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Observational Study of the Safety of Chiropractic vs Medical Care Among Older Adults With Neck Pain 老年颈部疼痛患者捏脊与医疗护理安全性的观察性研究。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-09-09 DOI: 10.1016/j.jmpt.2025.07.002
James M. Whedon DC, MS , Brian Anderson DC, PhD , Todd A. Mackenzie PhD , Leah Grout PhD , Steffany Moonaz PhD , Jon D. Lurie MD, MS , Scott Haldeman DC, MD, PhD

Objective

The purpose of this study was to evaluate the risk of selected adverse outcomes for older adults with a new episode of neck pain (NP) receiving chiropractic care compared to those receiving primary medical care with Prescription Drug Therapy (PDT) or primary care without medication.

Methods

Through analysis of Medicare claims data, we designed a retrospective cohort study including 291 604 patients with a new office visit for NP in 2019. We developed 3 mutually exclusive exposure groups: the Chiropractic Manipulative Therapy (CMT) group received spinal manipulative therapy from a chiropractor with no primary care visits; the PDT group visited primary care and filled an analgesic prescription within 7 days without chiropractic care, and the Primary Care Only (PCO) group visited primary care without chiropractic care or analgesic prescriptions. We analyzed possible complications, including adverse drug events, vertebrobasilar insufficiency, and other selected adverse outcomes, calculating incidence rate ratios over 24 months using Poisson regression with robust standard errors and inverse propensity weighing to balance the exposure groups regarding patient characteristics.

Results

Among 291 604 patients, 182 596 (63%) received chiropractic care. For CMT vs PDT, the rate for any measured adverse outcome was 20% lower; for CMT vs PCO, the rate was 14% lower, and for PDT vs PCO, the rate was 6% higher. PDT had the highest risk of any measured adverse outcome.

Conclusion

For Medicare Part B beneficiaries with new onset NP, management with chiropractic care was associated with lower rates of adverse events than primary medical care. The PDT group had the highest risk of any measured adverse outcome.
目的:本研究的目的是评估接受捏脊治疗的老年人新发颈部疼痛(NP)的不良结局风险,与接受处方药治疗(PDT)或不接受药物治疗的老年人进行比较。方法:通过分析医疗保险索赔数据,设计了一项回顾性队列研究,纳入了2019年新就诊的NP患者291604例。我们开发了3个相互排斥的暴露组:脊医推拿疗法(CMT)组在没有初级保健访问的情况下接受脊医的脊椎推拿治疗;PDT组在没有捏脊治疗的情况下,在7天内就诊并开具镇痛处方;PCO组在没有捏脊治疗或镇痛处方的情况下就诊。我们分析了可能的并发症,包括药物不良事件、椎基底动脉功能不全和其他选定的不良结局,使用具有稳健标准误差的泊松回归和逆倾向加权来计算24个月内的发病率比,以平衡暴露组的患者特征。结果:291 604例患者中,182 596例(63%)接受捏脊治疗。对于CMT和PDT,任何测量到的不良结果的发生率低20%;CMT与PCO相比,发病率低14%,PDT与PCO相比,发病率高6%。PDT有最高的不良后果风险。结论:对于新发NP的医疗保险B部分受益人,与初级医疗护理相比,脊椎指压治疗的不良事件发生率较低。PDT组出现任何不良结果的风险最高。
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引用次数: 0
Quality of Descriptions of Pelvic Floor Muscle Training Prescribed to Women With Dyspareunia: A Systematic Review 骨盆底肌肉训练对女性性交困难的质量描述:系统回顾。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-11-08 DOI: 10.1016/j.jmpt.2025.10.039
Isabela R.S. Cavalcanti MSc , Adriana C. Lunardi PhD , Daniela F. Carro MSc , Leda T.Y. da Silveira PhD , Elizabeth A. Ferreira PhD

Objective

The purpose of this study was to analyze the description quality of interventions with pelvic floor muscle training (PFMT) for dyspareunia treatment and to describe treatment modalities and protocols.

Methods

This was a systematic review of randomized clinical trials, longitudinal studies, and before–after studies. We searched MEDLINE/PubMed, Web of Knowledge, Scopus, Cochrane, LILACS, PEDro, and Embase, last updated June 2024. The Consensus on Exercise Reporting Template recommendations and Consensus on Therapeutic Exercise Training document were used to analyze the description of PFMT protocols.

Results

Among 769 retrieved articles, 17 were included, involving 963 women 20 to 70 years of age with dyspareunia, vulvodynia, pelvic pain, and/or sexual dysfunction. Dyspareunia was assessed with tools such as numeric or subjective pain scales and questionnaires like the Female Sexual Function Index. The mean Consensus on Exercise Reporting Template score was 7.3 ± 2.7 (40% of items accomplished). The mean Consensus on Therapeutic Exercise Training score was 5.4 ± 1.3 (61% of items accomplished). Most protocols applied supervised exercises at outpatient clinics and prescribed nonsupervised home exercises. PFMT encompassed muscle contraction with varied duration (3-60 seconds) and intensity (phasic and tonic), followed by muscle relaxation. Most associated therapy was biofeedback, followed by manual therapy and electrical stimulation.

