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January 2006, Vol. 16, No. 1
Table of Contents
CBP® Non-Profit Matches Dr. Bill Harris' $25,000 Research Grant • Counter Point Round III • Dr Deed Harrison is the Most Published Chiropractor in the Index Medicus • Flawed Thinking • It's Don's Opinion • JCCA Publishes CBP® Structural Rehab Protocol • More Studies to Confirm the Validity and Reliability of PosturePrint™ • Thriving in the New Health Care Marketplace • Organic Chiropractic • Patient Education • Point Round III • The Purpose Driven Practice • Radiation Hormesis • Research Corner • Subluxation Update • System Failure • Ten New Year's Resolutions for Your Practice • Chiropractic: A Useful Component of Traumatic Brain Injury Rehabiitation • Triano is a Chiropractic Pariah •
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Counter Point - Round III
Selective Reviews, Misrepresentation of Studies and Ignoring Biomechanics Research In Favor of Personal Opinion Lead to an Inappropriate Characterization of CBP® Technique - Part III
by Deed E. Harrison, DC
After his undergraduate pre-chiropractic courses at the University of Utah, Dr. Deed Harrison graduated from Life-West in 1996. He is co-author of more than 50 peer-reviewed, indexed, research articles. These include 32 in JMPT, 3 in Chiropractic Technique, and 15 at major Index Medicus journals. He is a Reviewer for an Index Medicus Orthopaedic journal. He is a certified instructor for CBP® Seminars, has written three new CBP® text books, and is Vice-President of CBP® Nonprofit, Inc. He has a private practice in Elko, Nevada.
I would like to thank Dr. McDaniel for his final counter point article in the AJCC and his compliment towards CBP® Non-Profit’s publication record and efforts. Again, due to the number and nature of criticisms, this article is longer than usually permitted. I have itemized Dr. McDaniel’s criticisms into 19 points and provide a rebuttal to each below.
• A) “Any citations to works which are in press or were observed in a poster presentation” are not appropriate in a debate.
To begin, I disagree with Dr. McDaniel’s view here. In press articles and scientific conference proceedings are appropriate scientific references. This is why they have such citations and venues. Second, it is odd to me that Dr. McDaniel does not like these two types of evidence but is more than willing to cite internet chat room debates and discussions as evidence (see Dr. McDaniel’s current citation #3).
For the readers’ benefit, Dr. McDaniel is referring to the presentation by Fredeche et al.1 It needs to be pointed out that Dr. McDaniel did obtain this abstract so clearly I did not make it up nor misrepresent it and this was a PLATFORM presentation not a poster presentation; the two are different.
Lastly, consistent with the two previous debates, Dr. McDaniel has failed to do an adequate literature review on the topics he has chosen to debate and has missed the publication by Stemper et al.2 in 2005 in the Journal of Biomechanics. I will elaborate on this in point M below.
• B) Dr. McDaniel believes that I have misrepresented the evidence I sited regarding CBP Non-Profit’s in press articles and the Fredeche et al presentation.
Dr. McDaniel offers only his personal opinion that I have misrepresented information in the citations that I used previously. Since there are no specific examples of this and only insinuations, I have no choice but to ignore this in favor of the review and interpretation of the literature that I offered in my previous two debates3,4 with Dr. McDaniel. Your personal opinion does not count as evidence with me, Dr. McDaniel.
• C) Dr. McDaniel makes the statement that I (Deed Harrison) am “convinced that my interpretation of the issues is always correct” and offers a quote for me: “The man who claims to be always right is surely wrong.”
Now this is truly an Ad Hominem attack on my character made by Dr. McDaniel. According to Stein,5 the ad hominem attack is one of the fallacies in scientific debates; instead of critiquing the science, attack the character of the individual. I should thank Dr. McDaniel as it is known that once an individual resorts to the Ad Hominem attack, they have lost the debate from a scientific and logical perspective. So I Thank You.
In this instance, I’m confident that I am correct and that Dr. McDaniel has done nothing but rely on poorly designed studies, a selective literature review, and his personal opinion in the end (which is contradicted by strong and numerous scientific manuscripts).
• D) Dr. McDaniel does not believe that Dr. Perle made any Ad Hominem statements regarding CBP® NonProfit’s research presentation6 at RAC 2004.
