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Green BN, Johnson CD, Crawford C, Tavares PA, Murnaghan K, Haldeman S, Hurwitz EL, Yang H, de Luca K. Association between spinal and non-spinal health conditions reported in epidemiological studies: a scoping review protocol. BMJ Open 2023; 13:e075382. [PMID: 37788930 DOI: 10.1136/bmjopen-2023-075382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The increasing prevalence of coexisting health conditions poses a challenge to healthcare providers and healthcare systems. Spinal pain (eg, neck and back pain) and spinal pathologies (eg, osteoporotic fractures and degenerative spinal disease) exist concurrently with other non-spinal health conditions (NSHC). However, the scope of what associations may exist among these co-occurring conditions is unclear. Therefore, this scoping review aims to map the epidemiological literature that reports associations between spine-related pain and pathologies (SPPs) and NSHCs. METHODS AND ANALYSIS This scoping review will follow the JBI protocol and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search the literature using key words and MeSH terms for SPPs and NSHCs. Terminology/vocabulary for NSHCs will include those for communicable and non-communicable diseases as reported by WHO Global Burden of Disease reports. Five databases will be searched from inception: MEDLINE, EMBASE, APA PsycInfo, Scopus and Web of Science Core Collection. Papers published in English, in peer-reviewed journals, including measures of association between SPPs and NSHCs and using observational epidemiologic study designs will be included. Excluded will be studies of cadaveric, animal or health behaviours; studies with no measures of association and non-observational epidemiologic studies. Results will include the number of studies, the studies that have evaluated the measures of association and the frequency of the studied associations between SPPs and NSHCs. Results will be reported in tables and diagrams. Themes of comorbidities will be synthesised into a descriptive report. ETHICS AND DISSEMINATION This scoping review was deemed exempt from ethics review. This review will provide a comprehensive overview of the literature that reports associations between SPPs and NSHCs to inform future research initiatives and practices. Results will be disseminated through publication in peer-reviewed journals and research conferences. REGISTRATION DETAILS https://osf.io/w49u3.
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Affiliation(s)
- Bart N Green
- Employer Based Integrated Primary Care Health Centers, Qualcomm Health Center, Stanford Health Care, San Diego, California, USA
- National University of Health Sciences, Lombard, Illinois, USA
| | | | | | | | - Kent Murnaghan
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Scott Haldeman
- Department of Neurology, University of California Irvine, Orange, California, USA
- World Spine Care, Tustin, California, USA
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, Hawaii, USA
| | - Haiou Yang
- University of California, Irvine, California, USA
| | - Katie de Luca
- CQUniversity Brisbane, Brisbane, Queensland, Australia
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Wang TJ, Ward T, Nguyen HT, Hurwitz EL. Equestrian-Related Musculoskeletal Injuries Presenting to a Chiropractic Practice: A Retrospective Chart Review of 19 Patients. J Chiropr Med 2023; 22:103-106. [PMID: 37346236 PMCID: PMC10280082 DOI: 10.1016/j.jcm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The purpose of this study was to describe the types of equestrian-related musculoskeletal injuries and their management. Methods We retrospectively reviewed the charts of 19 patients who presented with injuries from equestrian activities at a chiropractic practice from December 2000 to December 2020. Deidentified data were extracted from the charts and summarized. Results Of the 19 patients, 42.3% presented with acute trauma, 38.5% had overuse injuries, and 19.2% had chronic injuries as a result of previous trauma. We found that 90% of overuse injuries and 18.2% of acute injuries led to chronic conditions that needed ongoing management. Conclusion From this sample of patients, there was a high percentage of overuse and chronic injuries for patients who participated in equestrian activities.
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Affiliation(s)
- Tina J. Wang
- Physical Medicine and Rehabilitation, Loma Linda University School of Medicine, Loma Linda, California
| | - Toni Ward
- Private practice, Hacienda Heights, California
| | - Hang T. Nguyen
- Clinical Education Department, Southern California University of Health Sciences, Whittier, California
| | - Eric L. Hurwitz
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii
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de Luca K, Tavares P, Yang H, Hurwitz EL, Green BN, Dale H, Haldeman S. Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey. Int J Environ Res Public Health 2023; 20:5369. [PMID: 37047983 PMCID: PMC10094294 DOI: 10.3390/ijerph20075369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Spinal pain and chronic health conditions are highly prevalent, burdensome, and costly conditions, both in the United States and globally. Using cross-sectional data from the 2016 through 2018 National Health Interview Survey (n = 26,926), we explored associations between spinal pain and chronic health conditions and investigated the influence that a set of confounders may have on the associations between spinal pain and chronic health conditions. Variance estimation method was used to compute weighted descriptive statistics and measures of associations with multinomial logistic regression models. All four chronic health conditions significantly increased the prevalence odds of spinal pain; cardiovascular conditions by 58%, hypertension by 40%, diabetes by 25% and obesity by 34%, controlling for all the confounders. For all chronic health conditions, tobacco use (45-50%), being insufficiently active (17-20%), sleep problems (180-184%), cognitive impairment (90-100%), and mental health conditions (68-80%) significantly increased the prevalence odds of spinal pain compared to cases without spinal pain. These findings provide evidence to support research on the prevention and treatment of non-musculoskeletal conditions with approaches of spinal pain management.
