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Lowry V, Lavigne P, Zidarov D, Matifat E, Cormier AA, Desmeules F. A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders. Arch Phys Med Rehabil 2024; 105:411-426. [PMID: 37832814 DOI: 10.1016/j.apmr.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders. DATA SOURCES A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases. STUDY SELECTION Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included. DATA EXTRACTION CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into "recommended," "may be recommended," or "not recommended." Disagreements were resolved by discussion until reviewers reached consensus. DATA SYNTHESIS Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient's history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it. CONCLUSIONS Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada; Surgery Department, Medicine Faculty, University of Montreal, Montreal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Interdisciplinary Rehabilitation Montreal Research Center (CRIR), Montreal, Canada; Montreal University Institute for Physical Impairment Rehabilitation (IURDPM), Montreal, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
| | | | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
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van der Vossen B, de Zoete A, Rubinstein S, Ostelo R, de Boer M. Is the use of diagnostic imaging and the self-reported clinical management of low back pain patients influenced by the attitudes and beliefs of chiropractors? A survey of chiropractors in the Netherlands and Belgium. Chiropr Man Therap 2024; 32:1. [PMID: 38191460 PMCID: PMC10775452 DOI: 10.1186/s12998-023-00523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND No previous studies have examined the association between attitudes and beliefs of chiropractors and their adherence to low back pain (LBP) guidelines. The aim of this study is: (1) to assess the attitudes and beliefs towards the management of LBP of Dutch and Belgian chiropractors; and (2) to investigate the association of these attitudes and beliefs on the use of diagnostic imaging and on the adherence to diagnostic guidelines and guidelines in the management of patients with LBP. METHODS STUDY DESIGN: Cross-sectional study using a web-based questionnaire in chiropractic private practices in the Netherlands and Belgium. The survey included sociodemographic characteristics, use of diagnostic imaging, the Pain Attitude and Beliefs Scale-Physiotherapists (PABS.PT) and 6 vignettes (3 acute and 3 chronic LBP patients). We used Latent Profile Analysis (LPA) to categorise the chiropractors into clusters depending on their PABS.PT outcome, whereby the classes differed primarily on the biomedical score. We used linear, logistic, and mixed models to examine the associations between these clusters, and adherence to the recommendations of guidelines on: (1) diagnostic imaging use, and (2) management of LBP (i.e. advice on activity, treatment, return-to-work, and bedrest). RESULTS The response rate of the Dutch and Belgian chiropractors was 61% (n = 149/245) and 57% (n = 54/95), respectively. The majority of chiropractors scored midrange of the biomedical scale of the PABS.PT. Three clusters were identified using LPA: (1) high biomedical class (n = 18), (2) mid biomedical class (n = 117) and (3) low biomedical class (n = 23). Results from the vignettes suggest that chiropractors in the high biomedical class better adhere to diagnostic imaging guidelines and to LBP guidelines when it concerns advice on return-to-work and activity compared to the other two classes. However, no differences were identified between the classes for treatment of LBP. All chiropractors adhered to the guidelines' recommendation on bedrest. CONCLUSION The high biomedical class demonstrated better overall adherence to the practice guidelines for the management of LBP and diagnostic imaging than the other classes. Due to the small numbers for the high and low biomedical classes, these results should be interpreted with caution.
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Affiliation(s)
- Brenda van der Vossen
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, Amsterdam, The Netherlands.
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Sidney Rubinstein
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, VU University Amsterdam, Amsterdam Movement Sciences Research Institute Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michiel de Boer
- Department of Primary- and Long-Term Care, UMCG, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Johnson CD, Green BN, Agaoglu M, Amorin-Woods L, Brown R, Byfield D, Clum GW, Crespo W, Da Silva KL, Dane D, Daniels CJ, Edwards M, Foshee WK, Goertz C, Henderson C, Hynes R, Johnson V, Killinger L, Konarski-Hart K, Kopansky-Giles D, Kowalski M, Little C, McAllister S, Mrozek J, Nixdorf D, Peeace LD, Peterson C, Petrocco-Napuli KL, Phillips R, Snow G, Sorrentino A, Wong YK, Yelverton C, Young KJ. Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic. JOURNAL OF CHIROPRACTIC HUMANITIES 2023; 30:23-45. [PMID: 37841068 PMCID: PMC10569958 DOI: 10.1016/j.echu.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Objective This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels. Methods For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings. Results Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts. Conclusion A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.
