When you have a loved one who fits into the older demographic, some simple phrases take on new meanings – phrases such as “She had a fall.” It no longer represents an innocuous clumsy moment, from which she easily recovers. It can be very serious, even life threatening. In fact,
“falls account for more than 80% of injury-related hospital admissions in people older than 65 years, and they are the leading cause of injury-related death in older adults .”
Those facts provided a major motivation for Dr. Holt to progress down this stream of study. “Falls are often caused by a breakdown in sensorimotor function that can occur with ageing,” he says. “Our previous research suggests that when we adjust our patients, it improves their sensorimotor function, so I felt there was a potential role there for chiropractors to help prevent falls in older people. I want to find out whether that is the case.”
The results of that study recently appeared in the Journal of Manipulative and Physiological Therapeutics.
“It builds on the work I did through the rest of my PhD which looked at what we know already regarding chiropractic care, balance and falls. It also builds on our other previous research work that has shown when we adjust younger people we see changes in sensorimotor function such as joint position sense, the way the brain processes sensory information and controls muscle function. In this study we wanted to see whether we could change sensorimotor function in a way that may be important for reducing falls risk.”
Dr Holt is answering Spinal Research’s questions from Railway General Hospital in Rawalpindi, Pakistan. Here, he is hard at work studying the impact of chiropractic care on patients who have suffered a stroke. Holt and his colleagues are investigating whether chiropractic care alters the way these patients’ brains process information from their partially paralysed arms, and how it might impact strength, and the way the brain drives their leg muscles. It’s a collaboration with Riphah International University in Pakistan that could possibly deliver some fascinating outcomes for the world of chiropractic research.
Holt is optimistic but quickly alludes to the fact that the research journey isn’t without its nervous waits, especially if you want the results to be reliable and unbiased:
“When we were almost finished with the falls risk study, but before we’d looked at the results, I really didn’t know if we’d find anything positive or not. I’d spent over 5 years working on the study and it was possible we’d find no important changes.
I began to receive letters from study participants telling me about the amazing changes in their health that occurred while they were receiving chiropractic care. That made me feel really good. I thought then that if we didn’t get any positive findings it still would have been worthwhile because of the impact that the study had on the quality of life of the people that were writing to me. We’ve now written up a number of case studies based on patients in the trial so we can share those individual stories with the profession as well.”
Fortunately, the falls risk study did yield positive results. It looked at 60 community-dwelling participants over the age of 65. Participants received chiropractic care from one of twelve chiropractors, all of whom had to be registered with the New Zealand Chiropractic Board, and who had to have a permanent practice address. This meant that they checked and adjusted the patients according to their own protocols, using whatever combination of high-velocity, low-amplitude, table-aided or instrument-aided adjusting they deemed necessary to deliver the best care.
For the sake of this study, the primary outcome measure was ankle joint position sense error, or whether or not the patient could sense what was happening in their ankle while performing certain tasks. Secondary outcomes were choice stepping reaction time (a broad measure of sensorimotor function), postural stability, multisensory processing, and health-related quality of life. The study allowed researchers to look at proprioception and sensorimotor integration – important concepts to chiropractors and chiropractic researchers alike. It was a randomized controlled trial that measured outcomes at the baseline, at four weeks and at twelve weeks.
Compared with the control group, those receiving chiropractic care “improved significantly in ankle joint position sense error .” This shows a potential impact of chiropractic care on proprioception, or the brain’s ability to know where the body is in space.
There was also a significant improvement at the 12-week mark for choice stepping response time, showing increased sensorimotor function, in comparison with the control group. The interesting finding with the choice stepping reaction time task was that there was no improvement in the chiropractic group during their first 4 weeks of care, they only started to improve after 4 weeks of care.
The researchers also found a “significant overall group effect of chiropractic care on susceptibility to the sound-induced flash illusion, with the chiropractic group showing greater improvement than the control group across the 4- and 12-week assessments. The chiropractic group improved by 13.5% compared with the control group at the 12-week assessment .” This aspect of the study measured multisensory processing, an important factor in falls risk. All of these outcome measures are thought to play significant roles in falls risks.
The chiropractic group also displayed small, statistically significant improvements in quality of life related to physical health when compared with a “usual care” control. These results support previous research that suggests that chiropractic care may alter somatosensory processing, and sensorimotor integration and improve the physical component of quality of life.
Dr Holt offered some comment on how the results of this study can impact daily practice for chiropractors:
In general, older people are underrepresented in many chiropractic practices. That’s a real shame and it may come down to a belief that they’re beyond help and just have to accept the inevitable decline in their health and function that comes with ageing. This study should give chiropractors confidence that they can help improve function in their older patients and that may have an impact on their overall health and quality of life. We should encourage older adults to get checked!
“The other biggie that stood out for me is one of the measures we looked at, the choice stepping reaction time. It didn’t really change at all during the first 4 weeks of care, but there was a really big improvement in the chiropractic group between 4 and 12 weeks. I know when I was in practice there were times that I was disappointed if I didn’t see big changes with a patient in the first 4 weeks of care and that perhaps my patient would be better off seeing someone else.
I think this study shows that sometimes the improvements in function that we’re looking for just take time and maybe chiropractors shouldn’t give up too soon if they’re concerned about a lack of progress with some of their patients. We need to be pragmatic with this approach, of course, and always have the patient’s best interests in mind, but I think sometimes we do a disservice to our patients by giving up too soon because we haven’t seen the big changes we often expect to see in practice within the first few weeks of care.”
From this study, chiropractors can confidently say that
“12 weeks of chiropractic care has resulted in improvements in some factors that are important for falls risk (sensory and motor function), as well as improvement in the physical component of quality of life in a group of older adult patients.”
It also tells us that we can be a lot more confident when encouraging the older people in our practices, and loved ones to get checked and adjusted, and to do that for more than 4 weeks!
Keen to share these amazing results with the people under your care in your practice? Download a Poster to use in practice.
 Holt, Kelly R et al, “Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial,” Journal of Manipulative and Physiological Therapeutics.