How real is the subluxation? A research perspective.
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Humans↗
Biomedical subjects
C Leboeuf-Yde
Publications and source records attributed to C Leboeuf-Yde.
[The health project Ebeltoft: health check ups and discussions in general practice. Basic data from a 5-year, prospective, randomized, controlled population study].
A study was carried out to investigate people's interest in participating in health check-up and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health check-up, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. All general practitioners from the four practices in Ebeltoft and a random sample of 2,000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups-one control group and two intervention groups. One intervention group was given a health check-up which included a range og tests (Table 2 and 3); this group received written feedback from the general practitioner. The other intervention group was also given a health check-up and written feedback, in addition, they were given the opportunity to attend their general practitioner to discuss health-promoting measures. A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health check-up. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer: 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). There was considerable interest in participating in health promotion. Three out of four of those who had a health check-up were given health advice. Two out of three of those who were offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Longterm follow up is needed to determine effects and side effects of health check-up and health talks.
Adult↗
Why has the search for causes of low back pain largely been nonconclusive?
STUDY DESIGN: Cross-sectional data were collected in a postal questionnaire within the framework of a 5-year randomized, controlled, prospective, population-based study. OBJECTIVES: To investigate to what extent associations differ or concur when correlates of low back pain are rested against various subdefinitions of low back pain. SUMMARY OF BACKGROUND DATA: Numerous factors have been suspected to cause low back pain, but findings have not been constantly reproduced in epidemiologic studies. METHODS: Data were collected on 748 people reporting nonspecific low back pain some time during the year preceding the survey. Six correlates of low back pain (age, sex, marital status, attitude to a healthy life-style, self-reported physical activity at work, and smoking) were cross-tabulated against nonspecific low back pain and against four subgroups of low back pain. RESULTS: There was only one statistically significant strong association between the potential risk indicators and the nonspecific definition of low back pain, but several emerged when the low back pain group was split into subgroups. Different subgroups of low back pain did, indeed, relate differently to the various correlates. CONCLUSIONS: It is necessary to define some clinically relevant subgroups of low back pain to accelerate the search for causal mechanisms.
Adult↗
Frequency and characteristics of side effects of spinal manipulative therapy.
STUDY DESIGN: A prospective clinic-based survey. OBJECTIVES: To study the type, frequency, and characteristics of unpleasant side effects after spinal manipulative therapy. SUMMARY OF BACKGROUND DATA: Spinal manipulative therapy is a commonly used treatment, but there is little knowledge of its side effects. METHODS: Information regarding unpleasant reactions after spinal manipulative therapy was collected after 4712 treatments on 1058 new patients by 102 Norwegian chiropractors (response rate, 70%) through structured interviews. RESULTS: At least one reaction was reported by 55% of the patients some time during the course of a maximum of six treatments. Of the reported reactions, the most common were local discomfort (53%), headache (12%), tiredness (11%), or radiating discomfort (10%). Reactions were mild or moderate in 85% of patients. Sixty-four percent of reactions appeared within 4 hours of treatment, and 74% had disappeared within 24 hours. Uncommon reactions were dizziness, nausea, hot skin, or "other" complaints, each accounting for 5% or less of reactions. It was unusual that symptoms commenced later than on the day of or the day after treatment, were of long duration (not gone at the latest on the day after onset), described as severe, or that they resulted in reduced activities of daily living. There were no reports of serious complications in this study. CONCLUSIONS: Profiles now are described of common and uncommon reactions to spinal manipulative therapy and their latency, duration, and severity.
Activities of Daily Living↗
Interprofessional contacts between chiropractors and other health-care professionals in Sweden as seen from a chiropractic perspective.
OBJECTIVE: To investigate the type and extent of interprofessional contacts between chiropractors and members of the conventional Swedish health-care system and to study the possible barriers to effective cooperation between these groups. DESIGN: Surveys through self-administered questionnaires and a structured telephone interview. PARTICIPANTS: Twenty consecutive patients of 31 chiropractors (n = 616) participated in the questionnaire survey, and 15 randomly selected chiropractors participated in the telephone interview. SETTING: Chiropractic practices in Stockholm, Sweden. MAIN OUTCOME MEASURES: Information was sought on the type and number of interprofessional contacts and on barriers to free and effective communication. RESULTS: Eighteen percent of patients were recommended to chiropractic care by some other health-care practitioner. Only 1% of the participating patients were referred for chiropractic care with a written request. Almost all chiropractors (87%) could provide a list of the last three health-care professionals with whom they had contact. The median number of interprofessional contacts per month was estimated by the chiropractors to be 10. Legal recognition of chiropractors and the inclusion of these in the County Council reimbursement program were thought to have improved the image of chiropractic. Considerable barriers to cooperation were stated to exist still. CONCLUSION: Successful integration of chiropractors into the Swedish health-care system requires an overall policy plan and practical guidelines of cooperation.
