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Baechler M, Yerly N, Tauschek L, Schweinhardt P, Wirth B. A descriptive evaluation of a job analysis survey in the chiropractic profession in Switzerland - an update after more than 10 years. Chiropr Man Therap 2024; 32:25. [PMID: 38915075 PMCID: PMC11197174 DOI: 10.1186/s12998-024-00544-1] [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: 02/06/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES The aim of this cross-sectional study was to update the results of the first Swiss Job Analysis Survey in 2009 with regard to the demographics of the chiropractors and their patients, practice characteristics, interprofessional collaboration, the importance of imaging, and job satisfaction. METHODS In April 2020, the adapted 2009 questionnaire was electronically sent to all members of the Swiss Chiropractic Association ChiroSuisse (N = 316). Only complete questionnaires were included in the descriptive analysis. Demographic data were compared to all ChiroSuisse members. RESULTS The response rate was 76.3%. The mean age of the participants was 49.9 ± 12.3 years and 62.2% were male. Among the younger chiropractors (≤ 15 years of professional experience), 51.6% were male. Almost half of the participants worked in a joint office and one in five worked in a multidisciplinary setting. The typical chiropractic patient was middle-aged, female and suffered most frequently from acute lower back/pelvis pain and second most frequently from neck pain. Diversified osseous adjustment was the most commonly used technique, followed by advice on activities of daily living and trigger point therapy. Images (X-ray, CT, MRI) were ordered in less than 20% of the patients. 95% of the chiropractors were satisfied with their career choice. CONCLUSIONS No changes to 2009 were observed in terms of the typical patient or the applied techniques. However, the Swiss chiropractors were more experienced, to a larger proportion female, more often worked in multidisciplinary settings, and ordered fewer images. Job satisfaction among Swiss chiropractors was high.
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Affiliation(s)
- Mirjam Baechler
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, Zurich, 8008, Switzerland
| | - Nina Yerly
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, Zurich, 8008, Switzerland
| | - Lucas Tauschek
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, Zurich, 8008, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, Zurich, 8008, Switzerland
| | - Brigitte Wirth
- Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Forchstr. 340, Zurich, 8008, Switzerland.
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Uhrenholt L, Bakkegaard JH, Hansen K, Doktor KK. Towards the diagnosis of osteoporosis - contributions from coincidental diagnostic imaging findings in chiropractors' practice. Chiropr Man Therap 2024; 32:24. [PMID: 38915085 PMCID: PMC11194920 DOI: 10.1186/s12998-024-00545-0] [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: 02/04/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Osteoporosis is significantly associated with fractures and burdens the health of especially older people. Osteoporotic fractures cause pain, disability, and increased mortality. Early diagnosis of osteoporosis allows earlier initiation of treatment, thereby reducing the risk of osteoporotic fractures. Chiropractors encounter potential osteoporotic patients daily, and perform radiological evaluation of these and other patients, including evaluation of X-rays done for other purposes than osteoporosis. Therefore, chiropractors may identify vertebral fractures, vertebral deformity or osteopenia not otherwise suspected or recorded. METHODS This study examines procedures available to the chiropractor to describe conventional X-rays with the focus of osteoporosis related findings. We review the indications for radiological examination in chiropractic practice, and in the realm of osteoporosis we describe radiological methods available for examination of conventional radiographs, and the necessity of inter-disciplinary communication. RESULTS National guidelines are available regarding referral for X-rays in chiropractic practice. Standardized protocols ensure image acquisition of the highest quality in the chiropractors' radiological department. Conventional X-ray examination is not indicated on clinical suspicion of osteoporosis alone, as bone mineral density testing is the diagnostic test. Radiological assessment of all available X-rays of patients above the age of 50 years should include evaluation of the bone quality, and hip and vertebral fracture assessment. The Singh index, Genant Semi-Quantitative tool (GSQ), and Algorithm-Based Qualitative method (ABQ) should be used consistently during interpretation. Referral for additional imaging and evaluation should be prompt and systematic when needed. CONCLUSIONS This article presents an overview of evidence-based radiological procedures for the purpose of promoting early diagnosis of osteoporosis. We present recommendations to the clinicians where we propose an opportunistic evaluation of X-rays, done for any reason, which include systematic evaluation of bone quality, presence of hip and vertebral fractures, and vertebral deformation of all patients above the age of 50 years. Detailed referral to healthcare professionals for further diagnostic evaluation is performed when needed. Consistent, high-quality radiological procedures in chiropractic practices could feasibly contribute to the timely diagnosis of osteoporosis, ultimately minimizing the impact of osteoporosis-related complications on patients' health.
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Affiliation(s)
- Lars Uhrenholt
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Nortvig & Uhrenholt Kiropraktisk Klinik, Jens Baggesens Vej 88A, 8200, Aarhus N, Denmark.
| | | | - Kasper Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Klaus Knarberg Doktor
- Chiropractic Knowledge Hub, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Rygcenter Midtvest, Dalgas Alle 2, 7400, Herning, Denmark
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Fernandez M, de Luca K, Moore C, French SD, Ferreira P, Swain M. Insights into physical activity promotion among Australian chiropractors: a cross-sectional survey. Chiropr Man Therap 2024; 32:22. [PMID: 38877559 PMCID: PMC11179190 DOI: 10.1186/s12998-024-00543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. METHODS From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors' own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. RESULTS Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32-4.12)], while chiropractors who frequently treat children 0-3 years (OR = 0.5; 95% CI: 0.28-0.87), children 4-18 years (OR = 0.42; 95% CI: 0.21-0.86), and pregnant women (OR = 0.5; 95% CI: 0.26-0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32-6.41), were confident promoting (OR = 11.6; 95% CI: 1.37-98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03-9.99). CONCLUSION Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings.
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Affiliation(s)
- Matthew Fernandez
- Discipline of Chiropractic, Faculty, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Katie de Luca
- Discipline of Chiropractic, Faculty, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Craig Moore
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Song YP, Liu JL, Zong CZ, Zhang FS, Ren YF, Ching YL, Wang YX, Li WX, Zhao H, Huang YR, Gao K. A bibliometric study on trends in chiropractic research from 1920 to 2023. Complement Ther Med 2024; 82:103038. [PMID: 38582375 DOI: 10.1016/j.ctim.2024.103038] [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: 01/07/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE An increasing body of evidence suggests a positive role of chiropractic in the treatment of neuro-musculoskeletal disorders. This study aims to explore current research hotspots and trends, providing insights into the broad prospects of this field. METHODS A bibliometric review was conducted on all chiropractic articles included in the Web of Science Core Collection before December 31, 2023. RESULTS Over the past century, the volume of research in the field of chiropractic has been fluctuating annually, with four peaks observed in total. The United States, Canada, Australia, and the United Kingdom are leading countries. Chu, Eric Chun-Pu is the author with the most publications, while Bronfort, Gert has the highest total citation count. The University of Southern Denmark has produced the most publications, while Queens University - Canada is the most central institution. The Journal of Manipulative and Physiological Therapeutics is the journal with the most publications and citations, while the Journal of the American Medical Association is the most central journal. The two most-cited articles were both authored by Eisenberg DM. Emerging keywords include "chronic pain" and "skills". The theoretical mechanisms and scientific basis of chiropractic, its clinical practice and safety, education and training, integration with other disciplines, and patient experiences and satisfaction are the frontiers and hotspots of research. CONCLUSION This study integrates bibliometric analysis to summarize the current state of research and global network centers in the field of chiropractic, further highlighting the hotspots and trends in this field. However, Individual and national rankings should be interpreted with caution due to our focus on Web of Science rather than PubMed.
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Affiliation(s)
- Yi-Ping Song
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Li Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chen-Zhong Zong
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fang-Shuo Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yan-Feng Ren
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yuen-Lim Ching
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Xiao Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-Xun Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - He Zhao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Yi-Ran Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
| | - Kuo Gao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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Di Donato M, Gray S, Sheehan LR, Buchbinder R, Iles R, Collie A. How Much Physiotherapy, Chiropractic, and Osteopathy Care Do Compensated Australian Workers with Low Back Pain Receive? A Retrospective Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10202-1. [PMID: 38761339 DOI: 10.1007/s10926-024-10202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To identify the prevalence and frequency of physiotherapy, chiropractic, and/or osteopathy care in Australians with workers' compensation claims for low back pain (LBP). METHODS We included workers with accepted workers' compensation claims longer than 2 weeks from the Australian states of Victoria, Queensland, South Australia, and Western Australia. Workers were grouped by whether they attended physiotherapy, chiropractic, and/or osteopathy in the first 2 years of their claim. Descriptive statistics and logistic regression were used to describe differences between groups. Descriptive statistics and negative binomial regression were used to describe differences in the number of attendances in each group. RESULTS Most workers had at least one physical therapy attendance during the period of their claim (n = 23,619, 82.0%). Worker state, socioeconomic status, and remoteness were the largest contributing factors to likelihood of physical therapy attendance. Most workers only attended physiotherapy (n = 21,035, 89.1%, median of 13 times). Far fewer only attended chiropractic (n = 528, 2.2%, median of 8 times) or only osteopathy (n = 296, 1.3%, median of 10 times), while 1,750 (7.5%) attended for care with more than one type of physical therapy (median of 31 times). CONCLUSION Most Australian workers with workers' compensation time loss claims for LBP attend physiotherapy at least once during their claims. State of claim is the strongest predictor of which physical therapy profession they attend, possibly due to regional availability. Workers who see a physiotherapist have significantly more attendances. Future research should explore the relationship between these patterns of care and claimant outcomes, including work disability duration.
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Affiliation(s)
- Michael Di Donato
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia.
| | - Shannon Gray
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Luke R Sheehan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Ross Iles
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3000, Australia
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Amjad I, Niazi IK, Kumari N, Duehr J, Shehzad G, Rashid U, Duehr J, Trager RJ, Holt K, Haavik H. The effects of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with attention deficit hyperactivity disorder: a pilot RCT. Front Psychol 2024; 15:1323397. [PMID: 38770250 PMCID: PMC11104450 DOI: 10.3389/fpsyg.2024.1323397] [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: 10/17/2023] [Accepted: 04/11/2024] [Indexed: 05/22/2024] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) is a neurobiological disorder characterized by inattention, hyperactivity, and impulsivity. We hypothesized that chiropractic adjustments could improve these symptoms by enhancing prefrontal cortex function. This pilot study aimed to explore the feasibility and efficacy of 4 weeks of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with ADHD. Methods 67 children with ADHD were randomly allocated to receive either chiropractic adjustments plus usual care (Chiro+UC) or sham chiropractic plus usual care (Sham+UC). The Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS), Swanson, Nolan and Pelham Teacher and Parents Rating Scale (SNAP-IV), and ADHD Rating Scale-IV were used to assess outcomes at baseline, 4 weeks, and 8 weeks. Feasibility measures such as recruitment, retention, blinding, safety, and adherence were recorded. Linear mixed regression models were used for data analysis. Results 56 participants (mean age ± SD: 10.70 ± 3.93 years) were included in the analysis. Both the Chiro+UC and Sham+UC groups showed significant improvements in total and subscale ADHD scores at 4 weeks and 8 weeks. However, there were no significant differences between the two groups. Conclusion This pilot study demonstrated that it was feasible to examine the effects of chiropractic adjustment when added to usual care on ADHD outcomes in children. While both groups showed improvements, the lack of significant between-group differences requires caution in interpretation due to the small sample size. Further research with larger samples and longer follow-up periods is needed to conclusively evaluate the effects of chiropractic adjustments on ADHD in children.
