Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Abstract

Philip Afghani, Melissa FerrantiObjective: To describe the case of a patient who presented with lumbar disc herniation sequalae that masked symptoms of multiple sclerosis. Clinical Features: A 45-year-old female presented with lower back pain with radiation and paresthesia that were consistent with lumbar disc herniation sequalae from a previous motor vehicle collision (MVC) injury. Interventions and Outcomes: The patient was initially treated with chiropractic care for an MVC 2 years previously. After an initial improvement, her symptomatology improved, and she was released with occasional recurrence of symptoms that responded well to care. She returned 2 years post initial injury with lower back pain and paresthesia in bilateral legs and occasionally in her upper extremities. Patient attributed symptoms to previous injury, but after an evaluation she was referred to a neurosurgeon and underwent MRI with contrast where plaques were noted in her spinal cord, and she was subsequently diagnosis with multiple sclerosis. Conclusion: Patients with recurrence of symptoms consistent with previous injuries such as disc herniation or symptom progression should be monitored for the development of underlying neurological disorders that may present with similar symptoms. Patients with progressive neurological symptoms should be referred for a neurosurgical consult. (This is a conference presentation abstract and not a full work that has been published.)Whitney Amos McNaryObjective: To show the outcome of treatment using Shockwave therapy combined with cold laser for a CrossFit athlete with chronic right shoulder impingement. Clinical Features: A 31-year-old male presented with chronic right shoulder pain. The pain was described as dull and radiating into right arm. Noticeable bony protuberance over A/C joint. Radiograph revealed mild osteoarthritis in the right A/C joint. Moderate decreased range of motion (ROM) with pain, pinpoint pain over A/C joint. The Mumford procedure was the recommended medical treatment. Intervention and Outcome: The patient received chiropractic adjustments and manual therapy in his right shoulder region with slight improvement. Shockwave therapy combined with cold laser was introduced at revaluation. Patient was advised to rest and/or limit his workout regime. Patient was compliant with treatment visits, however, did not limit his activity. The patient was treated 1 to 2 days/week for 8 weeks resulting in a reduction of pain, improved ROM, and improved function. Opioid analgesic therapy cores also significantly decreased. Conclusion: This case shows that with this type of patient, Shockwave therapy along with cold laser can improve a chronic shoulder impingement providing a potential alternative to surgical intervention and opens the door for future research. (This is a conference presentation abstract and not a full work that has been published.)Brian Anderson, Steve McClellanObjective: Use insurance claims for low back pain to estimate risk of treatment escalation for different patterns of chiropractic care compared to medical care only. Methods: Retrospective analysis of insurance claims data from a single Fortune-500 company. Patterns of chiropractic care were: 1, exclusive chiropractic care; 2, initial chiropractic care followed by medical care; 3, some combination of chiropractic and medical care. Treatment escalation included any claims with imaging, injection, emergency room, or surgery. Modified Poisson regression modeling was used. Results: Claims (83,025) were categorized into 11,114 unique patient first episodes. Chiropractic care was present in 2977 (27%) claims; 2528 (85%) of these were initiated with chiropractic care, while 2343 (79%) were exclusive to chiropractic care. The estimated relative risk of treatment escalation was: 0.54 (0.50–0.58, p = 0.001) for pattern 1; 1.71 (1.57–1.86, p = 0.001) for pattern 2; 1.16 (1.06–1.28, p = 0.002) for pattern 3. Conclusion: For claims associated with low back pain, exclusive chiropractic care had half the risk of treatment escalation compared to medical care only. However, the risk of those with both chiropractic and medical care were higher than those with medical care only. (This is a conference presentation abstract and not a full work that has been published.)Alejandro Aponte, Bethany AponteObjective: Demonstrate the management of chronic left heel pain of a 91-year-old female and her response to low level laser therapy in combination with Kinesio tape. Clinical presentation: 91-year-old female presents with severe chronic heel pain that began insidiously 4 years ago. Upon visual inspection, bruising along inferior anterior portion of the tibia most likely due to anticoagulant medication. Haglund deformity of her left heel was suspected, with associated edema, hyperesthesia and pain affecting her ability to walk (0/10)PSFS and sleep (2/10)PSFS. Patient has a history of heart