Find a Chiro Contact us Call us Member login

Journal of the Canadian Chiropractic Association

March 1997 Volume 41 No. 1

    Report of The Task Force on Chiropractic Research in Canada- A study to examine and make recommendations about the design, direction and implementation of a coordinated plan to support the development of research in chiropractic in Canada

    • Alexander Grier, (Chair), DC, MBA
    • Michel Charbonneau, DC, MSc
    • Walter Herzog, PhD
    • David Peterson, DC
    • Howard Vernon, DC
    • Costa Papadopoulos, MHA

    Teaching chiropractic principles through patient centered problems


    Introduction: Large class size (148) and limited resources preclude application of the standard small group problem based learning that has generated both student and faculty satisfaction. An innovative method of teaching chiropractic philosophical foundations was developed and implemented utilizing cooperative learning, patient centered problem solving, and group presentations. Objectives: The objectives of this study were: 1) to measure the impact of an innovative method of cooperative learning on student satisfaction and class attendance; 2) to incorporate philosophical principles of chiropractic into patient centered problems; and 3) to promote cooperative and self directed learning. Methods: A class of 148 students was divided into groups of four students. Each group was assigned a patient centered problem based on clinical practice, and three to four questions related to the philosophical or “first” principles of chiropractic. The students working in the assigned groups prepared a paper addressing the questions in the context of a patient centered practice. Each group gave a thirty minute presentation followed by fifteen minutes of class interaction. Conclusions: Using cooperative student centered learning to teach chiropractic principles through patient centered problem solving generated high levels of student satisfaction and attendance in this large group. (JCCA 1997; 41(1):27-35)
    Key Words: chiropractic, patient, principles

    Introduction : étant donné les effectifs chargés (classe de 48 étudiants) et les ressources limitées, il n’est pas possible d’utiliser la méthode d’apprentissage traditionnelle, si chère aux étudiants et aux professeurs, basée sur la résolution des problèmes en petit groupe. Une méthode d’enseignement novatrice des fondements philosophiques de la chiropratique a été élaborée et mise en oeuvre. Elle repose sur l’apprentissage coopératif, la résolution des problèmes des patients et les présentations de groupe. Objectif : les objectifs de cette étude étaient : 1) de mesurer l’impact d’une méthode novatrice d’apprentissage coopératif sur la satisfaction des étudiants et leur participation aux cours; 2) d’incorporer des principes philosophiques de la chiropratique dans les problèmes du patient ; et, 3) de promouvoir l’apprentissage coopératif et l’initiative personnelle. Méthodes : une classe de 148 étudiants a été divisée en groupe de quatre. Chaque groupe a du résoudre le problème d’un patient en se basant sur la pratique clinique, et répondre à trois ou quatre questions liées aux principes philosophiques ou principes “fondateurs” de la chiropratique. Les groupes étudiants ont préparé un document répondant aux questions comme s’ils exerçaient dans un cabinet de chiropratique. Chaque groupe a effectué une présentation de trente minutes suivie d’une période interactive de 15 minutes. Conclusions : l’utilisation de l’apprentissage coopératif pour enseigner les principes de la chiropratique en se basant sur la résolution des problèmes du patient a eu un impact très positif sur la satisfaction des étudiants et leur participation aux cours. (JCCA 1997; 41(1):27-35)
    Mots-clés: chiropratique, patient, principes

    • Meridel Gatterman, MA, DC

    Before-after study to determine the effectiveness of an adjustable wood frame-foam and wool mattress bed-system (The Natura Mattress System) in reducing chronic back pain in adults


    Objective and Design: The purpose of this 6-week Before-After trial was to investigate the effectiveness of the Natura Mattress System in reducing back pain by >or = 1 unit on the 11-Point Pain Severity Scale (p< or = 0.05), in chronic low back pain sufferers. Subject Profile: The subjects were adults recruited from within and outside the Canadian Memorial Chiropractic College (CMCC) Outpatient Clinic, with chronic low back pain (LBP) of > or = 2 months duration at the time of entering the study. Sample Size: 15 subjects were targeted to complete the study. Outcome Measures: The primary outcome measure consisted of: morning severity of pain as measured by an 11-point ordinal pain scale(Numeric Rating Scale or NRS). Secondary outcome measures consisted of: (1) daily quality of sleep as measured by a 4-point ordinal scale; (2) effect on daily activity as measured by a 4-point ordinal scale; and (3) daily quantity of analgesics. These outcomes were collected via a daily diary-type of questionnaire. Statistical Analysis: Baseline to 4-week post treatment-commencement differences were analysed for statistical significance using Repeated Measures ANOVA, at the 0.05 level of significance. In addition, all outcome measures were graphed and examined descriptively for any clinically important change across the 6 week time-frame of the study. Methods Protocol: Eligible subjects who read and signed the written informed consent form, were given a package containing a copy of the written informed consent form, and upon completing the 2 week baseline daily diary questionnaires, were contacted by the bed manufacturer, who arranged with the subject a date and time of mutual convenience to deliver the bed (twin or queen size). The subject was then required to complete 4 more weeks of diary questionnaires. Thank-you cards were sent to each subject who completed the study. Results: The sample consisted of 6 caucasian females and 7 caucasian males, between the ages of 22 years and 75 years, with an average (sd) age of 37.0 (18.44) years. Five subjects were adult students, 5 had sendentary occupations, while 3 had relatively physical occupations. Baseline low back pain (LBP) severities of the sample ranged from 2 to 8 on the 11 point pain scale (NRS), with an average (sd) level of 3.0 (1.75). Average duration of the subjects’ chronic LBP state was 5.6 years, ranging from 3 months to 30 years. Only 2 subjects were taking LBP medications at the start of the study. Conclusion: For a generally well educated, young (20-40 years of age), caucasian population with mild-moderate chronic LBP, use of the Natura Bed can be expected to result in a clinically important reduction in pain severity upon both waking and at the end of the day, of at least 1 point (on the NRS) over a 4 week period (p< or = 0.05). Further research is recommended which utilizes the Randomized Clinical Trial (RCT) design to investigate the performance of the Natura Bed compared to other beds on the market, and assesses patient characterisitics predicting suitability for the Natura Bed. (JCCA 1997; 41(1):16-26)
    Key Words: sleep, bed, foam mattress, back pain, clinical trial

