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Re: PT-DC CONFLICT
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Re: PT-DC CONFLICT - March 8, 2004 2:28:00 AM
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Sebastian Asselbergs
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Doughnut, think a bit more internationally. The Dutch Physiotherapy Association celebrated its 100th (!) anniversary in 1990. Do the math.
Sebastian
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Re: PT-DC CONFLICT - March 8, 2004 4:45:00 AM
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researchdoc
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LouDC: what kind of filing system do you have that you cannot locate a simple study to support your claim that there are RCTs to support chiropractic treatment of children?
> Arch.Pediatric Adolescent(Osteopathic) Medicine.20003;157:861-866
Not a study of "chiropractic" - in fact chiropractic manipulation was specifically NOT employed in this study. I doubt you even read this paper.
> Journal Clinical Chiropractic Pediatrics 1997;2(2) Oct.
Never heard of this "journal". Any idea where a person can locate a copy of this journal? Do you even have a copy of this "study"?
> Journal Manipulative Physiologcal Therpeutics 1996 Mar-Apr,19(3):169-77
Non-randomized, non-blinded, no control group. Data collection method very susceptible to bias ("Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved."). In other words, JUNK SCIENCE.
Lou, you stated: "As to infantile colic and otitis media both are far better and safer with manipulation than with medication. There are RCTs on these conditions."
So, do you actually *have* studies to support this statement, or are you just blowing smoke - like the rest of your colleagues who visit this website?
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Re: PT-DC CONFLICT - March 8, 2004 5:28:00 AM
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Alex Brenner PT MPT OCS
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From: Kentucky
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[QUOTE]Originally posted by Doughnut:
.... Chiropractic ADJUSTMENT, it is not a manipulation.
In my opinion, Chiropractors don't manipulate. They put a power into the body so the body can ADJUST,{ or to make just, have justice }
pt's think they can do what a Chiropractor does with the knowlege and training they get is just generally off base.
[/QUOTE]
Doughnut, I could not agree more with your above quotes. Chiropractors "Adjust" the spine, PTs manipulate the spine. Manipulation is a DO or PT term, "adjustment" is the chiro term. Thanks for helping clarify these differences. Physical therapists that manipulate are not adjusting the spine, we are performing a level of mobilization that allows better joint movement and address movement restrictions. I am not trying to connect anyone with a spirit, just trying to get the joint to move better with less pain. I have never nor I have heard any physical therapist claim to do what a chiropractor does, "adjust", like you mentioned above. Just my thoughts. With that in mind, it is hard for me to believe that the chiropractors are suing a physical therapist in Arkansas for manipulating a spine. From what you and I both said above, manipulation is very different from an adjustment.
ArmyPT, OCS
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Re: PT-DC CONFLICT - March 8, 2004 11:34:00 AM
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UTDC
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Doughnut,
I think you are going overboard and being highly defensive here. The comments by PT's regarding the chiropractic profession in this thread were not inflammatory or accousatory (for the most part). It seems as though you have gone off on a tanget re: what profession was doing what, when. I think you need to chill out a bit.
Maybe we should pursue a constructive discussion on the present state of affairs instead of beating each other over the head with our respective versions of history.
Furthermore,I think that we all need to respect the fact that this is a physical therapy forum as has been expressed here recently.
Army PT:
Thanks for your input, I have appreciated hearing of your experience with DC's in the military. Manipulation is "adjusting" and vice versa, the only real difference is the dogma.
Jeff
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Re: PT-DC CONFLICT - March 8, 2004 2:13:00 PM
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researchdoc
Posts: 34
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Is this you, Lou?
[URL=http://www.chiroweb.com/ubb/open/Forum1/HTML/000059.html]http://www.chiroweb.com/ubb/open/Forum1/HTML/000059.html[/URL]
What, can't you find that RCT in your "files"?
Great response by your friend - is "googleing" the standard research method for chiropractors? You may want to inform your friend what "RCT" means; he seems confused.