This is really not a point worth discussing as it has no bearing on the validity of CBP® technique, but since Dr. McDaniel wishes to continue this point, I will placate him. To this end, I have three final remarks:
1. I offered three character witnesses of which Dr. McDaniel and Dr. Perle contacted one, Dr. Chris Colloca. Now, it’s no secret that I’m personal friends with Dr. Colloca. But it’s also no secret that Dr. Colloca is one of the most ‘politically correct’ individuals. This is a compliment and a good trait. Therefore, I suggest that Dr. McDaniel and Perle contact the other two (Dr. Jason Haas and Dr. Paul Oakley).
2. More importantly, prior to acceptance, the RAC policy is that all prospective studies using human subjects for research must have an IRB (see www.c3r.org/accrac06). Furthermore, upon request, we submitted the CBP® IRB’s to the RAC ‘governing persons’ for their review. Now, understandably, Dr. McDaniel may not realize this, but Dr. Perle does. Therefore, there was absolutely no need for Dr. Perle to “Question the CBP® Non Profit IRB.” It was already reviewed and accepted by the conference officials and it is no concern in any form of Dr. Perle’s. The only possible intent was to discredit CBP®’s presentation by attacking the ethics instead of the science.
3. Lastly, since 1995, I have attended annual orthopaedic, physical medicine, and chiropractic research conferences where I have listened to literally thousands of scientific presentations complete with questions from the audience. Honestly, I have never once heard an attending audience participant question the authors of the presentation on their IRB. This is proper scientific etiquette as the only possible interpretation of such questioning is ‘ethical’ or Ad Hominem in nature. Furthermore, it is accepted that proper procedures were followed to be a presenter at the conference and it is not legally or morally up to the audience to review IRB’s. Questioning an author’s IRB is the same as attacking their Ethics and is an Ad Hominem attack regardless of Dr. McDaniel’s or Perle’s view.
• E) Dr. McDaniel does not believe that his “Informed Consent” question regarding a CBP® NP publication7 were Ad Hominem in nature
First, I would ask Dr. McDaniel what his “informed consent” question has to do with the science behind and practice protocols of CBP® Technique and the study in question.7 Dr. McDaniel has no answer for this as of yet.
Second, it is well known (common knowledge) that informed consent is an integral part of the IRB procedure such that the two are inseparable. According to the Federal Register,8 “informed consent shall be documented by the use of a written consent form approved by the IRB and signed by the subject or the subject’s legally authorized representative. A copy shall be given to the person signing the form.”
Third, there are only two reasons for such a question by Dr. McDaniel: 1) to attempt to discredit the IRB/ Informed Consent procedure or ethics of such in the CBP® study7 (An Ad Hominem attack/attempt) or 2) he actually does not understand what an IRB is/does and what informed consent means relative to scientific publications. I conclude it is a combination of both as there is no legitimate reason to have questioned our informed consent that was approved and required by the CBP® NonProfit IRB and it is obvious that Dr. McDaniel believes that informed consent is separate from an IRB (which is opposite of the truth8).
• F) Dr. McDaniel believes that I have made an ‘error or misinterpreted’ the above Ad Hominem Attacks, therefore I must also be in error with my interpretation of the article by Hohl9 and others I previously cited.3,4
According to Dr. McDaniel, because I was in error concerning the IRB Ad Hominem attacks (which I was not; see items D and E above), I must be in error with my interpretation of the Hohl9 study and other articles I summarized in the first two debates.3,4 This is an interesting argument made by Dr. McDaniel.
In fact, Dr. McDaniel is guilty of the Fallacy of “Irrelevant Conclusion.” According to Stein,5 pg.45 “This fallacy is evident when an investigator intends to establish a particular conclusion by shifting his argument to another conclusion.”
Dr. McDaniel has not shown where and why my critiques4 are in error.
• G) Dr. McDaniel states the better pain improvements in the CBP® studies versus the RCT’s on SMT were likely due to the number of visits and not the particular treatment technique
This is the first point that we agree on. Because the CBP® non-randomized clinical control trials10-14 were not designed to compare standard care (SMT) to CBP® structural rehab care, there is no way of knowing whether the pain improvements were due to CBP® structural rehab care or an increased number of visits (3-4 times more on average). However, this is not true regarding spinal correction and CBP® care (see point J below).
Of interest to me and the readership of AJCC is that Dr. McDaniel is now contradicting his own statements made in part I of his debate with me. Dr. McDaniel emphatically stated, “similar pain control can be achieved in far fewer visits at far less cost”15 using standard SMT care. Apparently, Dr. McDaniel is conceding that he was wrong in as much as adequate pain control cannot be achieved with the limited visit model (10-15) that he adhered to originally; 40-45% reduction is not adequate.4
• H) Dr. McDaniel believes “that the selection bias inherent in non-randomized trials can account for differences observed”
Dr. McDaniel consistently makes loose ended statements with no direct examples of why this occurred and no evidence to support his position. Dr. McDaniel’s current statement that selection bias present in the CBP trials invalidates the outcomes of the studies is a classic example of this.
