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Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
CMT & Stroke Risk: Myth vs. Fact
By now, most of you have probably heard that the American Heart Association recently published a statement regarding the association between cervical dissection (CD) and cervical manipulative therapy (CMT).
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
March, 2012, Vol. 12, Issue 03
Trying to Get Something From Nothing
By Keith Eric Grant, PhD, NCTMB
"Sometimes nothing can be a real cool hand" – Paul Newman in the movie, "Cool Hand Luke."
You are going to be hearing more and more about evidence-based massage therapy (EBMT). Partly, this reflects a current trend in health care to re-evaluate treatment and to determine what has a sound basis for use and what doesn't. One example of this is the Institute of Medicine report, "Evidence-Based Medicine and the Changing Nature of Healthcare."
A second factor is the existence of the Massage Therapy Foundation (MTF), which has goals of making those in the profession aware of research, promoting research literacy and integrating research with practice. I would count the forthcoming book on such integration by Dryden and Moyer as among the efforts facilitated by the MTF.
A third factor is massage therapy now being regulated by the majority of states, combined with the legal presumption that such regulation is done for the protection of the public. If we consider that training is necessary for safe practice, the presumption of public protection can only be fulfilled when state-mandated training is based upon a solid foundation of objectively validated knowledge.
A final factor is the modern technology embodied in an interactive web. Communication without regard to physical proximity is facilitating extensive discussions among those both with a stake in massage therapy and with backgrounds in research and statistics. Alice Sanvito discusses evidence-based massage on her web site and provides a number of links there to additional resources. I like the definition she gives for EBMT.
Evidenced based massage therapy is massage therapy founded on ideas and principles supported by evidence. Many of the claims made and practices used by massage therapists are founded on tradition rather than evidence. Since there is not yet a large body of knowledge documenting the physiology of and effects of massage therapy, if we were only able to make statements strictly on the basis of scientific studies, we would be severely limited indeed. Some people prefer the term "evidence informed practice" as more accurate. An evidence informed practice takes into consideration scientific evidence, clinical experience and careful observation.
The concept of being evidence-based, however, necessitates having methods to collect such evidence. In this, we also need to be careful to distinguish between whether or not an intervention can be shown to work (beyond random chance) and the model that we believe is the mechanism underlying the intervention. It is fully possible, as with massage relieving muscle soreness and the lactic acid myth, for an intervention to be effective while the supposed mechanism is incorrect. The randomized controlled trial (RCT) is taken as the "gold standard" of clinical proof, but how does that work? We need three things: a study population, a methodology for the study and the ability to analyze the results for effectiveness.
For example, our study population might be those diagnosed with high blood pressure, over the age of 40, not having other medical complications and not knowing Morse code. The goal of our study might be to determine whether or not listening to relaxing messages keyed in Morse code by a live practitioner were effective in reducing blood pressure. A complicating factor for the study is that people respond to the presence of other people. As put by Ravensara Travillian recently, "As psychosocial beings, we respond psychologically and socially in ways that can be described as healing body and mind due to presence and caring attention from others." Thus, our study will need a means of differentiating the effects of the Morse code from those effects simply from the practitioner's presence and the setup of the trial itself.
After gaining a sufficient number of suitable participants, we would fulfill the "randomized" concept of the trial by randomly dividing them into three groups: control, sham Morse-code and Morse code. The intervention might be three-times per week for 12 weeks. Controls would come in, have their blood pressure (BP) measured, wait 30 minutes, and have their BP measured again. Those in the Morse-code group would, in the 30 minutes wait, listen to Morse-code keyed by one of several live practitioners. Those in the "sham-group" would listen to 30 minutes of keying, similar to Morse-code, but keyed by "practitioners" unfamiliar with Morse-code. With this protocol, we can look for short-term effects between sessions, beginning and session end, as well as for longer term effects over the length of the study. By taking follow-up measurements after the end of the 12 weeks, we can also look for persistence of any changes.
Now we get to the point of getting something from nothing. We assume the null hypothesis, that any differences between the groups is simply from random chance, and calculate the probability (p) that this assumption is true. We conclude that there is a statistically significant difference between groups only when the probability of our observations being due entirely to chance is less than 5% (p<0.05). We have three separate probabilities to check: whether the sham group is statistically different from the control group (psychosocial effect), whether the Morse code group is different from the control group (psychosocial plus Morse code), and whether the difference between the sham and code groups is significant (Morse code effect). In a recent paper, Bakker and Wicherts underscore the importance of doing the third test explicitly, even when the differences between the sham and control groups is not significant.
If there is no difference between the three groups, the study would conclude that, in the clinical trial as designed, neither psychosocial factors nor messages in Morse-code were effective. If the sham group differed statistically from the control, we would conclude that there was a psychosocial effect. Because the psychosocial effect would also be present in the code group, only if the code group was statistically different from the sham group could we conclude that there was an effect from Morse-code itself. Note that this code effect could be of either sign, adding to a psychosocial effect or negating it.
There you have the outline of a randomized control/clinical trial. Assuming initially that we get no difference, we end up with information. Sometimes "nothing can be a real cool hand."
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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