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Driehuis F, Bakker-Jacobs A, Staal JB, de Bie RA, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Parents' and healthcare professionals' perspectives on manual therapy in infants: A mixed-methods study. PLoS One 2023; 18:e0283646. [PMID: 37023071 PMCID: PMC10079100 DOI: 10.1371/journal.pone.0283646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Manual therapy in infants is embedded in Dutch healthcare despite inconsistent evidence and ongoing debate about its safety and merits. This study examines decision-making in manual therapy in infants and explores parents' and healthcare professionals' perspectives on this treatment approach. METHODS This mixed-methods study consisted of an online survey among manual physiotherapists and paediatric physiotherapists exploring decision-making on manual therapy in infants and interprofessional collaboration. These data prompted further exploration and were combined with data collected with semi-structured interviews exploring parents' and healthcare professionals' perspectives. Interviews were analysed using an inductive content analysis approach. RESULTS 607 manual physiotherapists and 388 paediatric physiotherapists completed the online survey; 45% and 95% indicated they treat infants, respectively. Collaboration was reported by 46% of manual physiotherapists and 64% of paediatric physiotherapists for postural asymmetry, positional preference, upper cervical dysfunction, excessive crying, anxiety or restlessness. Reasons to not treat or collaborate were: limited professional competence, practice policy, not perceiving added value, lack of evidence and fear of complications. Analysis of interviews with 7 parents, 9 manual physiotherapists, 7 paediatric physiotherapists, 5 paediatricians and 2 maternity nurses revealed that knowledge and beliefs, professional norms, interpersonal relation, treatment experiences and emotions of parents influenced attitudes and decision-making towards choosing for manual therapy in infants. CONCLUSION Parents' and healthcare professionals' attitudes towards manual therapy in infants can be divided as 'in favour' or 'against'. Those who experienced a good interpersonal relation with a manual physiotherapist and positive treatment outcomes reported positive attitudes. Lack of evidence, treatment experience and related knowledge, safety issues due to publications on adverse events and professional norms led to negative attitudes. Despite lacking evidence, positive treatment experiences, good interpersonal relation and parents feeling frustrated and despaired can overrule negative attitudes and directly influence the decision-making process and choosing for manual therapy treatment.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annick Bakker-Jacobs
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | | | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Doucet C, Dubuc É, Imbeau C, Pohlman KA, Blanchette MA. Chiropractic pediatric patient management and interdisciplinary collaboration: a descriptive cross-sectional study of chiropractors in Quebec. Chiropr Man Therap 2022; 30:54. [PMID: 36514117 PMCID: PMC9746577 DOI: 10.1186/s12998-022-00464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Worldwide, many patients, including minors, seek chiropractic care. The purpose of this study was to investigate the practice characteristics of chiropractors who treat pediatric patients in Quebec, Canada. METHODS We conducted a web-based cross-sectional survey of all licensed chiropractors working in Quebec (Canada). Data were collected using an adapted questionnaire. Descriptive statistics were produced for all the variables collected. RESULTS Among our 245 participants (response rate: 21%), 63% were women, and half defined themselves as general musculoskeletal (MSK) health care practitioners. Nearly all participants reported seeing 0-5 new pediatric patients/week, and the most common pediatric age group was 6-12 years old (57%). Pediatric patients were most commonly referred by family members and "word of mouth". The respondents most frequently indicated that they strongly agreed with statements affirming their confidence in their own diagnostic capacities regarding MSK disorders with respect to all age groups as well as non-MSK disorders with regard to young teens. They reported a moderate level of agreement with similar statements concerning the diagnosis of non-MSK disorders in newborns, preschoolers, and children. Chiropractors rarely referred their pediatric patients to a nurse/family doctor or a pediatrician. When presented with potential pediatric red flags, the respondents commonly indicated that they would refer the patient to a physician in an emergency situation or for comanagement. CONCLUSION Chiropractors in Quebec are confident in their diagnoses of pediatric MSK conditions and refer patients to physicians in the rare event of a worrisome presentation. However, some chiropractors may have expectations that are unsupported by evidence regarding the diagnosis and management of non-MSK complaints.
