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Activator Methods International Ltd.
2950 N. Seventh Street, Suite 200
Phoenix, AZ 85014
ofc 602-224-0220
fax 602-224-0230
toll free 1-800-598-0224
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May 29, 2002
Dana J. Lawrence, D.C., Editor
Journal of Manipulative & Physiological Therapeutics
200 E. Roosevelt Road
Lombard IL 60148
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To the Editor:
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Reply to Drs. Perle, Cooperstein, Lantz, & Schneider
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I regret that my use of the term "consensus" does not meet the definition that Perle & co-authors prefer; perhaps my confusion results from the mix of rating and consensus processes. Nevertheless, I think the Gatterman et al. project (1) makes clear how difficult the next step (beyond the Mercy Conference guidelines) will be, given the still meager state of our science.
I take exception, however, to Perle et al.'s insinuation that we at Activator Methods Intemational, Ltd. (AMI) have touted our research without justification, or that we have not been concerned with clinical research nor with clinical outcomes research. Studies of the reliability of the assessment procedures employed in Activator Methods Chiropractic, Technique (AMCT) are clinical research, and the various case reports, clinical series and randomized controlled clinical trials related to AMCT (see Table 1.) speak to our success in conducting and stimulating others to conduct AMCT-relevant investigations. We accept no "indictment" from Perle and his group, but acknowledge the continuing and formidable challenge to investigate the clinical value (including effectiveness) of AMCT. The success enjoyed by side-posture lumbar manipulation in the relief of low back pain provides a useful standard against which our and other' chiropractic methods may be compared. Contrary to Perle et al. ' s assertion, I have not claimed that AMCT is more effective than side-posture adjusting for low-back pain patients. I do hypothesize, based on nearly 40 years of clinical experience and the few available published data, that AMCT offers a useful mode of intervention for low-back pain patients.
I see no reason to apologize for the fact that our research interests and activities have addressed a variety of issues related to AMCT, including but not limited to the question of effectiveness. Studies of the physics of the Activator Adjusting Instrument (AAI) and of patient’s neurophysiological and biomechanical responses to AAI adjustments have explored important aspects of AMCT procedures including safety and therapeutic mechanism. This work may contribute, directly and/or indirectly, to the issue of effectiveness as our knowledge base grows.
Table 1: Clinical research related to Activator Methods Chiropractic Technique
Reliability~ studies:
Venn EK, Wakefield KA, Thompson PR et al. A comparative study of leg-Iength checks. European Journal of Chiropractic 1983 (June); 31(2): 68-80
DeBoer KF, Harmon RO, Savoie S, Tuttle CD. Inter- and intra examiner reliability of leg length differential measurements: a preliminary study. Journal of Manipulative & Physiological Therapeutics 1983 (2); 6(2): 61-6
Andrew S, Gemmell H. Inter-examiner agreement in determining side of functional short leg using the Activator Methods test for short leg. Journal of the Chiropractic Association of Oklahoma 1987; 5: 8-9
Shambaugh P, Solafani L, Fanselow D. Reliability of the Derefield- Thompson test for leg-Iength inequality, and use of the test to demonstrate cervical adjusting efficacy. Journal of Manipulative & Physiological Therapeutics 1988 (Oct); 11(5): 396-9
Youngquist MW, Fuhr AW, Osterbauer PJ. Interexaminer reliability of an isolation test for the identification of upper cervical subluxation. Journal of Manipulative & Physiological Therapeutics 1989 (Apr); 12(2): 93-7
Fuhr A W, Osterbauer PJ. Interexaminer reliability of relative leg length evaluations in the prone, extended position. Chiropractic Technique 1989 (Jan/Feb); 2(1): 13-8
Rhudy TR, Burk JM. Interexaminer reliability of functional leg- length assessment. American Journal of Chiropractic Medicine 1990 (June); 3(2): 63-6
Nguyen HT, Resnick DN, Caldwell SO, Elston EW, Bishop BB, Steinhouser JB, Oimmillaro TJ, Keating JC. Interexaminer reliability of activator methods relative leg length evaluation in the prone, extended position. Journal of Manipulative & Physiological Therapeutics 1999 (Nov/Dec); 22(9): 565-9
Case Reports:
Richards GL, Thompson JS, Osterbauer PJ, Fuhr A W .Low force chiropractic care of two patients with sciatic neuropathy and lumbar disc herniation. American Journal of Chiropractic Medicine 1990 (Mar); 3(1): 25-32
Frach JP, Osterbauer PJ, Fuhr AW. Chiropractic treatment of Bell's Palsy by mechanical force, manually assisted chiropractic adjusting and high voltage electrotherapy. Journal of Manipulative & Physiological Therapeutics 1992 (Nov/Dec); 15(9): 596-8
Phillips NJ. Vertebral subluxation and otitis media: a case study. Chiropractic 1992 (July); 8(2): 38-9
Polkinghorn BS. Conservative treatment of torn medial meniscus via mechanical force, manually assisted, short lever chiropractic adjusting procedures. Journal of Manipulative & Physiological Therapeutics 1994 (Sept); 17(7): 474-84 /,
Peterson KB. Two cases of spinal manipulation performed while the patient contemplated an associated stress event: the effect of the manipulation/contemplation on serum cholesterol levels in hypercholesterolemia subjects. Chiropractic Technique 1995 (May); 7(2): 55-9
