Topics in Integrative Health Care: an International Journal

Topics in Integrative Health Care

Sun, 10 Mar 2013 00:00:00 GMT

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

Review of the Use of Complementary and Alternative Medicine by Non-Hispanic Blacks

Sun, 10 Mar 2013 00:00:00 GMT

Introduction: Complementary and Alternative Medicine (CAM) has been on the rise over the past two decades. However, most CAM surveys demonstrate that blacks use CAM less often than whites. There is a shortage of review articles summarizing this discrepancy in use. Therefore a greater understanding of the true prevalence of different forms of CAM used by blacks is warranted.

Methods: This review was generated through a three-step process. The first step involved a 2002-2011 literature search performed using key terms: African Americans, blacks, complementary therapies, prayer, herbal medicine, massage therapy, chiropractic, acupuncture, and mind-body therapies.. Databases included the Index to Chiropractic Literature, PubMed, Alt Health Watch, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The intent was to find all peer-reviewed original articles about Non-Hispanic black usage of major forms of CAM during the intended time frame. The second step involved hand-searching numerous journal articles for relevant studies. The third step involved reference tracking of the articles that had already been discovered to find new articles. Following screening, articles were then grouped thematically for discussion purposes as follows: acupuncture, chiropractic, herbal medicine, massage therapy, mind-body therapies, and prayer as forms of CAM, as well as CAM use articles for specific health conditions.

Results: Thirty-six original articles met the inclusion criteria. This was composed of thirty-five original surveys and one focus-group analysis.

Conclusion: The existing evidence suggests that Non-Hispanic blacks use CAM significantly less than whites, with the exception of prayer. The reason for this difference should be further investigated.

Obesity and Transitory Healthcare Utilization Interferes with Acromegaly Diagnosis in Adult Male

Sun, 10 Mar 2013 00:00:00 GMT

This case is presented to highlight the impact of obesity and irregular healthcare utilization on the diagnosis of acromegaly. A new patient (32-year old obese white male) with no regular primary care physician presented for annual preventive exam. Primary care physician suspected acromegaly due to large hand size, but facial features were hidden by facial fat disbursement. Patient presented the following year with significant weight loss (106 lbs) revealing considerable enlargement of facial features. Laboratory analysis and MRI revealed secretory pituitary macro-adenoma with significant impact on multiple hormone levels. Patient’s lack of consistent primary care physician and obesity hindered early diagnosis of acromegaly.

Putting Research into Practice: A Comprehensive 12 Week Exercise Protocol for Fibromyalgia

Sun, 10 Mar 2013 00:00:00 GMT

Fibromyalgia is a chronic condition that most often affects young to middle-aged women. According to the American College of Rheumatology, it is diagnosed by the presence of widespread musculoskeletal pain for at least 3 months and excessive tenderness in at least 11 out of 18 defined tender points. Currently there are no definitive diagnostic laboratory tests or imaging for fibromyalgia. Its cause is still unknown. The purpose of this appraisal was to evaluate the effectiveness of aerobic training-based exercise programs compared to other types of physical activity on the symptomatology of fibromyalgia. Searches on PubMed/MEDLINE databases using key words, pool exercise, fibromyalgia, aerobic fitness and home-based exercise, were performed to identify articles comparing different exercise regimens. A treatment protocol was developed based on the articles identified.

Fast Facts

Sun, 10 Mar 2013 00:00:00 GMT

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:

Twenty minutes of exercise 3 times per week improved aerobic capacity, but did not improve musculoskeletal pain and other work-related factors in a 12-week intervention.

Gram B, Holtermann A, Bultmann U, Sjogaard G, Sogaard K. Does an exercise intervention improving aerobic capacity among construction workers also improve musculoskeletal pain, work ability, productivity, perceived physical exertion, and sick leave?: a randomized controlled trial. J Occup Environ Med. Dec 2012;54(12):1520-1526.

