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Source
Sygeplejersken. 1988 Aug 10;88(32):13
Publication Type
Article
Date
Aug-10-1988
Source
J Altern Complement Med. 2010 Jun;16(6):621-6
Publication Type
Article
Date
Jun-2010
Author
Joel Alcantara
Jeanne Ohm
Derek Kunz
Author Affiliation
International Chiropractic Pediatric Association, Media, PA 19063, USA. dr_jalcantara@yahoo.com
Source
J Altern Complement Med. 2010 Jun;16(6):621-6
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Canada
Child
Chiropractic - economics - statistics & numerical data
Cross-Sectional Studies
Europe
Female
Humans
Income - statistics & numerical data
Male
Manipulation, Spinal - statistics & numerical data
Office Visits - economics - statistics & numerical data
Osteopathic Physicians
Pediatrics - methods
Physician's Practice Patterns - economics - statistics & numerical data
Preventive Medicine
Referral and Consultation - statistics & numerical data
Reimbursement Mechanisms - statistics & numerical data
United States
Abstract
The objective of this study was to characterize the practice of pediatric chiropractic.
The study design was a cross-sectional descriptive survey.
The settings were private practices throughout the United States, Canada, and Europe.
The participants were 548 chiropractors, the majority of whom are practicing in the United States, Canada, and Europe.
Practitioner demographics (i.e., gender, years in practice, and chiropractic alma mater), practice characteristics (i.e., patient visits per week, practice income reimbursement), and chiropractic technique were surveyed. The practitioners were also asked to indicate common indicators for pediatric presentation, their practice activities (i.e., use of herbal remedies, exercise and rehabilitation, prayer healing, etc.), and referral patterns.
A majority of the responders were female with an average practice experience of 8 years. They attended an average of 133 patient visits per week, with 21% devoted to the care of children (
Notes
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Cites: J Dev Behav Pediatr. 2003 Feb;24(1):4-812584479
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Cites: Am J Public Health. 1998 May;88(5):771-69585743
Cites: JAMA. 1998 May 20;279(19):1548-539605899
Cites: JAMA. 1998 Nov 11;280(18):1569-759820257
Cites: J Altern Complement Med. 2008 Jul;14(6):763-718620477
Cites: Natl Health Stat Report. 2008 Dec 10;(12):1-2319361005
PubMed ID
20569028 View in PubMed
Less detail

Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain. Six-month follow-up.

https://arctichealth.org/en/permalink/ahliterature72681
Source
Spine. 1997 Sep 15;22(18):2167-77
Publication Type
Article
Date
Sep-15-1997
Author
E I Skargren
B E Oberg
P G Carlsson
M. Gade
Author Affiliation
Department of Caring Sciences, Faculty of Health Sciences, Linköping University, Sweden.
Source
Spine. 1997 Sep 15;22(18):2167-77
Date
Sep-15-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Chiropractic - economics
Comparative Study
Cost-Benefit Analysis
Female
Follow-Up Studies
Health status
Humans
Low Back Pain - economics - rehabilitation
Male
Middle Aged
Neck Pain - economics - rehabilitation
Pain Measurement
Physical Therapy Modalities - economics
Questionnaires
Research Support, Non-U.S. Gov't
Treatment Outcome
Abstract
STUDY DESIGN: A randomized, clinical trial was conducted in which patients with back/neck problems, visiting a general practitioner, were allocated to chiropractic or physiotherapy as primary management. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy in managing patients with low back or neck pain. SUMMARY OF BACKGROUND DATA: Earlier studies on the treatment of back pain by spinal manipulation have shown inconsistent results. When a "new" strategy--chiropractic--in the treatment of back pain was introduced in public health care in Sweden, there was a need to compare the effects and costs of chiropractic with the established physiotherapy. METHODS: Three hundred twenty-three patients aged 18 to 60 years who had no contraindications to manipulation and who had not been treated within the previous month were included in the study. Treatment was carried out at the discretion of the therapist. Outcome measures were primarily changes in pain intensity and general health, both assessed with visual analog scale and Oswestry pain disability questionnaire. Direct and indirect costs were measured. RESULTS: For patients with low back or neck pain visiting the general practitioner in primary care, both chiropractic and physiotherapy as primary treatment reduced the symptoms. No difference in outcome or direct or indirect costs between the two groups could be seen, nor in subgroups defined as duration, history, or severity. CONCLUSIONS: The effectiveness and total costs of chiropractic or physiotherapy as primary treatment were similar to reach the same result after treatment and after 6 months.
PubMed ID
9322328 View in PubMed
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Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial.

