Rating specific chiropractic technique procedures for common low back conditions.

OBJECTIVE: To rate specific chiropractic technique procedures used in the treatment of common low back conditions. DESIGN AND METHODS: A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process. RESULTS: For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain. CONCLUSIONS: The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.

Chiropractic technique procedures for specific low back conditions: characterizing the literature.

BACKGROUND: Many original clinical trials and several review papers have come to the conclusion that manipulation is safe and effective for the treatment of low back pain. However, it is necessary to determine which specific types of manipulation and nonmanipulative types of chiropractic adjustive care are most effective for particular types of low back pain across both tissue-specific and functional classifications. OBJECTIVE: To characterize the quantity and quality of literature gathered for an Expert Panel that was convened to rate various specific chiropractic adjustive procedures for the treatment of common types of low back pain, drawing on the clinical expertise of the panel members and the relevant literature. STUDY DESIGN: Systematic review of treatment-specific, condition-specific trials, studies, and case reports of chiropractic care for low back pain. METHODS: Computerized searching and hand searching were used to identify references in the medical and chiropractic literature pertaining to the chiropractic treatment of low back pain in which both the condition and specific treatment procedures were adequately described. This literature was then categorized according to a variety of characteristics and used by a panel to evaluate the specific procedures. RESULTS: The 3 most studied adjustive procedures are side-posture high-velocity, low-amplitude; distraction (mostly flexion distraction); and mobilization, respectively. The clinical condition most commonly addressed by the included studies is low back pain. The procedure with the widest base of evidence support is side posture manipulation for low back pain.

Automatic assessment of cardiac function from short-axis MRI: procedure and clinical evaluation.

Cardiac magnetic resonance imaging (MRI) provides a wealth of morphological and physiological information. Automatic extraction of this information is possible by implementing various image processing techniques. However, existing procedures mostly rely on extensive human interaction and are seldom evaluated on a clinical scale. In this study, a nearly automatic process that extracts physiological parameters from cardiac MR images has been both developed and clinically evaluated. Raw images were obtained in the short-axis view and acquired by a gradient-cho (GE) protocol. In images selected to be analyzed, the only manual step required is the indication of a point in the center of the left ventricle (LV). From a set of such images, the process extracts endocardial and epicardial contours and calculates left ventricular volumes, mass and ejection fraction (EF). The process implements novel approaches to image processing techniques such as thresholding and shape extraction and can be adapted to other acquisition protocols. The process has demonstrated a clear potential for accurate extraction of the endocardial contour but a lower one with respect to the epicardial contour as a result of the low contrast between myocardium and some surrounding tissues, generated by the gradient-echo protocol. The ability of the process to asses physiological parameters has been subjected to a systematic clinical evaluation, which compared parameters, derived manually and automatically, in 10 healthy subjects and 10 patients. The evaluation has indicated that although individual volumes and mass were not accurately assessed, the automatic process has shown high potential for assessing the ejection fraction with relatively high accuracy and reliability.

Measurement of soft tissue strain in response to consecutively increased compressive and distractive loads on a friction-based test bed.

PURPOSE: To abstract the essential elements of chiropractic prone leg checking and subject them to controlled, experimental parametric testing. DESIGN: Controlled, objective, repeated-measure analysis of the dynamic response of leg positions to distractive and compressive loading conditions. SETTING: Research laboratory in a chiropractic college. PARTICIPANTS: Twenty-five compression and 30 distraction subjects, most of whom were male, asymptomatic chiropractic students. INTERVENTION: The subjects were lowered to the prone position on a table optimized to detect dynamic leg positions, with separate sliding segments supporting each leg. A trial consisted of a 2-min control run, followed by two 2-min experimental runs in which compressive or distractive loads were applied incrementally to the table-leg segments. MAIN OUTCOME MEASURE: An optoelectric system measured real-time absolute and relative leg positions. RESULTS: Right legs showed a greater average response than left legs under both distractive and compressive loads, and tended to respond more proportionately to incremental load increases. The average response to compression exceeded the response to distraction. Both legs showed a greater average response in the second half of the trials. Correlation of weights with responses was about four times greater in traction than compression. CONCLUSION: The functional short leg is confirmed as a stable clinical reality, a multitrial mean of unloaded leg positional differences. The prone leg check may be a loading procedure, albeit unmeasured, that detects non-weight-bearing, functional asymmetry in loading responses. These probably reflect differences in left-right muscle tone, joint flexibility and tissue stiffness. The relatively nonmonotonic, nonlinear quality of left leg responses is consistent with asymmetric neurological responses.

Effect of cervical spinal adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes.