Conclusion

Most descriptions of PFMT protocols for dyspareunia treatment did not follow recommended consensus tools, making it difficult to compare data and transpose to clinical practice. Protocols of PFMT are heterogeneous among studies.
目的:本研究的目的是分析盆底肌训练(PFMT)治疗性交困难的描述质量,并描述治疗方式和方案。方法:这是一项随机临床试验、纵向研究和前后研究的系统综述。我们检索了MEDLINE/PubMed、Web of Knowledge、Scopus、Cochrane、LILACS、PEDro和Embase,最后更新于2024年6月。采用运动报告模板共识建议和治疗性运动训练共识文件对PFMT方案的描述进行分析。结果:在769篇检索文章中,纳入17篇,涉及963名20 - 70岁的女性,伴有性交困难、外阴痛、盆腔疼痛和/或性功能障碍。通过数字或主观疼痛量表和女性性功能指数等问卷来评估性交困难。平均共识运动报告模板得分为7.3±2.7(40%的项目完成)。治疗性运动训练的平均共识得分为5.4±1.3(61%的项目完成)。大多数协议在门诊诊所应用监督练习,并规定无监督的家庭练习。PFMT包括不同持续时间(3-60秒)和强度(相性和强直性)的肌肉收缩,随后是肌肉放松。大多数相关治疗是生物反馈,其次是手动治疗和电刺激。结论:大多数关于PFMT治疗性交困难方案的描述没有遵循推荐的共识工具,这使得比较数据和转移到临床实践变得困难。PFMT的方案在不同的研究中是不同的。
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引用次数: 0
Factors Influencing Initial Trial Planning for Low Back Pain Among Veterans Health Administration Chiropractors: A Descriptive Observational Survey 影响退伍军人健康管理局脊医腰痛初始试验计划的因素:一项描述性观察性调查。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-10-02 DOI: 10.1016/j.jmpt.2025.08.007
Victoria A. Bensel DC, MPH, MS , Paul E. Dougherty DC , Brenda T. Fenton PhD , Anthony J. Lisi DC

Objectives

The purpose of this study was to assess how chiropractors within the Veterans Health Administration (VHA) determine their perceived-optimal dosage (number of visits and trial duration) when planning initial trials of care for patients with low back pain, and to describe factors perceived to influence these decisions, as well as barriers and facilitators to implementation.

Methods

A cross-sectional electronic survey was distributed to all chiropractors with an active VHA appointment as of July 1, 2024 (N = 384). The survey, based on prior qualitative interviews and pilot testing, included a clinical vignette and questions related to perceived-optimal visit number and duration, modifying factors, and implementation. Descriptive and inferential statistics (Pearson’s chi-squares) were used to analyze responses in SAS 9.4.

Results

A total of 181 VHA chiropractors completed the survey (47.1% response rate). The most frequently reported perceived-optimal initial trial was 6 visits over 6 weeks (21.5%). Respondents reported that increasing patient age, higher pain intensity, greater functional impairment, and shorter duration of symptoms would increase the planned visit dosage. There was considerable variation in chiropractors’ perceptions of the ideal initial treatment trial. Most clinicians (62%) reported they were able to implement their preferred initial trial less than half of the time. The same barriers (including number of available chiropractic clinicians and treatment rooms) and facilitators (including the ability to collaborate with non-DC clinicians and the presence of clinical support staff) were reported by both the <25% and ≥75% optimal implementation groups. However, more chiropractors in the <25% optimal implementation group reported barriers than did those in the ≥75% optimal implementation group for the number of DC Clinicians (74% vs 39%, p = .0002), and clinical access parameters (67% vs 36%, p = .0002).

Conclusions

This study revealed that VHA chiropractors reported variable perceived-optimal initial trial dosages and endorsed several clinical and system-level factors that influence trial planning. Reported barriers to implementation were common, particularly those related to staffing and space limitations, with more chiropractors in the low implementation group reporting barriers.
目的:本研究的目的是评估退伍军人健康管理局(VHA)的脊医在计划腰痛患者护理的初始试验时如何确定他们认为的最佳剂量(就诊次数和试验持续时间),并描述影响这些决定的因素,以及实施的障碍和促进因素。方法:对截至2024年7月1日所有在VHA任职的脊医进行横断面电子调查(N = 384)。该调查基于先前的定性访谈和试点测试,包括临床小插曲和与感知最佳就诊次数和持续时间、修改因素和实施相关的问题。采用描述性和推断性统计(Pearson’s卡方)分析SAS 9.4的反应。结果:共有181名VHA脊医完成调查,回应率为47.1%。最常报道的最佳初始试验是6周内6次就诊(21.5%)。应答者报告说,患者年龄的增加、疼痛强度的增加、功能损害的加重和症状持续时间的缩短将增加计划的就诊剂量。脊医对理想初始治疗试验的看法存在相当大的差异。大多数临床医生(62%)报告说,他们能够在不到一半的时间内实施他们首选的初始试验。两项研究都报告了相同的障碍(包括可用的脊椎指压临床医生和治疗室的数量)和促进因素(包括与非dc临床医生合作的能力和临床支持人员的存在):本研究揭示了VHA脊椎指压医生报告了可变的感知最佳初始试验剂量,并认可了影响试验计划的几个临床和系统层面的因素。报告的实施障碍很常见,特别是与人员配备和空间限制有关的障碍,在低实施组中更多的脊医报告了障碍。
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引用次数: 0
Immediate Effects of Manual Therapy Techniques on Ankle Dorsiflexion: A Randomized Clinical Trial 手工治疗技术对踝关节背屈的直接影响:一项随机临床试验。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-10-02 DOI: 10.1016/j.jmpt.2025.09.002
Matheus de Castro Silva PT, MSc , Arthur de Sá Ferreira PT, PhD , Rodrigo de Marche Baldon PT, PhD , Carolina Lins PT, PhD , Gustavo Martins de Andrade , Gustavo Barros Braga de Castro Pereira , Natalia Camin Silva PT, MSc , Lilian Ramiro Felício PhD