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Affiliation(s)
- Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Physical Therapy Department, Riphah International University, Islamabad, Pakistan
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland, New Zealand
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Jens Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Gulyana Shehzad
- National Intitute of Psychology, Quid e Azam University, Islamabad, Pakistan
| | - Usman Rashid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Jenna Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Robert J. Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
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Steel A, Foley H, Graham K, Harnett J, Adams J. Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults. BMC PRIMARY CARE 2024; 25:151. [PMID: 38704562 PMCID: PMC11070095 DOI: 10.1186/s12875-024-02359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Australian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists. METHODS Data about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP's information-sharing behaviour or perceived experience of patient-centredness. RESULTS Across 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study. CONCLUSIONS Public health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.
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Affiliation(s)
- Amie Steel
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia.
| | - Hope Foley
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
| | - Kim Graham
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
| | - Joanna Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jon Adams
- ARCCIM, School of Public Health, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, NSW, Australia
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Bergström C, Axén I, Field J, Hartvigsen J, van der Marck M, Newell D, Rubinstein S, de Zoete A, Persson M. The chiropractors' dilemma in caring for older patients with musculoskeletal complaints: Collaborate, integrate, coexist, or separate? PLoS One 2024; 19:e0302519. [PMID: 38696495 PMCID: PMC11065304 DOI: 10.1371/journal.pone.0302519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/07/2024] [Indexed: 05/04/2024] Open
Abstract
The world's elderly population is growing at a rapid pace. This has led to an increase in demand on the health and welfare systems due to age-related disorders, with musculoskeletal complaints driving the need for rehabilitation services. However, there are concerns about health services' ability to meet this demand. While chiropractic care is gaining recognition for its benefits in treating older adults with musculoskeletal disorders, there is limited scientific literature on chiropractors' role and experiences in this area. To bridge this gap, we interviewed 21 chiropractors in Great Britain, the Netherlands, Norway, and Sweden. Inductive qualitative content analysis was used to analyse the interviews, and despite differences in integration and regulation between the countries, several common facilitators and barriers in caring for and managing older patients with musculoskeletal complaints emerged. While participants expressed optimism about future collaborations with other healthcare professionals and the integration of chiropractic into national healthcare systems, they also highlighted significant concerns regarding the existing healthcare infrastructure. The participants also felt that chiropractors, with their non-surgical and holistic approach, were well-positioned to be the primary point of contact for older patients. However, there were some common barriers, such as the affordability of care, limited integration of chiropractic, and the need to prioritise musculoskeletal complaints within public healthcare. Our findings suggest that chiropractors experience their clinical competencies as an underutilised resource in the available healthcare systems and that they could contribute to and potentially reduce the escalating burden of musculoskeletal complaints and associated costs among older patients. Additionally, our findings highlight the desire among the participants to foster collaboration among healthcare professionals and integrate chiropractic into the national public healthcare system. Integrating chiropractors as allied health professionals was also perceived to improve coordinated, patient-centred healthcare for older adults.
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Affiliation(s)
- Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Iben Axén
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
- The Norwegian Chiropractors’ Research Foundation “Et Liv i Bevegelse”, Oslo, Norway
| | | | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | | | - Dave Newell
- AECC University College, Bournemouth, United Kingdom
| | - Sidney Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA. Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data. BMJ Open 2024; 14:e078105. [PMID: 38692725 PMCID: PMC11086504 DOI: 10.1136/bmjopen-2023-078105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care. DESIGN Retrospective cohort study. SETTING US medical records-based dataset including >115 million patients attending academic health centres (TriNetX, Inc), queried 9 November 2023. PARTICIPANTS Opioid-naive adults aged 18-50 with a new diagnosis of radicular LBP were included. Patients with serious pathology and tramadol use contraindications were excluded. Variables associated with tramadol prescription were controlled via propensity matching. INTERVENTIONS Patients were divided into two cohorts dependent on treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care). PRIMARY AND SECONDARY OUTCOME MEASURES Risk ratio (RR) for tramadol prescription (primary); markers of usual medical care utilisation (secondary). RESULTS After propensity matching, there were 1171 patients per cohort (mean age 35 years). Tramadol prescription was significantly lower in the CSM cohort compared with the usual medical care cohort, with an RR (95% CI) of 0.32 (0.18 to 0.57; p<0.0001). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up. Utilisation of NSAIDs, physical therapy evaluation and lumbar imaging was similar between cohorts. CONCLUSIONS This study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up. These findings should be corroborated by a prospective study to minimise residual confounding.
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Affiliation(s)
- Robert James Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Regina M Casselberry
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Emary PC, Stuber KJ. A commentary on the use of mixed methods in chiropractic research: Part 3: integration of qualitative research with randomized controlled trials. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2024; 68:26-34. [PMID: 38840964 PMCID: PMC11149692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
This is the third of three papers in our series of articles on the use of mixed methods in chiropractic research. In this commentary, we discuss the mixed methods experimental (or intervention) design. This design is a complex mixed methods research design in which qualitative research is integrated with randomized controlled trials. We provide a brief overview of this study design as well as a case example from the literature to illustrate how this approach can be applied to research within the chiropractic profession.
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Affiliation(s)
- Peter C. Emary
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario
- Chiropractic Department, D’Youville University, Buffalo, New York
- Private Practice, Langs Community Health Centre, Cambridge, Ontario
| | - Kent J. Stuber
- Parker University Research Center, Parker University, Dallas, Texas
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario
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O'Neill SFD, Nim C, Newell D, Leboeuf-Yde C. A new role for spinal manual therapy and for chiropractic? Part I: weaknesses and threats. Chiropr Man Therap 2024; 32:11. [PMID: 38532401 DOI: 10.1186/s12998-024-00531-6] [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: 06/23/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024] Open
Abstract
Spinal manual therapy is central to chiropractic history, clinical practice, and professional identity. That chiropractors have developed an expertise in this domain has provided some considerable advantages. However, we contend it is also at the crux of the ideological schism that fractures the chiropractic profession. In this article, which is the first in a series of two, we discuss chiropractors' understanding and use of spinal manual therapy and do so with particular emphasis on what we see as weaknesses it creates and threats it gives rise to. These are of particular importance, as we believe they have limited the chiropractic profession's development. As we shall argue, we believe that these threats have become existential in nature, and we are convinced that they call for a resolute and unified response by the profession. Subsequently, in part II, we discuss various strengths that the chiropractic profession possesses and the opportunities that await, provided that the profession is ready to rise to the challenge.
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Affiliation(s)
- Søren Francis Dyhrberg O'Neill
- Medical Spinal Research Unit, Lillebaelt Hospital, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, Middelfart, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Casper Nim
- Medical Spinal Research Unit, Lillebaelt Hospital, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Charlotte Leboeuf-Yde
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Ivanova D, Newell D, Field J, Bishop FL. The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic. Chiropr Man Therap 2024; 32:10. [PMID: 38515190 PMCID: PMC10958961 DOI: 10.1186/s12998-023-00527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice. METHODS Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. RESULTS The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. CONCLUSIONS Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations.
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Affiliation(s)
- Dima Ivanova
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK.
| | - Dave Newell
- AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | | | - Felicity L Bishop
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK
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13
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Trager RJ, Baumann AN, Perez JA, Dusek JA, Perfecto RPT, Goertz CM. Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers. PLoS One 2024; 19:e0299159. [PMID: 38466710 PMCID: PMC10927125 DOI: 10.1371/journal.pone.0299159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period. METHODS A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES. Patients were divided into two cohorts: (1) LBP patients receiving CSM or (2) LBP patients receiving PT evaluation without spinal manipulation. Propensity score matching controlled for confounding variables associated with CES. RESULTS 67,220 patients per cohort (mean age 51 years) remained after propensity matching. CES incidence was 0.07% (95% confidence intervals [CI]: 0.05-0.09%) in the CSM cohort compared to 0.11% (95% CI: 0.09-0.14%) in the PT evaluation cohort, yielding a risk ratio and 95% CI of 0.60 (0.42-0.86; p = .0052). Both cohorts showed a higher rate of CES during the first two weeks of follow-up. CONCLUSIONS These findings suggest that CSM is not a risk factor for CES. Considering prior epidemiologic evidence, patients with LBP may have an elevated risk of CES independent of treatment. These findings warrant further corroboration. In the meantime, clinicians should be vigilant to identify LBP patients with CES and promptly refer them for surgical evaluation.
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Affiliation(s)
- Robert J. Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Anthony N. Baumann
- Department of Rehabilitation, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, United States of America
| | - Jaime A. Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - Jeffery A. Dusek
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Romeo-Paolo T. Perfecto
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Christine M. Goertz
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Durham, North Carolina, and Washington, District of Columbia, United States of America
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Ismail F, Myburgh C, Downing C. Interprofessional education interventions in undergraduate students of musculoskeletal healthcare professions: a scoping review protocol. BMJ Open 2024; 14:e078483. [PMID: 38458779 PMCID: PMC10928785 DOI: 10.1136/bmjopen-2023-078483] [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: 08/03/2023] [Accepted: 12/05/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Enhancing interprofessional education (IPE) fosters collaborative efforts among healthcare professionals specializing in musculoskeletal (MSK) care. This approach presents a valuable opportunity to address the pressing MSK disease burden in developing countries, with high prevalence rates and limited resources. While an abundance of literature on the various elements of IPE among healthcare students and professionals exists, shared contexts of practice of South African MSK disciplines are not currently developed through IPE at higher education level, establishing a need for South African formalised curricular IPE interventions with an explicit focus on undergraduate students of MSK healthcare professions. METHODS AND ANALYSIS The intended scoping review protocol is guided by the framework set out by Arksey and O'Malley, where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide the process of reporting. English sources (qualitative and quantitative methodological studies, conference papers and proceedings, systematic reviews, grey literature, unpublished materials, theses and dissertations) from the electronic databases PubMed, Scopus, ERIC and ProQuest with no date restriction will be included. A researcher, an independent reviewer and research librarian will search and extract data from abstracts and full texts for this scoping review, where any arising disagreements will be resolved by discussion. Reference lists of relevant literature will be scrutinised. Relevant literature will be recorded on a referencing software and deduplicated. The data collection will take place between May and October 2023. The findings will be reported narratively with the use of tables. ETHICS AND DISSEMINATION This scoping review does not require ethical approval as all literature used already exists in the public domain with no involvement of human participants. The findings from this planned review will be submitted to peer-reviewed journals and will be presented at higher education conferences. This scoping review protocol was registered on Open Science Framework with the registration osf.io/c27n4.