https://arctichealth.org/en/permalink/ahliterature86913
Source
BMC Musculoskelet Disord. 2008;9:40
Publication Type
Article
Date
2008
Author
Stochkendahl Mette J
Christensen Henrik W
Vach Werner
Høilund-Carlsen Poul Flemming
Haghfelt Torben
Hartvigsen Jan
Author Affiliation
Nordic Institute of Chiropractic and Clinical Biomechanics, Part of Clinical Locomotion Science, Odense, Denmark. m.jensen@nikkb.dk
Source
BMC Musculoskelet Disord. 2008;9:40
Date
2008
Language
English
Publication Type
Article
Keywords
Acute Disease
Chest Pain - etiology - physiopathology - prevention & control
Cost-Benefit Analysis
Diagnosis, Differential
Heart Diseases - diagnosis
Humans
Manipulation, Chiropractic - economics
Musculoskeletal Diseases - complications - diagnosis - physiopathology - therapy
Pain Clinics
Pain Measurement
Patient satisfaction
Prospective Studies
Questionnaires
Recovery of Function
Research Design
Single-Blind Method
Treatment Outcome
Abstract
BACKGROUND: Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking. METHODS/DESIGN: We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom chest pain may be of musculoskeletal rather than cardiac origin and to investigate the decision process of a chiropractor in diagnosing these patients; further, to examine whether chiropractic treatment can reduce pain and improve physical function when compared to advice directed towards promoting self-management, and, finally, to estimate the cost-effectiveness of these procedures. This study will include 300 patients discharged from a university hospital acute chest pain clinic without a diagnosis of acute coronary syndrome or any other obvious cardiac or non-cardiac disease. After completion of the clinic's standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a) a self-report questionnaire; b) a semi-structured interview; c) a general health examination; and d) a specific manual examination of the muscles and joints of the neck, thoracic spine, and thorax in order to determine whether the pain is likely to be of musculoskeletal origin. To describe the patients status with regards to ischemic heart disease, and to compare and indirectly validate the musculoskeletal diagnosis, myocardial perfusion scintigraphy is performed in all patients 2-4 weeks following discharge. Descriptive statistics including parametric and non-parametric methods will be applied in order to compare patients with and without musculoskeletal chest pain in relation to their scintigraphic findings. The decision making process of the chiropractor will be elucidated and reconstructed using the CART method. Out of the 300 patients 120 intended patients with suspected musculoskeletal chest pain will be randomized into one of two groups: a) a course of chiropractic treatment (therapy group) of up to ten treatment sessions focusing on high velocity, low amplitude manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect, and cost-effectiveness. DISCUSSION: This study may potentially demonstrate that a chiropractor is able to identify a subset of patients suffering from chest pain predominantly of musculoskeletal origin among patients discharged from an acute chest pain clinic with no apparent cardiac condition. Furthermore knowledge about the benefits of manual treatment of patients with musculoskeletal chest pain will inform clinical decision and policy development in relation to clinical practice. TRIAL REGISTRATION: NCT00462241 and NCT00373828.
PubMed ID
18377636 View in PubMed
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Economic and resource status of the chiropractic profession in Ontario, Canada: a challenge or an opportunity.

