Bloomington, MN, United States
Bloomington, MN, United States

Northwestern Health science University is a natural health care university located in Bloomington, Minnesota, a suburb of Minneapolis. The university has educational programs in chiropractic, Oriental medicine, acupuncture, therapeutic massage, and human biology. The university was founded in 1941 by John B. Wolfe, DC.Previously Northwestern College of Chiropractic, Northwestern Health science University has been an international leader in natural health care education, patient care, and research for over 70 years. Since 1991, Northwestern’s Wolfe-Harris Center for Clinical Studies has become one of the largest natural health care research institutions in the world, garnering more than $7 million in federally funded studies. Wikipedia.

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Bronfort G.,Northwestern Health Sciences University | Evans R.,Northwestern Health Sciences University | Anderson A.V.,Medical Pain Management | Svendsen K.H.,900 Forest Avenue | And 2 more authors.
Annals of Internal Medicine | Year: 2012

Background: Mechanical neck pain is a common condition that affects an estimated 70% of persons at some point in their lives. Little research exists to guide the choice of therapy for acute and subacute neck pain. Objective: To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term. Design: Randomized, controlled trial. ( registration number: NCT00029770) Setting: 1 university research center and 1 pain management clinic in Minnesota. Participants: 272 persons aged 18 to 65 years who had nonspecific neck pain for 2 to 12 weeks. Intervention: 12 weeks of SMT, medication, or HEA. Measurements: The primary outcome was participant-rated pain, measured at 2, 4, 8, 12, 26, and 52 weeks after randomization. Secondary measures were self-reported disability, global improvement, medication use, satisfaction, general health status (Short Form-36 Health Survey physical and mental health scales), and adverse events. Blinded evaluation of neck motion was performed at 4 and 12 weeks. Results: For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks (P ≤ 0.010), and HEA was superior to medication at 26 weeks (P = 0.02). No important differences in pain were found between SMT and HEA at any time point. Results for most of the secondary outcomes were similar to those of the primary outcome. Limitations: Participants and providers could not be blinded. No specific criteria for defining clinically important group differences were prespecified or available from the literature. Conclusion: For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points. Primary Funding Source: National Center for Complementary and Alternative Medicine, National Institutes of Health. © 2012 American College of Physicians.

Michaleff Z.A.,University of Sydney | Kamper S.J.,University of Sydney | Kamper S.J.,VU University Amsterdam | Maher C.G.,University of Sydney | And 3 more authors.
European Spine Journal | Year: 2014

Purpose: To identify and evaluate the effectiveness of conservative treatment approaches used in children and adolescents to manage and prevent low back pain (LBP).Methods: Five electronic databases and the reference lists of systematic reviews were searched for relevant studies. Randomised controlled trials (RCTs) were considered eligible for inclusion if they enrolled a sample of children or adolescents (<18 years old) and evaluated the effectiveness of any conservative intervention to treat or prevent LBP. Two authors independently screened search results, extracted data, assessed risk of bias using the PEDro scale, and rated the quality of evidence using the GRADE criteria.Results: Four RCTs on intervention and eleven RCTs on prevention of LBP were included. All included studies had a high risk of bias scoring ≤7 on the PEDro scale. For the treatment of LBP, a supervised exercise program compared to no treatment improved the average pain intensity over the past month by 2.9 points (95 % CI 1.6–4.1) measured by a 0–10 scale (2 studies; n = 125). For the prevention of LBP, there was moderate quality evidence to suggest back education and promotion programs are not effective in reducing LBP prevalence in children and adolescents.Conclusions: While exercise interventions appear to be promising to treat LBP in children and adolescents, there is a dearth of research data relevant to paediatric populations. Future studies conducted in children and adolescents with LBP should incorporate what has been learnt from adult LBP research and be of rigorous methodological quality. © 2014, Springer-Verlag Berlin Heidelberg.

Bronfort G.,University of Minnesota | Hondras M.A.,Palmer Center for Chiropractic Research | Schulz C.A.,Northwestern Health Sciences University | Evans R.L.,University of Minnesota | And 2 more authors.
Annals of Internal Medicine | Year: 2014

Objective: To determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with HEA alone reduces leg pain in the short and long term in adults with BRLP.Design: Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. ( NCT00494065).Setting: 2 research centers (Minnesota and Iowa).Patients: Persons aged 21 years or older with BRLP for least 4 weeks.Intervention: 12 weeks of SMT plus HEA or HEA alone.Results: Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over HEA (difference, 10 percentage points [95% CI, 2 to 19]; P = 0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P = 0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.Measurements: The primary outcome was patient-rated BRLP at 12 and 52 weeks. Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. Blinded objective tests were done at 12 weeks.Limitation: Patients and providers could not be blinded.Conclusion: For patients with BRLP, SMT plus HEA was more effective than HEA alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks.Background: Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. © 2014 American College of Physicians.