disease and hypothyroidism and is currently taking medication for such. Intervention and Outcome: Class-3B laser was applied to the patient's heel and Achilles tendon followed by the application of 2 strips Kinesio tape, one from the calcaneus to the superior aspect of the Achilles tendon and the second with 50% stretch horizontally over the inferior portion of the Achilles tendon. After 8 treatments, significant improvement is reported as per patient-specific functional scale, walking(7/10) and sleeping(10/10). Conclusion: Cold laser therapy and Kinesio tape combination treatment can be a safe alternative treatment for patients with symptomatic Haglund deformities with risk factors such as age and heart disease. (This is a conference presentation abstract and not a full work that has been published.)Jason Belcher, Nicholas SnyderObjective: Current evidence points toward extended recoveries (>21 days) for concussion patients that present with oculomotor abnormalities and dizziness detected by vestibular/ocular motor screening. Clinical Features: A 15-year-old female presents with headaches, photophobia, dizziness, and difficulty focusing on distant objects following a concussive injury sustained during a soccer game. Examination revealed oculomotor deficiencies, coordination deficits, elevated resting heart rate (RHR) and blood pressure (BP), and cervical ligamentous sprain with cervical muscular strain. Intervention and Outcome: Functional neurologic rehabilitation exercises, full spine chiropractic manipulation, cervical stretches and range of motion exercises, myofascial release therapy, and guidance for the patient's return to school consisting of 12 visits over 4 weeks was performed. At the 7th appointment, 16 days from injury, the patient was asymptomatic. At re-exam the patient was asymptomatic with no functional deficits, with additional improvements to RHR and BP. She received clearance for return to full participation in sports. Conclusion: This case demonstrates that concussion management with functional neurologic rehabilitation exercises warrants further research into the possibility of reducing recovery timelines for athletes with sports-related concussion. (This is a conference presentation abstract and not a full work that has been published.)Emma Berntheizel, Charles Fischer, Lauren Tollefson, Eric StefanowiczObjective: The purpose of this report is to present a case of neck and unilateral arm pain that led to the diagnosis of a Pancoast tumor in a patient with a history of smoking. Clinical Features: A 52-year-old African American male presented to a chiropractic office complaining of right-sided cervicothoracic pain and numbness into the right upper extremity. After a trial of conservative care where the patient initially improved, the numbness and weakness began to progress rapidly. Intervention and outcome: Initial radiographic imaging examination revealed tracheal deviation, followed by a chest CT that demonstrated a large mass-like lesion in the apex of the right lung, highly suggestive of bronchogenic carcinoma. Subsequent allopathic referral for evaluation and management resulted in chemotherapy and radiation. Conclusion: This report describes a presumptive case of cervical radiculopathy with no indication of medical red flags, that quickly developed into an urgent indication for imaging and referral to an oncology center. While the patient's eventual status illustrated a classic presentation of a Pancoast tumor, his initial exam and workup indicated a case of cervical radiculopathy that responded well to chiropractic manipulative therapy. (This is a conference presentation abstract and not a full work that has been published.)Serena Bezdjian, James Whedon, Robb Russell, Ian CoulterObjective: Current guidelines suggest the use of nonpharmacologic therapies, such as those offered by chiropractors, as a widely adopted approach for the management of spinal pain. However, to be effective the patient must adhere to the treatment plan suggested. The present pilot study examined the feasibility of developing and administering a patient survey to assess self-reported adherence to treatment recommendations from doctors of chiropractic at an academic health center. Methods: Participants included adult patients with spine pain seen by a doctor of chiropractic at an academic health center. A total of 62 respondents completed an institutional review board–approved 32-item anonymous survey. The survey was administered between October 2019 and March 2020. The survey items were developed by the authors and vetted by the university faculty members who serve as healthcare practitioners at the academic health center. Results: Overall, 89% of respondents adhered to their clinic appointments. Although 82% of respondents said that their doctor's recommendation made sense, only 44% of respondents reported completely following treatment recommendations for at-home stretching and exercise. Conclusions: Although patient