Chiropractic Health Care
Section Newsletter
Fall 2006

From the Section Chair

After reading the recent issue of APHA's official newspaper, The Nation's Health, I felt compelled to join our colleagues in saluting two most impressive articles which clearly recognize our role in collaborative efforts to address national health issues.  First was a picture of Mitch Haas, DC, who sits on that august panel of health scientists and brings both  professional and institutional perspectives to the Committee On Affiliates.  We were also favored with a descriptive history of our section in APHA by Jonathan T. Eagan, DC, MPH and Rand Braid, DC, MPH. Both gave The Nation's Health a history describing our efforts to bring to the table our genuine concerns for the public's health and the role that we could play in joining national efforts to shore up those concerns.


 


I look forward to seeing a strong presence in Boston at our Annual Meeting to partake of the scientific sessions and the social hours intended to facilitate camaraderie and renew acquaintances.  It promises to spare no efforts in insuring those goals.  See you there.


 


 

Points of Interest in Boston

If you'll be attending the APHA Annual Meeting in Boston, there is a lot to see and do. Here's just a sampling:


1. The North End: This closely knit and very atmospheric Italian neighborhood is clustered around Hanover and Salem Streets. There are a large number of restaurants, many of which have become unfortunately a bit slicked over and lost some of their original character--but others remain. Italian is still spoken in much of the neighborhood.


2. Kennedy's Pub: This is a fabulous upstairs grill and bar in downtown Boston. I think it is one of the best eateries of any kind that Boston has to offer. It's on a quaint street that's also close to some good exploring. It's not far from the Boston Common, which should probably best be seen from the periphery and not within after darkness.


3. Beacon Hill: This is the heart of Brahmin old-time Boston, also very concentrated and worth exploring on foot. There are a few restaurants about, plus great architecture.


4. Harvard Yard/Square: For those who want to see fair old Hahvahd, take the subway to Harvard Square in Cambridge. There you'll find an area that's great for walking, browsing, and finding a good restaurant or two. Bookshops abound, but not as many as we used to have! The Charles River is nearby, where you'll probably see some crewmembers out rowing in their sculls. 


5. Union Oyster House and Faneuil Hall Area: The Oyster House, dating back to the early 1800s, is the oldest restaurant in the United States, and offers delicious food as well. It is near the restored Fanueil Hall area, which is a bunch of shops if you're interested in that sort of thing -- but the architecture is great anyway.


CHC SECTION RECEPTION AT FCER!!


 


What: APHA-Chiropractic Health Care Section Reception 



When: 5:30 p.m. on Monday, Nov. 6



Where: Foundation for Chiropractic Education and Research


          1330 Beacon Street, Suite 315; Brookline, MA 02446-3202


 


Directions: Ride the subway/tram, Line C [Cleveland Circle]. Get off at the Coolidge Corner stop. FCER is at the northwest corner of Harvard and Beacon Streets. Look for the clock tower. 


 



Please rsvp to our host:


Anthony L. Rosner, PhD, LLD [Hon.]


Director of Research and Education


Foundation for Chiropractic Reseearch and Education


(617) 734-3397


rosnerfcer@aol.com


CHC Sessions at the 2006 APHA Meeting in Boston

Monday, November 6, 2006


8:30 a.m.-10:00 a.m.: Developing Policy and Defining Practice


Moderator: Craig F. Nelson, MS, DC


Behavioral barriers to seeking chiropractic care. Gerald L. Stevens, DC , MS, William L. Scheider, PhD


Implementation of best practice recommendations: Report of a focus group. Dana J. Lawrence, DC, Judith Polipnick, DC, PHD, MS, Ilke Schwarz, DC, William Meeker, DC, MPH, Marc Micozzi, MD, PHD


Practice profile of a Department of Defense chiropractic clinic in naval health care. Bart Green, MSEd, DC, Claire Johnson, MSEd, DC, Capt. Wayne Z. McBride, DO, MPH, FACPM