Objective

The purpose of this study was to evaluate the effects of combined techniques on ROM, performance, and dynamic postural balance in young adults.

Methods

Sixty participants were recruited, with a mean age of 25.35 (±8.00) years and ankle dorsiflexion ROM below 40° in closed kinetic chain (CKC). The participants were randomly divided into 2 groups: Joint mobilization based on the Mulligan Concept (Group 1); Joint mobilization based on the Mulligan Concept, together with the Maitland Method (Group 2). The participants were evaluated preintervention (A0), immediately after the intervention (A1), and 3 to 4 days after the intervention (A2). Primary outcome: DF ROM in CKC. Secondary outcomes: ROM in open kinetic chain, performance, and balance.

Results

Group 2 presented superior performance in the Triple Hop Test in evaluations A1 (Cohen’s d = 1.45) and A2 (Cohen’s d = 1.21), and after the intervention (A2) showed greater displacement (Cohen’s d = 3.22) in the Y Balance Test. Both groups showed increases of DF ROM in CKC and performance.

Conclusions

The combination of joint mobilization techniques can provide additional benefits in functional performance. Both techniques are effective for increasing ankle DF ROM.
目的:本研究的目的是评估综合技术对年轻人ROM、运动表现和动态姿势平衡的影响。方法:招募60名参与者,平均年龄25.35(±8.00)岁,踝关节背屈度小于40°闭合动力学链(CKC)。参与者随机分为2组:基于Mulligan概念的联合动员组(1组);基于穆里根概念和梅特兰方法的联合动员(第二组)。参与者在干预前(A0)、干预后立即(A1)和干预后3至4天(A2)进行评估。主要结局:慢性肾癌患者DF。次要结果:开放动力学链中的ROM,性能和平衡。结果:实验组2在三跳测试A1 (Cohen’s d = 1.45)和A2 (Cohen’s d = 1.21)中表现较优,干预后A2在Y平衡测试中位移较大(Cohen’s d = 3.22)。两组在CKC和生产性能方面均表现出DF - ROM的增加。结论:联合关节活动技术可以提供额外的功能表现。这两种技术对增加踝关节自由度都是有效的。
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引用次数: 0
Traction Loading Human Coracohumeral Ligaments With 20 and 40 Newton Forces and Sustained Creep Deformation: A Preliminary Cadaveric Investigation 在20和40牛顿力的牵引下人体喙肱韧带持续蠕变:初步的尸体研究。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-11-07 DOI: 10.1016/j.jmpt.2025.10.030
John F. Hoops ScD , Carla M. James ScD , Charles Nichols ScD , Jean-Michel Brismee ScD , Peter J. Rundquist PhD , Lee Atkins PhD , Stéphane Sobczak PhD

Objectives

The purpose of this study was to determine if different force magnitudes, loading cycle repetitions, and loading speeds alter creep deformation (CD) during cyclical traction loading of human cadaveric coracohumeral ligaments (CHL).

Methods

Fifteen unembalmed human cadaveric CHL specimens were assigned to 3 groups based on maximal force and loading speed: (1) 40Nslow: 40N; 0.83 mm/s; (2) 20Nslow: 20N; 0.83 mm/s; (3) 20Nfast: 20N; 2.5 mm/s. All specimens underwent 360 cycles of traction loading in a material testing system. The material testing system collected CD during loading at 60-cycle intervals. Micrometer measurements determined CD 60 minutes after loading. Friedman’s ANOVA was used to compare within-group CD changes, and Kruskal-Wallis ANOVA was used to compare between-group CD differences.

Results

All groups demonstrated increased CD during 360 cycles (P < .003) without differences between groups at any 60-cycle interval (P > .05). Sixty minutes after loading, CD was 7% (±5) in the 20Nslow, 15% (±12) in the 40Nslow, and 13% (±7) in the 20Nfast groups without between-group differences (P = .353).

