The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network.

OBJECTIVES: To characterize pediatric chiropractic and assess pediatric quality of life (QoL). DESIGN: A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States. SUBJECTS: A convenience sample of children (8-17 years) under chiropractic care and their parents. EXPOSURE: Chiropractic spinal adjustments and adjunctive therapies. OUTCOME MEASURES: Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome. RESULTS: The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1, p < 0.05), anxiety (Wald = 20.603, df = 1, p < 0.05), fatigue (Wald = 22.191, df = 1, p < 0.05), and pain interference (Wald = 47.422, df = 1, p < 0.05) after a trial of chiropractic care. CONCLUSIONS: The QoL of children improved with chiropractic care as measured by PROMIS.

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique.

OBJECTIVE: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women. DESIGN: A prospective cohort within a practice-based research network (PBRN). Setting/Locations: Individual chiropractic offices. SUBJECTS: Pregnant women (age ≥18 years) attending chiropractic care. INTERVENTION(S): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies). MAIN OUTCOME MEASURES: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL. RESULTS: A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks (median = 28 weeks; range = 0-42 weeks) and parity (i.e., the number of live births) of 0.92 live births (median = 1; range = 0-6). From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects (i.e., the mean difference of baseline minus comparative measures = -0.7322; p < 0.005). The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 (standard deviation [SD] = 22.69) and 3.30 (SD = 22.71), respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue (p < 0.05), pain interference (p < 0.05), sleep disturbance (p < 0.05), and an improvement in satisfaction with social roles (p < 0.05). A significant decrease was also found with pain interference (p < 0.05). No evidence was found that anxiety (p = 0.1404) or depression (p = 0.8785) changed. CONCLUSION: A PBRN study was successfully implemented among chiropractors to find pregnant patients highly satisfied and their QoL scores improving with care beyond chance.

Comparison of pediatric self reports and parent proxy reports utilizing PROMIS: Results from a chiropractic practice-based research network.

OBJECTIVE: To measure the cross-informant variant of pediatric quality of life (QoL) based on self-reports and parent proxy measures. METHODS: A secondary analysis of baseline data obtained from two independent studies measuring the QoL based on the pediatric PROMIS-25 self-report and the PROMIS parent-proxy items banks. A scoring manual associated raw scores to a T score metric (mean = 50; SD = 10). Reliability of QoL ratings utilized the ICC while comparison of mean T Scores utilized the unpaired t-test. RESULTS: A total of 289 parent-child dyads comprised our study responders. Average age for parents and children was 41.27 years and 12.52 years, respectively. The mean T score (child self-report: parent proxy) for each QoL domains were: mobility (50.82:52.58), anxiety (46.73:44.21), depression (45.18:43.60), fatigue (45.59:43.92), peer-relationships (52.15:52.88) and pain interference (47.47:44.80). CONCLUSION: Parents tend to over-estimate their child's QoL based on measures of anxiety, depression, fatigue, peer-relationships and pain interference.

The use of PROMIS and the RAND VSQ9 in chiropractic patients receiving care with the Webster Technique.

INTRODUCTION: Our ongoing efforts to demonstrate effectiveness of care examined the quality of life (QoL) and patient satisfaction of chiropractic patients presenting for care in a PBRN. METHODS: In addition to socio-demographic and clinical care information, we examined visit-specific satisfaction and QoL using the RAND VSQ and PROMIS-29, respectively. RESULTS: Our study population was comprised of 126 subjects (average age = 39.68; 97 females). The majority of respondents presented with musculoskeletal complaints with an average mean duration of 7.188 years. The mean PROMIS-25 mean T Scores were: depression (47.80); pain interference (53.49); fatigue (51.02); physical function (49.02); satisfaction with social role (52.10); anxiety (50.14); and sleep disturbance (49.88). The VSQ9 mean score was 93.4% indicating high satisfaction. CONCLUSIONS: Adults attending care in a chiropractic PBRN were able to successfully complete the PROMIS29 and VSQ9 instruments. Future longitudinal studies should quantify the minimal clinically important difference in mean T score changes.

The Chiropractic Care of Infants with Breastfeeding Difficulties.

OBJECTIVE: Chiropractors have long advocated on the benefits of breastfeeding and given the realized and potential role of chiropractors in the care of infants with breastfeeding difficulties, we performed this review of the literature on the subject to inform clinical practice. METHODS: For this article, we searched Pubmed [1966-2013], Manual, Alternative and Natural Therapy Index System (MANTIS) [1964-2013] and Index to Chiropractic Literature [1984-2013] for the relevant literature. The search terms utilized "breastfeeding", "breast feeding", "breastfeeding difficulties", "breastfeeding difficulty", "TMJ dysfunction", "temporomandibular joint", "birth trauma" and "infants", in the appropriate Boolean combinations. We also examined non-peer-reviewed articles as revealed by Index to Chiropractic Literature and secondary analysis of references. Inclusion criteria for review included breastfeeding difficulties regardless of peer-review and written in the English language. RESULTS: A total of 24 articles met our inclusion criteria. These consisted of 8 case reports, 2 case series, and 3 cohort studies. We were also able to identify 6 manuscripts (5 case reports and a case series) that involved breastfeeding difficulties as a secondary complaint. Our findings reveal a theoretical and clinical framework based on the detection of spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex and assessment of the infant while breastfeeding. CONCLUSIONS: Chiropractors care of infants with breastfeeding difficulties by addressing spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex.

The use of validated outcome measures in the chiropractic care of pregnant patients: A systematic review of the literature.

