| Acute neck pain (ANP) is a common condition that | | | | ultrasound, massage (most commonly used), heat, |
| has been shown in some studies to affect over 40% | | | | electrical stimulation, and cryotherapy. Soft tissue |
| of the population. Accordingly, many Chiropractors | | | | techniques (e.g., trigger point therapy) were also |
| treat patients with this condition, even though there | | | | commonly used. Further, advice about activities of |
| is little research evidence to support it. It should be | | | | daily living was given to the majority of patients, |
| noted, however, that no form of treatment has | | | | especially exercise recommendations. |
| been shown to be clearly effective for this condition | | | | 1,235 distinct cervical spine manipulations were |
| and, in general, the condition has not been studied | | | | performed, which were mostly carried out with the |
| very well. In fact, a systematic review by Vernon et | | | | patient in a supine position. 74% of the manipulations |
| al concluded that there were very few high-quality | | | | were applied below the level of C4, most commonly |
| clinical trials for any conservative treatments that are | | | | at the level of C6. |
| commonly used to treat ANP. | | | | Clinical Application & Conclusions: |
| There are a variety of reasons why so little research | | | | Patient improvements were observed when |
| has been carried out on ANP, but mainly it is because | | | | comparing sequential evaluations on all outcomes and |
| acute patients are often in the subacute or chronic | | | | nearly all of the patients who responded to the |
| stage by the time they are included in a clinical study. | | | | satisfaction questionnaire were very satisfied or |
| Because of this methodology problem, the current | | | | satisfied with their chiropractic care. These results |
| study used a practice-based research (PBR) model in | | | | compare favorably with the small number of other |
| order to shorten the delay between patient | | | | studies that have looked at chiropractic care for ANP. |
| recruitment and the beginning of chiropractic care. | | | | This study's main conclusion was that the |
| Hence, ANP patients would be much more likely to | | | | practice-based methodology that was utilized is a |
| be in the acute stage when they entered the study. | | | | feasible way to investigate the management of ANP |
| The purpose of this study was primarily to establish | | | | by chiropractors. That being said, it should be noted |
| a chiropractic PBR network and to determine the | | | | that it was very difficult to obtain follow-through |
| feasibility of using it to investigate chiropractic care | | | | from many of the doctors. Recruiting the |
| for patients with ANP. The current paper mainly | | | | chiropractors was fairly easy; a number of them |
| reports the study's treatment outcomes, including | | | | expressed interest in participating, enrolled in the |
| pain, disability, and patient satisfaction with the care | | | | practice-based network, and promised to recruit |
| they received. | | | | patients. However, most did not even begin to fulfill |
| Pertinent Results: | | | | their obligation. Only 10 out of 28 chiropractors who |
| A total of 99 ANP patients were included in the | | | | initially agreed to participate actually collected and |
| study; 34 (37.8%) were men and 56 (62.2%) were | | | | supplied data and most of the data came from just |
| women; the mean age of the group was 41.6 years. | | | | 4 of the chiropractors. As the primary investigator of |
| Ten chiropractors actually contributed data, | | | | this study, I urge readers who have the occasion to |
| despite the fact that 28 chiropractors agreed to | | | | participate in PBR to do everything in their power to |
| participate. The mean number of cases contributed | | | | cooperate with the investigators. Many investigators |
| by the chiropractors was 9.2, but the range was | | | | shy away from PBR because of its known difficulties, |
| from 1 to 54, which was rather wide. Four of the | | | | even though we as a profession could feasibly and |
| chiropractors were very active at recruiting subjects, | | | | economically multiply our research efforts if more |
| contributing 89% of the total data on the patients. | | | | PBR studies were carried out. |
| Progressive improvement of all outcome | | | | It is interesting that the rate of adverse effects in |
| measures was reported at each of the data | | | | this study was only 7.8% in patients where data was |
| collection points, except for a slight worsening of the | | | | available. In contrast, other studies have reported |
| Characteristic Pain Intensity (CPI) score at week 8. | | | | rates up to 6 times higher (2-4). Perhaps some of |
| Sixty-two (68.9%) of the patients completed | | | | this difference was due to the way the data were |
| the chiropractic care that was initially recommended | | | | collected. In the current study, the chiropractors |
| to them. | | | | reported adverse effects that they observed in their |
| Only 30% of the ANP episodes were caused by | | | | patients, whereas the patients completed |
| trauma, which were primarily (70% of the cases) | | | | questionnaires in the other studies. There are |
| related to injuries sustained in automobile collisions. | | | | problems with both methods. For instance, the |
| A prior history of neck pain was reported by | | | | patients may check off a number of selections in a |
| 54% of the patients and secondary conditions were | | | | questionnaire when presented with a laundry list of |
| reported by 62% of them, mainly involving back pain, | | | | symptoms. The power of suggestion (response bias) |
| headache, and/or an upper extremity problem. | | | | may prompt them to list adverse effects that they |
| Very few of the patients were referred to | | | | wouldn't otherwise think of. An example is fatigue |
| other healthcare providers: 4 to medical doctors and | | | | following manipulation, which is a question asked in |
| 2 to massage therapists. | | | | some of the above mentioned studies. I have |
| Patients were overall highly satisfied with their | | | | through the years had a number of patients tell me |
| chiropractic care, with 47 out of 49 (96%) of them | | | | that they felt very relaxed and were able to sleep |
| indicating that they were either "Very satisfied" or | | | | soundly for the first time in years after their first |
| "Satisfied" and 98% of them indicating that they | | | | adjustment. These patients considered these |
| "Definitely would" or were "Very likely" to choose | | | | "adverse effects" to be very positive, but they |
| chiropractic care again if they ever noticed a similar | | | | would appear to be negative effects in one of the |
| problem again. Patient satisfaction responses were | | | | studies because the patient would have selected the |
| provided by 49 of the patients. | | | | "fatigued" response. |
| The chiropractors reported that 7 patients had | | | | The chiropractor conveying the patient's adverse |
| transient minor adverse effects to chiropractic care; | | | | effects as was done in the current study may also |
| 7.8% of the patients where data was available. | | | | lead to problems; for instance, the patient may not |
| Symptoms included: | | | | tell the doctor about minor symptoms, the patient |
| increased neck pain in 5 patients (2 were very | | | | may leave care (possibly related to a severe reaction |
| mild, 2 mild, and 1 moderate) | | | | to treatment), the chiropractor may think that the |
| dizziness in 1 (moderate) | | | | adverse effect was not related to treatment, etc. |
| the "Other" category was selected in 1 case | | | | The best way to query patients about adverse |
| (mild) | | | | effects to chiropractic care has not, in my opinion, |
| Most of the patients (63) received physical therapy | | | | been devised yet and more studies are certainly |
| modalities in addition to manipulation, including | | | | needed. |