https://arctichealth.org/en/permalink/ahliterature158354
Source
J Manipulative Physiol Ther. 2008 Feb;31(2):104-14
Publication Type
Article
Date
Feb-2008
Author
Silvano A Mior
Audrey Laporte
Author Affiliation
Division of Research, Canadian Memorial Chiropractic College, Toronto, Canada. smior@cmcc.ca
Source
J Manipulative Physiol Ther. 2008 Feb;31(2):104-14
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Chiropractic - economics - manpower - statistics & numerical data
Databases, Factual
Health Surveys
Humans
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Professional Practice - statistics & numerical data
Abstract
Chiropractic is one of the most frequently sought nonphysician provider groups. Despite its apparent recognition, the profession faces numerous challenges, including the economic reality of an increasing supply within a market of questionable demand. This paper evaluates the chiropractic manpower status in Ontario, Canada.
Data collected from administrative and education databases, insurance billing data, and population health survey data between 1990 and 2004 were analyzed.
Between 1990 and 2004, the total number of chiropractic registrants in Ontario doubled, with an average annual rate of growth of about 5.4%; however, recent data suggest that the number of nonpracticing chiropractors is increasing, whereas the number of new registrants is decreasing. The rate of applications to a chiropractic institution rose sharply and peaked in 1996-1997, thereafter declining but leveling off in 2002-2003. Despite the continued growth in the number of practicing chiropractors, the utilization of chiropractic services among the Ontario population has remained relatively stable, resulting in a decline in the average net annual incomes adjusted for inflation to 2002 dollars.
Our results support previous reports projecting an oversupply of chiropractors and suggest that the chiropractic profession in Ontario is in long-run oversupply. Competition from other providers, changing population demographics, and the recent loss of public funding for services may present significant future challenges to current practitioners. Opportunities related to participation in multidisciplinary environments and accessing unmet population health needs may contribute to influencing the demand for chiropractic services. A concerted effort by professional and educational institutions is required.
PubMed ID
18328936 View in PubMed
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The effectiveness of standard care, early intervention, and occupational management in worker's compensation claims.

https://arctichealth.org/en/permalink/ahliterature186804
Source
Spine (Phila Pa 1976). 2003 Feb 1;28(3):299-304
Publication Type
Article
Date
Feb-1-2003
Author
Mark Lemstra
W P Olszynski
Author Affiliation
College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Source
Spine (Phila Pa 1976). 2003 Feb 1;28(3):299-304
Date
Feb-1-2003
Language
English
Publication Type
Article
Keywords
Accidents, Occupational - economics - statistics & numerical data
Back Pain - economics - epidemiology - rehabilitation
Cohort Studies
Comorbidity
Disability Evaluation
Disease Management
Humans
Incidence
Industry - statistics & numerical data
Manipulation, Chiropractic - economics - utilization
Occupational Diseases - economics - epidemiology - rehabilitation
Occupational Health Services - economics - standards
Outcome Assessment (Health Care)
Physical Therapy Modalities - economics - utilization
Prospective Studies
Retrospective Studies
Saskatchewan - epidemiology
Survival Analysis
Workers' Compensation - economics - statistics & numerical data
Abstract
A retrospective and prospective cohort.
To compare the effectiveness of occupational intervention, early intervention, and standard care in the management of Worker's Compensation injury claims.
The current management of occupational back pain and work-related upper extremity disorders with either standard care or early intervention appears to be ineffective.
A retrospective cohort compared injury claim incidence, duration, and costs between one company with access to standard care and another similar company with access to early intervention. A prospective cohort looked at the effect of one company changing from standard care to occupational management in comparison with the control group with early intervention. Survival analysis was used to attempt to explain differences in injury claim duration.
Standard care resulted in lower injury claim incidence, duration, and costs than early intervention, whereas occupational management resulted in lower injury claim incidence, duration, and costs than standard care. The covariates of physical therapist involvement, chiropractor involvement, injury severity, and relationship between Worker's Compensation and the employer were associated with delayed time to claim closure in the company with access to early intervention with the most important covariate being physical therapist involvement (hazard rate ratio 19.88, 95% confidence interval 7.95-39.77). Only the covariate of injury severity was associated with delayed time to claim closure in the company with access to occupational management (hazard rate ratio 1.67, 95% confidence interval 1.05-27.20).
It is recommended that an occupational management approach, in comparison with standard care or early intervention, be considered for management of occupational injuries.
PubMed ID
12567037 View in PubMed
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The influence of a continuum of care model on the rehabilitation of compensation claimants with soft tissue disorders.