I would ask Dr. McDaniel to define ‘selection bias’ in its proper context, point out specifically where and why it applies to the CBP® Non-Randomized Trials, and support with evidence how it changes the results of the studies in question? Until he can do this, these types of loose ended statements are meaningless and non-supported. In a debate, one must point out a criticism exactly and show when, where, and why it applies, Dr. McDaniel. It is not up to me to disprove every loose ended remark that you make.
• I) Dr. McDaniel believes that 0.8 points on a NRS is a statistically significant increase in pain between the CBP Trials and the SMT Trials
It is true that the average Numerical Rating Score (NRS) in the SMT trials was slightly higher than the NRS score for the CBP® trials. However, Dr. McDaniel has ignored the fact that every questionnaire used to rate pain and disability has a Standard Error of Measurement (SEM).
Interestingly enough, the NRS pain scale has an SEM of greater than ± 0.8.16,26 Accordingly, on the NRS, there is no real difference between a 4.0 and a 4.8, even though Dr. McDaniel would have us believe otherwise.
• J) Dr. McDaniel states “claiming technique superiority would seem premature”
On the surface, Dr. McDaniel’s statement seems to have merit, but, we must define what is meant by superiority. If we are talking about pain outcomes in the CBP® Clinical Control Trials as in letter G above, then I defer to that section. However, it appears as though Dr. McDaniel is ignoring my previous responses to his criticisms and has chosen to discount well-designed case studies as a form of evidence.
For example, in part II of this debate,4 under section F, I stated:
“More importantly, you are wrong Dr. McDaniel when you state there is no information to say that lordosis rehabilitation is superior to other types of care. For example, we have recently published several case studies where “standard care” failed to resolve a patient’s chronic condition; whereas CBP® lordosis/postural rehabilitation showed dramatic improvements in pain, ROM, disability scales, and health status (depending upon the study).44-50 Does more work need to be performed on this type...yes, we do need more advanced studies in this area.
Lastly, in terms of spinal correction, CBP® Technique has demonstrated superiority over traditional SMT treatment methods and over no care. I will not concede these points Dr. McDaniel. You are wrong and in fact are ignoring ALL evidence in favor of the RCT.
• K) Dr. McDaniel still takes issues with my hypothetical Report of Findings for his hypothetical case and offers his Opinion of an appropriate ROF
I find Dr. McDaniel’s report interesting. However, Dr. McDaniel’s opinion of an adequate ROF is simply that...his personal opinion and has no legitimate bearing on the scientific merits and clinical application of CBP® technique.
Dr. McDaniel wants me and other CBP® practitioners to provide the patient (in the ROF) with ‘full information’ including opposing views. He even goes so far as to suggest that we provide the typical patient with research articles out of Spine, J Biomechanics, etc... I find this amusing to say the least. To expect the average patient to read and understand key aspects of research methodology including, design, statistical analysis, etc..., is ludicrous.
However, what I will do and suggest the readership of the AJCC do, is to provide them with this 3-part debate between Dr. McDaniel and Myself. This will give the reader ‘Full Disclosure’ and they can weigh the evidence for themselves.
• L) Dr. McDaniel states that my (Deed’s) “Arguments drawing a connection to the early and progressive DJD fall short of convincing”
Again, this was addressed in the previous two debates. I presented a literature review of the topic between altered sagittal plane curves and early or progressive degenerative joint disease in Part II of this debate (see sections G,H,I,M). I offered the following statement:
“The available evidence from finite element models,59 analytical engineering stress/strain models,31-35,58,62 longitudinal surgical outcome studies on matched patients with and without abnormal curves and a variety of conditions,58,60-66 non-surgical longitudinal studies,67 and cross-sectional studies82-84 all indicate that straightened, S-curves, and kyphotic cervical curves predict and/or statistically correlate to the development and/or existence of DJD. In other words, a broad scope (not just one type of evidence) of research data points to the same result; that abnormal curves correlate to DJD.”
To rebut the above statement, Dr. McDaniel offers his personal opinion without any data. I note that Dr. McDaniel is not an expert/authority in spinal biomechanics, has not published a single article in a biomedical journal on this topic, and therefore, Dr. McDaniel’s opinion “falls short of convincing me” that I’m wrong. What about you?