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Affiliation(s)
- Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Science, CQ University, Brisbane, QLD 4701, Australia
| | - Patricia Tavares
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada
| | - Haiou Yang
- Center for Occupational and Environmental Health, University of California, Irvine, CA 92093, USA
| | - Eric L. Hurwitz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii, Mānoa, Honolulu, HI 96822, USA
| | - Bart N. Green
- Employer Based Integrated Primary Care Health Centers, Stanford Health Care, San Diego, CA 92121, USA
- Department of Publications, National University of Health Sciences, Lombard, IL 60148, USA
| | - Hannah Dale
- Discipline of Chiropractic, School of Health, Medical and Applied Science, CQ University, Brisbane, QLD 4701, Australia
| | - Scott Haldeman
- Department of Neurology, University of California, Irvine, CA 92093, USA
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Yang H, Hurwitz EL, Li J, de Luca K, Tavares P, Green B, Haldeman S. Bidirectional Comorbid Associations between Back Pain and Major Depression in US Adults. Int J Environ Res Public Health 2023; 20:4217. [PMID: 36901226 PMCID: PMC10002070 DOI: 10.3390/ijerph20054217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Low back pain and depression have been globally recognized as key public health problems and they are considered co-morbid conditions. This study explores both cross-sectional and longitudinal comorbid associations between back pain and major depression in the adult population in the United States. We used data from the Midlife in the United States survey (MIDUS), linking MIDUS II and III with a sample size of 2358. Logistic regression and Poisson regression models were used. The cross-sectional analysis showed significant associations between back pain and major depression. The longitudinal analysis indicated that back pain at baseline was prospectively associated with major depression at follow-up (PR 1.96, CI: 1.41, 2.74), controlling for health behavioral and demographic variables. Major depression at baseline was also prospectively associated with back pain at follow-up (PR 1.48, CI: 1.04, 2.13), controlling for a set of related confounders. These findings of a bidirectional comorbid association fill a gap in the current understanding of these comorbid conditions and could have clinical implications for the management and prevention of both depression and low back pain.
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Affiliation(s)
- Haiou Yang
- Center for Occupational and Environmental Health, University of California, Irvine, CA 92617, USA
| | - Eric L. Hurwitz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii, Mānoa, Honolulu, HI 96822, USA
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA
- School of Nursing, University of California, Los Angeles, CA 90095, USA
| | - Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, QLD 4000, Australia
| | - Patricia Tavares
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada
| | - Bart Green
- Employer Based Integrated Primary Care Health Centers, Stanford Health Care, National University of Health Sciences, San Diego, CA 92121, USA
| | - Scott Haldeman
- Department of Neurology, University of California, Irvine, CA 92868, USA
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Kizhakkeveettil A, Bezdjian S, Hurwitz EL, Toler AW, Rossi D, Uptmor S, Sagester K, Bangash M, MacKenzie TA, Lurie JD, Coulter I, Haldeman S, Whedon JM. Spinal Manipulation vs Prescription Drug Therapy for Chronic Low Back Pain: Beliefs, Satisfaction With Care, and Qualify of Life Among Older Medicare Beneficiaries. J Manipulative Physiol Ther 2022; 44:663-673. [DOI: 10.1016/j.jmpt.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/27/2022]
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Li Y, Lu Y, Hurwitz EL, Wu Y. Gender Disparities of Heart Disease and the Association with Smoking and Drinking Behavior among Middle-Aged and Older Adults, a Cross-Sectional Study of Data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study. Int J Environ Res Public Health 2022; 19:ijerph19042188. [PMID: 35206380 PMCID: PMC8872153 DOI: 10.3390/ijerph19042188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 12/13/2022]
Abstract
Heart disease remains the leading cause of death globally by gender and region. Smoking and alcohol drinking are known modifiable health behaviors of heart disease. Utilizing data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study, this study examines heart disease disparities and the association with smoking and drinking behavior among men and women in the US and China. Smoking and drinking behavior were combined to neither, smoke-only, drink-only, and both. In the US, the prevalence was higher in men (24.5%, 95% CI: 22.5-26.6%) than in women (20.6%, 95% CI: 19.3-22.1%) and a higher prevalence was found in the smoke-only group for both genders. In contrast, women in China had higher prevalence (22.9%, 95% CI: 21.7-24.1%) than men (16.1%, 95% CI: 15.1-17.2%), and the prevalence for women who smoked or engaged in both behaviors were ~1.5 times (95% CI: 1.3-1.8, p < 0.001) those who did not smoke or drink, but no statistical difference were found in men. The findings might be due to differences in smoking and drinking patterns and cultures by gender in the two countries and gender inequality among older adults in China. Culturally tailored health promotion strategies will help reduce the burden of heart disease.
