RESUMEN

OBJECTIVE: The aim of the study was to compare the clinical outcomes of 2 approaches to chiropractic care for patients with chronic musculoskeletal pain. Included were the approach most commonly used by doctors of chiropractic (diversified technique spinal manipulation) and a nonmanipulative mind-body approach (Bioenergetic Synchronization Technique). This clinical experiment tested the null hypothesis that there is no clinically or statistically significant difference in effect between the 2 approaches. METHODS: The study was conducted in the research clinic of the Parker College of Chiropractic. Patients were initially recruited by contacting a previously developed pool used for studies related to fall prevention in the elderly. Eighty-one patients (74 females; median age, 66 years) were enrolled and 78 (96%) completed the study. The primary end point was the end of a 3-week nontreatment interval after a 4-week treatment period. An intention-to-treat analysis was used; all patients who completed assessments were included whether or not they were compliant with the treatment protocol. A sample size of 55 per group was estimated to be necessary to detect a clinically significant (6-point) between-group difference in the Pain Disability Index (PDI). The primary outcome, the mean between-group difference between PDI scores at visit 1 and the exit visit, was tested with a 2-tailed t test for independent samples. RESULTS: Mean improvements in the PDI from visit 1 to the exit visit were 6.9 points in the Bioenergetic Synchronization Technique group (n = 40) and 6.4 in the diversified technique group (n = 38); the between-groups difference was not statistically or clinically significant (95% confidence interval, -4.7 to 5.8). CONCLUSIONS: For this particular group of patients, both groups demonstrated similar improvement scores on the PDI; the study's null hypothesis was not rejected.

Asunto(s)

Quiropráctica/métodos , Manipulación Espinal , Terapias Mente-Cuerpo , Sistema Musculoesquelético/fisiopatología , Manejo del Dolor , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dimensión del Dolor , Cooperación del Paciente , Satisfacción del Paciente , Resultado del Tratamiento

RESUMEN

BACKGROUND: Falls are a major health concern for older adults and their impact is a significant public health problem. The chief modifiable risk factors for falls in community-dwellers are psychotropic drugs, polypharmacy, environmental hazards, poor vision, lower extremity impairments, and balance impairments. This study focused on balance impairments. Its purpose was to assess the feasibility of recruiting older adults with possible balance problems for research conducted at a chiropractic research center, and to explore the utility of several widely used balance instruments for future studies of the effect of chiropractic care on balance in older adults. METHODS: This descriptive study was conducted from September through December 2004. Participants were recruited through a variety of outreach methods, and all were provided with an educational intervention. Data were collected at each of two visits through questionnaires, interviews, and physical examinations. Balance was assessed on both visits using the Activities-specific Balance Confidence Scale (ABCS), the Berg Balance Scale (BBS), and the One Leg Standing Test (OLST). RESULTS: A total of 101 participants enrolled in the study. Advertising in the local senior newspaper was the most effective method of recruitment (46%). The majority of our participants were white (86%) females (67%). About one third (32%) of participants had a baseline BBS score below 46, the cut-off point for predicting risk of falling. A mean improvement in BBS scores of 1.7 points was observed on the second visit. For the subgroup with baseline scores below 46, the mean change was 4.5 points, but the group mean remained below 46 (42.5). CONCLUSION: Recruitment of community-dwelling seniors for fall-related research conducted at a chiropractic research center appears feasible, and the most successful recruitment strategies for this center appeared to be a combination of targeted newspaper ads and personal contact through senior centers. The BBS and OLST appear to be promising screening and assessment instruments, which might have utility in future investigations of the possible effects of chiropractic care on balance.