• M) Dr. McDaniel states “the connection between variations in cervical curvature and increased damage in an automobile accident is very preliminary and tenuous”
I’m beginning to have some fun with Dr. McDaniel. Dr. McDaniel continues to make broad statements based on one study without doing an adequate literature search to weigh the evidence. It is interesting that McDaniel has tracked down the abstract by Frechede et al1 but still thinks that I misrepresented it? I accurately represented the Frechede et al1 study and in fact, the authors have published validation of their analytical methods.17
More importantly, you have missed and/or neglected the recent publication by Stemper et al2 in the J of Biomechanics. In a validated, computational modeling study, Stemper et al2 investigated alterations in the initial alignment (lordosis, straight, and kyphosis) of the cervical curve prior to exposure to rear end impacts. Specifically, a 2.6 m/s rear impact velocity was used and caused a 2.3g mean acceleration. Of interest to this discussion, in the kyphotic neck the C5/C6 facet capsular ligament experienced a 73% increased longitudinal strain compared to the neutral lordotic alignment. The authors concluded that kyphosis is an abnormal state of cervical curvature and predisposes the facet capsular ligament to sub-catastrophic injury (microscopic damage) due to increased strain.
What will you say about the Stemper et al2 study, Dr. McDaniel: that I misrepresented it? That you don’t believe it? That the methods are flawed? Or that you are in fact in error and my interpretation is correct in as much as my view is supported by the best available scientific evidence?
• N) Dr. McDaniel offers his views of Informed Consent and confuses IRB requirements for research and Clinical Practice Protocols
While Dr. McDaniel’s view of informed consent is interesting, it has no bearing on practice protocols from a legal stand point. I will offer this thought to Dr. McDaniel: You are confusing IRB Informed Consent requirements/regulations with Clinical Practice Guidelines and practices.
Summarily, according to Stein,5 pg 45 Dr. McDaniel is again guilty of the Fallacy of “Irrelevant Conclusion.” Thank you for offering your opinion to me and the readership of the AJCC, but it is not supported by any fact or evidence and has no relevance to clinical practice.
• O) Dr. McDaniel emphatically states that myself and other CBP®’ers are guilty of ‘misinterpretations of the evidence leading to excessive and premature confidence” in CBP® techniques’ ability to manage patient conditions
Once again, Dr. McDaniel freely offers his opinion and makes some very serious statements and insinuations. However, consistent with previous trends, Dr. McDaniel has not pointed out how this criticism exactly applies, has not shown when, where, and why it applies. Again, I will offer the following remark, “It is not up to me to disprove every loose ended remark that you make.” Lastly, refer to section P immediately below.
• P) Dr. McDaniel insinuates that CBP® technique has a ‘melding’ with practice management protocols
It needs to be stated to Dr. McDaniel and the readership of the AJCC that CBP® Technique is not practice management. Certain practice management organizations have chosen to incorporate ‘some’ of CBP® protocols and procedures in a loose attempt to support their recommendations.
Recently, we (CBP® Non-Profit) have developed CBP® Structural Rehab practice guidelines for clinicians18 (not insurance companies and IME’s). This review of the literature gives appropriate recommendations based on the best available information and clinical judgment. This is consistent with ‘evidence based practice’ (EBP). Where EBP is defined as clinical decision-making based on (1), sound external research evidence combined with individual clinical expertise and (2), the needs of the individual patient.24,25 The problem is Dr. McDaniel continues to ignore: clinical expertise, the needs of the individual, and ALL types of evidence providing a consensus.
At present, these ‘new guidelines’ are the best available guidelines for doctors desiring to provide structural rehabilitation to their patient populations.18 There are a few practice management groups that are recommending their clients adhere to these guidelines; these organizations should be acknowledged for their efforts not unjustly chastised by Dr. McDaniel.
As with any set of guidelines, these are amendable pending new or updated information. Lastly, since these guidelines18 were presented in a peer-reviewed forum, they severely outweigh Dr. McDaniel’s personal opinion on the matter.
• Q) Dr. McDaniel’s Views regarding CBP® technique have not changed due to this debate. He still relies on his opinion instead of the data I provided
I am really not surprised that Dr. McDaniel’s opinion regarding the scientific validity and clinical utility of CBP® technique remains unchanged.
I think it needs to be said to the readership of the AJCC that this is not unusual for you, Dr. McDaniel. As a well known IME in the state of California, I believe you are used to offering your personal opinion as if it were validated evidence while ignoring the actual facts or opposing scientific data of a case.