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Affiliation(s)
- Fatima Ismail
- Department of Chiropractic, University of Johannesburg, Doornfontein, Johannesburg, Gauteng, South Africa
| | - Cornelius Myburgh
- Department of Chiropractic, University of Johannesburg, Doornfontein, Johannesburg, Gauteng, South Africa
| | - Charlene Downing
- Department of Nursing, University of Johannesburg, Doornfontein, Johannesburg, Gauteng, South Africa
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Keating G, Hawk C, Amorin-Woods L, Amorin-Woods D, Vallone S, Farabaugh R, Todd A, Ferrance R, Young J, O'Neill Bhogal S, Sexton H, Alevaki H, Miller J, Parkin-Smith G, Schielke A, Robinson A, Thompson R. Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:216-232. [PMID: 37902954 PMCID: PMC10954607 DOI: 10.1089/jicm.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
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Affiliation(s)
- Genevieve Keating
- Fielding Graduate University, Santa Barbara, CA, USA
- Private Practice, Melbourne, Australia
| | - Cheryl Hawk
- US-Clinical Compass, Lexington SC, USA
- Texas Chiropractic College, TX, USA
| | - Lyndon Amorin-Woods
- School of Allied Health, Murdoch University, Murdoch, Australia
- Private Practice, Perth, Australia
| | - Deisy Amorin-Woods
- Edith Cowan University, Joondalup, Australia
- Private Practice, Insight Counselling, Perth, Australia
| | | | - Ronald Farabaugh
- Advanced Medicine Integration Group, Columbus, OH, USA
- Clinical Compass, Columbus, OH, USA
| | - Angela Todd
- Private Practice, Sale, Australia
- Aus-ACA, Sale, Australia
| | | | | | | | | | | | - Joyce Miller
- Anglo European College of Chiropractic, Bournemouth, United Kingdom
| | - Gregory Parkin-Smith
- Private Practice, Perth, Australia
- School of Allied Health, Murdoch University, Murdoch, Australia
| | | | | | - Robyn Thompson
- Private Practice, The Thompson Method Breastfeeding, Melbourne, Australia
- Australian Catholic University, Fitzroy, Australia
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Roseen EJ, Patel KV, Ward R, de Grauw X, Atlas SJ, Bartels S, Keysor JJ, Bean JF. Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018. J Gen Intern Med 2024; 39:578-586. [PMID: 37856007 PMCID: PMC10973298 DOI: 10.1007/s11606-023-08438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable. OBJECTIVE Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP. DESIGN/SETTING Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018. PARTICIPANTS 146,087 adults reporting LBP in prior 3 months. METHODS We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents. RESULTS Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016-2018 vs 2002-2015, OR = 1.15; 95% CI: 1.10-1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions > 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR = 0.62, 95% CI: 0.65-0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR = 0.98; 95% CI: 0.94-1.03) but lower for chiropractic care use (OR = 0.50; 95% CI: 0.47-0.53). CONCLUSIONS Although use of chiropractic care or OT/PT for LBP increased after the introduction of clinical guidelines in 2016, only about a third of US adults with LBP reported using these services between 2016 and 2018 and disparities in use have not improved.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA.
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA.
- Department of Rehabilitation Science, MGH Institute of Health Professions, Boston, MA, USA.
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Rachel Ward
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Xinyao de Grauw
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Steven J Atlas
- Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen Bartels
- Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie J Keysor
- Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
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Giroux D, Branconnier C, Bussières A, Théroux J, Blanchette MA. Frequency and indication of non-musculoskeletal examinations: a cross-sectional survey of Quebec chiropractors. Chiropr Man Therap 2024; 32:6. [PMID: 38419063 PMCID: PMC10903024 DOI: 10.1186/s12998-023-00522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Approximately 1% of low back pain is estimated to be caused by serious systemic diseases, including cancer, infection, or abdominal aortic dissection. This study aimed to determine the frequency of execution of non-MSK physical examination procedures among Quebec chiropractors and to identify the clinical context that prompts them to use these physical examination procedures. METHODS Cross-sectional survey containing 44 questions administered to a random sample of Quebec chiropractors using a succession of online, postal and phone questionnaires. The 4-part survey questionnaire contained six demographic questions, 28 single-choice questions to determine the frequency of execution of non-MSK physical examination procedures, seven short clinical vignettes for which the respondents had to select the non-MSK examinations that would be required, and two questions inquiring about the proportion of new patients for which participants' felt non-MSK examinations were necessary and whether appropriate assessments were performed. The questionnaire was pilot tested, and feedback received integrated prior to administration. We conducted descriptive statistics, Pearson correlations, and an ANOVA. RESULTS The survey was completed by 182 chiropractors (response rate: 36.4%). The most commonly non-musculoskeletal examination performed daily were blood pressure (12.1%) and cranial nerves (4.9%). The most common tests never performed were oxygen saturation (68.7%), cardiac auscultation (69.2%), tibio-brachial index (71.4%), breast (86.8%), rectal (96.7%), testicular (95.6%), and vaginal (99.9%) exams. Female chiropractors and Quebec University in Trois-Rivières graduates reported that a significantly higher proportion of their new patients required a non-musculoskeletal physical examination compared to male participants (37.2% vs 28.3%) or Canadian Memorial Chiropractic College graduates (33.9% vs 19.9%). Reason for not performing a physical examination included the belief that another healthcare professional was better positioned to perform and/or interpret the related tests (76.4%). CONCLUSIONS Vital signs and cranial nerve examinations were the most frequency performed non-musculoskeletal examinations reported by chiropractors. Apart from the genitourinary exam almost never performed, most participants chose non-musculoskeletal examinations deemed appropriate for the patient's presentation.
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Affiliation(s)
- Danikel Giroux
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada.
| | - Chloé Branconnier
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
| | - André Bussières
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jean Théroux
- School of Allied Health, Chiropractic Discipline, Murdoch University, Perth, WA, Australia
| | - Marc-André Blanchette
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
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18
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Lee WT, Chu ECP, Lam K, Lau R, Yeung J, Yau K, Chau C. Exploring Chiropractic Healthcare in Hong Kong: Sick Leave Certification Dilemma. Cureus 2024; 16:e52957. [PMID: 38406099 PMCID: PMC10894072 DOI: 10.7759/cureus.52957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Objective This study aims to investigate the characteristics of chiropractic patients in Hong Kong, their experiences with chiropractic care, and their perspectives on chiropractors' authority over sick leave certificates. Method A cross-sectional survey was conducted among individuals receiving chiropractic treatment in Hong Kong. Data were collected through an online survey from May 11 to August 8, 2023, and descriptive analysis was employed to examine patient demographics, treatment effectiveness, and views on chiropractic sick leave authorization. A total of 522 valid responses were received. Result Among respondents, back pain was the primary reason for seeking chiropractic care, with many experiencing rapid relief and high satisfaction. However, many patients initially consulted other healthcare professionals, indicating potential integration challenges. Lengthy orthopedic wait times in Hong Kong highlight the need for chiropractic care. Concerns arose over chiropractors' inability to issue sick leave certificates, impacting patient convenience, treatment effectiveness, finances, and emotional well-being. Allowing chiropractors to authorize sick leave, with proper regulation, could address these issues. Conclusion In conclusion, this study underscores chiropractic care's potential in Hong Kong's healthcare system and suggests that recognizing chiropractors' role in sick leave authorization can enhance comprehensive patient care.
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Affiliation(s)
- Wai Ting Lee
- Integrative/Complementary Medicine, Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Eric Chun-Pu Chu
- Integrative/Complementary Medicine, Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, CHN
| | - Kary Lam
- Integrative/Complementary Medicine, Chiropractic Doctors Association of Hong Kong, Hong Kong, HKG
| | - Rick Lau
- Therapeutics, Chiropractic Doctors Association of Hong Kong, Hong Kong, HKG
| | - Jacky Yeung
- Integrative/Complementary Medicine, Chiropractic Doctors Association of Hong Kong, Hong Kong, HKG
| | - Kristy Yau
- Integrative/Complementary Medicine, Chiropractic and Physiotherapy Centre, New York Medical Group, Hong Kong, HKG
| | - Cherie Chau
- Integrative/Complementary Medicine, EC Healthcare, Hong Kong, HKG
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19
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Trager RJ, Troutner AM, Pikus HJ, Daniels CJ, Dusek JA. Symptoms of Patients With Vertebral Artery Dissection Presenting to Chiropractors: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51297. [PMID: 38283533 PMCID: PMC10822691 DOI: 10.7759/cureus.51297] [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] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Early symptoms of vertebral artery dissection (VAD) may be nonspecific, including neck pain and headache. Neck pain and headache are also common reasons for patients to seek chiropractic care. We hypothesized that neck pain and/or headache would be the most prevalent symptoms among patients with undiagnosed VAD presenting to chiropractors compared to dizziness or other symptoms. We searched PubMed, Ovid, the Index to Chiropractic Literature, Google Scholar, and gray literature through September 2023 for observational studies describing patients aged ≥10 with previously undiagnosed VAD presenting to a chiropractor. Article selection, data extraction, and quality assessment were performed in duplicate. We synthesized the point prevalence of symptoms and other clinical features. We included 10 case reports describing 10 patients (mean age = 37, SD = 7, 60% female). All patients had either neck pain or headache (100%; 95% confidence interval (CI) = 100%-100%). The most prevalent individual symptoms were neck pain (90%; 95% CI = 71%-100%), headache (80%; 95% CI = 55%-100%), visual disturbance (50%; 95% CI = 19%-81%), and dizziness (40%; 95% CI = 10%-70%). The certainty of results was very low due to publication bias. While our findings suggest that neck pain and/or headache are the most prevalent symptoms among patients with undiagnosed VAD visiting a chiropractor, the small sample size and reliance on case reports preclude any definitive conclusions. Further research with larger sample sizes, control groups, and better control of confounders is required to corroborate these results. Chiropractors should be aware of VAD features and refer suspected patients for emergency care.
