Public Awareness of the Traditional and Complementary Medicine Act Governing Chiropractic in Malaysia: A Survey of Adults in Klang Valley.

Objective: This study aimed to assess the level of awareness of the traditional and complementary medicine law governing chiropractic among adults in Klang Valley, Malaysia. Methods: A cross-sectional study was conducted of patients attending the following 4 health care services: medicine, dentistry, pharmacy, and chiropractic. The study ran from July to November 2018. Data were collected through self-administered questionnaires and reported using descriptive statistics. Variables included demographic characteristics and awareness of the Traditional and Complementary Medicine Act 2016 (Act 775). Results: We obtained 440 responses, 186 (42.3%) from men and 254 (57.7%) from women, with ages ranging from 18 to 81 years. The majority of respondents (97.3%) were Malaysian from the non-Malay ethnic group. Almost half (47.5%) of the respondents had a bachelor's degree. The awareness of the traditional and complementary medicine law governing chiropractic was low (4.8%). Binary logistic regression revealed marital status as the only significant predictor of awareness of the Traditional and Complementary Medicine Act, with married individuals showing higher awareness (adjusted odds ratio: 2.77; 95% CI, 1.38-5.58). Conclusion: For this sample of adults, the awareness of the Traditional and Complementary Medicine Act 2016 governing chiropractic was found to be low. As the regulation of chiropractic is still new in Malaysia and other Asian countries, efforts are needed to increase public awareness to ensure the safety and quality of chiropractic services.

Ergonomic Risk Factors of Fourth- and Fifth-Year International Medical University Dental Students.

Objective: The purpose of this study was to identify and compare the ergonomic risk factors of year 4 and year 5 dental students attending International Medical University. Methods: This was an exploratory, observational study evaluating ergonomic risk factors among year 4 and year 5 dental students, with a total of 89 participants. The students' ergonomic risk components were evaluated using the Rapid Upper Limb Assessment (RULA) worksheet. Descriptive statistics were used to analyze the RULA scores, and the Mann-Whitney U test served to determine the difference of ergonomic risk between year 4 and year 5 dental students. Results: The descriptive analysis showed that the participants' (N = 89) median final RULA score was 6.00 (standard deviation = 0.716). One-year difference in the years of clinical practice did not produce a significant difference in the final RULA score (U = 913.0, P = 0.49). The final RULA scores showed year 4 dental students had a higher mean ranking (year 4 = 46.65, year 5 = 43.23). Furthermore, the Mann-Whitney U test indicated that this was not statistically significant (U = 913.0, P = 0.49). Conclusion: The descriptive analysis showed that the final RULA score of the participants indicated that the participants were in a high-risk category for experiencing work-related musculoskeletal disorders due to poor ergonomics. Contributing physical factors included working in asymmetric, awkward, and static positions in a confined workspace, infrequent use of dental loupes, and utilization of dental chairs that were not ergonomically appropriate.

Demographic Factors Associated With Public Awareness of Chiropractic in Klang Valley, Malaysia: A Cross-sectional Study.

Objective: The purposes of this study were to determine the public awareness of chiropractic in Klang Valley and to identify sociodemographic factors associated with this awareness. Methods: A cross-sectional study with a total of 440 respondents was conducted in medical, chiropractic, pharmacy, and dental health care facilities in Klang Valley. A self-administrated questionnaire was enclosed in an envelope and handed to the participants by the health care facilities' staff. Tables and figures were used to present the descriptive data. Data collected were also analyzed using inferential statistics such as binary logistic regression, odds ratio, and 95% confidence interval. The variables in this study were age, ethnicity, sex, education level, marital status, nationality, employment status, and health status along with awareness of chiropractic. Results: The respondents' ages ranged from 18 to 81 years, and the mean age was 33.1 years. The majority of respondents were single (52.1%), and 43.1% of respondents were married. Most of the respondents were employed (64.4%), followed by students (14.8%). Among the respondents, 40.2% perceived to have a good health status. Good awareness of chiropractic was 50.2%, whereas the poor awareness of chiropractic was 49.8%. Two sociodemographic factors that were statistically significantly associated with the awareness of chiropractic were ethnicity and employment status, with a P value of <.001 and .006, respectively. Conclusion: The level of public awareness of chiropractic was 50.2%, with ethnicity and employment status as statistically significant associated factors.

