There is a new concept in research which is rapidly gaining traction. It is that of the “Responder”. All medical treatments are researched and investigated with a view to “prove” whether or not they are effective. What usually follows is an observation that it worked really well for some people, didn’t change much for some people, and seemed to make some people worse. The conclusion when you average out these findings is often therefore that is isn’t particularly effective.
The problem with this rationale is that the treatment actually worked really well for a certain group of people, so it seems illogical to dismiss it completely. Chiropractic has existed for over 120 years, and over that time, has amassed a legion of supporters who swear that it worked miracles for them. People in the medical industry who hate chiropractors are quick to point to the other group who say it didn’t do anything to help them. So who’s right?
Well, let’s look at it differently. Regardless of the type of treatment, if a large number of people found it beneficial, then there may be some characteristic that they share (physiologically or genetically), that the others do not, which makes them more likely to respond to that particular treatment. So instead of applying a standard treatment to all patients who have a certain condition, it may be more useful to select those patients who are more likely to benefit from that treatment, and not persevere with those who don’t “fit the bill”.
Excerpt from Mathew Long’s Clinical Clarity Blog: http://cdi.edu.au/clarity/responders_are_different.php
“The study by Wong et al sought to quantify whether spinal manipulation changed anything within the spinal tissues of those individuals who do respond well. To do so, they assembled a group of patients suffering from lower back pain and measured spinal stiffness, lumbar multifidus thickness, and fluid diffusion within the intervertebral discs (ADC). A control group of asymptomatic individuals was also studied. After 3 treatment sessions in a one week period the following was found;
1. Responders to spinal manipulative therapy for low back pain are characterized by an immediate and sustainable decrease in spinal stiffness and an increase in lumbar multifidus muscle thickness ratio.
2. In comparison, spinal manipulative therapy non-responders and asymptomatic controls showed no change in spinal stiffness or lumbar multifidus contraction ratio.
3. Immediate enhancement of lumbar disc diffusion was observed after the first spinal manipulative therapy in participants who reported improved back pain–related disability at 1 week.”
1. Christensen, A. F., Esserlind, A.-L., Werge, T., Stefansson, H., Stefánsson, K., &Olesen, J. (2015). The influence of genetic constitution on migraine drug responses. Cephalalgia. http://doi.org/10.1177/0333102415610874
2. Hall, K. T., Loscalzo, J., &Kaptchuk, T. J. (2015). Genetics and the placebo effect: the placebome. Trends in Molecular Medicine, 21(5), 285–294. http://doi.org/10.1016/j.molmed.2015.02.009
3. Dougherty, P. E., Karuza, J., Savino, D., & Katz, P. (2014). Evaluation of a modified clinical prediction rule for use with spinal manipulative therapy in patients with chronic low back pain: a randomized clinical trial. Chiropractic & Manual Therapies, 22(1), 41. http://doi.org/10.1186/s12998-014-0041-8
4. Haskins, R., Osmotherly, P. G., & Rivett, D. A. (2015). Diagnostic Clinical Prediction Rules for Specific Subtypes of Low Back Pain: A Systematic Review. The Journal of Orthopaedic and Sports Physical Therapy, 45(2), 61–76. http://doi.org/10.2519/jospt.2015.5723
5. Kongsted, A., Andersen, C. H., Hansen, M. M., &Hestbaek, L. (2015). Prediction of outcome in patients with low back pain – A prospective cohort study comparing clinicians' predictions with those of the Start Back Tool. Manual Therapy, 1–8. http://doi.org/10.1016/j.math.2015.06.008
6. Vavrek, D., Haas, M., Neradilek, M. B., &Polissar, N. (2015). Prediction of pain outcomes in a randomized controlled trial of dose–response of spinal manipulation for the care of chronic low back pain. BMC MusculoskeletDisord, 16(1), 2163–13. http://doi.org/10.1186/s12891-015-0632-0
7. Wong, A. Y. L., Parent, E. C., Dhillon, S. S., Prasad, N., &Kawchuk, G. N. (2015). Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls? Spine, 40(17), 1329–1337. http://doi.org/10.1097/BRS.0000000000000981
Don’t worry if you don’t understand the details, essentially it means that as this research evolves, we may be able to tell fairly early in the treatment process if you are going to get a successful outcome (ie you are one of the “responders”) or if you are not, in which case we will look at other more appropriate treatment options for you.
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