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Affiliation(s)
- Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Alyssa M Troutner
- Department of Clinical Education, Southern California University of Health Sciences, Whittier, USA
| | - Harold J Pikus
- Neurosurgery, Upper Valley Neurology Neurosurgery, Lebanon, USA
| | - Clinton J Daniels
- Rehabilitation Care Services, Veterans Affairs Puget Sound Health Care System, Tacoma, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, USA
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Nordbo K, Dewhurst P. Association of pain neurophysiology knowledge and application amongst UK chiropractic students: A cross-sectional study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:82-89. [PMID: 37721388 PMCID: PMC11095656 DOI: 10.7899/jce-22-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/21/2023] [Accepted: 07/02/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To investigate if chiropractic placement students in the United Kingdom are aware of current pain evidence and how they relate this to the management of chronic pain patients. Moreover, to gain an understanding of how this can lead to improved pain education planning and engagement in the future. METHODS The revised Neurophysiology of Pain Questionnaire and the researchers' own questionnaire were administered online to chiropractic placement students. The aggregated total number of correct responses and the individual mean scores were calculated. Statistical analysis included tests of normality and difference using the Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, and Χ2 tests. RESULTS There was an overall response rate of 21.6% (n = 50). The mean score achieved on the revised neurophysiology of pain questionnaire was 37.8%. A significant difference between individual mean scores on the revised Neurophysiology of Pain Questionnaire was observed between male and female participants. No differences in mean score were observed between age, number of chronic pain patients seen, and previous qualifications. For the study-specific questionnaire, statistically significant differences were found in mean score for previous qualifications, number of patients seen, and sex. CONCLUSION Chiropractic placement students in the United Kingdom appear to have a lower level of pain knowledge than other health care professionals and education institutions may wish to consider how to best address this within their curricula.
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Hayes R, Imbeau C, Pohlman KA, Blanchette MA, Doucet C. Chiropractic care and research priorities for the pediatric population: a cross-sectional survey of Quebec chiropractors. Chiropr Man Therap 2023; 31:42. [PMID: 37752493 PMCID: PMC10523689 DOI: 10.1186/s12998-023-00514-z] [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: 04/20/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Chiropractors commonly treat pediatric patients within their private practices. The objectives of this study were (1) to identify the treatment techniques and health advice used by Quebec chiropractors with pediatric patients; (2) to explore the research priorities of Quebec chiropractors for the pediatric population; and (3) to identify Quebec chiropractors' training in the field of pediatric chiropractics. METHODS A web-based cross-sectional survey was conducted among all licensed Quebec chiropractors (Qc, Canada). Descriptive statistics were used to analyze all quantitative variables. RESULTS The results showed that among the 245 respondents (22.8% response rate), practitioners adapted their treatment techniques based on their patients' age group, thus using softer techniques with younger pediatric patients and slowly gravitating toward techniques used with adults when patients reached the age of six. In terms of continuing education, chiropractors reported an average of 7.87 h of training on the subject per year, which mostly came from either Quebec's College of Chiropractors (OCQ) (54.7%), written articles (46.9%) or seminars and conferences (43.7%). Both musculoskeletal (MSK) and viscerosomatic conditions were identified as high research priorities by the clinicians. CONCLUSIONS Quebec chiropractors adapt their treatment techniques to pediatric patients. In light of limited sources of continuing education in the field of pediatric chiropractics, practitioners mostly rely on the training provided by their provincial college and scientific publications. According to practitioners, future research priorities for pediatric care should focus on both MSK conditions and non-MSK conditions.
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Affiliation(s)
- Rebecca Hayes
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada.
| | - Camille Imbeau
- Département 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
- Département de Chiropratique, Université du Québec à Trois-Rivières (UQTR), 3351, Boul. Des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - 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
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22
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Jenkins HJ, Downie A, Wong JJ, Young JJ, Roseen EJ, Nim CG, McNaughton D, Øveras CK, Hartvigsen J, Mior S, French SD. Patient and provider characteristics associated with therapeutic intervention selection in a chiropractic clinical encounter: a cross-sectional analysis of the COAST and O-COAST study data. Chiropr Man Therap 2023; 31:39. [PMID: 37735450 PMCID: PMC10512629 DOI: 10.1186/s12998-023-00515-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: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Chiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chiropractic care, and patient and provider characteristics associated with intervention selection. METHODS Data were obtained from the Chiropractic Observation and Analysis STudy (COAST) and Ontario (O-COAST) studies: practice-based, cross-sectional studies in Victoria, Australia (2010-2012) and Ontario, Canada (2014-2015). Chiropractors recorded data on patient diagnosis and intervention selection from up to 100 consecutive patient visits. The frequency of interventions selected overall and for each diagnostic category (e.g., different musculoskeletal regions) were descriptively analysed. Univariable multi-level logistic regression (provider and patient as grouping factors), stratified by diagnostic category, was used to assess the association between patient/provider variables and intervention selection. RESULTS Ninety-four chiropractors, representative of chiropractors in Victoria and Ontario for age, sex, and years in practice, participated. Data were collected on 7,966 patient visits (6419 unique patients), including 10,731 individual diagnoses (mean age: 43.7 (SD: 20.7), 57.8% female). Differences in patient characteristics and intervention selection were observed between chiropractors practicing in Australia and Canada. Overall, manipulation was the most common intervention, selected in 63% (95%CI:62-63) of encounters. However, for musculoskeletal conditions presenting in the extremities only, soft tissue therapies were more commonly used (65%, 95%CI:62-68). Manipulation was less likely to be performed if the patient was female (OR:0.74, 95%CI:0.65-0.84), older (OR:0.79, 95%CI:0.77-0.82), presenting for an initial visit (OR:0.73, 95%CI:0.56-0.95) or new complaint (OR:0.82, 95%CI:0.71-0.95), had one or more comorbidities (OR:0.63, 95%CI:0.54-0.72), or was underweight (OR:0.47, 95%CI:0.35-0.63), or obese (OR:0.69, 95%CI:0.58-0.81). Chiropractors with more than five years clinical experience were less likely to provide advice/education (OR:0.37, 95%CI:0.16-0.87) and exercises (OR:0.17, 95%CI:0.06-0.44). CONCLUSION In more than 10,000 diagnostic encounters, manipulation was the most common therapeutic intervention for spine-related problems, whereas soft tissue therapies were more common for extremity problems. Different patient and provider characteristics were associated with intervention selection. These data may be used to support further research on appropriate selection of interventions for common musculoskeletal complaints.
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Affiliation(s)
- Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, USA
| | - Casper Glissmann Nim
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Spine Centre of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - David McNaughton
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Cecilie K Øveras
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Madsen SD, Morsø L, Vach W, Andersen MK, Lykkegaard J, Schiøttz-Christensen B, Stochkendahl MJ. Exploring usual care for patients with low back pain in primary care: a cross-sectional study of general practitioners, physiotherapists and chiropractors. BMJ Open 2023; 13:e071602. [PMID: 37648390 PMCID: PMC10471879 DOI: 10.1136/bmjopen-2023-071602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To explore the elements and composition of care provided by general practitioners (GPs), physiotherapists (PTs) and chiropractors (DCs) to patients with low back pain (LBP). DESIGN Observational study. SETTING Primary care setting, Denmark. PARTICIPANTS Primary care clinicians (GPs, PTs and DCs) in the Region of Southern Denmark were invited to register consecutive adult patient visits with LBP as the primary complaint. PRIMARY OUTCOME MEASURES Clinicians reported care elements provided to patients with LBP. Elements varied due to professional differences (eg, prescriptive rights). Data were descriptively analysed, on group and individual levels, for frequency and combination of care elements, and practice patterns were explored with latent class analysis. RESULTS The clinicians (33 GPs, 67 PTs and 43 DCs with a median experience of 15 years and 59% were females) registered 3500 patient visits. On average, the visits involved patients aged 51 years, and 51% were with females. The frequencies of common care elements across professions were information (42%-56% of visits between professions) and advice (56%-81%), while other common elements for GPs were pain medication (40%) and referrals to PTs (36%), for PTs, use of exercises (81%) and for DCs, use of manual therapy (96%). Substantial variation was observed within professions and distinct practice patterns, with different focuses of attention to information and advice versus exercise and manual therapy, were identified for PTs and DCs. CONCLUSIONS These data indicate substantial variation in the care elements provided by GPs, PTs and DCs to LBP patients. The compositions of care and practice patterns identified challenge the understanding of usual care as a uniform concept and professions as homogeneous groups. Strategic use of particular care elements in different parts of treatment courses is indicated. Longitudinal data and qualitative enquiry are needed to assess if or how care is tailored to individual patients.
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Affiliation(s)
- Simon Dyrløv Madsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Lars Morsø
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, OPEN Research Unit, University of Southern Denmark, Odense, Denmark
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | - Merethe Kirstine Andersen
- Faculty of Health Sciences, Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Jesper Lykkegaard
- Faculty of Health Sciences, Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Berit Schiøttz-Christensen
- Faculty of Health Sciences, Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Mette Jensen Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Baca KJ, Salsbury SA. Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action. Chiropr Man Therap 2023; 31:30. [PMID: 37580756 PMCID: PMC10426155 DOI: 10.1186/s12998-023-00503-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs. DISCUSSION This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas. CONCLUSION Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.
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Affiliation(s)
- Kira J Baca
- Palmer College of Chiropractic, 1000 Brady St, Davenport, IA, 52803, USA.
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA, 52803, USA
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Graham SE, Coleman BC, Zhao X, Lisi AJ. Evaluating rates of chiropractic use and utilization by patient sex within the United States Veterans Health Administration: a serial cross-sectional analysis. Chiropr Man Therap 2023; 31:29. [PMID: 37563677 PMCID: PMC10416500 DOI: 10.1186/s12998-023-00497-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use or utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics. METHODS A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005-2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic visits. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic visits, and sex. To calculate use, we determined the proportion of patients of each sex who received chiropractic services to the total patients of the same sex receiving any outpatient care within each facility. To calculate utilization, we determined the number of chiropractic care visits per patient per fiscal year. A linear mixed effects model was applied to examine the difference in chiropractic care utilization by sex. RESULTS The percentage of female VHA on-station chiropractic patients increased from 11.7 to 17.7% from FY2005-FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were slightly higher for females (median = 4.3 visits per year, mean = 4.9) compared to males (median = 4.1 visits per year, mean = 4.6). CONCLUSION We report higher use and utilization of VHA chiropractic care by females compared with males, yet for both sexes rates were lower than in the private US healthcare system. This highlights the need for further assessment of the determinants and outcomes of VHA chiropractic care.
