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combining all the identical requests into one section and marking them as answered
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===Response to the above requests===
===Response to the above requests===
I didn't realize Nobias500 (and their unlogged-in ISP) had requested this addition here. I saw that they had added these two identical sections to [[Chiropractic education]] and to [[Doctor of Chiropractic]]. I got them to fix the referencing of the "career" section and left it in both articles. I deleted the "cost effectiveness" section as irrelevant for those articles, reduced it to a sentence, and moved it to this article. I make no guarantees about this information, I just moved it as a favor to a newbie. If there are problems with the information or the sourcing, anyone may feel free to remove it. --[[User:MelanieN|MelanieN]] ([[User talk:MelanieN|talk]]) 04:40, 9 April 2013 (UTC)
I didn't realize Nobias500 (and their unlogged-in ISP) had requested this addition here. I saw that they had added these two identical sections to [[Chiropractic education]] and to [[Doctor of Chiropractic]]. I got them to fix the referencing of the "career" section and left it in both articles. I deleted the "cost effectiveness" section as irrelevant for those articles, reduced it to a sentence, and moved it to this article. I make no guarantees about this information, I just moved it as a favor to a newbie. If there are problems with the information or the sourcing, anyone may feel free to remove it. --[[User:MelanieN|MelanieN]] ([[User talk:MelanieN|talk]]) 04:40, 9 April 2013 (UTC)

== Change request-Chiropractic mixer guidelines do not meet the evidence based standard ==

Hello all, I'd like to dispute the text that reads, "Although mixers are the majority group." I think this was done to give the impression that chiropractors are less unethical than they really are and it is inaccurate. According to an appeal filed by Life University in 2001, straight programs are the majority group.

:The District Court committed a further mistake of law by delving into the chiropractic profession’s philosophical debate about its health care role in an attempt to probe whether CCE harbored an improper motive for not reaffirming LUCC’s accreditation. The District Court refused to apply the Wilfred “great deference” standard based on its finding, which was unsupported by any evidence in the record, that “an aggressive group of leaders of the eight liberal chiropractic schools . . . had undertaken a series of corporate manipulations in order to reduce the representation and dominance of the eight conservative chiropractic schools (of which Life was one) . . . which were calculated to give dominance to the liberal minority group over the conservative majority group; [and] the end result has been the disaccreditation of the largest of all the colleges. . . .” R4-28-3-4. Such an inquiry and the District Court’s unfounded speculation were manifestly improper.16 (see page 43 of attached appeal (CCE vs Life University, US Court of Appeals. 11th cir. NO. 03-11020J. April 23, 2003.)

Granted this is from 2003. Since that time enrollment in straight programs has slowed while mixer ones has increased and one program has closed, the satellite branch of the Cleveland College of Chiropractic, regarded as straight by its president, in Los Angeles. (http://www.chirobase.org/03Edu/schoolphilosophy.html). So although the trend has shifted, straight programs traditionally graduate more graduates. In 2003 Life claimed that 2/3 of all practicing chiropractors were straight, a claim that is supported by the reference that states that a majority of chiropractors, whether they be mixer or straight, support the subluxation complex. If mixers were really evidence based they wouldn't support an outdated subluxation/somatic lesion practice model so the reference shows that assertion to be false.

I am having trouble locating that reference but it doesn't matter because I will show that regardless of orientation, all chiropractic programs, whether they be mixer or straight, are based on a form of subluxation diagnosis.

This brings me to my second request for changes. The article is inconsistent in that it cherry picks references from a few academics and minority practitioners to imply that this false majority of mixers is moving towards evidence based practice:

:“and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[16]”

However, most practitioners currently accept the importance of scientific research into chiropractic,[5]and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;[21] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[22]
EB practice isn’t a concensus of what chiropractors say it is, but must have an objective standard based in critical thinking. The mixer EB practice model is to perform a differential diagnosis which is followed by screening the musculoskeletal system for subluxations (pseudoscience). The primary difference between the straight version of this is that straights don’t diagnose diseases so will refer out far fewer patients due to undiagnosed illnesses.