Attitudes of dental and chiropractic students towards a shared learning programme-An interprofessional learning model.

INTRODUCTION: Interprofessional learning (IPL) is the first stage towards the goal of interprofessional collaborative care. To enhance IPL experience, the School of Dentistry, International Medical University developed an IPL model based on the core competencies and the learning outcomes for dental and chiropractic students in their second and fourth year, respectively. The model was based on experiential learning and adult learning theories in addition to Miller's framework for clinical competencies. METHODS: The programme was developed as a student-centred, collaborative approach to achieve the learning outcomes for dental and chiropractic students. Second-year dental students (n = 46) and chiropractic students (n = 23) in their fourth year participated in the programme. The focus of the programme was to address the prevention of work-related musculoskeletal disorders (WMSDs) amongst dental students and to provide the chiropractic students with the opportunity to assess and identify risk factors for WMSDs in the dental setting. The readiness for interprofessional learning scale (RIPLS) questionnaire was completed prior to the interprofessional education programme and once again afterwards to determine dental and chiropractic students' awareness of roles and responsibilities of the other profession, and their attitudes to interprofessional education and teamwork. RESULTS: Dental and chiropractic students showed similar levels of readiness for shared learning. The results of this study suggest that the IPL programme contributed to the development of the students' positive perceptions towards the positive professional identity and the roles of other healthcare professionals. CONCLUSION: This study provides initial support for the integrated interprofessional learning experiences within the school. The results of the study will shape future curricula changes to further strengthen interprofessional education and subsequent interprofessional collaborative care.

Chiropractic Utilization Among Patients in Klang Valley, Malaysia.

OBJECTIVE: The purpose of this study was to estimate the utilization of chiropractic in Klang Valley, Malaysia. METHODS: This research was a cross-sectional study conducted in 4 health care centers, namely Klinik Mediviron Sri Rampai, Queck Dental Surgery, International Medical University (IMU) Healthcare Chiropractic Centre, and Be Pharmacy Bandar Sri Permaisuri, in Klang Valley from July to November 2018, with a total of 440 respondents. The data collection was done by the self-administration method using questionnaires that were enclosed in envelopes and passed on to the participants by the center's staff. Descriptive statistics were conducted on the data collected and are presented in tables and figures. The variables were sex, age, nationality, ethnicity, marital status, education level, employment status, and health status with the utilization of chiropractic. RESULT: There were 186 (42.3%) male and 254 (57.7%) female respondents. The youngest respondent was 18 years old, and the oldest was 81 years old. The median age was 30 years old. Most respondents (97.3%) were Malaysian from a non-Bumiputra (non-Malay) ethnic group. Almost half (47.5%) of the respondents had a bachelor's degree education level. The utilization of chiropractic was 35.9% (95% confidence interval [CI]: 31.4-40.5). CONCLUSION: The utilization of chiropractic was 35.9%, which was slightly lower than utilization among other traditional and complementary medicine practices in Malaysia.

Effects of Upper and Lower Cervical Spinal Manipulative Therapy on Blood Pressure and Heart Rate Variability in Volunteers and Patients With Neck Pain: A Randomized Controlled, Cross-Over, Preliminary Study.