Conclusion

Cyclical traction loading cadaveric CHL specimens with 20N and 40N forces increased CD without a difference between groups. Creep deformation was partially retained 60 minutes after loading. No CD differences were found using 20N loads at 2 different loading speeds.
目的:本研究的目的是确定在人类尸体喙肱韧带(CHL)的周期性牵引加载过程中,不同的力大小、加载循环次数和加载速度是否会改变蠕变变形(CD)。方法:将15例未经防腐处理的人尸CHL标本按最大受力和加载速度分为3组:(1)40Nslow: 40N;0.83毫米/秒;(2) 20Nslow: 20N;0.83毫米/秒;(3) 20Nfast: 20N;2.5毫米/秒。所有试件在材料测试系统中进行了360次牵引加载。材料测试系统在加载过程中以60个周期的间隔收集CD。千分尺测量加载后60分钟的CD。采用Friedman’s ANOVA比较组内CD变化,采用Kruskal-Wallis ANOVA比较组间CD差异。结果:所有组在360个周期内CD均增加(P < 0.003),而在任何60个周期内组间差异无统计学意义(P < 0.05)。加载后60分钟,20Nslow组CD为7%(±5),40Nslow组CD为15%(±12),20Nfast组CD为13%(±7),组间差异无统计学意义(P = .353)。结论:20N和40N力的循环牵引加载尸体CHL标本,CD在两组间无明显差异。加载后60分钟,蠕变部分保留。在2种不同加载速度下使用20N负载时,CD无差异。
{"title":"Traction Loading Human Coracohumeral Ligaments With 20 and 40 Newton Forces and Sustained Creep Deformation: A Preliminary Cadaveric Investigation","authors":"John F. Hoops ScD ,&nbsp;Carla M. James ScD ,&nbsp;Charles Nichols ScD ,&nbsp;Jean-Michel Brismee ScD ,&nbsp;Peter J. Rundquist PhD ,&nbsp;Lee Atkins PhD ,&nbsp;Stéphane Sobczak PhD","doi":"10.1016/j.jmpt.2025.10.030","DOIUrl":"10.1016/j.jmpt.2025.10.030","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this study was to determine if different force magnitudes, loading cycle repetitions, and loading speeds alter creep deformation (CD) during cyclical traction loading of human cadaveric coracohumeral ligaments (CHL).</div></div><div><h3>Methods</h3><div>Fifteen unembalmed human cadaveric CHL specimens were assigned to 3 groups based on maximal force and loading speed: (1) 40Nslow: 40N; 0.83 mm/s; (2) 20Nslow: 20N; 0.83 mm/s; (3) 20Nfast: 20N; 2.5 mm/s. All specimens underwent 360 cycles of traction loading in a material testing system. The material testing system collected CD during loading at 60-cycle intervals. Micrometer measurements determined CD 60 minutes after loading. Friedman’s ANOVA was used to compare within-group CD changes, and Kruskal-Wallis ANOVA was used to compare between-group CD differences.</div></div><div><h3>Results</h3><div>All groups demonstrated increased CD during 360 cycles (<em>P</em> &lt; .003) without differences between groups at any 60-cycle interval (<em>P</em> &gt; .05). Sixty minutes after loading, CD was 7% (±5) in the 20Nslow, 15% (±12) in the 40Nslow, and 13% (±7) in the 20Nfast groups without between-group differences (<em>P</em> = .353).</div></div><div><h3>Conclusion</h3><div>Cyclical traction loading cadaveric CHL specimens with 20N and 40N forces increased CD without a difference between groups. Creep deformation was partially retained 60 minutes after loading. No CD differences were found using 20N loads at 2 different loading speeds.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 1","pages":"Pages 483-489"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Angular Kinematic Analysis of Supine Cervical Thrusts Performed by Chiropractors and Chiropractic Students on Mannequins 脊医和脊医学生在人体模型上进行仰卧颈椎推举的角运动学分析。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-11-07 DOI: 10.1016/j.jmpt.2025.10.033
Mackenzie A. Keller DC , Brent S. Russell MS, DC , Ronald S. Hosek PhD, DC, MPH , Edward F. Owens Jr MS, DC

Objective

The purpose of this study was to examine characteristics of cervical axial rotation and other motion components during cervical spine manipulation.

Methods

Eleven doctors of chiropractic (DCs), 10 chiropractic students with patient experience, and 16 inexperienced students from our institution each performed 4 thrusts on a mannequin. The thrust measured is an essential component of chiropractic cervical spine manipulation, also known as a chiropractic adjustment. The mannequin was designed for chiropractic education and outfitted with inertial measurement units for motion capture. Data were analyzed in Excel for rotation, lateral bending, and flexion-extension at thrust onsets and peaks. Differences between groups were analyzed in R (R Foundation) using Kruskal-Wallis tests, followed by Dunn tests for pairwise comparisons.

Results

Mean rotation for DCs was 19.3° at thrust onset and 33.9° at peak; mean peak lateral bending and cervical extension were 32.0° and 10.4°, respectively. On average, 14.6° of rotation occurred in 144 milliseconds between onset and peak, with rotational velocity and acceleration maximum values of 192.9°/s and 4427°/s2, respectively. Most student characteristics were similar, but DCs’ acceleration means were significantly higher (Kruskal-Wallis P = .019), and experienced students used significantly greater lateral bending at onset (Kruskal-Wallis P = .049) and peak (P = .023).