The Administrative Case Number 2004-411 brought before the Board of Chiropractic Examiners for the State of California is an example of your inability to accommodate the facts of a case; instead you assimilate information into your pre-determined agenda.
I was hoping for a different outcome from you, but I expected this in the end.
• R) Dr. McDaniel is closely watching a patient class action suit against a practice management group and eagerly awaits the results
This statement made by Dr. McDaniel has no bearing on the scientific validity and clinical utility of CBP® technique. What is your purpose here?
• S) Dr. McDaniel would like me to answer three clinical questions for him
Since this is an invited guest section, I will oblige Dr. McDaniel’s 3 questions. I will provide answers only and ask the readers to refer to Dr. McDaniel’s article for the questions.
Answer 1: Both yes and no. A patient might be asymptomatic on the NRS but still has a measurable disability on a health status or disability index questionnaire. In other cases, a patient might only be asymptomatic for 1-2 days and are thus having a ‘good’ day(s) instead of an average or poor pain day. In other cases, if a patient is truly asymptomatic from this point on, then, maybe they may not need further SMT.
There is no way of knowing what will occur in a given patient such that in clinical practice, there is no right or wrong answer to this question. Finally, presence or absence of pain is not the only and, many times, is not the best indicator of a health disorder.19
Answer 2: Harrison Chiropractic Supply is not an affiliated company with CBP® Seminars; it is a separate company with separate owners. CBP® Seminars does not sell any home traction equipment. CBP® doctors tend to purchase home traction equipment as ancillary tools from companies advertised in our journal as they offer good quality equipment at a reasonable price.
Now to the point: I find it disturbing that Dr. McDaniel professes himself as ‘evidence based’ on one hand, but when it comes to applying CBP® Technique Procedures in a clinical practice, he is willing to throw caution to the wind. Home traction has never been subjected to a single case study let alone to a clinical trial. Therefore, it is clinically unsound and scientifically unsupported to send a patient home with traction as the sole means of treatment to rehabilitate their abnormal sagittal spinal curvatures.
Lastly, as I’ve stated numerous times now, the 10-15 visit standard care model only relieves 40-45% of a patient’s starting chronic pain intensity. Thus, they are not, on average, out of pain. Why do you not accept this fact, Dr. McDaniel?
Answer 3: It is well known that IME’s and Insurance Companies want clinicians to send patients home with rehabilitation exercises or self-management devices. In my opinion, this ‘self-management’ concept is nothing more than an attempt to limit legitimate patient visits and deny payment for legitimate treatment claims.
In support of my above statement, I offer the following:
1. In order to attain significant strength gains and subjective improvement, Jordan et al.20 recommended that supervised instruction, with home exercise programs on off days, should last a minimum of 2 months with 2-3 sessions per week. Postoperative & post-traumatic patients would require 3-4 months or longer of supervised instruction.
2. In-house rehabilitation programs have increased rates of patient compliance and greater improvements in pain and disability compared to non-supervised programs.21,22 Also communication of goals, expectations of rehabilitation, and lessening anxiety levels are enhanced in the clinical setting.23
3. Lastly, all the published CBP® non-randomized clinical control trials and case reports have utilized in office exercise and in office traction. Following the protocols and practices set forth in the scientific literature is part of current evidence based practice recommendations.
Conclusions
Regarding this 3-part debate with Dr. McDaniel, I have systematically pointed out the inaccuracies in Dr. McDaniel’s literature summaries and shown that his opinions are contrary to the known biomechanical and clinical studies on the debate topics. He has consistently relied on a selective literature review and his personal opinion instead of the complete picture presented in the literature.
Lastly, I have two recommendations for Chiropractors who are currently (or in the future) involved in an IME review process, Legal Case, or Board Hearing where Dr. McDaniel is an ‘Expert Witness’ against them or another IME is an expert witness against them and the issues of structural rehab in chiropractic are being debated:
1. Use this Three-Part Point Counter Point debate to assist you in your defense of any IME personal opinion attacks on your patient treatment and recommendations for corrective care,
2. Use Case No. 2004-411 from the Board of Chiropractic Examiners of the State of California as precedence to defend yourself from the personal opinion claims made by Dr. McDaniel as an IME.
Rounds 1-3: Need readers to judge the outcome due to biases of the individual authors. Email your position to drdeed@idealspine.com and we will present the results in the next issue of the AJCC.