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Affiliation(s)
| | - Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Mustafa Agaoglu
- AECC University College, Bournemouth, United Kingdom
- Turkish Chiropractic Association, Turkey
| | - Lyndon Amorin-Woods
- College of Health & Education, School of Allied Health, Murdoch University, Perth, Australia
| | | | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, United Kingdom
| | | | | | - Kendrah L. Da Silva
- Chiropractic Association of South Africa, Centurion, South Africa
- University of Johannesburg, Johannesburg, South Africa
| | - Dawn Dane
- Central Queensland University, Queensland, Australia
| | - Clinton J. Daniels
- Veterans Administration Puget Sound Health Care System, Tacoma, Washington
| | | | | | | | - Charles Henderson
- Henderson Technical Consulting and Life Chiropractic College West, Hayward, California
| | - Roger Hynes
- Palmer College of Chiropractic, Davenport, Iowa
| | - Valerie Johnson
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | - Matthew Kowalski
- Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig Little
- Council on Chiropractic Education, Scottsdale, Arizona
| | | | | | | | | | - Cynthia Peterson
- European Council on Chiropractic Education and Councils on Chiropractic Education International, British Columbia, Canada
- University of Johannesburg, Johannesburg, South Africa
| | | | | | - Gregory Snow
- Palmer College of Chiropractic West, San Jose, California
| | | | - Yi Kai Wong
- Association of Chiropractic Malaysia, Kuala Lumpur, Malaysia
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Lowry V, Desmeules F, Zidarov D, Lavigne P, Roy JS, Cormier AA, Tousignant-Laflamme Y, Perreault K, Lefèbvre MC, Décary S, Hudon A. "I wanted to know what was hurting so much": a qualitative study exploring patients' expectations and experiences with primary care management. BMC Musculoskelet Disord 2023; 24:755. [PMID: 37749557 PMCID: PMC10521438 DOI: 10.1186/s12891-023-06885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The management of shoulder pain is challenging for primary care clinicians considering that 40% of affected individuals remain symptomatic one year after initial consultation. Developing tailored knowledge mobilization interventions founded on evidence-based recommendations while also considering patients' expectations could improve primary care for shoulder pain. The aim of this qualitative study is to explore patients' expectations and experiences of their primary care consultation for shoulder pain. METHODS In this qualitative study, participants with shoulder pain and having consulted a primary care clinician in the past year were interviewed. All the semi-structured interviews were transcribed verbatim, and inductive thematic analysis was performed to identify themes related to the participants' expectations and experiences of primary care consultations for shoulder pain. RESULTS Thirteen participants with shoulder pain were interviewed (8 women, 5 men; mean age 50 ± 12 years). Eleven of them initially consulted a family physician or an emergency physician, and two participants initially consulted a physiotherapist. Four overarching themes related to patients' expectations and experiences were identified from our thematic analysis: 1) I can't sleep because of my shoulder; 2) I need to know what is happening with my shoulder; 3) But… we need to really see what is going on to help me!; and 4) Please take some time with me so I can understand what to do!. Several participants waited until they experienced a high level of shoulder pain before making an appointment since they were not confident about what their family physician could do to manage their condition. Although some participants felt that their physician took the time to listen to their concerns, many were dissatisfied with the limited assessment and education provided by the clinician. CONCLUSIONS Implementing evidence-based recommendations while considering patients' expectations is important as it may improve patients' satisfaction with healthcare. Several participants reported that their expectations were not met, especially when it came to the explanations provided. One unexpected finding that emerged from this study was the waiting period between the onset of shoulder pain and when patients decided to consult their primary care clinician.
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Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4.
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada.
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Institut Universitaire Sur La Réadaptation en Déficience Physique de Montréal (IURDPM), Montréal, Québec, Canada
| | - Patrick Lavigne
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Audrey-Anne Cormier
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), de l'Est-de-L'Île-de-Montréal, Montréal, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Kadija Perreault
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation Et Intégration Sociale (Cirris), Quebec City, QC, Canada
| | - Marie-Claude Lefèbvre
- Groupe de Médecine Familiale Universitaire (GMF-U) Maisonneuve-Rosemont, Montréal, Canada
| | - Simon Décary
- School of Rehabilitation, Medicine Faculty, University of Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada
| | - Anne Hudon
- School of Rehabilitation, Medicine Faculty, University of Montreal, 5415 L' Assomption Boulevard, Pav. Rachel Tourigny, Montreal, Canada, H1T 2M4
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
- Centre de Recherche en Éthique (CRÉ), Montréal, QC, Canada
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Henry-Blake C, Marshall M, Treadwell K, Parmar S, Higgs J, Edwards JJ, Peat G. The use of plain radiography in diagnosing osteoarthritis: A systematic review and time trend analysis. Musculoskeletal Care 2023; 21:462-477. [PMID: 36426659 DOI: 10.1002/msc.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The National Institute for Health and Care Excellence (NICE) suggest there is no role for routine radiography in the diagnosis of osteoarthritis (OA). It is not known how consistent this recommendation is across international guidelines, or the impact of UK guidance on domestic OA X-ray request rates. METHODS A systematic search identified guideline recommendations on the role of radiography in OA diagnosis. Full texts underwent dual screening and appraisal using the AGREE II tool. A narrative synthesis was performed. Consultation data were extracted from a UK primary care database: the Consultations in Primary Care Archives (CiPCA). The annual proportion of X-ray requests per 100 OA consulters from 2000 to 2012 were calculated. Joinpoint regression analysis examined if there were changes in the trend of X-ray request rates and compared these with the publication dates of UK guidelines. RESULTS Eighteen evidence-based OA guidelines were included in the review. Eleven recommended a clinical diagnosis of OA without radiographic confirmation. Seven recommended routine radiography; these guidelines were predominantly for radiologists. A mean of 17.3 X-rays per 100 patients were requested in patients consulting for OA per year between 2000 and 2012. A statistically significant reduction in X-ray request rates was seen in 2003. CONCLUSION Recommendations on the role of radiography in OA vary between medical specialty and countries. UK guidelines appear to have had a limited impact on X-ray request rates in OA.
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Affiliation(s)
| | | | - Kane Treadwell
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Simran Parmar
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Jordan Higgs
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - John J Edwards
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - George Peat
- School of Medicine, Keele University, Keele, Staffordshire, UK
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Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada. BMC PRIMARY CARE 2023; 24:49. [PMID: 36797670 PMCID: PMC9933814 DOI: 10.1186/s12875-023-01999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management. METHODS A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists' referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants' responses were compared between types of providers with Fisher's exact test. RESULTS Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes. CONCLUSIONS Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.
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Alqabbani S, Alsuwailem M, Alshammari M, Almutairi R, Alharthi G, Almuwais A. A preliminary exploration of attitudes, beliefs, and barriers to physical therapists' practices in ordering diagnostic imaging. J Back Musculoskelet Rehabil 2023; 36:609-618. [PMID: 36776037 DOI: 10.3233/bmr-220178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Diagnostic imaging (DI) studies are useful resources for examining musculoskeletal (MSK) conditions. When DI is used appropriately, it is an important tool for physical therapists (PTs). OBJECTIVE The purpose of this study was to explore the attitudes, beliefs, and barriers to PTs' practices in referring to DI in Saudi Arabia (SA). METHODS For this quantitative cross-sectional study, an online self-reported questionnaire was designed and distributed. A total of 138 PTs participated in the study. RESULTS Although most PTs had access to DI, few reported being able to order DI. The PTs demonstrated positive attitudes regarding their ability to refer patients for DI. Nevertheless, some PTs have adopted several beliefs and awareness of PTs regarding the clinical appropriateness of referring to DI, which may increase the unnecessary utilisation of DI requests. More than half of the PTs in this study reported that they were unfamiliar with the clinical rules used for prescribing imaging. CONCLUSION This study highlights recommendations to improve PTs' practices towards DI in SA, such as providing more DI courses targeting PTs and including clinical rules within DI education in undergraduate studies. Furthermore, a clear governmental policy is needed to permit PTs to refer to DI when specific criteria are met.
