Journal of Manual & Manipulative Therapy [some free content]

jmmt.jpg  JMMT is an international peer-reviewed journal dedicated to the publication of original research, case reports, and reviews of the literature that contribute to the advancement of knowledge in the field of manual therapy, clinical research, therapeutic practice, and academic training. In addition, each issue features an editorial written by the editor or a guest editor, media reviews, thesis reviews, and abstracts of current literature.

Free content from the current issue (v. 14, no. 2):

Guest Editorial Current Perspectives: The Clinical Application of Ultrasound Imaging by Physical Therapists
Online-Only Article Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion from a Veteran Chiropractor
Online-Only Article Concurrent Criterion-Related Validity of Acromioclavicular Joint Physical Examination Tests: A Systematic Review
Letter to the Editor Manual Therapy in Children
Book, CD, and Tape Reviews V14N2

Free content from 14(1):


Manual Therapy in Children: Role of the Evidence-Based Clinician
Online-Only Article Management of Lumbar Spinal Stenosis through the Use of Translatoric Manipulation and Lumbar Flexion Exercises: A Case Series
  Video Supplement 1 – Bilateral Thoracic Facet Joint Traction Manipulation
  Video Supplement 2 – Translatoric Lumbar Side Bending Manipulation
Online-Only Article Acceptance Speech for the John McM. Mennell Service Award

Note: Mac users can play the video files using VLC, a free video player. Download Here. 


Journal publications by Australian chiropractic academics: Are they enough? [Open Access]

bmc.gif This article was just published yesterday (July 27) in Chiropractic & Osteopathy:

Wayne Hoskins, Henry Pollard, John Reggars, Andrew Vitiello and Rod Bonello. Journal publications by Australian chiropractic academics: Are they enough? Chiropractic & Osteopathy 2006, 14:13

(Provisional Abstract) PURPOSE: To document the number of journal publications attributed to the academic faculty of Australian chiropractic tertiary institutions. To provide a discussion of the significance of this output and to relate this to the difficulty the profession appears to be experiencing in the uptake of evidence based healthcare outcomes and cultures.

METHODS: The departmental websites for the three Australian chiropractic tertiary institutions were accessed and a list of academic faculty compiled. It was noted whether each academic held a chiropractic qualification or research doctoral (not professional) degree qualification. A review of the literature was conducted using the names of the academics and cross-referencing to publications listed independently in the PubMed and Index to Chiropractic Literature (ICL) databases (from inception to February 27 2006). Publications were excluded that were duplicates, corrected reprints, conference abstracts/proceedings, books, monographs, letters to the editor/comments or editorials. Using this information an annual and recent publication rate was constructed.

RESULTS: For the 41 academics there was a total of 155 PubMed listed publications (mean 3.8, annual rate per academic 0.31) and 415 ICL listed publications (mean 10.1, annual rate 0.62). Over the last five years there have been 50 PubMed listed publications (mean 1.2, annual rate 0.24) and 97 ICL listed publications (mean 2.4, annual rate 0.47). Chiropractor academics (n=31) had 29 PubMed listed publications (mean 2.5, annual rate 0.27) and 265 ICL listed publications (mean 8.5, annual rate 0.57). Academics with a doctoral degree (n=13) had 134 PubMed listed publications (mean 10.3, annual rate 0.70) and 311 ICL listed publications (mean 23.9, annual rate 1.44). Academics without a doctoral degree (n=28) had 21 PubMed listed publications (mean 0.8, annual rate 0.13) and 104 ICL listed publications (mean 3.7, annual rate 0.24).

CONCLUSIONS: While several academics have compiled an impressive list of publications, overall there is a significant paucity of published research authored by the majority of academics, with a trend for a falling recent publication rate and not having a doctoral degree being a risk factor for poor publication productivity. It is suggested that there is an urgent necessity to facilitate the acquisition of research skills in academic staff particularly in research methods and publication skills. Only when undergraduate students are exposed to an institutional environment conducive to and fostering research will concepts of evidence based healthcare really be appreciated and implemented by the profession.
Index to Chiropractic Literature Record

Evaluating evidence-based practice performance

ebm_logo.gif  This article was just published in Evidence Based Medicine [subscription required]:

Green ML. Evaluating evidence-based practice performance. Evid Based Med 2006; 11(4):99-101.
Abstract: Evidence-based practice (EBP) educators need valid and feasible approaches to evaluate the impact of new curricula and to document the competence of individual trainees. As of 1999, however, the published evaluation instruments often lacked established validity and reliability, focused on critical appraisal to the exclusion of other EBP steps, and measured knowledge and skills but not behaviours in actual practice. Editorialists at the time lamented, “ironically, if one were to develop guidelines for how to teach EBM based on these results, they would be based on the lowest level of evidence”. In the ensuing years, educators have responded to the challenge. We now have several instruments, supported by multiple types of evidence for validity, to evaluate EBP knowledge and skills. In the parlance of Miller’s pyramid,3 these instruments can document that a trainee “knows” and “knows how” to practice evidence-based medicine. And promising EBP objective structured clinical examinations, while supported by more limited psychometric testing, allow trainees to “show how” in realistic clinical settings.
Journal Record  

Bloggers: A portrait of the internet’s new storytellers [Pew Internet report]

pew.gif    Here is a new report from Pew Internet:

Bloggers: A portrait of the internet’s new storytellers

A national phone survey of bloggers finds that most are focused on describing their personal experiences to a relatively small audience of readers and that only a small proportion focus their coverage on politics, media, government, or technology. Blogs, the survey finds, are as individual as the people who keep them. However, most bloggers are primarily interested in creative, personal expression – documenting individual experiences, sharing practical knowledge, or just keeping in touch with friends and family.

