A chiropractic service arrangement for musculoskeletal complaints in industry: a pilot study. (1/92)

Chiropractic services are commonly used by workers with musculoskeletal problems, especially low back and neck complaints. Research into the effectiveness and cost-effectiveness of this approach is, however, difficult to design without prior pilot studies. This study followed 32 workers with these complaints attending one such service and used five measures of outcome over a 6-month period. These measured pain (VAS), disability (FLP), quality of life (SF-36), perceived benefit and satisfaction with care. Additionally, sickness costs to the companies were recorded over two years encompassing the study period. Treatment utilization was also monitored. Over half the population were chronic sufferers. The effect sizes were large for pain and for seven out of eight dimensions of the SF-36 questionnaire at 6-month follow-up, although not for disability (FLP). High levels of satisfaction and perceived improvement were reported and sickness costs to the companies fell. However, the sample size in this pilot study was small and did not include controls. We would, therefore, recommend a full cost-effectiveness study incorporating a randomized trial in this area.  (+info)

A new gatekeeper for back pain. (2/92)

Managed care programs have evolved in response to the escalating costs of healthcare in the United States. Expenses related to back pain represent a significant portion of these costs. Chiropractic physicians handle more back pain visits than do medical doctors and are playing an increasing role in the management of neuromusculoskeletal problems in general. Furthermore, chiropractic patients are more satisfied with their care than are patients of family physicians. A number of studies have shown chiropractic medicine to have high efficacy and cost-effectiveness. Its utilization for neuromusculoskeletal problems in the managed care setting may well offer competitive advantages. Using chiropractic physicians as gatekeepers for back pain would result in more expedient movement through the algorithmic process and facilitate treatment of the patient with acute back pain. Many medical facilities are enhancing their services by utilizing chiropractic physicians as gatekeepers for the diagnosis and treatment of neuromusculoskeletal disorders.  (+info)

Complementary and alternative medicine for children: does it work? (3/92)

Paediatric use of complementary and alternative medicine is common and increasing, particularly for the sickest children. This review discusses the various options available including dietary supplements, hypnosis, massage, chiropractic, and acupuncture.  (+info)

Sinusitis in children: the importance of diagnosis and treatment. (4/92)

The complications from untreated sinusitis in a 10-month-old male infant, though at the more severe end of the spectrum, brings to light the importance of diagnosis and treatment even in the very young patient. Acute sinusitis should be diagnosed using established guidelines. Appropriate pharmacologic and osteopathic manipulative treatment should be initiated on diagnosis. Initial antibiotic therapy is a 14-day course of amoxicillin. If the sinusitis fails to resolve, a trial of a second-line antibiotic should be considered. The use of adjunctive medications such as antihistamines, decongestants, and nasal steroids remains controversial. If the patient fails maximal medical therapy, a computed tomography scan and referral to an otolaryngologist for possible surgical intervention should be considered.  (+info)

Characteristics, satisfaction, and perceptions of patients receiving ambulatory healthcare from osteopathic physicians: a comparative national survey. (5/92)

A national telephone survey was conducted in 1998 using random-digit dialing and the first Osteopathic Survey of Healthcare in America (OSTEOSURV-I) instrument to determine patients' satisfaction with their healthcare, as well as their perceptions of osteopathic medicine. Of the 1106 respondents, 243 (22.0%) had received medical care from an osteopathic physician, and another 307 (27.8%) claimed to be aware of osteopathic physicians. Patients of osteopathic physicians reported the highest levels of satisfaction in 8 of the 11 elements studied when compared with patients of allopathic physicians, chiropractors, and nonphysician clinicians other than chiropractors. Respondents perceived osteopathic manipulative treatment (OMT) to be beneficial for musculoskeletal disorders (P < .001). In addition, respondents perceived that healthcare services provided by osteopathic physicians were similar to those provided by allopathic physicians (P < .001), but not to those provided by chiropractors (P = .01). A total of 97.9% of current patients of osteopathic physicians agreed with the statement that osteopathic physicians practiced in their local community, compared with 80.6% of former patients of osteopathic physicians and 67.8% of patients who had never visited osteopathic physicians (P < .001). In general, the most favorable perceptions of osteopathic medicine were reported by current patients of osteopathic physicians, followed by former patients of such physicians. The least favorable perceptions came from patients who had never been patients of osteopathic physicians. The perception that OMT should be covered by health insurance was significantly associated with the use of osteopathic physicians (odds ratio, 3.2; 95% confidence interval, 1.5 to 6.7, among patients who had ever been to an osteopathic physician). The results of our survey suggest that greater access to osteopathic services, including OMT, is desirable and that promotional efforts aimed at encouraging the use of osteopathic medical services among the general population are warranted.  (+info)

