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Demographic and referral analysis of a free chiropractic clinic servicing ethnic minorities in the Buffalo, N.Y. area.
Gerald L. Stevens, DC, MS, MPH
Objective: The overall purpose of this study was to determine the characteristics of patients presenting to a free clinic in an ethnic poor neighborhood and how they came to find out about this clinic. The objective of this study was to collect and analyze the demographic and referral information of a free clinic.
Methods: Information was collected on patient age, race, sex, chief complaint, comorbidities, stages of care, zip code distribution, and referral source. The information collected was processed via Microsoft Excel (Microsoft Corp, Redmond, Wash.) and compared with other studies in the literature.
Results: The patient population (n = 256) was 65% (167) female and 35% (89) male. The race of most of the patients was African American (63%, 161). Lumbopelvic complaints were most common (57%, 147), followed by the neck (18%, 45) and thoracic complaints (7%, 17). Most conditions were chronic in nature (68%, 174), and most patients came from Buffalo zip codes (88%, 225) and/or were in poverty (78%, 199). Referrals were from patients (27%, 69), walk-ins (25%, 65), or the result of multiple marketing efforts (34%, 98).
Discussion: The low back/extremity chief complaints, number of female patients, and number of walk-ins to this free clinic were higher than expected when compared with other studies.
Conclusion: Most of the patient population seen at the Lighthouse Free Chiropractic Clinic was African American, female, from Buffalo, in poverty, and had lumbopelvic and/or chronic chief complaints. The largest number of referrals was from patients or walk-ins.
Collaborative community-based teaching clinics at the Canadian Memorial Chiropractic College: addressing the needs of local poor communities.
Deborah Kopansky-Giles, DC, Howard Vernon, DC, PhD, Igor Steiman, DC, MSc, Anthony Tibbles, DC, Phillip Decina, DC, Jarrod Goldin, DC, Maureen Kelly, MPA
Introduction: Inequities in access to health services, resulting from cuts in public sector budgets and inflation, greatly affect Canada's poorest and most vulnerable people. The purpose of this article is to describe the experiences of the community-based teaching clinics of the Canadian Memorial Chiropractic College (CMCC), located in the poor, inner city region of Toronto, where access to chiropractic care for this population has been enabled.
Discussion: Three chiropractic teaching clinics have been established in host facilities in the inner city community of Toronto. For over a decade, CMCC has had collaborative chiropractic clinics in the Sherbourne Health Centre (a southeast Toronto primary care facility), and Anishnawbe Health Toronto (an aboriginal health facility addressing the needs of urban First Nations people). For 3 years, we have been providing chiropractic services in the Department of Family and Community Medicine at St Michael's Hospital. The priority for these programs was the minimization of economic barriers to accessing care for poor and marginalized people. Outcomes have demonstrated high use when there is no economic barrier, excellent clinical outcomes and patient satisfaction, and a high level of collaboration with other health practitioners.
Conclusion: The CMCC's external clinics program has enabled access to chiropractic services to thousands of people living in the inner city and urban aboriginal communities of Toronto. This has resulted in the minimization of barriers to accessing care, the provision of appropriate and effective care, and collaboration. These clinics also greatly increase students' awareness of, sensitivity to, and commitment to being part of the solution to these problems.
Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects.
Mariana Ruiz-Sáez, PT, DO, César Fernández-de-las-Peñas, PT, PhD, Cleofás Rodríguez Blanco, PT, DO, Raquel Martínez-Segura, PT, DO, Rafael García-León, PT, DO
Objective: This study analyzed the immediate effects on pressure pain threshold (PPT) in latent myofascial trigger points (MTrPs) in the upper trapezius muscle of a single cervical spine manipulation directed at the C3 through C4 level.
Methods: Seventy-two volunteers (27 men and 46 women; mean age, 31 years; SD, 10 years) participated in this study. Subjects underwent a screening process to establish both the presence of MTrPs in the upper trapezius muscle as described by Simons, et al. (Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 2., 3rd ed. Baltimore: Williams & Wilkins, 1999. p. 23-34) and the presence of intervertebral joint dysfunction at the C3 through C4 level by the lateral gliding test for the cervical spine. Subjects were divided randomly into two groups: manipulative group, which received a cervical spine manipulation directed at the C3 through C4 level, and a placebo group, which received a sham manual procedure. The outcome measure was the PPT on the MTrP in the upper trapezius muscle ipsilateral to the side of the joint dysfunction, which was assessed pretreatment and 1, 5, and 10 minutes post-treatment by an assessor blinded to the treatment allocation of the subject.
