Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update

Schneider, Michael J.; Haas, Mitchell; Katz, Paul R.; Dougherty, Paul; Gleberzon, Brian J.; Killinger, Lisa; Weeks, John

doi:10.1016/j.jmpt.2017.02.001

Cited by 36 publications

(24 citation statements)

References 56 publications

(105 reference statements)

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“…In contrast to frequent recommendations to patients with VDB, manual therapy revealed not to be effective in our target population [40]. Also, the likelihood of injuries following cervical manipulations is increased with age-related diseases like osteoporosis or long-term use of anticoagulant therapy [61] and specific red flags should be assessed before using manual interventions in elderly [62].…”

Section: Main Findingsmentioning

confidence: 88%

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer

Seckler

Müller

et al. 2020

Preprint

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BackgroundVertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes. MethodsA systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥ 65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted. ResultsA total of 20 randomized and 2 non-randomized controlled trials with 1,876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms. Conclusion

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Section: Main Findingsmentioning

confidence: 88%

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer

Seckler

Müller

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In contrast to frequent recommendations to patients with VDB, manual therapy revealed not to be effective in our target population [40]. Considering other literature and the likelihood of injuries following cervical manipulations is increased with age-related diseases like osteoporosis or long-term use of anticoagulant therapy [61] and speci c red ags should be assessed before using manual interventions in elderly [62]. Considering the debatable entity of cervicogenic dizziness [63], MT cannot be recommended for older adults.…”

Section: Main Ndingsmentioning

confidence: 89%

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Regauer

Seckler

Müller

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Vertigo, dizziness and balance disorders (VDB) are among the most relevant contributors to the burden of disability among older adults living in the community and associated with immobility, limitations of activities of daily living and decreased participation. The aim of this study was to identify the quality of evidence of physical therapy interventions that address mobility and participation in older patients with VDB and to characterize the used primary and secondary outcomes.Methods: A systematic search via MEDLINE (PubMed), Cochrane Library, CINAHL, PEDro, forward citation tracing and hand search was conducted initially in 11/2017 and updated in 7/2019. We included individual and cluster-randomized controlled trials and trials with quasi-experimental design, published between 2007 and 2017/2019 and including individuals ≥ 65 years with VDB. Physical therapy and related interventions were reviewed with no restrictions to outcome measurement. Screening of titles, abstracts and full texts, data extraction and critical appraisal was conducted by two independent researchers. The included studies were heterogeneous in terms of interventions and outcome measures. Therefore, a narrative synthesis was conducted.Results: A total of 20 randomized and 2 non-randomized controlled trials with 1,876 patients met the inclusion criteria. The included studies were heterogeneous in terms of complexity of interventions, outcome measures and methodological quality. Vestibular rehabilitation (VR) was examined in twelve studies, computer-assisted VR (CAVR) in five, Tai Chi as VR (TCVR) in three, canal repositioning manoeuvres (CRM) in one and manual therapy (MT) in one study. Mixed effects were found regarding body structure/function and activities/participation. Quality of life and/or falls were assessed, with no differences between groups. VR is with moderate quality of evidence superior to usual care to improve balance, mobility and symptoms.Conclusion: To treat older individuals with VDB, VR in any variation and in addition to CRMs seems to be effective. High-quality randomized trials need to be conducted to inform clinical decision making.Trial Registration: PROSPERO 2017 CRD42017080291.

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“…Chiropractors who frequently treat older people are more likely to use soft tissue therapies, including trigger point therapy, massage therapy and muscle stretching. While a recent clinical trial reported no serious adverse events from the use of chiropractic spinal manipulative therapy for those aged over 65 years with low back pain, the higher use of more gentle soft tissue therapies for this patient group may relate to practitioner safety concerns when selecting manual therapy methods . Ageing is associated with multiple comorbidities and musculoskeletal changes including increased loss of hip, spine and ankle joint flexibility and osteoporosis .…”

Section: Discussionmentioning

confidence: 99%

“…For instance, there is now a growing body of research that has examined the effects of chiropractic management for older people with musculoskeletal complaints such as neck pain low back pain, with and without spinal stenosis and lower limb conditions . The advancement of this research has also been accompanied by the development of practice guidelines for the chiropractic management of older adults …”

Section: Introductionmentioning

confidence: 99%

Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors

et al. 2019

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Objective To examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older. Methods A national cross‐sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older. Results In total, 73.5% of participants report “often” treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72‐2.94), working in a non‐urban area (OR 1.85; 95% CI 1.35‐2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26‐2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15‐1.96). Conclusions The majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group.

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Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update

Abstract: This document provides a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients.

Cited by 36 publications

References 56 publications

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Physical therapy interventions for older people with vertigo, dizziness and balance disorders addressing mobility and participation: a systematic review

Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors

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