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Re: PT-DC CONFLICT - March 8, 2004 3:13:00 PM
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Mitch
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From: Somerdale, NJ
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THE TERM 'ADJUSTING' OR 'ADUSTMENT' IS BOGUS!! MAYBE YOU NEED TO ENTER THE OPERATING ROOM WITH DR. KUSLICH TO FIND OUT; THEN YOU CAN COMPARE THIS WITH WHAT IT WOULD BE LIKE WITH A PERSON WHO WAS NOT UNDER ANESTHETICS AND HOW MUCH LESS LIKELY IT WOULD BE FOR SOMEONE TO BE 'ADJUSTED' AND EVEN HOPE TO MAINTAIN THIS AGAINST THE FORCE OF GRAVITY! (See below)
Sheeze, I don't know where to start! I appreciate where the movement of spinal segments unobstructed or restricted is the goal and this certainly has more credence than attempting to adjust something that is unadjustable and for which many dellude themselves into believing they see.
JUST MAKE THE DANG SEGMENT MOVE FLUIDLY WITH LESS OR WITHOUT OBSTRUCTION!
I use many methods to achieve this, if I decide to utlize additional forces, I will do so by first exhausting mobilization forces and preferably starting with patient self mobilizations for their learning experience!
Palpation?
Palpation, intertester reliability is unreliable, no matter how skilled one supposedly is. Note: Mootz, et al, assessed sixty study volunteers for fixation in the lumbar spine using a passive motion palpation protocol. Fixations were judged present or absent for each of five lumbar motion segments. Moderate test-retest agreement beyond chance was noted at L1/2, minimal reliability at L4/5, and no significant agreement within examiners was detected for mid-lumbar segments. Interexaminer agreement beyond chance was poor for all segments assessed. When segments were grouped regionally and re-evaluated, some increase in intrarater agreement was evident, especially at L4/5/S, but interrater agreement was still absent (Mootz (chiropractor), et al, Intra- and Interobserver Reliability of passive Motion Palpation of the Lumbar Spine, Journal of Manipulative and Physiological Therapeutics, Vol. 12, Number 6, December, 1989, 440-445).
Mark St., DC indicates...: This goes right to the root of the subluxation theory as it applies to upper cervical work.
Specifically Tren. (full name omitted) rambling smooth talking octagon neuro-spine bull****. In humans nothing is truly symmetrical yet the concept is tantamount in the determination of subluxation and the means chosen for correction. Symmetry is only an implied reality. If one uses this implied reality as a basic operational premise they are operating with their own implied reality and assumptions, and not that of the natural. JMPT vol. 15, No. 9 Nov-Dec 1992 Asymmetry of the Occipital Condyles: A Computer-Assisted Analysis Teresa A. Febbo, D.C., Roger Morrison, D.C., and Richard Valente ABSTRACT Objective: To ascertain the incidence of asymmetry of the occipital condyles. The a priori hypothesis of symmetry (which is pervasive both in the determination of "subluxation" and in the means chosen for correction) was tested. Design: Data set design was used with a convenience sample. The condyles were chosen for convenience of visualization from plain film radiographs. The study was retrospectively designed, albeit with prospective implications for analytic investigation. Setting: The research department of Cleveland Chiropractic College, Kansas City, MO. Patients or Other Participants: One hundred fifty one submentovertex radiographs were examined using a computer-assisted digitizer. The radiographs were randomly obtained from the patient files of two doctors of chiropractic who routinely use this type of radiograph in their patient analysis. Interventions: The study was a side-to-side comparison of the condyles, which were subject to neither intervention nor change. Main Outcome Measures: Surface area of left and right condyles for 151 examined pairs. Results: Analysis with Pearson's correlation coefficient implied a lack of symmetry between condyles (r=.37;p<.0001). The scatterplot revealed values widely dispersed about the regression line, and the standard error of the estimate was 36.7. Conclusion: The data suggest that... the underlying premise of symmetry in chiropractic analysis needs to be reexamined.
STUDY AFTER STUDY AFTER STUDY...
Now consider what Kuslich notes:
Dr. Kuslich and the misaligned vertebra:
With regard to realigning vertebrae, Dr. Kuslich reports, “I can tell you what you’re not doing with Manipulation, (therefore other methodologies emphasizing the supposed realigning of vertebrae) “This is absolutely for sure.” “You are not correcting the alignment of the facet joints.” “Because if you do, these things will slip right back to where it was.” “These things do not get stuck out of place and you do not snap them back into place.” “Please don’t trust me on this one.” “Come into the operating room , you can look through the television screen, and we’ll have the patient move the back, or I’ll grab the spinous processes because they don’t hurt, we’ll move those facet joints for you.” “You will see the facet capsule bulge, you’ll see the balloon of the synovium move back and forth; there is just no way you can take a slippery little thing like that, which only moves about 3 mm anyway, and think that someone could bend it a certain way and have it stick...... (Kuslich, The McKenzie Institute, USA, Educational Update and Second General Membership Meeting, Minneapolis, MN, July 15, 1995).
