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Long-Term Effects of Infant Colic: Survey Comparison of Chiropractic Treatment & Nontreatment Groups
Joyce Miller, DC, Holly Lane Phillips, MChiro
Objective: Investigation into the alleviation of long-term effects of infant colic on the toddler is a neglected area of research. The aim of this study was to document any behavioral or sleep disturbances experienced by post-colicky toddlers who were previously treated with chiropractic care vs. those who had not experienced this treatment as an infant
Methods: Two groups of children were sampled from clinic records from a chiropractic clinic and from a child care center in similar regions of England. Patients were classified in the treatment group if they had been treated for infant colic with routine low-force chiropractic manual therapy. The nontreatment group consisted of post-colicky children in the same age group who had received no chiropractic care for their diagnosed colic as infants. A survey of parents of 117 post-colicky toddlers in a treatment group and 111 toddlers in the nontreatment group was performed.
Results: Toddlers who were treated with chiropractic care for colic were twice as likely to not experience long-term sequelae of infant colic, such as temper tantrums (relative risk, 2.0; 95% confidence interval, 1.3-3.0) and frequent nocturnal waking (relative risk, 2.0; 95% confidence interval, 1.5-2.8) than those who were not treated with chiropractic care as colicky infants.
Conclusion: Untreated post-colicky infants demonstrated negative behavioral patterns at 2 to 3 years of age. In this study, parents of infants treated with chiropractic care for excessive crying did not report as many difficult behavioral and sleep patterns of their toddlers. These findings suggest that chiropractic care for infants with colic may have an effect on long-term sequelae.
Best Practices Recommendations for Chiropractic Care for Infants, Children and Adolescents
Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD, Randy Ferrance, DC, MD, Elise Hewitt, DC, et al.
Objective: There has been much discussion about the role of chiropractic care in the evaluation, management, and treatment of pediatric patients. To date, no specific guidelines have been adopted that address this issue from an evidence-based perspective. Previous systematic reviews of the chiropractic literature concluded that there is not yet a substantial body of high-quality evidence from which to develop standard clinical guidelines. The purpose of this project was to develop recommendations on "best practices" related primarily to the evaluation and spinal manipulation aspects of pediatric chiropractic care; nonmanipulative therapies were not addressed in detail.
Methods: Based on both clinical experience and the results of an extensive literature search, a set of seed documents was compiled to inform development of the seed statements. These were circulated electronically to the Delphi panel until consensus was reached, which was considered to be present when there was agreement by at least 80% of the panelists.
Results: A multidisciplinary panel of 37 was made up primarily of doctors of chiropractic with a mean of 18 years in practice, many with postgraduate training in pediatrics. The panel represented five countries and 17 states; there were members of the American Chiropractic Association, the International Chiropractors Association, and the International Chiropractic Pediatric Association. The panel reached a minimum of 80% consensus on the 51 seed statements after four rounds.
Conclusions: A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to clinical evaluation, management, and manual treatment for pediatric patients, based on both scientific evidence and clinical experience.
Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule
Donald Murphy, DC, Eric Hurwitz, DC, PhD, Ericka McGovern, DC
Objective: The purpose of this study was to describe the clinical outcomes of patients with pregnancy-related lumbopelvic pain (PRLP) treated according to a diagnosis-based clinical decision rule.
Methods: This was a prospective observational cohort of consecutive patients with PRLP. Data on 115 patients were collected at baseline and on 78 patients at the end of the active treatment. Disability was measured using the Bournemouth Disability Questionnaire (BDQ). Pain intensity was measured using the Numerical Rating Scale for pain (NRS). Patients were also asked to self-rate their improvement. Care was provided by a chiropractic physician/physical therapist team.
Results: Fifty-seven patients (73%) reported their improvement as either "excellent" or "good." The mean patient-rated improvement was 61.5%. The mean improvement in BDQ was 17.8 points. The mean percentage of improvement in BDQ was 39% and the median was 48%. Mean improvement in pain was 2.9 points. Fifty-one percent of the patients had experienced clinically significant improvement in disability and 67% patients had experienced clinically significant improvement in pain. Patients were seen an average of 6.8 visits.