Pew Internet Mission:

The Pew Internet & American Life Project produces reports that explore the impact of the Internet on families, communities, work and home, daily life, education, health care, and civic and political life. The Project aims to be an authoritative source on the evolution of the Internet through collection of data and analysis of real-world developments as they affect the virtual world. The basis of the reports are nationwide random digit dial telephone surveys as well as online surveys. This data collection is supplemented with research from government agencies, academia, and other expert venues; observations of what people do and how they behave when they are online; in-depth interviews with Internet users and Internet experts alike; and other efforts that try to examine individual and group behavior. The Project releases 15-20 pieces of research a year, varying in size, scope, and ambition.

The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: a systematic review [Open Access]

bmc.gif   Just published online:

Vernon H, Humphreys BK, Hagino C. The outcome of control groups in clinical trials of conservative treatments for chronic mechanical neck pain: a systematic review. BMC Musculoskelet Disord. 2006 Jul 18;7(1):58 [Epub ahead of print]

BACKGROUND: Chronic neck pain is highly prevalent in Western societies, with about 15% of females and 10% of males suffering with it at any time. The course of untreated chronic neck pain patients in clinical trials has not been well-defined and the placebo effect has not been clarified.

METHODS: A systematic review of RCTs of conservative treatments for chronic mechanical neck pain was conducted. Studies were excluded if they did not include a control group, if they involved subjects with whiplash injuries, a predominance of headache or arm pain associated with chronic neck pain and if only one treatment was reported. Only studies scoring 3-5 out of 5 on the Jadad Scale for quality were included in the final analysis. Data on change in pain scores of subjects in both placebo (PL) as well as no-treatment (NT) control groups were analyzed. Mean changes in pain scores as well as effect sizes were calculated, summarized and compared between these groups.

RESULTS: Twenty (20) studies, 5 in the NT group and 15 in the PL group, with outcome intervals ranging from 1-52 weeks were included in the final analysis. The mean [95% CI] effect size of change in pain ratings in the no-treatment control studies at outcome points up to 10 weeks was 0.18 [-0.05,0.41] and for outcomes from 12-52 weeks it was 0.4 [0.12, 0.68]. In the placebo control groups it was 0.50 [0.10,0.90] at up to 10 weeks and 0.33. [-1.97,2.66] at 12-24 weeks. None of the comparisons between the no-treatment and placebo groups were statistically significant.

CONCLUSIONS: It appears that the changes in pain scores in subjects with chronic neck pain not due to whiplash who are enrolled in no-treatment and placebo control groups were similarly small and not significantly different. As well, they do not appear to increase over longer-term follow-up.

PubMed Record   Index to Chiropractic Literature Record

When physician-industry interactions go awry

This article was just published in the July 2006 supplement of the Journal of Pediatrics.

Kassirer JP.  When physician-industry interactions go awry. J Pediatr 2006 Jul;149(1S):S43-S46.

Financial connections between members of the profession and professional organizations and the pharmaceutical, device, and biotechnology industries are increasingly common and can lead to biased medical decision making, higher costs of care, and decline in the public’s trust of the profession. To preserve its reputation and its autonomy over medical decisions, the profession must begin to police itself.

This article is based on testimony delivered to the House of Representatives Ways and Means Committee (Subcommittee on Health; Hearings; Hearing on Value-Based Purchasing for Physicians under Medicare) on July 21, 2005. Read the full text of Dr. Kassirer’s testimony here.]

Journal link [full text by subscription only]; reprint requests: Dr Jerome P. Kassirer, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111.

Maintenance of Certification for Family Physicians (MC-FP) Self Assessment Modules (SAMs): The first year

jabfp.gif  Published in the July-August 2006 issue of the JABFM: [free full text]

Hagen MD, Ivins DJ, Puffer JC, Rinaldo J, Roussel GH, Sumner W, Xu J. Maintenance of Certification for Family Physicians (MC-FP) Self Assessment Modules (SAMs): The first year. J Am Board Fam Med 2006;19:398-403.

INTRODUCTION: In 2000, the American Board of Medical Specialties adopted Maintenance of Certification (MOC) to replace intermittent, periodic recertification. MOC consists of 4 components: demonstration of professionalism (part I); commitment to life-long learning (part II); demonstration of cognitive expertise (part III); and evaluation of performance in practice (part IV). The American Board of Family Medicine (ABFM) implemented Maintenance of Certification for Family Physicians (MC-FP) in 2004, with its MC-FP part II self-assessment modules (SAMs) as the focus of the first year’s activities.
METHODS: The SAMs use materials and resources provided at the ABFM’s website ( As of April 2005, approximately 7000 Diplomates had successfully completed SAMs in essential hypertension (N = 2351) and type 2 diabetes mellitus (N = 4648). Participants completed categorical modified Likert scale evaluations to receive continuing education credit, and many offered unstructured free-text comments regarding the clinical simulation component. These free-text comments were entered into the AnSWR qualitative analysis program from the Centers for Disease Control and Prevention. Text coding was performed by 2 authors (MDH, DJI). As no inferential analyses or comparisons were anticipated, the authors conducted no studies of inter-rater consistency. Results are reported as means (SD) and medians for continuous data, and as frequencies for count data.
RESULTS: Likert-scale ratings indicated generally favorable responses (predominantly 5 to 6 on a 6-point scale) to the hypertension and diabetes SAMs. In addition, over half (ie, 55% for hypertension and 54% for diabetes participants) of the respondents indicated that the experience would lead to changes in their practices. Navigation and system operation issues predominated in the free-text comments offered for the diabetes and hypertension simulations.
CONCLUSION: The MC-FP SAMs received generally favorable ratings in the program’s first year. The SAMs underwent a number of modifications and improvements during the first year, largely in response to feedback and suggestions from ABFM Diplomates.
Free Full Text