Now consider a patient who is not under any sort of anesthesia and the movement is less likely to occur due to the function of muscles to restrain sudden and/or aberrant movements.
Anyone interested in reviewing Crelins Study? For 'only' those who subsribe to the misalignment theory, you might be aware of this study which required the breaking of spines in order to duplicate the chiro. misalignment version of the subluxation. The ACA only replied by comparing the difference with the 'Living Dynamic Being', which basically forced them to put their own foot in their mouth as in a Living Being Muscles function to restrain motion (Beals & Beckwith).
Beal and Beckwith: Muscles serve not only to activate motion, but anatagonistic groups also serve to restrain motion. (Paris, S. Foundations of Clinical Orhopaedics, Paris, S., Institute Press, Division of Patris Inc., St. Augusine, Fl p. 112-114).
Imagine studying how much pressure the interposed tissues would have to endure in order to compress a nerve root in the spine? Now consider Dr. April's, et al, study:
Findings of a study entitled “Discographic Outcomes Predicted by the Centralization of Pain and “Directional Preference”: A Prospective, Blinded Study, was presented at the Eighth Annual International Intradiscal Therapy Society Meeting, held March 15-19, 1995 in La Jolla (San Diego), California. Dr. Charles Aprill was the presenter. The study was performed by Charles April, M.D., New Orleans, Robert Medcalf, PT, Atlanta, GA and Ronald Donelson, M.D., William Grant, Ph.D., Kristine Incorvaia, M.S., State University of New York at Syracuse, NY.
The study demonstrated a definite reliability with regard to identification of symptomatic discs, disc containment status, and axial fissure pattern by the Dynamic Spinal Assessment (DSA) as described by McKenzie and the Dynamic Intervertebral Disc Model (DIDM), strongly supporting a cause/effect relationship between the DIDM and symptom response patterns of centralization and directional preference as identified during DSA. The McKenzie spinal assessment appears to be a dynamic, noninvasive, functional evaluation of symptomatic disc pathology. (Study information provided to me personally by Robert Medcalf, PT, Dip MDT; study also presented at the McKenzie Institute, USA, Educational Update and Second General Membership Meeting, Minneapolis, MN, July 15 and 16, 1995).
As Jacob, DC says, “Don’t put the pathoanatomical cart before the empirical horse.” “When you start off from a position of what may be or could be, you will always loose site as to what the patient is experiencing.” “Find how they respond to different strategies, explore their movements first.”
Two Canadian chiropractors who conducted an extensive literature search found no scientific evidence supporting the widely held belief that periodic spinal adjustments improve health status. They also concluded: (1) the term "preventive maintenance" has not been precisely defined, (2) appropriate ways to measure health status have not been determined, and (3) both of these steps would be essential before valid controlled studies could be performed. [Aker PD, Martel J. Maintenance Care. Topics in Clinical Chiropractic 3(4):3235, 1996.] (Web Site: [URL=http://www.ncahf.org/newslett/nl18-3.html#mediamisleads]http://www.ncahf.org/newslett/nl18-3.html#mediamisleads[/URL]
Heikki Vanharanta, MD et al performed a study “Are Lumbar Flexion Extension Films Useful in Identifying Discogenic Pain?” They note that instability, hypermobility and hypomobility of the spine are often thought to be associated with back pain due to degeneration of the lumber discs. However, this hasn’t been clearly established. The purpose of their study was to determine if motion, measured from flexion extension was related to disc degeneration and/or discogenic pain assessed by CT discography. They found no statistically significant differences in the mean motions with respect to generation of annular disruption. However, clinically pain provocation was the best predictor of annular disruption assessed by CT discography, with an accuracy of 70%.
[This message has been edited by Mitch (edited March 13, 2004).]
