Questions fo rour Clear Chiro, Smith

[Pooka1]

You are certainly right, Jess.

I think the reason she won't answer about the number of radiographs is that it would shock everybody on this forum.

I think the reason she won't answer about the number of patients who were and were not sub-surgical after the growth spurt is because Clear's record is IDENTICAL to natural history.

That is, it hasn't saved a single child from surgery and Smith knows it. Or she doesn't know it through lack of understanding how to crunch the data and is fooling herself by thinking the cases that would not have advanced anyway were not advancing due to Clear. Chiros are not trained in research and it shows.

[mariaf]

I also thinks Smith under-estimates the intelligence of the average lay person to see right through her - and CLEAR.

"Cowardly" was an excellent choice of words, Sharon.

[LindaRacine]

I saw the writing on the wall when Smith asked for Sharon's definition of evidence driven.

[Pooka1]

I saw the writing on the wall when Smith asked for Sharon's definition of evidence driven.

I missed that. You have more experience at watching these players.

The main thing that bugs me is she claimed to have a regard for the bunnies. She lied.

[dovoranydoc]

Questions for CLEAR chiro DOVORANY


1. How many patients have you treated with curves <30*?

AIS cases with Cobb Angles below 30 degrees: 26

2. How does the rate at which they reach 50* differ from natural history?

I have not had a case under 30 reach 50. I currently have several cases that were diagnosed under 30 and are still under the treatment & monitoring phase; even through growth spurts and despite high ScoliScore risk factors (160-185), they are not increasing beyond the original diagnosed level 1-2 years after beginning care. However, more time is needed for a definitive value.


3. How many patients have you treated with curves >30*?

AIS cases with Cobb Angles between 31-49 degrees: 37
AIS cases with Cobb Angles above 49 degrees: 42

4. How does the rate at which they reach 50* differ from natural history?

I have not had a case start in the 31-49 degree range and progress to over 50. There are about 5 or so that I am unable to get the feedback from, due them moving or some form of communication breakdown. I have had 3 cases >50 degrees when starting that continued to progress - one that I know of underwent spinal fusion surgery which caused a second curve to form (the Crankshaft phenomenon) and required a second fusion. The other 2 are still undetermined.



5. How has Clear done with kids in the growth spurt with curves <30* to start?

I can’t speak for CLEAR collectively because I currently only have access to my patient base. In my clinic, these cases do respond very well. Most cases that are treated prior to 30 degrees reduce when not growing and stay stable through growth spurts, but again very difficult to answer since the majority of influx into our program has come in the last 2-3 years and generally kids that have curves at this level have not reached maturity yet. Still, preliminary results are very good in this category. 90% of curves less than 30 degrees have reduced to the teens or single digits with follow up x-rays demonstrating sustained changes 6-18 months post treatment with just home care.

6. How has Clear done with kids in the growth spurt with curves >30* to start?

My clinic has demonstrated a “see-saw” effect with this group - large reductions then some bounce back then reduced again with some bounce back, etc. Overall, the gains are sustained because the original curve numbers are sustained - meaning they aren’t getting worse with growth but the growth seems to undo some of the corrections. For instance, I recently completed follow-up with a case starting in 2006 - age 11 female with 39 degree right thoracic primary curvature, apical vertebrae T10. By October 2006 without CLEAR treatment she had progressed to 52 degrees. I started CLEAR shortly after that which reduced her curve to 39 degrees. Her program over the last 3 years has been a monthly visit with home care. Her June 2010 x-ray was 44 degrees (no treatment within 3 days of x-ray) with no visible body deformity. Had this patient been a candidate for bracing, this would be considered a success.
I have dozens of cases that are in this boat - going through growth and fluctuating but remaining very much controlled. With some of the new neuromuscular techniques developed by me, I am seeing much stronger hold of corrections and even self-correction with home care. So we are starting to see less “see-sawing,” but it still happens with primary thoracic spine cases with hypokyhosis of the thoracic spine. They seem to be the most resistant and have the heaviest bounce rate. I have a set of identical twins both with AIS smack dab in the midst of growth spurt. Diagnosed at 48* and the other at 37*, their 9-month follow-up (again, no treatment 72 hours before x-rays) demonstrated 26* and 24* respectively. They will be a published case study once they reach skeletal maturity.