Conclusion

Mean axial rotation for DCs during chiropractic cervical spinal adjustments was less than 34° at peak; most other measures were similar to previously reported findings.
目的:本研究的目的是研究颈椎推拿过程中颈椎轴向旋转和其他运动部件的特征。方法:我院11名捏脊医生、10名有临床经验的捏脊学生和16名无临床经验的捏脊学生分别对人体模型进行4次推力。测量的推力是捏脊颈椎手法的重要组成部分,也称为捏脊调整。该人体模型是为脊椎按摩教育设计的,并配备了用于运动捕捉的惯性测量单元。在Excel中分析了推力开始和峰值时的旋转、侧弯和屈伸数据。采用Kruskal-Wallis检验分析组间差异,随后采用Dunn检验进行两两比较。结果:DCs的平均旋转在推力开始时为19.3°,峰值为33.9°;平均侧弯峰和颈椎伸展峰分别为32.0°和10.4°。在144毫秒内,平均发生14.6°旋转,转速和加速度最大值分别为192.9°/s和4427°/s2。大多数学生的特征相似,但DCs的加速度平均值明显更高(Kruskal-Wallis P = 0.019),经验丰富的学生在开始时(Kruskal-Wallis P = 0.049)和峰值时(P = 0.023)使用了更大的侧向弯曲。结论:颈椎整复过程中DCs的平均轴向旋转峰值小于34°;大多数其他测量结果与先前报道的结果相似。
{"title":"Angular Kinematic Analysis of Supine Cervical Thrusts Performed by Chiropractors and Chiropractic Students on Mannequins","authors":"Mackenzie A. Keller DC ,&nbsp;Brent S. Russell MS, DC ,&nbsp;Ronald S. Hosek PhD, DC, MPH ,&nbsp;Edward F. Owens Jr MS, DC","doi":"10.1016/j.jmpt.2025.10.033","DOIUrl":"10.1016/j.jmpt.2025.10.033","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to examine characteristics of cervical axial rotation and other motion components during cervical spine manipulation.</div></div><div><h3>Methods</h3><div>Eleven doctors of chiropractic (DCs), 10 chiropractic students with patient experience, and 16 inexperienced students from our institution each performed 4 thrusts on a mannequin. The thrust measured is an essential component of chiropractic cervical spine manipulation, also known as a chiropractic adjustment. The mannequin was designed for chiropractic education and outfitted with inertial measurement units for motion capture. Data were analyzed in Excel for rotation, lateral bending, and flexion-extension at thrust onsets and peaks. Differences between groups were analyzed in R (R Foundation) using Kruskal-Wallis tests, followed by Dunn tests for pairwise comparisons.</div></div><div><h3>Results</h3><div>Mean rotation for DCs was 19.3° at thrust onset and 33.9° at peak; mean peak lateral bending and cervical extension were 32.0° and 10.4°, respectively. On average, 14.6° of rotation occurred in 144 milliseconds between onset and peak, with rotational velocity and acceleration maximum values of 192.9°/s and 4427°/s<sup>2</sup>, respectively. Most student characteristics were similar, but DCs’ acceleration means were significantly higher (Kruskal-Wallis <em>P</em> = .019), and experienced students used significantly greater lateral bending at onset (Kruskal-Wallis <em>P</em> = .049) and peak (<em>P</em> = .023).</div></div><div><h3>Conclusion</h3><div>Mean axial rotation for DCs during chiropractic cervical spinal adjustments was less than 34° at peak; most other measures were similar to previously reported findings.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 1","pages":"Pages 490-501"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
National Trends in the Utilization and Expenditure of Chiropractic Care in U.S. Adults: Analysis of the 2007-2016 Medical Expenditure Panel Survey 美国成年人脊骨神经科治疗使用和支出的全国趋势:2007-2016 年医疗支出小组调查分析》。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2024-09-27 DOI: 10.1016/j.jmpt.2024.08.005
Baojiang Chen PhD , Henry S. Brown PhD , David Douphrate PhD , Jud Janak PhD , Kelley Pettee Gabriel MS, PhD , Trent Peng PhD, DC, MS

Objective

This study aimed to examine the trends in the utilization and expenditure of chiropractic care in a representative sample of US adults, aged ≥18 years.

Methods

Serial cross-sectional data (2007-2016) from the Medical Expenditure Panel Survey (MEPS) were examined. Weighted descriptive statistics were analyzed to obtain national estimates of chiropractic utilization and expenditure, and time-series linear regression was used to assess trends over time. Socio-demographic characteristics and musculoskeletal diagnoses associated with chiropractic use were also reported.

Results

A statistically significantly increasing trend was observed for the number of adults receiving chiropractic care (p < .05), number of visits (p < .05) and utilization rate (P < .05) from 2007 to 2016. A similar trend was not found for chiropractic expenditure during this period (P > .05). The mean number of visits was 8.3 visits per year, with a mean expenditure of $86.94 USD per visit and $721.43 USD per person per year. Mean age of adult chiropractic users each year ranged between 48.6 and 51.2 years old, and users were primarily female (56.3%-60.4%), White persons (90.1%-93.5%), and privately insured (77.3%-82.8%). The most prevalent musculoskeletal diagnoses associated with chiropractic use were low back conditions (45.4%-58.1%), inflammatory/degenerative disc or joint conditions (21.2%-26.8%) and head and neck complaints (9.8%-13.7%).