Evaluation of Medicare's demonstration providing expanded coverage for chiropractic services. William B. Stason, MD, MSci, Christopher Tompkins, PhD, Donald S. Shepard, PhD, Jeffrey Prottas, PhD, Grant Ritter, PhD, Timothy C. Martin, PhD


Integrated collaboration in existing community health centres: Demonstrating collaboration between chiropractors and interdisciplinary health care provider teams. Michael J. Garner, MSc, Michael Birmingham, PhD, Peter Aker, DC


Chiropractic pilot project of the National Health Service Corps, Educational Loan Repayment Program, focus: The uninsured. Anne Peneff Albert, DC, Dipl Ac


10:30 a.m.-12:00 p.m.: Public Health Education and Service in Chiropractic


Moderator:  Maria A. Hondras, DC, MPH


Development of a health promotion and wellness certification program. Meridel Gatterman, DC, Cheryl Hawk, DC, PhD, Lisa Z. Killinger, DC


Small group approach to chiropractic education in public health. Irene N. Paulavicius, MA


Factors affecting chiropractic students' awareness and opinions regarding public health concepts. Samir Ayad, MD, Kevin Rose, DC, MPH, Raheleh Khorsan, MA


Celebrating 10 years as an official section: The history of chiropractic within the APHA, 1984-2005. Jonathon Todd Egan, DC, MPH, Rand Baird, DC, MPH, Lisa Z. Killinger, DC


Putting prevention into practice: Nutrition and healthy aging. Lisa Z. Killinger, DC


Implementing "Cobb Kids Straighten Up": A community-based children's health promotion educational initiative launched during National Public Health Week 2006. Ron Kirk, MA, DC


12:30 p.m.-2:00 p.m.: Status of Chiropractic Research


Moderator:  John K. Hyland, DC MPH


Prevalence of patients with diabetes mellitus at the Palmer College of Chiropractic Clinic: A retrospective study. Joseph O. Di Duro, Dennis L. Lopez


Quality assessment of the 2000 ACC Educational Conference scientific peer-review committee. Claire Johnson, MSEd, DC, Bart Green, MSEd, DC


Chiropractic kinesiology: The effects of treatment on participants in a harm reduction center in New York City. Lisa M. Avila, DC, Rebecca Gallo, David Rosenthal, PhD


Improving the scholarship of research in chiropractic faculty. Sivarama Prasad Vinjamury, MD, Gary D. Schultz, DC, DACBR, Raheleh Khorsan, MA, Anupama Kizhakkeveettil, BAMS


A practice-based study regarding the chiropractic treatment of acute neck pain. Michael Haneline, DC, MPH, Robert Cooperstein, MA, DC, Shaner Bongalon, BS


Dose-response in chiropractic care for headaches: Methodological issues for open-label RCTs. Adele Mattinat Spegman, PhD, RN, Mitchell Haas, DC, Bonnie Ganger


2:30 p.m.-4:00 p.m.: Increasing Research Potential in the Profession


NYCC post-graduate fellowships: Contributions to scholarship and teaching. Gerald Stevens, DC, MS, Judy M. Silvestrone, DC, MS


Training the next generation of chiropractic clinical scientists. Cynthia R. Long, PhD, William Meeker, DC, MPH


Launching chiropractic research and researchers by a nonprofit foundation. Anthony Rosner, PhD, LLD

Public Health Columns in Dynamic Chiropractic

Our columns in Dynamic Chiropractic continue to be not only a forum for public health and chiropractic information exchanges but also one of the biggest sources of visibility for the activities of the CHC Section and its leadership. We are allotted space for six columns each year. Four articles have appeared in 2006, and two more are already edited and ready to go! This year we welcomed four new authors: Miriam Kahan, MPH, PhD; Gerald Stevens, DC,;Michel Tetrault, DC; and Jonathon Egan, DC, MPH, PhD-cand. HIGXYZ84HIGZYX


Two of our old standbys, myself and Dr. Lisa Killinger, also each contributed an article. Although we met our "quota" of six, 2006 was actually the first year we did not exceed our quota. Dynamic Chiropractic has generously provided space for extra column articles when submitted in previous years, but this year there were no extras submitted.


