Journal of Manipulative and Physiological Therapeutics

Editorial Board

2010-01-01

Thank You to JMPT Peer Reviewers for 2009

Claire Johnson — 2010-01-01

Abstract: This article recognizes editorial board members and peer reviewers who completed manuscript reviews for the Journal of Manipulative and Physiological Therapeutics in 2009.

JMPT Highlights

2010-01-01

A Preliminary Path Analysis of Expectancy and Patient-Provider Encounter in an Open-Label Randomized Controlled Trial of Spinal Manipulation for Cervicogenic Headache

Mitchell Haas, Mikel Aickin, Darcy Vavrek — 2010-01-01

Abstract: Objective: The purpose of this article was to present a preliminary model to identify the effects of expectancy of treatment success and the patient-provider encounter (PPE) on outcomes in an open-label randomized trial.Methods: Eighty participants with chronic cervicogenic headache (CGH) were randomized to 4 groups: 2 levels of treatment dose (8 or 16) and 2 levels of therapy from a chiropractor (spinal manipulation or light massage). Providers were instructed to have equal enthusiasm for all care. Structural equation modeling with standardized path coefficients (β) was used in a path analysis to identify the effects of patient expectancy and the PPE on CGH pain. The model included monthly pain from baseline to 12 weeks. Expectancy and PPE were evaluated on Likert scales. The patient-provider encounter was measured as patient perception of chiropractor enthusiasm, confidence, and comfort with care.Results: Baseline patient expectancy was balanced across groups. The PPE measures were balanced across groups and consistent over the 8-week treatment period. Treatment and baseline pain had the strongest effects on pain outcomes (|β| = .46-.59). Expectations had little effect on pain (|β| < .15). The patient-provider encounter had a weak effect on pain (|β| = .03-.27) and on subsequent confidence in treatment success (|β| = .09 and .12).Conclusions: Encouraging equipoise in the PPE and balancing expectancy across treatment groups may protect against some confounding related to the absence of blinding in a randomized controlled trial of pain. In this trial, their effects were found to be small relative to the effects of treatment and baseline values.

Microstructural Damage in Arterial Tissue Exposed to Repeated Tensile Strains

Neal Austin, Lisa M. DiFrancesco, Walter Herzog — 2010-01-01

Abstract: Objectives: Vertebral artery (VA) damage has been anecdotally linked to high-speed, low-amplitude spinal manipulative treatments (SMTs) of the neck. Apart from a single study quantifying the maximum stresses and strains imposed on the VA during cervical SMT, there are no data on the mechanics of the VA for this treatment modality, and there is no information on the possible long-term effects of repeat exposure to cervical SMT. The purpose of this study was to quantify microstructural damage in arterial tissue exposed to repeat strain loading of a magnitude similar to the maximum strains measured in the VA during high-speed, low-amplitude cervical SMT.Methods: Twenty-four test specimens from cadaveric rabbit ascending aorta were divided into 2 control groups (n = 12) and 2 experimental groups (n = 6 each). Specimens were exposed to 1000 strain cycles of 0.06 and 0.30 of their in situ length. A pathologist, blinded to the experimental groups, assessed microstructural changes in the arteries using quantitative histology. Pearson χ2 analysis (α = .05) was used to assess differences in tissue microstructure between groups.Results: Control and 0.06 strain tissues were statistically the same (P = .406), whereas the 0.30 strain group showed microstructural damage beyond that seen in the control group (P = .024).Conclusions: We conclude that cadaveric rabbit arterial tissue similar in size and mechanical properties of that of the human VA can withstand repeat strains of magnitudes and rates similar to those measured in the cadaveric VA during cervical SMT without incurring microstructural damage beyond control levels.

