Back Clinic Research Studies. Dr. Alex Jimenez has compiled study and research projects that are pertinent to the science and art of chiropractic medicine. The subsets can be classified as following: Case Study, Case Series, Cross-Sectional, Cohort, Case-Control, and Randomized Control Trials. Each subset of study profiles has its merits and scientific significance.
It is our intention to bring clarity to present-day research models. We will discuss and present significant clinical interpretations that may serve outpatients well. Great care in selecting appropriate and well-documented models has been enforced in our blog. We gladly will listen and heed comments on the discussed subject matters presented. For answers to any questions you may have please call Dr. Jimenez at 915-850-0900
“Clinical decision rules, spinal pain classification and prediction of treatment outcome: A discussion of recent reports in the rehabilitation literature”
Abstract
Clinical decision rules are an increasingly common presence in the biomedical literature and represent one strategy of enhancing clinical-decision making to improve the efficiency and effectiveness of healthcare delivery. In the context of rehabilitation research, clinical decision rules have been predominantly aimed at classifying patients by predicting their treatment response to specific therapies. Traditionally, recommendations for developing clinical decision rules propose a multistep process (derivation, validation, impact analysis) using the defined methodology. Research efforts aimed at developing a diagnosis-based clinical decision rule have departed from this convention. Recent publications in this line of research have used the modified terminology diagnosis-based clinical decision guide. Modifications to terminology and methodology surrounding clinical decision rules can make it more difficult for clinicians to recognize the level of evidence associated with a decision rule and understand how this evidence should be implemented to inform patient care. We provide a brief overview of clinical decision rule development in the context of the rehabilitation literature and two specific papers recently published in Chiropractic and Manual Therapies.
Clinical Prediction Rules
Healthcare has undergone an important paradigm shift toward evidence-based practice. An approach thought to enhance clinical decision-making by integrating the best available evidence with clinical expertise and patients’ preferences.
Ultimately, the goal of evidence-based practice is to improve healthcare delivery. However, the translation of scientific evidence into practice has proven a challenging endeavor.
Clinical decision rules (CDRs), also known as clinical prediction rules, are increasingly common in the rehabilitation literature.
These are tools designed to inform clinical decision-making by identifying potential predictors of diagnostic test outcome, prognosis, or therapeutic response.
In the rehabilitation literature, CDRs are most commonly used to predict a patient’s response to treatment. They have been proposed to identify clinically relevant subgroups of patients presenting with otherwise heterogeneous disorders such as non-specific neck or low back pain, which is the perspective on which we intend to focus.
Clinical Prediction Rules
The ability to classify or subgroup patients with heterogeneous disorders such as spinal pain has been highlighted as a research priority and, consequently, the focus of much research effort. The appeal of such classification approaches is their potential for improved treatment efficiency and effectiveness by matching patients with optimal therapies. In the past, patient classification has relied on implicit approaches founded in tradition or unsystematic observations. The use of CDRs to inform classification is one attempt at a more evidence-driven approach, less dependent on unfounded theory.
CDRs are developed in a multistep process involving studies of derivation, validation, and analysis of impact, with each having a defined purpose and methodological criteria. As with all forms of evidence used to make decisions about patients, attention to appropriate study methodology is critical to assessing the potential benefits of implementation.
Benefits Of Clinical Prediction Rules
It can accommodate more factors than the human brain can take into account
CDR/CPR model will always give the same result (mathematical equation)
Ultimately, the usefulness of a CDR lies not with its accuracy but with its ability to improve clinical outcomes and enhance the efficiency of care.[15] Even when a CDR demonstrates broad validation, this does not ensure that it will change clinical decision-making or that the changes it produces will result in better care.
