Use of complementary healthcare practices among chiropractors in the United States: a survey.

CONTEXT: Although chiropractic is the most commonly used complementary healthcare practice, chiropractors have not been surveyed in depth about their attitudes toward and practice of complementary and alternative therapies apart from spinal manipulation. OBJECTIVES: To examine attitudes among US chiropractors on the role of their profession in complementary healthcare and to gather data on the types of complementary healthcare practices chiropractors use. DESIGN: Descriptive, cross-sectional study using a mail-in survey. SETTING: United States. PARTICIPANTS: Random sample of US chiropractors stratified by zip code region. RESULTS: A total of 563 surveys were completed, for a response rate of 30%. Respondents were almost equally divided on their responses to the question "Do you feel that chiropractic should at the present time be termed 'complementary'?" Although many respondents (68%) believed that chiropractic was viewed as a therapeutic modality, more (82%) believed that it should be viewed as a complete system. The therapies most commonly used by respondents in their practice were acupressure (72%), massage (72%), mineral supplements (63%), and herbs (56%). CONCLUSION: The disparity between the established view of chiropractic as synonymous with spinal manipulation and the profession's view of chiropractic as a complete system indicates a need for better interprofessional communication.

Measurement of soft tissue strain in response to consecutively increased compressive and distractive loads on a friction-based test bed.

PURPOSE: To abstract the essential elements of chiropractic prone leg checking and subject them to controlled, experimental parametric testing. DESIGN: Controlled, objective, repeated-measure analysis of the dynamic response of leg positions to distractive and compressive loading conditions. SETTING: Research laboratory in a chiropractic college. PARTICIPANTS: Twenty-five compression and 30 distraction subjects, most of whom were male, asymptomatic chiropractic students. INTERVENTION: The subjects were lowered to the prone position on a table optimized to detect dynamic leg positions, with separate sliding segments supporting each leg. A trial consisted of a 2-min control run, followed by two 2-min experimental runs in which compressive or distractive loads were applied incrementally to the table-leg segments. MAIN OUTCOME MEASURE: An optoelectric system measured real-time absolute and relative leg positions. RESULTS: Right legs showed a greater average response than left legs under both distractive and compressive loads, and tended to respond more proportionately to incremental load increases. The average response to compression exceeded the response to distraction. Both legs showed a greater average response in the second half of the trials. Correlation of weights with responses was about four times greater in traction than compression. CONCLUSION: The functional short leg is confirmed as a stable clinical reality, a multitrial mean of unloaded leg positional differences. The prone leg check may be a loading procedure, albeit unmeasured, that detects non-weight-bearing, functional asymmetry in loading responses. These probably reflect differences in left-right muscle tone, joint flexibility and tissue stiffness. The relatively nonmonotonic, nonlinear quality of left leg responses is consistent with asymmetric neurological responses.

Power spectral and microvector frequency analysis of dynamic standing foot force patterns in a normal male subject.

Power spectral and microvector frequency analyses of dynamic standing foot force patterns in a normal male subject were performed using a multiple-trial experimental protocol. Power spectral analysis of eight eyes-open vs. eyes-closed 50-sec trials revealed significant power increases in the 0.14 to 0.66 Hz range with eye closure, which were repeatable in trials performed on the same subject 2 wk later. Since power spectral differences are difficult to interpret biomechanically, a (micro)vector analysis of 1/20 sec changes in proportional weight transfer was employed. This methodology was able to reveal that foot force weight transfer exhibited a distinct preferred directionality, and that the eyes-closed condition was characterized by significant increases in both the occurrence and average magnitudes of these preferred microvectors.

Analysis of dynamic standing foot force patterns in a normal male subject by characterization of microvector weight transfer sequences.

Previous foot forceplate analyses in our laboratory have shown that postural sway in a normal male subject induces net weight transfers (microvectors) which have preferred directionalities, and that eye closure is characterized by increases in both the occurrence and magnitudes of these preferred microvectors. The same data generated from 8 x 8 blocks of eyes-open and eyes-closed trials were reanalyzed to examine microvector temporal sequences (i.e., macrovectors). Macrovectors were defined by the number of successive microvectors occurring along the same general direction, (anterior, posterior, right or left). Results suggest that with eye-closure, proprioceptive systems are unable to maintain lateral sway deviations within eyes-open limits. This instability increases lateral macrovector durations while only marginally affecting sagittal macrovector durations.

Normal paraspinal tissue compliance: the reliability of a new clinical and experimental instrument.