OBJECTIVE: The aims of this study were to examine autonomic nervous system responses by using heart rate variability analysis (HRV), hemodynamic parameters and numeric pain scale (NPS) when either upper (C1 and C2) or lower (C6 and C7) cervical segments were manipulated in volunteers, and whether such response would be altered in acute mechanical neck pain patients after spinal manipulative therapy (SMT). METHODS: A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups. RESULTS: The standard deviation of average normal to normal R-R intervals (SDNN) increased (83.54 ± 22 vs. 105.41 ± 20; P = .02) after upper cervical SMT. The normalized unit of high frequency (nuHF), which shows parasympathetic activity, was predominant (40.18 ± 9 vs. 46.08 ± 14) after upper cervical SMT (P = .03) with a significant decrease (109 ± 10 vs. 98 ± 5) in systolic BP (P = .002). Low frequency to high frequency (LF/HF) ratio, which shows predominance of sympathetic activity increased (1.05 ± 0.7 vs. 1.51 ± 0.5; P = .02) after lower cervical SMT in the healthy volunteers group. However, there was an increase in SDNN (70.48 ± 18 vs. 90.23 ± 20; P = .02 and 75.19 ± 16 vs 97.52 ± 22; P = .01), a decrease in LF/HF ratio (1.33 ± 0.3 vs. 0.81 ± 0.2; P = .001 and 1.22 ± 0.4 vs. 0.86 ± 0.3; P = .02), which was associated with decreased systolic BP (105 ± 10 vs. 95 ± 9; P = .01 and 102 ± 9 vs. 91 ± 10; P = .02) and NPS scores (3 ± 1 vs. 0; P = .01 and 3 ± 1 vs. 1 ± 1; P = .03) following both upper and lower cervical SMT in the patient's group. The baseline HR was 67 ± 9 vs 64 ± 5 (upper cervical) and 65 ± 7 vs 69 ± 11 (lower cervical) in both the healthy volunteer' and patient' groups. CONCLUSION: Upper cervical SMT enhances dominance of parasympathetic and lower cervical SMT enhances dominance of sympathetic activity in this young volunteer group. However, dominance of parasympathetic activity was found in patients with neck pain that received both upper and lower cervical SMT.

The location of the inferior angle of the scapula in relation to the spine in the upright position: a systematic review of the literature and meta-analysis.

Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order to enhance diagnostic accuracy and to specifically target the site of intervention. Authoritative sources usually state the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of T7, but some specify the T7-8 interspace or the T8 SP. The primary goals of this study were to systematically review the relevant literature; and conduct a meta-analysis of the pooled data from retrieved studies to increase their statistical power. Electronic searching retrieved primary studies relating the IAS to a spinal level, as determined by an imaging reference standard, using combinations of these search terms: scapula, location, landmark, spinous process, thoracic vertebrae, vertebral level, palpation, and spine. Only primary studies were included; review articles and reliability studies related to scapular position but lacking spinal correlations were excluded. Eight-hundred and eighty (880) articles of interest were identified, 43 abstracts were read, 22 full text articles were inspected, and 5 survived the final cut. Each article (with one exception) was rated for quality using the QUADAS instrument. Pooling data from 5 studies resulted in normal distribution in which the upright IAS on average aligns closely with the T8 SP, range T4-T11. Since on average the IAS most closely identifies the T8 SP in the upright position, it is very likely that health professionals, both manual therapists and others, who have been diagnosing and treating patients based on the IAS = T7 SP rule (the conventional wisdom), have not been as segmentally accurate as they may have supposed. They either addressed non-intended levels, or made numeration errors in their charting. There is evidence that using the IAS is less preferred than using the vertebra prominens, and may be less preferred than using the iliac crest for identifying spinal levels Manual therapists, acupuncturists, anesthesiologists, nurses, and surgeons should reconsider their procedures for identifying spinal sites in light of this modified information. Inaccurate landmark benchmark rules will add to patient variation and examiner errors in producing spine care targeting errors, and confound research on the importance of specificity in treating spinal levels.

Interexaminer reliability of cervical motion palpation using continuous measures and rater confidence levels.