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Affiliation(s)
- Sarah E Graham
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Brian C Coleman
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Xiwen Zhao
- Yale Center for Analytical Sciences, New Haven, CT, USA
| | - Anthony J Lisi
- VA Connecticut Healthcare System, West Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
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Mikhail J, Funabashi M, Sobczak S, Descarreaux M, Pagé I. Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: a cadaveric study. Chiropr Man Therap 2023; 31:24. [PMID: 37550682 PMCID: PMC10405484 DOI: 10.1186/s12998-023-00493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) clinical effects are believed to be linked to its force-time profile characteristics. Previous studies have revealed that the force measured at the patient-table interface is most commonly greater than the one applied at the clinician-patient interface. The factors explaining this force amplification remains unclear. OBJECTIVE To determine the difference between the force applied to a cadaveric specimen's thoracic spine and the resulting force measured by a force-sensing table, as well as to evaluate the relationship between this difference and both the SMT force-time characteristics and the specimens' characteristics. METHODS Twenty-five SMTs with different force-time profiles were delivered by an apparatus at the T7 vertebra of nine human cadaveric specimens lying prone on a treatment table equipped with a force plate. The difference between the force applied by the apparatus and the resulting force measured by the force plate was calculated in absolute force (Fdiff) and as the percentage of the applied force (Fdiff%). Kinematics markers were inserted into T6 to T8 spinous and transverse processes to evaluate vertebral displacements during the SMT thrusts. Mixed-effects linear models were run to evaluate the variance in Fdiff and Fdiff% explained by SMT characteristics (peak force, thrust duration and force application rate), T6 to T8 relative and total displacements, and specimens' characteristics (BMI, height, weight, kyphosis angle, thoracic thickness). RESULTS Sixty percent of the trials showed lower force measured at the force plate than the one applied at T7. Fdiff¸ was significantly predicted (R2marginal = 0.54) by peak force, thrust duration, thoracic thickness and T6-T7 relative displacement in the z-axis (postero-anterior). Fdiff% was significantly predicted (R2marginal = 0.56) by force application rate, thoracic thickness and total T6 displacements. For both dependant variables, thoracic thickness showed the highest R2marginal out of all predictors. CONCLUSION Difference in force between the clinician-patient and the patient-table interfaces is influenced by SMT force-time characteristics and by thoracic thickness. How these differences in force are associated with vertebral displacements remains unclear. Although further studies are needed, clinicians should consider thorax thickness as a possible modulator of forces being transmitted through it during prone SMT procedures.
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Affiliation(s)
- Jérémie Mikhail
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Martha Funabashi
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON, M2H 3J1, Canada
| | - Stéphane Sobczak
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Research Chair in Functional Anatomy, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, QC, G8Z 4M3, Trois-Rivières, Canada
| | - Martin Descarreaux
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Isabelle Pagé
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada.
- Research Group on Neuromusculoskeletal Disorders, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, QC, G8Z 4M3, Canada.
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSS-CN), 525 Boul. Wilfrid-Hamel, Québec City, QC, G1M 2S8, Canada.
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Chu ECP, Yau K, Yun SMH. Spondylodiscitis in a Patient Undergoing Chronic Peritoneal Dialysis Presenting to a Chiropractor: Case Report and a Review of the Literature. Cureus 2023; 15:e44312. [PMID: 37779747 PMCID: PMC10535716 DOI: 10.7759/cureus.44312] [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] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Spondylodiscitis is a rare but severe condition characterized by spinal and paraspinal infections that will present to healthcare providers, including chiropractors, because of neck pain. Patients who undergo peritoneal dialysis for end-stage renal disease or have a complex medical history may present with musculoskeletal complaints with complicated and uncommon underlying causes. This report reviews the possible relationship between spinal infection and dialysis, as well as the role of the chiropractor in identifying and managing critical conditions. A 66-year-old Asian man undergoing peritoneal dialysis presented to a chiropractic clinic with pain in the left arm. The patient did not present with a fever. Upon examination, the upper limb muscle strength and reflexes were diminished. Neck pain was also experienced during the range of motion examination, and movement was limited in all directions. Magnetic resonance imaging was ordered. The patient was diagnosed with acute spondylodiscitis. Due to its nonspecific presentation, patients with severe and urgent cases, such as spondylodiscitis, may present to chiropractic offices to seek conservative treatment of pain symptoms. This report highlights the potential role of chiropractors in the early detection and management of complex conditions such as spondylodiscitis in patients on chronic dialysis.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
| | - Kristy Yau
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
| | - Steve Ming Hei Yun
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
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Gorrell LM, Sawatsky A, Edwards WB, Herzog W. Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers. J Man Manip Ther 2023; 31:261-269. [PMID: 36382347 PMCID: PMC10324446 DOI: 10.1080/10669817.2022.2148048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The vertebral artery (VA) may be stretched and subsequently damaged during manual cervical spine manipulation. The objective of this study was to measure VA length changes that occur during cervical spine manipulation and to compare these to the VA failure length. METHODS Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers. Arteries were then excised, and elongation from arbitrary in-situ head/neck positions to first force (0.1 N) was measured. Following this, VA were stretched (8.33 mm/s) to mechanical failure. Failure was defined as the instance when VA elongation resulted in a decrease in force. RESULTS From arbitrary in-situ head/neck positions, the greatest average VA length change during spinal manipulation was [mean (range)] 5.1% (1.1 to 15.1%). From arbitrary in-situ head/neck positions, arteries were elongated on average 33.5% (4.6 to 84.6%) prior to first force occurrence and 51.3% (16.3 to 105.1%) to failure. Average failure forces were 3.4 N (1.4 to 9.7 N). CONCLUSIONS Measured in arbitrary in-situ head/neck positions, VA were slack. It appears that this slack must be taken up prior to VA experiencing tensile force. During cervical spine manipulations (using cervical spine extension and rotation), arterial length changes remained below that slack length, suggesting that VA elongated but were not stretched during the manipulation. However, in order to answer the question if cervical spine manipulation is safe from a mechanical perspective, the testing performed here needs to be repeated using a defined in-situ head/neck position and take into consideration other structures (e.g. carotid arteries).
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Affiliation(s)
- Lindsay M. Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zürich, Zürich ,Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Andrew Sawatsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
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Wong JJ, Lu M, Côté P, Watson T, Rosella LC. Effects of chiropractic use on medical healthcare utilization and costs in adults with back pain in Ontario, Canada from 2003 to 2018: a population-based cohort study. BMC Health Serv Res 2023; 23:793. [PMID: 37491238 PMCID: PMC10367314 DOI: 10.1186/s12913-023-09690-3] [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: 11/07/2022] [Accepted: 06/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Adults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain. METHODS We conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association. RESULTS There were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73-1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57-0.97). CONCLUSIONS Among adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system.
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Affiliation(s)
- Jessica J Wong
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada.
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada.
| | - Mindy Lu
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Pierre Côté
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON, M5T 3M7, Canada
| | - Tristan Watson
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- ICES, 155 College Street, Toronto, ON, M5B 1T8, Canada
| | - Laura C Rosella
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
- ICES, 155 College Street, Toronto, ON, M5B 1T8, Canada
- Stephen Family Chair in Community Health, Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA. Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data. BMJ Open 2023; 13:e073258. [PMID: 37479505 PMCID: PMC10364168 DOI: 10.1136/bmjopen-2023-073258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVES Radicular low back pain (rLBP) is often treated off-label with gabapentin or by chiropractors using chiropractic spinal manipulative therapy (CSMT). To date, no studies have examined the association between these interventions. We hypothesised that adults under 50 years of age receiving CSMT for newly diagnosed rLBP would have reduced odds of receiving a gabapentin prescription over 1 year-follow-up. DESIGN Retrospective cohort study. SETTING US network including linked medical records, medical claims and pharmacy claims of >122 million patients attending large healthcare organisations (TriNetX), queried 15 June 2023, yielding data from 2017 to 2023. PARTICIPANTS Adults aged 18-49 were included at their first occurrence of rLBP diagnosis. Exclusions were severe pathology, other spinal conditions, on-label gabapentin indications and gabapentin contraindications. Propensity score matching controlled for variables associated with gabapentin use and receipt of prescription medication over the preceding year. INTERVENTIONS Patients were divided into CSMT or usual medical care cohorts based on the care received on the index date of rLBP diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES OR for gabapentin prescription. RESULTS After propensity matching, there were 1635 patients per cohort (mean age 36.3±8.6 years, 60% women). Gabapentin prescription over 1-year follow-up was significantly lower in the CSMT cohort compared with the usual medical care cohort, with an OR (95% CI) of 0.53 (0.40 to 0.71; p<0.0001). Sensitivity analyses revealed early divergence in cumulative incidence of prescription; and no significant between-cohort difference in a negative control outcome (gastrointestinal medication) suggesting adequate control for pharmacological care preference. CONCLUSIONS Our findings suggest that US adults receiving CSMT for newly diagnosed rLBP have significantly reduced odds of receiving a gabapentin prescription over 1-year follow-up compared with those receiving usual medical care. Results may not be generalisable and should be replicated in other healthcare settings and corroborated by a prospective study to reduce confounding.
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- College of Chiropractic, Logan University, Chesterfield, Missouri, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Regina M Casselberry
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Hincapié CA, Hofstetter L, Lalji R, Korner L, Schläppi MC, Leemann S. Use of electronic patient records and encrypted email patient communication among Swiss chiropractors: a population-based cross-sectional study. Chiropr Man Therap 2023; 31:21. [PMID: 37461087 PMCID: PMC10353203 DOI: 10.1186/s12998-023-00495-z] [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: 04/14/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The implementation of electronic health information technologies is a key target for healthcare quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking. OBJECTIVES To estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland. METHODS Population-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the associations between clinician and practice characteristics and (1) EPR use, and (2) encrypted email use. RESULTS Among 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). Among respondents, 47% (95% confidence interval [CI], 40-54%) reported using an EPR in their practice, while 60% (95% CI, 54-67%) endorsed using encrypted email technology. Chiropractors aged ≥ 60 (versus those ≤ 39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants. CONCLUSIONS As of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland - just under 50% of responding Swiss chiropractors used an EPR system in clinical practice, while 60% used encrypted email technology. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and encouraged for the purpose of musculoskeletal healthcare quality improvement.
