Clinical Research


Identifying the site of treatment for spinal manipulative therapy

Triano, Jay & Budgell, Brian

The purpose of this project is to determine the quality of evidence in support of the methods used by clinicians to identify the site for application of spinal manipulative therapy. An archive is to be created consisting of articles published in peer-reviewed journals and pertaining to the methods by which pracititioners identify the site for application of spinal manipulative therapy. A collection of relevant studies has been made available by Cleveland Chiropractic College, and is to be supplemented by a literature search conducted at CMCC.
Relevant articles will be distributed to reviewers who will evaluate the quality of the studies using QUADAS. QUADAS is a tool for the retrospective evaluation of the quality of studies of diagnostic accuracy (Whiting et al 2003). The QUADAS checklist contains 14 discrete items pertaining to the execution of studies rather than to the quality of the manuscripts. Hence, items are graded as either present (executed in the study), absent (not executed in the study) or unclear (execution unclear from the manuscript). QUADAS has been used in evaluations of studies in a number of areas of musculoskeletal medicine, including manual medicine (van Trijffel et al 2005), and individual checklist items have demonstrated good inter-examiner reliability (Whiting et al 2006). Furthermore, it appears likely that reliability can be enhanced by provided reviewers with criteria which are tailored to the study or group of studies under consideration (Whiting et al 2006). For example, in evaluating studies concerning site of care for spinal manipulation, one might wish specify that descriptions of tests include a reference to the regions of the spine or even the precise vertebral level at which a test was applied – if this were relevant to the test in question.
Articles judged to be of sufficient quality will be abstracted to evidence tables and consensus will be sought on the quality of evidence for each procedure examined.

Effectiveness of a lumbar support in maintaining the lumbar lordosis in sitting: A radiographic comparison of initial and long-term effects on lumbar spine and pelvic posture during simulated prolonged driving

De Carvalho, Diana

According to the 2005 Statistics Canada General Social Survey, Canadians spend increasingly more time commuting to work; on average 63 minutes round trip. For professional drivers, such as truck drivers and police officers, driving time per day can be expected to be at least 7 hours. Sitting for prolonged periods of time in a vehicle has been identified as a cause of mechanical low back pain in the literature. In sitting, the pelvis rotates posteriorly and the lumbar lordosis flattens out. This places increased demand on back muscles and ligaments to hold the upper body erect and increases pressure in the discs of the spine. Maintaining the lumbar lordosis of the low back with a built in lumbar support has been suggested to relieve low back pain associated with prolonged sitting in a car seat. It is presently unknown whether this intervention actually causes a change at the level of the spine or merely compresses the soft tissue of the back. To date only one study has radiographically examined the changes in the lumbar spine in response to a lumbar support when sitting in a car seat; however, this study only included two participants one of which suffered from back pain. Radiographic analysis is deemed to be the most accurate representation of spine and pelvic mechanics as external measures of postures have been shown to be unreliable in the literature. Therefore, this study will explore the effectiveness of a lumbar support to cause a change in posture at the skeletal level at increments of horizontal excursion. Plain film x-rays taken concurrently with tri-axial accelerometers will be used to measure changes in lumbar spine and pelvic posture with and without a lumbar support

An exploratory, uncontrolled, pilot study investigating the effects of subtalar joint manipulation on two outcome measures: weight bearing dorsiflexion range of motion and center of pressure excursion index

Lee, Alex

Faulty biomechanical foot function, excessive pronation or supination, has been implicated in the generation of various lower extremity overuse injuries. Central to the creation of these complex movements is the function of the subtalar joint. The subtalar joint also plays a role in producing joint coupling movements that facilitate the development of gross functional foot movements, such as weight bearing dorsiflexion. It is postulated that subtalar joint manipulation may be able to correct aberrant subtalar joint motion and re-establish proper joint coupling during functional lower extremity maneuvers. Considering the subtalar joint pronates to contribute to the development of weight bearing lower limb dorsiflexion, the weight bearing dorsiflexion lunge test may be used to study the effects of subtalar joint manipulation. Plantar pressure parameters, specifically the center of pressure excursion index (CPEI), has been used previously to study various foot and ankle movements and pathologies. This measure has the potential to be used to study the effects of subtalar joint manipulation on dynamic foot function. No studies to date have investigated the effects of subtalar joint manipulation. Consequently, there exist no studies in the literature that can be used to obtain a sample size estimate. It is the purpose of this uncontrolled, exploratory pilot study to evaluate the utility of 2 outcome measures (weight bearing dorsilfexion range of motion and center of pressure excursion index) to study the effects of subtalar joint manipulation on foot function and to obtain data to determine a sample size estimate for a larger study investigating the effects of subtalar joint manipulation on foot function.