Manual therapy interventions in the management of adults with prior cervical spine surgery for degenerative conditions: a scoping review.

OBJECTIVE: Cervical spine surgeries for degenerative conditions are rapidly increasing. Cervical post-surgery syndrome consisting of chronic pain, adjacent segment disease, recurrent disc herniation, facet joint pain, and/or epidural scarring is common. Repeat surgery is regularly recommended, though patients are often unable to undergo or decline further surgery. Manual therapy is included in clinical practice guidelines for neck pain and related disorders, however clinical guidance for utilization of manual therapy in adults with prior cervical spine surgery is lacking. This study aimed to synthesize available literature and characterize outcomes and adverse events for manual therapy interventions in adults with prior cervical spine surgery due to degenerative conditions. METHODS: Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was followed. PubMed, Cumulative Index of Nursing and Allied Health Literature, physiotherapy evidence database, and Index to Chiropractic Literature were searched from inception through October 2021. English-language literature comprised of randomized clinical trials (RCT), case-control, cohort, and case report designs were included. Adults undergoing manual therapy, with or without combination of other interventions, with prior cervical spine surgery due to degenerative conditions were included. RESULTS: Twelve articles were identified, including 10 case reports, 1 low-quality RCT, and 1 acceptable-quality RCT. Eight case reports described 9 patients with history of fusion surgery. Two case reports described 2 patients with history of discectomy. One case report described one patient with separate operations of a discectomy at one level and a fusion at another level. One case report described 2 patients with history of cervical disc replacement surgery. The two RCTs included 63 and 86 participants, respectively. Use of manual joint mobilization/manipulation, table/instrument assisted mobilization/manipulation, and multimodal interventions were described in eligible studies. Favorable clinical outcomes were reported in 10 studies. Six case reports/series involving 8 patients described use of unclassified forms of manual therapy. Eight studies described the use of multimodal interventions along with manual therapy. One study described high patient satisfaction. Two studies, accounting for 3 patients, reported serious adverse events. CONCLUSIONS: There is a lack of literature informing evidence related to clinical outcomes, patient satisfaction, and adverse events associated with manual therapy for patients with prior cervical spine surgery due to degenerative conditions. High-quality studies of higher-level hierarchical study design are needed to understand the clinical utility and safety profile of manual therapy for this population.

A New Paradigm for Addressing Health Disparities in Inner-City Environments: Adopting a Disaster Zone Approach.

Inner cities are characterized by intergenerational poverty, limited educational opportunities, poor health, and high levels of segregation. Human capital, defined as the intangible, yet integral economically productive aspects of individuals, is limited by factors influencing inner-city populations. Inner-city environments are consistent with definitions of disasters causing a level of suffering that exceeds the capacity of the affected community. This article presents a framework for improving health among inner-city populations using a multidisciplinary approach drawn from medicine, economics, and disaster response. Results from focus groups and photovoice conducted in Milwaukee, WI are used as a case study for a perspective on using this approach to address health disparities. A disaster approach provides a long-term focus on improving overall health and decreasing health disparities in the inner city, instead of a short-term focus on immediate relief of a single symptom. Adopting a disaster approach to inner-city environments is an innovative way to address the needs of those living in some of the most marginalized communities in the country.

The Association Between Multimorbidity and Quality of Life, Health Status and Functional Disability.

INTRODUCTION: Approximately 50% of adults have multimorbidity (MM) that is associated with greater disability, poorer quality of life (QOL) and increased psychological distress. This study assessed the association between MM and QOL, health status and functional disability in U.S. adults. METHODS: Cross-sectional study of 23,789 patients from 2011 Medical Expenditure Panel Survey was conducted. Mean scores were calculated for QOL (physical component score [PCS] and mental component score [MCS]) and proportions for functional limitation (activities of daily living [ADL]; instrumental ADL [IADL] and physical functioning). Health status was assessed by depression and serious psychological distress. Regression models evaluated associations between MM and QOL, functional health status and functional limitations, while adjusting for confounders. RESULTS: Approximately 53% of 45-64-year-olds and 84% of those ≥65-years-old had MM. In adjusted models, ≥3 conditions were significantly associated with poorer outcomes-PCS QOL (ß = -9.15; 95% CI: -9.69 to -8.61), MCS QOL (ß = -1.98; 95% CI: -2.43 to -1.52), ADL (odds ratio [OR] = 5.80; 95% CI: 2.27-14.8), IADL (OR = 3.99; 95% CI: 2.31-6.88) and physical functioning (OR = 16.8; 95% CI: 12.0-23.6) compared with 1-2 conditions. Depression (PCS QOL: ß = -4.02; 95% CI: -4.89 to -3.15; MCS QOL: ß = -12.5; 95% CI: -13.2 to -10.9; ADL: OR = 2.49; 95% CI: 1.65-3.76; IADL: OR = 2.65; 95% CI: 1.88-3.72; physical functioning: OR = 2.44; 95% CI: 1.99-2.99) and serious psychological distress (PCS QOL: ß = -3.16; 95% CI: -4.30 to -2.03; MCS QOL: ß = -11.8; 95% CI: -12.8 to -10.8; ADL: OR = 1.57; 95% CI: 0.95-2.60; IADL: OR = 1.13; 95% CI: 0.80-1.59 and physical functioning: OR = 1.41; 95% CI: 1.11-1.78) were significantly associated with adverse outcomes. CONCLUSIONS: In this nationally representative sample of U.S. adults, MM was significantly associated with poorer QOL, functional health status and physical functioning, when adjusting for relevant confounders. A holistic view of the complexities associated with MM must dictate comprehensive care.