The outlook for 2007 is bright. Three of our very reliable authors have already committed to doing one article each for next year. That also means we still have room for at least three more. So all authors and would-be authors are urged to e-mail me at DrRandBaird@sbcglobal.net  with their articles or even ideas for articles.


A full report about the Dynamic Chiropractic columns will be submitted to the CHC Section Council at the APHA Annual Meeting in Boston.


 


 

Two State Public Health Associations Select Chiropractors as Presidents-Elect

Mitchell (Mitch) Haas, Dean of Research at Western States Chiropractic College, was selected by the Oregon Public Health Association Board to fill the position of president-elect. Haas will assume the position of President at the Oregon Public Health Association Annual Meeting in October. He has been serving as the affiliate's  representative to APHA for several years, has served on several committees and also was the founding president of the Chiropractic Section of APHA. Haas is the first chiropractor to become president of a state public health association.


 


Past APHA Chiropractic Health Care Section Student Rep. Andrew C. Cohen, DC, was elected as president-elect of the Hawaii Public Health Association at their recent annual meeting. This is the first time a Doctor of Chiropractic has sat on the board in any capacity. Cohen is the second chiropractor to become president of a state public health association. He looks at this as an opportunity to increase cooperation between the chiropractors in Hawaii and the Public Health community seeing he also serves as the Hawaii State Chiropractic Association secretary. Cohen is in private practice in Honolulu.


 

CHC Nominations

The election results are in and the newly elected officers, whose terms begin immediately after the Annual Meeting in Boston, are:


Chair-Elect


     Kurt Hegetschweiler, DC


Secretary


     Alisa Fairweather, MPH


Section Councilors (three-year terms)


     Jonathon Todd Egan, DC, MPH


     Lori Byrd Spencer


Governing Councilor (two-year term)


     Paul Dougherty, DC


Please congratulate each of them and give them your support as they carry out their duties for our CHC Section!


Also, please note that only 15.7 percent of all APHA members voted, but 23.5 percent of  CHC Section members voted.


 

CHC Membership Report

The CHC membership numbers continue to increase due to the efforts of many.  As of July 31, the CHC section had 249 members. The official membership tally for this year was expected to be completed on Aug. 31.


On July 26, CHC Membership Chair Lori Byrd Spencer,sent an e-mail to all current CHC members asking them to recruit at least one new member for the Section.  Many members reported success in recruiting others to be a part of APHA. Cheryl Hawk stated she had recruited three colleagues at Cleveland Chiropractic College.  Alisa Fairweather reported recruiting a clinic director at Western States Chiropractic College. Joseph Brimhall, President of Western States Chiropractic College, said he would work with his faculty to recruit as many new members as possible.  Jonathon Egan sent the article in The Nation’s Health about the CHC Section’s history to the entire faculty at New York Chiropractic College. Within five minutes, he had one new membership. Gerald Stevens of New York Chiropractic College also signed up three students.


Two recruitment articles were published in Dynamic Chiropractic. Lori Byrd Spencer wrote an article in the May 22 issue ("What's in It for Me, You Ask?") and co-wrote one with Andrea Haan, DC, a CHC student liaison, in the August 15th issue ("Did You Know That Chiropractors Do It Every Day?")  


Many thanks to all who rose to the challenge!

Editorial from our Student Rep

APHA has many sections, one of which is the Chiropractic Health Care (CHC).  Others are:

    * Alcohol, Tobacco, and Other Drugs
    * Community Health Planning and Policy Development
    * Epidemiology
    * Environment
    * Food and Nutrition 
   
* Gerontological Health 
   
* Health Administration 
    * HIV/AIDS 
    * Injury Control and Emergency Health Services 
    * International Health
    * Maternal and Child Health 
    * Medical Care 
    * Mental Health 
    * Occupational Health and Safety 
    * Oral Health 
    * Podiatric Health 
    * Population, Family Planning and Reproductive Health 
    * Public Health Education and Health Promotion 
    * Public Health Nursing 
    * School Health Education and Services 
    * Social Work 
    * Statistics 
    * Vision Care  


 


So as you can see, we are one of many.  The problem that we are facing in the Chiropractic Health Care Section is our small number of active members.  There needs to be a continuing effort to bring chiropractic into the fold of public health.  We need to show chiropractic students why they should join APHA and get engaged in the nation's health dialogue from a chiropractic perspective.