Polkinghorn BS. Chiropractic treatment of frozen shoulder (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. Journal of Manipulative & Physiological Therapeutics 1995a (Feb); 18(2):105-15
Polkinghorn BS. Posterior calcaneal subluxation: an important consideration in chiropractic treatment of plantar fasciitis (heel spur syndrome). Chiropractic Sports Medicine 1995b; 9(2): 44-51
Polkinghorn BS. Instrumental chiropractic treatment of frozen shoulder associated with mixed metastatic carcinoma. Chiropractic Technique 1995c (Aug); 7(3): 98-102
Polkinghorn BS. Treatment of cervical disc protrusions via instrumental chiropractic adjustment. Journal of Manipulative & Physiological Therapeutics 1998; 21(2): 114-21
Polkinghorn BS. Grand rounds discussion: patient with acute low back pain. Chiropractic Technique 1999; 11(1): 1-32
Polkinghorn BS. Chiropractic management of non-cardiac chest pain. Journal of Chiropractic Education 2002; 16(1): 90-1
Polkinghorn BS, Colloca CJ. Treatment of symptomatic lumbar disc herniation utilizing Activator Methods Chiropractic Technique. Journal of Manipulative & Physiological Therapeutics 1998; 21(3): 187-96
Polkinghorn BS, Colloca CJ. Chiropractic treatment of coccygodynia via external instrumental adjusting procedures utilizing Activator Methods Chiropractic Technique. Journal of Manipulative & Physiological Therapeutics 1999; 22(6): 411-6
Polkinghorn BS, Colloca CJ. Chiropractic treatment of postsurgical neck syndrome utilizing mechanical force, manually-assisted short lever spinal adjustments. Journal of Manipulative & Physiological Therapeutics 2001 (Nov/Dec); 24(9): 589-95
Polkinghorn BS, Colloca CJ. Chiropractic management of chest pain utilizing mechanical force, manually-assisted short lever adjusting procedures. Journal of Manipulative & Physiological Therapeutics 2002; in press
Clinical series:
Gemmell HA, Jacobson BH. Comparison of two adjustive indicators in patients with acute low back pain. Chiropractic Technique 1998; 10(1): 8-10
Osterbauer PJ, DeBoer KF, Widmaier RS, Petermann EA, Fuhr AW. Treatment and biomechanical assessment of patients with chronic sacroiliac joint syndrome. Journal of Manipulative & Physiological Therapeutics 1993; 16(2) 82-90
Osterbauer PJ, Derickson KL, Peles JD, DeBoer KF, Fuhr AW, Winters JM. Three-dimensional head kinematics and clinical outcome of patients with neck injury treated with spinal manipulative therapy: a pilot study. Journal of Manipulative & Physiological Therapeutics 1992 (Oct); 15(8): 501-11
Controlled trials:
Yates RG, Lamping NL, Abram C et al. The effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial. Journal of Manipulative & Physiological Therapeutics 1988 (Dec); 11(6): 484-8
Gemmell HA, Jacobson BH. The immediate effect of Activator vs. Meric adjustment on acute low back pain: a randomized controlled trial. Journal of Manipulative & Physiological Therapeutics 1995 (Sept); 18(7): 453-6
Yurkiw D, Mior S. Comparison of two chiropractic techniques on pain and lateral flexion in neck pain patients: a pilot study. Chiropractic Technique 1996 (Nov): 8(4): 155-62
Peterson KB. The effects of spinal manipulation on the intensity of emotional arousal in phobic subjects exposed to a threat stimulus: a randomized, controlled, double-blind clinical trial. Journal of Manipulative & Physiological Therapeutics 1997 (Nov/Dec); 20(9): 602-6
Wood TO, Colloca C], Matthews R. A pilot randomized clinical trial on the relative effect of instrumental versus manual thrust manipulation in the treatment of cervical spine dysfunction.
Journal of Manipulativ~ & Physiological Therapeutics 2001 (May); 24(4): 260-71
I note a degree of naivete in my critics' comparison of funding for pharmaceutical research with that for chiropractic techniques. The capital available for basic research and clinical trials in the drug industry outpaces that for investigating chiropractic clinical methods by several orders of magnitude. As well, the drug industry has enjoyed the spin-off knowledge and benefits of a vibrant medical research enterprise conducted by the federal government and its many investigative and funding branches.
Although AMI pioneered in federal funding for chiropractic research (2-4), and has partnered with a variety of funding agencies, proprietary companies, universities and chiropractic colleges in pursuit of our research goals (e.g., Arizona State University, Foundation for the Advancement of Chiropractic Education, Los Angeles College of Chiropractic, National Institute of Chiropractic Research, Tri-W-G Corporation), research resources are scarce (to put it mildly). However, with increasing collaborative opportunities, we have worked to expand the knowledge base where time and circumstances welcomed us. Some of these projects have arisen in the area of clinical effectiveness, and others in various other worthy topics of investigation. We do what we can in these uncharted waters.
Sincerely,
Arlan W. Fuhr, D.C., President
Activator Methods International, Ltd.
References:
1. Gattennan MI, Cooperstein R, Lantz C, Perle SM, Schneider MJ. Rating specific chiropractic technique procedures for common low back conditions. Journal of Manipulative & Physiological Therapeutics 2001 (Sept); 24(7): 449-56
2. Arlan W. Fuhr, D.C. and new sources of funding for chiropractic research. The American Chiropractor 1986; May, pp. 36, 38, 40, 42
3. Research at Activator Methods continues. Digest of Chiropractic Economics 1986 (Nov/Dec); 29(3): 7
4. Fuhr AW, Smith DB. Accuracy of piezoelectric accelerometers measuring displacement of a spinal adjusting instrument. Journal of Manipulative & Physiological Therapeutics 1986 (Mar); 9(1): 15-21
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