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Affiliation(s)
- Yifei Li
- Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (Y.L.); (Y.L.); (E.L.H.)
- Department of Disease Control and Prevention, Tang Du Hospital, Air Force Medical University, Xi’an 710038, China
| | - Yuanan Lu
- Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (Y.L.); (Y.L.); (E.L.H.)
| | - Eric L. Hurwitz
- Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (Y.L.); (Y.L.); (E.L.H.)
| | - Yanyan Wu
- Thompson School of Social Work & Public Health, University of Hawai‘i at Mānoa, Honolulu, HI 96822, USA; (Y.L.); (Y.L.); (E.L.H.)
- Correspondence:
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Whedon JM, Kizhakkeveettil A, Toler AWJ, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S. Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries. Spine (Phila Pa 1976) 2022; 47:E142-E148. [PMID: 34474443 PMCID: PMC8581066 DOI: 10.1097/brs.0000000000004118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We combined elements of cohort and crossover-cohort design. OBJECTIVE The objective of this study was to compare longterm outcomes for spinal manipulative therapy (SMT) and opioid analgesic therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP). SUMMARY OF BACKGROUND DATA Current evidence-based guidelines for clinical management of cLBP include both OAT and SMT. For long-term care of older adults, the efficiency and value of continuing either OAT or SMT are uncertain. METHODS We examined Medicare claims data spanning a five-year period. We included older Medicare beneficiaries with an episode of cLBP beginning in 2013. All patients were continuously enrolled under Medicare Parts A, B, and D. We analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP. RESULTS SMT was associated with lower rates of escalation of care as compared to OAT. The adjusted rate of escalated care encounters was approximately 2.5 times higher for initial choice of OAT vs. initial choice of SMT (with weighted propensity scoring: rate ratio 2.67, 95% confidence interval 2.64-2.69, P < .0001). CONCLUSION Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy.Level of Evidence: 3.
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Affiliation(s)
- James M Whedon
- Southern California University of Health Sciences, Whittier, CA, USA
| | | | - Andrew WJ Toler
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Serena Bezdjian
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Daniel Rossi
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Sarah Uptmor
- Southern California University of Health Sciences, Whittier, CA, USA
| | | | - Jon D Lurie
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eric L. Hurwitz
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Ian Coulter
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Scott Haldeman
- Southern California University of Health Sciences, Whittier, CA, USA
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Berg LS, Young JJ, Kopansky-Giles D, Eberspaecher S, Outerbridge G, Hurwitz EL, Hartvigsen J. Musculoskeletal Conditions in Persons Living with HIV/AIDS: A Scoping Review. Curr Med Sci 2022; 42:17-25. [PMID: 35089493 DOI: 10.1007/s11596-022-2524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Globally 37.9 million people are living with HIV/AIDS, and with mortality rates declining, there is an increasing focus on comorbidities including musculoskeletal (MSK) disorders. Therefore, the aim of this scoping review was to generate and summarize an overview of the existing scientific literature dealing with MSK complaints in people living with HIV/AIDS (PLWHAs). METHODS This scoping review followed the five-stage methodological framework proposed by Arksey and O'Malley. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library from inception to June 1, 2020. Two reviewers independently reviewed the articles for eligibility. A data extraction form was used to chart information such as author, year of publication, data source, sample size, country of origin, ethnicity, age, gender, antiretroviral therapy, MSK condition prevalence, and anatomical location. RESULTS The search identified 10 522 articles. Of these, 27 studies were included after full-text screening for data extraction. Studies were conducted in thirteen different countries with diverse data sources such as outpatient clinic files, hospital records, primary care clinic files, and AIDS Service Organization files. PLWHAs have a variety of MSK conditions. Most studies reported spinal pain such as lower back or neck pain, but pain in the extremities and osteoarthritis (OA) were also represented. However, the frequencies of pain at various anatomical sites were highly variable. CONCLUSION There is a lack of knowledge regarding MSK conditions in PLWHAs. Future studies designed to specifically study MSK complaints and disabilities are needed to gain a better picture of the impact of these conditions in PLWHAs and to inform prevention and treatment strategies globally in this often-underserved population.