I don't need to tell you that chiropractic has had an uphill battle showing what we can do and teaching the public about what we are and what we are not.  With or without a subluxation model, chiros are on the outside looking in. We need to be within the health care spectrum, and APHA is a good place to start.  Just as we are getting into the VA system, we need to become "ordinary" in the best sense of the word.


The Chiropractic Health Care Section has only been around for 10 years, being started by Rand Baird, DC, MPH, who "was the first to recognize that chiropractors deserved a place in public health, and then worked tirelessly to obtain APHA section status." (quote is from John Hyland , DC, MPH).



Chiropractic and public health should be "married" in everyone's mind -- This will result in greater recognition and acceptance of chiropractic as an important piece of the health care puzzle.  Public health was the first real attempt to bring long-term health care needs of the population into the responsibility of the government.  At first it was sanitation and clean water, and soon it became infectious disease.  Infectious disease is no longer as big of a threat to the health of our nation as it was throughout the 20th century.  No doubt that advances made in infectious disease prevention have extended lives and increased our quality of life.  This is so apparent that we don't even think about infectious disease in the United States anymore, and we see those in Africa and Asia who die from these problems in large numbers as, truly, another world apart from us.


So what are our problems today?  Longevity is great, but what we really want is quality of life.  We want to be free from discomfort, and we want to be able to pursue our activities, whether work or play, free of pain, and with full function.  We want to be 60 and moving like we are 30.  We don't want to miss work with infirmities that allopathic medicine wants to mask with meds and pain-relievers -- we want real resolution of health concerns, or, better yet, prevention of health problems before they occur.


Most Americans are not aware of the role chiropractic might play in keeping their bodies in full capability. Aging American, or "baby boomers," may be more well-educated than their parents, more affluent, and more open to new ideas about wellness. This is a great time for chiropractors to educate our aging population about our potential role in health and wellness. 


The Public Health community also can be educated about chiropractic's role in keeping the U.S. population active and healthy.  Americans want to be treated as intelligent health care consumers.  Many Americans were pretty happy with their health in their 20-30s and were comfortable with the idea that their bodies were able to heal most problems with minimal help from "modern medicine."  We certainly don't think that we "are growing old," nor do we want to accept it.


Chiropractic can play an important part in keeping people at optimal health, resolving complaints of pain and infirmity with patient cooperation and allowing the patient to play a role in their own health care.  Gone are the days of showing up to your medical doctor, accepting a pill and a shot, and expecting that passive relief will take place.  Americans read daily about side-effects of drugs that can even include death.  Americans want to have their earlier good health maintained, not replaced by pills and conciliatory attitudes about aging.  Americans want a role in their own well-being, and have similar goals as chiropractors: to be free of disease, to feel our best and to prevent disease. This leaves allopathic and osteopathic medicine to care for acute medical emergencies and surgical intervention if needed.


Who better than the chiropractor to take the lead in wellness, health promotion and prevention of disease?  The chiropractor of today knows what he/she can appropriately manage and what health scenarios must be referred for care elsewhere.  We know the limitations of our field, and we know the capabilities of our field.


Health care will always need the MD and DO, and the public health care system will always recognize that.  It is time that the public health community recognizes the contribution of chiropractic to the public's health and well-being.


--Jerry Lane (class of December 2007) UBCC, 6th semester student


 


Low Back Pain and Spinal Manipulative Therapy: The Importance of Sub-grouping


In the United States, low back pain has reached epidemic proportions and represents a significant threat to the public health of its citizens [1].  Previous estimates as to the total annual cost of low back pain in the United States have ranged from $20 to $50 billion [1, 2].  More recent opinions have placed the figure at between $100 to $200 billion per annum [3].  A closer evaluation of low back pain’s economic impact reveals that it is the number one reason for individuals under the age of 45 to limit their activity [4, 5], number two complaint seen in physician’s offices [6], the third leading cause for surgery and the fifth most common requirement for hospitalization [7].


