A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Exercise Therapy Following Motor Vehicle Trauma (Pt. 2)
In cases of cervical spine trauma, particularly trauma related to a motor vehicle accident, my plan is to teach the patient one exercise per session and build a progression. This is an effective approach I call an "activation circuit."
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
May, 2015, Vol. 15, Issue 05
Research Examines Effectiveness of Thai Massage and Physical Therapy
By Massage Therapy Foundation Contributor
Contributed by April V. Neufeld, BS, LMP; Jolie Haun, PhD, EdS, LMT; & Renee Stenbjorn, MPA, LMT
If you have ever plunged into the details of an original published research article, then you know how tedious some research can be to read.However, if you have ever been too afraid to explore an original article, then let this month's Massage Therapy Foundation research column review be a call to face your fears! The research in a recent publication of Clinical Interventions in Aging is a great place to start exploring scientific writing. "The efficacy of traditional Thai massage in decreasing spasticity in elderly stroke patients" is an easy read compared to most research papers, and although it has it's fair share of statistics and graphs, the authors do an excellent job of explaining their process.
The purpose of this study was to compare the effectiveness of traditional Thai massage to traditional physical therapy for decreasing muscle spasticity in stroke patients over the age of 50 years. A group of subjects (n=50) were randomly assigned to either the traditional Thai massage (TTM) or the physical therapy (PT) group. Since muscle spasticity causes pain and can limit functional abilities affecting posture and joint contracture, this condition often affects quality of life (QoL) and emotional states. The researchers measured anxiety and depression, activities of daily living (ADL), limb motor function and muscle spasticity. Functional abilities in self care and mobility were measured with the Barthel Index (BI), where a high score (0-20) means better function. The modified Ashworth Scale (MAS) measured spasticity (0 = no increase in muscle tone and 4 = the effected body part is ridged in flexion or extensions).
The study outlines the participant exclusion process and presents a clear flowchart (Figure 1) to illustrate their approach to screening 220 people at study onset to the final follow-up at week 6 of the 50 subjects. For readers who might be considering creating their own research study, this figure in conjunction with the methods section provides an excellent illustration of how small sample sizes can result in useful research. It's often difficult to find willing volunteers; volunteers who are not excluded for various risk factors and who are dedicated to finishing the study protocol. If you read through Figure 1, you will see that of the 26 people assigned to the PT group, 4 of them did not complete the final follow-up due to "inconvenience." This is fairly common in research studies involving any volunteers.
The TTM routine was standardized by an unnamed Thai massage organization and performed by certified practitioners. Often research articles do not describe the massage therapy techniques being studied in clear enough detail for replication. Fortunately, this publication (see Table S1) described the TTM routine, areas and duration of treatment (in minutes). Unfortunately, the PT description was lacking similar detail. Both groups (TTM n=24, PT n=26) received one hour treatments, twice a week for six weeks.
If you read the original article, the statistical analysis and results sections may seem intimidating at first, but I encourage you to read through them. The authors provide simple and accurate descriptions of their findings and provide an excellent discussion of the study limitations. If you do read through the study and if you do not have training in statistics the results may appear to you to support TTM over PT, but for each test category the study found no statistical difference between PT and TTM groups.
Here is an outline of the results at week six:
The authors do an excellent job discussing the limitations of this study, suggesting future research is needed with larger sample sizes. Also they suggest subjects with a low functional mobility score (low BI at the beginning of the study) could have indicated a higher likelihood of developing spasticity and a lower likelihood of recovery. This study did not evaluate the long-term effects of either TTM or PT on spasticity.
Based on the findings, you may be wondering what the benefit is for stroke patients receiving TTM when the standard treatment is equally effective. First, it is important for patients and healthcare providers to know that alternative (TTM) and traditional (PT) options of treatment are available which produce similar outcomes. This can support individualized treatments plans based on personal preferences. Second, in a world of challenges with insurance and billing, increasingly treatment options are directed by effectiveness of treatment and cost. Although this study does not address this subject, cost of TTM and PT should be considered. In general, the health care industry is in need of cost effective options, as such cost comparison studies are needed to determine how much could potentially be saved, in the case where different treatment options may not produce statistically different outcomes.
Overall, this study provides an example of bodywork therapy research that is clearly illustrated and mostly replicable, making an important contribution to the field of massage therapy research. For those readers interested in case reports, this study could potentially be used as a roadmap for writing your own report. The methods used to evaluate effects of TTM on spasticity (measuring spasticity, QoL, depression, anxiety, and functional ability) could be used to measure the efficacy of TTM on other conditions or massage therapy's effect on spasticity.
Are you a massage therapy student who has an interesting case of your own? The deadline to submit to the MTF Student Case Report Contest is June 1, 2015. If you or your students are interested in learning how to write and submit a case report of your own, check out the MTF's five-part case report webinar series to learn the how to write a winning case report.
To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation review article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.
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