Current Issue:  Volume 5, Issue 2 (2014)

Topics in Integrative Health Care: an International Journal (TIHC) is a peer-reviewed, open-access online journal. It is dedicated to advancing the integration of multiple disciplines, both complementary and mainstream, into diverse health care settings in order to provide optimal patient care. It presents themed issues on topics of current relevance to health care providers interested in integrative, conservative care, health promotion and disease prevention. It includes international, interdisciplinary Grand Rounds in order to facilitate communication and patient comanagement among various health professions, for the good of patients everywhere.

Topics in Integrative Health Care (TIHC) is published by Healthindex, Inc. (ChiroACCESS).


Topics in Integrative Health Care

Cheryl Hawk, DC, PhD, CHES    

Topics in Integrative Health Care 2014, Vol. 5(2)     ID: 5.2001   

Topics in Integrative Health Care welcomes unsolicited manuscripts with original research, Grand Rounds, clinical briefs and “fast facts” collections. All submissions are peer-reviewed.


Recommendations to the Musculoskeletal Health Network, Health Department of Western Australia related to the Spinal Pain Model of Care made on behalf of the Chiropractors Association of Australia (Western Australian Branch)

Lyndon G. Amorin-Woods, BAppSci(Chiropractic)    

Gregory F. Parkin-Smith, MTech(Chiro), MBBS, MSc, DrHC    

Vern Saboe, DC, DACAN, FACO    

Anthony L. Rosner, Ph.D., LL.D.[Hon.], LLC    

Topics in Integrative Health Care 2014, Vol. 5(2)     ID: 5.2002   

The 2009 Spinal Model of Care published by the Western Australian Health Department via the Musculoskeletal Health Network would benefit from an update. Best-evidence synthesis and cost-risks-benefits estimations suggest that such guidelines should provide: (1) the early assessment of patients with non-malignant spinal pain (particularly low back) by a musculoskeletal clinician, be it a chiropractor, musculoskeletal physician, osteopath or musculoskeletal physiotherapist with referral within the early stages of the disorder; and (2) the provision of manipulative therapy, where indicated, as a first-line treatment while also providing rehabilitation, health promotion, and contemporary wellness/wellbeing management with the intention of avoiding chronicity. Emerging workforce capacity suggests that early assessment and evidence-based management of non-malignant spinal pain is feasible, leading to better patient outcomes. The authors and the association are hopeful that providing this submission in open access may prove useful for advocates of the chiropractic profession in other jurisdictions.


Supportive Pad Impact on Upper Extremity Blood Flow While Wearing a Military Backpack

John Ward, DC, MA, MS

Jesse Coats, D.C., B.S., D.A.A.P.M.

Ashley Devers

Braeden Murphy

Topics in Integrative Health Care 2014, Vol. 5(2)     ID: 5.2003   

Introduction: The Spine Buddy® supportive pad was developed to be inserted underneath military backpacks to help disperse heavy loads.

Purpose: The purpose of this study was to determine the impact the additional supportive pad has on upper extremity blood flow when wearing a heavy military backpack.

Methods: Forty healthy participants (age= 26.4 + 5.5 yr, height= 1.74 + 0.11 m, body mass= 79.6 + 20.4 kg: mean + SD) were equally randomized into an AB:BA crossover study design. Twenty participants were in the AB group, and twenty were in the BA group. The study involved a 15-minute rest period between each of the 2 conditions: A (wearing a 45.3 kg military backpack) vs B (wearing a 45.3 kg military backpack with an additional ergonomic support pad underneath). Participants wore the backpack for 2 minutes during each condition (A or B) and then upper extremity blood flow measurements were taken. Outcome measures were index finger pulse oximetry and radial artery spectral Doppler Resistance Index (RI) assessed under each condition. An independent samples t-test was used to make comparisons between A and B conditions.

Results: No statistically significant difference was shown between pulse oximetry or RI between A and B conditions.