Chiropractic↗
Chiropractic in Sweden: a short description of patients and treatment.
BACKGROUND: Most information on chiropractors and chiropractic emanates from North America. With an increasing number of chiropractors in Europe, it is important to produce relevant documentation concerning the European practice of chiropractic. OBJECTIVES: To describe the typical Swedish chiropractic patient and the treatment he/she receives. DESIGN: Chiropractors interviewed 10 consecutive patients using a standardized questionnaire. OUTCOME VARIABLES: Age, sex, previous treatment by chiropractor, area and duration of complaint, area and type of treatment and number of return visits (truncated data). RESULTS: Of the 86 chiropractors who could take part in the study, 78% participated. They each collected information on 10 consecutive patients (n = 628, response rate 73% of target sample), altogether 1858 return visits. Most patients were aged between 25 and 64 yr, with no difference in numbers between genders. Typically, they sought care for low back pain of up to 1 month's duration, were treated with spinal manipulation and received 2-3 treatments. Swedish chiropractic patients thus seem to seek care relatively early and undergo a short-lasting treatment program. However, a larger number of treatments was given to patients with problems of longer duration; patients who had not previously consulted a chiropractor presented with more long-lasting problems. CONCLUSIONS: The findings are in line with present-day concepts that emphasize the concurrent needs to avoid both the development of chronicity and long-lasting, invasive clinical intervention. Chiropractic care seems not to be a first choice therapy for those who have not previously received chiropractic care.
Adult↗
Side effects of chiropractic treatment: a prospective study.
OBJECTIVES: To investigate whether the characteristics of unpleasant sid effects after spinal manipulative therapy coincide with those obtained in a previous study. DESIGN: A prospective interview survey using standard questionnaires. SETTING: Sixty-six Swedish private practices of chiropractic (response rate, 78%). SUBJECTS: Ten consecutive patients per chiropractor (625 patients, 73% of target sample; 1858 recorded visits). INTERVENTION: Spinal manipulation. MAIN OUTCOME MEASURES: Self-reported unpleasant reactions, time of onset, duration and severity of symptoms. RESULTS: Reactions to spinal manipulation are common and benign. They typically arise and disappear shortly after treatment (usually gone the day after treatment). The most common reactions are local discomfort in the area of treatment (two thirds of reactions), followed by pain in areas other than that of treatment, fatigue or headache (10% each). Nausea, dizziness or "other" reactions are uncommonly reported (< 5% of reactions). Reactions are most commonly reported by women and (for both genders) at the beginning of the treatment series. Patients with long lasting problems are more likely to report treatment reactions; however, patients with no prior experience of chiropractic care do not report more reactions than patients previously treated by chiropractors. CONCLUSION: Common and uncommon reactions to chiropractic spinal manipulation have been identified, are to a large degree foreseeable and seem to be predominantly physiological in nature.
Adult↗
How common is low back pain in the Nordic population? Data from a recent study on a middle-aged general Danish population and four surveys previously conducted in the Nordic countries.
STUDY DESIGN: Data were obtained in a Danish cross-sectional postal survey and compared with information from four methodologically similar studies conducted in some of the Nordic countries between 1977-1985. OBJECTIVES: The objectives were to estimate the lifetime cumulative incidence and the 1-year period prevalence of low back pain in the general population, to study whether there are any differences in the occurrence of low back pain according to age and sex, and to investigate whether low back pain is on the increase. SUMMARY OF BACKGROUND DATA: The prevalence of low back pain commonly is thought to be high, but estimates differ considerably between studies. It is also not known whether low back pain is more common in men or women or in certain age groups, and it is unclear whether the prevalence of low back pain has increased in the past years. METHODS: Prevalence estimates were established in a current study, and results then were adjusted to suit the age and sex criteria of four previous studies. RESULTS: Between 60-65% of 30- to 50-year-old men and women living in the Nordic countries reported at least one incident of low back pain during their lifetime, based on the information from four studies with a total sample size of 3513. The most likely 1-year period prevalence estimate is between 44-54%, based on two studies and a total sample of 2035 individuals. There was no consistent evidence favoring higher figures with increasing age or relating to any of the genders. No clearly observed time-related trend was noted. CONCLUSIONS: When data were examined from five methodologically similar studies on the 30- to 50-year-old Nordic population, there was reasonable consistency of prevalence figures. Thus, approximately 66% report having had low back pain at least sometime during their lifetime and approximately 50% sometime during the preceding year, with no significant differences relating to age or sex. The best method to investigate whether low back pain is on the increase might be through replicate studies.