Simulation Tests for Cervical Nonorganic Signs: A Study of Face Validity

Howard Vernon, Dan Proctor, Dianna Bakalovski, Jesse Moreton — 2010-01-01

Abstract: Objectives: The purpose of this study was to develop and determine the face validity of additional cervical nonorganic simulation tests.Methods: Four simulation tests were either selected from the literature or newly designed: simulated sitting trunk/shoulder rotation (SR; test no. 1), active vs passive cervical rotation (CR; test no. 2), Libman's test (LT; test no. 3) of pressure over the mastoid process, and side-lying passive shoulder abduction (SA; test no. 4). Three groups, 1 without neck pain (n = 44) and 2 with neck pain (n = 43 and 27), were formed. Outcome measures consisted of questions on provocation of pain (Yes/No) and appropriateness (Yes/No) as well as measurements of cervical rotation (goniometric) and pressure pain threshold (pressure algometer). Group test responses were evaluated and scored. A threshold of acceptance was established at 80% agreement for face validity. Ranges of rotation and pressure threshold values were analyzed with the Student t test.Results: In nonneck pain subjects, all 4 tests were rated as nonpainful and 3 were rated as “appropriate” for neck pain examination (not SR). In neck pain subjects, this test and SA were rated as nonpainful, whereas LT was rated as painful in 26% of subjects. Only CR and LT were rated as “appropriate.” In neck pain subjects, passive rotations exceeded actives by 10% to 14% (P = .000). On a second round of testing with a slightly modified method, SR and SA achieved acceptable “appropriateness.”Conclusions: Once 2 tests were slightly modified, all 4 tests were found to have acceptable face validity. Further research into the reliability of these tests as well as into the combinations of these tests is warranted.

Development of a Quality Checklist Using Delphi Methods for Prescriptive Clinical Prediction Rules: The QUADCPR

2010-01-01

Abstract: Objective: Clinical prediction rules (CPRs) are clinician decision-making aids designed to improve the accuracy of a variety of decisions made during patient care. To our knowledge, there are no formally developed consensus-based guidelines designed to provide standards for the creation of CPRs.Methods: The study used a 3-round Delphi method for consensus of a quality checklist initially developed based on recommendations derived from the literature. The 9 Delphi participants were randomly selected from the authors of peer-reviewed publications of prescriptive CPRs.Results: During the 3 rounds, the Delphi participants modified the originally derived checklist and, based on a consensus standard, agreed upon a final 23-item checklist, which involved 4 constructs: (1) sample and participants, (2) outcome measures, (3) quality of tests and measures, and (4) statistical assumptions.Conclusions: Use of the checklist has potential for improving the design and reporting of future prescriptive CPRs.

Immediate Effects of Hamstring Muscle Stretching on Pressure Pain Sensitivity and Active Mouth Opening in Healthy Subjects

2010-01-01

Abstract: Objective: This study analyzed the immediate effect of hamstring muscle stretching on pressure pain sensitivity over the masseter and the upper trapezius muscles and maximum active mouth opening in healthy subjects.Methods: One hundred twenty volunteers, 70 males and 50 females, between the ages of 22 and 47, were randomly divided into 3 groups: group 1 (control group) that did not receive any intervention, group 2 where a unilateral hamstring muscle stretching was applied, and group 3 where a bilateral stretching was applied. Pressure pain thresholds (PPTs) were bilaterally assessed over the masseter and upper trapezius muscles pre- and 5 minutes posttreatment by an assessor blinded to group assignment. Maximum mouth opening was also assessed pre- and 5 minutes posttreatment. Mixed-model analyses of variance (ANOVAs) were used to examine the effects of the intervention. The primary analysis was the group × time interaction.Results: The ANOVA revealed significant group × time interaction for changes in PPTs over the upper trapezius (F = 4.5; P = .01) and masseter (F = 6.3; P = .002) muscles. Pre-post effect sizes were moderate (0.5 > d > 0.7) for both stretching groups and negative (d < −0.2) for the control group. A significant group × time interaction (F = 8.15; P < .001) for maximum mouth opening was also found; both experimental groups showed greater improvement when compared to the control group (P < .001). Pre-post effect sizes were large (d > 0.7) for both stretching groups and negative (d < −0.2) for the control group.Conclusions: The application of a stretching of the hamstring musculature produced an immediate increase in PPTs over both masseter and upper trapezius muscles in healthy subjects.