[dovoranydoc]

continued

7. Do you belong to an evidence-based chiro group? If so which one?

No, because the evidence-based chiropractic groups tend to be anti-structural care and base all evidence of successful treatment on functional testing and oswestry forms, which is not the primary goal of structural chiros. Functional improvement to me is a secondary goal, meaning if my scoliosis patients have limited functional deficits but have a 50 degree curve, if I restore the structure the function will improve indirectly. The main docs involved with evidence-based programs for chiropractic have limited their paradigm and approach to focus on achieving functional improvements while disparaging structural corrective care; however in my opinion this type of approach is ultimately doomed to failure.
The so called insurance-derived functional model really doesn’t make a good fit with scoliosis care, since scoliosis patients are not your typical 45 year old chronic back pain case where functional baselines are needed to determine efficacy of standard chiropractic care (which CLEAR is certainly NOT standard chiro care).
Personally, because I have a dual practice, I do use functional outcome assessments for standard chiro care patients so I would be considered an Evidence-Based Chiropractor; however, I also measure x-rays and posture and place more emphasis on this aspect then on the functional model so I don’t always see eye to eye with this group.

8. How exactly are evidence-based chiros different than regular chiros?

It depends how you describe evidence-based. Functional models are different because they base all passive and active care programs on Oswestry measurements and functional tests; again, great for typical adults with pain and measurable functional deficits, but when measuring Cobb angles, not completely applicable – not every patient with scoliosis will have functional deficits or be in pain. I have developed some specific quantifiable sensory integration tests that are being integrated into the CLEAR system called SISL (sensory integration skill level); other relevant functional tests may include spirometry, torso rotation strength, etc., but again evidence-based chiropractic as it exists today is not apples to apples because it is an entirely different patient type. The fact is that evidence-based treatment is an ethical thing - doing what is best for the patient to get the desired result in the most cost-effective and least time-consuming manner. It’s not a club; you either are science-based or not. Subluxation, philosophy-based chiros are not my thing. I measure everything.

9. What exactly do you do that makes you evidence-based that you didn't do before you were evidence-based?

I have always based clinical outcomes on measurable goals - both subjective and objective criteria - and I personally have never measured subluxation in the traditional sense of “bone out of place,” because the spine does not misalign in that fashion. Rather, it misaligns in predictable, functional units based on muscle attachments and gravitational global balance which is very measurable and quantifiable.

10. If a child has Scoliscore done and has a score of <41, do you send them home and save them the treatment costs or do you recommend Clear treatment even though there is a 0% chance of reaching 40*?

It depends how healthy their overall posture is, but they certainly will not receive the full CLEAR protocols with a curve less than 25 degrees and a low ScoliScore. They may receive postural care with less time in office and home care recommendations, but there’s definitely a huge difference in treatment recommendations.
I am treating and monitoring a case from Chicago, 12 year old boy diagnosed at 21 degrees, low genetic risk as measured by ScoliScore, treated 4 days with intensive care and a ½ day every 90 days, no heavy-duty therapy equipment at home, just daily rehab exercises.
1 year follow up (again no treatment prior), 0* Cobb
So, yes, if there is postural instability and poor sensory integration skills, I will treat a low score. That’s what I would do for my children, so why wouldn’t I hold the same standard for this child?

This should be about 75% of the people who come in with smallish curves.

Scoliscore was introduced into my practice in April 2010.

I have only performed 10 scoliscore tests and only one was <50. CLEAR doesn’t see a lot of small curves - we tend to be the “oh my gosh it’s getting really bad” stop on the healthcare highway. Things are starting to change with earlier awareness and an understanding that neuromuscular-based rehabilitation can alter stability and progression. Again, the research will come in time; regarding this statement, this is based on my personal clinical experience and the experience of some of my close colleagues including Morningstar.

11. Now it maybe you don't get many people who come in with smallish curves but do you still give people will large curves Scoliscore?

I have only tested curves <25 degrees so far, but in skeletally immature patients with a relatively large growth timeframe ahead of them I may recommend the test. Remember ScoliScore just changed the curve levels so your question is a bit premature.

12. Would you give a person with a 40* curve Scoliscore?

As you know, that is the cutoff of the test. Essentially, you don't need to do the test to know if that person will reach 40*.

I think again it would depend on how much growth is expected, but I like to know what I am dealing with since the prognostic test determines the possibility of progression to 50 degrees. There are other factors that would influence this decision, and it is certainly a judgment call made on a case by case basis. Being involved in treatment of mostly advanced highly progressive cases, there is no need if they are young enough and the curve is large enough. It also depends on apical vertebrae locations and curve patterning because certain curve types are more progressive and less stable than others.