https://arctichealth.org/en/permalink/ahliterature159001
Source
Spine (Phila Pa 1976). 2007 Dec 1;32(25):2898-904
Publication Type
Article
Date
Dec-1-2007
Author
Brian Stephens
Douglas P Gross
Author Affiliation
Departments of Public Health Sciences, University of Alberta, Workers' Compensation Board Alberta Millard Health, Edmonton, Alberta, Canada.
Source
Spine (Phila Pa 1976). 2007 Dec 1;32(25):2898-904
Date
Dec-1-2007
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Case Management - economics
Chiropractic - economics
Continuity of Patient Care - economics
Contract Services - economics
Cost-Benefit Analysis
Decision Support Techniques
Disability Evaluation
Employment
Female
Health Care Costs
Humans
Male
Middle Aged
Musculoskeletal Diseases - economics - rehabilitation
Patient satisfaction
Physical Therapy Specialty - economics
Population Surveillance
Program Evaluation
Proportional Hazards Models
Questionnaires
Time Factors
Treatment Outcome
Workers' Compensation - economics
Abstract
Population-based before-and-after design with concurrent control group.
As continuums of care have been little studied, we evaluated the impact of the Workers' Compensation Board of Alberta (WCB-Alberta) model on sustained return to work, satisfaction with care, and cost.
Musculoskeletal conditions, such as back pain, continue to be leading causes of disability and work loss. From 1996 through 1997, the WCB-Alberta implemented a continuum of care model to guide rehabilitation service delivery for claimants with soft tissue injury. The model was designed as a decision-making tool to promote a consistent, evidence-based approach to care within the jurisdiction.
The model was implemented province-wide so the entire population of workers insured by the WCB-Alberta was studied. Data were extracted from the WCB-Alberta administrative database from 2 years before implementation (1994-1995) to 5 years after (1996-2000). An intervention group was created from patients filing soft tissue injury claims for the low back, ankle, knee, elbow, and shoulder. The comparison group was formed of workers experiencing fractures or other traumatic non-soft tissue injuries. Satisfaction was measured through surveys. Primary outcome was cumulative days receiving wage replacement benefits. Multivariable Cox regression was used to determine the model's effect.
Over the entire study period, 70,116 claimants filed soft tissue injury claims while 101,620 claimants experienced non-soft tissue injuries. Significant improvement was observed in intervention group return-to-work outcomes after model implementation (hazard ratio = 1.54). Median duration of benefits decreased from 13 to 8 days. Little change was seen in the control group's disability duration (median duration, consistently 10 days). The majority of claimants were satisfied with care received. Cost savings over a 2-year full implementation period was $21.5 million (Canadian).
Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery.
PubMed ID
18246015 View in PubMed
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[Medical treatment of back problems--10 times more expensive than treatment by chiropractors].

https://arctichealth.org/en/permalink/ahliterature224346
Source
Tidsskr Nor Laegeforen. 1992 Feb 10;112(4):526
Publication Type
Article
Date
Feb-10-1992
Author
O. Stokke
Source
Tidsskr Nor Laegeforen. 1992 Feb 10;112(4):526
Date
Feb-10-1992
Language
Norwegian
Publication Type
Article
Keywords
Back Pain - economics - therapy
Chiropractic - economics
Humans
Norway
PubMed ID
1532465 View in PubMed
Less detail

Modeling a chiropractor:population ratio.