OBJECTIVES: To determine whether spinal adjustments, delivered to the upper vs. lower cervical spine, might result in tonic neck reflex-induced alterations in the activity of the lumbar paraspinal musculature. DESIGN: Randomized, double-blind, before/after treatment comparisons. SETTING: Cervical Ergonomics Laboratory, Palmer College of Chiropractic-West, Sunnyvale, CA. SUBJECTS: Healthy, nonsymptomatic chiropractic college students, about evenly divided with respect to gender and ranging from 23-38 yr of age. INTERVENTION: Modified "diversified" spinal adjustments, delivered bilaterally to either the upper (C2) or lower (C7) cervical region. MAIN OUTCOME MEASURE: Tissue compliance measures using a tissue compliance meter, obtained from each subject at sites 2 cm on either side of the spinous processes of L1, L2, L3, L4 and L5 both prior to and within 15 min following treatments. RESULTS: Upper cervical adjustments produced changes in lumbar tissue compliance which were only slight (p < .05) and not significantly different from that which occurred following upper cervical sham manipulation (p > .1). However, lower cervical adjustments induced increases in tissue compliance (decreases in tone) which were highly significant (p < .001) and relatively robust compared to those found following upper cervical adjustments (p < .01). Furthermore, the greatest effects were observed on either side of the L4 and L5 spinous processes, suggesting influences on the gluteal musculature in particular. CONCLUSIONS: Results indicate that cervical spinal manipulation can have significant effects on the tone of the lumbopelvic musculature, presumably by facilitating tonic neck reflexes involving intersegmental spinal pathways.

The descriptive profile of low back pain patients of field practicing chiropractors contrasted with those treated in the clinics of west coast chiropractic colleges.

OBJECTIVE: To compare the demographic and clinical characteristics of low back pain patients from chiropractic college clinics and private practice settings on the west coast of the United States. DESIGN AND SETTING: A survey analysis of consecutive new patients in a specified time frame from multiple private office settings contrasted with a previous survey of consecutive new patients in a similar time frame from chiropractic college clinics. PATIENTS: In the private practice setting, new patients were selected on a consecutive basis as subjects for the study. Selection was limited to low back pain patients. INTERVENTIONS: None. This was a self-report survey only. MAIN OUTCOME: There is a strong similarity of the two low back pain patient groups, with the exception of higher levels of income, work time loss, severity and functional disability reported in the private practice setting. RESULTS: Similarities between the two low back pain patient groups were found in the distribution of gender, age, job description and education. Statistical significances were not determined due to variations in data collection. CONCLUSIONS: The two patient populations are reasonably comparable in sociodemographic variables, but clinical variation does exist. These results suggest the need to consider clinical findings when extrapolating research findings in a college clinic setting to the chiropractic profession in general.

Interexaminer concordance in detecting joint-play asymmetries in the cervical spines of otherwise asymptomatic subjects.

Interexaminer concordance for motion-based palpation of the middle and lower cervical spine was investigated. The palpatory task consisted of determining whether end-range joint resistance on lateral flexion was greater on one side of a given cervical segment when compared to that of the contralateral joint. Palpators also were asked to indicate the relative magnitude of the asymmetry, when detected. All experiments were carried out using reasonably healthy, pain-free, chiropractic college students. Three series of experiments involving two pairs of practitioners and a total of 270 subjects were carried out. Interexaminer agreement rates with respect to the side of greatest fixation were not found to be significantly different from those expected by chance alone. Furthermore, this was the case regardless of whether palpators had rated the magnitude of the asymmetry as being slight, moderate or severe. These poor agreement rates did not appear to be due to significant interexaminer differences with respect to the distributions of right vs. left calls, to a preponderance of agreements occurring more on one side over the other, or to differences with respect to the distribution of severity ratings. More importantly, there appeared to be no consistent relationships between the degree of severity indicated by the first examiner and that indicated by the second, nor were there any significant correlations between right vs. left agreement rates obtained for various combinations of severity ratings.(ABSTRACT TRUNCATED AT 250 WORDS)

Statistical analysis of temperature-dependent neuronal activity.

A set of computer programs which collect and analyze data on the temperature dependence of neuronal activity is described. Data on the response to thermal stimulation of cultured neurons of the rat preoptic area were collected and displayed on-line and were stored on disk for off-line analysis. Statistical analysis of the data examined two alternate models of thermosensitivity: one that the relationship between neuronal activity and temperature was well fit by a linear relationship and the other, that it was well fit by semi-log regression. For each of the models, a neuron was considered to have temperature-dependent activity if two criteria were met: first, that the model was considered adequate by a lack-of-fit F-test and second, that the slope of the regression line differed from zero using a t-test. A statistical method was also used to test the hypothesis that the neuronal response to temperature displays a change point. This method did not identify any neurons whose thermal response relationship could be better fit by two intersecting regression lines than by one regression line.