While the economic consequences of low back pain are quite apparent, the same cannot be said for many of its conservative treatment options.  Many forms of treatment have demonstrated conflicting results in the literature.  One example is spinal manipulative therapy, a common treatment of low back pain which has shown promise in a number of randomized clinical trials [8-11].  Conversely, other studies have revealed spinal manipulative therapy to have equivocal outcomes in comparison to other forms of treatment [12-15].  One of the theories as to this discrepancy is the inability to recognize a priori, those patients with low back pain who are most likely to benefit from spinal manipulative therapy [12, 16, 17].  In other words, low back pain is a condition which tends to be studied as though the etiology of pain is of a common source.  As a result, spinal manipulative therapy has been evaluated as a therapy applied to this heterogeneous population. This may have resulted in a dilution of its clinical outcomes as reflected in the small effect sizes observed in such studies. 



This observation lead researchers to pursue the development [18] and validation [10] of a clinical prediction rule for the identification of the sub-group of patients with low back pain who are likely to experience sustained decreases in both pain and disability following the application of spinal manipulative therapy.  This body of work has identified several key characteristics of patients suffering from low back pain which can be used to predict a favorable response to spinal manipulative therapy (duration of current episode of low back pain of less than 16 days.):


 



  1. Not having symptoms distal to the knee.
  2. Fear avoidance beliefs questionnaire work subscale score of less than 19 points.
  3. One or more hypomobile lumbar segments present on manual evaluation.
  4. At least one hip with greater than 35 degrees of internal rotation range of motion.

Clinical behavior within the chiropractic profession has utilized spinal manipulative therapy in the same fashion as the research community has traditionally evaluated its application.  Often times, chiropractors view this treatment approach as a panacea for all types of low back pain and apply it as a monotherapy or in combination with other conservative treatments.  As a result, the same dilution effect of treatment outcomes can be observed.  If chiropractors were to recognize the uniqueness of presentation in the low back pain population, their clinical decision making and outcomes would improve.  By sub-grouping low back pain patients based on their demographic and physical examination findings, the most efficacious treatment option can be selected; thus yielding a more streamlined approach to the benefit of the patient, provider and healthcare system as a whole.



As field practitioners, researchers, educators and members of APHA, the recently developed clinical prediction rule for manipulation should alter the looking glass by which we view patients with low back pain.  Instead of viewing this patient population as a homogenous group suffering from a pain based on its location, they should be viewed as individuals with a unique functional deficit, some of whom will likely respond well to spinal manipulative therapy.  For those patients who do not fit this criterion, it is important that we also recognize the necessity of stabilization or directional preference exercise, traction therapy or referral for more invasive treatment options.  Preliminary work on a clinical prediction rule for stabilization exercise has already been accomplished [19] and there are future plans to further evaluate the role of centralization exercise and traction therapy.


While there is still much work to be done in this area of study, these initial findings represent encouraging accomplishments in the ongoing effort of evaluating conservative interventions for low back pain. This line of research also signifies a tremendous opportunity for chiropractors to improve their clinical outcomes and further contribute to the improved state of public health in the United States and abroad.


1.  Deyo, R.A., Low-back pain. Sci Am, 1998. 279(2): p. 48-53.


2.  Nachemson, A.L., Newest knowledge of low back pain. A critical look. Clin Orthop Relat Res, 1992(279): p. 8-20.


3.  Katz, J.N., Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am, 2006. 88 Suppl 2: p. 21-4.


4.  Lively, M.W., Sports medicine approach to low back pain. South Med J, 2002. 95(6): p. 642-6.


5.  Bratton, R.L., Assessment and management of acute low back pain. Am Fam Physician, 1999. 60(8): p. 2299-308.


6.  Deyo, R.A. and W.R. Phillips, Low back pain. A primary care challenge. Spine, 1996. 21(24): p. 2826-32.


Pai, S. and L.J. Sundaram, Low back pain: an economic assessment in the United States. Orthop Clin North Am, 2004. 35(1): p. 1-5.