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Affiliation(s)
- Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI) and University Spine Centre Zurich (UWZH), University of Zurich and Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
| | - Longin Korner
- Swiss Chiropractic Association (ChiroSuisse), Bern, Switzerland
| | | | - Serafin Leemann
- Swiss Chiropractic Association (ChiroSuisse), Bern, Switzerland
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Gliedt JA, Reynolds M, Moonaz S, Long CR, Russell R, Schneider MJ. Identifying and addressing patient substance use: a survey of chiropractic clinicians. Chiropr Man Therap 2023; 31:18. [PMID: 37400861 PMCID: PMC10316550 DOI: 10.1186/s12998-023-00490-4] [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: 04/14/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Chiropractors commonly encounter patients who present for spine pain with parallel substance use. There is currently no widespread training within the chiropractic profession to prepare chiropractors to recognize and address substance use in clinical practice. The purpose of this study was to examine chiropractors' confidence, self-perceptions, and interest in education associated with identifying and addressing patient substance use. METHODS A 10-item survey was developed by the authors. The survey addressed chiropractors' assessment of their training, experiences, and educational interest/needs regarding identifying and addressing patient substance use. The survey instrument was uploaded to Qualtrics and was electronically distributed to chiropractic clinicians at active and accredited English-speaking Doctor of Chiropractic degree programs (DCPs) in the United States. RESULTS A total of 175 individual survey responses were returned from a total of 276 eligible participants (63.4% response rate) from 16 out of 18 active and accredited English-speaking DCPs (88.8% of DCPs) in the United States. Nearly half of respondents strongly disagreed or disagreed (n = 77, 44.0%) that they were confident in their ability to identify patients who misuse prescription medication. The majority of respondents (n = 122, 69.7%) indicated that they did not have an established referral relationship with local clinical providers who provide treatment for individuals who use drugs or misuse alcohol or prescription medications. Most respondents strongly agreed or agreed (n = 157, 89.7%) that they would benefit from participating in a continuing education course on topics related to patients who use drugs or misuse alcohol or prescription medications. CONCLUSIONS Chiropractors indicated a need for training to help them identify and address patient substance use. There is a demand among chiropractors to develop clinical care pathways for chiropractic referrals and collaboration with health care professionals who provide treatment for individuals who use drugs or misuse alcohol or prescription medications.
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Affiliation(s)
- Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, 1155 N. Mayfair Rd, Milwaukee, WI, 53226, USA.
| | - Maureen Reynolds
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steffany Moonaz
- Southern California University of Health Sciences, Whittier, CA, USA
- Maryland University of Integrative Health, Laurel, MD, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Robb Russell
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical Translation and Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Lee WT, Chu ECP, Chau C. Understanding the Utilization, Challenges, and Attitudes Towards Laboratory Testing and Radiological Imaging Among Chiropractors in Hong Kong: A Cross-Sectional Survey. Cureus 2023; 15:e40784. [PMID: 37363113 PMCID: PMC10286685 DOI: 10.7759/cureus.40784] [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] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
Objective This cross-sectional survey aimed to investigate the utilization, challenges, and attitudes of chiropractors in Hong Kong towards laboratory testing and radiological imaging. Method An online survey was conducted between May 1, 2023, and June 1, 2023. The target population for the survey was registered chiropractors in Hong Kong, which has a total of 325 practitioners. A total of 151 chiropractors participated in the survey, resulting in a response rate of 46.5%. The respondents provided information on their demographics, years of experience, practice settings, awareness of their right to request diagnostic tests, utilization of laboratory testing and imaging, and attitudes towards evidence-based practice. The survey data were analyzed using descriptive statistics. Result The survey findings revealed that a significant proportion of chiropractors in Hong Kong utilized laboratory testing and radiological imaging in their practice. Most respondents reported using laboratory testing to diagnose medical conditions and monitor existing conditions. Imaging is commonly used for diagnosing medical conditions and monitoring disease progression. However, a notable proportion of chiropractors reported facing rejection of their tests and imaging requests, which limited their ability to provide optimal care to their patients. The identified challenges included high rejection rates for specific imaging requests, leading to patient frustration, increased costs, and delayed diagnosis. Nevertheless, chiropractors in Hong Kong showed a strong belief in evidence-based practice and demonstrated a willingness to search for literature and incorporate it into their daily practice. By addressing this issue, our aim was to gain valuable insights into the status of laboratory testing and radiological imaging among chiropractors in Hong Kong. The findings of this study underscore the necessity for collaborative efforts among chiropractors, healthcare professionals, healthcare facilities, policymakers, and insurance companies to effectively address the challenges identified and improve patient care outcomes. Specifically, enhancing access to diagnostic tests and working towards reducing rejection rates will play a pivotal role in supporting chiropractors' role as primary healthcare providers in Hong Kong.
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Affiliation(s)
- Wai Ting Lee
- Research Committee, Chiropractic Doctors Assocaition of Hong Kong, Hong Kong, CHN
| | - Eric Chun-Pu Chu
- Research Committee, Chiropractic Doctors Association of Hong Kong, Hong Kong, CHN
| | - Cherie Chau
- Research Committee, Chiropractic Doctors Association of Hong Kong, Hong Kong, CHN
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Muller D, Thandar Y, Haffejee F. Factors Associated With Compliance With Self-Management Home Therapies for Spine Pain: A Survey of Participants Attending a Chiropractic Teaching Clinic in South Africa. J Chiropr Med 2023; 22:96-102. [PMID: 37346237 PMCID: PMC10280084 DOI: 10.1016/j.jcm.2022.09.001] [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: 12/10/2021] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The purpose of this study was to determine factors that affect compliance with various prescribed home therapies based on reported feedback from participants with spine pain. Methods This was a descriptive, quantitative, cross-sectional survey. A purposive sampling method was used to recruit 121 participants with neck and back pain attending the Durban University of Technology Chiropractic Day Clinic located in KwaZulu-Natal, South Africa. Data were collected using a self-administered questionnaire. Descriptive statistics, including frequencies and percentages, were used to summarize the data, and odds ratios (ORs) were calculated. Results Most participants presented with chronic pain, reporting an average severity of 6 out of 10 and little disability from the pain. Home therapy included stretches (92.2%), heat therapy (49.1%), and ice therapy (38.8%). Almost two-thirds (62.1%) of participants reported being fully compliant with the prescribed home therapy, while 32.8% reported partial compliance. The main factors that potentially affected compliance were laziness and forgetfulness. Participants who reported having depression were less compliant (OR, 0.181), while those with chronic pain were more compliant (OR, 3.74). Those who believed that home therapy would alleviate their pain were also more compliant (OR, 3.83). Conclusion The study found that a majority of participants with spine pain were compliant with prescribed chiropractic home treatment. Key factors that potentially influenced compliance were identified.
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Affiliation(s)
- Devereaux Muller
- Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - Yasmeen Thandar
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - Firoza Haffejee
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
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Gorrell LM, Brown BT, Engel R, Lystad RP. Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review. BMJ Open 2023; 13:e067526. [PMID: 37142321 PMCID: PMC10163511 DOI: 10.1136/bmjopen-2022-067526] [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: 08/17/2022] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES To describe if there has been a change in the reporting of adverse events associated with spinal manipulation in randomised clinical trials (RCTs) since 2016. DESIGN A systematic literature review. DATA SOURCES Databases were searched from March 2016 to May 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spinal manipulation; chiropractic; osteopathy; physiotherapy; naprapathy; medical manipulation and clinical trial. METHODS Domains of interest (pertaining to adverse events) included: completeness and location of reporting; nomenclature and description; spinal location and practitioner delivering manipulation; methodological quality of the studies and details of the publishing journal. Frequencies and proportions of studies reporting on each of these domains were calculated. Univariable and multivariable logistic regression models were fitted to examine the effect of potential predictors on the likelihood of studies reporting on adverse events. RESULTS There were 5399 records identified by the electronic searches, of which 154 (2.9%) were included in the analysis. Of these, 94 (61.0%) reported on adverse events with only 23.4% providing an explicit description of what constituted an adverse event. Reporting of adverse events in the abstract has increased (n=29, 30.9%) while reporting in the results section has decreased (n=83, 88.3%) over the past 6 years. Spinal manipulation was delivered to 7518 participants in the included studies. No serious adverse events were reported in any of these studies. CONCLUSIONS While the current level of reporting of adverse events associated with spinal manipulation in RCTs has increased since our 2016 publication on the same topic, the level remains low and inconsistent with established standards. As such, it is imperative for authors, journal editors and administrators of clinical trial registries to ensure there is more balanced reporting of both benefits and harms in RCTs involving spinal manipulation.
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Affiliation(s)
- Lindsay M Gorrell
- Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Benjamin T Brown
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Roger Engel
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Chu ECP. Remission of cervicogenic dysphagia associated with biomechanical dysfunction following chiropractic therapy. J Med Life 2023; 16:794-798. [PMID: 37520480 PMCID: PMC10375352 DOI: 10.25122/jml-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/09/2023] [Indexed: 08/01/2023] Open
Abstract
Cervicogenic dysphagia is a complex condition that can arise from biomechanical dysfunction in the cervical spine. Conventional treatment outcomes are not always guaranteed. Chiropractic treatment is considered an alternative treatment for dysphagia, yet there is a lack of evidence supporting its effectiveness. We present the case of a 48-year-old male who had difficulty swallowing for eight months. He had a feeling of food stuck in his throat when eating hard food but without any pain when swallowing, and eventually, he could not swallow any dry food. He was diagnosed with dysphagia associated with an anxiety disorder and was treated with medication, but there was no improvement in his condition. A full-spine radiograph revealed biomechanical dysfunction, including reduced cervical lordosis and levoscoliosis of the upper thoracic spine. After nine months of conventional physiotherapy, the patient completely recovered from his symptoms, with significantly improved biomechanical parameters. This study highlights the potential mechanism of cervicogenic dysphagia and the effect of chiropractic treatment in managing it. Applying chiropractic treatment, including spinal manipulative therapy, instrument-assisted soft tissue manipulation, and mechanical traction, might bring a positive outcome for dysphagia patients with careful consideration.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
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Inban P, Zahdeh T, Chandrasekaran SH, Intsiful TA, Gowthavaram CA, Ebong AK, Kejela Y, Singh S, Khan A, Awale A. Non-small Cell Lung Carcinoma With Metastases to Various Levels of Vertebra: A Case Report and Literature Review. Cureus 2023; 15:e37851. [PMID: 37213967 PMCID: PMC10198757 DOI: 10.7759/cureus.37851] [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] [Accepted: 04/19/2023] [Indexed: 05/23/2023] Open
Abstract
The consequences of lung cancer over the past century have been quite deadly and cost millions of lives. Besides the statistics that show its brutal mortality rate, the comorbidities secondary to lung cancer have had their toll and burden on patients too. Lung cancer is broadly and histologically divided into small and non-small cell lung cancers (NSCLC), with the latter associated with a heavy smoking history. Initial presentation of NSCLC varies, and many patients present with an advanced disease that has spread to different parts of the body. Metastasis to the bone can lead to severe pain requiring extreme analgesia regimens. Here, we present a case of a 68-year-old male with advanced NSCLC who initially presented with bony pain due to metastasis.