Follow-up data for an average of 11 months after the end of treatment were collected on 61 patients. Upon follow-up, 85.5% of patients rated their improvement as either "excellent" or "good." The mean patient-rated improvement was 83.2%. The mean improvement in BDQ was 28.1 points. The mean percentage of improvement in BDQ was 68% and the median was 87.5%. Mean improvement in pain was 3.5 points. Seventy-three percent of the patients had experienced clinically significant improvement in disability and 82% patients had experienced clinically significant improvement in pain.
Conclusions: The management strategy used in this study appeared to yield favorable outcomes in this patient population and appears to be a safe option for patients with PRLP, although because of this study's sample size, rare complications are not likely to be detected. In addition, the absence of randomization and a control group limits interpretation with regard to clinical effectiveness. Randomized, controlled trials are necessary to distinguish treatment effects from the natural history of PRLP.
Recurrent Neck Pain and Headaches Associated With Mechanical Dysfunction of the Cervical Spine
Sue Weber Hellstenius, DC, MSc
Objective: To identify if there were differences in the cervical biomechanics in preadolescents who had recurrent neck pain and/or headaches and those who did not.
Methods: A controlled comparison study with a convenience sample of 131 students (10-13 years old) was performed. A questionnaire placed students in the no-pain group or in the neck pain/headache group. A physical examination was performed by a doctor of chiropractic to establish head posture, active cervical rotation, passive cervical joint functioning, and muscle impairment. The unpaired t test and the X2 test were used to test for differences between the two groups, and data were analyzed using SPSS 15 (SPSS Inc, Chicago, Ill.).
Results: Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.
Conclusion: In this study, the physical examination findings between preadolescents with neck pain and/or headaches and those who were symptom-free differed significantly in one of the parameters measured. Cervical joint dysfunction was a significant finding among those preadolescents complaining of neck pain and/or headache as compared to those who did not.
Contribution of Chiropractic Therapy to Resolving Suboptimal Breast-Feeding
Joyce miller, DC, Laura Miller, Ann-Kristin Sulesund, Andriy Yevtushenko
Objective: The purpose of this study was to describe the circumstances, clinical features, role, and results of chiropractic management of infants who were referred to a chiropractic clinic for failure to adequately feed at the breast.
Methods: Clinical case series of 114 infant cases of hospital-diagnosed or lactation consultant diagnosed feeding problems that were treated with chiropractic therapy in addition to routine care and followed to short-term result.
Results: The most common age of referral was 1 week (mean 3 weeks; range, 2 days to 12 weeks), and the most common physical findings were cervical posterior joint dysfunction (89%), temporomandibular joint imbalance (36%), and inadequate suck reflex (34%). Treatment was chiropractic therapy in addition to any support given elsewhere. All children showed some improvement with 78% (N = 89) being able to exclusively breast-feed after two to five treatments within a two-week time period.
Conclusion: Cooperative multidisciplinary care to support breast-feeding was demonstrated in this population. Chiropractic treatment may be a useful adjunct to routine care given by other professionals in cases of diagnosed breast-feeding problems with a biomechanical component.
Developmental-Delay Syndromes: Psychometric Testing Before and After Chiropractic Treatment
Scott Cuthbert, DC, Michel Barras, DC
Objective: This study presents a case series of 157 children with developmental delay syndromes, including the conditions such as dyspraxia, dyslexia, attention-deficit hyperactivity disorder, and learning disabilities who received chiropractic care.
Clinical Features: A consecutive sample of 157 children ages 6 to 13 years (86 boys and 71 girls) with difficulties in reading, learning, social interaction, and school performance who met these inclusion criteria were included.
Intervention and Outcomes: Each patient received a multimodal chiropractic treatment protocol, applied kinesiology chiropractic technique. The outcome measures were a series of eight standardized psychometric tests given to the children by a certified speech therapist pre- and posttreatment, which evaluate 20 separate areas of cognitive function, including patient- or parent-reported improvements in school performance, social interaction, and sporting activities. Individual and group data showed that at the end of treatment, the 157 children showed improvements in the eight psychometric tests and 20 areas of cognitive function compared with their values before treatment. Their ability to concentrate, maintain focus and attention, and control impulsivity and their performance at home and school improved.
Conclusions: This report suggests that a multimodal chiropractic method that assesses and treats motor dysfunction reduced symptoms and enhanced the cognitive performance in this group of children.
JMPT abstracts appear in DC with permission from the journal. Due to space restrictions, we cannot always print all abstracts from a given issue. Visit www.journals.elsevierhealth.com/periodicals/ymmt for access to the complete October 2009 issue of JMPT.