Current thinking of the rest of the manipulative professions (PT, DO) recognizes that subluxations are not real lesions and mandates that manipulation is done solely to assist recovery from legitimate diagnosed conditions. (Peter Huijbregts, PT. Clinical Prediction Rules: Time to Sacrifice the Holy Cow of Specificity? The Journal of Manual & Manipulative Therapy. Vol. 15 No. 1 (2007), 5–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565597/pdf/jmmt0015-0005.pdf)

So while in the past guidelines that recognized subluxation findings may have been justifiable as evidence based practice current analysis shows that the assessments are too flawed to use for diagnosis. Former NACM member and published author Tim Mirtz DC admits this is true and writes of the NACM's supposedly evidence based but now outdated subluxation/somatic lesion based guidelines of their time,

:[Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license.
:[Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of.
:[Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away.
:(Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1)

To a chiropractor, whether he be mixer or straight, the presence of a malady is not a requirement for treatment because evidence of subluxation by itself is considered a risk factor for future disease. So the only difference it makes is whether a DC bills the insurance carrier (for a diagnosed condition+subluxation) or not (subluxation only). Moreover, as more evidence that all chiropractors support subluxation, no chiropratic college teaches that clinical prediction rules be applied in order to stop treatment of patients who show only false positives from subluxation but are otherwise asymptomatic.
So these sections need to be re-written. As Life affirmed, the majority of practicing chiropractors, whether they be mixer or straight program graduates, treat subluxations (aka somatic lesions) in some form, all evidence based practice guidelines are based on subluxation and are not really evidence based, and historically the idea of eliminating subluxation diagnosis, has been defeated by the majority of the profession and is universally rejected by all organizations and schools. Only a few scattered academics have proposed abandoning subluxation diagnosis but there has been no movement to put this into practice, explaining why the majority support subluxation/somatic lesion diagnosis which is falsely portrayed as legitimate evidence based practice when it really is pseudoscience. [[User:Abotnick|Abotnick]] ([[User talk:Abotnick|talk]]) 13:04, 18 April 2013 (UTC)

Revision as of 13:04, 18 April 2013


Treatment, Safety (Proposed revision, March 2013) Part 1 of 2

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

  • manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
  • exercise, rehabilitative programmes and other forms of active care;
  • psychosocial aspects of patient management;
  • patient education on spinal health, posture, nutrition and other lifestyle modifications;
  • emergency treatment and acute pain management procedures as indicated;
  • other supportive measures, which may include the use of back supports and orthotics;
  • recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

Lumbar, cervical and thoracic chiropractic spinal manipulation.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques[1] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[2] Spinal manipulation gained mainstream recognition during the 1980s.[3] Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.[4] It is the most common and primary intervention used in chiropractic care;[5] In North America, chiropractors perform over 90% of all manipulative treatments[6] with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[7] Typically, it is performed on patients who have failed to respond to other forms of treatment.[8]There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.[9] Although serious injuries and fatal consequences can occur and may be under-reported,[10] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.[11]

Definitions

High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation [12] It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.

Categories

Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.[13] Manual and mechanically-assisted articular manipulative procedures can include:

  • HVLA manipulation
  • HVLA manipulation with recoil
  • LVLA manipulation (mobilization)
  • Drop tables and terminal point manipulative thrust
  • Flexion-distraction and traction-type tables
  • Pelvic blocks
  • Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:

  • Reflex and muscle relaxation procedures
  • Muscle energy techniques
  • Myofascial ischemic compression procedures
  • Myofascial, and soft tissue manipulative techniques
show full draft

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

  • manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
  • exercise, rehabilitative programmes and other forms of active care;
  • psychosocial aspects of patient management;
  • patient education on spinal health, posture, nutrition and other lifestyle modifications;
  • emergency treatment and acute pain management procedures as indicated;
  • other supportive measures, which may include the use of back supports and orthotics;
  • recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

Lumbar, cervical and thoracic chiropractic spinal manipulation.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques[1] as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.[2] Spinal manipulation gained mainstream recognition during the 1980s.[14] Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.[4] It is the most common and primary intervention used in chiropractic care;[5] In North America, chiropractors perform over 90% of all manipulative treatments[15] with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.[16] Typically, it is performed on patients who have failed to respond to other forms of treatment.[17]There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.[9] Although serious injuries and fatal consequences can occur and may be under-reported,[10] these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.[11]

Definitions

High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation [18] It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.

