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Chiropractic theories > II. Done Manipulable lesions > Flashcards

II. Done Manipulable lesions Flashcards

1
Q

What is a condition that responds positively to manipulation, is anticipated to do so, or a condition in which manipulation is not contraindicated?

A

Manipulable lesion

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2
Q

Pain, restriction, joint locking, malposition and fibromyalgia are examples of what kind of NMS system disorder?

A

functional, because the diagnosis is based on symptoms and cause remains elusive

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3
Q

Structural disorders and neoplastic changes are examples of what kind of NMS system disorder?

A

organic, because we can test, see or pinpoint the cause of symptoms

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4
Q

Pain syndromes of mechanical origins, posterior joint syndrome, IVD syndrome, SI syndrome, headache and myofascial pain syndrome are examples of what type of spinal manipulative condition?

A

functional (biomechanical)

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5
Q

Osteoarthritis (DJD), inflammatory disease (ankylosing spondylitis), autoimmune disease (RA), congenital/developmental defects, disc herniations, thoracic outlet syndrome, traumatic/postural sprains and strains are examples of what type of spinal manipulative condition?

A

organic (anatomic)

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6
Q

What are the steps to identifying a manipulable lesion?

A
  • examine patient
  • determine is there is a health care problem
  • establish the healthcare problem is a manipulable condition
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7
Q

A study that generates new data based on events that occur after the study begins?

A

prospective

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8
Q

A study that reviews events that have already occurred?

A

retrospective

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9
Q

Measurements taken or information gathered at one point in time?

A

cross-sectional

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10
Q

A study involving serial measurements taken oven time?

A

longitudinal

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11
Q

A study in which the researcher observes events as they occur naturally or in the course of normal practice, without attempting to influence them?

A

observational

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12
Q

A study about a clinical event (lowest level in hierarchy of evidence)?

A

anecdote

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13
Q

A written report on the details of a single case (limited generalizability)?

A

case study

-practice-based

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14
Q

A written report on the details of a series of related cases?

A

case-series

-practiced based

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15
Q

A study in which a group of patients who already have a condition is compared to another group of controls who do not?

A

case-control

-valuable for studying rare outcomes or diseases

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16
Q

A study where observations are made in a group of subjects that is followed over time while risk factors are documented and outcomes observed?

A

cohort study

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17
Q

A prospective longitudinal experiment designed to assess the comparative effectiveness of a treatment?

A

clinical trial

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18
Q

A prospective longitudinal study in which patients are divided into tow or more groups on a randomized basis?

A

randomized controlled trial

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19
Q

A study in which the patients are blinded as to whether they are in the experimental group or the comparison group?

A

single-blind study

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20
Q

A study in which patient and wither doctor or outcome assessors are blinded?

A

double-blind study

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21
Q

A study in which, patients, doctors and outcome assessors are blinded?

A

triple-blind study

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22
Q

A summary of scientific knowledge in an area accomplished by a review of published research, in which explicit objective methods are used to evaluate the methodological quality and the results?

A

systematic review

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23
Q

A systematic review that usually includes a ranking of quality of each study, plus statistical pooling of the data from all studies to determine average effect of treatment?

A

meta-analysis

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24
Q

The degree to which the results can be expected to hold true in settings other than the study setting?

A

external validity

-need big sample with lots of variation

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25
Q

The degree to which the results of a study are accurate for the sample of patients actually studied?

A

internal validity

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26
Q

What are the threats to internal validity?

A
  • bias
  • placebo effect
  • sample size too small
  • inappropriate control group
  • inadequate treatment group description
  • natural history
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27
Q

Examples of systematic error that produce bias?

A
  • selection bias
  • measurement bias
  • intervention bias
  • instrument bias
  • expectation bias
  • etc.
28
Q

The degree to which the results of a study are accurate for the sample of patients actually studied are dependent on what?

A
  • appropriate design
  • appropriate statistics
  • appropriate interpretation of the results
  • appropriate conclusions
29
Q

A perceived or actual improvement not

attributable to the actual treatment but to patient perception and expectation

A

Placebo effect

  • Will be part of the response to any therapeutic intervention
  • Can be difficult to distinguish from the natural progression of the condition
  • It can be influenced by many factors: type of condition, objective or subjective reporting, enthusiasm of the doctor, presence of deception, etc.
30
Q

Problems with using personal clinical experience for determining what is manipulable.

A

-placebo effect
-regression to the mean
-doctors have a financial incentive to feel that their
interventions are effective

31
Q

Statistical principle that things tend to even out,
or move toward a more average state. Since people generally seek care when their
symptoms are more severe, the statistical likelihood is that their symptoms will improve during the course of treatment.

A

Regression to the mean
I.e. Any intervention aimed at a group or
characteristic that is very different from the average will appear to be successful

32
Q

Why is patient testimony the weakest level of evidence?

A
  • Often exaggerated or inaccurate
  • They may not want to hurt your feelings.
  • Those with poor outcomes may not tell you. They just don’t show up again. You get a skewed impression of your success.
  • Patients have a financial incentive to feel better.
33
Q

The “Everything works” fallacy results from…

A

Ignorance of the “regression to the mean” principle which leads to false conclusions and interpretations

34
Q

As chiropractors, our main area of expertise is mainly:

A

NMS condition

I.e. we are conservative care orthopedics

35
Q

structural (idiopathic) scoliosis with associated joint dysfunction or subluxation syndrome is an example of what kind of disorder?