Pincus T.,Royal Holloway, University of London | Kent P.,University of Southern Denmark | Bronfort G.,Northwestern Health Sciences University | Bronfort G.,Nordic Institute of Chiropractic and Clinical Biomechanics | And 6 more authors.
Spine | Year: 2013

STUDY DESIGN.: An integrated review of current knowledge about the biopsychosocial model of back pain for understanding etiology, prognosis, and interventions, as presented at the plenary sessions of the XII International Forum on LBP Research in Primary Care (Denmark; October 17-19, 2012). OBJECTIVE.: To evaluate the utility of the model in reference to rising rates of back pain-related disability, by identifying (a) the most promising avenues for future research in biological, psychological, and social approaches, (b) promising combinations of all 3 approaches, and (c) obstacles to effective implementation of biopsychosocial-based research and clinical practice. SUMMARY OF BACKGROUND DATA.: The biopsychosocial model of back pain has become a dominant model in the conceptualization of the etiology and prognosis of back pain, and has led to the development and testing of many interventions. Despite this back pain remains a leading source of disability worldwide. METHODS.: The review is a synthesis based on the plenary sessions and discussions at the XII International Forum on LBP Research in Primary Care. The presentations included evidence-based reviews of the current state of knowledge in each of the 3 areas (biological, psychological, and social), identification of obstacles to effective implementation and missed opportunities, and identification of the most promising paths for future research. RESULTS.: Although there is good evidence for the role of biological, psychological, and social factors in the etiology and prognosis of back pain, synthesis of the 3 in research and clinical practice has been suboptimal. CONCLUSION.: The utility of the biopsychosocial framework cannot be fully assessed until we truly adopt and apply it in research and clinical practice. © 2013 Lippincott Williams & Wilkins.

Davis A.E.,Northwestern Health Sciences University
Transplantation | Year: 2014

BACKGROUND: The national organ allocation system for deceased-donor kidney transplant will endure increased burden as the waitlist expands and organ shortage persists. The Department of Health and Human Services issued the “Final Rule” in 1998 that states “Organs and tissues ought to be distributed on the basis of objective priority criteria and not on the basis of accidents of geography.” However, it has not been addressed whether the rule was effective in encouraging regions to share the additional burden equitably.OBJECTIVE: To assess the significance of changes of geographic disparities for four metrics since the rule’s adoption: waiting times, transplant rates, pretransplant mortality, and organ quality.METHODS: Using Organ Procurement and Transplant Network data from 1988 through 2009, annual ranges of the metrics were calculated for all donor service areas and United Network for Organ Sharing regions. Time series analyses were used to compare the metrics before and after the enactment of the Final Rule.RESULTS: A total of 412,127 kidney transplant candidates and 178,163 deceased-donor recipients were analyzed. Demographics varied significantly by region. The ranges of the four metrics have worsened by approximately 30% or more after the Final Rule at both the regional and donor service area levels.CONCLUSION: Increasing geographic disparity in allocation procedures may yield diverging outcomes and experiences in different locations for otherwise similar candidates. Consensus for measuring allocation discrepancies and policy interventions are required to mitigate the inequities. © 2014 by Lippincott Williams & Wilkins

Evans R.,Northwestern Health Sciences University | Bronfort G.,Northwestern Health Sciences University | Maiers M.,Northwestern Health Sciences University | Schulz C.,Northwestern Health Sciences University | Hartvigsen J.,University of Southern Denmark
European Spine Journal | Year: 2014

Purpose: Global Perceived Effect (GPE) is a commonly used outcome measure for musculoskeletal conditions like neck pain; however, little is known regarding the factors patients take into account when determining their GPE. The overall objective of this work was to describe the thematic variables, which comprise the GPE from the patient's perspective. Methods: This was a mixed-methods study in which qualitative data were collected within a randomized clinical trial assessing exercise and manual therapy for chronic neck pain. A consecutive sample of 106 patients who completed the trial intervention took part in semi-structured interviews querying the meaning of GPE. Quantitative measures were collected through self-report questionnaires. Interview transcripts were analyzed using content analysis to identify themes, which were then quantified to assess potential relationships. Results: A model of GPE for chronic neck pain emerged comprised of five main themes: neck symptoms (cited by 85 %), biomechanical performance (38 %), activities of daily living (31 %), self-efficacy (10 %), and need for other treatment (6 %). Influencing factors included those contributing to GPE: treatment process (64 %), biomechanical performance (51 %), self-efficacy (16 %), and the nature of the condition (8 %). Factors, which detracted from GPE or prevented recovery included perceived nature of condition (58 %), required daily activities (10 %), lack of diagnosis (5 %), and history of failed treatment (5 %). Conclusions: GPE appears to capture chronic neck pain patient perceptions of change in different domains important to their individual pain experiences that may not be captured by other outcome instruments. Thus, GPE is a suitable patient-oriented outcome that can complement other measures in research and clinical practice. Importantly, many chronic neck pain patients believe it impossible to reach complete recovery because of a perceived intractable aspect of their neck condition; this has important implications regarding long-term disability and health-seeking behaviors. © 2014 Springer-Verlag.

