User talk:Blueter112
Welcome and introduction[edit]
Hi, Blueter112. This is NOT some automated message...it's from a real person. You can talk to me right now. Welcome to Wikipedia! I noticed you've just joined, and wanted to give you a few tips to get you started. If you have any questions, please talk to us. The tips below should help you to get started. Best of luck! Chzz ► 03:48, 24 January 2011 (UTC)
Good luck with editing; please drop me a line some time on my own talk page. There's lots of information below. Once again, welcome to the fantastic world of Wikipedia! -- Chzz ► 03:48, 24 January 2011 (UTC)
|
Hi, welcome to Wikipedia! I reverted your changes to the Chiropractic article, but not because they were bad or anything; they just need some work with formatting and probably a round of discussion on the talk page. There's been A LOT of debate about which studies to highlight and how to summarize them. Please see the article's talk page where we can figure out if there's a good way to incorporate your edits. Let me know if you have any questions, Ocaasi (talk) 07:10, 24 January 2011 (UTC)
- Hi Blueter, I was aware of several of your points, already, as the article is far better researched than it may appear. The Spine 2008 article is indeed already used in the Safety section; the question here is only whether or not it should be in the WP:LEAD paragraphs specifically. I was not aware of the J Rheumatology article, but I'll take a look at it. If you can find a citation supporting the claim that many chiropractors perform/prescribe common physical therapy exercises, we can probably add it in. Discussion should be ongoing at the talk page. I'd also encourage you to keep editors User:BullRangifer and USER:Puhlaa on your short list, if you have questions regarding our policy. User:QuackGuru has repeatedly been a strong voice against changes at the article, and we are in continual attempts to craft revisions which meet policy expectations about sourcing and neutrality. Ocaasi (talk) 00:58, 25 January 2011 (UTC)
- See the talk page for the most recent discussion. The biggest problem with the 2007 Rheumatology article is that it is primarily about neck pain and not about manipulation specifically. It might be partly applicable to the Effectiveness section, but it doesn't address the safety/risk issues, and we have more direct sources which describe Chiropractic and neck pain. It doesn't address Vertebral artery dissection or adverse incident rates, which are the main concern with spinal manipulation in the literature. There is an enormous tension between what Chiropractors think is dangerous (not much), what data shows is dangerous (not much), and what sources claim is tolerable risk (not much). Basically, because there's has not been a proven benefit from Chiropractic specifically with regard to neck pain, the very small chance that it could tear arteries makes it a no-go for doctors. QuackGuru is a very strident editor who may or may not be a kind of professional skeptic, or just a devoted opponent of Chiropractic, or a particular particular advocate of one of our policies in one specific area. He does offer policy rationales, so it helps to have some sense of them before getting involved. Frankly, this article is a tough one to get an education on, since it is so contentious and closely watched. The main guideline which governs here is WP:MEDRS, since it describes which medical/scientific sources take precedence. Reading that should help explain the territory better. Also, please sign your posts by typing ~ 4 times, like ~ ~ ~ ~ but with no spaces. Ocaasi (talk) 06:05, 28 January 2011 (UTC)
- Basically, this just isn't specific enough: "We noted strong evidence of benefit for maintained pain reduction... improvement in function, and positive global perceived effect favoring exercise plus mobilization/manipulation versus control for subacute/chronic MND. We found moderate evidence of longterm benefit for improved function favoring direct neck strengthening and stretching for chronic MND, and for high global perceived effect favoring vertigo exercises... We found many treatments demonstrating short-term effects. CONCLUSION: Exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic MND; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits." Ocaasi (talk) 06:15, 28 January 2011 (UTC)
- I responded on my talk page to keep the conversation together. You can add my page to your WP:Watchlist if you want.
- Please sign your posts with: ~ ~ ~ ~ but no spaces.