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Affiliation(s)
- Pugazhendi Inban
- Department of General Medicine, Government Medical College, Omandurar, Chennai, IND
| | - Tamer Zahdeh
- Internal Medicine, Hadassah Medical Center, Jerusalem, ISR
| | | | | | | | - Abasiono K Ebong
- College of Medicine, Richmond Gabriel University, Arnos Vale, VCT
| | - Yabets Kejela
- Department of Surgery, Hayat Hospital Medical College, Addis Ababa, ETH
| | - Satyam Singh
- Internal Medicine, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Aadil Khan
- Department of Internal Medicine, Lala Lajpat Rai (LLR) Hospital, Kanpur, IND
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Trager RJ, Daniels CJ, Meyer KW, Stout AC, Dusek JA. Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data. Chiropr Man Therap 2023; 31:10. [PMID: 36895028 PMCID: PMC9999664 DOI: 10.1186/s12998-023-00481-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND This review aimed to identify variables influencing clinicians' application of spinal manipulative therapy (SMT) for persistent spine pain after lumbar surgery (PSPS-2). We hypothesized markers of reduced clinical/surgical complexity would be associated with greater odds of applying SMT to the lumbar region, use of manual-thrust lumbar SMT, and SMT within 1-year post-surgery as primary outcomes; and chiropractors would have increased odds of using lumbar manual-thrust-SMT compared to other practitioners. METHODS Per our published protocol, observational studies describing adults receiving SMT for PSPS-2 were included. PubMed, Web of Science, Scopus, OVID, PEDro, and Index to Chiropractic Literature were searched from inception to January 6, 2022. Individual patient data (IPD) were requested from contact authors when needed for selection criteria. Data extraction and a customized risk-of-bias rubric were completed in duplicate. Odds ratios (ORs) for primary outcomes were calculated using binary logistic regressions, with covariates including age, sex, symptom distribution, provider, motion segments, spinal implant, and surgery-to-SMT interval. RESULTS 71 articles were included describing 103 patients (mean age 52 ± 15, 55% male). The most common surgeries were laminectomy (40%), fusion (34%), and discectomy (29%). Lumbar SMT was used in 85% of patients; and of these patients was non-manual-thrust in 59%, manual-thrust in 33%, and unclear in 8%. Clinicians were most often chiropractors (68%). SMT was used > 1-year post-surgery in 66% of cases. While no primary outcomes reached significance, non-reduced motion segments approached significance for predicting use of lumbar-manual-thrust SMT (OR 9.07 [0.97-84.64], P = 0.053). Chiropractors were significantly more likely to use lumbar-manual-thrust SMT (OR 32.26 [3.17-327.98], P = 0.003). A sensitivity analysis omitting high risk-of-bias cases (missing ≥ 25% IPD) revealed similar results. CONCLUSIONS Clinicians using SMT for PSPS-2 most often apply non-manual-thrust SMT to the lumbar spine, while chiropractors are more likely to use lumbar-manual-thrust SMT relative to other providers. As non-manual-thrust SMT may be gentler, the proclivity towards this technique suggests providers are cautious when applying SMT after lumbar surgery. Unmeasured variables such as patient or clinician preferences, or limited sample size may have influenced our findings. Large observational studies and/or international surveys are needed for an improved understanding of SMT use for PSPS-2. Systematic review registration PROSPERO (CRD42021250039).
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA. .,College of Chiropractic, Logan University, Chesterfield, MO, 63017, USA.
| | - Clinton J Daniels
- VA Puget Sound Health Care System, Rehabilitation Care Services, 9600 Veterans Drive, Tacoma, WA, 98493, USA
| | - Kevin W Meyer
- VA Puget Sound Health Care System, Rehabilitation Care Services, 9600 Veterans Drive, Tacoma, WA, 98493, USA
| | - Amber C Stout
- Lakeside Hospital Library, Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
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Howitt SD, Welsh P, DeGraauw C. Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes. J Manipulative Physiol Ther 2023; 46:182-189. [PMID: 38142379 DOI: 10.1016/j.jmpt.2023.11.001] [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: 04/21/2022] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care. METHODS This study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages. RESULTS There was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care. CONCLUSION This sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.
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Affiliation(s)
- Scott D Howitt
- Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
| | - Patrick Welsh
- Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Christopher DeGraauw
- Clinical Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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Muller RD, Graham SE, Zhao X, Bastian LA, Sites AR, Corcoran KL, Lisi AJ. A Systems Approach for Assessing Low Back Pain Care Quality in Veterans Health Administration Chiropractic Visits: A Cross-Sectional Analysis. J Manipulative Physiol Ther 2023; 46:171-181. [PMID: 38142380 DOI: 10.1016/j.jmpt.2023.11.002] [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: 05/26/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The purpose of this study was to explore a systemwide process for assessing components of low back pain (LBP) care quality in Veterans Health Administration (VHA) chiropractic visits using electronic health record (EHR) data. METHODS We performed a cross-sectional quality improvement project. We randomly sampled 1000 on-station VHA chiropractic initial visits occurring from October 1, 2017, to September 30, 2018, for patients with no such visits within the prior 12 months. Characteristics of LBP visits were extracted from VHA national EHR data via structured data queries and manual chart review. We developed quality indicators for history and/or examination and treatment procedures using previously published literature and calculated frequencies of visits meeting these indicators. Visits meeting our history and/or examination and treatment indicators were classified as "high-quality" visits. We performed a regression analysis to assess associations between demographic/clinical characteristics and visits meeting our quality criteria. RESULTS There were 592 LBP visits identified. Medical history, physical examination, and neurologic examination were documented in 76%, 77%, and 63% of all LBP visits, respectively. Recommended treatments, such as any manipulation, disease-specific education/advice, and therapeutic exercise, occurred in 75%, 69%, and 40% of chronic visits (n = 383), respectively. In acute/subacute visits (n = 37), any manipulation (92%), manual soft tissue therapy (57%), and disease-specific advice/education (54%) occurred most frequently. Female patients and those with a neck pain comorbid diagnosis were significantly less likely to have a "high-quality" visit, while other regression associations were non-significant. CONCLUSION This study explored a systemwide process for assessing components of care quality in VHA chiropractic visits for LBP. These results produced a potential framework for uniform assessment of care quality in VHA chiropractic visits for LBP and highlight potential areas for improvements in LBP care quality assessments.
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Affiliation(s)
- Ryan D Muller
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, Yale University, New Haven, Connecticut.
| | - Sarah E Graham
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Xiwen Zhao
- Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Anna R Sites
- Quality Insights, Inc, Charleston, West Virginia
| | - Kelsey L Corcoran
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Anthony J Lisi
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, Yale University, New Haven, Connecticut
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Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature. JOURNAL OF INTEGRATIVE MEDICINE 2023; 21:159-167. [PMID: 36841750 DOI: 10.1016/j.joim.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/14/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles. OBJECTIVE There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level. SEARCH STRATEGY Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021. INCLUSION CRITERIA Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review. DATA EXTRACTION AND ANALYSIS Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status. RESULTS A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%). CONCLUSION This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: a scoping review of the literature. J Integr Med. 2023; Epub ahead of print.
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Affiliation(s)
- Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Antoinette L Spector
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joni Williams
- Department of Medicine, Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Staci Young
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Chu ECP, Trager RJ, Lee WT, Cheong BKC, Hei SYM. Lung Cancer With Vertebral Metastases Presenting as Low Back Pain in the Chiropractic Office: A Case Report. Cureus 2023; 15:e34821. [PMID: 36919062 PMCID: PMC10008126 DOI: 10.7759/cureus.34821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Lung cancer commonly metastasizes to the skeletal system, and when affecting the spine, it may initially be mistaken for a typical musculoskeletal source of back pain. We report a previously healthy 52-year-old male non-smoker with an eight-week history of low back pain that radiated into his left thigh and recent weight loss, yet no respiratory symptoms. Initially, the patient visited his primary care physician, who suspected a musculoskeletal condition and prescribed a nonsteroidal anti-inflammatory drug and muscle relaxant, then referred the patient to the chiropractor. Based on the patient's pain pattern, limited mobility, and other features, the chiropractor suspected a lumbar disc herniation. However, the patient's condition worsened during a one-week trial of care, so the chiropractor ordered magnetic resonance imaging (MRI) and, as the findings suggested vertebral metastasis, promptly referred the patient to an oncologist, who confirmed a diagnosis of lung adenocarcinoma via positron emission tomography (PET)/computed tomography and biopsy. Chiropractors should be aware of warning signs of malignancy, such as unexplained weight loss or progressive worsening despite treatment. If providers suspect spinal metastasis, they should order advanced imaging such as an MRI and refer patients to an oncologist for timely care.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
| | - Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Wai Ting Lee
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
| | | | - Steve Yun Ming Hei
- New York Chiropractic and Physiotherapy Centre, New York Medical Group, Kowloon, HKG
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Manansala C, Ferbers S, Johnson M, Passmore S. Factors associated with non-pharmacological, non-operative treatment utilization prior to thoracolumbar spine surgery in Manitoba: A Canadian Spine Outcomes Research Network (CSORN) study. Musculoskelet Sci Pract 2023; 63:102695. [PMID: 36473826 DOI: 10.1016/j.msksp.2022.102695] [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] [Received: 07/14/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence for managing chronic low back pain suggests beginning with non-invasive treatments and having surgery as a last resort. Currently, no studies examine treatment engagement for back pain in the six-months preceding elective spine surgery assessment. OBJECTIVES This study aims to: 1) determine the engagement in non-pharmacological, non-operative treatment before elective thoracolumbar spine surgery (ETSS) assessment in XXXXXXXX; and 2) investigate potential factors associated with engagement in this population. DESIGN Retrospective cohort design. METHODS Canadian Spine Outcomes Research Network (CSORN) registry data were analyzed to compare groups who reported minimal engagement in non-pharmacological, non-operative treatment before ETSS assessment to those who engaged. Binary logistic regression was used to identify factors associated with engagement. RESULTS A total of 144 patients qualified, 41.7% reported minimal engagement with non-pharmacological, non-operative treatment in the six-months preceding ETSS assessment. Four statistically significant factors associated with minimal engagement were identified: 1) 61-90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0-10.7, p < .001); 2) Oswestry disability index (ODI) score >60% (OR 3.5, 95% CI 1.4-9.2, p = .010; 3) body mass index (BMI) score 25-29.9 (OR 6.7, 95% CI 2.2-20.9, p < .001) and BMI ≥ 30 (OR 4.2, 95% CI 1.4-12.2, p = .009); and 4) female biological sex (OR 2.4, 95% CI 1.0-5.6, p = .039. CONCLUSIONS In total, 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Factors associated with minimal engagement included: older age, high disability, increased BMI, and female biological sex.