Lumbar Spine and Pelvic Posture Between Standing and Sitting: A Radiologic Investigation Including Reliability and Repeatability of the Lumbar Lordosis Measure

Diana E. De Carvalho, David Soave, Kim Ross, Jack P. Callaghan — 2010-01-01

Abstract: Objective: Sitting has been identified as a cause of mechanical low back pain. The purpose of this study was to use plain film x-rays to measure lumbar spine and pelvic posture differences between standing and sitting.Methods: Eight male subjects were radiographed standing and sitting in an automobile seat. Measures of lumbar lordosis, intervertebral disk angles, lumbosacral angle, lumbosacral lordosis, and sacral tilt were completed. One-way analysis of variance (α = .05) was conducted on the variables stated above. A Bland-Altman analysis was conducted to assess agreement and repeatability of the lumbar lordosis angle using 2 raters.Results: Lumbar lordosis values in standing (average, 63° ± 15°) and sacral inclination (average, 43° ± 10°) decreased by 43° and 44°, respectively, in sitting. Intervertebral joint angles in sitting underwent substantial flexion (L1/L2—5° [±3°], L2/L3—7° [±3°], L3/L4—8° [±3°], L4/L5—13° [±3°], and L5/S1—4° [±10°]). Measures of lumbar lordosis; intervertebral disk angles between L2/L3, L3/L4, and L4/L5; lumbosacral lordosis; lumbosacral angle; and sacral tilt were significantly decreased between standing and sitting (P < .001). Intervertebral disk angle between L5/S1 was not significantly different. Analysis using the Bland-Altman technique found good agreement and stable repeatability of measures with no statistical significant differences between or within raters (R1, P = .8474; R2, P = .4402; and R-R2, P = .8691).Conclusion: The significant differences in lumbar and pelvic measures from standing to sitting further emphasize the range of motion experienced at vertebral levels in sitting. Based on the results of this study, interventions to return motion segments to a less flexed posture should be investigated because they may play a role in preventing injury and low back pain.

Recruitment Methods and Costs for a Randomized, Placebo-Controlled Trial of Chiropractic Care for Lumbar Spinal Stenosis: A Single-Site Pilot Study

Jerrilyn A. Cambron, Jennifer M. Dexheimer, Mabel Chang, Gregory D. Cramer — 2010-01-01

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.

Patients With Symptoms and Signs of Stroke Presenting to a Rural Chiropractic Practice

Robert A. Leach — 2010-01-01

Abstract: Objective: The purpose of this article was to present a retrospective case series of patients with symptoms and signs suggesting a stroke or prodrome and discuss the potential for health education and promotion initiatives in chiropractic that might affect this serious disease.Methods: A database and hand search of records from a rural Mississippi chiropractic practice was performed to identify all cases of patients presenting with symptoms and signs of stroke during the past 4 years, as well as stroke mortality among active patients during the same period.Results: Six subjects met inclusion criteria of about 500 active patients during any given year of the 4-year study period, including patients who had stroke symptoms or signs (n = 4) or who died as a result of stroke without presenting to the office (n = 2). Records and magnetic resonance angiograms were obtained after referral was made for a 77-year-old white female, 71-year-old white male, 59-year-old white male, and 24-year-old Hispanic female. Three of the 4 surviving patients were eventually diagnosed with stroke, and one with seizure disorder. Common presenting complaints were unilateral arm weakness and slurred speech; other complaints included episodic loss of vision, dysphagia, dysphonia, and same-sided leg weakness.Conclusions: Patients with symptoms and signs of stroke may infrequently present to chiropractic physicians for evaluation and treatment. Prevention, screening, early identification of stroke symptoms and signs, and referral for prompt treatment are cornerstones of the national stroke policy as espoused by the Centers for Disease Control. Chiropractic physicians have opportunities for practice-related health education initiatives focusing on the role of health and wellness in stroke prevention and for prompt lifesaving referral of emergency presentations.

