regression model was used to attempt de- velopment of a CPR for predicting suc- cess with SMT. PERTINENT FINDINGS OF THIS STUDY INCLUDE: • 22 of 49 subjects (1 was not included in the analysis) were considered to be a treatment success – all 22 were a success based on a 50 per cent NPRS improvement while 17 of 22 scored minimum 4+ on the GROC – that is, 45 per cent of subjects had symp- tomatic relief with SMT • NPRS improvement in the treatment success group was roughly 80 per cent, while in the non-success group it was only 12 per cent • based on the regression model, five characteristics were identifi ed as a di- agnostic test item cluster that could potentially for a CPR: difference in hip internal rotation side to side > 14° (*) ankle dorsifl exion with knee fl exed > 16° navicular drop > 3mm no stiffness with sitting > 20 minutes 1. 2. 3. 4. 5. squatting is the most painful activity * the most robust predictor of success was a side-to-side difference in hip internal rotation > 14° (positive like- lihood ratio 4.9) – if this factor was present, probability of treatment suc- cess increased to 80 per cent • the presence of three of the five pre- dictors raised probability of treatment success to 94 per cent. CONCLUSIONS AND PRACTICAL APPLICATION: This study establishes a starting point for developing a CPR for spinal manipulation in those with PFPS. The results must be expanded and replicated before concrete recommendations can be made. How- ever, the authors suggest that clinicians could, with some confi dence, utilize SMT in those patients with a difference in hip internal rotation > 14°. This is the take home, potentially applicable message, from this study. $2,000 SCHOLARSHIP FOR CANADIAN STUDENTS The Parker College of Chiropractic is proud to announce a new scholarship for Canadian chiropractic students. All new Canadian students referred by a Canadian DC. will receive two thousand dollars to apply to their education. “This incredible scholarship opportunity, combined with the high value of the Canadian dollar, makes a first- class chiropractic education very affordable for Canadian students,” said Dr. Fabrizio Mancini, president of Parker College. “We already have a strong Canadian presence among our students, and we look forward to increasing that presence in the future.” Parker College of Chiropractic, located in Dallas, Texas, is one of the country’s leading educators of health-care professionals with an international student enrollment. Founded in 1982, this private, non-profi t educational in- stitution prepares men and women to become doctors of chiropractic. Parker College of Chiropractic is accredited by the Commission on Colleges of the Southern Associa- tion of Colleges and Schools to award the bachelor of science and doctor of chiropractic degrees. If you care to refer any current or potential student, please contact Kara Holliday, Assistant Director of Admissions at [email protected] or 1-800-438-6932 x7005 14 • CANADIAN CHIROPRACTOR | SEPTEMBER 2008 www.canadianchiropractor.ca Further studies will provide further clarity on this issue, as this study was underpowered to detect a cause and ef- fect relation between SMT and symptom improvement. Anecdotally, chiropractors claim suc- cess in treating PFPS with lumbopelvic manipulation. This study represents an important step in establishing a base of evidence to support this practice. ADDITIONAL REFERENCES: 1) Suter E, McMorland G, Herzog W, Bray R. Conservative lower back treatment reduces inhibition in knee-extensor muscles: a randomized controlled trial. Journal of Manipulative and Physiologi- cal Therapeutics 2000; 23: 76-80. 2) Suter E, McMorland G, Herzog W, Bray R. Decrease in quadriceps inhibition after sacroiliac joint manipulation in pa- tients with anterior knee pain. Journal of Manipulative and Physiological Thera- peutics 1999; 22: 149-153. 3) Hillerman B, Gomes AN, Korporaal C, Jackson D. A pilot study comparing the effects of spinal manipulative therapy with those of extra-spinal manipulative therapy on quadriceps muscle strength. Journal of Manipulative and Physiologi- cal Therapeutics 2006; 29: 145-149.• news
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