Integrative Medicine at the University of Maryland Interview with Brian Berman, MD

Sun, 10 Mar 2013 00:00:00 GMT

Brian Berman is a tenured professor of family medicine and director of the Center for Integrative Medicine at the University of Maryland School of Medicine, Dr. Berman trained in family medicine and pain management as well as complementary medical approaches such as Traditional Chinese Medicine. He has dedicated his career to evaluating the efficacy, safety and cost-effectiveness of complementary and integrative medicine. In 1991 he founded the first U.S. academic medical center-based program for integrative medicine.

Topics in Integrative Health Care

Mon, 31 Dec 2012 00:00:00 GMT

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

Anti-Vaccination Attitudes within the Chiropractic Profession: Implications for Public Health Ethics

Mon, 31 Dec 2012 00:00:00 GMT

Even though vaccination is generally seen as one of the great successes of modern public health, pockets of resistance to vaccination exist. One such pocket of resistance is within the chiropractic profession. Reasons for this may relate to the philosophical basis for the profession and the antipathy the medical profession has traditionally shown chiropractic. This paper examines the nature of chiropractic opposition to immunization and places it squarely in the context of bioethics and public health, with a professional emphasis on personal autonomy over community good.

Sleep Characteristics in Patients with Whiplash-Associated Disorders: A Descriptive Study

Mon, 31 Dec 2012 00:00:00 GMT

Study Objectives: The purpose of this study was to explore sleep habits and characteristics of patients with whiplash-associated disorders (WAD) presenting at an outpatient, chiropractic clinic using the Medical Outcomes Study (MOS) Sleep Scale.

Methods: Fifty-one patients from an outpatient chiropractic and physical therapy clinic specializing in spinal rehabilitation participated in this cross-sectional, descriptive study. Data were collected using a descriptive survey, the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the self-administered 12-item MOS Sleep Scale. Data analysis included descriptive statistics to describe pain, disability, and sleep characteristics of the study sample, and computation of confidence intervals to determine differences in means of sleep characteristics between the non-WAD population (as determined by previous studies) and the study sample of WAD patients.

Results: Results indicate that when compared to normative values of the non-WAD population, the sample of WAD patients in this study presents with significantly greater measures of neck disability (NDI), neck pain (VAS), sleep disturbance, snoring, shortness of breath and headache, sleep somnolence and sleep problems index I and II. This sample also presents with significantly lower measures of optimal sleep when compared to the general population.

Conclusion: Consistent with previous research, findings from this study indicate that WAD patients have increased neck disability and pain, and poorer sleep outcomes, indicating the need for clinicians to assess sleep characteristics and incorporate interventions aimed at alleviating these symptoms when planning rehabilitation. Findings provide evidence for the need to further explore sleep disturbances among WAD patients to establish a stronger understanding of the course and prognosis of this condition.

Comparison of Resting Pulse Rates in Chiropractic Students Versus the General Population

Mon, 31 Dec 2012 00:00:00 GMT

Introduction: Research typically shows that a lower resting pulse rate (RPR) is healthier than a higher RPR. Limited research on reduction of RPR following chiropractic care warrants further research. Accordingly, the present study compares RPRs between a small group of chiropractic student-patients and a similar group from the general population.

Methods: RPR data from a convenience sample of 17 chiropractic students, who were also chiropractic patients (CSP), were compared to a reference group from the general population. Both groups consisted of young adult white males and were compared using a two sample t test and effect size.

Results: The CSP group had a mean RPR of 65.2 BPM compared to the general population group whose mean RPR was 71 BPM, a difference that was statistically significant (p = 0.0097). A low-to-medium effect size (of 0.39) was observed for this difference as well.

Conclusion: This group of chiropractic student-patients had a lower average resting pulse rate compared to their reference group. Further study with random sampling and an accounting of other potential confounders such as physical fitness is warranted.