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Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: Clinical Practice Guideline Methods. J Orthop Sports Phys Ther 2022; 52:665-674. [PMID: 35881706 DOI: 10.2519/jospt.2022.11307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. J Orthop Sports Phys Ther 2022;52(10):665-674. Epub: 27 July 2022. doi:10.2519/jospt.2022.11307.
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Daghiani M, Negahban H, Ebrahimzadeh MH, Moradi A, Kachooei AR, Raeesi J, Divandari A. The effectiveness of comprehensive physiotherapy compared with corticosteroid injection on pain, disability, treatment effectiveness, and quality of life in patients with subacromial pain syndrome: a parallel, single-blind, randomized controlled trial. Physiother Theory Pract 2022:1-15. [DOI: 10.1080/09593985.2022.2044421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maryam Daghiani
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Moradi
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Kachooei
- Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Raeesi
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
| | - Akram Divandari
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, East Door of Ferdowsi University, Mashhad, Iran
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Kioh SH, Pooke TG, Chong SV. Use of Radiography for New Patients Presenting to a Chiropractic Teaching Clinic: A Cross-sectional Analysis. JOURNAL OF CHIROPRACTIC HUMANITIES 2021; 28:9-14. [PMID: 35002573 PMCID: PMC8720650 DOI: 10.1016/j.echu.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to identify the number and type of indications for radiographs ordered in a chiropractic teaching clinic in Malaysia. METHODS A cross-sectional retrospective analysis was conducted using the medical health records of new patients who presented to the International Medical University Bukit Jalil teaching clinic for chiropractic care between August 2018 and July 2019. Data about sociodemographic characteristics, region of presenting complaint, radiography ordering rates, and referral indications were collected. We compared indications reported in the patient records with those listed in the International Medical University Chiropractic Clinical Manual. We conducted χ2 and logistic regression analysis to identify the association between radiography indications and the number of radiographs ordered. RESULTS Data were collected for 1451 patients (741 [51.1%] women and 700 [48.9%] men). The most common body region for the presenting complaint was the lumbar/pelvic region (39.0%), and the overall radiograph use rate was 2.7%, with the highest number of radiographs for the lumbar spine. CONCLUSION For the patient files sampled in this study, the overall radiograph order rate in the International Medical University Bukit Jalil Chiropractic teaching clinic was 2.7%.
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Affiliation(s)
- Sheng Hui Kioh
- Corresponding author: Sheng Hui Kioh, Department of Chiropractic, International Medical University, 126, Jln Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory of Kuala Lumpur, Kuala Lumpur, Malaysia
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11
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Coleman BC, Goulet JL, Higgins DM, Bathulapalli H, Kawecki T, Ruser CB, Bastian LA, Martino S, Piette JD, Edmond SN, Heapy AA. ICD-10 Coding of Musculoskeletal Conditions in the Veterans Health Administration. PAIN MEDICINE 2021; 22:2597-2603. [PMID: 33944953 DOI: 10.1093/pm/pnab161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE We describe the most frequently used musculoskeletal diagnoses in Veterans Health Administration (VHA) care. We report the number of visits and patients associated with common musculoskeletal ICD-10 codes and compare trends across primary and specialty care settings. DESIGN Secondary analysis of a longitudinal cohort study. SUBJECTS Veterans included in the Musculoskeletal Diagnosis Cohort with a musculoskeletal diagnosis from October 1, 2015 through September 30, 2017. METHODS We obtained counts and proportions of all musculoskeletal diagnosis codes used and the number of unique patients with each musculoskeletal diagnosis. Diagnosis use was compared between primary and specialty care settings. RESULTS Of over 6,400 possible ICD-10 M-codes describing "Diseases of the Musculoskeletal System and Connective Tissue", 5,723 codes were used at least once. The most frequently used ICD-10 M-code was "Low Back Pain" (18.3%) followed by "Cervicalgia" (3.6%). Collectively, the 100 most frequently used codes accounted for 80% of M-coded visit diagnoses, and 95% of patients had at least one of these diagnoses. The most common diagnoses (spinal pain, joint pain, osteoarthritis) were used similarly in primary and specialty care settings. CONCLUSION A diverse sample of all available musculoskeletal diagnosis codes were used; however, less than 2% of all possible codes accounted for 80% of the diagnoses used. This trend was consistent across primary and specialty care settings. The most frequently used diagnosis codes describe the types of musculoskeletal conditions, among a large pool of potential diagnoses, that prompt veterans to present to VHA for musculoskeletal care.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA.,Boston University School of Medicine, Boston, MA
| | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Todd Kawecki
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Christopher B Ruser
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Steve Martino
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - John D Piette
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.,University of Michigan School of Public Health, Ann Arbor, MI
| | - Sara N Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Alicia A Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
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12
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Riera J, Smythe A, Malliaras P. French physiotherapy management of rotator cuff related shoulder pain: An observational study. Musculoskeletal Care 2021; 19:484-494. [PMID: 33666355 DOI: 10.1002/msc.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Rotator cuff related shoulder pain (RCRSP) is a common and disabling cause of shoulder pain contributing to great socio-economic costs. Conservative management is recommended as first-line treatment, with studies performed in the United Kingdom, Belgium, the Netherlands and Australia finding practice generally consistent with guideline recommendations. Current French guidelines for management of RCRSP were published more than a decade ago, and it is unknown if French physiotherapists manage RCRSP in line with the current guideline recommendations. The aim of this survey is to evaluate if management delivered by French physiotherapists for RCRSP is in line with the current evidence. METHODS A cross-sectional online survey was conducted and disseminated through various social media platforms and a mailing list from December 2018 to March 2019. RESULTS Two hundred and six French physiotherapists completed the survey. The results demonstrated that the majority of physiotherapists provide care consistent with recommended guideline management, through the delivery of exercise and education. Ideology and specific parameters of treatment delivery, particularly exercise treatment, were highly variable among the cohort, but comparable to findings among physiotherapists in the United Kingdom, Belgium, the Netherlands and Australia. CONCLUSION French physiotherapists are broadly consistent with providing guideline recommended care of RCRSP; however, heterogeneity exists in the ideals and practice of specific treatment delivery, particularly within exercise management.