Adult↗
Side-effects of chiropractic spinal manipulation: types frequency, discomfort and course.
OBJECTIVE: To make a preliminary appraisal of the types of unpleasant reactions reported by patients after spinal manipulation and to estimate their frequency. STUDY DESIGN: Standardized interview data collected in a longitudinal survey. METHOD: Ten chiropractors collected data on all unpleasant reactions that were reported after a maximum of six visits by ten consecutive patients per chiropractor, with the use of a questionnaire that contained mainly closed-ended questions. RESULTS: Following 368 treatments in 95 patients, some type of side-effect was reported after 1/3 of treatments. Local or radiating symptoms were most commonly reported (23%). No alarming events were reported. Ninety percent of all reactions were graded by the patients as moderate or slight. They commenced on the day of therapy in 87% of cases, and had disappeared within 24 hours in 83%. CONCLUSION: Results from this preliminary study indicate that reactions to spinal manipulation may be relatively common but benign in nature and of short duration. No estimate could be made of rare or serious side-effects.
Adult↗
Predictors of side effects to spinal manipulative therapy.
OBJECTIVE: To study whether side effects of spinal manipulative therapy can be predicted and, if so, whether they are patient- or treatment-related. Also, to determine if there are different predictors for common reactions (i.e., local discomfort, headache, tiredness or radiating discomfort) and for uncommon reactions (i.e., dizziness, nausea, hot skin or "other" complaints). STUDY DESIGN: Data were collected in patient interviews using standard questionnaires in a prospective clinic-based survey. Several outcome variables (reactions during the course of treatment, reactions after each treatment, specific types of treatment reactions, severe or long-lasting reactions) were then cross-tabulated against sex, age, treatment session number, type of area treated, number of areas treated and type of treatment. SETTING: Chiropractic clinics in Norway. PARTICIPANTS: One hundred and two chiropractors (response rate: 70%) and 12 consecutive patients per chiropractor (resulting in 1058 chiropractic patients) attending for up to six treatments (totaling 4712 treatments). RESULTS: Some patient- and treatment-related predictors were identified. Women were more likely to report reactions to treatment than men. There were also differences between gender in the types of reactions reported. More reactions occurred during the first treatment sessions, when more than one spinal region was treated, or when the thoracic spine only was treated. However, there were no specific predictors for uncommon side effects. CONCLUSION: Some predictors to the side effects of spinal manipulative therapy were identified but more information is needed regarding their clinical significance.
Adolescent↗
Quality assurance in chiropractic practice: a comparison of two study methods.
OBJECTIVES: A comparison was made of two methods of data collection used in a quality-assurance study to determine whether the study samples were comparable and self-reported satisfaction similarly. We also investigated whether patients who dropped out of treatment early were more dissatisfied than those who remained for more treatments. STUDY DESIGN: A comparison was made of data collected through self-administered, structured questionnaires in the two studies. Participants were invited consecutively by chiropractors in study 1; chiropractic patients, selected randomly from a reimbursement register, received a postal questionnaire in study 2. PARTICIPANTS: Study 1 aimed for a maximum of 20 patients for each of 31 chiropractors included under a reimbursement scheme in the county of Stockholm, Sweden. Six hundred and sixteen patients entered the study, and 83% participated in a survey conducted at their third visit. Three hundred patients were invited to respond to the postal questionnaire at least 1 month after they received chiropractic care; the response rate was 77%. MAIN OUTCOME MEASURES: Sociodemographic factors, area of complaint, sick-leave, perceived improvement, unpleasant side-effects and overall satisfaction with care. RESULTS: There were no differences noted between the two study groups, and patients who received fewer than three treatments were no less satisfied than those who received more. Additional analyses indicate that factors other than dissatisfaction influence whether patients remain in therapy for fewer than three visits. CONCLUSION: Quality-assurance studies conducted in the chiropractor's practice, using consecutive sampling and anonymous questionnaires, seem to give results that are similar to the more complex and costly method of obtaining randomly selected study subjects from a central source and collecting the information through anonymous postal surveys.
Adolescent↗
The risk of over-reporting spinal manipulative therapy-induced injuries: a description of some cases that failed to burden the statistics.