References
1. -Frechede B, Saillant G, LaVaste F, Skalli W. Risk of injury of the human neck during impact: role of geometrical and mechanical parameters. Paper A29; Presented at the European Cervical Spine Research Society Annual Meeting; 2004 Porto, Portugal, May 30-June 5.
2.- Stemper BD, Yohanandan N, Pintar FA. Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading. J Biomechanics 2005;38:1313-1323.
3. -Harrison DE. Counter-point article-A Selective Literature Review, Misrepresentation of Studies, & Side Stepping Spine Biomechanics Lead to an Inappropriate Characterization of CBP® Technique. Part I. AJCC January 2005.
4. -Harrison DE. Counter-point article-A Selective Literature Review, Misrepresentation of Studies, & Side Stepping Spine Biomechanics Lead to an Inappropriate Characterization of CBP® Technique. Part II. AJCC April 2005.
5. -Stein F. Anatomy of Research in Allied Health. New York: John Wiley & Sons. 1976, pg 45.
6. -Research Agenda Conference 2004 March, Las Vegas NV. Question and answers session following the presentation: Harrison DE, Cailliet R, Betz JW, Harrison DD, Haas JW, Janik TJ, Holland B. Harrison Mirror Image Methods for Correcting Trunk List: A Non-randomized Clinical Control Trial. Eur Spine J 2005;14:155-162.
7. -Harrison DE, Harrison DD, Betz J, Janik T, Holland B, Colloca C, Haas J. Increasing the Cervical Lordosis with Chiropractic Biophysics Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Nonrandomized Clinical Control Trial. JMPT 2003; 26(3):139-151.
8. -Federal Register. Rules and Regulations. Subpart B- Informed Consent of Human Subjects. 1981;48(17): Tuesday Jan 27, page 8851.
9. -Hohl M. Soft-tissue injuries of the neck in automobile accidents. J Bone and Joint Surgery 1974;56-A:1675-1682.
10. -Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: A nonrandomized clinical controlled trial. Arch Phys Med Rehab 2002;83:447-453.
11. -Harrison DE, Harrison DD, Betz J, Colloca CJ, Janik TJ, Holland B. Increasing the cervical lordosis with seated combined extension-compression and transverse load cervical traction with cervical manipulation: Nonrandomized clinical control trial. J Manipulative Physiol Ther 2003;26:139-151.
12. -Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in sagittal lumbar configurations with a new method of extension traction: Nonrandomized clinical controlled trial. Arch Phys Med Rehab 2002;83:1585-1591.
13. -Harrison DE, Cailliet R, Betz J, et al. Conservative methods for reducing lateral translation postures of the head: A non-randomized clinical control trial. J Rehab Res Dev 2004; 41(4): 631-640.
14. -Harrison DE, Cailliet R, Betz J, et al. Non-randomized clinical control trial of Harrison Mirror Image Methods for correcting trunk list (lateral translations of the thoracic cage). Euro Spine J 2005;14:155-162.
15. -McDaniel J. My opinion of the Short Comings of CBP® Technique Research and Practice Protocols. AJCC Jan 2005. Point Counter Point Debate Part I.
16. -Bolton JE, Wilkinson RC. J Manipulative Physiological Therapeutics 1998;21:1-7.
17. -Dumas R, Aissaoui R, Mitton D, Skalli W, de Guise JA. Personalized body segment parameters from biplanar low-dose radiography. IEEE Trans Biomed Eng. 2005;52(10):1756-1763.
18. -Oakley PA, Harrison DD, Harrison DE, Haas JW. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications. J Can Chiropr Assoc 2005;49(4):268-294.
19. -Griffith HW. Complete guide to symptoms, illness, and surgery. Tucson (AZ): The Body Press; 1985.
20. -Jordon A, Ostergaard K. J Manipulative Physiol Ther 1996; 19(1): 32-35.
21. -Reilly K, et al. J Occup Med 1989; 31: 547-550.
22. -Harkapaa K, Jarvikoski A, Mellin G, Hurri H. Scand J Rehabil Med 1989; 21: 81-89.
23. -Fordyce WE, Brockway JA, Bergman JA, Spengler D. J Behav Med 1986; 9: 127-40.
24. -Bolton JE. The evidence in evidence-based practice: what counts and what doesn’t count? J Manipulative Physiol Ther 2001;24:362-366.
25. -Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: How to practice and teach EBM. New York:Churchill-Livingstone, 1997:
26. -Jensen MP, Turner JA, Romano JM, et al. Comparative reliability and validity of chronic pain intensity measures. Pain 1999;83:157-162.
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