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Journal ArticleDOI

Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study

01 Jul 2014-Chiropractic & Manual Therapies (BioMed Central)-Vol. 22, Iss: 1, pp 24-24
TL;DR: There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM - providing evidence that neck manipulation has a mechanical effect at segmental levels, however, patient-reported outcomes were not related to this.
Abstract: Background: Spinal manipulation for nonspecific neck pain is thought to work in part by improving inter-vertebral range of motion (IV-RoM), but it is difficult to measure this or determine whether it is related to clinical outcomes. Objectives: This study undertook to determine whether cervical spine flexion and extension IV-RoM increases after a course of spinal manipulation, to explore relationships between any IV-RoM increases and clinical outcomes and to compare palpation with objective measurement in the detection of hypo-mobile segments. Method: Thirty patients with nonspecific neck pain and 30 healthy controls matched for age and gender received quantitative fluoroscopy (QF) screenings to measure flexion and extension IV-RoM (C1-C6) at baseline and 4-week follow-up between September 2012-13. Patients received up to 12 neck manipulations and completed NRS, NDI and Euroqol 5D-5L at baseline, plus PGIC and satisfaction questionnaires at follow-up. IV-RoM accuracy, repeatability and hypo-mobility cut-offs were determined. Minimal detectable changes (MDC) over 4 weeks were calculated from controls. Patients and control IV-RoMs were compared at baseline as well as changes in patients over 4 weeks. Correlations between outcomes and the number of manipulations received and the agreement (Kappa) between palpated and QF-detected of hypo-mobile segments were calculated. Results: QF had high accuracy (worst RMS error 0.5o) and repeatability (highest SEM 1.1o, lowest ICC 0.90) for IV-RoM measurement. Hypo-mobility cut offs ranged from 0.8o to 3.5o. No outcome was significantly correlated with increased IV-RoM above MDC and there was no significant difference between the number of hypo-mobile segments in patients and controls at baseline or significant increases in IV-RoMs in patients. However, there was a modest and significant correlation between the number of manipulations received and the number of levels and directions whose IV-RoM increased beyond MDC (Rho=0.39, p=0.043). There was also no agreement between palpation and QF in identifying hypo-mobile segments (Kappa 0.04-0.06). Conclusions: This study found no differences in cervical sagittal IV-RoM between patients with non-specific neck pain and matched controls. There was a modest dose-response relationship between the number of manipulations given and number of levels increasing IV-RoM - providing evidence that neck manipulation has a mechanical effect at segmental levels. However, patient-reported outcomes were not related to this.

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Journal ArticleDOI
TL;DR: Some types of mobilizations probably produce an immediate and short-term, statistically significant increase in skin sympathetic nerve activity when compared to a sham procedure, whereas spinal SNAGs and spinal HVLA techniques may have no acute effect on the studied markers of ANS activity.
Abstract: The autonomic nervous system (ANS) interests many chiropractors and manual therapists, because joint manipulative techniques (JMT), e.g. high velocity low amplitude (HVLA) manipulations and mobilizations, appear to produce acute changes in ANS mediated physiology. The complexity of this issue justifies a systematic critical literature review. To review the literature comparing the acute changes in markers of ANS activity between JMT applied on spinal or peripheral joints and a sham procedure in healthy or symptomatic subjects. We searched PsycINFO, PEDro, PubMed, Cochrane library, EMBASE, and Medline up to December 2017. We updated the search with PubMed, Cochrane library, EMBASE, and Medline including July 2018. Inclusion criteria were: randomized sham-controlled trials assessing the effect of JMT on markers of ANS activity; manually applied JMT, regardless of technique, applied on either healthy or symptomatic humans; outcome measurements recorded at baseline and repeated during and/or after interventions. Selection of articles and data extraction were performed independently by two reviewers. The quality of studies was assessed using the Cochrane ‘risk of bias’ tool and a technical check-list. Results were reported narratively with some meta-analyses. The Cochrane GRADE approach was used to assess the certainty of evidence. Twenty-nine of 2267 studies were included in the synthesis. Mobilizations (oscillatory technique) probably produce an immediate and short-term, bilateral increase in skin sympathetic nerve activity (reflected by an increase in skin conductance) regardless of the area treated (moderate-certainty evidence). It is uncertain whether the sympathetic arousal also explains an increase in respiratory rate (very low-certainty evidence). Our evaluation of the literature suggests that spinal sustained apophyseal glides (SNAGs) mobilization and HVLA manipulation of the spine may have no acute effect on the studied markers of ANS activity (very low- to low-certainty evidence). Some types of mobilizations probably produce an immediate and short-term, statistically significant increase in skin sympathetic nerve activity when compared to a sham procedure, whereas spinal SNAGs and spinal HVLA techniques may have no acute effect on the studied markers of ANS activity. No region-specific results were noted. The literature suffers from several shortcomings, for which reason we strongly suggest further research.