Conclusion

The findings showed statistically significant increasing trends for the number of adult chiropractic users, the number of visits, and percent utilization of chiropractic care from 2007 to 2016. Conversely, we found a statistically null trend for the total annual expenditure on chiropractic care during the same time period. Findings from this analysis imply that, while chiropractic care appears to be growing, it may still be under-utilized, and more efforts should be devoted to ensuring sustained growth and a larger role in the management of musculoskeletal health.
研究目的本研究旨在对年龄≥18岁的美国成年人进行代表性抽样调查,以了解脊骨神经治疗的使用和支出趋势:方法:研究了来自医疗支出面板调查(MEPS)的连续横截面数据(2007-2016年)。对加权描述性统计进行分析,以获得脊骨神经治疗利用率和支出的全国估计值,并使用时间序列线性回归评估随时间变化的趋势。同时还报告了与脊骨神经治疗使用相关的社会人口特征和肌肉骨骼诊断:从2007年到2016年,接受脊骨神经治疗的成年人数量(P < .05)、就诊次数(P < .05)和使用率(P < .05)均呈明显的统计学增长趋势。在此期间,脊骨神经治疗支出未发现类似趋势(P > .05)。平均就诊次数为每年8.3次,每次平均花费86.94美元,每人每年平均花费721.43美元。每年接受脊骨神经科治疗的成年患者平均年龄在 48.6 岁至 51.2 岁之间,主要为女性(56.3%-60.4%)、白人(90.1%-93.5%)和私人投保者(77.3%-82.8%)。与脊骨神经科治疗相关的最常见肌肉骨骼疾病诊断为腰背疾病(45.4%-58.1%)、椎间盘或关节炎症/退行性病变(21.2%-26.8%)以及头颈部不适(9.8%-13.7%):研究结果表明,从2007年到2016年,成人脊骨神经治疗使用者的数量、就诊次数和脊骨神经治疗使用率在统计学上呈显著增长趋势。与此相反,我们发现同期脊骨神经治疗的年度总支出在统计学上呈负增长趋势。这一分析结果表明,虽然脊骨神经治疗似乎在不断增长,但可能仍未得到充分利用,因此应加大力度确保其持续增长,并在肌肉骨骼健康管理中发挥更大作用。
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引用次数: 0
Predictors of Utilization Frequency of and Expenditure Amount for Chiropractic Care in U.S. Adults: A Retrospective Cohort Study 美国成年人脊骨神经治疗使用频率和支出金额的预测因素:回顾性队列研究
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2024-09-28 DOI: 10.1016/j.jmpt.2024.08.004
Baojiang Chen PhD , Henry S. Brown PhD , David Douphrate PhD , Jud Janak PhD , Kelley Pettee Gabriel MS, PhD , Trent Peng PhD, DC, MS

Objective

This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years).

Methods

Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure.

Results

The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure.

Conclusion

This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.
研究目的本研究旨在评估美国成年人(≥18 岁)的基线个人特征与脊骨神经治疗使用频率和支出的前瞻性关联:数据来自2014年至2016年医疗支出小组调查中1358名使用脊骨神经治疗的受访者。个人、家庭、健康相关和行为因素作为协变量被纳入多变量分析模型。通过泊松和多项式逻辑回归模型来研究预测因素与脊骨神经治疗使用率和支出之间的关系:年平均就诊次数为8.2次(95% 置信区间[CI]:7.9, 8.5),年花费为677.43美元(95% CI:595.47-759.39美元),每次就诊花费为84.84美元(95% CI:77.89-91.78美元)。女性的就诊次数比男性高 19%(比率比 [RR] = 1.19,95% CI:1.01, 1.41)。与私人投保者相比,公共投保者和未投保者的就诊次数分别高出 44%(RR = 1.44,95% CI:1.14, 1.82)和低 36%(RR = 0.64,95% CI:0.48, 0.86)。与没有关节炎的人相比,类风湿性关节炎的高支出风险是中等支出风险的 7.38 倍(95% CI:2.61, 24.67)。与身体活跃的人相比,身体不活跃的人就诊频率高 27%(相对风险比 = 1.27,95% CI:1.09, 1.49),高支出风险比低支出高 82%(相对风险比 = 1.82,95% CI:1.05, 3.14):这项分析发现,不同的基线预测因素会导致不同的使用和支出模式。女性性别、是否有公共保险、是否患有类风湿性关节炎以及是否不运动与支出的差异有关。这项研究的结果可能有助于识别有较高使用率或支出倾向的脊骨神经科患者,并可间接帮助预测对治疗反应较慢的患者。
{"title":"Predictors of Utilization Frequency of and Expenditure Amount for Chiropractic Care in U.S. Adults: A Retrospective Cohort Study","authors":"Baojiang Chen PhD ,&nbsp;Henry S. Brown PhD ,&nbsp;David Douphrate PhD ,&nbsp;Jud Janak PhD ,&nbsp;Kelley Pettee Gabriel MS, PhD ,&nbsp;Trent Peng PhD, DC, MS","doi":"10.1016/j.jmpt.2024.08.004","DOIUrl":"10.1016/j.jmpt.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years).</div></div><div><h3>Methods</h3><div>Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure.</div></div><div><h3>Results</h3><div>The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure.</div></div><div><h3>Conclusion</h3><div>This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 1","pages":"Pages 10-26"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of Swimming and Running Exercise-Induced Changes in Muscle Fibers, Bone Structure, and Oxidative Stress in Aging Rats 游泳和跑步运动对衰老大鼠肌纤维、骨结构和氧化应激变化的影响。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-11-08 DOI: 10.1016/j.jmpt.2025.10.048
Mahmut Sürmeli PhD , Fikret Gevrek PhD , Elif Azize Özşahin Delibaş PhD , Funda Demirtürk PhD , Eylem Tütün Yümin PhD

Objective

The purpose of this study was to investigate the effects of weight-bearing and nonweight-bearing aerobic exercises on bone morphometry, muscle fiber types, and oxidative stress markers.

