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Comparison between chiropractic frequency and co-management of urinary incontinence and prostatic carcinoma between 1996 and 2016: should chiropractors co-manage urinary incontinence in males with prostate carcinoma undergoing androgen deprivation therapy to screen for spinal loss of bone density?

ABSTRACT: In 2010, Serpa Neto et al, conducted systematic review and meta-analysis of thirty-two studies and found that patients with prostate cancer who underwent androgen deprivation therapy had lower levels of bone mineral density and higher rates of osteoporosis and fractures compared to patients not undergoing androgen deprivation therapy.

OBJECTIVE: This study compared chiropractic frequency and co-management for urinary incontinence and prostatic carcinoma between 1996 and 2016 to determine chiropractic practice patterns. An increase in chiropractic co-management for urinary incontinence in males with prostate cancer undergoing androgen deprivation therapy can help reduce the risk of spinal loss of bone mass density.

METHODS: A search of the Job Analysis reports between 1996 and 2016 was performed. Only the Job Analysis reports between 1996 and 2016 were included. Data not derived from the Job Analysis was excluded from this study.

RESULTS: A lower frequency of patients and lower co-management of prostatic carcinoma was observed when compared to a higher frequency of patients and higher co-management of urinary incontinence. The frequency for prostatic carcinoma was 0.3 (scale from 0 to 4) while the frequency for urinary incontinence was 0.8. Moreover, the co-management for prostatic carcinoma was 17% while the co-management for urinary incontinence was 49%.

CONCLUSION: A positive correlation between frequency and co-management was observed when comparing prostatic carcinoma and urinary incontinence in this study. Perhaps frequency would increase by educating patients who are undergoing androgen deprivation therapy about visiting a chiropractor who would then screen for vertebral loss of bone density through x-rays.

Furthermore, chiropractors can provide nutritional supplementation to help co-manage urinary incontinence. Finally, chiropractors should evaluate whether patients undergoing androgen deprivation therapy is a relative risk for spinal manipulative therapy.

Keywords: Incontinence, chiropractic, prostate, bone, androgen

INTRODUCTION

Several studies have linked androgen deprivation therapy with loss of bone density and osteoporosis. In 2010, Serpa Neto et al, conducted a systematic review and metaanalysis of thirty-two studies and found that patients with prostate cancer who underwent androgen deprivation therapy had lower levels of bone mineral density and higher rates of osteoporosis and fractures compared to patients not undergoing androgen deprivation therapy. (1) Recently, in 2014, Lassemillante et al, conducted a metaanalysis and found that the prevalence of osteoporosis varies between 9 and 53% for males undergoing androgen deprivation therapy. (2)

The prevalence of incontinence appears to be high in males after a radical prostatectomy. In 2012, Ficarra, et al, conducted a systematic review and meta-analysis of 51 articles and found that the 12-month urinary incontinence rates for robot assisted radical prostatectomy ranged from 4% to 31%. (3)

The condition of urinary incontinence was selected due to the promising research supporting chiropractic treatment and pelvic exercises for the treatment of incontinence. In 2006, Zhang et al, conducted a retrospective study of 13 patients with incontinence. This study showed that after 1-8 weeks of chiropractic adjustments, the urinary frequency at night was significantly reduced from 3.8 to 1.2. (4) In 2012, Cuthbert et al, conducted a case series of 21 patients which revealed that patients showed improvement in urinary incontinence symptoms that persisted over time. (5) The prevalence of males with prostate carcinoma who seek chiropractic treatment is 18%. (6)

According to a recent Canadian review of the diagnosis and management of osteoporosis in men, all prostate cancer patients beginning androgen deprivation therapy should be screened with DEXA scans at baseline; anyone aged[greater than or equal to]65 and anyone with kyphosis, back pain, substantial height loss, or other symptoms suggesting vertebral fractures should also be screened with thoracic and lumbar spine x-ray. (7)

Pelvic exercises have also showed promising results in the treatment of urinary incontinence. In 2015, Fernandez et al, conducted a meta-analysis of randomized controlled trials and concluded that programs including at least three sets of 10 repetitions of muscle training daily appear to improve continence rate after radical prostatectomy. (8) In 2016, Chang et al, conducted a systematic review and meta-analysis of eleven studies and found that preoperative pelvic floor muscle exercise improves postoperative urinary incontinence after radical prostatectomy at 3 months (9)

While the aforementioned studies discuss the effectiveness of chiropractic treatment and pelvic floor exercises they fail to evaluate the frequency and co-management of prostate carcinoma and incontinence.

The purpose of this study is to compare chiropractic frequency and co-management of prostate carcinoma and incontinence in order to help predict if an increase in frequency could lead to an increase in co-management.

