Health and Medical Research
Along with our commitment to patient care, Burswood Health Professionals is involved in assorted research projects. In this section of the site, you can learn more about our research work, with their specific focus on the neuromuscular and musculoskeletal systems.
Dr Bryner has published a number of research papers in peer-reviewed journals. We highlight some for your perusal. Recently Dr Bryner has been involved with the Chiropractic International Research Team, which conducted a large international survey of chiropractic patients regarding the types of symptoms they found changed (improved) whilst they had chiropractic care. See below.
Numbness around the spine
Dr Bryner presented recent clinical research on numbness to the Chiropractors and Osteopathic College of Australasia College Annual Conference in Melbourne. Read the research.Self-reported nonmusculoskeletal responses to chiropractic intervention
A multination survey.Leboeuf-Yde C, Pedersen EN, Bryner P, Cosman D, Hayek R, Meeker WC, Shaik J, Terrazas O, Tucker J, Walsh M.
Back Research Center, Backcenter Funen, Denmark. chyd@shf.fyns-amt.dk
OBJECTIVE: To replicate a previous study of nonmusculoskeletal responses to chiropractic intervention and to establish whether such responses are influenced by the country of study, chiropractors' attitudes, and information to patients, patients' demographic profiles, and treatment regimens. METHODS: Information obtained through questionnaires by chiropractors and patients on return visit within 2 weeks of previous treatment from chiropractic practices in Canada, United States, Mexico, Hong-Kong, Japan, Australia, and South Africa. In all, 385 chiropractors collected valid data on 5607 patients. Spinal manipulation with or without additional therapy was the intervention provided by chiropractors. Outcome measures included self-reported improved nonmusculoskeletal reactions (allergy, asthma, breathing, circulation, digestion, hearing, heart function, ringing in the ears, sinus problems, urination, and others). RESULTS: The results from the previous study were largely reproduced. Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%). Some variables were identified that somewhat influenced the outcome: patients informed that such reactions may occur (odds ratio [OR] 1.5), treatment to the upper cervical spine (OR 1.4), treatment to lower thoracic spine (OR 1.3), and female sex (OR 1.3). However, these had a very small "explanatory" value (pseudo R2 3%). CONCLUSION: A minority of patients with self-reported nonmusculoskeletal symptoms report definite improvement after chiropractic care, and very few report definite worsening. Future studies should use stringent criteria to investigate a possible treatment effect and concentrate on specific diagnostic subgroups such as digestive problems and tinnitus.
Medline Link
Presented at the World Federation of Chiropractic 8th Biennial Congress in Sydney, June 2005
Indigestion and heartburn:
A descriptive study of prevalence in persons seeking care from chiropractors.
In: J Manipulative Physiol Ther. 1996 Jun;19(5):317-23.
Bryner P, Staerker PG.
OBJECTIVE: To determine the prevalence of indigestion and mid-back pain in persons seeking chiropractic care. DESIGN: A cross-sectional survey using a self-report questionnaire. SETTING: Three primary care private chiropractic practices in metropolitan Perth, Australia. SUBJECTS: Persons seeking chiropractic care during a 1-month period. INTERVENTION: None. OUTCOME MEASURES: Six-month prevalence of indigestion and mid-back pain, rate of association between indigestion and mid-back pain, and distribution of thoracic dysfunction and manipulation. Proportion who report relief from manipulation.
OBSERVATIONS: Of 1567 persons who consulted 8 chiropractors on 2974 occasions during November 1994, 1494 responses were obtained. There were 119 first-time consultations. The mean age of respondents was 41 yr (range 10-94); 57% were women. Fifty-seven percent reported indigestion infrequently or more and 71% reported mid-back pain during the previous 6 months. Forty-six percent experienced both symptoms during this time. Of these, 36% reported the symptoms together at some time. Twenty-two percent of those with indigestion reported some relief after chiropractic care. Compared with those reporting no relief, mid-back pain was more common among those reporting indigestion. The level at which the manipulation was given was unrelated to relief. No major differences were noted between the three clinics in patient demographics or the main outcome measures.
CONCLUSIONS: Indigestion and mid-back pain are commonly experienced in this population. A person with indigestion is more likely to report mid-back pain. Relief of indigestion by manipulation is more common among those who report mid-back pain. Further research is needed to understand differences between subgroups and differences compared with other studies.