Methods

Eighteen 15-month-old male rats were divided into control, swimming, and running groups (n = 6 each). After a 2-week adaptation period, the exercise groups underwent 8 weeks of moderate-intensity swimming or running. Blood, gastrocnemius muscle, and femur bone samples were collected postexercise. Parameters analyzed included total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) in blood, muscle fiber types by immunohistochemistry, and bone characteristics by histostereology.

Results

OSI values were similar across groups (P > .05), but oxidative stress was elevated in the exercise groups. The ratio of type I fibers was higher in the exercise groups compared to controls (P < .05) and similar between swimming and running groups (P > .05). Type IIa fiber ratio was highest in the control group and lowest in the running group (P < .05). Bone surface area, trabecular thickness, and cortical thickness were greater in the running group than in controls (P < .05). The swimming group had a higher distal femur bone area and trabecular width than controls (P < .05), but no significant differences were found between the exercise groups (P > .05).

Conclusions

Weight-bearing and nonweight-bearing exercises had a significant effect on muscle fiber composition, bone structure, and oxidative stress in elderly rats. Running particularly enhanced bone surface area and thickness, while swimming also benefited bone health. Both exercises increased oxidative stress and antioxidant capacity.
目的:研究负重和非负重有氧运动对骨形态、肌纤维类型和氧化应激指标的影响。方法:15月龄雄性大鼠18只,随机分为对照组、游泳组和跑步组,每组6只。经过2周的适应期后,运动组进行了8周的中等强度游泳或跑步。运动后采集血液、腓肠肌和股骨标本。分析的参数包括血液中总氧化状态(TOS)、总抗氧化状态(TAS)、氧化应激指数(OSI)、免疫组织化学测定的肌纤维类型和组织体学测定的骨骼特征。结果:各组间OSI值相似(P < 0.05),但运动组氧化应激升高。与对照组相比,运动组I型纤维的比例更高(P < 0.05),游泳组和跑步组之间相似(P < 0.05)。IIa型纤维比例以对照组最高,跑步组最低(P < 0.05)。跑步组骨表面积、骨小梁厚度、骨皮质厚度均显著高于对照组(P < 0.05)。游泳组股骨远端骨面积和股骨小梁宽度均高于对照组(P < 0.05),运动组间差异无统计学意义(P < 0.05)。结论:负重和非负重运动对老年大鼠肌纤维组成、骨骼结构和氧化应激有显著影响。跑步尤其能增加骨骼表面积和厚度,而游泳也有益于骨骼健康。这两种运动都会增加氧化应激和抗氧化能力。
{"title":"Effects of Swimming and Running Exercise-Induced Changes in Muscle Fibers, Bone Structure, and Oxidative Stress in Aging Rats","authors":"Mahmut Sürmeli PhD ,&nbsp;Fikret Gevrek PhD ,&nbsp;Elif Azize Özşahin Delibaş PhD ,&nbsp;Funda Demirtürk PhD ,&nbsp;Eylem Tütün Yümin PhD","doi":"10.1016/j.jmpt.2025.10.048","DOIUrl":"10.1016/j.jmpt.2025.10.048","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to investigate the effects of weight-bearing and nonweight-bearing aerobic exercises on bone morphometry, muscle fiber types, and oxidative stress markers.</div></div><div><h3>Methods</h3><div>Eighteen 15-month-old male rats were divided into control, swimming, and running groups (n = 6 each). After a 2-week adaptation period, the exercise groups underwent 8 weeks of moderate-intensity swimming or running. Blood, gastrocnemius muscle, and femur bone samples were collected postexercise. Parameters analyzed included total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) in blood, muscle fiber types by immunohistochemistry, and bone characteristics by histostereology.</div></div><div><h3>Results</h3><div>OSI values were similar across groups (<em>P</em> &gt; .05), but oxidative stress was elevated in the exercise groups. The ratio of type I fibers was higher in the exercise groups compared to controls (<em>P</em> &lt; .05) and similar between swimming and running groups (<em>P</em> &gt; .05). Type IIa fiber ratio was highest in the control group and lowest in the running group (<em>P</em> &lt; .05). Bone surface area, trabecular thickness, and cortical thickness were greater in the running group than in controls (<em>P</em> &lt; .05). The swimming group had a higher distal femur bone area and trabecular width than controls (<em>P</em> &lt; .05), but no significant differences were found between the exercise groups (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>Weight-bearing and nonweight-bearing exercises had a significant effect on muscle fiber composition, bone structure, and oxidative stress in elderly rats. Running particularly enhanced bone surface area and thickness, while swimming also benefited bone health. Both exercises increased oxidative stress and antioxidant capacity.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 1","pages":"Pages 617-630"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reliability and Validity of Telehealth Spinal Examination Components: A Systematic Review 远程医疗脊柱检查组件的信度和效度:系统评价。
IF 1.4 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-01-01 Epub Date: 2025-09-23 DOI: 10.1016/j.jmpt.2025.08.008
Frank M. Bucki DC, Victoria A. Bensel DC, MS, Clarice H. Wallert DC, MS, Brittney N. Walters DC, MS

Objective

The purpose of this study was to systematically review the literature on the reliability or validity of telehealth spine examination components.