METHODS

A search of the Job Analysis reports between 1996 and 2016 was performed. Only the Job Analysis reports between 1996 and 2016 were included. Other surveys were excluded because the Job Analysis is the most reliable nationwide survey and has the largest sample population.

Data not derived from the Job Analysis was excluded from this study. Analysis reports with a different measuring scale were excluded as well. Frequency was measured on a scale from 0 to 4 where 0 was never and 4 was routinely. The average frequency was calculated from all the analysis reports obtained. Moreover, co-management was measured as a percentage of chiropractors and was also averaged. A scatter plot was then constructed to evaluate if there was a positive correlation between frequency and co-management for both prostate carcinoma and incontinence.

RESULTS

Four Job Analysis reports were found between 1996 and 2016 corresponding to the years 2000, 2005, 2010 and 2015. The reports for the years 2005 and 2010 met the inclusion criteria.

The 2015 Job Analysis report was excluded because the frequency scale changed from 0 to 4 to 0 to 5. The sample population for the years 2005 and 2010 was 2,167 and 1,379 respectively.

The 2000 Job Analysis was excluded since the category tested was "Prostate Disorders' instead of "Prostate Carcinoma". For prostatic carcinoma, the frequency for the years 2005 and 2010 was 0.3 on a scale from 0 to 4. The co-management of prostate carcinoma for the years 2005 and 2010 was 16.6%. For incontinence, the frequency for the years 2005 and 2010 was 0.8 on a scale from 0 to 4. The co-management of incontinence for the years 2005 and 2010 was 49.4%.

DISCUSSION

The plausibility of Chiropractors co-managing incontinence in males with prostate carcinoma undergoing androgen deprivation therapy was discussed in the introduction. Another plausible explanation has to do with the evidence of chiropractic efficacy with enuresis. In 1994, Reed et al, conducted a controlled clinical trial of forty-six enuretic children and found that chiropractic treatment was effective at reducing the frequency of enuresis. (10) In 2009, Van Poecke et al, reported a case series of 33 consecutive patients with primary enuresis. The study found that there was a 66.6% resolution rate within 1 year in 33 consecutive children and teenagers who experienced primary nocturnal enuresis. (11)

Other studies have evaluated the correlation between back pain and urinary problems. In 2012, Cashley et al, reported a case series of eight chiropractic patients and found that bladder and urinary problems may be associated with spinal dysfunction for some patients. (12) In 2014, Walden et al, conducted a study of 140 chiropractic patients and found that the prevalence of bowel and bladder symptoms in chiropractic patients was high. (13)

A topic not mentioned in this study was nutritional supplementation for urinary incontinence. In 2002, Dvorkin et al, conducted a randomized, placebo-controlled, 1 -year trial examining the effect of pumpkin seeds (Cucurbita pepo), in 476 patients with lower urinary tract symptoms and benign prostate hypertrophy. The score improved 6.8 points with active treatment, which was 1.2 points better than placebo reported as a statistically significant difference. (14)

Finally, other drugs causing spinal loss of bone density include proton pump inhibitors and depot medroxyprogesterone acetate which should increase awareness if undergoing chiropractic treatment. (15,16)

CONCLUSION

A positive correlation between frequency and co-management was observed when comparing prostatic carcinoma and urinary incontinence in this study. Perhaps frequency would increase by educating patients who are undergoing androgen deprivation therapy about visiting a chiropractor who would then screen for vertebral loss of bone density through x-rays.

Furthermore, chiropractors can provide nutritional supplementation to help co-manage urinary incontinence. Finally, Chiropractors should evaluate whether patients undergoing androgen deprivation therapy is a relative risk for spinal manipulative therapy.

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References

(1.) Serpa neto A, Tobias-machado M, Esteves MA et al. A systematic review and meta-analysis of bone metabolism in prostate adenocarcinoma. BMC Urol. 2010;10:9.

(2.) Lassemillante AC, Doi SA, Hooper JD, Prins JB, Wright OR. Prevalence of osteoporosis in prostate cancer survivors: a meta-analysis. Endocrine. 2014;45(3):370-81.

(3.) Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405-17.

(4.) Zhang J, Haselden P, Tepe R. A case series of reduced urinary incontinence in elderly patients following chiropractic manipulation. Journal of Chiropractic Medicine. 2006;5(3):88-91. doi:10.1016/S0899-3467(07)60139-6.

(5.) Cuthbert SC, Rosner AL. Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report. Journal of Chiropractic Medicine. 2012;11(1):49-57. doi: 10.1016/j.jcm.2011.10.002.

(6.) Kao GD, Devine P. Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy. Cancer. 2000;88(3):615-9.

