|
|
Re: Looking like a fool on chiro open forum
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: Looking like a fool on chiro open forum - March 2, 2006 8:10:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
I believe that Josh Cleland has some study underway where patients in the study will be probably randomized into 1 of 3 particular treatment options. 1) the manipulative technique Childs used or 2) a different manipulative technique or 3) a mobilization technique. The patients will also receive a home exercise program and will also perform activities in the clinic. The only difference between the treatments appeared to be the type of manual therapy provided by the therapist. I don't know when data collection begins, the tentative termination date or when a paper will be completed. So Greg, a paper like that will address the issues of the manual component in the treatment of that particular defined patient group.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 2, 2006 9:05:00 AM
|
|
|
Jeffre
Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
Status: offline
|
Yes, it's the on referenced above. It is also a free full-text article online.
_____________________________
"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 2, 2006 12:31:00 PM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
Jeep,
The article was referenced by Bill Bossinoult in "Articulations," an AAOMPT publication. I am not surprised to find that the AMA and VHA recognize manipulation as part of (D)PT practice, but I was surprised to see the profession of chiropractic admit this:
A section reads:
In 2004 the Veterans Health Administration (VHA) recognized physical therapists as a provider of manual therapy services including spinal mobilization/manipulation within the VHA. In 1999 Dr. Tom Gustafson, Director of Center for Health Plans and Providers, Department of Health and Human Services stated that physical therapists provide services including manipulative treatment of the spine and other areas for Medicare recipients. In 1998 a code to be used by physical therapists reading; “manual therapy techniques (mobilization/ manipulation, lymphatic drainage, manual traction” was approved by the American Medical Association’s Common Procedural Terminology (CPT) code panel. In 1999 the Virginia Board of Medicine Department of Health Professions was charged to study spinal manipulation and the risk of harm to the public. After intense data gathering, the task force concluded that no limitations regarding the use of manipulation be placed on physical therapists.
The RAND meta-analysis and AHCPR guidelines, frequently cited by “doc” and a handful of other ChiroWeb chiropractors as justification as to why chiropractors alone should be the sole providers of manipulation, is actually a justification of why physical therapists, not chiropractors, should be the primary provider of manipulative services (not that I suggest that DC’s should be barred from providing manipulation). Dr. Bossinault, PT, DHSc writes, "Of the 27 research papers cited in these two landmark
reports, the manipulative services were provided by physical therapists in 12 of the studies compared to only 4 for chiropractors."
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 2, 2006 1:10:00 PM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
Drew-
That still does not address my original inquiry. Perhaps you can provide the original requested links, before changing topics. Thank-you.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 2, 2006 1:28:00 PM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Jeep,
Its interesting that you refer to the manipulation as primitive and rudimentary. I would agree that it is non specific as you state but would suggest that the literature indicates that all manipulation is non specific and has a multisegmental neuro modulation effect. McGill has studied the accuracy of lumbar spine manipulation directed at a specific level and found that the intended level was only manipulated 47% of the time. Herzog has demonstrated changes in muscle tone on a more global scale immediately following manipulation.
There is also significant research to indicate that our palpatory findings have low accuracy and that they likely only contribute a small piece of the clinical picture.
If a technique is successful in 92% of individuals with recognizable clinical traits I would suggest that it is as advanced as anything we have in the field of manual therapy.
Steve
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 2, 2006 1:53:00 PM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
Links not available unless you're an AAOMPT member.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 2:42:00 AM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
Drew-
You make claims:
[QUOTE]It may be informative to know that of the 25 articles in the RAND and AHCR studies on manipulation, 19 were manipulations done by PT's, 4 were manipulations done by chiropractors [/QUOTE]I want to verify those claims, and look at the content and relevance of said claims. Can you please provide per my request?
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 3:12:00 AM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
Steve-
[QUOTE]Its interesting that you refer to the manipulation as primitive and rudimentary. [/QUOTE]SOME manipulation manuevers are "primitative and rudimentary". There are many different manipulation techniques and methods, some, more "primitive and rudimentary" (ie. non-specific, being one aspect), than others. So while the "chicago" was used in this study, it cannot be considered "manipulation at large". Other manipulative procedures may have yielded different results.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 4:44:00 AM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Jeep,
Agreed that there are many different types of manipulation and they may have different results but we really have no idea what those results will be. My point was that research is indicating all manipulation is non specific in that we can not manipulate one specific spinal segment with confidence and are unable to identify a dysfunctional specific segment with any kind of confidence despite many clinicians beliefs to the contrary. If this is so, I'm not sure how one technique can be considered crude and rudimentary.