Methods

MEDLINE database from inception to May 17, 2022. Subject headings include virtual, telerehabilitation, telehealth, telemedicine, spine, spinal, neurologic, cervical, thoracic, lumbar, back, and examination. Studies not done synchronously, lacked comparisons to in-person, involved non-spine pathologies, or lacked reliability/validity were excluded. Reliability and validity data were captured using Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Quality and risk of bias were assessed with Quality Appraisal Tool for Studies of Diagnostic Reliability and the Scottish Intercollegiate Guidelines Network diagnostic accuracy checklist.

Results

Six studies, with sample sizes of 11 to 100, were included. In 2 studies, Quality Appraisal Tool for Studies of Diagnostic Reliability was low, and the remaining were moderate to high. Two validity studies had high Scottish Intercollegiate Guidelines Network methodologic quality. Two studies suggested high validity and/or reliability for inspection, cranial nerve testing, pain localization, range of motion, deep neck flexion endurance, Lhermitte sign, and cervical spine neuroforaminal compression. Five studies suggested reliability for inspection, lower extremity muscle testing, pain localization, straight leg raise, Sorensen test, 5 repetitive sit-to-stand test, Lasègue test, reverse Lasègue test, Adams test, and pain on heel strike and poor postural inspection reliability.

Conclusion

This review found that components of telehealth spine examinations, such as those done in physical therapy or chiropractic clinical settings, were valid or reliable and provided support for clinical use.
目的:本研究的目的是系统地回顾有关远程医疗脊柱检查组件的信度或效度的文献。方法:MEDLINE数据库自成立至2022年5月17日。主题标题包括虚拟、远程康复、远程保健、远程医疗、脊柱、脊柱、神经、颈椎、胸椎、腰椎、背部和检查。未同步进行的研究、缺乏与现场比较、涉及非脊柱病变或缺乏信度/效度的研究被排除在外。可靠性和有效性数据使用系统评价和元分析标准的首选报告项目来获取。使用诊断可靠性研究质量评价工具和苏格兰校际指南网络诊断准确性检查表评估偏倚的质量和风险。结果:纳入6项研究,样本量为11 ~ 100。在2项研究中,诊断可靠性研究的质量评价工具较低,其余研究均为中至高。两项效度研究具有较高的苏格兰校际指南网络方法学质量。两项研究表明,检查、颅神经测试、疼痛定位、活动范围、深颈屈耐力、Lhermitte体征和颈椎神经孔压迫具有高效度和/或可靠性。5项研究提示检查信度、下肢肌肉测试、疼痛定位、直腿抬高、Sorensen测试、5重复坐立测试、las测试、反向las测试、Adams测试、足跟疼痛和姿势检查信度差。结论:本综述发现,远程医疗脊柱检查的组成部分,如在物理治疗或脊椎指压临床环境中进行的检查,是有效或可靠的,并为临床应用提供了支持。
{"title":"Reliability and Validity of Telehealth Spinal Examination Components: A Systematic Review","authors":"Frank M. Bucki DC,&nbsp;Victoria A. Bensel DC, MS,&nbsp;Clarice H. Wallert DC, MS,&nbsp;Brittney N. Walters DC, MS","doi":"10.1016/j.jmpt.2025.08.008","DOIUrl":"10.1016/j.jmpt.2025.08.008","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to systematically review the literature on the reliability or validity of telehealth spine examination components.</div></div><div><h3>Methods</h3><div>MEDLINE database from inception to May 17, 2022. Subject headings include virtual, telerehabilitation, telehealth, telemedicine, spine, spinal, neurologic, cervical, thoracic, lumbar, back, and examination. Studies not done synchronously, lacked comparisons to in-person, involved non-spine pathologies, or lacked reliability/validity were excluded. Reliability and validity data were captured using Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Quality and risk of bias were assessed with Quality Appraisal Tool for Studies of Diagnostic Reliability and the Scottish Intercollegiate Guidelines Network diagnostic accuracy checklist.</div></div><div><h3>Results</h3><div>Six studies, with sample sizes of 11 to 100, were included. In 2 studies, Quality Appraisal Tool for Studies of Diagnostic Reliability was low, and the remaining were moderate to high. Two validity studies had high Scottish Intercollegiate Guidelines Network methodologic quality. Two studies suggested high validity and/or reliability for inspection, cranial nerve testing, pain localization, range of motion, deep neck flexion endurance, Lhermitte sign, and cervical spine neuroforaminal compression. Five studies suggested reliability for inspection, lower extremity muscle testing, pain localization, straight leg raise, Sorensen test, 5 repetitive sit-to-stand test, Lasègue test, reverse Lasègue test, Adams test, and pain on heel strike and poor postural inspection reliability.</div></div><div><h3>Conclusion</h3><div>This review found that components of telehealth spine examinations, such as those done in physical therapy or chiropractic clinical settings, were valid or reliable and provided support for clinical use.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 1","pages":"Pages 86-98"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Manipulative and Physiological Therapeutics
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