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Affiliation(s)
- Louise Schade Berg
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
- Department of Research, Canadian Memorial Chiropractic College, Toronto, M2H 3J1, Canada
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, M2H 3J1, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, MG5 1V7, Canada
| | - Stefan Eberspaecher
- Department of Orthopedic Surgery, Princess Marina Hospital, Gaborone, 8WVF+7H3, Botswana
| | - Geoff Outerbridge
- World Spine Care, Canadian Memorial Chiropractic College, Toronto, M2H 3J1, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, 96822, USA
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark.
- Chiropractic Knowledge Hub, Odense, 5230, Denmark.
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Goertz CM, Hurwitz EL, Murphy BA, Coulter ID. In Reply: A Missed Opportunity. J Manipulative Physiol Ther 2021; 44:517-518. [PMID: 34332768 DOI: 10.1016/j.jmpt.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Christine M Goertz
- Duke Clinical Research Institute, Duke University, Durham, North Carolina.
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii
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Goertz CM, Hurwitz EL, Murphy BA, Coulter ID. In Reply: Misleading Article by Goertz et al. J Manipulative Physiol Ther 2021; 44:515-516. [PMID: 34332770 DOI: 10.1016/j.jmpt.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Christine M Goertz
- Duke Clinical Research Institute, Duke University, Durham, North Carolina.
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work andPublic Health, University of Hawai'i at Mānoa,Honolulu, Hawaii
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Cross-ethnic comparison of the association between central sleep apnea and atrial fibrillation/flutter: The Kuakini Honolulu-Asia Aging Study and the Osteoporotic Fractures in Men (Mr.OS) study. Int J Cardiol Heart Vasc 2021; 35:100834. [PMID: 34258384 PMCID: PMC8256179 DOI: 10.1016/j.ijcha.2021.100834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
Introduction Few studies indicated the impact of ethnicity on an association between central sleep apnea (CSA) and atrial fibrillation/flutter (AF) in older populations. We assessed possible ethnic differences in the association among elderly Japanese-American and White-American men. Methods We performed a cross-sectional analysis using two population studies of Japanese-American and White-American men. The Kuakini Honolulu-Asia Aging Study is a longitudinal cohort study of Japanese-American men living in Hawaii. Sleep data were collected between 1999 and 2000. The Osteoporotic Fractures in Men (Mr.OS) Sleep Study was conducted between 2003 and 2005 on the continental U.S. The majority of Mr.OS participants were White-American. We selected 79-90 year old males, who had overnight polysomnography from both studies. Total participants were 690 Japanese-American and 871 White-American men. The central apnea index (CAI) was the measure of the number of central apneas. CSA was defined by CAI>=5. Cheyne-Stokes breathing (CSB) was defined as a minimum consecutive 5-10 min period of a crescendo-decrescendo respiratory pattern associated with CSA. Results The prevalence of AF was 5.7% in Japanese-American men and 9.0% in White-American men. The prevalence of CSA and CSB in White-Americans were higher than in Japanese-Americans (11.5% vs 6.5% and 5.7% vs 3.3%, respectively). In multivariable-adjusted logistic regression models, CSA was associated with higher odds of AF, and the association was stronger in Japanese-Americans [Odds Ratio (OR) = 4.77, 95% confidence interval (CI): 1.95-11.67] than in White-Americans (OR = 2.09, 95 %CI: 1.09-4.01). CSB showed similar trends as CSA. Conclusions After adjustment, CSA and CSB were significantly associated with AF in both Japanese-American and White-American men.
