Improvement in Heart Rate Variability Following Spinal Adjustment: A Case Study in Statistical Methodology for a Single Office Visit
Keywords:Chiropractic adjustment, heart rate variability, biostatistics, Grubbs test.
Introduction: Statistical analysis is typically applied at the group level. The present study analyzes data during a single office visit as a novel approach providing real-time feedback to the clinician and patient regarding efficacy of an intervention. In this study, heart rate variability (HRV) was analyzed before versus after a chiropractic spinal adjustment.
Methods: The patient is an adult female who signed a consent form for the study. HRV was measured twice before a chiropractic adjustment and once afterwards using app-based technology. The three HRV values (two pre and one post) were then statistically analyzed using an online calculator for outliers using Grubbs test.
Results: The two pre-adjustment HRV (rMSSD) readings were consistently low: pre 1 = 16.0 milliseconds [ms] and pre 2 = 16.2 ms. The low HRV was an indicator that the patient’s nervous system was not functioning optimally. The patient’s atlas (C1) vertebra was palpated to be slightly out of alignment. These two findings (low HRV and vertebral misalignment) indicated the presence of a chiropractic subluxation (of the atlas vertebra). The subluxation was adjusted and within minutes the HRV increased (improved) to 27.5 ms. This improvement was calculated to be a statistically significant outlier (p < 0.05).
Conclusion: This study is an example of how statistical methods can be applied to the level of an individual patient during one office visit to assess neurological effectiveness of a chiropractic adjustment. Since this is a case study, the results may not apply to all patients. Therefore, further studies in other patients, and for longer follow-up times, are reasonable next steps.
Hart J, Schwartzbauer M. Analysis of resting pulse rates before and after a single chiropractic adjustment for an individual patient: A descriptive study. The Internet Journal of Chiropractic 2016; 5(1).
Hart J. Heart rate variability following spinal adjustment: A practice-based study. Internet Journal of Neurology 2019; 21(1).
Usman Z, et al. Relation of high heart rate variability to healthy longevity. The American Journal of Cardiology 2010; 105(8): 1181-1185. https://doi.org/10.1016/j.amjcard.2009.12.022 DOI: https://doi.org/10.1016/j.amjcard.2009.12.022
Urbanik D, Podgórski M, Mazur G. Heart rate variability – clinical significance. Family Medicine & Primary Care Review; 2018; 20(1): 87-90. https://doi.org/10.5114/fmpcr.2018.73710 DOI: https://doi.org/10.5114/fmpcr.2018.73710
Baek HJ, Cho CH, Cho J, Woo JM. Reliability of ultra-short-term analysis as a surrogate of standard 5-min analysis of heart rate variability. Telemedicine 2015; 21(5): 404-414. https://doi.org/10.1089/tmj.2014.0104 DOI: https://doi.org/10.1089/tmj.2014.0104
Kim GM, Woo JM. Determinants for heart rate variability in a normal Korean population. Journal of Korean Medical Science 2011; 26: 1293-1298. https://doi.org/10.3346/jkms.2011.26.10.1293 DOI: https://doi.org/10.3346/jkms.2011.26.10.1293
Altini M. Heart rate variability Logger – app details. December 12, 2013. Accessed 1-1-19 at: https://www.marcoaltini.com/blog/heart-rate-variability-logger-app-details
Plews DJ, Scott B, Altini M, Wood M, Kilding AE, Laursen PB. Comparison of heart rate variability recording with smart phone photoplethysmographic Polar H7 chest strap and electrocardiogram methods. International Journal of Sports Physiology and Performance 2017; 12(10): 1-17. https://doi.org/10.1123/ijspp.2016-0668 DOI: https://doi.org/10.1123/ijspp.2016-0668
Vescio B, Salsone M, Gambardella A, Quattrone A. Comparison between electrocardiographic and earlobe pulse photoplethysmographic detection for evaluating heart rate variability in healthy subjects in short- and long-term recordings. Sensors 2018; 18: 844. https://doi.org/10.3390/s18030844 DOI: https://doi.org/10.3390/s18030844
GraphPad. Outlier calculator. Available at: https://www.graphpad.com/quickcalcs/Grubbs1.cfm
Kessinger R, Anderson MF, Adlington JW. Improvement in pattern analysis, heart rate variability & symptoms following upper cervical chiropractic care. Journal of Upper Cervical Chiropractic Research 2013; 32-42.
Win N, Jorgensen A, Chen Y, Haneline M. Effects of upper and lower cervical spinal manipulative therapy on blood pressure and heart rate variability in volunteers and patients with neck pain: A randomized controlled, cross-over, preli-minary study. Journal of Chiropractic Medicine 2015; 14: 1-9. https://doi.org/10.1016/j.jcm.2014.12.005 DOI: https://doi.org/10.1016/j.jcm.2014.12.005
Zhang J, Dean D, Nosco D, Strathopulos D, Floros M. Effect of chiropractic care on heart rate variability and pain in a multisite clinical study. Journal of Manipulative and Physiological Therapeutics 2006; 29: 267-274. https://doi.org/10.1016/j.jmpt.2006.03.010 DOI: https://doi.org/10.1016/j.jmpt.2006.03.010
Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007; 21(5): 347-52. https://doi.org/10.1038/sj.jhh.1002133 DOI: https://doi.org/10.1038/sj.jhh.1002133
Hart J. Association of hypertension mortality rates with geographic concentrations of chiropractors and medical doctors in the U.S., 2008. Dose Response 2013; 11(4): 543-549. https://doi.org/10.2203/dose-response.13-003.Hart DOI: https://doi.org/10.2203/dose-response.13-003.Hart
Hart J. Resting pulse rates under chiropractic care: A preliminary practice-based study. Internet Journal of Chiropractic 2018; 7(1): 1-5.
Hart J. Reduction of resting pulse rate following chiropractic adjustment of atlas subluxation. Annals of Vertebral Subluxation Research 2014; 16-21.
Kessinger R, Qualls T, Dallies H, Anderson M, Hart J. Pulse pressure findings following upper cervical care: A practice-based observational study. Journal of the Canadian Chiropractic Association 2019; 63(1): 51-58.
Benichou T, et al. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLOS One 2018. https://doi.org/10.1371/journal.pone.0195166 DOI: https://doi.org/10.1371/journal.pone.0195166
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