OBJECTIVE: To describe some cases of severe or fatal symptoms that might be attributed to spinal manipulative therapy and one case that illustrates the importance of witnesses when a patient dies under unusual circumstances. CLINICAL FEATURES: Three of these cases were fatal (two strokes and one heart attack) and one was potentially lethal (a bleeding basilar aneurysm). Another patient developed paresis of one arm and leg (cervical disc prolapse). A case of lower limb paresis and incontinence is also described (cauda equina). INTERVENTION: Because of chance, none of these patients actually received chiropractic treatment. CONCLUSION: The incidence of iatrogenic events that occur after chiropractic treatment is unknown. Such events are generally thought to be under-reported. However, the possibility of over-reporting should also be kept in mind.
Adult↗
Does smoking cause low back pain? Results from a population-based study.
OBJECTIVES: To investigate (a) whether there is a causal link between smoking and low back pain (LBP), (b) whether smoking is uniquely associated with symptoms in the lumbar spine and (c) the role of respiratory problems in the possible link between smoking and LBP. STUDY DESIGN: Data were collected through questionnaires in a cross-sectional study of a representative sample of the general Danish population, consisting of 1370 men and women aged 30-50 yr, with a response rate of 69%. BACKGROUND: In some epidemiological studies (mostly those of cross-sectional design) smoking has been associated with LBP; this association, however, is not consistently present in all reports. Several theories exist that attempt to explain a possible association between the two; only rarely have these theories been systematically tested. However, cross-sectional data can also be used to obtain answers to questions relating to causes and mechanisms. METHOD: A list of expectations was produced that related to three hypotheses previously forwarded in the epidemiological literature. The fit of the data in the present study was then considered in the light of these expectations. RESULTS: There is evidence in favor of a causal link between smoking and some definitions of LBP. Smoking was not uniquely associated with the lumbar spine. Respiratory symptoms seemed to be positively associated with LBP but only when linked with smoking. CONCLUSIONS: The clinical significance of these findings is limited, but it needs to be considered in future research. Abstinence from smoking may, however, be a useful means of primary prevention of certain types of LBP.
Adult↗
The prevalence of low back pain in the literature. A structured review of 26 Nordic studies from 1954 to 1993.
STUDY DESIGN: A systematic review was done for all prevalence studies on low back pain in the Nordic population between 1954 and 1992 that could be identified. OBJECTIVE: To investigate the homogeneity of data. SUMMARY OF BACKGROUND DATA: Costs resulting from low back pain are steadily increasing, but it is not known whether this has been caused by changes in healthcare behavior or whether there is an underlying increase in the occurrence of low back pain in the general population. The prevalence rate of low back pain has been continually estimated over the last 40 years, but are the studies sufficiently homogeneous to allow pooling of data? METHODS: Twenty-six population-based epidemiologic surveys on the occurrence of low back pain in the Nordic countries were assessed for the following criteria: quality of the report according to a checklist related to the representativeness of the study sample, quality of data, and definition of low back pain; study design (study population, definition of low back pain, and recall periods); probability of data, taking into account the quality of the report, the definition of low back pain, type of population, age, and sex. RESULTS: Only 10 studies fulfilled a minimum of 75% of the methodologic criteria. There were large differences between studies regarding study design, and the poolability of data was limited to a few studies, none of which fulfilled all of the above criteria. CONCLUSION: A more stringent, systematic, and uniform methodologic approach to studying the prevalence (or incidence) of back pain is needed.
Adolescent↗
Ebeltoft project: baseline data from a five-year randomized, controlled, prospective health promotion study in a Danish population.
BACKGROUND: There is increasing political pressure on the medical profession to approach welfare diseases, such as coronary heart disease and diabetes, through prevention. General practitioners are required to offer regular health checks to healthy people, in spite of the lack of scientific evidence for the universal need, usefulness and side effects of such an intervention. Randomized controlled trials are needed. AIM: A study was carried out to investigate people's interest in participating in health checks and in discussions about health with their own general practitioner, participants' health status, the proportion who received health advice following health checks, and the lifestyle goals they set following discussion with their general practitioner. This study reports the baseline data from a five-year randomized, controlled, prospective, population-based study in general practices in Ebeltoft, Denmark. METHOD: All general practitioners from the four practices in Ebeltoft and a random sample of 2000 people aged between 30 and 50 years were invited to participate. Participants were randomly divided into three groups--one control group and two intervention groups. One intervention group were given a health check which included being screened for cardiovascular risk factors, lung and liver function, fitness, sight and hearing and an optional test for the human immunodeficiency virus (HIV); this group received written feedback from the general practitioner. The other intervention group were also given a health check and written feedback; in addition, they were given the opportunity to attend their general practitioner to discuss preventive health. RESULTS: A total of 1370 people participated in the study (69% response rate). Health advice was given to 76% of 905 participants following health checks. Almost all of the 456 participants (96%) who were offered the opportunity of discussing their health with their general practitioner took up the offer; 64% of the 456 participants reported that they had decided to undertake lifestyle changes. Eleven of those who discussed their health with the doctor were referred to a specialist (2%). CONCLUSION: There was considerable interest in participating in health promotion. Three out of four of those having a health check were given health advice. Two out of three of those offered a health talk with the general practitioner appeared willing to make relevant lifestyle changes. Long-term follow up is needed to determine effects and side effects of health checks and health talks.
