CJA Vol.34 Issue 2Guest Editorial: Where Will Limited Medicare Take Chiropractic -
p41 Diagnosis of Chest Pain in the Chiropractic Practice
Setting: An Evidence-Based Review - p42 The Placebo, the Sensory Trick and Chiropractic -
p58 Expectations: A Potent Trigger to Non-Specific
Intervention in Chiropractic Practice - p63 A Preliminary study of Sacral Base Obliquity
Measured on Erect Radiographs Taken in a Clinical Setting -
p68 Letters to the Editors - p76 Corrigenda- p77 ABSTRACTS Diagnosis of Chest Pain in the Chiropractic Practice Setting: An Evidence-Based Review MONICA SMITH, KEITH WELLS and MATTHEW ELLERBROOK Objective: To qualitatively review the health literature regarding chest pain, particularly to what extent and how neuromusculoskeletal (NMS) chest pain is discussed concerning prevalence based on clinical settings, as well as evidence-based diagnostic protocols and management. Method: Literature search of MEDLINE, CINAHL, MANTIS and Index to Chiropractic Literature databases using a variety of search terms. Three hundred fifty citations were captured with a final yield of 108 journal articles and 4 book chapters for this study. Results: The prevalence of chest pain and types of diagnoses varies with the clinical setting. NMS chest pain prevalence might be as high as 50% in ambulatory care settings. The prevalence in emergency settings is much lower, and the diagnoses rendered vary greatly. The importance of NMS aetiologies for chest pain appears under-appreciated in the literature. Conclusion: Chest pain is a prevalent complaint in primary and portal-of-entry health provider offices, ambulatory care facilities, and urgent/emergent care facilities. The resulting diagnoses appear to be categorised mainly into cardiac, gastroesophageal, and psychiatric problems Attention to (NMS) diagnoses seems limited, although a small number of studies indicate NMS chest pain may be more prevalent in private office settings than previously realised. In addition, it is unknown to what degree chiropractors encounter chest pain as a primary or concurrent complaint. Chiropractors may provide a diagnosis and care for patients that have previously been overlooked. They may also make a substantial contribution to building much needed scientific and clinical evidence in the diagnosis and care of NMS chest pain. INDEX TERMS: (MeSH): ALGORITHMS; ANGINA PECTORIS; CHEST PAIN; DIAGNOSIS, DIFFERENTIAL; GUIDELINES; MUSCULOSKELETAL DISEASE; MYOCARDIAL INFARCTION; NEURITIS, INTERCOSTAL. (Other): CHEST WALL SYNDROME; NONCARDIAC CHEST PAIN; PATHWAYS; PROTOCOLS; STANDARDS. Chiropr J Aust 2004; 34: 42-57 The Placebo, the Sensory Trick and Chiropractic BRIAN S. BUDGELL Background: As standards for randomised, controlled, clinical trials in medicine evolve, there is debate about whether the RCT model of investigation is appropriate for chiropractic and other forms of so-called "complementary and alternative medicine." There may be some question as to whether the use of placebo interventions can be justified ethically and scientifically given that experimental treatments must eventually compete in a marketplace where there is often already a clinical alternative which is more effective than placebo. Beyond these concerns, design of an appropriate placebo for chiropractic trials is particularly problematic since the therapeutic component of overall chiropractic treatment may be difficult to isolate. Objective: To compare placebo interventions in current use in chiropractic clinical research with simple somatic stimuli that produce significant physiological effects in a selected group of patients (those suffering from dystonia). Methods: A literature search was made using MEDLINE, with the key words dystonia, sensory trick and geste antagoniste. Articles were reviewed for descriptions of these stimuli. The stimuli were compared, in terms of site and modality, with placebo interventions used in recent chiropractic clinical trials. Results: Stimuli used as placebo procedures in recent chiropractic clinical trials are quite similar, in terms of site and modality, to the "sensory tricks" that either cause substantial temporary relief, or, alternatively, provocation of symptoms in dystonic patients. Conclusions: Caution should be used in assuming that control (placebo) procedures used in chiropractic clinical trials-procedures that involve physical contact or positioning of patients-lack specific effects on neuromusculoskeletal symptomatology. INDEX TERMS: MeSH) CHIROPRACTIC; PLACEBO EFFECT. (Other): GESTE ANTAGONISTE; SENSORY TRICK. Chiropr J Aust 2004; 34: 58-62. Expectations: A Potent Trigger to Non-Specific Intervention in Chiropractic Practice JENNIFER R. JAMISON Expectations are believed to influence clinical outcomes. This study investigates the outcome expectations of chiropractors and chiropractic patients with respect to various non-musculoskeletal conditions and explains how expectation can influence patient care. Research Method: Practitioner opinion was sought by e-mail. E-mails were sent until 50 randomly selected and 50 purposively selected chiropractors had received an e-mail. Convenience sampling of patients was undertaken. Both groups were asked to indicate how effectively they anticipated chiropractic care would be in the management of a number of non-musculoskeletal problems. Results: Two hundred and four (204) patients and 15 chiropractors participated. Although outcome expectations differed somewhat depending on the condition, the tendency amongst those who provided feedback was to expect chiropractic care to provide good or moderate benefit. Except for diabetes, where chiropractic benefit was regarded with less optimism, less than 10% of the sample anticipated no or a poor response of any listed conditions to chiropractic care. Discussion: There is increasing scientific evidence confirming that expectations are important non-specific triggers influencing clinical outcomes. Research has shown that verbally induced expectations of pain relief can reduce the amount of analgesia requested, alter the anatomical area in which relief is experienced and modify various psychological and physiological parameters. As expectations are determined more by perception than reality, placebo-induced analgesia has the potential to contribute to the outcome of every chiropractic clinical encounter. Conclusion: The contribution of the placebo response to chiropractic care should ideally be maximized in every clinical encounter and acknowledged in chiropractic education. INDEX TERMS: (MeSH): PLACEBO EFFECT. (Other): EXPECTATIONS. Chiropr J Aust 2004; 34: 63-7. JOHN DULHUNTY Objective: The object of the study is to quantify the incidence and magnitude of structural asymmetry of the sacral base, involving absolute and relative sacral obliquity, measured on erect spinal radiographs taken in a clinical setting. Methods: Retrospective analysis of specifically taken erect A-P radiographs of 85 randomly selected patients attending a regional multi-practitioner chiropractic centre. The 3 variables measured were: absolute femur-head angle (AFHA), absolute sacral-base angle (ASBA), and absolute iliac-crest angle (AICA). From this data the relative positional relationships of these structures were calculated as x-axis rotations. Results: The subjects ranged from 9 to 80 years of age with an average age of 38.9 years (SD 15.2 years). There were 43 males and 42 females in the study. The data indicates that the clinician would expect to find patients have a sacral obliquity of about 3o, a leg length inequality of 1.7o and an inequality of the iliac crests of about 2o. Conclusion: The data suggests sacral obliquity is of significance in defining "normal" alignment of the lumbo-pelvic spine and has implications for the clinician in defining functional parameters and structural integrity for each individual. INDEX TERMS: (MeSH): BIOMECHANICS; CHIROPRACTIC; RADIOGRAPHY; PELVIS; SACRUM. (Other): PELVIC ASYMMETRY; SACRAL OBLIQUITY. Chiropr J Aust 2004; 34: 68-75. |
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