A

A combination of functional and anatomic

36
Q

What are some examples of motion segment dysfunction syndromes?

A
  • pain syndromes of mechanical origin
  • posterior joint syndromes
  • IVD syndrome
  • SI syndrome
37
Q

Subluxation/joint dysfunction syndromes, Hypomobility, Hypermobility and Facet syndrome are all examples of:

A

Posterior joint syndromes

38
Q

Minor mechanical derangements of the Intervertebral disc

A

IVD syndrome (interdiscal)

39
Q

Dysfunction of the posterior joints of the pelvis (SI joints)

A

SI syndrome

40
Q

What are some specific examples of functional (biomechanical) spinal manipulative conditions?

A
  • motion segment dysfunction syndromes
  • myofascial pain syndromes
  • headache
41
Q

Myofascial pain syndromes are also called:

A

Trigger point syndrome

42
Q

What are the three classes of headaches?

A
  • Cervicogenic
  • Muscle tension
  • Migraine
43
Q

Is there evidence for treating NMS conditions with manipulation/mobilization?

A

Yes, especially for back pain, neck pain and headaches

44
Q

What are some examples of organic (anatomic) spinal manipulative conditions?

A
  • joint dysfunction syndromes secondary to things like DJD (osteoarthritis), inflammatory disease, autoimmune disease, congenital/developmental defect, traumatic and postural complications, orthopedic neuropathy
45
Q

What is the level of evidence for treating non-NMS conditions with chiropractic
methods?

A

There is low to moderate quality evidence and much of it is inconclusive or against treating non-NMS conditions with chiropractic methods

46
Q

It has been suggested that only about _____% of

commonly used therapies have clinical research support.

A

15

Examples:
Expectorants
Arthroscopic knee surgery
Rehabilitation following arthroscopic rotator cuff repair

47
Q

___________ is one of the most supported therapies for some

NMS conditions.

A

Manipulation

48
Q

What is the highest level of evidence on the pyramid?

A

Systematic reviews

49
Q

What is the second highest level of evidence on the pyramid?

A

RCT’s

50
Q

What is the 3rd highest level of evidence on the pyramid?

A

Cohort studies

51
Q

Rank in order of evidence hierarchy (highest to lowest):
Case series
Case reports
Case-control studies

A

Case control studies
Case series
Case reports

52
Q

What is the lowest level of evidence on the evidence pyramid?

A

Animal research and laboratory studies

53
Q

What is the second to last level of evidence on the evidence hierarchy pyramid?

A

Editorial and opinions

54
Q

What are some ways to stay current with medical literature as a doctor?

A
  • subscribe to journals
  • use internet sources such as PubMed
  • attend continuing education programs
55
Q

Legal standards by which conditions are identified as manupilable?

A
  • board rules (treatment parameters set by states licensing boards)
  • court rulings (malpractice cases set precedence)
56
Q

Professional health care guidelines by which conditions are identified as manipulable?

A
  • Professional associations, panels, specialty boards, etc.
  • government agencies
  • Issues addressed in the consensus process of developing practice
    guidelines
57
Q

During the consensus process of developing practice guidelines, there review of the literature must show what in order for a condition to be identified as manipulable?

A
  • Outcome effectiveness
  • Cost effectiveness
  • Risk vs. benefit analysis
  • Reasonableness (biologic plausibility)
58
Q

What is EBP (Evidence-Based Practice)

A

Using the best research evidence and combining it with clinical expertise and factoring in the patient’s unique values and circumstances in order to provide healthcare

59
Q

Is there always clear evidence or a standard of care?

A
  • No, there is much uncertainty about many things
  • Absent or inconclusive clinical research
  • Lack of clinical guidelines
  • Unique individual expression of pathology or modifying factors
  • We may be tempted to look for answers where none exist.
60
Q

The technique systems are attractive to those with a low tolerance for ______ because techniques promise to dictate exactly where, when, how, and why to adjust.

A

ambiguity

61
Q

In light of there still being a lot of uncertainty in evidence based practice, an appropriate attitude might be:

A

“Ethical pragmatic skepticism”

62
Q

What is biologic plausibility

A

plausible according to currently accepted
scientific views regarding the pathobiological processes involved

NOTE: Doesn’t mean that somebody, somewhere thinks that it’s
plausible.

63
Q

What are some CLEAR examples of techniques that purport to treat patients by means of speculative physiological pathways that tend to lie outside what has been established by normal science?

A
  • Sacro-Occipital Technique (SOT)
  • Applied Kinesiology and its spinoffs (AK)
  • Bioenergetic Synchronization Technique (BEST)
  • Directional Non-Force Technique (DNFT)
  • Network Spinal Analysis
  • Spinal Stressology
  • Toftness Technique
64
Q

What are some POSSIBLE examples of techniques that purport to treat patients by means of speculative physiological pathways that tend to lie outside what has been established by normal science?

A
  • Logan technique
  • receptor tonus technique
  • activator methods
  • some upper cervical techniques
65
Q

What are three questions you can ask yourself when dealing with uncertainty and lack of evidence to back up a treatment?

A
  • is treatment reasonable?

- do the benefits outweigh the risks?

66
Q

When comparing the benefits and risks of a treatment, what must be considered?

A
  • inherent safety of the procedure and how it changes with the specific patient (pre-existing conditions, complications)
  • cost effectiveness
  • patient satisfaction
  • past clinical experience
  • honest explanation of condition and informed consent obtained from patient
  • if the treatment is novel or experimental, should you charge them?

Chiropractic theories (8 decks)

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