Week 9 Flashcards
(26 cards)
What does research say about SMT for neck and low back pain?
SMT is supported by low–moderate quality evidence for reducing pain and improving function, especially in chronic, nonspecific cases.
What are the benefits of SMT over medical management?
SMT is relatively safe, cost-effective, and reduces opioid reliance.
What treatment appears most effective for chronic neck pain?
Multimodal care (e.g., SMT + exercise + education + postural correction).
What did recent RCTs reveal about targeted vs non-targeted SMT?
Moderate-certainty evidence found no significant difference in outcomes for pain or disability.
What is the purpose of Chiropractic Maintenance Care (CMC)?
To prevent relapse, optimize health, reduce symptoms, and support long-term function through ongoing care.
What does CMC include beyond SMT?
Exercises, diet counselling, patient education, and supplements.
What did studies on CMC for chronic LBP find?
Patients receiving long-term CMC maintained lower disability scores compared to those receiving short-term care only.
What are common reasons chiropractors recommend CMC?
To prevent recurrence (95%), optimize health (90%), and provide palliative care (86%).
What are the 3 types of care schedules in chiropractic?
(i) Crisis/Symptom Care, (ii) Supportive Care, (iii) Maintenance Care.
What are clinical prediction rules in chiropractic?
Criteria that predict likelihood of success with SMT (e.g., pain duration <16 days, no leg symptoms, good hip IR).
What impacts SMT effectiveness in research?
Patient selection, frequency, target site selection, and multimodal integration.
What should clinicians consider before adjusting?
Evidence-based reasoning, symptom patterns, validated tests, patient preferences, and red flags.
What are clinical red flags?
Signs or symptoms suggestive of serious pathology needing urgent referral.
Which red flags have empirical evidence of accuracy?
History of malignancy and strong clinical suspicion.
Give examples of red flags.
Saddle anesthesia, acute confusion, urinary incontinence, progressive weakness, suicidal ideation, unexplained fever.
What is the danger of relying on unvalidated red flags?
It may lead to over-referral, underdiagnosis, or clinical confusion.
What is primordial prevention?
Universal public health interventions (e.g., fluoridated water).
What is primary prevention?
Actions to avoid disease development (e.g., smoking cessation).
What is secondary prevention?
Early detection (e.g., mammograms) to avoid progression.
What is tertiary prevention?
Reducing impact of diagnosed conditions (e.g., rehab exercise).
. Appraise evidence investigating the effectiveness of manual therapies on neck and low back pain:
SMT is supported by low to moderate quality evidence for chronic nonspecific neck and low back pain.
Multimodal approaches (SMT, exercise, education) show best results.
Cost-effective and relatively safe compared to medical management.
Targeting specific vertebrae has no significant effect on pain/disability outcomes.
Dose matters: 12+ visits show stronger benefits for chronic cases.
Explain the purpose and perceived effectiveness of CMC (Chiropractic Maintenance Care):
Aims to prevent recurrence, optimize wellness, reduce symptoms, and maintain gains.
Includes SMT, exercise, lifestyle advice, and education.
Perceived as effective by 90–95% of chiropractors and patients.
RCTs show long-term benefits in disability and pain control, particularly for chronic low back pain.
- Apply research findings to chiropractic clinical practice:
Use SMT as part of multimodal care, not in isolation.
Emphasize shared decision-making, patient education, and exercise.
Tailor care using clinical prediction rules and consider evidence-informed frequency of visits.
Avoid over-reliance on unvalidated diagnostic tests.
. Understand and contextualize clinical red flags according to the research:
Red flags are warning signs that may indicate serious pathology.
Only two with strong empirical support:
History of malignancy
Strong clinical suspicion
Many red flags are non-specific and should be interpreted in context with the full clinical picture.
Use to guide, not dictate, decision-making.