self-reported adherence to clinic appointments was high, adherence to treatments was not. Future research should also survey practitioners to corroborate patient adherence. (This is a conference presentation abstract and not a full work that has been published.)Charles Blum, Jeffrey MerskyObjective: This study investigated the use of cranial and infant inversion therapy for the treatment of plagiocephaly in 2 infants initially considered needing helmet therapy. Also specifically discussed is infant inversion therapy as a diagnostic (Peiper-Isbert reaction) or treatment (DeJarnette pediatric cranial procedure) modality. Clinical Features: Two 4-month-old infants were presented to 2 different chiropractic offices for assessment and treatment of plagiocephaly as an alternative to helmet therapy. Intervention: Similar care was offered, which focused on sacro occipital technique pediatric cranial procedures and inversion therapy in the office and for parents to perform at home. Care was provided over a 3-month period and averaged around 6–8 office visits. Outcome: Within the first 2 visits the parents noticed the child having better cervical ranges of motion, and by the 4th office visit, improvement in plagiocephaly was beginning to be noticed. Neither child necessitated utilizing helmet therapy. Conclusion: There have been published studies on cranial treatment of plagiocephaly, however there is a paucity of studies published on infant inversion therapeutic applications. In these 2 cases the cranial and inversion therapy was well tolerated and may offer an alternative for helmet therapy if a child is resistant or the parent(s) prefers another conservative therapeutic option. (This is a conference presentation abstract and not a full work that has been published.)Gina Bonavito-Larragoite, Oowais SiddiqueObjective: This case study illustrates an example of the shift from the traditional hands-on delivery of chiropractic care to engaging through telehealth. Clinical features: A 31-year-old female patient was referred to the chiropractic clinic with an exacerbation of cervicalgia with associated headaches. Due to the COVID-19 pandemic, the chiropractic clinic was limiting in-person treatment to emergencies. The patient was treated by this provider in 2015 and 2018 for the same condition with positive outcomes. She reports insidious onset several weeks prior with a constant dull pain at the base of the neck radiating between the shoulder blades. provoked by poor posture with computer use and uncomfortable sleep. Visual examination of posture and cervical range of motion was performed. Veteran was instructed to self-palpate musculature of the neck and shoulders. She reported tenderness in the cervical paraspinal, scalene, trapezius muscles bilaterally, left greater than right. Intervention and Outcome: Treatment provided through video conferencing included home-based exercise program, acupressure with mindfulness and durable medical equipment. Follow-up phone call reports cervicalgia resolved, and headaches managed with acupressure. Conclusion: Successful chiropractic management via telehealth occurred utilizing the diverse skills available to the chiropractor without use of hands-on spinal manipulative therapy. (This is a conference presentation abstract and not a full work that has been published.)Ryan Burdick, Stephanie Halloran, Brian Coleman, Anthony LisiObjective: To investigate the geospatial distribution of chiropractors in Connecticut and its relationship to population health characteristics and sociodemographic factors. Methods: Cross-sectional analyses of public data sources was used. Chiropractic provider locations were obtained from the National Provider Identifier Registry (September 2020); demographics from the US Census Bureau (2016–2018); and population health characteristics from DataHaven, a Connecticut health equity nonprofit organization (June 2020). Data were analyzed with descriptive statistics. Results: Chiropractic provider location densities varied across demographics and geography. Overall chiropractic provider density was 23 per 100,000 residents. For individuals eligible for Medicare and/or Medicaid beneficiaries (36% of the general population, SD 11%), chiropractic provider density was 16 per 100,000 in regions +1 SD, and 24 per 100,000 in −1 SD. When compared with a schema incorporating median income, poverty rate, and population density, the aggregated rate of doctors of chiropractic (DCs) per capita was highest in wealthy towns (30 DCs per 100,000 residents) followed by suburban (29 per 100,000), urban-periphery (25 per 100,000), urban core (14 per 100,000), and rural (11 per 100,000). Conclusion: Chiropractic provider locations per capita are more concentrated in regions with affluent residents and less concentrated in areas with higher percentages of Medicare/Medicaid populations. (This is a conference presentation abstract and not a full work that has been published.)Tara CheuvrontObjective: To describe the importance of appropriate diagnosis and comanagement of a patient. Clinical Features: A 55-year-old male patient with multiple comorbidities including a history of smoking and alcoholism had a chronic history of lower back pain and bilateral leg pain. After a short course of conservative care with only minor improvement, patient was referred for special testing. Intervention and Outcome: Lumbar x-rays demonstrated moderate degenerative changes of the lumbar spine in addition to atherosclerosis of abdominal aorta and bilateral iliac arteries. Patient was then referred for lower extremity Doppler ultrasound. Findings were consistent with a 90% occlusion of left iliac artery and 75 percent occlusion of right iliac artery. Patient underwent vascular surgery in which 4 stents were placed in left iliac artery and 3 stents were placed in right iliac artery. He continues to be comanaged with his cardiologist. Patient had full resolution of bilateral lower extremity pain. Conclusion: Ruling out red flags with proper diagnosis and referral for comanagement is of utmost importance to provide the best possible care for a patient presenting with potential lumbar radiculopathy but symptomatology revealed to be related to significant vascular occlusion of the lower extremities. (This is a conference presentation abstract and not a full work that has been published.)Katherine Clark, Julie JohnsonObjective: To describe the development and implementation of virtual clinical experiences for students. Methods: To convey clinical experience with examination procedures, flow, and case types in a virtual setting, Clinicians were tasked with creating a virtual learning environment for students. Cases were created, edited, and presented by a team of clinicians. Virtual exams were orchestrated and schedule in Microsoft Teams. Groups of 4–6 interns met with a clinician for presentation, discussion, demonstration, and practice of clinical exams. Limited credits could be earned in this manner. Results: Most students had at least 50 patient encounters before going virtual. This live introduction and then deeper discussion online gave a unique perspective of student understanding. Virtual exams reviewed how to use orthopedic and neurologic testing leading to a differential diagnosis and make proper referrals. Students were challenged to create a report of findings and discuss alternate treatment options. Feedback indicated that the process aided the student in thinking less like a technician and more like a clinician. Conclusion: Virtual experiences provided a valuable learning experience for students and will be incorporated in the educational process after distancing limitations are lifted. (This is a conference presentation abstract and not a full work that has been published.)Michael Cole II, Jason Napuli, Ross MattoxObjective: To illustrate successful case management and utilization of telehealth during the COVID-19 pandemic, which led to short courses of live care in a VA chiropractic clinic. Clinical Features: Case 1: 83-year-old male referred to chiropractic clinic with chronic low back pain. Case 2: 71-year-old male referred to chiropractic clinic for chronic low back pain with stenotic features. Intervention and Outcomes: During COVID-19 clinic shuttering, the initial consultations were conducted via telehealth. Both patients received home exercise plans and recommendations. Subsequent telehealth visits were aimed at providing patient reassurance and modifying home exercise plans and were also supplemented with virtual whole health services. Both patients reported decreased pain and increased mobility with home exercise plans. Following clinic reopening, both patients presented in person with less pain than at the virtual consult and were successfully released from care following just two visits each of live chiropractic care. Conclusion: Telehealth allowed for successful management of chronic back pain during the COVID-19 pandemic while clinics were shuttered, possibly reducing the number of live visits within a VA chiropractic clinic necessary before discharge. Further studies to demonstrate the utility of telehealth in chiropractic care should be considered. (This is a conference presentation abstract and not a full work that has been published.)Brian Coleman, Zachary Cupler, Vivian Ly, Harini Bathulapalli, Suzanne Decker, Clinton Daniels, Michael Anderson, Joseph GouletObjective: To examine if receiving chiropractic care by veterans with spine disorders affects risk of unnatural death, including suicide. Methods: A cross-sectional analysis of veterans who entered the VA Musculoskeletal Disorders Cohort from 2004 to 2013 with back or neck pain. We used the Mortality Data Repository to identify cause of death occurring after 1 year but within 5 years of cohort entry. The association between chiropractic care use within 1 year after index spine diagnosis and unnatural death was modeled using logistic regression, controlling