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Affiliation(s)
| | - Andrew Smythe
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia.,A Game Physiotherapy, Somerville, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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13
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Johnson CD. Chiropractic Day: A Historical Review of a Day Worth Celebrating. JOURNAL OF CHIROPRACTIC HUMANITIES 2020; 27:1-10. [PMID: 34061916 PMCID: PMC8074684 DOI: 10.1016/j.echu.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The purpose of this paper is to review and discuss historical concepts about the celebration of Chiropractic Day. DISCUSSION Daniel David Palmer attributed September 18, 1895 to be the day that he delivered the first chiropractic adjustment. As the chiropractic profession grew, the celebration of Chiropractic Day became more widespread throughout the United States and the world. This paper offers suggestions about how to celebrate Chiropractic Day. Activities include educating, learning, honoring, volunteering, and engaging. CONCLUSION The chiropractic profession celebrates its birth on September 18. Regardless of the many different names used over the past 125 years, including Chiropractic Founder's Day, Chiropractic Rally Day, Chiropractic Anniversary, and Chiropractic Discovery Day, the celebration of this special day provides an opportunity to reflect on how far the profession has come and how chiropractors continue to help and serve their patients.
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Affiliation(s)
- Claire D. Johnson
- Corresponding author: Claire D. Johnson, DC, MSEd, PhD, 200 E Roosevelt Dr., Lombard, IL 60148
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14
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Askew JJ, Kranz KC, Whalen WM. Federal Employees' Compensation Act and Mandating the Use of X-ray for Chiropractic Management of Federal Employees: An Exploration of Concerns and a Call to Action. JOURNAL OF CHIROPRACTIC HUMANITIES 2020; 27:11-20. [PMID: 33324132 PMCID: PMC7729097 DOI: 10.1016/j.echu.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/20/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this article is to explore concerns regarding sections of the federal workers' compensation law that apply to the treatment and management of work-related injuries of federal employees by chiropractors, and to offer a call to action for change. DISCUSSION A 1974 amendment to the Federal Employees' Compensation Act (FECA) stipulates that chiropractic services rendered to injured federal workers are reimbursable. However, the only reimbursable chiropractic treatment is "manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist." This means the chiropractor must take radiographs in order to be reimbursed. As with other health care professions, chiropractors are expected to practice according to best practices guided by studies in the scientific literature. Yet in the federal workers' compensation arena, this law requires chiropractors to practice in a manner that is fiscally wasteful, contradicts current radiology standards, and may expose patients to unnecessary X-ray radiation. Presently, there is discord between what the law mandates, chiropractic training and scope, and what professional guidelines recommend. In this article we discuss how FECA creates problems in the following 7 categories: direct harm, indirect harm, contradiction of best practices, ethical dilemma, barriers to conservative treatment, fiscal waste, and discrimination. CONCLUSION The 1974 FECA provision requiring chiropractors to take radiographs regardless of presenting medical necessity should be updated to reflect current chiropractic education, training, and best practice. To resolve this discrepancy, we suggest that the radiographic requirement and the limitations placed on chiropractic physicians should be removed.
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Affiliation(s)
- Jeff J. Askew
- Sanford Health Chiropractic and Occupational Medicine, Bismarck, North Dakota
| | - Karl C. Kranz
- New York State Chiropractic Association, City, Niskayuna, New York
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15
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Hawk C, Whalen W, Farabaugh RJ, Daniels CJ, Minkalis AL, Taylor DN, Anderson D, Anderson K, Crivelli LS, Cark M, Barlow E, Paris D, Sarnat R, Weeks J. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med 2020; 26:884-901. [PMID: 32749874 PMCID: PMC7578188 DOI: 10.1089/acm.2020.0181] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: To develop an evidence-based clinical practice guideline (CPG) through a broad-based consensus process on best practices for chiropractic management of patients with chronic musculoskeletal (MSK) pain. Design: CPG based on evidence-based recommendations of a panel of experts in chronic MSK pain management. Methods: Using systematic reviews identified in an initial literature search, a steering committee of experts in research and management of patients with chronic MSK pain drafted a set of recommendations. Additional supportive literature was identified to supplement gaps in the evidence base. A multidisciplinary panel of experienced practitioners and educators rated the recommendations through a formal Delphi consensus process using the RAND Corporation/University of California, Los Angeles, methodology. Results: The Delphi process was conducted January-February 2020. The 62-member Delphi panel reached consensus on chiropractic management of five common chronic MSK pain conditions: low-back pain (LBP), neck pain, tension headache, osteoarthritis (knee and hip), and fibromyalgia. Recommendations were made for nonpharmacological treatments, including acupuncture, spinal manipulation/mobilization, and other manual therapy; modalities such as low-level laser and interferential current; exercise, including yoga; mind-body interventions, including mindfulness meditation and cognitive behavior therapy; and lifestyle modifications such as diet and tobacco cessation. Recommendations covered many aspects of the clinical encounter, from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral. Appropriate referral and comanagement were emphasized. Conclusions: These evidence-based recommendations for a variety of conservative treatment approaches to the management of common chronic MSK pain conditions may advance consistency of care, foster collaboration between provider groups, and thereby improve patient outcomes.