Categories

File:Flexion distraction.jpg
A chiropractor using a flexion-distraction table and manual therapy to the lumbo-sacral spine for low back pain

Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.[13] Manual and mechanically-assisted articular manipulative procedures can include:

  • HVLA manipulation
  • HVLA manipulation with recoil
  • LVLA manipulation (mobilization)
  • Drop tables and terminal point manipulative thrust
  • Flexion-distraction and traction-type tables
  • Pelvic blocks
  • Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:

  • Reflex and muscle relaxation procedures
  • Muscle energy techniques
  • Myofascial ischemic compression procedures
  • Myofascial, and soft tissue manipulative techniques

Neuromusculoskeletal and somatovisceral disorders

Manual and manipulative therapies is a common intervention used primarily by manual medicine practitioners for the treatment of neuromusculoskeletal disorders. Spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain. However the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial.[19]

Research status

  • Acute low back pain: It is not known if chiropractic care improves clinical outcomes in those with lower back pain more or less than other treatments.[20] A 2012 Cochrane review found that spinal manipulation was no more effective than standard medical care, sham manipulation, physiotherapy or exercises therapy or inert intenventions. [21] A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.[22] In 2007 the American College of Physicians and the American Pain Society jointly recommended that spinal manipulation be considered for people who do not improve with self care options.[23]
  • Chronic low back pain: The effectiveness of spinal manipulation appears to be the same as other commonly prescribed treatment for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy.[24] Some national guidelines consider its use optional, some do not recommend and others suggest a short course in those who do not improve with other measures.[25] Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations.[26]
  • Radiculopathy: There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy[27] and acute lumbar disc herniation with associated radiculopathy.[28] The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy.[27]
  • Neck pain: The effectiveness of spine manipulation for the treatment of neck pain is controversial.[29] Cervical spine manipulation and mobilisation may provide immediate- or short-term improvements for mechanical neck pain; neither manipulation nor mobilisation have been found to be superior to one another and no long-term data are available.[30] Thoracic spinal manipulation has a therapeutic benefit to some patients with neck pain and therefore it may also be a suitable intervention to use in combination with other interventions in the treatment of non-specific neck pain.[31][32][30] Other manual therapies such as massage have also been found to be effective for mechanical neck pain.[33][34][35][36]
  • Extremity conditions: Manual and manipulative therapy added to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.[37] There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.[38] The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) result in significantly better pain relief and functional improvements in both the short and long-term.[39] There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,[40] limited to low level evidence supporting chiropractic management of shoulder pain[41] and limited or fair evidence supporting chiropractic management of leg conditions.[42]
  • Headache: Spinal manipulation may improve migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.[43] SM might be as effective as propranolol or topiramate in the prevention of migraine headaches,[44][45] as well as other types of headaches. [46] [44][47]
  • Cervicogenic dizziness: There is moderate evidence to support the use of manual therapy for cervicogenic dizziness.[48]
  • Pediatrics: The use of manual therapy for pediatric health conditions is supported by only low levels of evidence[49][50][51]
  • Mental health: There is evidence that spinal manipulation improves psychological outcomes compared to verbal interventions.[52]
  • Other: A 2013 Cochrane reviews found some effectiveness of manipulative therapy as an complementary intervention for pneumonia in adults. Current evidence suggests manipulative therapy reduces the duration of hospital stay, duration of intravenous antibiotic use, and total antibiotic use, but did not improve primary patient outcomes including fever, improvement on X-ray, cure rate, or mortality.[53] In 2013, a systematic review and meta-analysis of five randomized controlled trials concluded that existing evidence suggests that SMT may improve lower urinary tract symptoms in adult women such as urinary incontinence (involuntary leakage of urine), nocturia (waking up at night to urinate), and urinary hesitancy, but called for further study with additional large, rigorous randomized controlled trials.[54] There is insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension.[55] There is very low evidence for spinal manipulation for adult scoliosis (curved or rotated spine)[56] and no scientific data for idiopathic adolescent scoliosis.[57] There is insufficient evidence from reviews to draw definitive conclusions for a wide variety of other non-neuromusculoskeletal conditions, including ADHD/learning disabilities, vision and other conditions.[58] Other reviews have found no evidence of significant benefit for asthma,[59] baby colic,[50][60] bedwetting,[61] carpal tunnel syndrome,[62] fibromyalgia,[63] gastrointestinal disorders,[64] kinetic imbalance due to suboccipital strain (KISS) in infants,[50][65] menstrual cramps,[66] or pelvic and back pain during pregnancy.[67]