for covariates including age, gender, race, marital status, pain severity, inpatient musculoskeletal disorders cohort entry, medical and mental health comorbidities. Results: There were 684,080 veterans included in the study, with 6293 dying from unnatural causes within 5 years of cohort entry. Risk of unnatural death was significantly lower (OR = 0.751, 95% confidence interval = 0.612–0.921) in those receiving chiropractic care when controlling for other covariates. Conclusion: Suicide prevention is a priority for the Veterans Health Administration with the goal to equip and empower diverse communities to participate in suicide prevention. In veterans with spine pain, the provision of chiropractic care is associated with a lower risk of unnatural death, including suicide death, likely due to co-occurrence of other self-preserving behaviors. (This is a conference presentation abstract and not a full work that has been published.)Stephan Cooper, Mark Pfefer, Chelsey Holstrom, Paige PulliamObjective: Describe a rare case of Parsonage-Turner syndrome (PTS) involving the shoulder and the intervention using a multidisciplinary approach. Clinical Features: A 52-year-old male experienced a new episode of weakness and severe, burning pain in the left shoulder and radiation of pain in the upper arm. Intervention and Outcome: The patient consulted a chiropractor complaining of severe left should pain, abduction weakness although full range of motion (ROM) was possible, and scapular winging. Cervical ROM was normal, but shoulder pain increased slightly with flexion. The patient denied a history of trauma or overuse. The initial differential diagnosis included cervical radiculopathy and rotator cuff pathology. An MRI of the shoulder was obtained when there was no improvement following a short trial of chiropractic care. Structural and signal abnormalities suggestive of PTS were present. The patient was significantly improved after 8 months using a combination of pharmacologic and nonpharmacologic management. Some residual weakness with no shoulder pain continued. Conclusion: PTS can mimic other conditions commonly seen in chiropractic practice. Although rare, PTS should be an included differential diagnosis in severe, nontraumatic shoulder pain. (This is a conference presentation abstract and not a full work that has been published.)Kelsey Corcoran, Douglas Peterson, Xiwen Zhao, Eileen Moran, Anthony LisiObjective: To assess the characteristics and productivity of chiropractors employed by the Department of Veterans Affairs (VA). Methods: Cross-sectional and serial analyses of VA administrative data were conducted. Characteristics and productivity of the chiropractor workforce were evaluated from fiscal year (FY) 2016 to FY2019. Productivity was measured as work relative value units (wRVUs). Results: From FY2016 to FY2019, the number of chiropractor employees increased from 102 to 167. In FY2019, the average chiropractor was male, white, and 45.9 years old with 5.2 years of VA experience. In FY2019, the VA chiropractor workforce was 25.1% female, 10.8% racial minority, and 20.4% veteran, and the number of individuals from each of these groups increased from FY2016. The average annual productivity of a chiropractor increased from 3034 wRVUs in FY2016 to 3100 wRVUs in FY2019. In FY2019, chiropractor age was the only facility or provider characteristic studied that was significantly correlated with a productivity increase (coef = 21, p = .038) after adjusting for other covariates. Conclusion: Provider characteristics and productivity metrics of the VA chiropractor employee workforce are presented. These results may be relevant to future modeling of chiropractor personnel in VA and other healthcare systems. (This is a conference presentation abstract and not a full work that has been published.)Clinton Daniels, Derek Anderson, Zachary CuplerObjective: This case series describes a representative display of coordination of care between a chiropractic and behavioral therapy clinic within an integrated hospital-based system. Clinical Features: This report describes the recognition of untreated mental health symptoms, referral to behavioral health providers, and the subsequent treatment approaches. These individuals had musculoskeletal complaints with comorbid mental health symptoms and were predominately referred to a behavioral health service for concern for adjustment disorder, but also endorsed depressive symptoms, anxiety, and 1 case indicated suicidal ideation. Intervention and Outcome: All 3 cases presented to mental health provider following chiropractic referral; 1 was managed with individual cognitive behavioral therapy; 1 responded well to individual cognitive behavioral therapy transitioned to group-based pain skills, resiliency, and mindfulness therapy; and 1 patient necessitated additional referral to primary care-mental health integration for pharmacological treatment. The 3 patients responded positively to