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Affiliation(s)
- Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
| | | | | | | | | | | | | | | | | | | | | | - David Paris
- VA Northern CA Health Care System, Redding, CA, USA
| | - Richard Sarnat
- Advanced Medicine Integration Group, L.P., Columbus, OH, USA
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16
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Smythe A, White J, Littlewood C, Bury J, Haines T, Malliaras P. Physiotherapists deliver management broadly consistent with recommended practice in rotator cuff tendinopathy: An observational study. Musculoskelet Sci Pract 2020; 47:102132. [PMID: 32148327 DOI: 10.1016/j.msksp.2020.102132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/02/2019] [Accepted: 02/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rotator cuff tendinopathy is a common and disabling cause of shoulder pain. While conservative treatment is recommended as initial management, recent findings suggest that general practitioners and rheumatologists do not consistently align with recommended care. This study aimed to survey Australian physiotherapists to explore the extent to which recommended management is being applied. METHODS A cross-sectional online survey. RESULTS Five hundred and two Australian physiotherapists completed the survey. Results demonstrated the majority of physiotherapists provide conservative management consistent with guideline recommendations, through delivery of exercise and education, comparable to management by physiotherapists in the United Kingdom, Belgium and the Netherlands. Parameters and construction of exercise treatment programs were highly variable within the cohort, qualitative analysis highlighting varied reasoning underpinning these management decisions. CONCLUSIONS Australian physiotherapists are broadly consistent with providing recommended management, however heterogeneity exists in the methods and parameters of treatment delivery.
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Affiliation(s)
- A Smythe
- A Game Physiotherapy, Somerville, Melbourne, 3912, Australia.
| | - J White
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| | - C Littlewood
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, ST54 5BG, UK
| | - J Bury
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster Royal Infirmary, Doncaster, DN2 5LT, UK
| | - T Haines
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
| | - P Malliaras
- School of Primary and Allied Health Care, Monash University, Frankston, 3199, Australia
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17
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Doiron-Cadrin P, Lafrance S, Saulnier M, Cournoyer É, Roy JS, Dyer JO, Frémont P, Dionne C, MacDermid JC, Tousignant M, Rochette A, Lowry V, Bureau NJ, Lamontagne M, Coutu MF, Lavigne P, Desmeules F. Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations. Arch Phys Med Rehabil 2020; 101:1233-1242. [PMID: 32007452 DOI: 10.1016/j.apmr.2019.12.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults. DATA SOURCES A systematic bibliographic search was conducted up until May 2018 in Medline, Embase, and Physiotherapy Evidence Database, or PEDro, databases, in addition to 12 clinical guidelines search engines listed on the Appraisal of Guidelines for Research and Evaluation (AGREE) website. STUDY SELECTION Nine CPGs on the management of rotator cuff disorders in adults or workers, available in English or French, and published from January 2008 onward, were included and screened by 2 independent reviewers. DATA EXTRACTION CPG methodology was assessed with the AGREE II checklist. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following 4 levels: "essential," "recommended," "may be recommended," and "not recommended." DATA SYNTHESIS Methodological quality was considered high for 3 CPGs and low for 6. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen or nonsteroidal anti-inflammatory drug prescriptions and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return-to-work strategies included intervening early, use of a multidisciplinary approach, and adaptation of work organization. CONCLUSIONS Only 3 CPGs were of high quality. The development of more rigorous CPGs is warranted.
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Affiliation(s)
- Patrick Doiron-Cadrin
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada
| | - Simon Lafrance
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada
| | - Marie Saulnier
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada
| | - Émie Cournoyer
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec City, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Québec, Canada
| | - Joseph-Omer Dyer
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Pierre Frémont
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | - Clermont Dionne
- Department of Rehabilitation, Faculty of Medicine, Laval University, Québec City, Québec, Canada; Laval University Hospital Center of Research, Québec City, Québec, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Michel Tousignant
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, Québec, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada; Center for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
| | - Véronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada
| | - Nathalie J Bureau
- Department of Radiology, Oncology and Nuclear Medicine, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada; University of Montréal Hospital Research Center (CHUM), Montréal, Québec, Canada
| | - Martin Lamontagne
- Department of Medicine, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Marie-France Coutu
- Centre for Work Disability Prevention and Rehabilitation, Charles Le Moyne Hospital Research Centre affiliated with Sherbrooke University, Longueuil, Canada
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada; Department of Surgery, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada.
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18
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Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain. J Manipulative Physiol Ther 2019; 42:635-650. [DOI: 10.1016/j.jmpt.2019.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/15/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022]
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of closed hand and wrist injuries in the emergency department (part 5 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2018; 30:610-640. [DOI: 10.1111/1742-6723.12969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/16/2018] [Accepted: 02/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kirsten Strudwick
- Emergency Department; Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service; Brisbane Queensland Australia
- Physiotherapy Department; Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service; Brisbane Queensland Australia
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Megan McPhee
- Physiotherapy Department; Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service; Brisbane Queensland Australia
| | - Anthony Bell
- Emergency and Trauma Centre; Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service; Brisbane Queensland Australia
- Faculty of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research; Faculty of Medicine, The University of Queensland; Brisbane Queensland Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences; The University of Queensland; Brisbane Queensland Australia
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20
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Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series). Emerg Med Australas 2018; 30:456-485. [PMID: 29345427 DOI: 10.1111/1742-6723.12921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/24/2017] [Accepted: 11/23/2017] [Indexed: 01/16/2023]
Abstract
Shoulder injuries are a commonly presenting complaint to the ED. In the absence of an obvious deformity, they can be difficult to assess and definitively diagnose because of the multiple structures that cause shoulder pain, the acuity and severity of pain and the lack of range of motion in the ED setting. The quality of ED care provided to patients with musculoskeletal shoulder pain is crucial to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common shoulder injuries and conditions in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines published in English-language in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were considered for inclusion. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence. The search revealed 1902 articles, of which 73 were included in the review (n = 12 primary articles, n = 49 systematic reviews and n = 12 guidelines). This rapid review provides clinicians who manage shoulder dislocations, fractures and soft tissue injuries in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is strong evidence to support taking a thorough history and physical examination, with cautious use of special tests because of their poor diagnostic accuracy. Key points regarding the diagnosis and management of these injuries are provided.
