Journal of Manipulative and Physiological Therapeutics RSS feed: Current Issue. Journal of Manipulative and Physiological Therapeutics (JMPT) is dedicated to the advancement of chiropractic health care. It provides the latest information on current developments in therapeutics, as well as reviews of clinically oriented research and practical information for use in clinical settings. The Journal's editorial board includes some of the world's leading clinical low-back and spine researchers from medicine, osteopathy, chiropractic, and post-secondary education. JMPT , the premier biomedical publication in the chiropractic profession, publishes peer-reviewed original articles, case reports, journal abstracts, commentary, and new media reviews. Readers include chiropractors, osteopaths, physical therapists, physiatrists, radiologists, and sports medicine specialists. JMPT is the only chiropractic journal included in Index Medicus. It is also indexed/abstracted in Current Contents/Clinical Medicine and Index to Chiropractic Literature. Special discount of $99 offered to COCA members.http://www.jmptonline.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Journal of Manipulative and Physiological Therapeutics0161-4754336July 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jmptonline.org/article/PIIS016147541000165X/abstract?rss=yesEditorial Board10.1016/S0161-4754(10)00165-XJournal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0IFCIFChttp://www.jmptonline.org/article/PIIS0161475410001624/abstract?rss=yesAbstract: Social justice in public health involves the process and product of a community acting to fairly distribute advantages and burdens to improve the health of its population and to reasonably take care of the disadvantaged. Although publications are available about chiropractic public health history, programs, and policy, the potential role of chiropractic in social justice has received little attention. This article discusses Beauchamp's 4 principles of social justice and suggests actions that the chiropractic profession may consider to participate in the practice of social justice in the field of public health.Chiropractic and Social Justice: A View From the Perspective of Beauchamp's PrinciplesBart N. Green, Claire Johnson10.1016/j.jmpt.2010.07.001Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Editorial407411http://www.jmptonline.org/article/PIIS016147541000148X/abstract?rss=yesJMPT Highlights10.1016/j.jmpt.2010.06.001Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0412412http://www.jmptonline.org/article/PIIS0161475410001569/abstract?rss=yesAbstract: Objective: The recommendations of health care providers have been shown to be a predictor of future healthy behaviors. However, patient adherence to these recommendations may differ based upon the type of health care professional providing the information. This study explored patient compliance in the United States over a 12-month period and contracted the patient response to recommendations given by chiropractors versus medical doctors.Methods: Multiple logistic regression models were used for analyses of data from the Sample Adult Core component of the 2006 National Health Interview Survey (n = 24 275). Analyses were performed separately for recommendation and compliance of weight loss, increase exercise, and diet change by health profession subtype (chiropractor and medical doctor).Results: About 30.5% of the respondents reported receiving advice from their provider. Among these, 88.0% indicated they complied with the advice they received. Patients who were advised were more likely to comply (odds ratio [OR] [95% CI], 10.41[9.34-11.24]). Adjusting for seeing a physical therapist, age, and body mass index, chiropractors were less likely to advice patients compared to medical doctors (OR [95% CI], 0.38 [0.30-0.50]). In general, there was a 21% increased odds that patients who received and complied with health promotion advice from their health care provider would report an improved health status (OR [95% CI], 1.21 [1.10-1.33]) compared with those who did not comply or were not advised.Conclusion: Chiropractors in the United States give health promotion recommendation to their patients but are less likely to do so than general medical doctors. Patients tend to comply with health providers' recommendations and those who do report better health.The Health Care Provider's Role and Patient Compliance to Health Promotion Advice From the User's Perspective: Analysis of the 2006 National Health Interview Survey DataHarrison Ndetan, Marion Willard Evans, Sejong Bae, Martha Felini, Ronald Rupert, Karan