Conclusion: Preliminarily, the results of this study suggest that wearing an additional support pad underneath a military backpack has no short-term impact, positive or negative, on pulse oximetry or upper extremity blood flow.

Traditional Versus a Modified Problem-based Learning Activity: Is There a Difference in Student Knowledge Retention?

Martha A. Kaeser, MA, DC

Jeffrey Kamper, DC

Cheryl Hawk, DC, PhD, CHES

Topics in Integrative Health Care 2014, Vol. 5(2)     ID: 5.2004   

Objective: This comparative study of a modified problem based learning activity examined the knowledge retention immediately after instruction and at six weeks post-instruction in two groups of students who were presented patient information either through a teacher-led lecture or student-directed patient interaction.

Methods: Eighty-four students were randomly divided into two groups; active participation versus didactic. Students were provided information on a patient with neurological signs and symptoms. This was done either through a teacher-led verbal and written presentation of the case or a collaborative student directed thorough history taking and examination using a standardized patient.

Results: The majority in both groups reported that they would retain information if they were actively involved in the learning process (91% and 94%, respectively). Overall, the group that was able to interact with a patient during a clinical simulation scored statistically significantly higher on both Test 1 (CI, 0.2-1.9) and Test 2 (CI, 0.3-1.7).

Discussion: Problem based learning activities include varying aspects of student participation. Students report higher satisfaction with activities in which they actively participate. There is a paucity of research demonstrating that factual knowledge retention increases when students are actively involved.

Conclusion: Overall, this study suggested that there may be differences in knowledge retention when instruction is provided actively versus didactically.

Conservative Treatment of Chronic Traumatic Ankle Arthropathy: A Case Report

Stefanie Coforio, DC, MS

Kristina Kulcak, DC

Alham Samani, DC

Topics in Integrative Health Care 2014, Vol. 5(2)     ID: 5.2005   

Introduction: This paper reports on a 47-year-old Caucasian female who presented to a chiropractic college teaching clinic with pain and unresolved functional deficits from an untreated traumatic calcaneal fracture of 10 years duration diagnosed by radiograph.

Case Presentation: The patient had altered gait, range of motion deficits in the right ankle, hypesthesia and weakness in the right lower leg, and sacroiliac joint pain provoked with lumbar ranges of motion and orthopedic testing. The chiropractic diagnosis was traumatic right ankle arthropathy, pain in the right ankle, myalgia of the right lower extremity, as well as lumbosacral joint dysfunction.

Intervention and Outcomes: Conservative treatment included chiropractic manipulation of the lower extremity and lumbosacral spine, acupuncture in the right ankle region for pain control, soft tissue techniques including myofascial release and instrument-assisted soft tissue mobilization, adjunctive therapies (heat, interferential current and ice massage) and rehabilitative exercises. Outcome measures included the numerical rating scale (NRS) for pain, the Lower Extremity Functional Scale (LEFS), and the Revised Oswestry. The patient attained clinically significant improvement in her NRS and LEFS scores.

Discussion: Untreated traumatic structural changes in the calcaneus can produce chronic pain, inflammation and adhesions along with restricted movement resulting in arthropathy. A combination of conservative therapies and rehabilitation was successful in reducing functional deficits and pain in this patient.

Fast Facts

Fast Facts

THIC Staff    

Topics in Integrative Health Care 2014, Vol. 5(2)     ID: 5.2006   

Readers are welcome to contribute to Fast Facts. Please include the original abstract (with citation) that is the source of your contribution. Contributors’ names will be included along with the item.

The following is an excerpt:

A formula of ginkgo biloba plus choline formula demonstrated isolated and modest effects on cognitive and immune functioning among healthy older adults with no history of significant cognitive deficits.

Lewis JE, Melillo AB, Tiozzo E, Chen L, Leonard S, Howell M, Diaz J, Gonzalez K, Woolger JM, Konefal J, et al: A double-blind, randomized clinical trial of dietary supplementation on cognitive and immune functioning in healthy older adults. BMC Complement Altern Med 2014, 14:43.