https://arctichealth.org/en/permalink/ahliterature214385
Source
J Manipulative Physiol Ther. 1995 Sep;18(7):464-70
Publication Type
Article
Date
Sep-1995
Author
A R Grier
R. Lepnurm
Author Affiliation
Health Care Administration, University of Saskatchewan, Saskatoon, Canada.
Source
J Manipulative Physiol Ther. 1995 Sep;18(7):464-70
Date
Sep-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Chiropractic - economics - utilization
Demography
Female
Health Services Accessibility
Health services needs and demand
Humans
Male
Middle Aged
Models, Theoretical
Musculoskeletal Diseases - epidemiology - rehabilitation - therapy
Patient Selection
Saskatchewan
Abstract
As the cost of disability from musculoskeletal conditions increases, more attention needs to be directed toward the number of health care practitioners required to effectively treat these problems. This study describes a methodology to estimate the number of chiropractors needed to effectively serve a given population.
The data on the utilization of chiropractic services over time comes from the Saskatchewan Medical Care Insurance Branch.
A Medline search was performed using these key words: musculoskeletal, back pain, neck pain, headaches and prevalence. Chiropractic journals were reviewed for the analysis of the kinds of conditions treated by chiropractors.
Saskatchewan data shows a steady increase in the percentage of the population treated by chiropractors in response to an increase in the number of chiropractors. A regression function was defined using the number of chiropractors as the independent variable and the number of patients treated annually as the dependent variable, where all Saskatchewan patients with musculoskeletal conditions could be treated by chiropractors.
Of the general population, 36.1% annually suffer from some sort of musculoskeletal problem. In Saskatchewan, this means that 366,848 people could be treated by chiropractors if enough chiropractors were available. Saskatchewan needs 391 chiropractors to effectively serve the musculoskeletal problems of the general population. This is an ideal chiropractor:population ratio of 1:2,588. Health care policymakers should design incentives to channel the appropriate patients into chiropractic offices.
PubMed ID
8568429 View in PubMed
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One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.

https://arctichealth.org/en/permalink/ahliterature72490
Source
Spine. 1998 Sep 1;23(17):1875-83; discussion 1884
Publication Type
Article
Date
Sep-1-1998
Author
E I Skargren
P G Carlsson
B E Oberg
Author Affiliation
Department of Neuroscience and Locomotion: Physiotherapy, Faculty of Health Sciences, Linköping University, Sweden.
Source
Spine. 1998 Sep 1;23(17):1875-83; discussion 1884
Date
Sep-1-1998
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Chiropractic - economics - utilization
Comparative Study
Cost-Benefit Analysis
Direct Service Costs
Female
Follow-Up Studies
Humans
Low Back Pain - economics - psychology - therapy
Male
Middle Aged
Outcome Assessment (Health Care) - economics
Physical Therapy Modalities - economics - utilization
Prospective Studies
Quality of Life
Recurrence
Research Support, Non-U.S. Gov't
Sweden
Abstract
STUDY DESIGN: A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy as primary treatment for patients with back and neck pain, with special reference to subgroups, recurrence rate, and additional health care use at follow-up evaluation 12 months after treatment. SUMMARY OF BACKGROUND DATA: Earlier studies on the effect of spinal manipulation have shown inconsistent results. Mostly they include only short-term follow-up periods, and few cost-effectiveness analyses have been made. METHODS: A group of 323 patients aged 18-60 years who had no contraindications to manipulation and who had not been treated within the previous month were included. Outcome measures were changes in Oswestry scores, pain intensity, and general health; recurrence rate; and direct and indirect costs. RESULTS: No differences were detected in health improvement, costs, or recurrence rate between the two groups. According to Oswestry score, chiropractic was more favorable for patients with a current pain episode of less than 1 week (5%) and physiotherapy for patients with a current pain episode of greater than 1 month (6.8%). Nearly 60% of the patients reported two or more recurrences. More patients in the chiropractic group (59%) than in the physiotherapy group (41%) sought additional health care. Costs varied considerably among individuals and subgroups; the direct costs were lower for physiotherapy in a few subgroups. CONCLUSIONS: Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.
PubMed ID
9762745 View in PubMed
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17 records – page 1 of 2.