The changes it produces will result in better care. McGinn et al.[2] identified three explanations for the failure of a CDR at this stage. First, if clinician judgment is as accurate as a CDR-informed decision, there is no benefit to its use. Second, the application of a CDR may involve cumbersome calculations or procedures which discourage clinicians from utilizing the CDR. Third, using the CDR may not be feasible in all environments or circumstances. In addition, we would include the reality that experimental studies may involve patients that are not entirely representative of those seen in routine care and that this may limit the actual value of a CDR. Therefore, to fully understand the utility of a CDR and its ability to improve healthcare delivery, it is necessary to undertake a pragmatic examination of its feasibility and impact when applied in an environment reflecting real-world practice. This can be undertaken with different study designs such as randomized trials, cluster-randomized trials, or other approaches such as examining the impact of a CDR before and after its implementation.
Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules.
Aims were (1) to determine the proportion of patients with lumbar impairments who could be classified at intake by McKenzie syndromes (McK) and pain pattern classification (PPCs) using Mechanical Diagnosis and Therapy (MDT) assessment methods, manipulation, and stabilization clinical prediction rules (CPRs) and (2) for each Man CPR or Stab CPR category, determine classification prevalence rates using McK and PPC.
CPRs are sophisticated probabilistic and prognostic models where a group of identified patient characteristics and clinical signs and symptoms are statistically associated with meaningful prediction of patient outcomes.
Two separate CPRs were developed by researchers for identifying patients who would respond favorably to manipulation.33,34 Flynn et al. developed the original manipulation CPR using five criteria, i.e., no symptoms below the knee, recent onset of symptoms (<16 days), low fear-avoidance belief questionnaire36 score for work (<19), hypomobility of the lumbar spine, and hip internal rotation ROM (>35 for at least one hip).33
Flynn’s CPR was subsequently modified by Fritz et al. to two criteria, that included no symptoms below the knee and recent onset of symptoms (<16 days), as a pragmatic alternative to reduce clinician burden for identifying patients in primary care most likely to respond to thrust manipulation.34 positively
“Potentia.l Pitfalls Of Clinical Prediction Rules”
What Are Clinical Prediction Rules?
A clinical prediction rule (CPR) is a combination of clinical findings that have statistically demonstrated meaningful predictability in determining a selected condition or prognosis of a patient who has been provided with a specific treatment 1,2. CPRs are created using multi-variate statistical methods, are designed to examine the predictive ability of selected groupings of clinical variables3,4, and are intended to help clinicians make quick decisions that may normally be subject to underlying biases5. The rules are algorithmic in nature and involve condensed information that identifies the smallest number of statistically diagnostic indicators to the targeted condition6.
Clinical prediction rules are generally developed using a 3-step method14. First, CPRs have derived us prospectively-
ing multivariate statistical methods to examine the predictive ability of selected groupings of clinical variables3. The second step involves validating the CPR in a randomized controlled trial to reduce the risk that the predictive factors developed during the derivation phase were selected by chance14. The third step involves conducting an impact analysis to determine how the CPR improves care, reduces costs, and accurately defines the targeted objective14.
Although there is little debate that carefully constructed CPRs can improve clinical practice, to my knowledge, there are no guidelines that specify methodological requirements for CPRs for infusion into all clinical practice environments. Guidelines are created to improve the rigor of study design and reporting. The following editorial outlines potential methodological pitfalls in CPRs that may significantly weaken the transferability of the algorithm. Within the field of rehabilitation, most CPRs have been prescriptive; thus, my comments here are reflective of prescriptive CPRs.
Methodological Pitfalls
CPRs are designed to specify a homogenous set of characteristics from a heterogeneous population of prospectively selected consecutive patients5,15. Typically, the resulting applicable population is a small subset of a larger sample and may only represent a small percentage of the clinician’s actual daily caseload. The setting and location of the larger sample should be generalizable15,16, and subsequent validity studies require assessment of the CPR in different patient groups, in different environments, and with a typical patient group seen by most clinicians16. Because many CPRs are developed based on a very distinct group that may or may not reflect a typical population of patients, the spectrum transportability17 of many current CPR algorithms may be limited.