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Affiliation(s)
- Chantale Doucet
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
| | - Élisa Dubuc
- grid.265703.50000 0001 2197 8284Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC G9A 5H7 Canada
| | - Camille Imbeau
- grid.265703.50000 0001 2197 8284Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC G9A 5H7 Canada
| | | | - Marc-André Blanchette
- grid.265703.50000 0001 2197 8284Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC G9A 5H7 Canada
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Driehuis F, Keijsers NLW, Nijhuis-van der Sanden MWG, De Bie RA, Staal JB, Hoogeboom TJ. Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. J Man Manip Ther 2020; 29:40-50. [PMID: 32282288 PMCID: PMC7889092 DOI: 10.1080/10669817.2020.1746896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown. Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test. Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants’ upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other’s outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen’s kappa (ĸ) and the proportion of agreement (Pra) were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated. Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (ĸ: 0.077–0.727; Pra: 0.46–0.86) and objective outcomes (ICC: 0.019–0.496) varied between pairs of manual therapists. Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Institute Research, Development & Education, Sint Maartenskliniek , Ubbergen, The Netherlands.,Department of Rehabilitation, Cognition and Behavior, Donders Institute for Brain, Radboud University Medical Center , Nijmegen, The Netherlands
| | | | - Rob A De Bie
- CAPHRI Research School, Department of Epidemiology, Maastricht University , Maastricht, The Netherlands
| | - J Bart Staal
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands.,Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences , Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands
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Corso M, Cancelliere C, Mior S, Taylor-Vaisey A, Côté P. The safety of spinal manipulative therapy in children under 10 years: a rapid review. Chiropr Man Therap 2020; 28:12. [PMID: 32093727 PMCID: PMC7041232 DOI: 10.1186/s12998-020-0299-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue. OBJECTIVES We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions. EVIDENCE REVIEW We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (case reports/series, cohort studies and randomized controlled trials) were critically appraised. Studies of high and acceptable methodological quality were included. The lead author extracted data. Data extraction was independently validated by a second reviewer. We conducted a qualitative synthesis of the evidence. FINDINGS Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown. CONCLUSION The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.
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Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
| | - Carol Cancelliere
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada
- Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, M2H 3J1, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Centre for Disability Prevention and Rehabilitation, Ontario Tech University and CMCC, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada.
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Driehuis F, Hoogeboom TJ, Nijhuis-van der Sanden MWG, de Bie RA, Staal JB. Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes. PLoS One 2019; 14:e0218940. [PMID: 31237917 PMCID: PMC6592551 DOI: 10.1371/journal.pone.0218940] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking. OBJECTIVE To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. METHODS PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed. RESULTS Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment. CONCLUSIONS Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Miller JE, Hanson HA, Hiew M, Lo Tiap Kwong DS, Mok Z, Tee YH. Maternal Report of Outcomes of Chiropractic Care for Infants. J Manipulative Physiol Ther 2019; 42:167-176. [PMID: 31029467 DOI: 10.1016/j.jmpt.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/11/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom. METHODS This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate. RESULTS In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events. CONCLUSION In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.
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Affiliation(s)
- Joyce E Miller
- Outpatient Teaching Clinic, AECC University College, Bournemouth, Dorset, UK.
| | | | - Mandy Hiew
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | | | - Zicheng Mok
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | - Yun-Han Tee
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
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Maiers M, Agaoglu M, Brown R, Cassirer C, DaSilva K, Lystad RP, Mohammad S, Wong JJ. Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap 2018; 26:26. [PMID: 30026909 PMCID: PMC6048707 DOI: 10.1186/s12998-018-0194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Abstract
The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women's, children's, and adolescents' health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve.