INTRODUCTION: Motion palpators usually rate the movement of each spinal level palpated, and their reliability is assessed based upon discrete paired observations. We hypothesized that asking motion palpators to identify the most fixated cervical spinal level to allow calculating reliability at the group level might be a useful alternative approach. METHODS: Three examiners palpated 29 asymptomatic supine participants for cervical joint hypomobility. The location of identified hypomobile sites was based on their distance from the T1 spinous process. Interexaminer concordance was estimated by calculating Intraclass Correlation Coefficient (ICC) and mean absolute differences (MAD) values, stratified by degree of examiner confidence. RESULTS: For the entire participant pool, ICC [2,1] = 0.61, judged "good." MAD=1.35 cm, corresponding to mean interexaminer differences of about 75% of one cervical vertebral level. Stratification by examiner confidence levels resulted in small subgroups with equivocal results. DISCUSSION AND CONCLUSION: A continuous measures study methodology for assessing cervical motion palpation reliability showed more examiner concordance than was usually the case in previous studies using discrete methodology.

INTRODUCTION: Généralement, la palpation évalue le mouvement de chaque niveau de la moelle épinière palpé, et sa fiabilité est évaluée sur des observations jumelées et séparées. Nous avons émis l'hypothèse que l'utilisation de la palpation afin d'identifier le niveau de la moelle épinière cervicale le moins mobile, dans le but de permettre le calcul de sa fiabilité à l'échelle du groupe pourrait être une approche alternative utile. MÉTHODOLOGIE: Trois examinateurs ont palpé 29 participants asymptomatiques allongés atteints d'hypomobilité de l'articulation cervicale. L'emplacement de ces segments hypomobiles s'est fondé sur leurs distances par rapport à l'apophyse épineuse T1. La concordance entre les examinateurs a été estimée en calculant le coefficient de corrélation interne (ICC) et les valeurs de la différence absolue moyenne (MAD), stratifiés selon le degré de confiance de l'examinateur. RÉSULTATS: Pour tout le bassin de participants, ICC [2,1] = 0,61, jugé « bon ¼. MAD = 1,35 cm, ce qui correspond à la différence moyenne entre les examinateurs d'environ 75 % d'un segment de la colonne vertébrale. La stratification par le niveau de confiance de l'examinateur a entraîné des petits sousgroupes avec des résultats équivoques. DISCUSSION ET CONCLUSION: Une méthodologie ayant recours à des mesures continues pour l'évaluation de la fiabilité de la palpation de la colonne vertébrale a indiqué une plus grande concordance entre les examinateurs qu'à l'accoutumée lors des précédentes études, qui utilisaient la méthodologie séparée.

Interexaminer reliability of thoracic motion palpation using confidence ratings and continuous analysis.

OBJECTIVE: Motion palpation is integral to most chiropractic techniques and can be found in curricula of most every chiropractic college. Paradoxically, most studies do not show strong reliability for motion palpation. The purpose of this study was to determine if allowing motion palpators to rate their confidence in their findings, as well using a continuous data analytic method, would influence the level of concordance. METHODS: Subjects were 52 asymptomatic chiropractic student volunteers. Two palpators assessed posterior to anterior glide of T3-10 in the prone position, alternating in their order and blinded as to each other's results. Each examiner identified the location of maximal restriction in this range and also whether they were "very confident" or "not confident" in their finding. RESULTS: For all subjects combined, the examiners' calls were "poor": intraclass correlation coefficient [2,1] = .3110 (95% CI, .0458-.5358). In contrast, interexaminer agreement was "good" when both examiners were very confident: intraclass correlation coefficient [2,1] = .8266 (95% CI, 0.6257-0.9253). CONCLUSION: When each examiner was "very confident" as to the most fixated thoracic segment, the levels they identified were very close. This corresponds to "good" agreement, an uncommon result in most interexaminer motion palpation studies. Thus, the confidence level of examiners had an effect on the interexaminer reliability of thoracic spine. Our novel continuous measures, statistical methodology, and subtyping the subjects according to the confidence of the palpators seem more capable than level-by-level discrete analysis of detecting interexaminer agreement.

Chiropractic care for patients with acute neck pain: results of a pragmatic practice-based feasibility study.

