n = 228) who presented for chiropractic treatment, (no chiropractic or manual therapy in the previous 3 months). Patients completed the numerical pain rating scale (NRS) and Bournemouth questionnaire (BQN) at baseline. At 1, 3 and 6 months after start of treatment the NRS and BQN were completed along with the Patient Global Impression of Change (PGIC) scale. Demographic information was also collected. Improvement at each follow-up data collection point was categorized using the PGIC as ‘improved’ or ‘not improved’. Differences between the two groups for NRS and BQN subscale and total scores were calculated using the unpaired Student’s t-test. Gender differences between the patients with dizziness were also calculated using the unpaired t-test.Females accounted for 75% of patients with dizziness. The majority of patients with and without dizziness reported clinically relevant improvement at 1, 3 and 6 months with 80% of patients with dizziness and 78% of patients without dizziness being improved at 6 months. Patients with dizziness reported significantly higher baseline NRS and BQN scores, but at 6 months there were no significant differences between patients with and without dizziness for any of the outcome measures. Females with dizziness reported higher levels of depression compared to males at 1, 3 and 6 months (p = 0.007, 0.005, 0.022).Neck pain patients with dizziness reported significantly higher pain and disability scores at baseline compared to patients without dizziness. A high proportion of patients in both groups reported clinically relevant improvement on the PGIC scale. At 6 months after start of chiropractic treatment there were no differences in any outcome measures between the two groups.The complaint of neck pain is second only to low back pain in terms of common musculoskeletal problems in society today with a lifetime p
Fostering critical thinking skills: a strategy for enhancing evidence based wellness care
Jennifer R Jamison
Chiropractic & Manual Therapies , 2005, DOI: 10.1186/1746-1340-13-19
Abstract: This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system.This case study describes how health may be promoted and disease prevented through development of personalized wellness programs. As critical thinking is essential to the provision of evidence based wellness care, diverse learning opportunities for developing and refining critical thinking skills have been created. Three of the learning opportunities are an intrinsic component of the subject and, taken together, contributed over 50% of the final grade of the unit. They include a literature review, developing a client wellness contract and peer evaluation. In addition to these 3 compulsory exercises, students were also given an opportunity to develop their critical appraisal skills by undertaking voluntary self- and unit evaluation. Several opportunities for informal self-appraisal were offered in a structured self-study guide, while unit appraisal was undertaken by means of a questionnaire and group discussion at which the Head of School was present.Formal assessment showed all students capable of preparing a wellness program consistent with current thinking in contemporary health care. The small group of students who appraised the unit seemed to value the diversity of learning experiences provided. Opportunities for voluntary unit and self-appraisal were used to varying degrees.Unit evaluation provided useful feedback that led to substantial changes in unit structure.Students have demonstrated themselves capable of applying critical thinking in construction of evidence based wellness programs. With respect to unit design, selective use of learning opportunities highlighted the desirability of using obligatory learning opportunities to ensure exposure to core constructs while
Are chronic low back pain outcomes improved with co-management of concurrent depression?
Peter Middleton, Henry Pollard
Chiropractic & Manual Therapies , 2005, DOI: 10.1186/1746-1340-13-8
Abstract: The current scientific literature was investigated using the online web databases CINAHL, Medline/PUBMED, Proquest, Meditext and from manual library searches.Databases were searched from 1980 to the present (2005). Articles were searched with the key words "depression" and "low back pain". Over three hundred articles were sourced and articles were then selected on their relevance to the chronic spinal pain states that present to manual therapy practitioners.Pain is a subjective awareness of peripheral nociceptive stimulation, projected from the thalamus to the cerebral cortex with each individual's pain experience being mediated by his or her psychological state. Thus a psychological component will often be associated with any painful experience. A number of studies suggest (among other things) that the incidence of depression predicts chronicity in lower back pain syndromes but that chronic lower back pain does not have the reciprocal action to predict depression.The aetiology of chronic pain is multifactorial. There is sufficient evidence in the literature to demonstrate a requirement to draw treatment options from many sources in order to achieve a favourable pain relief outcome. The treatment should be multimodal, including mental and emotional support, counseling and herbal advice. While a strong correlation between depression and chronic low back pain can be demonstrated, an apparent paucity of literature that specifically addresses the patient response to chiropractic treatment and concurrent psychotherapy identifies the need for prospective studies of this nature to be undertaken. It is likely that multimodal/multidisciplinary treatment approaches should be encouraged to deal with these chronic lower back pain syndromes.Specific causes for acute back pain, such as infections, tumours, osteoporosis, spondyloarthropathies, and trauma actually represent a minority of pain syndromes requiring specific therapeutic approaches [1]. Chronic pain, by definition is pa
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