(7.) Egerdie B, Saad F. Bone health in the prostate cancer patient receiving androgen deprivation therapy: a review of present and future management options. Canadian Urological Association Journal. 2010;4(2):129-135.

(8.) Fernandez RA, Garcia-hermoso A, Solera-martinez M, Correa MT, Morales AF, Martinez-vizcaino V. Improvement of continence rate with pelvic floor muscle training post-prostatectomy: A meta-analysis of randomized controlled trials. Urol Int. 2015;94(2):125-32.

(9.) Chang JI, Lam V, Patel MI. Preoperative Pelvic Floor Muscle Exercise and Postprostatectomy Incontinence: A Systematic Review and Meta-analysis. Eur Urol. 2016;69(3):460-7.

(10.) Reed WR, Beavers S, Reddy SK, Kern G. Chiropractic management of primary nocturnal enuresis. J Manipulative Physiol Ther. 1994;17(9):596-600.

(11.) Van poecke AJ, Cunliffe C. Chiropractic treatment for primary nocturnal enuresis: a case series of 33 consecutive patients. J Manipulative Physiol Ther. 2009;32(8):675-81.

(12.) Cashley MA, Chiropractic care of interstitial cystitis/painful bladder syndrome associated with pelvic lumbar spine dysfunction: a case series. J Chiropr Med. 2012;11(4):260-6.

(13.) Walden AL, Salsbury SA, Reed WR, Lawrence DJ. Bladder and Bowel Symptoms Among Adults Presenting With Low Back Pain to an Academic Chiropractic Clinic: Results of a Preliminary Study. Journal of Chiropractic Medicine. 2014; 13(3): 178-187. doi:10.1016/j.jcm.2014.07.006.

(14.) Dvorkin L, Song KY. Herbs for benign prostatic hyperplasia. Ann Pharmacother. 2002;36(9):1443-52.

(15.) Isaza, A. (2017, January) Comparison between frequency and co-management of PUD and GERD by chiropractors between 1996 and 2016: Should chiropractors provide nutritional counseling and screen patients with PUD and GERD taking proton pump inhibitors in order to reduce spinal fractures. Nutritional Perspectives, Volume 40 issue 1.

(16.) Isaza, A. (2017, January) Comparison between frequency and co-management of PUD and GERD by chiropractors between 1996 and 2016: Should chiropractors provide nutritional counseling and screen patients with PUD and GERD taking proton pump inhibitors in order to reduce spinal fractures. Nutritional Perspectives, Volume 40 issue 1.

(17.) Examiners NB, Kollasch MW. Job Analysis of Chiropractic 2005, A Project Report, Survey Analysis, and Summary of the Practice of Chiropractic Within the United States. NATIONAL BOARD OF CHIROPRACTIC EXAMINERS; 2005.

(18.) Christensen M, Kollasch M, Hyland J. Practice Analysis of Chiropractic. Greeley, CO: National Board of Chiropractice Examiners; 2010.

by: Adrian Isaza, DC, DACBN, CCAP
TABLE 1 - CHIROPRACTIC FREQUENCY AND CO-MANAGEMENT OF PROSTATE
CARCINOMA

Year                                Condition  Frequency 0-4

National Board of Chiropractic      Prostate   0.3
Examiners. Job
Analysis of Chiropractic 2005 (17)  Carcinoma  Rarely
National Board of Chiropractic      Prostate   0.3
Examiners. Job
Analysis of Chiropractic 2010 (18)  Carcinoma  Rarely
Total/Avg                                      0.3

Year                                Co-Management  Sample Size

National Board of Chiropractic      16.6%          2,167 Chiropractors
Examiners. Job
Analysis of Chiropractic 2005 (17)
National Board of Chiropractic      16.6%          1,379 Chiropractors
Examiners. Job
Analysis of Chiropractic 2010 (18)
Total/Avg                           16.6%          3,546 Chiropractors

TABLE 2 - CHIROPRACTIC FREQUENCY AND CO-MANAGEMENT OF INCONTINENCE

Year                            Condition     Frequency 0-4

National board of Chiropractic  Incontinence  0.8
examiners. Job analysis of                    Rarely
chiropractic 2005 (17)
National board of Chiropractic  Incontinence  0.8
examiners. Job analysis of                    Rarely
chiropractic 2010 (18)
Total/Average                                 0.8

Year                            Co-Management  Sample Size

National board of Chiropractic  49.4%          2,167 Chiropractors
examiners. Job analysis of
chiropractic 2005 (17)
National board of Chiropractic  49.4%          1,379 Chiropractors
examiners. Job analysis of
chiropractic 2010 (18)
Total/Average                   49.4%          3,546 Chiropractors
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Author:Isaza, Adrian
Publication:Original Internist
Date:Sep 1, 2017
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