Chinese Herbs for the Management of Atopic Dermatitis: A Case Report

Mon, 31 Dec 2012 00:00:00 GMT

Atopic dermatitis is a chronic disease that is characterized by itchy and inflamed skin. The prevalence of atopic dermatitis has significantly increased during the past several decades. There has been significant interest in Chinese herbal medicine as a treatment for atopic dermatitis. The objective of this case study is to report a case of the use of Chinese herbs for treating atopic dermatitis in a six-month-old boy. This patient presented with dry erythematous and pruritic patches on both cheeks and the creases of both elbows and knees. He was diagnosed with atopic dermatitis by his pediatrician when he was two months old. The original medical advice was to change the infant’s formula to one that was soy-based, but the condition continued. Hydrocortisone 0.5% ointment was prescribed but the patient’s family preferred not to use it. The patient was prescribed a Chinese herbal decoction prepared from Feng Guang Shen, Fu Ling and Shan Yao to be administered in his formula. This was administered four times per day for six months. The skin rashes gradually decreased and the patient stopped scratching his skin. By the age of 15 months the symptoms had completely disappeared. The patient was monitored for the next six years, during which time there was no recurrence of his symptoms reported by patient’s family. This case report supports the conduction of quantitative studies of the role of Chinese herbs in the management of pediatric atopic dermatitis.

Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain

Mon, 31 Dec 2012 00:00:00 GMT

The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain.^1-3

Fast Facts

Mon, 31 Dec 2012 00:00:00 GMT

The following is an excerpt:

A randomized trial of 169 pregnant women compared standard obstetric care alone to standard obstetric care plus a multimodal approach to low back and pelvic pain incorporating manual therapy, stabilization exercises, and patient education provided by chiropractic specialists. Results showed that the multimodal approach benefited patients more than standard obstetric care alone.

George JW, Skaggs CD, Thompson PA, Nelson DM, Gavard JA, Gross GA. A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy. Am J Obstet Gynecol Oct 23 2012. DOI: 10.1016/j.ajog.2012.10.869

Integrative Health Care for a Medicaid Population: Interview with Alan Post, DC

Mon, 31 Dec 2012 00:00:00 GMT

In the United States, Medicaid is the government-sponsored health insurance program for people with the lowest incomes and many who are disabled. Medicaid is paid for by a combination of federal and state government funds, with the federal share covering the majority of costs. In the state of Rhode Island, Medicaid initiated in 2012 a pilot program under which management of patients with chronic pain would include the option of chiropractic, acupuncture and massage therapy services. In this interview with Rhode Island chiropractor Alan Post, DC, he describes the specifics of the program and emphasizes its cost-saving potential.

Topics in Integrative Health Care

Wed, 26 Sep 2012 00:00:00 GMT

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

The Supreme Court Speaks, U.S. Health Reform Continues

Wed, 26 Sep 2012 00:00:00 GMT

The United States Supreme Court has upheld the Patient Protection and Affordable Care Act as constitutional. While the Court limited the power of the federal government to require state governments to expand Medicaid coverage to include many more low-income Americans, the rest of the Affordable Care Act stands as the law of the land. Unless repealed, its provisions will be implemented. For all Americans, it is now very important to know what changes this involves, so that we may further educate ourselves as to their likely effects, as well as the likely effects of eliminating them by repeal.

Chiropractic Utilization and Medicaid Coverage for Individuals with Arthritis: Making the Case for More Accessible and Affordable Chiropractic Care

Wed, 26 Sep 2012 00:00:00 GMT

Purpose: Effective utilization of complementary and alternative medicine (CAM) for management of chronic conditions has been steadily increasing over the past decade. Access to provider-based CAM services such as chiropractic is determined, in part, by healthcare coverage. Chiropractic care is covered by Medicaid although the coverage may be limited based upon individual state regulations. The purpose of this study was to evaluate patterns of chiropractic and other healthcare use in the U.S by Medicaid recipients with arthritis, the number one chronic musculoskeletal condition and the leading cause of disability in the U.S.

