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News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
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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