Safety

The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. [11] Most contraindications apply only to the manipulation of the affected region.[36]

Adverse events in spinal manipulation studies appear to be under-reported [68] and appear to be more common following HVLA manipulation than mobilization.[69] Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness.[9] These events typically dissipates within 24–48 hours [70] Serious injuries and fatal consequences can occur, and are believed to result from upper cervical rotatory manipulation.[71] but are regarded as rare when spinal manipulation is employed skillfully and appropriately.[36]

There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.[72][73][74] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.[75] A 2012 systematic review determined that there is insufficient evidence to support any association between cervical manipulation and stroke.[76]

Cost-effectiveness

Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches.[77] Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.[78]

References

  1. ^ a b Swedlo DC (2002). "The historical development of chiropractic" (PDF). In Whitelaw WA (ed.) (ed.). Proc 11th Annual History of Medicine Days. Faculty of Medicine, The University of Calgary. pp. 55–58. Retrieved 2008-05-14. {{cite conference}}: |editor= has generic name (help); Unknown parameter |booktitle= ignored (|book-title= suggested) (help)
  2. ^ a b Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.
  3. ^ Francis RS (2005). "Manipulation under anesthesia: historical considerations". International MUA Academy of Physicians. Retrieved 2008-07-06.
  4. ^ a b Winkler K, Hegetschweiler-Goertz C, Jackson PS; et al. (2003). "Spinal manipulation policy statement" (PDF). American Chiropractic Association. Retrieved 2008-05-24. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  5. ^ a b Christensen MG, Kollasch MW (2005). "Professional functions and treatment procedures". Job Analysis of Chiropractic. Greeley, CO: National Board of Chiropractic Examiners. pp. 121–38. ISBN 1-884457-05-3. {{cite book}}: |access-date= requires |url= (help); |format= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)[dead link]
  6. ^ "About chiropractic and its use in treating low-back pain" (PDF). NCCAM. 2005. Archived from the original (PDF) on 2008-02-27. Retrieved 2008-03-24.
  7. ^ Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES (2005). "Manipulation under anesthesia: a report of four cases". J Manipulative Physiol Ther. 28 (7): 526–33. doi:10.1016/j.jmpt.2005.07.011. PMID 16182028.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ Michaelsen MR (2000). "Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin". J Manipulative Physiol Ther. 23 (2): 127–9. doi:10.1016/S0161-4754(00)90082-4. PMID 10714542.
  9. ^ a b c Ernst, E (2007). "Adverse effects of spinal manipulation: a systematic review". Journal of the Royal Society of Medicine. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. ISSN 0141-0768. PMC 1905885. PMID 17606755. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help); Unknown parameter |month= ignored (help)
  10. ^ a b E Ernst (2010). "Deaths after chiropractic: a review of published cases". Int J Clinical Practice. 64 (8): 1162–1165. doi:10.1111/j.1742-1241.2010.02352.x. PMID 20642715.
  11. ^ a b c Cite error: The named reference WHO-guidelines was invoked but never defined (see the help page).
  12. ^ Maitland, G.D. Peripheral Manipulation 2nd ed. Butterworths, London, 1977.
    Maitland, G.D. Vertebral Manipulation 5th ed. Butterworths, London, 1986.
  13. ^ a b Chapter 10 - Modes Of Care And Management. Canadian Chiropractic Association
  14. ^ Francis RS (2005). "Manipulation under anesthesia: historical considerations". International MUA Academy of Physicians. Retrieved 2008-07-06.
  15. ^ "About chiropractic and its use in treating low-back pain" (PDF). NCCAM. 2005. Archived from the original (PDF) on 2008-02-27. Retrieved 2008-03-24.