13. How many radiographs do you typically take in the typical week-long treatment of a child?

(1) 8 x 10 (1-2), 7 x 17 (2-3), 14 x 17 (2-3), and additional films if needed on a case by case basis.

As far as all this x-ray concern, it’s honestly unwarranted when dealing with plain film radiography. Two of my best friends are radiologists and they feel the same way. I had a CT scan done for a kidney stone which gave me more radiation in one dose then my scoliosis patients get in a lifetime.

14. How many in a typical two-week treatment?
Same.

15. I don’t take offense to your criticisms and persistent nature. My job is to behave responsively, analyze clinical data, and do my very best for every patient that seeks my help - end of story. I am not dogmatic; I am constantly seeking more information and changing my program when I find things that work better. I challenge the “status quo” and make judgments based on actual clinical data - not what someone tells me or what a research article says, but on applied knowledge. The most respected and brilliant rehab specialists did hundreds if not thousands of clinical applications with patients before there was ever a controlled study done on that technique, so constantly asking for proof and research is inane. Even your beloved surgeons figured out different, more effective techniques, and before the technique was published, some of them might have been attacked by their peers and scientific community, but it didn’t stop them from pressing forward in the best interest of finding a better way.


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[dovoranydoc]

I have a very busy practice and will not have time to respond as quickly as you may want or expect me to. As far as my colleague Dr. Smith, she is a working mom and does not have the ability to be online for this discussion.

regards,
Dr. Dovorany

[skevimc]

Questions for CLEAR chiro DOVORANY

Thanks for your responses. I know it appears that CLEAR gets raked over the coals on this forum, certainly Chiro's do. Some of the critique might be warranted and then other portions of the critique just seem to get a touch personal for my liking. I also think this forum has been fairly and unfairly criticized.

Regardless, I'm glad you responded. From the initial Morningstar paper in 2004 I have been interested in the general technique of CLEAR as it makes physiological sense to me. But have been wary of the perceived Chiro approach of adjustment/subluxation for all. Reading that you don't approach it in that way is helpful for my own biases.

Being an active participant on this forum has definitely helped me better define and clarify some of the not so evident things in scoliosis research. For example the idea of stopping measurement once the patient reaches bone maturity and/or 18 years old. I more clearly understand the argument that if a treatment does not prevent surgery in the long run then it wasn't successful. I don't entirely agree with that, but having that debate has been a helpful thing for me to think about.

At any rate, I hope you continue to respond.

[kidbusiness2]

just stopping

I just pop in from time to time because i suffer from scoliosis. I read this entire thread and the other thread in regards to CLEAR. I think the "SMith" was probably feeling very attacked and pressured and thats why she did not come back on. I wouldn't come back on either if things were said and worded the way they were on here to her & the group. Just my opinion as someone coming on here to look for valuable information in regards to scoliosis treatment and long term care.

[Pooka1]

Okay it is obvious you spent a fair amount of time putting together these answers so I thank you very much for that. Just some clarifications... no rush since I think you are willing to stay.

Questions for CLEAR chiro DOVORANY

1. How many patients have you treated with curves <30*?

AIS cases with Cobb Angles below 30 degrees: 26

2. How does the rate at which they reach 50* differ from natural history?

I have not had a case under 30 reach 50.

Sorry I wasn't clear. I meant after the adolescent growth spurt is complete and they are done growing for sure. How many of the 26 are done growing and done with treatment? Also how do you feel this compares to natural history?

3. How many patients have you treated with curves >30*?

AIS cases with Cobb Angles between 31-49 degrees: 37
AIS cases with Cobb Angles above 49 degrees: 42

4. How does the rate at which they reach 50* differ from natural history?

I have not had a case start in the 31-49 degree range and progress to over 50.

Sorry I again was unclear. How many of these 37 patients are done growing and done with treatment? How do you feel this compares to natural history?

5. How has Clear done with kids in the growth spurt with curves <30* to start?

I can’t speak for CLEAR collectively because I currently only have access to my patient base. In my clinic, these cases do respond very well. Most cases that are treated prior to 30 degrees reduce when not growing and stay stable through growth spurts, but again very difficult to answer since the majority of influx into our program has come in the last 2-3 years and generally kids that have curves at this level have not reached maturity yet. Still, preliminary results are very good in this category. 90% of curves less than 30 degrees have reduced to the teens or single digits with follow up x-rays demonstrating sustained changes 6-18 months post treatment with just home care.