    Objectifs et méthodologies: le but de cette étude avant-après d’une durée de 6 semaines était de vérifier l’efficacité du système de matelas Natura dans la réduction des maux de dos atteignant 1 point ou plus sur l’échelle de 11 points de gravité de la douleur (p<0,05), chez les personnes souffrant de lombalgie chronique. Profil des sujets: les sujets étaient des adultes recrutés à l’intérieur et à l’extérieur de la clinique de consulta
    Mots-clés: sommeil, lit, matelas en mousse, maux de dos, essai clinique

    • Parham Erfanian, DC
    • Carol Hagino, BSc, MBA

    A case report of a congenital cleft of the anterior atlas arch: a rare variant of the atlas mimicking fracture


    Congenital anterior midline clefts of the atlas are rare developmental anomalies with only a few reported cases in the literature. This normal variant of the atlas results when the anterior arch fails to fuse during the ossification process. Series of cadaveric dissections have demonstrated anterior midline atlas clefts in 0.1 -0.2% of the general population. Histological examinations have revealed that the bony defect, which ranges from 1 – 5 millimetres in width, is bridged by fibrocartilagenous tissue, resulting in what is generally believed to be a stable atlas. Radiographically, congenital anterior clefts mimic many types of atlantal fractures, including Jefferson burst fractures, and vertical fractures of the anterior arches. The distinct radiographic appearances of congenital clefts and acute fractures of the atlas help to distinguish them from each other. In the majority of cases, anterior clefts of the atlas remain undetected and have no clinical ramifications. Detection usually occurs during emergency post-traumatic radiographic imaging of the upper cervical spine. Under these circumstances, the presence of this congenital anomaly can make it difficult to differentiate between an acute fracture and a congenital variant. Where there is suspicion of fracture, computed tomography (CT) must be considered, as it is the most useful means of differentiating between these two clinical entities. Chiropractors considering spinal manipulative therapy should be concerned with stability of an atlas with an anterior cleft, particularly in patients with a recent history of injury to the cervical spine. Appropriate clinical and radiographic examinations must be used to rule out cervical spine instability, before treatment is commenced. A reasonable course of treatment may include the judicious use of spinal manipulation. (JCCA 1997; 41(1):9-15)
    Key Words: abnormalities, athletic injuries, atlas; cervical vertebrae, chiropractic, diagnosis, differential, radiography, sports medicine, manipulation

    Les fentes congénitales antérieures médianes de l’atlas sont des anomalies de développement rares. Quelques cas seulement ont été signalés dans la littérature. Cette variante normale de l’atlas apparaît lorsque l’arc antérieur ne parvient pas à fusionner lors du processus d’ossification. Plusieurs séries de dissections de cadavres ont démontrés des fentes antérieures médianes de l’atlas chez 0,1 à 0,2% de la population globale. Des examens histologiques ont montré que le défaut osseux, allant de 1 à 5 mm de largeur, était couvert par le tissu fibrocartilagineux, et ressemblait donc à un atlas stable. Sur les radiographies, les fentes congénitales antérieures ressemblent à de nombreux types de fracture atloïdiennes, y compris les fractures de Jefferson et les fractures verticales des arcs antérieurs. La physionomie distincte des fentes congénitales et des fractures aiguës de l’atlas sur une radiographie permet de les distinguer les unes des autres. Dans la majorité des cas, les fentes antérieures de l’atlas ne sont pas détectées et n’ont aucune ramification clinique. Elles sont généralement identifiées sur les radios d’urgence de la colonne cervicale supérieure qui sont effectuées à l’issue d’un traumatisme. Dans ces circonstances, la présence de cette anomalie congénitale peut compliquer le processus de différentiation entre une fracture aiguë et une variante congénitale. Lorsqu’on suspecte une fracture, on doit envisager la tomographie par ordinateur, car il s’agit du moyen le plus utile de différentier ces deux entités cliniques. Les chiropraticiens qui envisagent une manipulation vertébrale doivent s’inquiéter de la stabilité de l’atlas avec fente antérieure, particulièrement chez les patients présentant des antécédents récents de blessure de la colonne cervicale. Des examens cliniques et radiographiques appropriés doivent être utilisés pour écarter le risque d’instabilité de la colonne cervicale, avant de commencer le traitement. Un traitement raisonnable pourrait inclure des manipulations judicieuses de la colonne. (JCCA 1997; 41(1):9-15)
    Mots-clés: anormalités, blessures sportives, atlas, vertèbre cervicale, chiropratique, diagnostic, différentiel, radiographie, médecine sportive, manipulation

    • Andre Cardin, DC, DACBR
    • Paul Nolet, DC, FCCSS(C)
    • Gabrielle van der Velde, DC, FCCS(C), PhD (candidate)

    Canadian Chiropractic Association Position Statement- Articular Adjustments/Spinal Manipulations. L’Association chiropratique canadienne – Énoncé de principes- Adjustements articulaires/manipulations vertébrales