Successful Treatment of Primary Dysmenorrhea by Collateral Meridian Acupressure Therapy

2010-01-01

Abstract: Objectives: This case report describes the observation of relief from painful dysmenorrhea and its associated symptoms in a female patient having primary dysmenorrhea after collateral meridian acupressure therapy (CMAT) treatment.Clinical features: A 36-year-old female patient presented with primary dysmenorrhea (abdominal cramping and referred lower back pain). She previously had taken oral analgesic pills to alleviate her symptoms during the menstrual period. The observation period was 6 months.Intervention and outcome: Collateral meridian acupressure therapy was performed once on the second day of both the first (partial treatment) and fourth (complete treatment) menstrual period. Pain was resolved immediately after partial CMAT treatment during the first menstrual period, but the pain recurred 20 minutes later. Satisfactory results were obtained during the fourth menstrual period after complete CMAT treatment, which were also carried over to the next session (fifth menstrual period). In addition, no oral analgesics were necessary after treatment. However, the symptoms of dysmenorrhea recurred 2 months after treatment (sixth menstrual period).Conclusion: This case report indicates that CMAT treatment may be effective in relieving the associated symptoms of dysmenorrhea. The carryover effect might suggest that there is a potential to produce a long-lasting effect on dysmenorrhea.

Effects of a Manual Medicine Treatment Procedures on Nitric Oxide Release in 23 Healthy Adults

James E. Kiernan — 2010-01-01

Abstract: Objective: The objective of this study was to measure if a manual treatment would alter the levels of exhaled nitric oxide levels in healthy adults.Methods: A study was performed using 23 healthy adults (age, 18-30 years). Nitric oxide (NO) was measured amperometrically before and after a manual treatment. The treatment used was a cranial-thoracic trapezius stretch.Results: In healthy adults, manual manipulation was associated with changes in NO levels in exhaled breath. The level of NO increased from 13.3 ± 2.09 (SD) to 15.0 ± 2.95 (SD) ppb (P = .001, based upon the paired t tests of the subjects). The median level of NO before manual manipulation was 13.0 ppb (ranging from 8 to 17ppb); after manual manipulation, it was 16.0 ppb (ranging from 6 to 18 ppb).Conclusion: The cranial-thoracic trapezius stretch was associated with an increase in exhaled NO, compared to baseline levels for the subjects in this study.

2010-01-01

Information for Readers

2010-01-01

Journal of Manipulative and Physiological Therapeutics

Editorial Board

Thank You to JMPT Peer Reviewers for 2009

JMPT Highlights

A Preliminary Path Analysis of Expectancy and Patient-Provider Encounter in an Open-Label Randomized Controlled Trial of Spinal Manipulation for Cervicogenic Headache

Microstructural Damage in Arterial Tissue Exposed to Repeated Tensile Strains

Simulation Tests for Cervical Nonorganic Signs: A Study of Face Validity

Development of a Quality Checklist Using Delphi Methods for Prescriptive Clinical Prediction Rules: The QUADCPR

Immediate Effects of Hamstring Muscle Stretching on Pressure Pain Sensitivity and Active Mouth Opening in Healthy Subjects

Lumbar Spine and Pelvic Posture Between Standing and Sitting: A Radiologic Investigation Including Reliability and Repeatability of the Lumbar Lordosis Measure

Recruitment Methods and Costs for a Randomized, Placebo-Controlled Trial of Chiropractic Care for Lumbar Spinal Stenosis: A Single-Site Pilot Study

Patients With Symptoms and Signs of Stroke Presenting to a Rural Chiropractic Practice

Successful Treatment of Primary Dysmenorrhea by Collateral Meridian Acupressure Therapy

Effects of a Manual Medicine Treatment Procedures on Nitric Oxide Release in 23 Healthy Adults

Contents

Information for Readers