Association between spirituality and depression in adults with type 2 diabetes.

PURPOSE: The purpose of the study was to examine the association between spirituality and depression among patients with type 2 diabetes. METHODS: This study included 201 adult participants with diabetes from an indigent clinic of an academic medical center. Participants completed validated surveys on spirituality and depression. The Daily Spiritual Experience (DSE) Scale measured a person's perception of the transcendent (God, the divine) in daily life. The Center for Epidemiologic Studies-Depression scale assessed depression. Linear regression analyses examined the association of spirituality as the predictor with depression as the outcome, adjusted for confounding variables. RESULTS: Greater spirituality was reported among females, non-Hispanic blacks, those with lower educational levels, and those with lower income. The unadjusted regression model showed greater spirituality was associated with less depression. This association was mildly diminished but still significant in the final adjusted model. Depression scores also increased (greater depression risk) with females and those who were unemployed but decreased with older age and non-Hispanic black race/ethnicity. CONCLUSIONS: Treatment of depression symptoms may be facilitated by incorporating the spiritual values and beliefs of patients with diabetes. Therefore, faith-based diabetes education is likely to improve self-care behaviors and glycemic control.

Association of health literacy with complementary and alternative medicine use: a cross-sectional study in adult primary care patients.

BACKGROUND: In the United States, it is estimated that 40% of adults utilize complementary and alternative medicine (CAM) therapies. Recently, national surveys report that over 90 million adults have inadequate health literacy. To date, no study has assessed health literacy and its effect on CAM use. The primary objective of this study was to assess the relationship between health literacy and CAM use independent of educational attainment. Second objective was to evaluate the differential effect of health literacy on CAM use by race. METHODS: 351 patients were recruited from an outpatient primary care clinic. Validated surveys assessed CAM use (I-CAM-Q), health literacy (REALM-R), and demographic information. We compared demographics by health literacy (adequate vs. inadequate) and overall and individual CAM categories by health literacy using chi square statistics. We found a race by health literacy interaction and ran sequential logistic regression models stratified by race to test the association between health literacy and overall CAM use (Model 1), Model 1 + education (Model 2), and Model 2 + other demographic characteristics (Model 3). We reported the adjusted effect of health literacy on CAM use for both whites and African Americans separately. RESULTS: 75% of the participants had adequate literacy and 80% used CAM. CAM use differed by CAM category. Among whites, adequate health literacy was significantly associated with increased CAM use in both unadjusted (Model 1, OR 7.68; p = 0.001) and models adjusted for education (Model 2, OR 7.70; p = 0.002) and other sociodemographics (Model 3, OR 9.42; p = 0.01). Among African Americans, adequate health literacy was not associated with CAM use in any of the models. CONCLUSIONS: We found a race by literacy interaction suggesting that the relationship between health literacy and CAM use differed significantly by race. Adequate health literacy among whites is associated with increased CAM use, but not associated with CAM use in African Americans.

National patterns and correlates of complementary and alternative medicine use in adults with diabetes.