P. Singh10.1016/j.jmpt.2010.06.009Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles413418http://www.jmptonline.org/article/PIIS0161475410001557/abstract?rss=yesAbstract: Objective: The importance of integrating healthy behavior counseling into routine health care is universal but may depend on the type of medical care provider as well as the conditions presented by patients. The purpose of this study was to evaluate whether health promotion (HP) recommendations for known risk factors of arthritis differed between general medical doctors and doctors of chiropractic (DCs) in a nationally representative US population with arthritis.Methods: Multiple logistic regression models were used for analyses of data from the Sample Adult Core component of the 2006 National Health Interview Survey (n = 6374 diagnosed with arthritis). Analyses were performed separately for recommendation of weight loss and increase in exercise by health profession subtype (chiropractor and medical doctor).Results: Comparing the reported HP efforts between DCs and medical doctors (MDs), while adjusting for the effect of physical therapist and body mass index, we observed no significant differences (weight loss: adjusted odds ratio [95% confidence interval] = 0.76 [0.50-1.18]; increased exercise: adjusted odds ratio [95% confidence interval] = 0.87 [0.59-1.29]).Conclusion: Health promotion efforts to patients with arthritis do not differ significantly between MDs and DCs, as reported by National Health Interview Survey 2006. This investigation makes it difficult to suggest that DCs or MDs are doing all they can do to manage arthritis through suggested modification of lifestyle in their patients. More research specific to what is and can be recommended to those with arthritis should be conducted particularly because it relates to health-promoting behaviors. Given the recent implementation of required clinical competencies in HP into chiropractic college curriculums, future studies regarding translation of HP messages into public practice should be more informative.Chiropractic and Medical Use of Health Promotion in the Management of Arthritis: Analysis of the 2006 National Health Interview SurveyHarrison Ndetan, Marion Willard Evans, Martha Felini, Sejong Bae, Ronald Rupert, Karan P. Singh10.1016/j.jmpt.2010.06.008Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles419424http://www.jmptonline.org/article/PIIS0161475410001491/abstract?rss=yesAbstract: Objective: A high prevalence of poor standing posture among elementary schoolchildren indicates the need for the introduction of school-based interventions for improvement of postural alignments. For assessing the effect of intervention programs, reliable quantitative measures of standing posture should be used. Therefore, the purpose of this study was to examine the reliability of a photographic method for assessment of standing posture among elementary schoolchildren.Methods: The study was conducted on a convenience sample of 273 male students between 10 and 13 years old. Each subject was photographed in habitual standing posture, 3 times in a front view and 3 times in a side view. Deviations from ideal postural alignment were calculated with Posture Image Analyzer software and UTHSCSA ImageTool software. Interitem reliability was estimated using intraclass correlation coefficient.Results: Intraclass correlation coefficients for posture deviations assessed with Posture Image Analyzer ranged from 0.81 for knee joints deviation and ankle joints deviation in the coronal plane to 0.92 for trunk deviation and knee joints deviation in the sagittal plane. Intraclass correlation coefficients for posture deviations assessed with UTHSCSA ImageTool ranged from 0.80 for knee joints deviation in the coronal plane to 0.91 for trunk deviation and knee joints deviation in the sagittal plane.Conclusions: This study showed a satisfactory interitem reliability of a photographic method for the assessment of standing posture among elementary schoolchildren.Reliability of a Photographic Method for Assessing Standing Posture of Elementary School StudentsJelena Paušić, Željko Pedišić, Dražan Dizdar10.1016/j.jmpt.2010.06.002Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles425431http://www.jmptonline.org/article/PIIS0161475410001508/abstract?rss=yesAbstract: Objective: Back pain has consistently ranked among the top general health complaints among college students, but few studies have examined risk factors for back pain in this age group. This cross-sectional survey evaluated the association between the self-reported annual low back pain with the estimated