26 citations

Journal ArticleDOI
TL;DR: This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers and there was no significant change in lordosis in patients after 4 weeks of cervical spinal manipulation.
Abstract: The association between cervical lordosis (sagittal alignment) and neck pain is controversial. Further, it is unclear whether spinal manipulative therapy can change cervical lordosis. This study aimed to determine whether cervical lordosis changes after a course of spinal manipulation for non-specific neck pain. Posterior tangents of C2 and C6 were drawn on the lateral cervical fluoroscopic images of 29 patients with subacute/chronic non-specific neck pain and 30 healthy volunteers matched for age and gender, recruited August 2011 to April 2013. The resultant angle was measured using ‘Image J’ digital geometric software. The intra-observer repeatability (measurement error and reliability) and intra-subject repeatability (minimum detectable change (MDC) over 4 weeks) were determined in healthy volunteers. A comparison of cervical lordosis was made between patients and healthy volunteers at baseline. Change in lordosis between baseline and 4-week follow-up was determined in patients receiving spinal manipulation. Intra-observer measurement error for cervical lordosis was acceptable (SEM 3.6°) and reliability was substantial ICC 0.98, 95 % CI 0.962–0991). The intra-subject MDC however, was large (13.5°). There was no significant difference between lordotic angles in patients and healthy volunteers (p = 0.16). The mean cervical lordotic increase over 4 weeks in patients was 2.1° (9.2) which was not significant (p = 0.12). This study found no difference in cervical lordosis (sagittal alignment) between patients with mild non-specific neck pain and matched healthy volunteers. Furthermore, there was no significant change in cervical lordosis in patients after 4 weeks of cervical spinal manipulation.

18 citations


Cites background from "Does inter-vertebral range of motio..."

  • ...Seven patients reported using hot or cold packs during the study period, and 18 used over the counter pain-relieving medication [22]....

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  • ...spective cohort study [22] (the ‘parent study’) investigating the effect of spinal manipulation on inter-vertebral...

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Journal ArticleDOI
TL;DR: The results suggest that a single SM of the thoracic spine has no specific effect on cardiovascular autonomic activity and the relationship between autonomic outcomes and pressure pain threshold after the SM is found.
Abstract: The autonomic nervous system interacts with the pain system. Knowledge on the effects of high velocity low amplitude spinal manipulations (SM) on autonomic activity and experimentally induced pain is limited. In particular, the effects of SM on autonomic activity and pain beyond the immediate post intervention period as well as the relationship between these two outcomes are understudied. Thus, new research is needed to provide further insight on this issue. The aim was to assess the effect of a single SM (i.e. SM vs. sham) on cardiovascular autonomic activity. Also, we assessed the relationship between cardiovascular autonomic activity and level of pain threshold after the interventions. We conducted a randomized, cross-over, sham-controlled trial on healthy first-year chiropractic students comprising two experimental sessions separated by 48 h. During each session, subjects received, in a random order, either a thoracic SM or a sham manipulation. Cardiovascular autonomic activity was assessed using heart rate and systolic blood pressure variabilities. Pain sensitivity was assessed using pressure pain threshold. Measurements were performed at baseline and repeated three times (every 12 min) during the post intervention period. Participants and outcome assessors were blinded. The effect of the SM was tested with linear mixed models. The relationship between autonomic outcomes and pressure pain threshold was tested with bivariate correlations. Fifty-one participants were included, forty-one were finally analyzed. We found no statistically significant difference between SM and sham in cardiovascular autonomic activity post intervention. Similarly, we found no post-intervention relationship between cardiovascular autonomic activity and pressure pain threshold. Our results suggest that a single SM of the thoracic spine has no specific effect on cardiovascular autonomic activity. Also, we found no relationship between cardiovascular autonomic activity and pressure pain threshold after the SM. Further experimental research should consider the use of several markers of autonomic activity and a more comprehensive pain assessment. N° NCT03273868. Registered September 6, 2017.