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Affiliation(s)
- Christian Manansala
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada.
| | - Spencer Ferbers
- Max Rady College of Medicine, University of Manitoba, 260 Brodie Centre - 727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Michael Johnson
- Departments of Orthopedics and Neurosurgery, AD401 - 820 Sherbrook Street, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Steven Passmore
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada
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Chu ECP, Trager RJ, Tao C. Improvement of Chronic Neck Pain After Posterior Atlantoaxial Surgical Fusion via Multimodal Chiropractic Care: A Case Report. Cureus 2023; 15:e34630. [PMID: 36891015 PMCID: PMC9988189 DOI: 10.7759/cureus.34630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
There is a lack of research regarding the effectiveness and safety of manual therapies, including spinal manipulative therapy (SMT), for patients with previous cervical spine surgery. A 66-year-old, otherwise healthy, woman who underwent C1/2 posterior surgical fusion for rotatory instability during adolescence presented to a chiropractor with a six-month history of progressive worsening of chronic neck pain and headaches despite acetaminophen, tramadol, and physical therapy. Upon examination, the chiropractor noted postural changes, limited cervical range of motion, and muscle hypertonicity. Computed tomography revealed a successful C1/2 fusion, and degenerative findings at C0/1, C2/3, C3/4, and C5/6, without cord compression. As the patient had no neurologic deficits or myelopathy and tolerated spinal mobilization well, the chiropractor applied cervical SMT, along with soft tissue manipulation, ultrasound therapy, mechanical traction, and thoracic SMT. The patient's pain was reduced to a mild level and the range of motion improved over three weeks of treatment. Benefits were maintained over a three-month follow-up as treatments were spaced apart. Despite the apparent success in the current case, evidence for manual therapies and SMT in patients with cervical spine surgery remains limited, and these therapies should be used with caution on an individual patient basis. Further research is needed to examine the safety of manual therapies and SMT in patients following cervical spine surgery and determine predictors of treatment response.
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Affiliation(s)
- Eric Chun-Pu Chu
- Department of Chiropractic and Physiotherapy, New York Chiropractic and Physiotherapy Centre, Kowloon, HKG
| | - Robert J Trager
- Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Cliff Tao
- Radiology, Private Practice of Chiropractic Radiology, Irvine, USA
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Chu ECP, Trager RJ, Lee LYK, Niazi IK. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep 2023; 13:1254. [PMID: 36690712 PMCID: PMC9870863 DOI: 10.1038/s41598-023-28520-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1-5 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, EC Healthcare, 41/F Langham Place Office Tower, 8 Argyle Street, Kowloon, Hong Kong
| | - Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.
- College of Chiropractic, Logan University, Chesterfield, MO, 63017, USA.
| | - Linda Yin-King Lee
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Kowloon, Hong Kong
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, 1060, New Zealand
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Muacevic A, Adler JR. Prostate Cancer Presenting as Hip Pain at the Chiropractic Office: A Case Report and Literature Review. Cureus 2023; 15:e34049. [PMID: 36824534 PMCID: PMC9941037 DOI: 10.7759/cureus.34049] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/23/2023] Open
Abstract
Prostate cancer is one of the most common cancers found in males, and it tends to metastasize to bony parts such as the hip, spine, and pelvis, resulting in pain and/or radicular pain, which can present similarly to musculoskeletal complaints. The lack of routine screening and musculoskeletal symptoms present challenges in the diagnosis of prostate cancer. We report the case of a 62-year-old male with no history of cancer and no previous prostate cancer screening who visited a chiropractor for the care of worsening left hip pain after a marathon. The patient visited other healthcare providers and was suggested to have degenerative conditions; he received nonsteroidal anti-inflammatory medication, physiotherapy, and acupuncture. Given the patient's limited improvement by other providers and neurological symptoms, the chiropractor requested lumbar spine radiography, which revealed suspected bone metastasis, and ordered a hip MRI accordingly. MRI findings suggested prostate cancer, and the chiropractor referred the patient to an oncologist, who performed additional imaging and testing to make a presumptive prostate cancer diagnosis. A literature search found nine cases of undiagnosed prostate cancer presenting to a chiropractor for care. All patients included in this case were older males with no previous prostate screening or bone metastasis. The study is focused on the need for a comprehensive evaluation of patients with hip pain during a chiropractic visit due to the chances of prostate cancer. There are higher chances of ignoring cancer symptoms during a hip examination. Comprehensive evaluation and advanced imaging could help chiropractors detect patients with prostate cancer.
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Affiliation(s)
- Alexander Muacevic
- Department of Chiropractic and Physiotherapy, New York Chiropractic and Physiotherapy Centre, Hong Kong, HKG
| | - John R Adler
- Department of Chiropractic and Physiotherapy, New York Chiropractic and Physiotherapy Centre, Hong Kong, HKG
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De Carvalho DE, Callaghan JP. The effect of lumbar spinal manipulation on biomechanical factors and perceived transient pain during prolonged sitting: a laboratory-controlled cross-sectional study. Chiropr Man Therap 2022; 30:62. [PMID: 36585725 PMCID: PMC9805135 DOI: 10.1186/s12998-022-00472-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: 08/16/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spinal manipulation has been shown to affect muscle activity, posture, and pain. To date, no studies have examined the effect of manipulation on biomechanical factors during sitting. Therefore, the purpose of this study was to investigate the immediate effect of lumbar spinal manipulation on trunk muscle activation, spine posture and movements, and perceived ratings of transient pain in asymptomatic adults during prolonged office sitting. METHODS Twenty healthy adults were recruited for a single laboratory session that included a standardized office sitting/data entry protocol (120 min total, 3 blocks of 40 min). Data were collected between July and August 2012. The first block (baseline) was immediately followed by two experimental blocks. Prior to the start of each experimental block, participants were transferred to a therapy plinth and placed side lying (right side down), and a random presentation of either a control or high velocity low amplitude thrust directed at L4/L5 was delivered. Continuous measures of muscle activity, spine posture, and spine movements were recorded throughout the sitting trials. Perceived transient pain was measured by visual analogue scale at 10-min intervals (including immediately before and after the randomized maneuvers). RESULTS There were no significant differences in spine or pelvic posture or perceived back pain following either the manipulation or control maneuvers. Significantly reduced muscle activity and increased shifts of the lumbar spine angle were identified in the block following manipulation compared to both baseline and post control blocks. CONCLUSIONS Spinal manipulation does not appear to have an immediate impact on spine or pelvic posture in healthy adults but does appear to reduce muscle activity and increase spine movement during sitting. Future work should replicate this study with a larger population in a field setting. It may be worthwhile to explore the implication of reduced muscle activation and increased spine movements during prolonged sitting for office workers that receive manipulations or mobilizations during their workday.
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Affiliation(s)
- D. E. De Carvalho
- grid.25055.370000 0000 9130 6822Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6 Canada
| | - J. P. Callaghan
- grid.46078.3d0000 0000 8644 1405Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON N2L 3G1 Canada
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Trager RJ, Daniels CJ, Perez JA, Casselberry RM, Dusek JA. Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data. BMJ Open 2022; 12:e068262. [PMID: 36526306 PMCID: PMC9764600 DOI: 10.1136/bmjopen-2022-068262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Chiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however, limited research has examined the relationship between these therapies. We hypothesised that adults receiving CSMT for newly diagnosed LDH or LSR would have reduced odds of lumbar discectomy over 1-year and 2-year follow-up compared with those receiving other care. DESIGN Retrospective cohort study. SETTING 101 million patient US health records network (TriNetX), queried on 24 October 2022, yielding data from 2012 query. PARTICIPANTS Adults age 18-49 with newly diagnosed LDH/LSR (first date of diagnosis) were included. Exclusions were prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis. Propensity score matching controlled for variables associated with the likelihood of discectomy (eg, demographics, medications). INTERVENTIONS Patients were divided into cohorts according to receipt of CSMT. PRIMARY AND SECONDARY OUTCOME MEASURES ORs for lumbar discectomy; calculated by dividing odds in the CSMT cohort by odds in the cohort receiving other care. RESULTS After matching, there were 5785 patients per cohort (mean age 36.9±8.2). The ORs (95% CI) for discectomy were significantly reduced in the CSMT cohort compared with the cohort receiving other care over 1-year (0.69 (0.52 to 0.90), p=0.006) and 2-year follow-up (0.77 (0.60 to 0.99), p=0.040). E-value sensitivity analysis estimated the strength in terms of risk ratio an unmeasured confounding variable would need to account for study results, yielding point estimates for each follow-up (1 year: 2.26; 2 years: 1.92), which no variables in the literature reached. CONCLUSIONS Our findings suggest receiving CSMT compared with other care for newly diagnosed LDH/LSR is associated with significantly reduced odds of discectomy over 2-year follow-up. Given socioeconomic variables were unavailable and an observational design precludes inferring causality, the efficacy of CSMT for LDH/LSR should be examined via randomised controlled trial to eliminate residual confounding.
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Affiliation(s)
- Robert James Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- College of Chiropractic, Logan University, Chesterfield, Missouri, USA
| | - Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, Washington, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Regina M Casselberry
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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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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Fernandez M, Young A, Milton K, Pinhiero M, de Luca K, Ferreira P, Hebert J. Physical activity promotion in chiropractic: a systematic review of clinician-based surveys. Chiropr Man Therap 2022; 30:55. [PMID: 36514061 PMCID: PMC9749165 DOI: 10.1186/s12998-022-00467-9] [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: 05/16/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. METHODS Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the 'Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices' tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors' views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. RESULTS From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). CONCLUSION A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors' own PA participation.
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Affiliation(s)
- Matthew Fernandez
- School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Anika Young
- grid.1004.50000 0001 2158 5405Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Karen Milton
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marina Pinhiero
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie de Luca
- grid.1023.00000 0001 2193 0854School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Paulo Ferreira
- grid.1013.30000 0004 1936 834XSydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Jeffrey Hebert
- grid.266820.80000 0004 0402 6152Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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