usual backpack weight among college students.Methods: Data were collected from health education students during the spring semester of 2007 at the Colorado State University using an online survey. Adjusted odds ratios were calculated using logistic regression.Results: Four hundred sixty-five (94.6%) health education students completed the online survey. The annual prevalence of low back pain was 29.2% (n = 136). A 25% increase in the odds of annual low back pain for each 4-kg increase in the estimated usual backpack weight was observed after adjusting for sex, smoking, reporting frequently feeling overwhelmed, and body mass index (adjusted odds ratio per 4-kg increase, 1.25; 95% confidence interval, 1.17-1.32). There was no evidence of an increased association of annual low back pain with carrying a backpack weight greater than 10% of the students body weight compared with those carrying less (adjusted odds ratio, 1.02; 95% confidence interval, 0.63-1.65).Conclusions: The results of this study suggest that increasing reported backpack weight is associated with increased prevalence of annual low back pain. However, these results do not provide evidence to support the recommendation that the backpack weight necessarily be less than 10% of body weight.The Association of Self-Reported Backpack Use and Backpack Weight With Low Back Pain Among College StudentsZachary Heuscher, David P. Gilkey, Jennifer L. Peel, Catherine A. Kennedy10.1016/j.jmpt.2010.06.003Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles432437http://www.jmptonline.org/article/PIIS0161475410001533/abstract?rss=yesAbstract: Objective: The purpose of this study was to explore the short-term effects of chiropractic care on pain and function in patients with hip osteoarthritis.Methods: A convenience sample of 14 patients waiting to undergo unilateral hip arthroplasty at a large university hospital received either chiropractic care (n = 7) or no additional treatment (n = 7) during a 3-week period. The main outcome was the change in self-rated hip pain on a 100 mm Visual Analogue Scale (VAS, 0-100). Secondary outcomes were the change in the five Hip disability and Osteoarthritis Outcome Subscales (HOOS, 0-100), which include pain, other symptoms, function in daily living, function in sport and recreation and hip related quality of life. Nonparametric statistics were used to explore outcome changes from baseline to follow-up after three weeks within and between the groups.Results: Patients receiving chiropractic care, on average 4.4 (SD ±1.0) treatments over 3 weeks, showed a clinically and statistically significant improvement in self-rated hip pain, VAS - 26.0 (SD ±28.4), P = .043. The chiropractic patients also had clinically important, but not statistically significant, improvement scores in HOOS function in daily living 18.6 (SD ±18.5), pain 15.4 (SD ±17.2), and hip-related quality of life 12.4 (SD ±19.6). The waiting list controls had no statistically significant improvements in any outcome measured, but a clinically relevant improvement in HOOS Pain 12.2 (SD ±18.2), P = .051 was observed. There were no statistically significant differences between the groups due to the small sample size. Approximately 25 patients per arm would be required to adequately power a full scale randomized controlled trial with VAS for hip pain as the main outcome measure.Conclusions: Chiropractic care may provide a short-term benefit in decreasing hip pain for patients with hip osteoarthritis waiting for hip arthroplasty. The pilot findings warrant larger scale randomized controlled trials with longer-term follow-ups.Effects of Chiropractic Care on Pain and Function in Patients With Hip Osteoarthritis Waiting for Arthroplasty: A Clinical Pilot TrialPernilla Thorman, Alexander Dixner, Tobias Sundberg10.1016/j.jmpt.2010.06.006Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles438444http://www.jmptonline.org/article/PIIS0161475410001521/abstract?rss=yesAbstract: Objective: Hip osteoarthritis (HOA) affects 30 million Americans or more, and is a leading cause of disability, suffering, and pain. Standard treatments are minimally effective and carry significant risk and expense. This study assessed treatment effects of a chiropractic protocol for HOA.Methods: Eighteen individuals, who did not qualify due to low baseline Western Ontario and McMaster Osteoarthritis Index scores (WOMAC) for other ongoing HOA randomized control trials, were selected. A prospectively planned protocol, consisting of axial manipulation to the affected hip with modified Thomas and active assisted stretch, was combined with full kinetic chain treatment