15 citations


Cites background from "Does inter-vertebral range of motio..."

  • ...For instance, the effects of spinal manipulative techniques have been explored using biomechanical [5, 6] and neurophysiological outcomes, in the latter case studying e....

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Journal ArticleDOI
TL;DR: Quantitative fluoroscopy was found to have a high level of accuracy and with a few exceptions, moderate to substantial repeatability for the measurement of translation and FCR from fluoroscopic motion sequences.

13 citations

Journal ArticleDOI
TL;DR: This is the first report of quantified anti-directional cervical flexion and extension motion and it document that large proportions of anti- Directional cervical Flexion and Extension motions were normal.

13 citations


Cites background from "Does inter-vertebral range of motio..."

  • ...Comparing ratios of anti-directional joint motion of joints between flexion and extension showed there was a significant interaction between movement and joints (Mixed ANOVA: F [6, 119] = 8....

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  • ...Video-fluoroscopy has previously been reported reliable for in vivo investigation of spine kinematics [4,6,24]....

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  • ...Cervical anti-directional motion Anti-directional joint motions have previous been reported for cervical joints; however the reports have not given quantified descriptions [6,10,12]....

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  • ...anti- and pro-directional motions (ANOVA: F [6, 119] = 10....

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  • ...The upper cervical joints (C0/C1, C1/C2, C2/C3) showed higher ratios of antidirectional motions compared with lower cervical joints (C4/C5, C5/C6, and C6/C7) (ANOVA: F [6, 119] = 14....

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References
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Journal ArticleDOI
Jacob Cohen1
TL;DR: In this article, the authors present a procedure for having two or more judges independently categorize a sample of units and determine the degree, significance, and significance of the units. But they do not discuss the extent to which these judgments are reproducible, i.e., reliable.
Abstract: CONSIDER Table 1. It represents in its formal characteristics a situation which arises in the clinical-social-personality areas of psychology, where it frequently occurs that the only useful level of measurement obtainable is nominal scaling (Stevens, 1951, pp. 2526), i.e. placement in a set of k unordered categories. Because the categorizing of the units is a consequence of some complex judgment process performed by a &dquo;two-legged meter&dquo; (Stevens, 1958), it becomes important to determine the extent to which these judgments are reproducible, i.e., reliable. The procedure which suggests itself is that of having two (or more) judges independently categorize a sample of units and determine the degree, significance, and

34,965 citations


"Does inter-vertebral range of motio..." refers methods in this paper

  • ...Analysis of proportions of dichotomous variables was by 2-way Fisher Exact tests for comparison of cohorts and by Cohen’s Kappa statistic [41] for agreement between palpated and measured hypo-mobility....

    [...]

