by Terry A. Rondberg, DC, President of the World Chiropractic Alliance

I’ve been hearing more and more comments about the Integrative Outcomes Measurements (IOM) Wellness Assessment tool and I wanted to share this video by Jason Lord, DC, founder and CEO of HouseCall Rehab.

As Dr. Lord notes, the IOM system really is revolutionary. Doctors can have individuals take the evaluation online for free, on their own home or work computers. It’s all Internet based, so providers don’t have to install any new programs on your computer. The people get their overall score, then return to the doctor for a “report of findings” and the more detailed scores. They retake the test after receiving care, and they and their provider get to see specifically the areas and extent of improvement for each intervention.

One thing I was really impressed with is the low cost — just $97 a month for unlimited access (you could have 10,000 people take the evaluation!) There’s no contract so members can quit at any time (although, apparently, very few do!)

Take a minute to hear what Jason has to say:

The study recruited 50 patients with chronic low back pain through media advertising in a mid-western suburban area. Medical history and a low back examination were completed at a chiropractic clinic.

Subjects were randomized to either a treatment group receiving custom-made shoe orthotics or a wait-list control group. After six weeks, the wait-list control group also received custom-made orthotics.

This study measured change in perceived pain levels (Visual Analog Scale) and functional health status (Oswestry Disability Index) in patients with chronic low back pain at the end of six weeks of orthotic treatment compared with no treatment and at the end of 12 weeks of orthotic treatment.

The study showed changes in back pain and disability with the use of shoe orthotics for six weeks compared with a wait-list control group. It appears that improvement was maintained through the 12-week visit, but the subjects didn’t continue to improve during this time.

The orthotics used in the study were provided by Foot Levelers.

SOURCE: “Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Pilot Study,” Journal of Manipulative and Physiological Therapeutics, May 2011, Vol. 34, Issue 4, pgs. 254-260

While dynamic chest compression has been well studied in events such as motor vehicle collisions, chest compression forces have not been studied during chiropractic manipulation. In a study published online in May, in the JMPT, researchers quantified and analyzed the magnitude of chest compressions during typical as well as maximum chiropractic manipulation and have found them to be well under the threshold for injury.

“Results from this preliminary study showed that maximum chest compression during chiropractic manipulation of the thoracic spine is unlikely to result in injury,” according to lead investigator Associate Professor Brian D. Stemper, PhD, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee. “We performed this study to get a better understanding of the force limits of chiropractic manipulation. This information may lead to safer manipulation procedures and help to decrease the possibility of adverse patient outcomes.”

In the first part of the study, Prof. Stemper and his co-investigators worked with two practicing doctors of chiropractic, each with a minimum of four years of doctoral training and at least seven years of health care experience. Using a crash test dummy, they measured the level of chest compression induced during “normal” chiropractic manipulation and during spinal manipulations in which the DCs exerted maximum effort. They performed simulated chiropractic manipulations on the test dummy at the mid back level (T7 to T8 vertebrae).

In the second part of the study, an instrumented mechanical device was used to apply and measure the forces necessary to induce chest compression in the test dummy. These forces were increased until injurious levels of force were reached. The likelihood of injury was assessed and classified using the Abbreviated Injury Scale (AIS), a useful classification system that has been correlated to injury thresholds during biomechanical experimentation.

In the present study, manipulations incorporating typical and maximum efforts by the chiropractors resulted in maximum chest compressions corresponding to minimal risk of AIS 1 level injuries.

As with all types of patient care, Prof. Stemper cautions that “individual patient characteristics including age, degeneration, and gender” should be taken into consideration.

SOURCE: “An Experimental Study of Chest Compression During Chiropractic Manipulation of the Thoracic Spine Using an Anthropomorphic Test Device” by Brian D. Stemper, PhD, et al. It will appear in the print edition of JMPT, Volume 34, Issue 5, June 2011.

