CJA Vol.31 Issue 2Editorial: Competence, Context and Choice Chiropractic Treatment of Fibromyalgia: Two Case
Studies Maintenance Care: An Australian Case
Study/b> The Multidisciplinary Specialised Spinal Pain Unit
at Townsville General Hospital A Survey of Sets of Principles of
Chiropractic History Corner: Chiropractic and Medicine in Mid-Twentieth Century Germany Report: Eleventh Annual Meeting of the Chiropractic Research Journal Editors’ Council ABSTRACTS Chiropractic Treatment of Fibromyalgia: Two Case Studies PAUL WISE and MAXWELL J. WALSH Objective: To present and discuss two cases of fibromyalgia and their response to chiropractic therapy. Clinical Features: Two female patients presented with widespread bilateral pain of over three months duration with no demonstrable related pathology or neurological abnormalities. The history and examination of tender points revealed that they satisfied the diagnostic criteria for fibromyalgia. Intervention and Outcome: Both cases were monitored for fibromyalgia syndrome (FMS) symptom levels: Tender Point Count (TPC), Total Myalgic Score (TMS) and Visual Analogue Scale (VAS) scores for pain, fatigue, anxiety, stiffness, tiredness, depression and sleep. Other outcome measures were assessed as part of the Fibromyalgia Impact Questionnaire (FIQ) and the Clinical Health Assessment Questionnaire (CLINHAQ) survey. Monitoring was done at baseline and after five weeks and ten weeks of treatment. Treatment consisted of spinal manipulative therapy, soft tissue therapy, and lifestyle and ergonomic advice where indicated. Spinal manipulative therapy consisted of standard high-velocity, low-amplitude chiropractic adjustments to areas of joint dysfunction. The soft tissue therapy consisted of deep tissue massage to the paraspinal muscles. Conclusions: The cases studied indicate that patients with fibromyalgia syndrome may benefit from chiropractic therapy consisting of spinal manipulation, soft tissue therapy and adjunctive advice. For these cases, optimal improvement was achieved after approximately 12 treatments over five weeks, and beyond that, further improvement is only marginal at best. INDEX TERMS: (MeSH) CHIROPRACTIC; FIBROMYALGIA; MANIPULATION, ORTHOPEDIC. Chiropr J Aust 2001;31:42-6. Maintenance Care: An Australian Case Study JENNIFER R. JAMISON This study provides an Australian perspective of maintenance care. Method: A survey of members of the Chiropractic Association of Australia was undertaken. Of the 400 randomly selected chiropractors, 138 responded to he mailed questionnaire. Data from closed questions were correlated, and thematic analysis of pen questions was undertaken. Results: Maintenance care is perceived as a practice for promoting optimal health. Although some respondents believed this could be achieved by spinal adjustment alone, many also advocated lifestyle education. Maintenance care is believed to benefit all age groups and should be continued for life. Treatment schedules should be tailored to patient needs, but frequency varies from weekly to annually. Most effective for musculoskeletal health, maintenance care is also believed to benefit various visceral disorders. Indications for maintenance care ranged from “being alive” to “condition recurrences.” Criteria for evaluating the success of maintenance care varied from “keeping optimal health” (no definition provided) to remaining asymptomatic. Two in three respondents felt that maintenance care should be supported by health funds, and one in three agreed that maintenance care if frequently overused for financial gain. Conclusion: Maintenance care is an integral part of chiropractic practice. Its benefits are not perceived to be limited to musculoskeletal health. The frequency and type of clinical intervention used to achieve a wellness outcome varies between chiropractors. The criteria for advocating maintenance care and identifying a successful outcome require clarification if this practice is to be acknowledged in conventional health care circles. INDEX TERMS: (MeSH) CHIROPRACTIC. (OTHER) MAINTENANCE CARE. Chiropr J Aust 2001;31:47-52. The Multidisciplinary Specialised Spinal Pain Unit at Townsville General Hospital LYNTON G.F. GILES Objective: The main objective of this prospective study is to document the number of new patients seen to date, their radiological findings, the treatment modalities used and whether any significant complications were reported by patients during treatment or at follow-up. Design and Setting: Patients could be referred or self-referred to the Spinal Pain Unit at Townsville General Hospital. Interventions: Patient management consists of chiropractic manipulative therapy, excluding rotational manipulation of the cervical spine; needle acupuncture treatment and medical treatment. Results: One thousand four hundred and sixty five patients (783 males : 682 females) presented to the Spinal Pain Unit. Medical referral accounted for 49% of patients, chiropractic for 3%, osteopathic for 2%, physiotherapy for 0.4%, podiatry for 0.4% and psychology for 0.2%. The remaining 45% were self-referred or referred for medicolegal consultation and examination. Ninety-eight percent (98%) of patients presented with chronic pain(>13 weeks duration) and only 2% with acute pain (<7 days). Following extensive investigations, 1,229 (83.9%) patients presented with identifiable pathology or osseous or soft tissue anomalies. One hundred and seventy-five patients (12%) were referred for further opinions. There was only one significant complication out of 1,465 patients treated, representing only 0.068% of patients, and 0.007% of the total of 14,187 examinations and treatments administered. Conclusion: The results show that a hospital-based specialised spinal pain syndrome unit is useful for medical practitioners who wish to refer spinal pain syndrome patients for specialised examination and management. In addition, concerns regarding the safety of chiropractic treatment are unfounded.</p /> INDEX TERMS: (MESH): BACK PAIN; CLINICAL TRIALS; ACUPUNCTURE; CHIROPRACTIC; MEDICINE; ADVERSE EFFECTS; PAIN CLINICS. (0THER): MULTIDISCIPLINARY STUDY. Chiropr J Aust 2001;31:53-7. A Survey of Sets of Principles of Chiropractic PHILLIP EBRALL The author conducted a hand search of the RMIT University general collection, its Historical Chiropractic collection, and the author’s own collection, to purposefully select texts reporting or discussing principles of chiropractic. A search of the Index to Chiropractic Literature was also conducted to extract articles which contained evidence-based comment relevant to the principles of chiropractic. Early copies of the Journal of the Australian Chiropractors’ Association were also hand-searched. A contemporary context was found from a critical review of the Conference on Philosophy in Chiropractic Education sponsored by the World Federation of Chiropractic (WFC) and held in Florida in November 2000. This review is published elsewhere (Ebrall PS. Philosophy in chiropractic education—the importance of globalisation as opposed to Americanisation [guest editorial]. Chiropr J Aust 2001;31:1-7). Review of the selected literature in the contemporary context allowed the synthesis of the theme of consistency over time and congruence with the founding premise, providing a framework into which the published understandings of chiropractic principles could be placed. This survey documents the major contributions to the development of understanding of the principles of chiropractic and leads to the synthesis of three contemporary principles of chiropractic which encapsulates the historical principles and related critical comment in the literature base of the chiropractic profession. INDEX TERMS: (MeSH) CHIROPRACTIC; VITALISM; HUMANISM. (0THER) CHIROPRACTIC PRINCIPLES; CHIROPRACTIC PHILOSOPHY; HOLISM; NATURALISM; CONSERVATISM; RATIONLISM. Chiropr J Aust 2001;31:58-69. |
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