Test-retest reliability of a hand-held tissue compliance meter was evaluated in 20 normal subjects at four paraspinal locations to determine possible effects of probe response or other sources of variability on measurements taken 10 min later at exactly the same location. If tissue compliance, as measured by this instrument, is to be used in a pre-post context to evaluate treatment effects, caution is urged, since 26% of the sites were significantly (+/- 1.96 SD) different on 10 min retest though subjects remained supine and without intervention. In addition, since 85% of these normal subjects displayed at least one paraspinal compliance asymmetry large enough to qualify as pathological by Fischer's criteria, revision of these criteria may be appropriate, at least for these paraspinal locations.

Interexaminer concordance in detecting joint-play asymmetries in the cervical spines of otherwise asymptomatic subjects.

Interexaminer concordance for motion-based palpation of the middle and lower cervical spine was investigated. The palpatory task consisted of determining whether end-range joint resistance on lateral flexion was greater on one side of a given cervical segment when compared to that of the contralateral joint. Palpators also were asked to indicate the relative magnitude of the asymmetry, when detected. All experiments were carried out using reasonably healthy, pain-free, chiropractic college students. Three series of experiments involving two pairs of practitioners and a total of 270 subjects were carried out. Interexaminer agreement rates with respect to the side of greatest fixation were not found to be significantly different from those expected by chance alone. Furthermore, this was the case regardless of whether palpators had rated the magnitude of the asymmetry as being slight, moderate or severe. These poor agreement rates did not appear to be due to significant interexaminer differences with respect to the distributions of right vs. left calls, to a preponderance of agreements occurring more on one side over the other, or to differences with respect to the distribution of severity ratings. More importantly, there appeared to be no consistent relationships between the degree of severity indicated by the first examiner and that indicated by the second, nor were there any significant correlations between right vs. left agreement rates obtained for various combinations of severity ratings.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic illusions: the reliability of random chance.

A "Monte Carlo" experiment was performed in order to determine chance concordance rates for multiple test scenarios often encountered in chiropractic diagnosis. The Monte Carlo simulation took into account the following variables: the number of tests involved in the diagnosis; the number of vertebral segments implicated by each test; the proportion of tests in agreement relative to the number of tests performed; and the segmental margin of error accepted. Random data for up to five diagnostic tests performed on 500 "patients" were computer generated and a wide variety of test scenarios analyzed. One typical analysis asked: if four diagnostic tests are performed on each patient, each test implicating on average three vertebral segments, and a plus or minus one segment error margin is accepted, what are the chance odds that any three out of the four tests will implicate the same vertebral segment? The answer, determined by simply counting how often this happened in the 500 "patients," was 89%. Many test scenarios yielded chance levels much higher than might have been expected. High probability situations as well as those test criteria yielding relatively low chance concordance rates are identified.

Concordance between galvanic skin response and spinal palpation findings in pain-free males.

The concordance between areas of paraspinal low resistance, i.e., galvanic skin response (GSR) and positive palpatory findings in pain-free male subjects was investigated. The concordance between vertebral segments implicated by GSR and by palpation was not found to be significantly different from chance concordance as determined by a t-test comparison of experimental results to randomly generated simulations, and by the application of Cohen's Kappa index of concordance to experimental data. This was true even when the locations of low resistance areas along the dorsal trunk were compared to only those vertebral palpatory findings rated as "severe." When test-retest reliability of GSR was examined, only 27% of vertebral segments implicated by GSR on initial examination were also implicated in the same subjects 4 h later. It was noted that low resistance areas detected by GSR were always punctate in nature and appeared to correspond well to known acupuncture loci. Further investigation revealed that, indeed, the GSR unit was not only effective in locating those acupuncture points that happened to be in a state of lowered resistance at the time but was also able, within about 5 sec, to decrease the resistance of any particular point not already in its lowest state of resistance to a level sufficient to generate a positive and persistent GSR reading where none had been detected previously. It is suggested that GSR may not be a reliable predictor of the location of vertebral pathology, at least as assessed by palpation in pain-free subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Attentional alterations of slant-specific interference between line segments in eccentric vision.

Slant-specific interference between line segments in eccentric vision was altered by attentional methods in hypnotically susceptible observers. These methods included negative and positive posthypnotic hallucination of the inducing elements of the array, and nonhypnotic instruction to actively ignore the elements. Contributions to the experimental effects apparently derived in part from intrinsic inhibitory or facilitatory skill in the individual observer, sharpened by hypnotic training in hallucinations. Control observers with low and with high hypnotic susceptibility were not able to alter significantly the interference effect when attempting to simulate the hallucination conditions. The results seemingly link these attentional alterations to an early cortical stage of visual processing.