OBJECTIVE: The purpose of this study was to determine the feasibility of a chiropractic practice-based research network to investigate the treatment of acute neck pain (ANP) and to report resulting findings. METHODS: Participating chiropractors recruited sequentially presenting ANP patients on their initial visit to the office. Patients were treated by the chiropractors using their usual methods. Data were prospectively collected by having patients complete the Neck Disability Index, Characteristic Pain Intensity score, and a patient satisfaction questionnaire. Questionnaires were completed during routine office visits at baseline and then at weeks 1, 2, 4, 8, and 26, either in the office or by mail. RESULTS: Ten chiropractors supplied data on 99 patients. The number of cases contributed by each of the participating chiropractors ranged from 1 to 54, with a mean (SD) of 9.2 (10.5). Mean (SD) Neck Disability Index scores were 36 (17.9) at baseline and 9.8 (12.2) at the final evaluation; the Characteristic Pain Intensity scores were initially 55.3 (20.4) and were 24.5 (21.5) at the final evaluation. Transient minimal adverse effects were reported by chiropractors for only 7 (7.8%) patients. No serious adverse reactions were reported. CONCLUSION: The practice-based research methodology used in this study appears to be a feasible way to investigate chiropractic care for ANP, and its methodologies could be used to plan future research.

The notion of a "whiplash culture": a review of the evidence.

OBJECTIVE: Most whiplash patients eventually recover, although some are left with ongoing pain and impairment. Why some develop long-term symptoms after whiplash, whereas others do not, is largely unknown. One explanation blames the cultural expectations of the population wherein the injury occurred, engendering the moniker whiplash culture. The purpose of this review was to locate and discuss studies that were used as a basis for developing the whiplash culture concept and to evaluate its plausibility. METHODS: The PubMed database was searched using combinations of the terms whiplash culture, whiplash OR WAD, and chronic OR late OR long term. Search dates spanned from 1950 to June 2008. Filters were set to only retrieve English-language citations. Articles that dealt with the whiplash culture were selected and examined to determine which studies had been used to create the concept. RESULTS: Nineteen articles discussed the cultural aspects of whiplash and were explored to determine which were used as a basis for the whiplash culture. Eight studies were found that met this final criterion. CONCLUSION: There are many unanswered questions about the basis of chronic whiplash, and the notion of a whiplash culture is controversial. Chronic whiplash symptoms are surely not caused entirely by cultural issues, yet they are probably not entirely physical. Presumably, a tissue injury component exists in most chronic whiplash-associated disorder victims that becomes aggravated in those who are susceptible to biopsychosocial factors. As with many other controversial health care topics, the answer to the debate probably lies somewhere in the middle.

Survey of health attitudes and behaviors of a chiropractic college population.

OBJECTIVES: We gathered information about health behaviors on a chiropractic campus, including compliance with recent guidelines for exercise as well as diet, smoking, and binge drinking. We also assessed the perceived importance of the chiropractic physician in role modeling and teaching healthy behaviors to patients. METHODS: A survey instrument composed of 16 questions was designed and distributed to 279 students, faculty, and staff at a chiropractic college campus in northern California. Confidentiality was maintained throughout the process, and a response rate of 92% was obtained. Statistical analysis was performed on the data collected. RESULTS: The levels of obesity, inactivity, and smoking on this college campus are lower than the levels reported for the metropolitan area, the state, and the nation. The level of binge drinking among our students was high but similar to the reported rates for college students generally. We found interesting and significant relationships between the behaviors of physical activity and diet (red meat consumption), obesity, and self-reported perceived health in our surveyed chiropractic college population. Without exception, all surveyed members of our campus community view doctors of chiropractic as having a responsibility to role model healthy behaviors and to educate their patients with regard to healthy behaviors; however, we also found that less importance was placed on role modeling and patient education by those who were obese or who consumed red meat in excess. CONCLUSIONS: This chiropractic college campus places a high level of importance on both educating patients and role modeling healthy behaviors. In the behavioral domain, the rates of smoking, obesity, and inactivity are lower than what is seen in the general population. However, there remains room for considerable improvement to bring actual health behaviors closer in line with evidence-informed behavioral health practices.

