Self-reported recognition of undiagnosed life threatening conditions in chiropractic practice: a random survey.

BACKGROUND: The purpose of this study was to identify the type and frequency of previously undiagnosed life threatening conditions (LTC), based on self-reports of chiropractic physicians, which were first recognized by the chiropractic physician. Additionally this information may have a preliminary role in determining whether chiropractic education provides the knowledge necessary to recognize these events. METHODS: The study design was a postal, cross-sectional, epidemiological self-administered survey. Two thousand Doctors of Chiropractic in the US were randomly selected from a list of 57878. The survey asked respondents to state the number of cases from the list where they were the first physician to recognize the condition over the course of their practice careers. Space was provided for unlisted conditions. RESULTS: The response rate was 29.9%. Respondents represented 11442 years in practice and included 3861 patients with a reported undiagnosed LTC. The most commonly presenting conditions were in rank order: carcinoma, abdominal aneurysm, deep vein thrombosis, stroke, myocardial infarction, subdural hematoma and a large group of other diagnoses. The occurrence of a previously undiagnosed LTC can be expected to present to the chiropractic physician every 2.5 years based on the responding doctors reports. CONCLUSION: Based on this survey chiropractic physicians report encountering undiagnosed LTC's in the normal course of practice. The findings of this study are of importance to the chiropractic profession and chiropractic education. Increased awareness and emphasis on recognition of LTC is a critical part of the education process and practice life.

Are patients receiving health promotion advice in the chiropractic teaching clinic setting?: an impact assessment of a brief intervention to increase advising rates and goal setting.

PURPOSE: The aim of this study was to analyze patient-reported health issues and levels of engagement, discussion of needed lifestyle changes, and goal setting with the patient's intern or staff doctor before and after a brief intervention to increase health-promoting activities in the clinic. METHODS: Patient surveys were developed and administered to outpatients before and after a brief intervention aimed at increasing staff and intern engagement with patients on health promotion measures. Patients self-reported areas of need and levels of engagement by their doctor or intern. Data were analyzed as pre- and postintervention independent, cross-sectional samples. Frequencies and chi-square assessments were performed. RESULTS: One hundred twenty-eight preintervention surveys and 162 postintervention surveys were collected. Back pain was the most common reason for being seen in the clinic (60% of patients) and most patients were white. More than 10% were smokers in both samples. Many patients reported poor diet, unhealthy weight, sleep issues, stress, or lack of regular physical activity, but 65% of the preintervention group and 72% of the postintervention group said a needed lifestyle change was discussed. Goals were set for 74% of the preintervention group and 84% of the postintervention group (p = .04). Information on lifestyle change was received by 52% of preintervention patients and 62% of postintervention patients and most were satisfied with this information. Goal setting was more common when a lifestyle change was discussed. Written information that was related to physical activity, for example, increased 350% (p < .0001). CONCLUSION: There are many opportunities for discussing needed lifestyle changes with patients. Patients self-report health behavioral issues related to physical activity, unhealthy weight, diet, stress, and sleep. More can be done in this area by this clinic, but initial assessments of impact from a brief intervention seem to have increased some levels of engagement by interns.

Faculty perception of clinical value of five commonly used orthopedic tests.

PURPOSE: The purpose of this study is to examine the perceptions of the value of five orthopedic tests (straight leg raise, Braggard's test, Kemp's test, Valsalva maneuver, and Patrick's fabere test) in the diagnosis of specific neuromusculoskeletal conditions among the chiropractic faculty at a large chiropractic college. METHODS: This is an observational study that employed a survey of 41 academic and clinic faculty members with a Doctor of Chiropractic degree. RESULTS: Of the 12 posed questions, only five demonstrated statistically significant consistency (positive straight leg raise for the presence of disc pathology, positive Valsalva maneuver for the presence of disc pathology, negative Valsalva maneuver to rule out disc pathology, negative Braggard's test to rule out the presence of disc pathology, and positive Patrick's fabere test for the presence of hip joint pathology). Subgroup analysis demonstrated that the school of graduation may be the only predictor of consistency. CONCLUSION: There were strong indications that faculty members were not consistent in their perception of the value for common orthopedic tests for diagnosing specific conditions. In an evidence-based model of education, there should be a consensus among academic and clinical faculty in order for the students to learn, integrate, and apply in practice what they have learned in the classroom. Active intervention in the academic process is required to accomplish necessary change.

Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?

BACKGROUND: Traction therapy has been utilized in the treatment of low back pain for decades. The most recent incarnation of traction therapy is non-surgical spinal decompression therapy which can cost over $100,000. This form of therapy has been heavily marketed to manual therapy professions and subsequently to the consumer. The purpose of this paper is to initiate a debate pertaining to the relationship between marketing claims and the scientific literature on non-surgical spinal decompression. DISCUSSION: Only one small randomized controlled trial and several lower level efficacy studies have been performed on spinal decompression therapy. In general the quality of these studies is questionable. Many of the studies were performed using the VAX-D unit which places the patient in a prone position. Often companies utilize this research for their marketing although their units place the patient in the supine position. SUMMARY: Only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.

Treatment of chronic nonresponsive patients with a nonforce technique.

OBJECTIVE: To investigate how chronic pain patients respond to treatment with Bio-Energetic Synchronization Technique (BEST). METHODS: Twenty-four adult patients with chronic pain-related conditions that failed to respond to previous chiropractic care were recruited. Subjects were given baseline assessments including pain Visual Analog Scale, Profile of Mood States, and the Global Well-being Scale. The 5-week treatment program consisted of an initial 3-day session with BEST therapy, followed by a single treatment session for the following 4 weeks. Patients were reevaluated at the end of the 3-day session and at weekly intervals throughout the course of care. At the end of week 5, patients were asked to assess their degree of satisfaction with the treatment. RESULTS: Patients had 3 main categories of pain: headache (n = 8, mean duration 15 years), neck pain (n = 18, mean duration 11 years), and low back pain (n = 17, mean duration 10 years). Global Well-Being Scale scores significantly improved at the end of the 3-day session (P > .05) but not subsequently. The Profile of Mood States reflected favorable changes in all areas. Significant improvement in vigor (P > .003) and fatigue (P > .006) existed at the end of 5 weeks (P < .01). The reduction of pain was significant at both the end of the 3-day session and at follow-up (P = .0003). A statistically significant decrease in depression (P = .004) was noted after 3 days, and a substantial although not significant (P = .06) decrease in depression existed at the end of 1 month. Eighty-two percent reported satisfaction with BEST (47% reported being "extremely satisfied" and 35% "satisfied"). CONCLUSION: In this group of chronic pain patients, improvement in patient outcome measures was seen after 5 weeks of therapy. These patients also responded with a high degree of satisfaction with care.

Calibration and electrical safety status of therapeutic ultrasound used by chiropractic physicians.

BACKGROUND: Ultrasound therapy is a commonly used therapeutic modality within the chiropractic profession. Previous calibration studies of ultrasound units within the physical therapy communities in Scotland and Canada have shown that approximately two thirds of units tested did not conform to minimum calibration standards. Similar failure rates may exist in the chiropractic profession and need to be addressed. OBJECTIVE: To determine whether ultrasound machines used by chiropractic physicians met established calibration and electrical safety standards, and to assess frequency of ultrasound therapy use. DESIGN: This cross-sectional study tested 45 ultrasound units for ultrasonic output and electrical safety. Additionally, we asked the doctors to complete a short survey relating to education, usage, and maintenance of their ultrasound equipment. RESULTS: Of the 45 machines tested, 44% failed either calibration or electrical safety inspection. Failure rate was age dependent (P < or =.05). Only 2 of the 45 machines tested had been safety checked within the last year. CONCLUSIONS: A large percentage of ultrasound machines in chiropractic physicians' offices deliver too much or too little dosage to the patient. Electrical safety inspections also revealed a significant failure rate. Chiropractic physicians must become more aware of the requirement for yearly calibration and safety inspections, and understand that failure to maintain their equipment could result in loss of therapeutic effectiveness and pose a threat to the safety of their patients and staff.