or manipulative therapy to the spine, knee, ankle, or foot and assessed with use of valid and reliable outcome measures.Results: The primary outcome measure, the Overall Therapy Effectiveness Tool, was assessed with χ2 and demonstrated that 83.33% of participants were improved after the ninth visit, P = .005, and 78% improved at the 3-month follow-up, P = .018. Using the paired t test, WOMAC was improved 64% at the ninth visit, P = .000, and 47% at follow-up, P = .016.Conclusion: In HOA patients with lower WOMAC scores, a highly organized HOA treatment appears to have resulted in statistically and clinically meaningful intragroup changes in the Overall Effectiveness Therapy Tool, WOMAC, Harris Hip Scale, and range of motion, all with P ≤ .05. Although the directionality and strength of the findings are encouraging, fully powered clinical trials are necessary to report generalizable findings.A Single-Group Pretest Posttest Design Using Full Kinetic Chain Manipulative Therapy With Rehabilitation in the Treatment of 18 Patients With Hip OsteoarthritisJames W. Brantingham, Gary A. Globe, Tammy Kay Cassa, Denise Globe, Katie de Luca, Henry Pollard, Felix Lee, Charles Bates, Muffit Jensen, Stephan Mayer, Charmaine Korporaal10.1016/j.jmpt.2010.06.005Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles445457http://www.jmptonline.org/article/PIIS0161475410001545/abstract?rss=yesAbstract: Objective: As the chiropractic profession delineates its role in the emerging health care marketplace, it will become increasingly important that the scope of appropriate chiropractic care is clearly defined relative to overall patient case management. Therefore, the Council on Chiropractic Guidelines and Practice Parameters engaged in a multidisciplinary consensus process addressing the terminology related to “levels of care.”Methods: A formal consensus process was conducted in early 2009, following the RAND/UCLA method for rating appropriateness. Panelists were selected to provide a broad representation of the profession in terms of geographic location and organizational affiliation, and an attempt was made to include members of other professions, including representation from third-party payors. The Delphi process was conducted electronically in January-February 2009. A nominal group panel was conducted through an online meeting service using an experienced group facilitator. Twenty-seven panelists were selected; all but 3 were doctors of chiropractic. Six of the panelists had experience as consultants with third-party payors.Results: Fifteen seed statements were circulated to the Delphi panel. Consensus was reached on all statements after 3 Delphi rounds, with further refinements made through the nominal group panel.Conclusions: By using a recognized formal consensus process, the Council on Chiropractic Guidelines and Practice Parameters has endeavored to establish a set of terms that are acceptable to the chiropractic community in order to facilitate their use within the broader health care community.Consensus Terminology for Stages of Care: Acute, Chronic, Recurrent, and WellnessMark D. Dehen, Wayne M. Whalen, Ronald J. Farabaugh, Cheryl Hawk10.1016/j.jmpt.2010.06.007Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles458463http://www.jmptonline.org/article/PIIS0161475410001570/abstract?rss=yesAbstract: Objective: At this time, the scientific evidence base supporting the effectiveness of chiropractic care for musculoskeletal conditions has not yet definitively addressed its appropriateness for older adults. Expert consensus, as a form of evidence, must be considered when higher levels of evidence are lacking. The purpose of this project was to develop a document with evidence-based recommendations on the best practices for chiropractic care of older adults.Methods: A set of 50 seed statements was developed, based on the clinical experience of the multidisciplinary steering committee and the results of an extensive literature review. A formal Delphi process was conducted, following the rigorous RAND-UCLA (University of California, Los Angeles) methodology. The statements were circulated electronically to the Delphi panel until consensus was reached. Consensus was defined as agreement by at least 80% of the panelists. There were 28 panelists from 17 US states and Canada, including 24 doctors of chiropractic, 1 physical therapist, 1 nurse, 1 psychologist, and 1 acupuncturist.Results: The Delphi process was conducted in January-February 2010; all 28 panelists completed the process. Consensus was reached on all statements in 2 rounds. The resulting best practice document defined the parameters of an appropriate approach to chiropractic care for older adults, and is presented in this article.Conclusion: A multidisciplinary panel of experienced chiropractors was able to reach a high level (80%) of consensus on evidence-informed best practices for the chiropractic approach to evaluation, management, and manual treatment for older adult patients.Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus ProcessCheryl Hawk, Michael Schneider, Paul Dougherty, Brian J. Gleberzon, Lisa Z. Killinger10.1016/j.jmpt.2010.06.010Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Original Articles464473http://www.jmptonline.org/article/PIIS016147541000151X/abstract?rss=yesAbstract: Objective: Osteoarthritis is the most common musculoskeletal disorder, estimated to affect 3 million Australians. Previous studies support structured exercise programs and manipulation for hip osteoarthritis; however, no trials have examined treatment of the lower limb kinetic chain. The purpose of this case series was to report hip range of motion and pain scale outcomes in 4 patients diagnosed with hip osteoarthritis who were treated with chiropractic management of the lower limb kinetic chain.Methods: Four subjects (mean age 59.5; SD ± 6.7) were provided with 9 sessions of chiropractic treatment. This included long-axis traction pulls and pre/post adjustment stretching of the symptomatic hip, with additional manipulation and mobilization of the lumbar spine, sacroiliac, knee, and ankle joints. Outcome measures included range of motion as measured and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results: All 4 subjects had improvements in WOMAC scores, with a mean group reduction of 382.5 (SD ± 115.8) and overall improvement of 68.1%. As a group, there were improvements in internal rotation (51.7%, mean 7.3°; SD ± 6.2°), adduction (26.7%, mean 5.3°; SD ± 5.0°), abduction (21.1%, mean 6.8°; SD ± 5.4°), flexion (15.3%, mean 15°; SD ± 4.8°) and external rotation (8.5%, mean 8.5°; SD ± 6.0°).Conclusions: Four patients diagnosed with hip osteoarthritis had decreases in WOMAC scores and increases in hip range of motion after chiropractic management. Further research in the form of large scale randomized controlled trials is needed to investigate the effectiveness and clinical significance of chiropractic management for hip osteoarthritis.Chiropractic Management of the Kinetic Chain for the Treatment of Hip Osteoarthritis: An Australian Case SeriesKatie de Luca, Henry Pollard, James Brantingham, Gary Globe, Tammy Cassa10.1016/j.jmpt.2010.06.004Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Case Report474479http://www.jmptonline.org/article/PIIS0161475410001582/abstract?rss=yesThe study by Austin et al is very interesting and was well written in a cautious manner. They suggested that…“the results should not be translated to the human VA (vertebral artery) without due consideration.” Their opinion, that the application of 1000 repeat load cycles in a single session represents a “worst case scenario,” seems at face value to be reasonable. However, given the limitations of the two studies, some of which they discussed, there could be other “worst case scenarios” that need to be considered.Microstructural damage of arterial tissue due to repeated tensile strainsMichael J. Haynes10.1016/j.jmpt.2010.06.011Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Letters to the Editor480480http://www.jmptonline.org/article/PIIS0161475410001594/abstract?rss=yesWe thank the author of the letter to the editor for their constructive criticism. The authors indicate that modeling studies revealed up to 42% strain of the vertebral artery (VA) on the C1/C2 level. If this was indeed the case, then our present study and previous work would suggest that cervical spinal manipulations needed to be stopped immediately, as repeat application of 30% strain produces significant micro-trauma to arterial tissues and an average strain of 53% causes complete mechanical failure of the VA.In ReplyWalter Herzog, Bruce Symons10.1016/j.jmpt.2010.06.012Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0Letters to the Editor480481http://www.jmptonline.org/article/PIIS0161475410001661/abstract?rss=yesTable of Contents10.1016/S0161-4754(10)00166-1Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0FrontmatterA1A1http://www.jmptonline.org/article/PIIS0161475410001673/abstract?rss=yesInformation for Readers10.1016/S0161-4754(10)00167-3Journal of Manipulative and Physiological Therapeutics 33, 6 (2010)2010-07-01Journal of Manipulative and Physiological Therapeutics2010-07-01336S0161-4754(10)X0007-0FrontmatterA2A2