- You can put related conversations in the same section by clicking edit in the section title at the bottom of the page. Ocaasi (talk) 00:09, 29 January 2011 (UTC)s
- Basically, this just isn't specific enough: "We noted strong evidence of benefit for maintained pain reduction... improvement in function, and positive global perceived effect favoring exercise plus mobilization/manipulation versus control for subacute/chronic MND. We found moderate evidence of longterm benefit for improved function favoring direct neck strengthening and stretching for chronic MND, and for high global perceived effect favoring vertigo exercises... We found many treatments demonstrating short-term effects. CONCLUSION: Exercise combined with mobilization/manipulation, exercise alone, and intramuscular lidocaine for chronic MND; intravenous glucocorticoid for acute whiplash associated disorders; and low-level laser therapy demonstrated either intermediate or longterm benefits." Ocaasi (talk) 06:15, 28 January 2011 (UTC)
- See the talk page for the most recent discussion. The biggest problem with the 2007 Rheumatology article is that it is primarily about neck pain and not about manipulation specifically. It might be partly applicable to the Effectiveness section, but it doesn't address the safety/risk issues, and we have more direct sources which describe Chiropractic and neck pain. It doesn't address Vertebral artery dissection or adverse incident rates, which are the main concern with spinal manipulation in the literature. There is an enormous tension between what Chiropractors think is dangerous (not much), what data shows is dangerous (not much), and what sources claim is tolerable risk (not much). Basically, because there's has not been a proven benefit from Chiropractic specifically with regard to neck pain, the very small chance that it could tear arteries makes it a no-go for doctors. QuackGuru is a very strident editor who may or may not be a kind of professional skeptic, or just a devoted opponent of Chiropractic, or a particular particular advocate of one of our policies in one specific area. He does offer policy rationales, so it helps to have some sense of them before getting involved. Frankly, this article is a tough one to get an education on, since it is so contentious and closely watched. The main guideline which governs here is WP:MEDRS, since it describes which medical/scientific sources take precedence. Reading that should help explain the territory better. Also, please sign your posts by typing ~ 4 times, like ~ ~ ~ ~ but with no spaces. Ocaasi (talk) 06:05, 28 January 2011 (UTC)
Thanks for the additional sources and information. I'll try and respond in the next few days. I've also passed this on to User:Puhlaa who is right up your alley and better informed than I am about the field (he's a chiropractor, interested in the evidence-based-medicine side of the field). Please feel free to chat with him, just drop him a note that we had spoken before and he'll understand the context; he is also a frequent editor at the page and can assist with adding material. BTW, you should check the references in the Chiropractic article. About half of the studies you mention are already there (though you might want them more strongly represented in the body). The other half is where this is either a great addition, or the same old wall of Wikipedia policy. Cheers, Ocaasi (talk) 13:34, 20 March 2011 (UTC)
Some feedback on your supplied research and proposed issues with the article[edit]
Blueter112, Thanks for your interest in ensuring the chiropractic article represents the most accurate and current research that exists in the literature! The chiropractic article is a controversial one, and there are strong emotions involved on both sides of the controversy. This is evidenced by the 'locked' state of the chiropractic article (vandalism control). In order to ensure that no 'side' of the controversy has more 'weight' carried in the article than is owed by the current level of scientific evidence, we seem to have to enforce ultra strict adherence to wikipedia policies. One important policy is WP:MEDRS, which gives a system of hierarchy to scientific articles. I have pasted a brief excerpt below, but the entire article might be worth a read to you if you want to contribute (which I hope you do).Puhlaa (talk) 21:54, 8 March 2011 (UTC)
- Knowing the quality of the evidence helps editors distinguish between minority and majority viewpoints, determine due weight, and identify information that will be accepted as evidence-based medicine. The best evidence comes from meta-analyses of randomized controlled trials (RCTs) and systematic reviews of bodies of literature of overall good quality and consistency addressing the specific recommendation.
Further, Wikipedia has a policy against original research WP:OR, which prohibits us from stating conclusions in the article unless they have been made by published sources. Thus, while I agree with you that there is research showing C-manipulation is effective for some things and the benefits indeed outweigh the risks for many patients, there is no systematic review that states this. What we cannot say is: there are studies that show benefits, there are studies to show limited risk, thus we will add to the article that the risks do not outweigh the benefits. This would be original research that links two outcomes to make a conclusion that neither published source actually says. Ernst’s conclusion is the “highest” level of evidence (systematic review), the most recent source to examine risk/benefit, and must be included in the Wikipedia article. I am waiting for a systematic review to accurately examine the research and contradict Ernst’s statement; at that point we can add it to Wikipedia. Puhlaa (talk) 15:09, 20 March 2011 (UTC)
- Now lets look at the research you have provided on Ocaasi’s talk page.
- Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache – This source is interesting, but if we try to add it to the article we will get slaughtered in the ensuing debate because: 1) It is not published in a peer-reviewed journal, 2) it is paid for and commissioned by the FCER (thus biased like Ernst but oppositely), 3) There are no references provided to verify its claims (what the hell? Who does an evidence report and doesn’t add references? Tell me I missed the references somehow but they are there!). Can you find a review that examines the treatment of cervicogenic HA with manipulation? If so, it would be great to add it to the body of the article under Effectiveness!
- SPINE Volume 33, Number 4S, pp S176–S183 – This source is already in the body of the Wikipedia article under safety. It will never make it to the LEAD, as it is a primary source and not a review. As soon as a review covers this and other articles and concludes that the risks of C-manip do not outweigh the benefits then we will change the LEAD and reduce the impact of Ernst’s bias source.
- COST OF CARE FOR COMMON BACK PAIN CONDITIONS – again, a primary source. The body of the Wikipedia article already includes 3 systematic reviews that examine cost effectiveness, thus to add a lower quality source would be difficult and other editors will fight it adamantly. This article will not add value until it has been examined in a review that looks at the sum of all research in the area to make broad conclusions. Once this new article in JMPT is reviewed in a systematic review we will include the conclusions of the systematic review and no-one can say otherwise :)
- CHIRO Study – again, a primary source! The Wikipedia article already includes multiple systematic reviews examining effectiveness for LBP. It will not be long before someone writes a systematic review looking at a comparison of medical/chiro/physio Tx and this will be added to the article.
- Chiros can use physio Tx – I agree, and know that its true, but a source is needed. For this, if you can provide a link to a credible site (or multiple, the more the better) that states explicitly that chiro’s scope includes the use of physiotherapy Tx then we can definitely include this info in the article. If there is no source then it will not be allowed by other editors.
Sorry for the long post, I hope it addresses some of your concerns. If not, let me know what bugs you and we can hash it out Regards! Puhlaa (talk) 15:09, 20 March 2011 (UTC)