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Affiliation(s)
- Kirsten Strudwick
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan McPhee
- Physiotherapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Anthony Bell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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21
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Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Mathiassen SE, Barbe MF, Ali S. Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders. BMC Musculoskelet Disord 2017; 18:395. [PMID: 28899384 PMCID: PMC5596923 DOI: 10.1186/s12891-017-1694-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/24/2017] [Indexed: 01/04/2023] Open
Abstract
Background This study systematically summarizes quantitative imaging biomarker research in non-traumatic neck and shoulder musculoskeletal disorders (MSDs). There were two research questions: 1) Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?, 2) Are there quantitative imaging biomarkers associated with the severity of neck and shoulder MSDs? Methods PubMed and SCOPUS were used for the literature search. One hundred and twenty-five studies met primary inclusion criteria. Data were extracted from 49 sufficient quality studies. Results Most of the 125 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. Only half controlled for potential confounders via exclusion or in the analysis. Approximately one-third reported response rates. In sufficient quality articles, 82% demonstrated at least one statistically significant association between the MSD(s) and biomarker(s) studied. The literature synthesis suggested that neck muscle size may be decreased in neck pain, and trapezius myalgia and neck/shoulder pain may be associated with reduced vascularity in the trapezius and reduced trapezius oxygen saturation at rest and in response to upper extremity tasks. Reduced vascularity in the supraspinatus tendon may also be a feature in rotator cuff tears. Five of eight studies showed an association between a quantitative imaging marker and MSD severity. Conclusions Although research on quantitative imaging biomarkers is still in a nascent stage, some MSD biomarkers were identified. There are limitations in the articles examined, including possible selection bias and inattention to potentially confounding factors. Recommendations for future studies are provided. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1694-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith E Gold
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden. .,Gold Standard Research Consulting, 830 Montgomery Ave, Bryn Mawr, PA, USA.
| | - David M Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Fredrik Hellström
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Martin Björklund
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Albert G Crenshaw
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Svend Erik Mathiassen
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University Medical School, Philadelphia, PA, USA
| | - Sayed Ali
- Department of Radiology, Temple University Medical School, Philadelphia, PA, USA
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22
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Hawk C, Minkalis AL, Khorsan R, Daniels CJ, Homack D, Gliedt JA, Hartman JA, Bhalerao S. Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions. J Manipulative Physiol Ther 2017; 40:293-319. [DOI: 10.1016/j.jmpt.2017.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 12/18/2022]
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Young KJ. Historical influence on the practice of chiropractic radiology: Part I - a survey of Diplomates of the American Chiropractic College of Radiology. Chiropr Man Therap 2017; 25:14. [PMID: 28503292 PMCID: PMC5421324 DOI: 10.1186/s12998-017-0146-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/02/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND It is known that not all chiropractors follow mainstream guidelines on the use of diagnostic ionising radiation. Various reasons have been discussed in the literature, including using radiography to screen for congenital anomalies, to perform postural analysis, to search for contraindications to spinal manipulation, and to document chiropractic subluxations, i.e., tiny anatomical displacements of vertebrae thought to affect nerves and health. The visualisation of subluxations was the reason chiropractic first adopted the x-ray in 1910. There has never been a study of the influence of this historical paradigm of radiography on the practices of chiropractic radiologists (DACBRs or Diplomates of the American Chiropractic College of Radiology). METHODS A survey was administered with a modified Dillman method using SurveyMonkey and supplemented by hard copies distributed at a professional conference. The target population was all active DACBRs. There were 34 items, which consisted of multiple choice and open-ended interrogatives on all three areas in which chiropractic radiologists work: education, clinical practice, and radiology practice. RESULTS The response rate was 38% (73 of 190 DACBRs). Respondents reported that the historical paradigm of radiography was found in all areas of practice, but not as a major aspect. The majority of respondents did not condone that historical paradigm, but many tolerated it, particularly from referring chiropractors. Radiographic subluxation analysis was reportedly perpetuated by private clinical practitioners as well as technique instructors and supervising clinicians in the teaching institutions. CONCLUSIONS Within the chiropractic profession, there is a continuing belief in radiographically visible subluxations as a cause of suboptimal health. This situation is sustained in part due to the reticence of other chiropractors to report these practices to licensing and registration boards. Investigation into other structures supporting a vitalistic belief system over science in chiropractic is recommended. In addition, it may be useful to explore remunerative systems that move beyond the inherently conflicted fee-for-service model.
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Affiliation(s)
- Kenneth J. Young
- School of Arts, School of Health Professions, Murdoch University, Perth, WA 6150 Australia
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Young KJ. Historical influence on the practice of chiropractic radiology: part II - thematic analysis on the opinions of diplomates of the American Chiropractic College of Radiology about the future. Chiropr Man Therap 2017; 25:15. [PMID: 28503293 PMCID: PMC5421334 DOI: 10.1186/s12998-017-0145-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past 20 years, various authors have addressed the question of the future of chiropractic. Most were positive about the future, with some advocating evidence-based practice and integration with mainstream healthcare, some advocating continued separation with an emphasis on subluxation-based care or the traditional/historical paradigm of chiropractic, and some calling for tolerance and unity. No papers were found specifically inquiring about the future of chiropractic radiology. METHODS The study population consisted of all current members of the American Chiropractic College of Radiology (ACCR), estimated at 190 people, known as chiropractic radiologists or Diplomates of the American Chiropractic Board of Radiology (DACBRs). An internet-based, anonymous survey using SurveyMonkey was implemented, supplemented by hard copies distributed at a conference. The main point of interest for this paper is the final item of the overall questionnaire. This item inquired about the future of chiropractic radiology. Thematic analysis was used on the responses, coded in both constructionist and inductive ways to extract both a general outlook and more specific themes. The inductive themes were also assigned secondarily to a SWOT (strengths, weaknesses, opportunities, and threats) analysis. RESULTS The overall response rate to the survey was 38% (73/190); within the group of respondents, 71 of 73 (98%) answered the item that is the subject of this paper. Opinions on the outlook for chiropractic radiology in the future were more negative than positive, with 14 respondents giving a positive outlook, 26 negative, and 14 non-committal. 28 respondents advocated integration with the wider healthcare community, 11 recommended emphasising separateness or a focus on working within chiropractic, and 15 did not express an opinion on this issue. Ten strengths were noted, 11 weaknesses, 57 opportunities, and 30 threats. CONCLUSIONS The increasing necessity of demonstrating evidence for diagnostic and therapeutic procedures in healthcare makes it likely that chiropractic radiologists and the wider chiropractic profession will need to take a more active position on evidence-based practice. Re-evaluation of guidelines and legislation as well as enforcement policies and practices will be necessary. The consequences of failing to do so may include increased marginalisation and reduced viability as a profession.