Indigestion and mid-back pain are commonly experienced in this population. A person with indigestion is more likely to report mid-back pain. Relief of indigestion by manipulation is more common among those who report mid-back pain. Further research is needed to understand differences between subgroups and differences compared with other studies. We found a small subgroup of individuals (80 odd out of 1500) who had discovered that their indigestion was repeatedly relieved by spinal manipulation.
Medline Link
This study was awarded second prize for private practitioners at the 100th year celebrations of chiropractic in 1995 (World Congress in
Extent measurement in localised low-back pain: a comparison of four methods.
Bryner P. IN: Pain. 1994 Nov;59(2):281-5.
Seventeen drawings of localised low-back pain were analysed by two assessors using 4 systems. Three were grid-based systems and one was by computer. The mean area or 'extent' was calculated to be 7.7%, 4.7%, 3.6% and 2.3% of the body outline using 45, 200, 560 and 61,102 section analyses, respectively. The computer-assisted method provided a significantly lower estimate of pain extent than the grid-based assessments as expected. Analysis of variance showed that the method of analysis provided greater source of variation than raters (P < 0.0001). Inter-rater reliability was high using all 4 systems calculated using intraclass correlation and the kappa statistic. Correlation coefficients of extent between the systems varied from 0.46 to 0.94. Correlation was highest between systems of adjacent magnitude of sections. It is concluded that grid-based assessment of small areas overestimates the actual area of pain and this may account for the lack of sensitivity to change in clinical status.
Medline Link
Drawing “pain” onto a body outline - Summary
A thesis submitted for the degree Master of Chiropractic Science of Royal Melbourne Institute of Technology by Peter Bryner
Pain is a universal experience yet despite this we only experience our own pain. As such we tacitly "understand" it - even if there is no obvious cause. The pain of another person is much more difficult to understand than our own pain.
There are many ways we can try to understand the pain of another person and almost all forms of human communication have been used to this end. Drawing is one method used to describe pain. It has been used in the clinical practice of chiropractors and medical practitioners as well as in research settings.
This work reviews how drawings of pain have been used in the past. It investigated the existing forms of pain drawing analysis (PDA) and demonstrated that existing methods of pain area estimation are inaccurate and that using higher resolution methods area assessment can be both a reliable and responsive measure of pain.
This research applied pain drawings using chiropractic practice as the setting. Problems associated with pain drawings and their interpretation were identified. Chiropractors were asked to rate one form of drawing analysis - that of rating drawings for likely psychological involvement. They did not consider it particularly useful in their practices and in addition to other limitations this form of analysis should be used carefully.
Pain drawings were also used in three additional studies to: a) select and describe a pain condition of the low back, b) investigate how headaches are described during a treatment trial, and c) illustrate how mid-back pain and the "visceral" symptom of indigestion are reported by persons seeing chiropractors.
It was found that localised unilateral low back pain specifically sited above the iliac crest might be a good indicator for involvement of the quadratus lumborum. In the five cases of primary strain identified over a one year period there was no referred pain to the sacroiliac region in contrast to reports of when the quadratus lumborum is affected by the "myofascial pain syndrome".
With a group of persons suffering long-standing headaches who participated in a clinical trial on manipulation of the upper neck, it was found that the pain extent (area) was indeed responsive to change, contrary to other reports. This finding depends on the improved method of calculating the area of involvement. It was also found that the area of involvement and pain intensity correlated poorly, and it is suggested that these two measures of pain assess different aspects of pain.
Persons seeking chiropractic care commonly experienced indigestion and a portion reported relief after receiving chiropractic care, though only a very small number specifically sought care for this symptom primarily. The location of this symptom was mainly about the sternum and under the ribs, while mid-back pain was mainly experienced in the mid-thoracic region. There was an association between those suffering mid-back pain and indigestion and those who had reported indigestion and mid-back pain during the last 6 months more commonly reported relief.
In general this research work demonstrates that there should be greater emphasis on how pain drawings are derived and on how they are interpreted. Protocols need to be refined so that methodological variation is minimised. This will help to reveal variation based on meaningful factors.
From the research conducted, it was found that pain drawings are useful if applied carefully. Extent assessment gives results that are different to other forms of pain analysis, including other forms of PDA. With area assessment there is substantial variation partly because of the greater complexity of the method than, say the one dimension visual analogue scale (VAS) for pain intensity. Pain drawings should be interpreted with care. Cautious use of pain drawings can help those who suffer pain. It may also assist in identifying hitherto unrecognised anatomic sources of pain.
RMIT Library Record