Attitudes toward vaccination: a survey of Canadian chiropractic students. (6/92)

BACKGROUND: Although the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiropractic students. METHODS: An 11-item questionnaire about attitudes toward vaccination was distributed to students enrolled at CMCC during the 1999/2000 academic year. The responses for the 11 items were then summed to arrive at a total score ranging from 0 (most negative attitude toward vaccination) to 22 (most positive attitude toward vaccination). Respondents' perceptions of sources of vaccine information were also investigated. RESULTS: Over 75% of the students (467 of 621) completed the questionnaire. Most students (53.3%) reported that in general they agreed with vaccination. This was especially true among first-year students (60.7%). However, among fourth year students, only 39.5% agreed with vaccination. The proportion of respondents who stated that they were against vaccination in general was 5 (4.5%) of 112 first-year students, 10 (8.3%) of 121 second-year students, 16 (13.9%) of 115 third-year students and 35 (29.4%) of 119 fourth-year students. The mean scores on the questionnaire were progressively lower with each higher year of study at the College. The mean survey scores for each year of study were first year, 15.9 (95% confidence interval [CI] 15.2-16.6); second year, 16.1 (95% CI 15.3-1 7.0); third year, 14.5 (95% CI 13.5-15.4); and fourth year, 12.8 (95% CI 11.7-13.9). The mean scores varied among year of study and were statistically significant using one-way ANOVA (p < 0.0001). Among students who relied primarily on informal sources of vaccine information, such as the chiropractic literature and informal talks at CMCC, anti-vaccination attitudes were more prevalent in later years. INTERPRETATION: Most CMCC students reported pro-vaccination attitudes, but there appeared to be an increase in anti-vaccination attitudes as students progressed through the CMCC program. This pattern was seen almost exclusively among students who relied primarily on informal sources of vaccine information rather than on core CMCC lectures or prior lectures at university.  (+info)

Chiropractic and medical care costs of low back care: results from a practice-based observational study. (7/92)

OBJECTIVE: To compare the 1-year costs for patients treated for acute and chronic ambulatory low back pain by medical physicians and chiropractors. STUDY DESIGN: Prospective, practice-based observational study undertaken in 13 general medical practices and 51 chiropractic community-based clinics. PATIENTS AND METHODS: Of 2872 study patients, 2263 had complete 1-year records of services. Service data, collected from billing records, chart audits, and provider questionnaires, were assigned relative value units that were converted into 1995 dollar costs. Prescription drug costs for medical patients were included. Patient data on health status, pain and disability, and socioeconomic characteristics were obtained from self-administered questionnaires. RESULTS: The direct office costs of treating both chiropractic and medical patients over a 1-year period were relatively small. Forty-three percent of chiropractic patients and 57% of medical patients incurred costs of less than $100. However, the mean costs associated with chiropractic patients ($214) were significantly higher than those for medical patients ($123), especially when compared with medical patients who were not referred for further treatment or evaluation ($103). Chiropractic patients had somewhat lower baseline levels of pain and disability than nonreferred medical patients, but the 2 groups were relatively similar on most patient characteristics. There also were no statistically significant differences in the improvements in pain and disability between these 2 groups of patients. CONCLUSION: The results of this study indicate that patients treated in chiropractic clinics incur higher costs over a 1-year period, but have about the same degree of relief as nonreferred patients treated in medical clinics.  (+info)

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study. (8/92)

OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. METHODS: Satisfaction scores (on a 10-50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. RESULTS: The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients' satisfaction. CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.  (+info)