7.  United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. Bmj, 2004. 329(7479): p. 1377.


8.  Aure, O.F., J.H. Nilsen, and O. Vasseljen, Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine, 2003. 28(6): p. 525-31; discussion 531-2.


9.  Childs, J.D., J.M. Fritz, T.W. Flynn, et al., A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med, 2004. 141(12): p. 920-8.


10. Giles, L.G. and R. Muller, Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine, 2003. 28(14): p. 1490-502; discussion 1502-3.


11. Assendelft, W.J., S.C. Morton, E.I. Yu, et al., Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med, 2003. 138(11): p. 871-81.


12. Assendelft, W.J., S.C. Morton, E.I. Yu, et al., Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev, 2004(1): p. CD000447.


13. Assendelft, W.J., S.C. Morton, E.I. Yu, et al., Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev, 2004(1): p. CD000447.


14. Cherkin, D.C., K.J. Sherman, R.A. Deyo, et al., A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med, 2003. 138(11): p. 898-906.


15. Ernst, E. and P.H. Canter, A systematic review of systematic reviews of spinal manipulation. J R Soc Med, 2006. 99(4): p. 192-6.


16. Borkan, J.M. and D.C. Cherkin, An agenda for primary care research on low back pain. Spine, 1996. 21(24): p. 2880-4.


17. Bouter, L.M., M.W. van Tulder, and B.W. Koes, Methodologic issues in low back pain research in primary care. Spine, 1998. 23(18): p. 2014-20.


18. Flynn, T., J. Fritz, J. Whitman, et al., A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine, 2002. 27(24): p. 2835-43.


19. Hicks, G.E., J.M. Fritz, A. Delitto, et al., Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil, 2005. 86(9): p. 1753-62.


 


CHC Section Manual

The APHA CHC Section Manual has been updated and will be available to all members by mid-September on the CHC Web site, http://www.apha-chc.org/ .

Chiropractic Health Care Section Leadership 2006 Roster

Chair: Andrew Isaacs, DC


Chair-elect: Elaine Cooperstein, DC


Past-chair: John Hyland, DC, MPH


Secretary: Michael Haneline, DC, MPH


Section Council:


Ashley Cleveland, DC, MA


Karen Konarski-Hart, DC


Mitchell Haas, DC, MA


John Pammer, Jr., DC, DACBR


Joseph Brimhall, DC


Maria Hondras, DC, MPH


Governing Council:


Kurt Hegetschweiler, DC


Lisa Killinger, DC


Committee Chairs:
Awards: Sharon Jaeger, DC, DACBR


Membership: Lori Byrd-Spencer


Nominations: John Hyland, DC, MPH, DACBR, DABCO


Program: John Stites, DC, MPH


Publicity: John Pammer, Jr., DC, DACBR


Resolutions: Gerald Stevens, DC


Newsletter: Alisa Fairweather, MPH


Action Board Rep: Christine Goertz Choate, DC, PhD


Section Manual:  Mitchell Haas, MA, DC


APHA-CHC Task Forces:


Public Health Curriculum: Cheryl Hawk, DC, PhD


Policy: John Pammer Jr., DC, DACBR


Occupational Health Certification: Karen Konarski-Hart, DC and Robert Mootz, DC, DABCO


Diversity:  Andrew Isaacs, DC


Web Page:  Cheryl Hawk, DC, PhD and Raheleh Khorsan, MA


Dynamic Chiropractic Column Editor:  Rand Baird, DC, MPH


Others: 


Paul Dougherty, DC


Jonathan Egan, DC, MPH


Will Evans, DC, PhD, CHES


Eric Hurwitz, DC, PhD


Dana Lawrence, DC


Cynthia Long, PhD


Bill Meeker, DC, MPH


Monica Smith, DC, PhD


APHA is the oldest, largest, and most influential public health association in the United States and in the world. All doctors of chiropractic are urged to join this important multidisciplinary organization (http://www.apha.org), and members wishing to volunteer to participate more actively can volunteer by contacting any of the APHA Chiropractic Health Care Section officers listed above.