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Affiliation(s)
- Kenneth J. Young
- School of Arts, School of Health Professions, Murdoch University, Perth, WA 6150 Australia
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Lukersmith S, Hopman K, Vine K, Krahe L, McColl A. A new framing approach in guideline development to manage different sources of knowledge. J Eval Clin Pract 2017; 23:66-72. [PMID: 27198591 DOI: 10.1111/jep.12566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
Abstract
RATIONALE Contemporary guideline methodology struggles to consider context and information from different sources of knowledge besides quantitative research. Return to work programmes involve multiple components and stakeholders. If the guideline is to be relevant and practical for a complex intervention such as return to work, it is essential to use broad sources of knowledge. AIMS AND OBJECTIVE This paper reports on a new method in guideline development to manage different sources of knowledge. METHODS The method used framing for the return-to-work guidance within the Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. The development involved was a multi-disciplinary working party of experts including consumers. The researchers considered a broad range of research, expert (practice and experience) knowledge, the individual's and workplace contexts, and used framing with the International Classification of Functioning, Disability and Health. Following a systematic database search on four clinical questions, there were seven stages of knowledge management to extract, unpack, map and pack information to the ICF domains framework. Companion graded recommendations were developed. RESULTS The results include practical examples, user and consumer guides, flow charts and six graded or consensus recommendations on best practice for return to work intervention. CONCLUSIONS Our findings suggest using framing in guideline methodology with internationally accepted frames such as the ICF is a reliable and transparent framework to manage different sources of knowledge. Future research might examine other examples and methods for managing complexity and using different sources of knowledge in guideline development.
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Affiliation(s)
| | | | - Kristina Vine
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| | - Lee Krahe
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
| | - Alexander McColl
- University of New South Wales Rural Clinical School, Port Macquarie, Australia
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Young KJ. Evaluation of publicly available documents to trace chiropractic technique systems that advocate radiography for subluxation analysis: a proposed genealogy. JOURNAL OF CHIROPRACTIC HUMANITIES 2014; 21:1-24. [PMID: 25431540 PMCID: PMC4245702 DOI: 10.1016/j.echu.2014.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate publicly available information of chiropractic technique systems that advocate radiography for subluxation detection to identify links between chiropractic technique systems and to describe claims made of the health effects of the osseous misalignment component of the chiropractic subluxation and radiographic paradigms. METHODS The Internet and publicly available documents were searched for information representing chiropractic technique systems that advocate radiography for subluxation detection. Key phrases including chiropractic, x-ray, radiography, and technique were identified from a Google search between April 2013 and March 2014. Phrases in Web sites and public documents were examined for any information about origins and potential links between these techniques, including the type of connection to BJ Palmer, who was the first chiropractor to advocate radiography for subluxation detection. Quotes were gathered to identify claims of health effects from osseous misalignment (subluxation) and paradigms of radiography. Techniques were grouped by region of the spine and how they could be traced back to B.J Palmer. A genealogy model and summary table of information on each technique were created. Patterns in year of origination and radiographic paradigms were noted, and percentages were calculated on elements of the techniques' characteristics in comparison to the entire group. RESULTS Twenty-three techniques were identified on the Internet: 6 full spine, 17 upper cervical, and 2 techniques generating other lineage. Most of the upper cervical techniques (14/16) traced their origins to a time when the Palmer School was teaching upper cervical technique, and all the full spine techniques (6/6) originated before or after this phase. All the technique systems' documents attributed broad health effects to their methods. Many (21/23) of the techniques used spinal realignment on radiographs as one of their outcome measures. CONCLUSION Chiropractic technique systems in this study (ie, those that advocate for radiography for subluxation misalignment detection) seem to be closely related by descent, their claims of a variety of health effects associated with chiropractic subluxation, and their radiographic paradigms.
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Affiliation(s)
- Kenneth J. Young
- Murdoch University, South Street, Murdoch, WA 6150 Australia. Tel.: + 61 8 9360 7370; fax: + 61 8 9360 1203.
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Young KJ. Gimme that old time religion: the influence of the healthcare belief system of chiropractic's early leaders on the development of x-ray imaging in the profession. Chiropr Man Therap 2014; 22:36. [PMID: 25392731 PMCID: PMC4228104 DOI: 10.1186/s12998-014-0036-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 10/12/2014] [Indexed: 12/23/2022] Open
Abstract
Background Chiropractic technique systems have been historically documented to advocate overutilization of radiography. Various rationales for this have been explored in the literature. However, little consideration has been given to the possibility that the healthcare belief system of prominent early chiropractors may have influenced the use of the diagnostic modality through the years. The original rationale was the visualisation of chiropractic subluxations, defined as bones slightly out of place, pressing on nerves, and ultimately causing disease. This paradigm of radiography has survived in parts of the chiropractic profession, despite lacking evidence of clinical validity. The purpose of this paper is to compare the characteristics of the chiropractic technique systems that have utilised radiography for subluxation detection with the characteristics of religion, and to discover potential historical links that may have facilitated the development of those characteristics. Discussion Twenty-three currently or previously existing technique systems requiring radiography for subluxation analysis were found using a search of the internet, books and consultation with experts. Evidence of religiosity from the early founders’ writings was compared with textbooks, published papers, and websites of subsequently developed systems. Six criteria denoting religious thinking were developed using definitions from various sources. They are: supernatural concepts, claims of supremacy, rules and rituals, sacred artefacts, sacred stories, and special language. All of these were found to a greater or lesser degree in the publicly available documents of all the subluxation-based chiropractic x-ray systems. Summary The founders and early pioneers of chiropractic did not benefit from the current understanding of science and research, and therefore substituted deductive and inductive reasoning to arrive at conclusions about health and disease in the human body. Some of this thinking and rationalisation demonstrably followed a religion-like pattern, including BJ Palmer’s use of radiography. Although access to scientific methods and research education became much advanced and more accessible during the past few decades, the publicly available documents of technique systems that used radiography for chiropractic subluxation detection examined in this paper employed a historically derived paradigm for radiography that displayed characteristics in common with religion. Electronic supplementary material The online version of this article (doi:10.1186/s12998-014-0036-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kenneth John Young
- School of Arts; Senior Lecturer, School of Health Professions, Murdoch University, South Street, Murdoch, 6150 Australia
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Abstract
As musculoskeletal disorders are a common cause of emergency department visits in the United States, it is vital for nurses and nurse practitioners to understand the decision rules for ordering imaging tests when triaging patients with musculoskeletal complaints. Proper knowledge and command of selecting the most appropriate imaging for these frequent emergency department presentations will help reduce costs, decrease ionizing radiation exposure, and increase patient throughput. This article reviews the current evidence-based literature for musculoskeletal imaging in the emergency department and discusses the epidemiology, etiology, management, and prevention of the most common musculoskeletal disorders.
