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Posts from the ‘Education and Research’ Category


Comparison of Treatment Outcomes in Nonspecific Low-Back Pain Patients With and Without Modic Changes Who Receive Chiropractic Treatment.

Annen Michèle M, Peterson Cynthia C, Humphreys B Kim BK

PubMedClinical StudyReal-world Evidence




Published:2018 09

Created at:

Last revised:2019-11-13

Source:Journal of manipulative and physiological therapeutics (J Manipulative Physiol Ther), volume 41, issue 7, 2018, ISSN: 1532-6586

Publication Country:United States

Publication Type:Journal Article, Research Support, Non-U.S. Gov’t

Keywords:Chiropractic, Diagnostic Imaging, Manipulation, Spinal, Outcome Assessment (Health Care)

MeSH Terms:Adolescent; Adult; Aged; Aged, 80 and over; Disability Evaluation; Female; Humans; Low Back Pain (therapy); Lumbar Vertebrae (diagnostic imaging); Magnetic Resonance Imaging; Male; Manipulation, Spinal; Middle Aged; Pain Measurement; Prospective Studies; Young Adult


OBJECTIVE: The aim of this study was to determine if there was a difference in outcomes in patients with nonspecific low back pain, both with and without Modic changes (MCs), who received chiropractic care.

METHODS: This prospective outcomes study included 112 patients with low back pain without disc herniation on magnetic resonance imaging. All patients were treated with spinal manipulative therapy. At baseline, the numerical rating scale (NRS) and Bournemouth Questionnaire (BQ) for disability were collected. The NRS, BQ, and Patient‘s Global Impression of Change (primary outcome) were collected at the follow-up time points of 1 week, 1 month, and 3 months to assess overall improvement. Magnetic resonance imaging scans were analyzed for the presence of MCs and, if present, classified as Modic I or II. The χ2 test was used to compare the proportion of patients reporting clinically relevantimprovement” between patients with and without MCs and between Modic I and Modic II patients. The unpaired Student t test was used to compare NRS and BQ at baseline and change scores at all follow-up time points.

RESULTS: For the primary outcome measure, the proportion of patients reporting relevantimprovement” (Patient‘s Global Impression of Change), and for the secondary outcome measures (NRS and BQ change scores), there were no significant differences between Modic positive and Modic negative patients or between Modic I and Modic II patients.

CONCLUSION: Neither the presence nor absence of MCs nor the Modic change category were related to treatment outcomes for patients with low back pain without disc herniation who received chiropractic care.

Copyright © 2018. Published by Elsevier Inc.





Health care utilization and costs associated with adherence to clinical practice guidelines for early magnetic resonance imaging among workers with acute occupational low back pain.

Graves Janessa M JM, Fulton-Kehoe Deborah D, Jarvik Jeffrey G JG, Franklin Gary M GM

PubMedClinical StudyReal-world Evidence




Published:2014 Apr

Created at:

Last revised:2017-02-20

Source:Health services research (Health Serv Res), volume 49, issue 2, 2014, ISSN: 1475-6773

Publication Country:United States

Publication Type:Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov’t, Research Support, U.S. Gov’t, P.H.S.

Keywords:Low back pain, clinical practice guidelines, costs, diagnostic imaging, utilization, workers’ compensation

MeSH Terms:Acute Disease; Adult; Female; Guideline Adherence (statistics & numerical data); Health Expenditures; Health Services (economics, utilization); Humans; Insurance Claim Review (statistics & numerical data); Low Back Pain (diagnosis); Magnetic Resonance Imaging; Male; Middle Aged; Occupational Diseases (diagnosis); Practice Guidelines as Topic; Socioeconomic Factors; Washington (epidemiology); Workers’ Compensation


OBJECTIVE: To estimate health care utilization and costs associated with adherence to clinical practice guidelines for the use of early magnetic resonance imaging (MRI; within the first 6 weeks of injury) for acute occupational low back pain (LBP).

DATA SOURCESWashington State Disability Risk Identification Study Cohort (D-RISC), consisting of administrative claims and patient interview data from workers’ compensation claimants (2002-2004).

STUDY DESIGN: In this prospective, populationbased cohort study, we compared health care utilization and costs among workers whose imaging was adherent to guidelines (no early MRI) to workers whose imaging was not adherent to guidelines (early MRI in the absence of red flags).

DATA COLLECTION/EXTRACTION METHODS: We identified workers (age>18) with work-related LBP using administrative claims. We obtained demographic, injury, health, and employment information through telephone interviews to adjust for baseline differences between groups. We ascertained health care utilization and costs from administrative claims for 1 year following injury.

PRINCIPAL FINDINGS: Of 1,770 workers, 336 (19.0 percent) were classified as nonadherent to guidelines. Outpatient and physical/occupational therapy utilization was 52-54 percent higher for workers whose imaging was not adherent to guidelines compared to workers with guidelineadherent imaging; utilization of chiropractic care was significantly lower (18 percent).