  16. ^ Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES (2005). "Manipulation under anesthesia: a report of four cases". J Manipulative Physiol Ther. 28 (7): 526–33. doi:10.1016/j.jmpt.2005.07.011. PMID 16182028.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ^ Michaelsen MR (2000). "Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin". J Manipulative Physiol Ther. 23 (2): 127–9. doi:10.1016/S0161-4754(00)90082-4. PMID 10714542.
  18. ^ Maitland, G.D. Peripheral Manipulation 2nd ed. Butterworths, London, 1977.
    Maitland, G.D. Vertebral Manipulation 5th ed. Butterworths, London, 1986.
  19. ^ "Visceral responses to spinal manipulation". J Electromyogr Kinesiol. 22 (5): 777-84. 2012. PMID 22440554. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  20. ^ Cite error: The named reference walker_2011 was invoked but never defined (see the help page).
  21. ^ Rubinstein, SM (2012 Sep 12). "Spinal manipulative therapy for acute low-back pain". Cochrane database of systematic reviews (Online). 9: CD008880. PMID 22972127. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  22. ^ Cite error: The named reference dagenais_2010 was invoked but never defined (see the help page).
  23. ^ Cite error: The named reference chou_2007 was invoked but never defined (see the help page).
  24. ^ Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (2011). Rubinstein, Sidney M (ed.). "Spinal manipulative therapy for chronic low-back pain". Cochrane Database Syst Rev (2): CD008112. doi:10.1002/14651858.CD008112.pub2. PMID 21328304.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. ^ Koes, BW (2010 Dec). "An updated overview of clinical guidelines for the management of non-specific low back pain in primary care". European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 19 (12): 2075–94. PMID 20602122. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  26. ^ Cite error: The named reference dagenais_2008 was invoked but never defined (see the help page).
  27. ^ a b Cite error: The named reference Leininger B, Bronfort G, Evans R, Reiter T 2011 105–25 was invoked but never defined (see the help page).
  28. ^ Cite error: The named reference Hahne AJ, Ford JJ, McMeeken JM 2010 E488–504 was invoked but never defined (see the help page).
  29. ^ Posadzki P (2012). "Is spinal manipulation effective for pain? An overview of systematic reviews". Pain Med. 13 (6): 754–761. PMID 22621391.
  30. ^ a b Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL (2010). "Manipulation or mobilisation for neck pain". Cochrane Database Syst Rev.: CD004249. doi:10.1002/14651858.CD004249.pub3. PMID 20091561.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. ^ "The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review". Disabil Rehabil. 2013. PMID 23339721. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  32. ^ Cross KM, Kuenze C, Grindstaff TL, Hertel J. (2011). "Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review". J Orthop Sports Phys Ther. 41 (9): 633–642. doi:10.2519/jospt.2011.3670. PMID 21885904.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ^ Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010). "Effectiveness of manual therapies: the UK evidence report". Chiropractic & Osteopathy. 18 (3): 3. doi:10.1186/1746-1340-18-3. PMC 2841070. PMID 20184717.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  34. ^ "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4): 123–152. 2008. PMID 18204386. {{cite journal}}: Cite has empty unknown parameter: |month= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  35. ^ Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.
  36. ^ a b c Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. PMC 1839918. PMID 17549134. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
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  37. ^ Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA (2011). "Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review". J Physiother. 57 (1): 11–20. doi:10.1016/S1836-9553(11)70002-9. PMID 21402325.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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No discussion of new POV fork material added (controversy and criticism)