Clinical prediction rules use outcome measures to determine the effectiveness of the intervention. Outcome measures must have a single operational definition5 and require enough responsiveness to capture appropriate change in the condition14 truly; in addition, these measures should have a well-constructed cut-off score16,18 and be collected by a blinded administrator15. The selection of an appropriate anchor score for measurement of actual change is currently debated19-20. Most outcome measures use a patient recall-based questionnaire such as a global rating of change score (GRoC), which is appropriate when used in the short term but suffers from recall bias when used in long-term analyses19-21.
A potential drawback for CPRs is the failure to maintain the quality of the tests and measures used as predictors in the algorithm. Therefore, the perspective test and measures should be independent of one another during modeling16; each should be performed in a meaningful, acceptable manner4; clinicians or data administrators should be blinded to the patient’s outcomes measures and condition22.
Sources
Potential Pitfalls Of Clinical Prediction Rules; The Journal of Manual & Manipulative Therapy Volume 16 Number Two [69]
Jeffrey J Hebert and Julie M Fritz; Clinical decision rules, spinal pain classification and prediction of treatment outcome: A discussion of recent reports in the rehabilitation literature
Gale Grijalva suffered from severe back pain as a result of an automobile accident injury. Where it was once very difficult to go about her regular daily tasks, Gale Grijalva is now able to participate in physical activities she wasn’t able to engage in before thanks to Dr. Alex Jimenez, chiropractor in El Paso, TX. Gale Grijalva describes how patient Dr. Jimenez is and she discusses how thoroughly he’s been able to help her, including answering any concerns she may have. Gale Grijalva also experienced results through rehabilitation.
Chiropractic Severe Back Pain Treatment
Severe chronic back pain is a serious, recurring condition which affects a person’s everyday life. Back pain lasting over three months is considered chronic. The spine is an essential component of the body. Severe chronic back pain might be the backbone’s manner of telling the body that there is an issue. The spine is composed of bony vertebrae, soft spinal discs, facet joints, tendons, ligaments and tendons. Within the bony vertebral artery lies the spinal cord, the delicate but effective nerve pathway of the central nervous system.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
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Due to his significant craftsmanship in San Antonio, TX, Ottis Hamlet must largely rely on the use of his best tools: his hands. Unfortunately, Mr. Hamlet developed debilitating symptoms in both of his arms because of carpal tunnel syndrome, which dramatically impacted his capacity to participate in his occupation and therefore affecting his quality of life as a result. Ottis Hamlet was able to find relief for his hand and wrist pain with Dr. Alex Jimenez through a trip to El Paso, TX and he received chiropractic treatment for his carpal tunnel syndrome, preventing the need to undergo any surgical interventions.
Carpal Tunnel Chiropractic Treatment
Carpal tunnel syndrome is a medical condition resulting from the compression of the nerve that travels via the wrist and in the lymph nodes. Typical symptoms include pain, tingling sensations and numbness, at the thumb, index finger, middle finger, and the thumb side of this ring fingers. Symptoms normally begin gradually and may continue throughout the day. Symptoms may stretch throughout the arm and also diminished grip power may also happen. Carpal tunnel syndrome may be diagnosed according to its symptoms.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and recommend�us.
Terry Peoples, relies on her ability to perform her day to day tasks on a regular basis as a beauty adviser in El Paso, TX. However, when she endured a car incident injury, she had no choice but to rely upon others to execute her daily pursuits. That is when Terry Peoples obtained a recommendation to seek chiropractic treatment with Dr. Alex Jimenez. Terry Peoples makes sure to visit Dr. Alex Jimenez’s office as necessary, feeling better and refreshed each time.
Car Accident Chiropractic Pain Treatment
In accordance with the National Highway Traffic Safety Administration (NHTSA), more than three million people are injured each year in car accidents across the country. The several injuries brought on by an auto accident can be as varied as the individual requirements of each episode, but some automobile accidents are more prevalent than the others. The indicators of some automobile collisions may resolve by themselves, but most accidents and/or conditions caused by the effect of a vehicle crash might call for immediate medical care, such as chiropractic treatment, to ultimately help improve the symptoms.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and recommend�us.