Steve
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 6:37:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Good posts Steve and I agree with you.
[QUOTE]...Other manipulative procedures may have yielded different results. [/QUOTE]This is currently being researched and is under scrutiny. I predict that we will find out that a specific technique will be no better than a shotgun or "rudimentary" technique. I also find it interesting that this type of research is being done primarily by PTs.
[QUOTE]i think the part you are missing SJ is that knowing when to manipulate and when not to manipulate is what takes knowledge and skill.[/QUOTE]Ben, how hard is it to look for the 5 clinical predictors in your patients with low back pain? Not very. Students on their first clinical rotations are coming to our clinics are making easy decisions and are manipulating with great success. You still seem to hold on to the idea that manipulation is held in this ivory tower for only the "experts".
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 7:47:00 AM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Alex,
The inside word is that initial data between chicago, "specific manip" and mobilization all yield similar results. One further comment is that these studies on the CPR are setting a very high standard for clinical research and hopefully this trend will continue.
Steve
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 8:56:00 AM
|
|
|
truthseeker
Posts: 148
Joined: June 23, 2005
Status: offline
|
BTW Doc has posted a post mortem on poor Mr. Glascow. Doc informs the readers and posters on chiroweb that Mr. Glascow will no longer be posting here. Either they are friends or perhaps share the same clothes.
Did Glascow ever say he wasn't posting here? or is Doc a bit psychic?
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 11:44:00 AM
|
|
|
FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
Status: offline
|
I am crying myself to sleep now
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 3, 2006 12:56:00 PM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
Jeep,
Are you asking for the bibliography of the studies included in the RAND and AHCPR Meta Analysis? If that's the case, the reference is the RAND and AHCPR reports themselves. Otherwise, I'm not sure what you mean by "reference."
You can buy a copy of the study from RAND at the following web address for $4.00:
http://www.rand.org/pubs/reprints/RP485/
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 5, 2006 1:53:00 AM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
[QUOTE]It may be informative to know that of the 25 articles in the RAND and AHCR studies on manipulation, 19 were manipulations done by PT's, 4 were manipulations done by chiropractors [/QUOTE]Drew-
You make the above claim. I am asking you, and have been asking you, for documentation of that claim. You have been dodging my request. Please provide your source, that I can resource, to back up your claim. You can certainly provide this.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 5, 2006 3:39:00 AM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
Jeep,
Not dodging at all, but there are some things that one simply can't do for another person. Forget what the ACA has been telling you and simply READ the RAND study. You're asking for me to reprint copyrighted information without permission of RAND or AAOMPT, either that or pay for your information requests. I'm simply not going to do that --- but I have, and will continue, to point you in the direction of obtaining the information you're looking for.
Use the links provided above, follow-up by reading the studies included in the Meta-Analysis. A commentary on the subject is written by Bill Boissinault, PT, DHSc in the latest volume of ARTICULATIONS, which, if you're a member, can be accessed on the AAOMPT website.
I'd be happy to provide you with his e-mail address if you'd like to ask him for a reprint of his commentary.
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 5, 2006 4:48:00 AM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
Drew-
Excerpts of articles are accepted. You can certainly post the documentation for your claim. I am not asking you to copy/paste the entire article. If there are links to support your claim-----Post them.
PS- What does the ACA say about this article? Please provide a link. What is the link to the original article that is the basis of your claim?
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 5, 2006 5:39:00 AM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
Jeep,
My apologies. I made the assumption of professional respect that as a doctor of sorts, be it DC or DPT, that the ability to complete your own evidence-based MEDLINE or Google Scholar search would be a basic skill. I'd be happy to help next time, however, if you'd simply ask to be taught and not demand to be "spoon-fed" the information.
The original RAND article was:
Spinal manipulation for low-back pain. Shekelle PG, et al. Ann Intern Med. 1992 Oct 1;117(7):590-8.