This made the NPOV issue even worse. What is bizarre it was a bold series of edits without any discussion (as is customary). Hence the bold edit is being reverted and IRWolfie is free to discuss why this material should be added. DVMt (talk) 01:28, 3 April 2013 (UTC)[reply]

Please discuss matters in the talk page before making controversial changes. TippyGoomba (talk) 03:35, 3 April 2013 (UTC)[reply]
What part of BRD don't you understand? IRWolfie made a bold series of edits, with no discussion. Then I reverted it and talked about at the talk page. Then you, reverted me (BRRD). The policy is quite clear on this. DVMt (talk) 03:49, 3 April 2013 (UTC)[reply]
You should check with an admin on that. TippyGoomba (talk) 05:40, 3 April 2013 (UTC)[reply]
I think technically it would only be BRRD if the same editor reverted twice. As to the merge, as discussed above, I am in favour of it - it is needed to prevent a WP:POVFORK. Alexbrn talk|contribs|COI 05:52, 3 April 2013 (UTC)[reply]
I'm a little confused. DVMt said the article I merged from was a POV fork (and I agreed), yet he complains when I merge it back, IRWolfie- (talk) 00:15, 4 April 2013 (UTC)[reply]

Multiple edit requests from the same user

Edit request on 8 April 2013

24.15.12.217 (talk) 15:14, 8 April 2013 (UTC)[reply]

Cost-effectiveness

Analysis of a clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 found that the clinical and cost utilization of chiropractic services based on 70, 274 member-months over a 7-year period demonstrated ==decreases== of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame [201].


Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [64]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [65]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.


201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract 202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm 203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/

Edit request on 8 April 2013

Nobias500 (talk) 15:50, 8 April 2013 (UTC)[reply]

Cost-effectiveness of Chiropractic Care

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:

-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs

when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [36].

36. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract

Edit request on 8 April 2013

Nobias500 (talk) 16:01, 8 April 2013 (UTC)[reply]


Cost-effectiveness of Chiropractic Care

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:

-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs

when compared with the use of conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [201].


Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract

202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm

201. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.


202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm 203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/ — Preceding unsigned comment added by Nobias500 (talk • contribs) 16:03, 8 April 2013 (UTC)[reply]

Response to the above requests

I didn't realize Nobias500 (and their unlogged-in ISP) had requested this addition here. I saw that they had added these two identical sections to Chiropractic education and to Doctor of Chiropractic. I got them to fix the referencing of the "career" section and left it in both articles. I deleted the "cost effectiveness" section as irrelevant for those articles, reduced it to a sentence, and moved it to this article. I make no guarantees about this information, I just moved it as a favor to a newbie. If there are problems with the information or the sourcing, anyone may feel free to remove it. --MelanieN (talk) 04:40, 9 April 2013 (UTC)[reply]

Change request-Chiropractic mixer guidelines do not meet the evidence based standard

Hello all, I'd like to dispute the text that reads, "Although mixers are the majority group." I think this was done to give the impression that chiropractors are less unethical than they really are and it is inaccurate. According to an appeal filed by Life University in 2001, straight programs are the majority group.

