title: Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 1: informant interviews.
abstract: BACKGROUND
  Conditions of the hand and wrist often occur in older patients, but decision-making algorithms and manual treatment protocols for this age group have not been developed or assessed. Further, effects of age-related co-morbidities are poorly understood.
  
  
  OBJECTIVE
  To build an understanding of an appropriate treatment protocol from the ground up that does not assume that generic spinal or extremity manipulative therapy is indicated.
  
  
  METHODS
  The project was conducted in two phases, involving (1) interviews with chiropractors (reported here) and (2) a single cohort, longitudinal design, identifying the conditions of the hand and wrist and concomitant comorbidities as well as promising accommodations and chiropractic treatments of these symptoms in older people. In the first phase, data were gathered, through in-person focus group and telephone interviews, from 58 chiropractors treating older patients presenting with hand and wrist symptoms.
  
  
  RESULTS
  Chiropractors indicated they accommodated treatments to the health status and co-morbidities of their older patients and considered "management," rather than "cure," a more realistic concept in treating chronic conditions. With older patients, chiropractors recommended using a lighter touch, rehabilitative passive stretching, traction, nutritional counseling, soft-tissue work, and home exercises. Chiropractors also cautioned providers to take extra time in history-taking and extra diligence with older patients, identifying use of medications, and conducting blood pressure, bone density, blood clotting assessments, if indicated, before treatment.
  
  
  CONCLUSIONS
  Chiropractors provided valuable orientation, indicating that caring for older patients requires careful history-taking and treatment plans that accommodate to presenting co-morbidities and the patients' general health statuses.
authors.affiliation: Basic Sciences Department, Northwestern Health Sciences University, Bloomington, MN.
authors.forename: James R
authors.initials: JR
authors.lastname: Hulbert
authors.forename: Richard
authors.initials: R
authors.lastname: Printon
authors.forename: Paul
authors.initials: P
authors.lastname: Osterbauer
authors.forename: P Thomas
authors.initials: PT
authors.lastname: Davis
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lamaack
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