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Affiliation(s)
- Michele Maiers
- Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431 USA
| | - Mustafa Agaoglu
- Bahçeşehir University Health Sciences School of Chiropractic, No:10, Gayrettepe, 34353 Beşiktaş, Istanbul, Turkey
| | - Richard Brown
- World Federation of Chiropractic, 160 Eglinton Avenue East Suite 601, Toronto, ON M4P 3B5 Canada
| | - Christopher Cassirer
- Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431 USA
| | - Kendrah DaSilva
- Chiropractic Association of South Africa, Crossway Office Park, 240 Lenchen Ave, Centurion, Pretoria, 0157 South Africa
| | - Reidar P. Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarkaw Mohammad
- Hillcrest Spinal Centre, 174 Cambridge Road Hillcrest Hamilton, Hamilton, 3216 New Zealand
| | - Jessica J. Wong
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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Siegenthaler MH. Pediatric Patients in Swiss Chiropractic Clinics: A Questionnaire Survey. J Manipulative Physiol Ther 2017; 40:477-485. [PMID: 29079254 DOI: 10.1016/j.jmpt.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/08/2017] [Accepted: 03/14/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate practice characteristics of chiropractors who treat pediatric patients in Swiss chiropractic clinics. METHODS An online survey questionnaire was created and tested for face and content validity. Participation by Swiss chiropractors was voluntary and anonymous and completed November to December 2015. The data were analyzed using SPSS. The analysis consisted of descriptive statistics. RESULTS The sample consisted of 144 chiropractors, which represented a 53% response rate, and 98% of the responding practitioners treated patients younger than age 18. The proportion of pediatric patients treated was 8.7%. The most common pediatric age groups were schoolchildren and adolescents, with infants younger than 6 months being the third most common. Musculoskeletal complaints were the most common conditions treated in all age groups. In children younger than 2 years old, nonmusculoskeletal conditions were well represented. Prophylactic examination was common among children 6 years and younger. A total of 61% of responding chiropractors received direct referrals from medical doctors and 56% received direct referrals from pediatricians. The most common age groups for referrals from pediatricians were schoolchildren and adolescents. Only 15% of the chiropractors wrote reports about their pediatric patients to their pediatrician often or regularly; 90% of the responding chiropractors stated they rarely or never refer to a pediatric specialist, and 80% of the chiropractors have never or have rarely been invited to attend medical congresses or to teach the pediatric health care community about chiropractic care for children. CONCLUSION The majority of chiropractors in Switzerland treat pediatric patients, most commonly schoolchildren and adolescents for musculoskeletal disorders.
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Goncalves G, Le Scanff C, Leboeuf-Yde C. Primary prevention in chiropractic practice: a systematic review. Chiropr Man Therap 2017; 25:9. [PMID: 28321293 PMCID: PMC5358050 DOI: 10.1186/s12998-017-0140-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/14/2017] [Indexed: 01/08/2023] Open
Abstract
Background Chiropractors are primarily concerned with musculoskeletal disorders but have the responsibility to deal also with prevention in other areas. Objectives To establish the prevalence of chiropractors who have a positive opinion on the use of primary prevention (PP), their actual use of PP, and the proportion of patients who consult for PP in relation to (i) musculoskeletal disorders, (ii) public health issues, or (iii) chiropractic treatment for wellness. Method A systematic search for literature was done using PubMed, Embase, Index to Chiropractic Literature, and Google Scholar and updated on February 15th 2017. Inclusion criteria were: surveys on chiropractors and/or chiropractic patients, information had to be present on PP in relation to the percentage of patients who consult for PP in chiropractic practice or in a chiropractic student clinic, and/or the percentage of chiropractors who reported using PP, and/or information on chiropractors’ opinions of the use of PP, in the English, French, or Scandinavian languages. The review followed the PRISMA guidelines. Articles were classified as ‘good’, ‘acceptable’ and ‘unacceptable’ based on scores of quality items. Results from the latter group were not taken into account. Results Twenty-five articles were included, reporting on twenty-six studies, 19 of which dealt with wellness. The proportion of chiropractors who stated that they had a positive opinion on PP was generally higher than the proportion of chiropractors offering PP. Most chiropractors offered some type of PP for musculoskeletal disorders and more than a half stated that they did so in the public health area but also for wellness. For all types of PP, however, it was rarely stated to be the reason for patients consulting. Regardless the type of PP, the proportion of patients who actually consulted specifically for PP was much smaller than the proportion of chiropractors offering PP. Conclusion More research efforts have been put into wellness than into prevention of musculoskeletal disorders or public health-related disorders. It therefore seems that parts of the chiropractic profession are in search of an understanding of various aspects of clinical practice over and above its traditional musculoskeletal role. Interestingly, only a small proportion of chiropractic patients consult for PP, despite the readiness of the profession to offer such services.
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Affiliation(s)
- Guillaume Goncalves
- CIAMS, University of Paris-Sud, University of Paris-Saclay, F- 91405 Orsay Cedex, France.,CIAMS, University of Orléans, F- 45067 Orléans, France.,Institut Franco Européen de Chiropraxie, 24 boulevard Paul Vaillant Couturier, F- 94200 Ivry sur Seine, France
| | - Christine Le Scanff
- CIAMS, University of Paris-Sud, University of Paris-Saclay, F- 91405 Orsay Cedex, France.,CIAMS, University of Orléans, F- 45067 Orléans, France
| | - Charlotte Leboeuf-Yde
- CIAMS, University of Paris-Sud, University of Paris-Saclay, F- 91405 Orsay Cedex, France.,CIAMS, University of Orléans, F- 45067 Orléans, France.,Institut Franco Européen de Chiropraxie, 24 boulevard Paul Vaillant Couturier, F- 94200 Ivry sur Seine, France
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