The District Court committed a further mistake of law by delving into the chiropractic profession’s philosophical debate about its health care role in an attempt to probe whether CCE harbored an improper motive for not reaffirming LUCC’s accreditation. The District Court refused to apply the Wilfred “great deference” standard based on its finding, which was unsupported by any evidence in the record, that “an aggressive group of leaders of the eight liberal chiropractic schools . . . had undertaken a series of corporate manipulations in order to reduce the representation and dominance of the eight conservative chiropractic schools (of which Life was one) . . . which were calculated to give dominance to the liberal minority group over the conservative majority group; [and] the end result has been the disaccreditation of the largest of all the colleges. . . .” R4-28-3-4. Such an inquiry and the District Court’s unfounded speculation were manifestly improper.16 (see page 43 of attached appeal (CCE vs Life University, US Court of Appeals. 11th cir. NO. 03-11020J. April 23, 2003.)

Granted this is from 2003. Since that time enrollment in straight programs has slowed while mixer ones has increased and one program has closed, the satellite branch of the Cleveland College of Chiropractic, regarded as straight by its president, in Los Angeles. (http://www.chirobase.org/03Edu/schoolphilosophy.html). So although the trend has shifted, straight programs traditionally graduate more graduates. In 2003 Life claimed that 2/3 of all practicing chiropractors were straight, a claim that is supported by the reference that states that a majority of chiropractors, whether they be mixer or straight, support the subluxation complex. If mixers were really evidence based they wouldn't support an outdated subluxation/somatic lesion practice model so the reference shows that assertion to be false.

I am having trouble locating that reference but it doesn't matter because I will show that regardless of orientation, all chiropractic programs, whether they be mixer or straight, are based on a form of subluxation diagnosis.

This brings me to my second request for changes. The article is inconsistent in that it cherry picks references from a few academics and minority practitioners to imply that this false majority of mixers is moving towards evidence based practice:

“and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[16]”

However, most practitioners currently accept the importance of scientific research into chiropractic,[5]and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;[21] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[22] EB practice isn’t a concensus of what chiropractors say it is, but must have an objective standard based in critical thinking. The mixer EB practice model is to perform a differential diagnosis which is followed by screening the musculoskeletal system for subluxations (pseudoscience). The primary difference between the straight version of this is that straights don’t diagnose diseases so will refer out far fewer patients due to undiagnosed illnesses.

Current thinking of the rest of the manipulative professions (PT, DO) recognizes that subluxations are not real lesions and mandates that manipulation is done solely to assist recovery from legitimate diagnosed conditions. (Peter Huijbregts, PT. Clinical Prediction Rules: Time to Sacrifice the Holy Cow of Specificity? The Journal of Manual & Manipulative Therapy. Vol. 15 No. 1 (2007), 5–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565597/pdf/jmmt0015-0005.pdf)

So while in the past guidelines that recognized subluxation findings may have been justifiable as evidence based practice current analysis shows that the assessments are too flawed to use for diagnosis. Former NACM member and published author Tim Mirtz DC admits this is true and writes of the NACM's supposedly evidence based but now outdated subluxation/somatic lesion based guidelines of their time,

[Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license.
[Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of.
[Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away.
(Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1)

To a chiropractor, whether he be mixer or straight, the presence of a malady is not a requirement for treatment because evidence of subluxation by itself is considered a risk factor for future disease. So the only difference it makes is whether a DC bills the insurance carrier (for a diagnosed condition+subluxation) or not (subluxation only). Moreover, as more evidence that all chiropractors support subluxation, no chiropratic college teaches that clinical prediction rules be applied in order to stop treatment of patients who show only false positives from subluxation but are otherwise asymptomatic.

So these sections need to be re-written. As Life affirmed, the majority of practicing chiropractors, whether they be mixer or straight program graduates, treat subluxations (aka somatic lesions) in some form, all evidence based practice guidelines are based on subluxation and are not really evidence based, and historically the idea of eliminating subluxation diagnosis, has been defeated by the majority of the profession and is universally rejected by all organizations and schools. Only a few scattered academics have proposed abandoning subluxation diagnosis but there has been no movement to put this into practice, explaining why the majority support subluxation/somatic lesion diagnosis which is falsely portrayed as legitimate evidence based practice when it really is pseudoscience. Abotnick (talk) 13:04, 18 April 2013 (UTC)[reply]

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