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Re: PT-DC CONFLICT - March 8, 2004 7:22:00 PM
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steve
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Am I the only one who finds doughnuts post offensive, aggressive and distasteful? You come on to a physical therapy site and spew about the inadequacies of our training and go on to state that we need supervision by DC's? I have no problem with chiros posting here, UTDC and Lou have both done so in a polite way that provokes thought and discussion but your post is the antithesis of these posters.
Steve
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Re: PT-DC CONFLICT - March 8, 2004 9:00:00 PM
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LouDC
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Researchdoc
yea its me.
You ask about my files. I am going to give you a NIGHTMARE.
I have 41 years of paper files all in loose leaf binders(eariest one 1937-WWII) I continually flip through thsee files to refresh my memory. I found that if I placed them in a cabinet I didn't review rhem periodicly. None of these articles are indexed so when I need to retrieve one its like trying to find your wife in a mall at Christmas. I currently indexing them and placing them on the computer, It will take me years to do this.
The trial on infantile colic is an RCT and a pretty good one to me. the others, as I mentioned, are just studies and not RCTs. I found the article on the net and read them I did not go to the journal itself. I can not locate so far a RCT on Otitis Media but I think it exist I just have to find it. There is currently an RCT on Otitis Media being set up by Palmer college.
Lou
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Re: PT-DC CONFLICT - March 9, 2004 1:40:00 AM
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Alex Brenner PT MPT OCS
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[QUOTE]Originally posted by Doughnut:
[B]
PT is manipulation
Chiropractic is adjusting
They are both very different from their roots and to say otherwise is a lie.[B][/QUOTE]
Doughnut,
Please forward this down to the lobbying chiros in Arkansas and convince them to stop suing PTs for manipulating spines.
ArmyPT, OCS
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Re: PT-DC CONFLICT - March 9, 2004 3:08:00 AM
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Dr.Wagner
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Instead of files of papers...go through and reread the papers with a VERY critical eye. Check out "Comparison of Review Articles Published in Peer-Reviewed and Throwaway Journals"
JAMA, Jun 2002; 287: 2853 - 2856.
To help guide you through your folders and decide what is craaap and what is worthwhile.
Or try "Users' Guides to the Medical Literature: XXIII. Qualitative Research in Health Care A. Are the Results of the Study Valid?"
JAMA, Jul 2000; 284: 357 - 362.
I really get annoyed when people quote articles that are so flawed in their conclusions, methods, and validity that it is purposeless. It comes down to "do you believe everything that you read". Critical eyes are extremely important.
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Re: PT-DC CONFLICT - March 9, 2004 5:10:00 AM
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mcap56
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Well no.....I don't find doughnut's post distasteful. I would have to take it seriously for that. His rantings are nonsense. I am afraid however, that many DCs think just like he/she does.
mcap
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Re: PT-DC CONFLICT - March 9, 2004 5:32:00 AM
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researchdoc
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Lou-
Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.
Is this your RCT for colic?
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Re: PT-DC CONFLICT - March 9, 2004 8:21:00 AM
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LouDC
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Researchdoc
Yes, thats the RCT.
Dr. Wagoner
As to research and publications Chiropractic has never had the infra- structure that has been available to MDs or DCs. We didn't have public funding and even our private resources were meager in comparison. Now we have come along way in the last 30 years financially and we are starting to have some nice research. RCTs are expensive and time consuming. It took 15 years for the Meade study to be completed. Its the best RTC existing that compares Chiropractic to Medical Management for Musculo/skeletal problems. Some posters have already discounted it as flawed. Everything that was mentioned in my somato-viscero reflex post is true as to their influence on internal organs and MDs,PTs, DOs including Greenman, all agree on this. What we lack is the RCTs, we have studies, papers,etc. but not RTCs. Hold on, we are going to get them.
Lou
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Re: PT-DC CONFLICT - March 9, 2004 8:59:00 AM
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researchdoc
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Lou- Sportelli, is it?
The RCT I found above for which you proclaim a basis for chiropractic treatment of colic has several flaws which should cause pause. I won't bore you with the details. (by the way, I found it on PubMed in less than two minutes time - something to consider for addressing your filing woes)
I will take a poke at this somato-visceral reflex issue, and perhaps elucidate what it is that bothers us non-chiropractors about your statements.