Maiers M.J.,Northwestern Health Sciences University | Westrom K.K.,Northwestern Health Sciences University | Legendre C.G.,Northwestern Health Sciences University | Bronfort G.,Northwestern Health Sciences University
BMC Health Services Research | Year: 2010

Background. For the treatment of chronic back pain, it has been theorized that integrative care plans can lead to better outcomes than those achieved by monodisciplinary care alone, especially when using a collaborative, interdisciplinary, and non-hierarchical team approach. This paper describes the use of a care pathway designed to guide treatment by an integrative group of providers within a randomized controlled trial. Methods. A clinical care pathway was used by a multidisciplinary group of providers, which included acupuncturists, chiropractors, cognitive behavioral therapists, exercise therapists, massage therapists and primary care physicians. Treatment recommendations were based on an evidence-informed practice model, and reached by group consensus. Research study participants were empowered to select one of the treatment recommendations proposed by the integrative group. Common principles and benchmarks were established to guide treatment management throughout the study. Results. Thirteen providers representing 5 healthcare professions collaborated to provide integrative care to study participants. On average, 3 to 4 treatment plans, each consisting of 2 to 3 modalities, were recommended to study participants. Exercise, massage, and acupuncture were both most commonly recommended by the team and selected by study participants. Changes to care commonly incorporated cognitive behavioral therapy into treatment plans. Conclusion. This clinical care pathway was a useful tool for the consistent application of evidence-based care for low back pain in the context of an integrative setting. Trial registration. NCT00567333. © 2010 Maiers et al; licensee BioMed Central Ltd.

Westrom K.K.,Northwestern Health Sciences University | Maiers M.J.,Northwestern Health Sciences University | Evans R.L.,Northwestern Health Sciences University | Bronfort G.,Northwestern Health Sciences University
Trials | Year: 2010

Background: Low back pain (LBP) is a prevalent and costly condition in the United States. Evidence suggests there is no one treatment which is best for all patients, but instead several viable treatment options. Additionally, multidisciplinary management of LBP may be more effective than monodisciplinary care. An integrative model that includes both complementary and alternative medicine (CAM) and conventional therapies, while also incorporating patient choice, has yet to be tested for chronic LBP.The primary aim of this study is to determine the relative clinical effectiveness of 1) monodisciplinary chiropractic care and 2) multidisciplinary integrative care in 200 adults with non-acute LBP, in both the short-term (after 12 weeks) and long-term (after 52 weeks). The primary outcome measure is patient-rated back pain. Secondary aims compare the treatment approaches in terms of frequency of symptoms, low back disability, fear avoidance, self-efficacy, general health status, improvement, satisfaction, work loss, medication use, lumbar dynamic motion, and torso muscle endurance. Patients' and providers' perceptions of treatment will be described using qualitative methods, and cost-effectiveness and cost utility will be assessed.Methods and Design: This paper describes the design of a randomized clinical trial (RCT), with cost-effectiveness and qualitative studies conducted alongside the RCT. Two hundred participants ages 18 and older are being recruited and randomized to one of two 12-week treatment interventions. Patient-rated outcome measures are collected via self-report questionnaires at baseline, and at 4, 12, 26, and 52 weeks post-randomization. Objective outcome measures are assessed at baseline and 12 weeks by examiners blinded to treatment assignment. Health care cost data is collected by self-report questionnaires and treatment records during the intervention phase and by monthly phone interviews thereafter. Qualitative interviews, using a semi-structured format, are conducted with patients at the end of the 12-week treatment period and also with providers at the end of the trial.Discussion: This mixed-methods randomized clinical trial assesses clinical effectiveness, cost-effectiveness, and patients' and providers' perceptions of care, in treating non-acute LBP through evidence-based individualized care delivered by monodisciplinary or multidisciplinary care teams.Trial registration: NCT00567333. © 2010 Westrom et al; licensee BioMed Central Ltd.

Leininger B.,Northwestern Health Sciences University | Bronfort G.,Northwestern Health Sciences University | Evans R.,Northwestern Health Sciences University | Reiter T.,Inpatient Rehabilitation Center
Physical Medicine and Rehabilitation Clinics of North America | Year: 2011

In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions. © 2011 Elsevier Inc.

Northwestern Health Sciences University | Date: 2012-10-16

Printed instructional and teaching materials in the fields of chiropractic, acupuncture, Oriental medicine, massage therapy and natural health care; pamphlets and brochures in the fields of chiropractic, acupuncture, Oriental medicine, massage therapy and natural health care. educational services, namely, developing and conducting courses at the university level in the fields of chiropractic, acupuncture, Oriental medicine, massage therapy, natural health care, and undergraduate studies; conducting educational research in the fields of chiropractic, acupuncture, Oriental medicine, massage therapy, and natural health care; educational services, namely, providing seminars, conferences, workshops, and lectures and distributing course materials in connection therewith at the undergraduate, post-graduate, adult education and professional levels in the fields of chiropractic, acupuncture, Oriental medicine, massage therapy, and natural health care; health coaching in the fields of nutrition and exercise as they relate to musculoskeletal therapy and maintenance. Medical and scientific research, namely, conducting clinical research. health care services in the nature of chiropractic, acupuncture, Oriental medicine in the nature of alternative medicine, massage therapy, in-person energy healing touch, naturopathy, nursing, medical counseling; providing information in the field of health and wellness.

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