Adult↗
Does smoking cause low back pain? A review of the epidemiologic literature for causality.
BACKGROUND: Smoking has been associated with low back pain (LBP) in several epidemiologic studies but the results are contradictory. Despite this, smoking is often assumed to be a causative factor of LBP. STUDY OBJECTIVE: To appraise the epidemiologic literature to establish whether there is evidence for a causal link between smoking and LBP. DATA SOURCES: Twenty-two original research reports published between 1974 and 1993 were reviewed and a systematic investigation was made of eight of these, which were retained because they included study samples representative of their target populations. DATA SYNTHESIS: To uncover any evidence for a causal relationship between smoking and LBP, these eight reports were examined in detail for strength of association, dose-response effect, temporality and consistency of findings. RESULTS: Some studies found a positive association between smoking and LBP; when present, the strength of this association was generally small. Some associations remained unchanged after multivariate analysis, whereas others became statistically nonsignificant. Contradictory results were also noted in studies which reported on the dose-response relationship and time of exposure in relation to time of onset of LBP. There was inconsistency of findings within and between studies relating to LBP. However, the evidence was consistently against a causal association between smoking and sciatica/discal hernia. CONCLUSION: It cannot be clearly deduced whether smoking has a causal effect on LBP or whether the positive findings sometimes noted are linked to some other, still unidentified factor. However, there is clearly no proof supporting a causal association between smoking and sciatica/discal hernia.
Causality↗
Smoking and low back pain: is the association real?
STUDY DESIGN: A review was made of the epidemiological literature on the association between smoking and low back pain (LBP). OBJECTIVES: The first objectives was to identify studies that challenged their preliminary results with additional test factors and to see what effect this had on the outcomes. The second objective was to identify test factors that were unique to studies in which the original association disappeared after multivariate analysis. SUMMARY OF BACKGROUND DATA: The literature on this subject is confusing and no systemic investigation seems to have been made on the possibility of spurious data interpretation. METHODS: Twenty-four articles reporting on 126 epidemiological studies (in 24 reports) on the association between smoking and LBP were systematically reviewed by the authors, independently and jointly. RESULTS: In eight of the thirteen studies that tested a preliminary positive association between smoking and LBP, this association remained after multivariate analysis, whereas it disappeared in after analysis in five. Two variables, marital status and occupation, were uniquely present in some of the studies in which the initial positive association was lost. However, their study samples were probably nonrepresentative of the general population. CONCLUSIONS: A more strategic approach is needed in the study of the role of extraneous factors. In particular, marital status and occupation should be further investigated.
Epidemiologic Methods↗
Is it possible to differentiate people with or without low-back pain on the basis of test of lumbopelvic dysfunction?
OBJECTIVE: To determine the prevalence of positive chiropractic test results in relation to low back pain status and to determine the sensitivity, specificity, and predictive (positive and negative) values of these tests. DESIGN: Study subjects were examined by a chiropractor who was unaware of their low back pain status. Information on low back pain was then collected in a self-report questionnaire. SETTING: Research laboratory at the Odense University Hospital (Denmark). SUBJECTS: A subset of 166 healthy twins taken from a panel of population-generated twins born between 1953-1982. EXAMINER: Chiropractor with approximately 10 years of clinical experience. MAIN OUTCOME MEASURES: The prevalence of a number of lumbopelvic dysfunctional tests (4 observational, 6 pain-on-movement, and 2 pain provocation tests), and a diagnostic conclusion based on these test results were studied in relation to low back pain status. RESULTS: There was no single test that was clinically acceptable in relation to all 5 aspects of the study. At least one pain-on-movement test was the only variable that had a totally acceptable pattern. CONCLUSION: Although no individual test was accurate, the diagnostic discrimination on the basis of these tests was satisfactory.
Adult↗