1. J Hum Hypertens. 2007 May;21(5):347-52. Epub 2007 Mar 2.
Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.
Bakris G1, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B.
1Department of Preventive Medicine, Rush University Hypertension Center, Chicago, IL, USA. firstname.lastname@example.org
Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution. [J Hum Hypertens. 2007] Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution.Grassi G. J Hum Hypertens. 2007 May; 21(5):341-2. Epub 2007 Jan 25.
Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naïve (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.1. J Manipulative Physiol Ther. 2007 May;30(4):263-9.
Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update.
Sarnat RL1, Winterstein J, Cambron JA.
1Alternative Medicine Integration Group, LP, Highland Park, Ill 60035, USA. email@example.com <firstname.lastname@example.org>
Our initial report analyzed 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 and includes first-time comparisons in data points among PCPs of different licensures who were oriented toward complementary and alternative medicine (CAM).
Independent physician association-incurred claims and stratified random patient surveys were descriptively analyzed for clinical utilization, cost offsets, and member satisfaction compared with conventional medical IPA normative values. Comparisons to our original publication’s comparative blinded data, using nonrandom matched comparison groups, were descriptively analyzed for differences in age/sex demographics and disease profiles to examine sample bias.
Clinical and cost utilization 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.
During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure. The validity and generalizability of this observation are guarded given the lack of randomization, lack of statistical analysis possible, and potentially biased data in this population
1. J Altern Complement Med. 2011 Jan;17(1):39-44. doi: 10.1089/acm.2010.0113. Epub 2011 Jan 3.
Evaluation of a standardized wellness protocol to improve anthropometric and physiologic function and to reduce health risk factors: A retrospective analysis of outcome.
Division of Clinical Sciences, Life University-College of Chiropractic, Marietta, GA 30060, USA. email@example.com
The objective of this study was to determine whether a standardized, commercial wellness protocol (Creating Wellness) that focuses on diet, exercise, vitamin supplementation, and one-on-one coaching improves anthropometric and physiologic function and reduces health risk factors.
Using a retrospective analysis of subject data collected through a central data repository, several measures of anthropometric and physiologic function were analyzed for changes in outcome.
There were 197 private chiropractic clinics in the United States utilizing the Creating Wellness protocol in 2007. A total of 178 subjects completed an 18-week protocol and had initial and final assessments. All anthropometric and physiologic measures showed improvement following the intervention; therefore, this standardized wellness protocol was shown to improve weight, heart rate, blood pressure, strength, body-mass index, and forced vital capacity. Paired sample t tests and significance testing for the entire sample, and for both genders separately, determined that these changes were statistically significant.
The Creating Wellness protocol leads to improved health risk factor outcomes based on improvement in anthropometric and physiologic measures in this study population. The results of these tests are generally accepted measures of risk for cardiovascular events, diabetes, metabolic syndrome, and cancer. There are little evaluative data on health outcomes related to programs designed to reduce risk of lifestyle-related diseases. For those clients utilizing the program evaluated in this study, there appears to be evidence suggesting improved health risk factor outcomes from participation in this specific protocol. The results of this study have implications related to a broad number of public health issues related to management of chronic lifestyle diseases
1. Spine (Phila Pa 1976). 2013 May 15;38(11):953-64. doi: 10.1097/BRS.0b013e3182814ed5.
Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.
Keeney BJ1, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM.
1Department of Orthopaedics, Geisel School of Medicine at Dartmouth College, Lebanon, NH 03756, USA. Benjamin.J.Keeney@Dartmouth.edu
Prospective population-based cohort study.
To identify early predictors of lumbar spine surgery within 3 years after occupational back injury.
SUMMARY OF BACKGROUND DATA:
Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury.
Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model’s ability to identify correctly workers who underwent surgery.
In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery.
Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury even after adjustment for other important variables.PMID: 23238486 [PubMed – indexed for MEDLINE]