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Expanding nurse initiated X-rays in emergency care using team-based learning and decision support. ACTA ACUST UNITED AC 2013; 16:10-20. [DOI: 10.1016/j.aenj.2012.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 11/23/2022]
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Smith SD, Beran TN. Practice Analysis of Chiropractic Radiology: Identifying Items for Part I of the Clinical Competency Examination. J Manipulative Physiol Ther 2012. [DOI: 10.1016/j.jmpt.2012.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Taylor JA, Bussières A. Diagnostic imaging for spinal disorders in the elderly: a narrative review. Chiropr Man Therap 2012; 20:16. [PMID: 22625868 PMCID: PMC3438046 DOI: 10.1186/2045-709x-20-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 05/24/2012] [Indexed: 12/19/2022] Open
Abstract
The high prevalence of neck and low back pain in the rapidly aging population is associated with significant increases in health care expenditure. While spinal imaging can be useful to identify less common causes of neck and back pain, overuse and misuse of imaging services has been widely reported. This narrative review aims to provide primary care providers with an overview of available imaging studies with associated potential benefits, adverse effects, and costs for the evaluation of neck and back pain disorders in the elderly population. While the prevalence of arthritis and degenerative disc disease increase with age, fracture, infection, and tumor remain uncommon. Prevalence of other conditions such as spinal stenosis and abdominal aortic aneurysm (AAA) also increase with age and demand special considerations. Radiography of the lumbar spine is not recommended for the early management of non-specific low back pain in adults under the age of 65. Aside from conventional radiography for suspected fracture or arthritis, magnetic resonance imaging (MRI) and computed tomography (CT) offer better characterization of most musculoskeletal diseases. If available, MRI is usually preferred over CT because it involves less radiation exposure and has better soft-tissue visualization. Use of subspecialty radiologists to interpret diagnostic imaging studies is recommended.
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Affiliation(s)
- John Am Taylor
- Department of Chiropractic, D'Youville College, 320 Porter Avenue, Buffalo, NY, 14201, USA.
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Evans KD, Roll SC, Volz KR, Freimer M. Relationship between intraneural vascular flow measured with sonography and carpal tunnel syndrome diagnosis based on electrodiagnostic testing. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:729-36. [PMID: 22535720 PMCID: PMC3673781 DOI: 10.7863/jum.2012.31.5.729] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The purpose of this study was to document and analyze intraneural vascular flow within the median nerve using power and spectral Doppler sonography and to determine the relationship of this vascular flow with diagnosis of carpal tunnel syndrome based on electrodiagnostic testing. METHODS Power and spectral Doppler sonograms in the median nerve were prospectively collected in 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted with a 12-MHz linear transducer. Strict inclusion criteria were established for postexamination assessment of waveforms; routine quality assurance was completed; electrodiagnostic tests were conducted on the same day as sonographic measurements; and the skin temperature was controlled. Included waveforms were categorized by location and averaged by individual for comparative analysis to electrodiagnostic testing. RESULTS A total of 416 waveforms were collected, and 245 were retained for statistical analysis based on strict inclusion criteria. The mean spectral peak velocity among all waveforms was 4.42 (SD, 2.15) cm/s. At the level of the pisiform, the most consistent data point, mean peak systole, was 3.75 cm/s in symptomatic patients versus 4.26 cm/s in asymptomatic controls. Statistical trending showed an initial increase in the mean spectral peak velocity in symptomatic but diagnostically negative cases, with decreasing velocity as diagnostic categories progressed from mild to severe. CONCLUSIONS An inverse relationship may exist between intraneural vascular flow in the median nerve and an increasing severity of carpal tunnel syndrome based on nerve conduction results. Randomized controlled trials are needed to determine whether spectral Doppler sonography can provide an additive benefit for diagnosing the severity of carpal tunnel syndrome.
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Affiliation(s)
- Kevin D Evans
- School of Allied Medical Professions, The Ohio State University, College of Medicine, Columbus, OH 43210, USA.
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Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. CHIROPRACTIC & OSTEOPATHY 2010; 18:3. [PMID: 20184717 PMCID: PMC2841070 DOI: 10.1186/1746-1340-18-3] [Citation(s) in RCA: 274] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 02/25/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions. METHODS The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs. RESULTS By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines.Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments. CONCLUSIONS Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.
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Affiliation(s)
- Gert Bronfort
- Northwestern Health Sciences University, Bloomington, MN, USA.
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Johnson C, Baird R, Dougherty PE, Globe G, Green BN, Haneline M, Hawk C, Injeyan HS, Killinger L, Kopansky-Giles D, Lisi AJ, Mior SA, Smith M. Chiropractic and Public Health: Current State and Future Vision. J Manipulative Physiol Ther 2008; 31:397-410. [DOI: 10.1016/j.jmpt.2008.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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