OBJECTIVE: The aim of this study was to determine national patterns and correlates of complementary and alternative medicine (CAM) use among adults with diabetes. METHODS: The authors compared CAM use in 2474 adults with and 28,625 adults without diabetes who participated in the most comprehensive national survey on CAM use (2002 National Health Interview Survey). Eight CAM use categories were created, including dietary, herbal, chiropractic, yoga, relaxation, vitamin, prayer, and other (acupuncture, Ayurveda, biofeedback, chelation, energy healing or Reiki therapy, hypnosis, massage, naturopathy, and homeopathy). An overall CAM use category also was created that excluded vitamins and prayer. Patterns of use were compared with chi-square and independent correlates of CAM use with multiple logistic regression controlling for relevant covariates. STATA was used for analysis to account for the complex survey design. RESULTS: Prevalence of overall use of CAM did not differ significantly by diabetes status (47.6 versus 47.9%, p = 0.81). Diabetes was not an independent predictor of overall use of CAM (OR 0.93, 95% confidence interval [CI] 0.83, 1.05). However, persons with diabetes were more likely to use prayer (OR 1.19, 95% CI 1.05, 1.36), but less likely to use herbs (OR 0.86, 95% CI 0.75, 0.99), yoga (OR 0.56, 95% CI 0.43, 0.72), or vitamins (OR 0.82, 95% CI 0.72, 0.93) than people without diabetes after controlling for relevant covariates. Independent correlates of overall use of CAM differed by age, income, employment, comorbidity, and health status between people with and without diabetes. CONCLUSIONS: This study found that there has been a dramatic increase in overall use of CAM in adults with diabetes; diabetes was not an independent predictor of overall use of CAM; and people with diabetes were more likely to use prayer, but less likely to use herbs, yoga, or vitamins compared to persons without diabetes.

Disease-focused or integrated treatment: diabetes and depression.

This article reviewed the literature on the adverse health outcomes of the coexistence of diabetes and depression, the challenges of treating coexisting diabetes and depression in a fragmented health care system, and the need for integrated care as a strategy to improve the quality of care for patients who have complex medical illnesses (eg, patients who have coexisting diabetes and depression).

Association between complementary and alternative medicine use, preventive care practices, and use of conventional medical services among adults with diabetes.

OBJECTIVE: To assess the association between complementary and alternative medicine (CAM) use, preventive care practices, and use of conventional medical services among adults with diabetes. RESEARCH DESIGN AND METHODS: We analyzed data on 2,474 adults with diabetes. We created an overall CAM-use category based on use of any of the following: diets, herbs, chiropractic care, yoga, relaxation, acupuncture, ayuverda, biofeedback, chelation, energy healing, Reiki therapy, hypnosis, massage, naturopathy, and homeopathy. We used multiple logistic regression to assess the effect of CAM use on preventive care practices (receipt of influenza and pneumonia vaccines) and use of conventional medical services (number of primary care and emergency department visits). STATA was used for statistical analysis to account for the complex survey design. RESULTS: A total of 48% of adults with diabetes used some form of CAM. CAM use was independently associated with receipt of pneumonia vaccination (odds ratio 1.56 [95% CI 1.26-1.94]) but not significantly associated with receipt of influenza vaccination (1.17 [0.92-1.48]). CAM use was independently associated with visiting the emergency department (1.34 [1.06-1.70]), having six or more primary care visits (1.44 [1.14-1.83]), and having eight or more primary care visits (1.66 [1.22-2.25]). CONCLUSIONS: In contrast to the findings of previous studies, CAM use appears to be associated with increased likelihood of receipt of preventive care services and increased emergency department and primary care visits. CAM use may not be a barrier to use of conventional medical services in adults with diabetes.

The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes.

OBJECTIVE: This study compared the prevalence and pattern of use of complementary and alternative medicine (CAM) in individuals with and without diabetes and identified factors associated with CAM use. RESEARCH DESIGN AND METHODS: The 1996 Medical Expenditure Panel Survey, a nationally representative sample of the U.S. noninstitutionalized civilian population, was analyzed. Estimates of CAM use in individuals with common chronic conditions were determined, and estimates of CAM use in patients with diabetes were compared with that in individuals with chronic medical conditions. Patterns of use and costs of CAM use in patients with diabetes were compared with those in nondiabetic individuals. Multiple logistic regression was used to determine independent predictors of CAM use in individuals with diabetes, controlling for age, sex, race/ethnicity, household income, educational level, and comorbidity. RESULTS: Individuals with diabetes were 1.6 times more likely to use CAM than individuals without diabetes (8 vs. 5%, P < 0.0001). In the general population, estimates of CAM use were not significantly different across selected chronic medical conditions, but diabetes was an independent predictor of CAM use. Among individuals with diabetes, older age (> or =65 years) and higher educational attainment (high school education or higher) were independently associated with CAM use. CONCLUSIONS: Diabetes is an independent predictor of CAM use in the general population and in individuals with diabetes. CAM use is more common in individuals aged > or =65 years and those with more than high school education.