The fact that somato-visceral reflexes exist is not necessarily in question; rather the issue is to what extent does manipulation, particularly that provided by chiropractors, affect these reflexes. Of course, judging by your post, you already have the answer, and are just awaiting "research" to "prove" this. Which leads me to believe that you are entirely unprepared for any studies or evidence which contradict your position.
And of course we haven't even begun to explore the issue of whether or not assessment techniques employed by chiropractors to identify these so-called somato-visceral reflexes are adequate from a clinical standpoint.
Incidentally, the fact that you admit that sufficient research doesn't exist to support your beliefs, and yet seem to have no qualms about making claims of efficacy for same, is disturbing and causes suspicion on my part that no matter what the research eventually shows, you will continue to maintain your position - perhaps the contrary results were due to anti-chiropractic bias or some other retread excuse we hear so often from chiropractors. The point here is that to say "hold on, the studies are coming" is an irresponsible position for a health professional to take, especially in light of the fact that chiropractors generally reject any legitimate evidence which contradicts long-espoused claims anyway. The chiropractic profession's reputation precedes you in this regard.
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Re: PT-DC CONFLICT - March 9, 2004 9:01:00 PM
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LouDC
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From: Florence,Italy
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Researchdoc
I think PTs,MDS,DCs are all in the same boat according to a few studies I've seen about what percent of our respective practices is EBM.
Chiropractic Report V1n6pg3
Contrary to popular belief, the effectiveness of most health care treatments has never been established by clinical trial.
"The basis on which efficacy has been judged in the past in physiotherapy, and on which it is still mainly based today, is clinical experience and personal opinion".
April 1987 BJ Phsiotherapy-Cecily Partridge, PT,Ph.D
(End Article)
I was in charge of a Navy hospital PT department with 6 PTs, have worked in OT, and as a PT in small center. I have worked side by side wth PTs, MDs for 41 years. Does that above quote bother me-absolutey not. We would like to have the RCTs, there nice, but they are not indepensible. The important thing is that we get the job done effectively. From the field of Chiropractic I feel we are performing very well even though we don't have RCTs to prove it but we'll get them. We just need the AMA to make another mistake to pay for them (joke).
Lou
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Re: PT-DC CONFLICT - March 10, 2004 3:37:00 AM
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chiroortho
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Regarding EBM and whiplash-associated disorders, a subject near and dear to my heart, PTs AND DCs have a lot of research work to do. Here's what Nick Bogduk has to say about a letter from a PT in SPINE, regarding PT for WAD:
"Physiotherapists may have a faith in their polyvalent algorithms but I find no evidence that compels me to share that faith. The evidence indicates that reassuring instruction is as good as anything. If rehabilitation counseling is all that physiotherapy limits itself to I have no objection. What I cannot share is the faith that applying modalities, traction, and manual therapy in anything but acute cases is either scientifically valid or cost-beneficial.
Consensus protects physiotherapy for the time being but does not excuse it from the research priorities nominated by the Task Force, for if physiotherapy had been vindicated, why should the Task Force conclude what is the efficacy and cost-effectiveness of common therapeutic interventions for whiplash associated disorders?"
Nikolai Bogduk MD
Faculty of Medicine and Health Sciences; University of Newcastle; Newcastle, Australia
Spine: Volume 21(1) 1 January 1996 pp 150,151
------------------
ChiroOrtho
[This message has been edited by chiroortho (edited March 10, 2004).]
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Re: PT-DC CONFLICT - March 10, 2004 6:14:00 AM
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researchdoc
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Lou, I get the sense you are trying to change the subject. I could ask you for references to the studies that you cite regarding the evidence base of DCs as compared to other health professionals. But you probably can't find it in your files anyway, so I won't bother.
Your quote from a PT from 1987 and a cryptic reference to "The Chiropractic Report" aside, chiropractors are truly unique in the healthcare industry in regards to their perspective on, and use of, research and evidence based practices. Not only do they generally reject contrary evidence, but they also are uniformly convinced that future studies will simply confirm their beliefs about their practices; so much so that the profession as a whole doesn't even flinch when chiropractors make claims of efficacy for some disease or other without support for same- surely future research will demonstrate that it is true, if only we had the funding.
You are a prime example of this tendency. Fallcious logic underpins chiropractic practice; science is a gimmick, and research is a marketing ploy. And yet strangely, chiropractors wonder why they are looked upon with suspicion by mainstream medical professionals.
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