CJA Vol.30 Issue 3Editorial: Making the Vital Connection Transient Syncope in Chiropractic Practice: A Case
Series Case Study: Response of Arrhythmia to Spinal
Manipulation: Monitoring by ECG with Analysis of Heart-Rate
Variability Health Promotion: Exploring the Behaviour of
Chiropractic Patients Oregon Board of Chiropractic Examiners
Guidelines ABSTRACTS Transient Syncope in Chiropractic Practice'. A Case Series PHILLIP EBRALL and W. BRUCE ELLIS Objective: To present and comment critically on a series of six case reports where patients experienced transient syncope during the course of chiropractic assessment and/or treatment. Clinical Features. Syncope is a clinical complex in which the patient may experience a range of transient signs and symptoms including facial erythema, Iight-headedness, nausea, diaphoretic, pallor, loss of ability to respond to verbal commands, and perhaps loss of consciousness. The occurrence of syncope can be frightening to both the patient and the practitioner. Setting: One private practice of chiropractic in Victoria, Australia. The practitioner has over 15 years of practice experience and has maintained competency through continuous clinical practice and continuing education since graduation. Methodology: Purposive selection of patient files from within a defined time period, each file including at least one recorded episode of transient syncope; Intervention and Outcome:hfq patients received a level of assessment and evaluation befitting the responsibility of chiropractors registered in the state of Victoria, Australia, as primary contact, primary health care providers. The intervention in all cases was traditional chiropractic practice, including physical examination, directed orthopaedic and neurotoxic testing, documentation of findings and outcomes, and intervention in the traditional chiropractic manner of manual spinal adjustment and soft tissue technique. Conclusion: It appears that transient syncope is an event likely to be observed by practitioners of therapeutic intervention to the cervical spine. Given the pre-eminent role of chiropractors in this field and the current questioning of the value of predictive tests, one would reasonably expect the various professional bodies and funding agencies to place further formal investigation of transient syncope and related clinical events high on the chiropractic research agenda. INDEX TERMS: MeSH: SYNCOPE; CHIROPRACTIC ; CEREBRAL ISCHEMIA, TRANSIENT; MANIPULATION, ORTHOPEDIC; VERTEBRAL ARTERY; VERTEBROBASILAR INSUFFICIENCY; AUSTRALIA. OTHER: ISCHEMIC ATTACK, TRANSIENT. Chiropr J Aust 2000; 30: 82-91. YOSHIKI IGARASHII and BRIAN S. BUDGELL Objective.. To discuss a case of arrhythmia which improved coincident with a course of spinal manipulative therapy and to discuss the role of ECG and analysis of heart rate variability in monitoring the patient response. Clinical Features: A 22-year-old male with a history of fatigability and a medical diagnosis of arrhythmia underwent a course of spinal manipulative therapy. Intervention and Outcome:-The patient received a course of spinal manipulation to the upper cervical and upper thoracic regions. No adjunctive therapies were employed. During the course of treatment, his symptoms improved, and there were changes in ECG and heart rate variability. Conclusion: Spinal manipulative therapy may be a useful modality in some instances of arrhythmia and may exert its effects through modification of the activity of the autonomic nervous system. INDEX TERMS: MeSH: ARRHYTHMIA; CHIROPRACTIC; MANIPULATION, ORTHOPEDIC; ELECTROCARDIOGRAPHY; HEART RATE; AUTONOMIC NERVOUS SYSTEM, Chiropr J Aust 2000; 30: 92-5. Health Promotion: Exploring the Behaviour of Chiropractic Patients JENNIFER R. JAMISON ABSTRACT: It has been suggested that clinicians should be looking at new ways to enhance their patients' self-care. Patient education is one strategy which primary providers may use. This study investigates the behaviour of chiropractic patients with a view to identifying the health information messages most needed in the chiropractic clinic. Research Methodsq An exploratory study of chiropractic patients was undertaken to investigate patients' health-relevant behaviours. Purposive sampling of nine Australian chiropractic clinics was undertaken. Convenience sampling of patients attending these clinics resulted in 102 patients participating. Participants completed a questionnaire. Data was collected and collated with a view to describing the participants' dietary, exercise, medication and risk-screening behaviours. J?es/.z/l,i.r-l-he majority of patients in this study were non-smokers, did not abuse alcohol, exercised regularly, had a diverse diet: made sensible dietary choices and did not over-medicate. Most also had been screened for predictors of cardiovascular disease. The majority of females had been screened for the early detection of cervical and breast cancer. Conclusions:-The behaviour of participants in this study suggests that many chiropractic patients are aware of and behave in a manner consistent with well established health promotion messages. As a group, chiropractic attests may nonetheless benefit from their chiropractor's evaluation of topical health information. Health information messages should, however, always be tailored to the needs of the individual. INDEX TERMS: MeSH: CHIROPRACTIC; HEALTH PROMOTION; PATIENT EDUCATION; OBESITY OTHER: PATIENT BEHAVIOR. Chiropr J Aust 2000; 30: 96-101. Oregon Board of Chiropractic Examiners Guidelines MERIDEL I. GATTERMAN A three-tiered process to revise the current Oregon Practice and Utilization Guidelines is described. The focus of this process is patient-centred and evidence-based. The new guidelines will make recommendations to guide patients and practitioners in making appropriate health care decisions. Where strong evidence exists tankards of quality that address minimum competency will also be included. While guidelines are designed to be flexible and non-binding educational tools, standards of quality provide administrative tools on which to base peer review criteria. The strength of this process is that it is profession-înitîated with broad representation and it differentiates guidelines from standards of quality. INDEX TERMS: MeSH: CHIROPRACTIC, STANDARDS; EVIDENCE-BASED MEDICINE; GUIDELINES; PATIENT-CENTERED CARE; OREGON; QUALIRASSURANCE, HEALTH CARE. Chiropr J Aust 2000; 30: 102-108. |
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