The location of the inferior angle of the scapula in relation to the spinal level of prone patients.

BACKGROUND: In two previous studies we established the mean location of the upright inferior angle of the scapula (IAS) to be near the spinous process of T8. The current study investigates the common belief that the prone IAS lines up with the T6 SP. METHODS: The location of the IAS in relation to the spine of 20 mostly asymptomatic subjects was assessed on a Hi-Lo table in 7 different postures, 2 upright and 5 prone. RESULTS: THE SCAPULA MOVED CEPHALAD IN TWO OF THE TEST POSITIONS: prone, arms at side and prone, chicken-wing. It moved caudad in the other 4 test positions, including prone, using armrest (18.4 mm). CONCLUSIONS: With the prone patient's arms on the arm pieces, the most likely patient posture, the average caudad IAS movement is about one vertebral level, notwithstanding the common belief that the IAS is one level cephalad to the upright level.

A review of intraexaminer and interexaminer reliability of static spinal palpation: a literature synthesis.

OBJECTIVE: The purposes of this study were to locate articles that assessed the reliability of static palpation of the spine and sacroiliac joints, to appraise the quality of these studies, and synthesize their results. METHODS: A structured literature search was conducted of chiropractic and medical databases PubMed, Manual Alternative and Natural Therapy System, Index to Chiropractic Literature, and Cumulative Index to Nursing and Allied Health Literature from 1965 through October 2007. Reference sections were inspected for additional citations. Only peer-reviewed articles in English containing information about static palpation of the spine or sacroiliac joints were selected. The resulting studies were appraised for quality by both of the authors using a 6-point scale instrument developed to assess the quality of reproducibility studies. RESULTS: The search generated 343 citations, and another 7 were harvested from the reference lists. After removing articles not meeting the inclusion criteria, 29 were retained. A total of 14 studies focused on the reliability of locating painful or tender points, 10 on the location of landmarks, and 5 on position or alignment of bone structures. A higher proportion of studies that assessed painful or tender points reported acceptable levels of reliability. However, there were no significant differences between methods of palpation when considering the proportions of high-quality studies that reported good reliability. Thus, no form of static palpation could be considered to be superior. CONCLUSION: Reported indices of agreement were generally low. More of the pain palpation studies reported acceptable kappa levels, although no one method of palpation could be deemed clearly superior.

An annotated bibliography of spinal motion palpation reliability studies.

BACKGROUND: Several literature reviews have addressed the reliability of spinal and sacroiliac (SI) motion palpation (MP), finding that, in general, interexaminer reliability is slight and intraexaminer reliability is moderate. METHODS: We performed a literature search of four biomedical databases to locate articles that dealt with MP of the spine or SI joints. The abstracts of the retrieved citations were independently screened for inclusion by two of the authors. The full-text of potentially includable articles was examined by the same two authors to assess whether they met all of the inclusion criteria. The validity of the included studies was evaluated using a 6-point scale. RESULTS: The initial searches netted 415 citations; another 30 were harvested from the secondary search. Fifty-nine articles were removed as duplicates and 305 failed to meet the inclusion criteria. Another 33 were excluded because they did not adequately describe the method of analysis, used a combination of tests, were not actually MP studies, or were not reliability studies. ANNOTATED BIBLIOGRAPHY: Summaries of 48 articles that dealt with the reliability of spinal and SI MP are presented. Where appropriate, we have commented on some of the methodological deficiencies that were discovered.

Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis.