PURPOSE: To review the use, complications, and efficacy of spinal manipulation as a treatment for low-back pain. DATA IDENTIFICATION: Articles were identified through a MEDLINE search, review of articles' bibliographies, and advice from expert orthopedists and chiropractors. STUDY SELECTION: All studies reporting use and complications of spinal manipulation and all controlled trials of the efficacy of spinal manipulation were analyzed. Fifty-eight articles, including 25 controlled trials, were retrieved. DATA ANALYSIS: Data on the use and complications of spinal manipulation were summarized. Controlled trials of efficacy were critically appraised for study quality. Data from nine studies were combined using the confidence profile method of meta-analysis to estimate the effect of spinal manipulation on patients' pain and functional outcomes. RESULTS OF DATA SYNTHESIS: Chiropractors provide most of the manipulative therapy used in the United States for patients with low-back pain. Serious complications of lumbar manipulation, including paraplegia and death, have been reported. Although the occurrence rate of these complications is unknown, it is probably low. For patients with uncomplicated, acute low-back pain, the difference in probability of recovery at 3 weeks favoring treatment with spinal manipulation is 0.17 (for example, increase in recovery from 50% to 67%; 95% probability limits of estimate, 0.07 to 0.28). For patients with low-back pain and sciatic nerve irritation, the difference in probabilities of recovery at 4 weeks is 0.098 (probability limits, -0.016 to 0.209). CONCLUSIONS: Spinal manipulation is of short-term benefit in some patients, particularly those with uncomplicated, acute low-back pain. Data are insufficient concerning the efficacy of spinal manipulation for chronic low-back pain.
In 1993 Dr. Paul Shekelle, wrote an article addressing his concerns about chiropractic misrepresentation of his study. In an issue for the ACA Journal of Chiropractic he stated:
"...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor . . . RAND's studies were about spinal manipulation, not chiropractic, and dealt with appropriateness, which is a measure of net benefit and harms. Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."
What you'll have to do, Jeep, is actually read the specfic article, look in the reference section for the 25 articles that were clinical trials, and read them. At that point you'll realize that 19 of the studies are manipulation done by PT's. (I would suggest, however, that you start in reverse. Check out the following study, cross-reference the works cited, and you'll have a clear piture as to which studies examined manipulation conducted by DC's, and which did not.)
While we're on the subject, what DC's also don't generally mention is an editorial in the British Medical Journal noted in July, 1998 (E. Ernst, et al. Chiropractic for low back pain: we don't know whether it does more good than harm), nor the meta-analysis referenced, stating that that there are no less than 51 reviews of spinal manipulation for back pain. Few are on chiropractic, and those that are (only 8 RCT's)were methodologically flawed and of those 8, it was concluded that they, "did not provide convincing evidence for the effectiveness of chiropractic for acute or chronic [low-back pain]." (Assendelft WJJ, Koes BW, van der Heijden GJMG, Bouter LM. The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling. J Manipulative Physiol Ther 1996;19:499-507.)
In fact, in a century, the profession of chiropractic has been unable to provide convincing evidence that chiropractic manipulation is even effective for uncomplicated, low-back pain, the mainstay of its practitioners. By contrast, the majority of the quality evidence base with respect to the clinical value of manual therapy and manipulation, as well as clinical predition rules, has been and continues to be, supplied not by chiropractors, but by physical therapist researchers.
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 5, 2006 6:04:00 AM
|
|
|
Jeep
Posts: 353
Joined: March 28, 2003
From: USA
Status: offline
|
[QUOTE]What you'll have to do, Jeep, is actually read the article, look in the reference section for the 25 articles that were clinical trials, and read them. At that point you'll realize that 19 of the studies are manipulation done by PT's. [/QUOTE]Drew-
Should I interpret this as: you cannot supply/document the source of your claim?
Should I also interpret the rest of your post as a means of trying to obfuscate my one and only request?
I think that your reluctance or inability to provide data to support your claim is revealing. I asked only one(1) very specific question. You have been unwilling or unable to answer my question. Until you can do so-----I will, and everybody else should, consider it unverified.
|
|
|
|
|
Re: Looking like a fool on chiro open forum - March 5, 2006 6:15:00 AM
|
|
|
Andrew M. Ball PT PhD
Posts: 855
Joined: July 28, 2002
From: Charlotte, NC
Status: offline
|
No. You should interpret it as inappropriate and unprofessional to ask another professional to spoon-feed you information to the point that you have no responsiblity whatsoever for obtaining the information yourself. You should interpret me as gracious for providing you with the specific references that I have. It is referenced and peer-reviewed information, but you should realize that the reponsiblity of actually reading and processing the information rests with the individual asking the question. You're asking for more than to document, which I've done. You're asking to not have to actually go to the medical school library and copy the articles, and you're asking for me to provide you with it telepathically. Now how is that possible?
I have provided you clearly referenced, and verifiable information one from Annals of Internal Medicine, and the other from British Medical Journal.
What else would you have me do, list the references of each study? Come on!
Drew
_____________________________
Dr. Andrew M. Ball, PT, DPT, Ph.D.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.109
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Re: Looking like a fool on chiro open forum 
