Objectives: The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status. Methods: A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.
Results: One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with no fallers (P = .04).
Conclusions: A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified
Key Indexing Terms: Chiropractic; Accidental Falls; Aged; Risk Factors; Postural Balance; Quality of Life
The effects of manual therapy on balance and falls: A systematic review
Holt, K. R., Haavik, H., & Elley, C. R. (2012)
Journal of manipulative and physiological therapeutics, 35(3), 227-234.
Objective: The purpose of this study was to review the scientific literature on the effects of manual therapy interventions on falls and balance.
Methods: This systematic review included randomized and quasi-randomized controlled trials that investigated the effects of manual therapy interventions on falls or balance. Outcomes of interest were rate of falls, number of fallers reported, and measures of postural stability. Data sources included searches through June 2011 of Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complimentary Medicine, Current Controlled Trials, Manual Alternative and Natural Therapy Index System, Index to the Chiropractic Literature, National Institutes of Health (USA), and Google Scholar.
Results: Eleven trials were identified that met the inclusion criteria. Most trials had poor to fair methodological quality. All included trials reported outcomes of functional balance tests or tests that used a computerized balance platform. Nine of the 11 trials reported some statistically significant improvements relating to balance after an intervention that included a manual therapy component. The ability to draw conclusions from a number of the studies was limited by poor methodological quality or very low participant numbers. A meta-analysis was not performed due to heterogeneity of interventions and outcomes. Only 2 small trials included falls as an outcome measure, but as a feasibility study and a pilot study, no meaningful conclusions could be drawn about the effects of the intervention on falls.
Conclusion: A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance. More well-designed controlled trials with sufficient participant numbers are required to draw meaningful clinical conclusions about the role that manual therapies may play in preventing falls or improving postural stability and balance.
This review provides an overview of some of the growing body of research on the effects of spinal manipulation on sensory processing, motor output, functional performance and sensorimotor integration. It describes a body of work using somatosensory evoked potentials (SEPs), transcranial magnetic nerve stimulation, and electromyographic techniques to demonstrate neurophysiological changes following spinal manipulation. This work contributes to the understanding of how an initial episode(s) of back or neck pain may lead to ongoing changes in input from the spine which over time lead to altered sensorimotor integration of input from the spine and limbs.
Chiropractic Care in New Zealand: Theories, Practice and Research
Holt KR, Haavik H. (2012)
New Zealand Journal of Natural Medicine, Issue 6 Aug-Nov.
Selective changes in cerebellar-cortical processing following motor training
The aim of this study was to investigate the effect of varying stimulation rate and the effects of a repetitive typing task on the amplitude of somatosensory evoked potential (SEP) peaks thought to relate to cerebellar processing. SEPs (2,000 sweep averages) were recorded following median nerve stimulation at the wrist at frequencies of 2.47, 4.98, and 9.90 Hz from 12 subjects before and after a 20-min repetitive typing task.
Typing and error rate were recorded 2-min pre- and post-typing task. Effect of stimulation rate was analysed with ANOVA followed by pairwise comparisons (paired t tests). Typing effects were analysed by performing two-tailed paired t tests. Increasing stimulation frequency significantly decreased the N30 SEP peak amplitude (p < 0.02). Both the 4.98 and 9.90 Hz rates lead to significantly smaller N30 peak amplitudes compared to the 2.47 Hz (p ≤ 0.01). The N24 amplitude significantly increased following the typing task for both 4.98 and 2.47 Hz (p ≤ 0.025). In contrast, there was a highly significant decrease (p < 0.001) in the N18 peak amplitude post-typing at all frequencies. Typing rate increased (p < 0.001) and error rate decreased (p < 0.05) following the typing task.
The results suggest that the N24 SEP peak amplitude is best recorded at 4.98 Hz since the N30 amplitude decreases and no longer contaminates the N24 peak, making the N24 visible and easier to measure, while still enabling changes due to repetitive activity to be measured. The decrease in N18 amplitude along with an increase in N24 amplitude with no change in N20 amplitude may be explained by the intervention reducing inhibition at the level of the cuneate nucleus and/or interior olives leading to alterations in cerebellar-cortical processing.
Keywords: Cerebellum, Cortical plasticity, Repetitive movement, Somatosensory evoked potentials, Human
Effectiveness of chiropractic care in improving sensorimotor function associated with falls risk in older people
This thesis assessed whether chiropractic care was effective in improving sensorimotor function that is related to fall risk in community-dwelling older adults over a 12 week period. A pragmatic randomised controlled trial was conducted that compared the effect of chiropractic care to a ‘usual care’ control on proprioception (joint position sense), postural stability (static posturography), a broad measure of sensorimotor function (choice stepping reaction time), multisensory integration (the sound-induced flash illusion), and health-related quality of life (SF-36). Outcomes were assessed at four weeks and 12 weeks after a baseline assessment. Participants in the trial included 60 community dwelling older adults from the Auckland region. Of potential participants screened for eligibility, 92% were eligible. Chiropractic care was provided by 12 chiropractic practices from across Auckland in their usual practice setting, following an approach tailored to the participants’ individual clinical needs.
The key findings from the study were that the chiropractic group improved compared to the usual care control group in ankle joint position sense (p=0.045, mean difference across four and 12 week assessments 0.20˚, 95% CI 0.01-0.39˚), and choice stepping reaction time (p=0.01, mean difference at 12 week assessment 118ms, 95% CI 24 to 212ms), and they were also less susceptible to the sound-induced flash illusion (p=0.01, mean difference at 12 week assessment 13.5%, 95% CI 2.9 to 24.0%). Between group differences were also observed in the physical component of health-related quality of life with the chiropractic group improving compared to the control group between the four and 12 week assessments (p=0.047, mean difference 2.4, 95% CI 0.04 to 4.8).
Further research is now required to understand the potential mechanisms of action associated with the improvements that were observed in sensorimotor function, multisensory integration, and the physical component of quality of life in the chiropractic group. Future studies are also required to investigate whether chiropractic care may play a role in preventing falls in older people.
The Reality Check: A quest to understand chiropractic from the inside out