Jesus Rabelo makes a living as an 18 wheeler truck driver at El Paso, TX. After being involved in a crash, Mr. Rabelo suffered from back and shoulder pain that influenced his private life and function, forcing him to need to start all over again. In reference to a highly appreciated recommendation, Jesus Rabelo found Dr. Alex Jimenez, chiropractor in El Paso, TX. Mr. Rabelo describes receiving outstanding service from the team and he highly recommends Dr. Alex Jimenez himself.
18 Wheeler Accident Chiropractic Treatment
In 2013, 54 million individuals sustained injuries from traffic crashes. This led in 1.4 million deaths in 2013, up from 1.1 million deaths in 1990. Automobile accidents can be grouped into various kinds, such as head-on, rear-end, side accidents, and rollovers. Psychological issues may happen because of auto accidents. A variety of injuries and ailments could result in the blunt force injury brought on by a crash, such as whiplash and back pain, among others.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and recommend�us.
Vincent Garcia, an athlete training in mixed martial arts, or MMA, suffered a knee injury and developed turf toe, but that has not stopped him from engaging in his normal training regimen. In order to return to as well as enhance his first physical performance, Vincent Garcia found treatment with Dr. Alex Jimenez, doctor of sports chiropractic. Now recovering from his sports injuries, Vincent Garcia looks forward to regaining his strength, flexibility and freedom to go back to sport.
Sports Injury Chiropractic Treatment
Exercising is important for overall health and wellness, but occasionally, an individual can suffer an injury when playing sports or engaging in physical activities. Accidents, poor training methods, or improper equipment can cause them. Some people today get hurt because they aren’t in shape. Not warming up or stretching enough can also lead to injuries. Treatment often begins with the RICE (Rest, Ice, Compression, and Elevation) method to relieve pain, reduce swelling, and speed recovery. Other possible treatments include pain relievers, rehabilitation, and sometimes surgery, if needed.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and recommend�us.
James Hill, father and teacher to two older sons and a younger daughter called Madison Hill, belong to an athletic family. Madison began participating in several sports because she had been a young woman, but she consequently experienced numerous sports injuries. Luckily, James Hill and his daughter Madison Hill went to go to Dr. Alex Jimenez and he has tremendously helped her recover after every injury she experiences. Collectively, they’ve learned to trust in chiropractic care, particularly following Dr. Alex Jimenez’s innovative treatment techniques and procedures. Mr. Hill expresses his gratitude in addition to how far Dr. Alex Jimenez’s understanding in sports injury therapy has greatly enlarged his general comprehension of the human body’s healing process. After Madison suffered a recent ankle sprain, she was instantly reassured by Dr. Alex Jimenez regarding how much faster she’d return-to-play during chiropractic care. James Hill and Madison Hill highly recommend Dr. Alex Jimenez as the non-surgical selection for volleyball sports injuries, among others..
Chiropractor Ankle Sprain Treatment
Every year, millions of young athletes engage in high school sports. However, once an injury occurs, it might develop into an issue that might result in them having to discontinue their particular sport or physical activity if not treated properly. The pressure to continue participating in the sport or physical activity may cause young athletes not to follow proper recovery guidelines, which might subsequently result in more injury with long-term consequences. Sports injuries among young athletes fall into two key categories: overuse injuries and acute injuries. Both kinds include injuries to the soft tissues and bones. Whether an injury is acute or due to overuse, a young athlete who develops a symptom which impacts their athletic performance should be diagnosed appropriately by a health care professional. Sports accidents which are untreated can lead to permanent disability. Many high school sports injuries can be avoided through appropriate instruction and conditioning.
We are blessed to present to you�El Paso�s Premier Wellness & Injury Care Clinic.
As El Paso�s Chiropractic Rehabilitation Clinic & Integrated Medicine Center,�we passionately are focused treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.
If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and recommend�us.
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