Methods: Weighted proportions from a nationally representative longitudinal cohort from Panel 13 (n = 18,287) of the Medical Expenditure Panel Survey spanning 2008-2009 were selected for this study to represent healthcare coverage, health status, and healthcare utilization among individuals with arthritis. The population was stratified by self-report physician-diagnosed arthritis, and healthcare coverage status. Chi-square tests were used to compare differences among healthcare coverage and arthritis status to demographics, health status, and healthcare utilization.

Results: Medicaid recipients reported the least utilization of chiropractic services compared to the privately insured and the uninsured (P < .01). More Medicaid recipients utilized office-based physician visits, filled prescription drugs, and reported poorer perceived general and mental health than the privately insured (P < .01).

Conclusion: Chiropractors need to be aware of the demographics of individuals with chronic conditions receiving Medicaid who may potentially benefit from their services and continue efforts at increasing availability of their services to vulnerable groups through healthcare reform.

The Effect of the Tri-Core® Cervical Pillow on Sleep Outcomes Among Whiplash Associated Disorder (WAD) Patients

Wed, 26 Sep 2012 00:00:00 GMT

Objectives: The purpose of this study was to determine the effectiveness of a semi-customized orthopedic cervical pillow on sleep outcomes in Whiplash Associated Disorder (WAD) patients.

Methods: A convenience sample of forty-three WAD patients who participated in this study was randomly assigned to an intervention or control group. The intervention group was given a Tri-Core® (Core Products International, Inc., Osceola) semi-customized orthopedic cervical pillow for sleep. Both the intervention and control groups received the Funhab® rehabilitation protocol (Sports and Spine Rehab Holdings Inc., Fort Washington). Outcome measures collected at the initial visit (baseline) and at discharge in both groups included characteristics of self-reported sleep operationalized by research participants completing the Medical Outcomes Study (MOS) Sleep questionnaire. Duration in the study varied among patients depending on individual progression and needs. Data were analyzed using descriptive statistics and repeated measures ANOVA.

Results: There were no differences between the control group and intervention group in sleep problems, sleep disturbances and sleep adequacy. The only significant finding between groups was the improvement in self-reported snoring in the intervention group.

Conclusion: These findings indicate that WAD patients who use a semi-customized cervical pillow in combination with a standard rehabilitation protocol did not experience improvements in most of their sleep outcomes beyond those experienced by a control condition that used the rehabilitation protocol alone. The single variable which did decline among patients who used the TriCore® pillow and increased in the control condition was self-reported snoring. Future research is warranted to further examine other sleep characteristics associated with snoring as a result of using the TriCore® cervical pillow and the Funhab rehabilitation program.

Clinical Brief: Recognition and Treatment of the Elusive Sports Hernia

Wed, 26 Sep 2012 00:00:00 GMT

Sports hernia is a chronic groin injury in athletes related to repetitive kicking, twisting, or turning at high speeds. A cluster of five signs and symptoms warrants investigation of sports hernia: (1) a complaint of deep groin/ lower abdominal pain, (2) pain exacerbated by sport-specific activities and relieved at rest, (3) palpable tenderness over the pubic ramus, (4) pain with resisted hip adduction, and (5) pain with resisted abdominal curl-up. The diagnosis is clinical in nature and it is appropriate that health care providers are well educated and knowledgeable in the clinical presentation, differential diagnosis, and management options when confronted with athletes suffering from groin pain. This article attempts to provide a thorough summary of involved anatomy, clinical diagnosis, imaging, manual therapy and surgical management.

Fast Facts

Wed, 26 Sep 2012 00:00:00 GMT

The following is an excerpt:

This pilot randomized trial found that it was feasible for a multidisciplinary, outpatient team composed of CAM and conventional practitioners to deliver coordinated, individualized interventions to patients with subacute LBP. Results showed a promising trend for benefit of treating patients with persistent LBP with this integrated care model.

Eisenberg DM, Buring JE, Hrbek AL, et al. A model of integrative care for low-back pain. J Altern Complement Med. Apr 2012;18(4):354-362.