Gilbert et al. conclude that evidence from the Open Science Collaboration's Reproducibility Project: Psychology indicates high reproducibility, given the study methodology. Their very optimistic assessment is limited by statistical misconceptions and by causal inferences from selectively interpreted, correlational data. Using the Reproducibility Project: Psychology data, both optimistic and pessimistic conclusions about reproducibility are possible, and neither are yet warranted.A cross multiple indicators of reproducibility, the Open Science Collaboration (1) (OSC2015) observed that the original result was replicated in~40 of 100 studies sampled from three journals. Gilbert et al. (2) conclude that the reproducibility rate is, in fact, as high as could be expected, given the study methodology. We agree with them that both methodological differences between original and replication studies and statistical power affect reproducibility, but their very optimistic assessment is based on statistical misconceptions and selective interpretation of correlational data.Gilbert et al. focused on a variation of one of OSC2015's five measures of reproducibility: how often the confidence interval (CI) of the original study contains the effect size estimate of the replication study. They misstated that the expected replication rate assuming only sampling error is 95%, which is true only if both studies estimate the same population effect size and the replication has infinite sample size (3, 4). OSC2015 replications did not have infinite sample size. In fact, the expected replication rate was 78.5% using OSC2015's CI measure (see OSC2015's supplementary information, pp. 56 and 76; https://osf.io/k9rnd). By this measure, the actual replication rate was only 47.4%, suggesting the influence of factors other than sampling error alone.Within another large replication study, "Many Labs" (5) (ML2014), Gilbert et al. found that 65.5% of ML2014 studies would be within the CIs of other ML2014 studies of the same phenomenon and concluded that this reflects the maximum reproducibility rate for OSC2015. Their analysis using ML2014 is misleading and does not apply to estimating reproducibility with OSC2015's data for a number of reasons.First, Gilbert et al.'s estimates are based on pairwise comparisons between all of the replications within ML2014. As such, for roughly half of their failures to replicate, "replications" had larger effect sizes than "original studies," whereas just 5% of OSC2015 replications had replication CIs exceeding the original study effect sizes.Second, Gilbert et al. apply the by-site variability in ML2014 to OSC2015's findings, thereby arriving at higher estimates of reproducibility. However, ML2014's primary finding was that by-site variability was highest for the largest (replicable) effects and lowest for the smallest (nonreplicable) effects. If ML2014's primary finding is generalizable, then Gilbert et al.'s analysis may leverage by-site variability in ML2014's larger effects to exaggerate the effect of by-sit...

The concern over x-ray exposure risks can overshadow the potential benefit of radiography, especially in cases where manual therapy is employed. Spinal malalignment cannot be accurately visualized without imaging. Manual therapy and the load tolerances of injured spinal tissues raise different criteria for the use of x-rays for spinal disorders than in medical practice. Current regulatory bodies rely on radiography risk assessments based on Linear-No-Threshold (LNT) risk models. There is a need to consider radiography guidelines for chiropractic which are different from those for medical practice. Radiography practice guidelines are summaries dominated by frequentist interpretations in the analysis of data from studies. In contrast, clinicians often employ a pseudo-Bayesian form of reasoning during the clinical decision-making process. The overrepresentation of frequentist perspectives in evidence-based practice guidelines alter decision-making away from practical assessment of a patient’s needs, toward an overly cautious standard applied to patients without regard to their risk/benefit likelihoods relating to radiography. Guidelines for radiography in chiropractic to fully assess the condition of the spine and spinal alignment prior to manual therapy, especially with high velocity, low amplitude spinal manipulation (HVLA-SM), should necessarily differ from those used in medical practice.

This study demonstrated that lumbar vertebral rotation, focal film distance, and measurement methods are potential sources of error in retrolisthesis measurement.

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BackgroundA review of literature for in-office, low to medium energy (.04mj/mm2 to .4mj/mm2) Extracorporeal Shockwave Therapy (ESWT) shows a substantial body of evidence suggesting strong efficacy and safety for the use of this form of Acoustic Compression Therapy. Much of this evidence is focused on the treatment of a specific region of the body, such as lateral epicondylitis, plantar fasciitis, and shoulder tendinopathies. This evaluation is designed to address the clinical utility of low to medium energy ESWT in an outpatient health care office setting, including delivery to multiple regions of the body, and for patients considered good candidates based on the failure of at least six months of prior conservative care.MethodsOrdinary least squares (OLS) models with errors clustered at the patient level estimate the association between shockwave treatments and patient-reported pain levels. Additional models utilizing polynomial treatment indicators test for a non-linear relationship between treatment number and reported pain level.ResultsFor the sixty-one patients represented in this analysis, the mean reduction in pain was 2.3 points on a 10 point scale, representing a 47% reduction in average reported pain levels. Results suggest that each treatment is associated with a 0.33 point reduction in reported pain levels (on a 10 point scale), controlling for patient demographics and treatment intensity. Additional models utilizing polynomial treatment indicators suggest a non-linear relationship between treatment number and reported pain level, indicating that the initial benefit of treatment is a 0.67 point reduction in pain for the first treatment, and falling slightly with each subsequent treatment. A subset of patients responded to follow up requests to ascertain reported pain levels at least three months after the final treatment. All patients were contacted, out of which 24 responded, reporting average pain levels of 2.9 out of 10, a substantial improvement from initial reported pain levels following final treatment (4.0), representing a decrease of 28%.ConclusionThe results suggest the use of Acoustic Compression at these doses on properly selected cases can improve clinical outcomes for conservatively treated patients who may otherwise end up requiring more aggressive measures in the absence of ESWT. Evidence reviewed suggests that continued healing time leads to further improvement.