Book
01 Jan 2000
TL;DR: Suitable for those new to statistics as well as students on intermediate and more advanced courses, the book walks students through from basic to advanced level concepts, all the while reinforcing knowledge through the use of SAS(R).
Abstract: Hot on the heels of the 3rd edition of Andy Field's award-winning Discovering Statistics Using SPSS comes this brand new version for students using SAS(R). Andy has teamed up with a co-author, Jeremy Miles, to adapt the book with all the most up-to-date commands and programming language from SAS(R) 9.2. If you're using SAS(R), this is the only book on statistics that you will need! The book provides a comprehensive collection of statistical methods, tests and procedures, covering everything you're likely to need to know for your course, all presented in Andy's accessible and humourous writing style. Suitable for those new to statistics as well as students on intermediate and more advanced courses, the book walks students through from basic to advanced level concepts, all the while reinforcing knowledge through the use of SAS(R). A 'cast of characters' supports the learning process throughout the book, from providing tips on how to enter data in SAS(R) properly to testing knowledge covered in chapters interactively, and 'real world' and invented examples illustrate the concepts and make the techniques come alive. The book's companion website (see link above) provides students with a wide range of invented and real published research datasets. Lecturers can find multiple choice questions and PowerPoint slides for each chapter to support their teaching.

25,020 citations


"Does inter-vertebral range of motio..." refers background in this paper

  • ...A sample size of 30 participants in each group would allow adequate opportunity for normal distributions of interval data if present [24] with a realistic recruitment target given the time and resources available....

    [...]

Journal ArticleDOI
TL;DR: In this article, the authors present guidelines for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges, and the confidence intervals for each of the forms are reviewed.
Abstract: Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among six different forms of the intraclass correlation for reliability studies in which n target are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability and the application to be made of the reliability results. Confidence intervals for each of the forms are reviewed.

21,185 citations


"Does inter-vertebral range of motio..." refers methods in this paper

  • ...Agreement was calculated for both tests as standard errors of measurement (SEM) [33] and intraclass correlation coefficients (ICC 2C,1 and 3C,1) for reliability [34]....

    [...]

Journal ArticleDOI
TL;DR: A 5-level version of the EQ-5D has been developed by the EuroQol Group and further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
Abstract: This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument's sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording 'slight-moderate-severe' problems, with anchors of 'no problems' and 'unable to do' in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

5,345 citations


"Does inter-vertebral range of motio..." refers methods in this paper

  • ...Patients completed an 11-point numerical rating scale for pain (NRS), the Neck Disability Index (NDI) [26], and the EuroQol EQ-5 L [27]....

    [...]

Journal ArticleDOI
01 Nov 2001-Pain
TL;DR: Using a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies, and the application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies.
Abstract: Pain intensity is frequently measured on an 11-point pain intensity numerical rating scale (PI-NRS), where 0=no pain and 10=worst possible pain. However, it is difficult to interpret the clinical importance of changes from baseline on this scale (such as a 1- or 2-point change). To date, there are no data driven estimates for clinically important differences in pain intensity scales used for chronic pain studies. We have estimated a clinically important difference on this scale by relating it to global assessments of change in multiple studies of chronic pain. Data on 2724 subjects from 10 recently completed placebo-controlled clinical trials of pregabalin in diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and osteoarthritis were used. The studies had similar designs and measurement instruments, including the PI-NRS, collected in a daily diary, and the standard seven-point patient global impression of change (PGIC), collected at the endpoint. The changes in the PI-NRS from baseline to the endpoint were compared to the PGIC for each subject. Categories of "much improved" and "very much improved" were used as determinants of a clinically important difference and the relationship to the PI-NRS was explored using graphs, box plots, and sensitivity/specificity analyses. A consistent relationship between the change in PI-NRS and the PGIC was demonstrated regardless of study, disease type, age, sex, study result, or treatment group. On average, a reduction of approximately two points or a reduction of approximately 30% in the PI-NRS represented a clinically important difference. The relationship between percent change and the PGIC was also consistent regardless of baseline pain, while higher baseline scores required larger raw changes to represent a clinically important difference. The application of these results to future studies may provide a standard definition of clinically important improvement in clinical trials of chronic pain therapies. Use of a standard outcome across chronic pain studies would greatly enhance the comparability, validity, and clinical applicability of these studies.

4,568 citations