Results: The analysis of variance showed a significant effect for time (F = 5.157; P = .02) but not for side (F = 0.234; P = .63). Furthermore, an interaction between group and time was also found (F = 37.240; P < .001). The experimental group showed a trend toward an increase in PPT levels after the manipulative procedure, whereas the control group showed a trend toward a decrease in PPT. Positive within-group effect sizes ranging from medium to small were found in the manipulative group (0.1 < d < 0.5), whereas negative within-group effect sizes ranging from large to medium were found in the placebo group (0.3 < d < 1).
Conclusions: Our results suggest that a cervical spine manipulation directed at the C3 through C4 segment induced changes in pressure pain sensitivity in latent MTrPs in the upper trapezius muscle. Different therapeutic mechanisms, either segmental or central, may be involved at the same time.
Importance of strain direction in regulating human fibroblast proliferation and cytokine secretion: a useful in vitro model for soft-tissue injury and manual medicine treatments.
Thomas S. Eagan, BS, Kate R. Meltzer, MS, Paul R. Standley, PhD
Objective: Manual medicine treatments (MMTs) rely on biophysical techniques that use manually guided forces in numerous strain directions to treat injuries and somatic dysfunctions. Although clinical outcomes post-MMT are positive, the underlying cellular mechanisms responsible remain elusive. We previously described an in vitro model of strain-induced tissue injury and MMTs. Using this model, the current study sought to determine if strain direction (equibiaxial [EQUI] vs. heterobiaxial [HETERO]) differentially regulates human fibroblast function.
Methods: Fibroblasts were strained EQUI at 10% beyond their resting length for 48 hours followed by assessment of cell morphology, proliferation, and cytokine secretion via protein cytokine array and enzyme-linked immunosorbent assay (ELISA). These observations were then compared with those obtained previously for HETERO fibroblasts.
Results: No alterations in cell morphology were seen in EQUI fibroblasts despite our report of such changes in HETERO cells. Fibroblasts secretion profiles for 60 cytokines (via cytokine protein array) showed that in EQUI strained cells, fractalkine significantly increased (121%), whereas macrophage-derived chemoattractant/chemokine and pulmonary and activation-regulated chemokine significantly decreased (32% and 10%, respectively) compared with nonstrained cells (P < .05). The EQUI fibroblasts when compared with HETERO fibroblasts exhibited a significant decrease in proliferation (22%), inflammatory interleukin 6 secretion (75%, measured by ELISA), and macrophage-derived chemoattractant/chemokine secretion (177%, measured by ELISA, P < .05).
Conclusions: These divergent observations in HETERO vs. EQUI strained fibroblasts may underlie the relative efficacies of MMTs carried out in different tissue strain directions. We are currently modeling MMTs such as myofascial release to further investigate this.
Behavioral and access barriers to seeking chiro-practic care: a study of three New York clinics.
Gerald L. Stevens, DC, MS, MPH
Objective: The overall objectives of this study are threefold: (1) attempt to identify the behavioral and access barriers and their resultant delay to seeking chiropractic care; (2) determine which type of delay is most common in different populations and the variables related to this delay; (3) obtain demographic information on patient populations.
Methods: A 16-question survey was administered to new patients at the Depew Health Center, Lighthouse Free Chiropractic Clinic, and University of Buffalo Student Clinic. The data were entered in Microsoft Excel 2003 and analyzed via SPSS 14.0 for Windows.
Results: A total of 240 surveys were collected and showed that the referral source, severity, home treatments, belief of discomfort, and effectiveness did not affect delay in care. Transportation, cost, insurance, and belief symptoms would resolve increased delay in care.
Discussion: The three populations analyzed were demographically different. Access barriers and hope of symptom resolution increased delay in seeking chiropractic care.
Conclusion: In this study, access barriers and hope of symptom resolution increased delay in seeking chiropractic care. Utilization delay and appraisal delay appeared to increase treatment time. Demographic characteristics of the various populations were significantly different and only younger age decreased delay in seeking chiropractic care. Condition variables had no effect in increasing or decreasing delay in seeking chiropractic care in this study.
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