Are these patients done with the growth spurt? Do you recommend home care the rest of their life to sustain the reduction? I'm sorry I did not emphasize that the only thing that matter here is the point after the growth spurt with all these questions.

6. How has Clear done with kids in the growth spurt with curves >30* to start?

My clinic has demonstrated a “see-saw” effect with this group - large reductions then some bounce back then reduced again with some bounce back, etc. Overall, the gains are sustained because the original curve numbers are sustained - meaning they aren’t getting worse with growth but the growth seems to undo some of the corrections. For instance, I recently completed follow-up with a case starting in 2006 - age 11 female with 39 degree right thoracic primary curvature, apical vertebrae T10. By October 2006 without CLEAR treatment she had progressed to 52 degrees. I started CLEAR shortly after that which reduced her curve to 39 degrees. Her program over the last 3 years has been a monthly visit with home care. Her June 2010 x-ray was 44 degrees (no treatment within 3 days of x-ray) with no visible body deformity. Had this patient been a candidate for bracing, this would be considered a success.
I have dozens of cases that are in this boat - going through growth and fluctuating but remaining very much controlled. With some of the new neuromuscular techniques developed by me, I am seeing much stronger hold of corrections and even self-correction with home care. So we are starting to see less “see-sawing,” but it still happens with primary thoracic spine cases with hypokyhosis of the thoracic spine. They seem to be the most resistant and have the heaviest bounce rate. I have a set of identical twins both with AIS smack dab in the midst of growth spurt. Diagnosed at 48* and the other at 37*, their 9-month follow-up (again, no treatment 72 hours before x-rays) demonstrated 26* and 24* respectively. They will be a published case study once they reach skeletal maturity.

Again I wasn't clear. How many started treatment in or before the growth spurt with a curve >30* and who are now <50* (the surgical trigger) after growth is complete and after treatment ends?

Thanks again.

[Pooka1]

15. I don’t take offense to your criticisms and persistent nature.

I certainly hope not. Criticism and persistence is how science moves forward. These are scientific questions that hopefully would produce something close to what would be boiled down into a journal article abstract so it is easy for folks to understand.

[dovoranydoc]

[QUOTE=Pooka1;113490]
How many of the 26 are done growing and done with treatment? Also how do you feel this compares to natural history?
7
since natural history doesn't cause substantial reduction, better?



How many of these 37 patients are done growing and done with treatment? How do you feel this compares to natural history?

23 have reached mensus and are through their major growth spurt.
again many have achieved reduction so better.



Are these patients done with the growth spurt? Do you recommend home care the rest of their life to sustain the reduction? I'm sorry I did not emphasize that the only thing that matter here is the point after the growth spurt with all these questions.
no, I don't recommend home care for life but some responsible spinal stability hygiene is always a good recommendation

[Pooka1]

How many of the 26 are done growing and done with treatment? Also how do you feel this compares to natural history?
7
since natural history doesn't cause substantial reduction, better?

Okay this is clearly not my field and I again flubbed the question.

I meant to ask how many are 2 years past menses and/or have documented closed growth plates and stopped treatment for at least a while and OF THAT GROUP how does that compare with natural history? How many are in that group now? I think it might be too early to ask that question perhaps. If you can beat natural history on that for that group then I hope you publish that in a very prominent location.

How many of these 37 patients are done growing and done with treatment? How do you feel this compares to natural history?

23 have reached mensus and are through their major growth spurt.
again many have achieved reduction so better.

I was told two years post menses is the time that growth can be sure to have ceased. If that is correct, how many patients are in that group and have stopped treatment and how does THAT compare to natural history?

In other words, for girls, anything not at least 2 years post menses or documented to have closed growth plates is premature in terms of a long term result.

[Pooka1]

By the way, given the time you have put into this, I think you care about the bunnies.

[mamamax]

I just pop in from time to time because i suffer from scoliosis. I read this entire thread and the other thread in regards to CLEAR. I think the "SMith" was probably feeling very attacked and pressured and thats why she did not come back on. I wouldn't come back on either if things were said and worded the way they were on here to her & the group. Just my opinion as someone coming on here to look for valuable information in regards to scoliosis treatment and long term care.

Yes, I see it that way too. Glad to see Dr. D responded and look forward to his contributions.