interdisciplinary care and realized functional improvements. Conclusion: All 3 cases utilized mental health services following referral from a chiropractic provider. Different approaches to mental health care were afforded to each of these individuals to meet their individual preferences and needs. (This is a conference presentation abstract and not a full work that has been published.)Barbara DelliGatti, Annette Osenga, Krista Ward, Donna Odierna, Monica SmithObjective: We report using research readiness surveys to develop our clinical research literacy (CRL) curricula. Methods: We pilot-tested (2015–2016) a prevalidated research readiness survey from Central Michigan University, which tests information literacy (IL) skills in higher education. From the pilot, we created our own research readiness survey (RRS) to test 4 critical IL skills: determining the information needed, accessing information effectively, critically evaluating information, and using information ethically and legally. We collected RRS data and demographics for 8 freshman cohorts (2017–2018). Results: For n = 253 students, the average score was 17 (SD 3.84) out of a maximum possible score of 28. One-way ANOVA (Tukey post hoc) showed significant differences (p = .008) in RRS score by prior degree, for example, bachelor vs associate degree holders. Incoming cohort groups also varied in IL subset skills, such as critically evaluating information (p = .002). Conclusion: We used information from RRS data and other sources to structure three courses in clinical research literacy (CRL): CRL I (basic), CRL II (intermediate), and CRL III (proficient). The RRS data on students' prior knowledge and their IL needs also encouraged student self-reflection, and supported our customizing the IL presentations within the CRL series to each cohort's specific needs. (This is a conference presentation abstract and not a full work that has been published.)Amberly Ferguson, John Crouse, Judy Bhatti, Elissa Twist, Ward JonesObjective: Examine chiropractic faculty perceptions and methods used during the rapid transition to online teaching due to the pandemic. Methods: A descriptive 21-question online survey was administered to 65 chiropractic faculty at a single chiropractic institution following a mandatory term of online teaching. Results: The survey had a 49% response rate (n = 32). Most faculty had no previous online teaching experience (n = 27). All respondents (n = 32) rated the transition as a challenge, with over half (n = 19) reporting this to be moderate to significant. The challenges included the lack of interaction/classroom dynamic, uncertainty with student assessment, and loss of sense of community. Along with challenges, positive opportunities such as synchronous and asynchronous instruction and chat contributions from reserved students were reported. Faculty (n = 20) reported a 3.3 mean increase in work hours. For hands-on/lab-based classes and lecture-based classes, instructors found faculty-created videos (n = 17) to be most useful for online learning. Thirteen respondents prefer to never teach online, 15 would like all or a portion to be online instruction. Conclusion: Rapid change from face-to-face to online learning presented challenges and opportunities to chiropractic educators. Faculty developed and explored new online methods of instruction and assessment not previously used in their face-to-face classes. (This is a conference presentation abstract and not a full work that has been published.)Heidi Haavik, Kelly Holt, Christopher Merkle, Nitika Kumari, Imran Amjad, Muhammad Samran Navid, Imran Khan NiaziThis study aimed to compare neurophysiological outcomes of an adjustive thrust directed at a chiropractic subluxation in the cervical spine compared to a thrust directed at a normally functioning cervical motion segment. In this parallel group randomized controlled trial, 96 participants with evidence of a chiropractic subluxation in their cervical spine were randomly allocated to receive a specific adjustive thrust, using an Activator Adjusting Instrument, to a subluxated cervical vertebrae or to a cervical vertebrae deemed to be functioning normally. Somatosensory evoked potentials (SEPs) from median nerve stimulation were recorded before and immediately after the intervention. The amplitude of the N30 SEP peak was the primary outcome measure (an indicator of early sensorimotor integration[ SMI]). A 2-way ANOVA revealed a significant interactive effect (p < .01) with a significant N30 peak decrease (p < .01) in the subluxation adjustment group (−16.76% ± 28.32%), and a nonsignificant (p = .4) increase in the nonsubluxation thrust group (19.58% ± 55.09%). This study showed that directing a specific adjustive thrust to a chiropractic subluxation resulted in significant neurophysiological changes in SMI similar to those observed in previously published papers, while thrusts directed at nonsubluxated segments had no significant effect. (This is a conferen