BACKGROUND: Healthcare systems recognize the need to incorporate patient-reported outcomes as part of their clinical and research measures. We performed this review on the use of validated outcome measures in the chiropractic care of pregnant patients. METHODS: Pubmed, CINAHL, Medline, Index to Chiropractic Literature and MANTIS were searched for (1) primary investigation reports (i.e., case reports, case series, case control, randomized controlled trials and survey or surveillance studies) published in English; (2) involving the care of pregnant patient(s) and (3) utilizing a valid outcome measure. RESULTS: Our review found 8 articles using the Patient's Global Impression of Change, the NRS, the Oswestry, Bournemouth, Fear Avoidance Belief and Quebec Disability questionnaires, PROMIS-29 and the Measure Yourself Medical Outcome Profile. CONCLUSION: Despite their heterogeneity and inconsistency of use in the studies reviewed, our findings demonstrate some measure of effectiveness in the chiropractic care of pregnant patients.

An integrative review of the literature on the chiropractic care of infants with constipation.

INTRODUCTION: Constipation compromises the health-related quality of life of children. Chiropractic is a popular alternative therapy for children with constipation. We performed this integrative review of the literature to inform clinical practice. METHODS: Our integrative review of the literature began with an examination of the databases Pubmed [1966-2013], MANTIS [1964-2013] and Index to Chiropractic Literature [1984-2013]. The search terms used were "constipation", "chronic constipation", and "bowel dysfunction" in the context of chiropractic. Inclusion criteria involved the care of children 0-18 years old published in the English language. RESULTS: We found 14 case reports, one case series, and one review of the literature. A number of chiropractic techniques were described with treatment varying according to the diagnosis, chief complaint and age of the patient. CONCLUSION: Our integrative review revealed the need for more research and theoretical development on the care of children with constipation.

The chiropractic care of patients with cancer: a systematic review of the literature.

BACKGROUND AND SIGNIFICANCE: Cancer is the leading cause of death worldwide and accounted for 7.4 million deaths in 2004. By 2030, deaths from cancer have been estimated at 12 million with 30% being preventable. Complementary and alternative medicine remains popular among cancer patients; particularly with chiropractic services. However, the nature of the chiropractic clinical encounter and its reported benefits remains to be fully investigated. Towards these efforts, we begin with a systematic review of the literature on the chiropractic care of patients with cancer. METHODS: The following electronic databases were searched: MANTIS [1965-2010]; Index to Chiropractic Literature [1984-2010]; Pubmed [1966-2010]; Medline [1965-2010] EMBASE [1974-2010], AMED [1975-2010], CINAHL Plus [1965-2010], Alt-Health Watch [1965-2010] and PsychINFO [1965-2010]. Key words used were "cancer" and "neoplasm" in Boolean combination with "chiropractic." Primary investigation/reports in peer-reviewed English journals involving chiropractic care were reviewed. RESULTS: Our review revealed 60 case reports, 2 case series, 21 commentaries, 2 survey studies, and 2 literature reviews. The case reports were diagnostic with commentaries highlighting the importance of recognizing the patient presenting with NMS complaints due to an underlying neoplasm. The chiropractic clinical encounter prior to cancer diagnosis and subsequent medical referral is poorly characterized in the literature. CONCLUSION: Patients with cancer seek the care of chiropractors. The literature does not reflect or describe the totality of the chiropractic clinical encounter. We encourage further research in this field.

The chiropractic care of infants with colic: a systematic review of the literature.

PURPOSE: To perform a systematic review of the literature on the chiropractic care of patients with infantile colic. METHODS: The following databases were interrogated: MANTIS [1965-2010]; Pubmed [1966-2010]; Index to Chiropractic Literature [1984-2010]; EMBASE [1974-2010]; AMED [1967-2010]; CINAHL [1964-2010]; Alt-Health Watch [1965-2010], and PsychINFO [1965-2010]. Inclusion criteria were manuscripts addressing the chiropractic care of infantile colic published in the English language. RESULTS: Our systematic review of the literature revealed 26 articles meeting our inclusion criteria. These consisted of three clinical trials, two survey studies, six case reports, two case series, four cohort studies, five commentaries, and four reviews of the literature. Our findings reveal that chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events. CONCLUSIONS: Chiropractic care is an alternative approach to the care of the child with colic. We encourage more research, both quantitative and qualitative, in this area of pediatric care.

A systematic review of the literature on the chiropractic care of patients with autism spectrum disorder.

BACKGROUND: In addition to impacting the affected child and his/her family's quality of life, recent estimates place the lifetime cost for an individual with ASD at $3.2 million and $35 billion for the entire birth cohort. Given the clinical heterogeneity of ASD, treatment approaches are multidisciplinary including alternative therapies, particularly when no pharmaceutical agent is effective for the core symptoms of ASD. Chiropractic is a popular alternative therapy for children. A systematic review of the literature was performed to provide context for future research endeavors in this field. METHODS: A systematic review of the literature on the chiropractic care of patients with ASD utilized 8 databases. Eligibility criteria for inclusion included: (1) the study was a primary investigation/report published in an English peer-reviewed journal; (2) the study involved patients ≤18 years; and (3) patients are diagnosed with autism, Asperger's Syndrome, PDD-NOS, or ASD. RESULTS: Our systematic review of the literature revealed a total of five articles consisting of three case reports, one cohort study and one randomized comparison trial. The literature is lacking on documenting the chiropractic care of children with ASD. DISCUSSION: At the heart of the core symptoms of ASD (ie, impaired social interactions, deficits in communication and repetitive or restricted behavioral patterns) is abnormal sensory processing. Preliminary studies indicate that the chiropractic adjustment may attenuate sensorimotor integration based on somatosensory evoked potentials studies. CONCLUSION: We encourage further research for definitive studies on chiropractic's effectiveness for ASD. However, given the ineffectiveness of pharmaceutical agents, a trial of chiropractic care for sufferers of autism is prudent and warranted.