CONCLUSIONSNonadherence to guidelines for early MRI was associated with increased likelihood of lumbosacral injections or surgery and higher costs for out-patient, inpatient, and nonmedical services, and disability compensation.

© Health Research and Educational Trust.






Trends in the use and cost of chiropractic spinal manipulation under Medicare Part B.

2013 Nov;13(11):1449-54. doi: 10.1016/j.spinee.2013.05.012. Epub 2013 Jun 15.

Trends in the use and cost of chiropractic spinal manipulation under Medicare Part B.



Concern about improper payments to chiropractic physicians prompted the US Department of Health and Human Services to describe chiropractic services as a “significant vulnerability” for Medicare, but little is known about trends in the use and cost of chiropractic spinal manipulation provided under Medicare.


To quantify the volume and cost of chiropractic spinal manipulation services for older adults under Medicare Part B and identify longitudinal trends.


Serial cross-sectional design for retrospective analysis of administrative data.


Annualized nationally representative samples of 5.0 to 5.4 million beneficiaries.


Chiropractic users, allowed services, allowed charges, and payments.





Contrasting real time quantitative measures (weekly SMS) to patients’ retrospective appraisal of their one-year’s course of low back pain; a probing mixed-methods study.

2019 Feb 26;27:12. doi: 10.1186/s12998-018-0222-y. eCollection 2019.

Contrasting real time quantitative measures (weekly SMS) to patients’ retrospective appraisal of their one-year’s course of low back pain; a probing mixed-methods study.



Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. However, methods of frequent measuring still need development and validation. Therefore, this study aims to evaluate the agreement between continuous, quantitative self-assessment (weekly SMS) of the course of LBP over a one-year period and qualitatively derived retrospective patient self-appraisal of the same time-period.


Participants were 32 subjects with LBP from primary care. The quantitative measures consisted of weekly SMS questions for one-year about pain intensity, days with LBP, and activity limitations for that week. For each subject, the weekly responses were graphed and categorized into categories based on intensity, variation and overall change patterns. Qualitative measures were based on semi-structured telephone interviews one-year after a consultation for LBP, where two coders independently categorized the self-appraisal of LBP course into the same predefined categories as the SMS-based trajectories. Furthermore, patients’ perceived overall recovery was related to variation patterns from SMS track.


There was perfect agreement for 48% in the pain intensity domain, 53% in the variation domain and 63% in the change pattern domain. Most of the discordant cases were classified in neighboring categories with the majority relating to fluctuating patterns. The self-perceived overall recovery status seemed to be reflected quite well by the quantitative measures of pain intensity and days with pain in this study.


This study shows that a real time quantitative measure (weekly SMS) and the patient’s retrospective appraisal do not fundamentally differ in their reflection of the one-year course of LBP.As a first investigation into this area, these results are promising, as longitudinal quantitatively derived trajectories of LBP seem to reflect the lived experience of the patient to a large degree. Furthermore, the patient’s ability to retrospectively recall their one-year course of LBP appears to be quite good. Future studies should focus on refining the categories of trajectories.


Back pain; Course; Interview; Mixed methods; Recall; SMS; Trajectories

[Indexed for MEDLINE]

Free PMC Article


Conclusion: A patient with TVL improved under chiropractic care using atlas orthogonal technique.

2018 Dec;17(4):231-236. doi: 10.1016/j.jcm.2018.07.002. Epub 2019 Jan 12.

Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome.



This case report describes chiropractic treatment for a patient diagnosed with bow hunter syndrome with transient vision loss (TVL).

Clinical Features:

A 39-year-old woman presented to a chiropractic clinic with hand and arm numbness that began after she was injured in a motor vehicle collision 18 months earlier. The primary symptom was TVL that began 3 days after the motor vehicle collision. At that time, she had been diagnosed with bow hunter syndrome using dynamic angiography findings. She had previously declined surgery recommended by her attending neurosurgeon at a local hospital.

Intervention and Outcome:

The patient was treated using atlas orthogonal chiropractic technique for 8 visits over a 6-week period. Examination before and the after the initial treatment included cervical radiographic analysis and vascular ultrasound measurement of the right and the left vertebral artery (VA). After the initial spinal manipulation, there was an improvement in blood flow volume of 8.2% in the left VA and 22.2% in the right VA. There was improvement of the symptom of TVL and a measured reduction of rotational misalignment of the first and second cervical vertebra on the radiographic views. After 6 weeks, the patient’s perception of TVL was absent.


A patient with TVL improved under chiropractic care using atlas orthogonal technique.


Chiropractic; Ultrasonography; Vertebrobasilar Insufficiency