A new report from the Agency for Healthcare Research and Quality (AHRQ) shows that, in 2008, insurers and consumers spent nearly $233 billion on a wide array of prescription drugs. The number one class of drugs (accounting for $52.2 billion, 22% of the total) was metabolic medicine used to control diabetes and cholesterol.

The next four “biggest sellers” of outpatient prescription drugs in 2008 were :

• Central nervous system drugs, used to relieve chronic pain and control epileptic seizures and Parkinson’s Disease tremors – $35 billion.

• Cardiovascular drugs , including calcium channel blockers and diuretics – $29 billion.

• Antacids, antidiarrheals, and other medicines for gastrointestinal conditions – $20 billion.

• Antidepressants, antipsychotics, and other psychotherapeutic drugs – $20 billion.

Overall purchases of these five therapeutic classes of drugs totaled nearly $156 billion, or two-thirds of the almost $233 billion that was spent on prescription medicines used in the outpatient treatment of adults.

Most industry experts say the prescription and spending figures have continued to climb since 2008 and will soon top $300 billion, despite overwhelming evidence that diet can effectively control both diabetes and cholesterol in almost all cases.

A study published in the Sept. 1, 2009 issue of the Annals of Internal Medicine, found that 56% of patients following what has been called the “Mediterranean diet” (a diet high in fruits, vegetables, whole grains and healthy fats, including olive oil, with an emphasis on lean protein sources such as fish, chicken and nuts) were able to control their blood sugar without medication. That same group also showed improvements in triglyceride and HDL cholesterol levels.

In addition, there is significant clinical evidence that chiropractic care, including correction of subluxation, can impact neurologic function and, as a result, have a beneficial effect on both blood sugar and cholesterol levels. By educating patients about alternatives to prescription drugs, chiropractors can help reduce the negative effects of these conditions.

SOURCES: “Expenditures for the Top Five Classes of Outpatient Prescription Drugs, Adult ages 18 and Older, 2008,” Agency for Healthcare Research and Quality (AHRQ), www.meps.ahrq.gov/mepsweb/data_files/publications/st313/stat313.pdf

“Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes,” Annual of Internal Medicine, Sept. 1, 2009, vol. 151 no. 5 306-314. Abstract online

Although chiropractors have often been ridiculed for using unequal leg lengths as a diagnostic tool, a recent research paper published in the Annals of Internal Medicine has linked arthritis in the knee to the common trait of having one leg that is longer than the other. Whether or not leg length differential is a direct cause of osteoarthritis isn’t clear, but the findings may allow people to take preventive measures even as early as childhood.

“Most pediatricians adopt a ‘wait and see’ attitude for children with limb misalignment when they’re growing,” said Derek Cooke, Queen’s University adjunct professor and a co-author of the study. “If we can spot factors creating changes in alignment early in bone development, theoretically we could stop or slow down the progression of osteoarthritis.”

The data was collected using x-ray images from more than 3,000 adults aged 50 to 79 who either had knee pain or risk factors for knee osteoarthritis as a part of the Multi Centre Osteoarthritis Study (MOST). Subjects were reassessed after a 30-month period and the researchers found that osteoarthritic changes in the knee were most significant in individuals with pronounced (more than 1 cm) leg length inequality, the shorter leg being most affected.

“Because the condition often goes undiagnosed, many people don’t realize they have a leg length differential until they’re diagnosed with osteoarthritis,” noted the Queen’s University press release on the study.

Evidence about the negative impact of unequal leg lengths has been available for decades but generally ignored or underestimated by the medical community, possibly because leg length checks were so closely associated with chiropractors.

According to a report by J. Philip Gofton, MD in a 1985 issue of the Journal of Rheumatology “Leg length inequality and low back pain go hand in hand.” His research found that a leg length difference of 12.5 mm will cause a lateral tilt of the sacrum of about 4° with a compensatory scoliosis in the lumbar spine. Gofton also demonstrated the biomechanical and clinical problem of leg length disparity and its relationship to hip osteoarthritis.

William F Harvey from Boston University, currently at Tufts Medical Center, was the lead author on the paper.