OBJECTIVES: The purpose of this project was to review the literature for the use of spinal manipulation for low back pain (LBP). METHODS: A search strategy modified from the Cochrane Collaboration review for LBP was conducted through the following databases: PubMed, Mantis, and the Cochrane Database. Invitations to submit relevant articles were extended to the profession via widely distributed professional news and association media. The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. RESULTS: A total of 887 source documents were obtained. Search results were sorted into related topic groups as follows: randomized controlled trials (RCTs) of LBP and manipulation; randomized trials of other interventions for LBP; guidelines; systematic reviews and meta-analyses; basic science; diagnostic-related articles, methodology; cognitive therapy and psychosocial issues; cohort and outcome studies; and others. Each group was subdivided by topic so that team members received approximately equal numbers of articles from each group, chosen randomly for distribution. The team elected to limit consideration in this first iteration to guidelines, systematic reviews, meta-analyses, RCTs, and coh ort studies. This yielded a total of 12 guidelines, 64 RCTs, 13 systematic reviews/meta-analyses, and 11 cohort studies. CONCLUSIONS: As much or more evidence exists for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence. There was less evidence for the use of manipulation for patients with LBP and radiating leg pain, sciatica, or radiculopathy.

Spinal motion palpation: a comparison of studies that assessed intersegmental end feel vs excursion.

OBJECTIVE: Spinal motion palpation (MP) is a procedure used to detect intersegmental hypomobility/hypermobility. Different means of assessing intersegmental mobility are described, assessing either excursion of the segments (quantity of movement) or end feel (quality of motion when stressed against the paraphysiological space). The objective of this review was to classify and compare studies based on method of MP used, considering that some studies may have used both methods. METHODS: Four databases were searched: MEDLINE-PubMed, Manual Alternative and Natural Therapy System, Index to Chiropractic Literature, and Cumulative Index to Nursing and Allied Health Literature databases for the years 1965 through January 2007. Retrieved citations were independently screened for inclusion by 2 of the authors consistent with the inclusion and exclusion criteria. Included studies were appraised for quality, and data were extracted and recorded in tables. RESULTS: The search strategy generated 415 citations, and 29 were harvested from reference lists. After removing articles that did not meet the inclusion criteria, 44 were considered relevant and appraised for quality. Fifteen studies focused on MP excursion, 24 focused on end feel, and 5 used both. Eight studies reported high levels of reproducibility (kappa = >or=0.4), although 4 were not of acceptable quality, and 2 were only marginally acceptable. When only high-quality studies were considered, 3 of 24 end-feel studies reported good reliability compared with 1 of 15 excursion studies. There was no statistical support for a difference between the 2 groupings. CONCLUSIONS: A difference in reported reliability was observed when the method of MP varied, although it was not statistically significant. There was no support in the literature for the advantage of one MP method over the other.

Chiropractic and public health: current state and future vision.

This article provides an overview of primary chiropractic issues as they relate to public health. This collaborative summary documents the chiropractic profession's current involvement in public health, reflects on past barriers that may have prevented full participation within the public health movement, and summarizes the relationship of current chiropractic and public health topics. Topics discussed include how the chiropractic profession participates in preventive health services, health promotion, immunization, geriatrics, health care in a military environment, and interdisciplinary care.

Determining spinal level using the inferior angle of the scapula as a reference landmark: a retrospective analysis of 50 radiographs.

OBJECTIVE: The purpose of this study was to determine which spinal segment most closely corresponds to the level of the inferior angle of the scapula (IAS) using measurements taken on A-P full-spine radiographs. METHODS: Fifty sequentially selected radiographs were analyzed independently by two examiners. A straight edge was used to ascertain which spinal levels corresponded with the right and left IASs. For analysis, each spinal level was subdivided into three regions: upper vertebral body, lower vertebral body, and intervertebral space. RESULTS: he mean spinal level corresponding to the left IAS was midway between the T8-9 interspace and the upper T9 body (range, lower T7 to upper T10). The mean spinal level corresponding to the right IAS was slightly lower, but still within the upper T9 body (range, lower T7 to lower T10). These levels correspond to the T8 spinous process. CONCLUSIONS: There is a considerable amount of variability in where the IASs are located, but most commonly, they correspond to the level of the upper body of T9.