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Affiliation(s)
- Tagayasu Anzai
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Andrew Grandinetti
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Alan R Katz
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Eric L Hurwitz
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Yan Yan Wu
- University of Hawai'i at Mānoa, Office of Public Health Studies, Thompson School of Social Work and Public Health, 1960 East-West Road, Honolulu, HI, USA
| | - Kamal Masaki
- University of Hawai'i at Mānoa, Department of Geriatric Medicine, John A. Burns School of Medicine, 347 N Kuakini St, Honolulu, HI, USA.,Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA
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Yamanaka AB, Davis JD, Wilkens LR, Hurwitz EL, Fialkowski MK, Deenik J, Leon Guerrero RT, Novotny R. Determination of Child Waist Circumference Cut Points for Metabolic Risk Based on Acanthosis Nigricans, the Children's Healthy Living Program. Prev Chronic Dis 2021; 18:E64. [PMID: 34166179 PMCID: PMC8269744 DOI: 10.5888/pcd18.210021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Waist circumference is a common anthropometric measure for predicting abdominal obesity and insulin resistance. We developed optimal waist circumference cut points for children aged 2 to 8 years in the US-Affiliated Pacific (USAP) region based on the relationship of waist circumference and acanthosis nigricans in this population. METHODS We conducted a cross-sectional analysis from the Children's Healthy Living Program's 2012-2013 data on 4,023 children. We used receiver-operating characteristic analysis to determine the sensitivity and specificity for acanthosis nigricans across waist circumference, by sex and age. We determined optimal waist circumference cutoff points corresponding to Youden index (J), (equal to [sensitivity + specificity] - 1), with acanthosis nigricans. We compared these cut points with the 90th percentile. RESULTS The 90th-percentile cut points for boys aged 2 to 5 years (58.15 cm) and 6 to 8 years (71.63 cm) were slightly higher than for girls in both age groups (aged 2-5 y, 57.97 cm; 6-8 y: 70.37 cm). The optimal cut points (corresponding to the highest sensitivity and specificity) were as follows: for boys aged 2 to 5 years, 90th percentile (58.25 cm; sensitivity, 48.0%; specificity, 91.5%); for boys aged 6 to 8 years, 78th percentile (63.59 cm; sensitivity, 86.8%; specificity, 82.8%); for girls aged 2 to 5 years, 62nd percentile (53.27 cm; sensitivity, 71.4%; specificity, 63.1%), and for girls aged 6 to 8 years, 80th percentile (63.63 cm; sensitivity, 55.4%; specificity, 82.9%). CONCLUSION Among USAP children, waist circumference was a reasonable predictor for acanthosis nigricans. Further analysis is warranted to examine causes of acanthosis nigricans at lower-than-expected waist circumference percentiles. The cut points can be used for early detection of metabolic risk.
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Affiliation(s)
- Ashley B Yamanaka
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
- College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, 1955 East West Rd, Agricultural Sciences 216, Honolulu, Hawai'i 96822.
| | - James D Davis
- Department of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Lynne R Wilkens
- Biostatistics and Informatics Shared Resource, University of Hawai'i Cancer Center, Honolulu, Hawai'i
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Marie K Fialkowski
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Jonathan Deenik
- Department of Tropical Plant and Soil Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | | | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
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Matsunaga M, Hurwitz EL, Li D. Adequate intake of plant protein foods and moderate intake of animal protein foods are inversely associated with C-reactive protein in US adults with diabetes: A cross-sectional study with National Health and Nutrition Examination Survey. Nutrition 2021; 89:111276. [PMID: 34091193 DOI: 10.1016/j.nut.2021.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study examined the association between index component score levels of the Dietary Approaches to Stop Hypertension (DASH) density-based index and the Healthy Eating Index-2015 (HEI-2015) for protein foods and a high-sensitivity C-reactive protein (hs-CRP) level in US adults with diabetes status. METHODS This cross-sectional study used data from adult participants (≥20 y) in the National Health and Nutrition Examination Survey 2005-2010 (n = 12070) to obtain hs-CRP levels and index scores in US adults. Odds ratios (OR) of having an elevated hs-CRP (>3.0 mg/L) by score levels of protein food components (low: <80% versus high: ≥80% of the maximum score) were acquired using survey multivariable logistic regression analysis. RESULTS After adjusting for age group, sex, race/ethnicity, and other potential confounders, participants with a low score were more likely to have an elevated hs-CRP level than those with a high score (DASH plant proteins and HEI-2015 seafood and plant proteins: P < 0.001). Adults with diabetes who had a low score were more likely to have an elevated hs-CRP than adults without diabetes who had a high score (DASH animal proteins: OR 1.53, 95% confidence interval [CI] 1.24-1.87) (DASH plant proteins: OR 1.51, 95% CI 1.22-1.87) (HEI-2015 seafood and plant proteins: OR 1.38, 95% CI 1.16-1.65). Among adults with diabetes, those with a low score for animal protein foods were more likely to have an elevated hs-CRP (DASH animal proteins: OR 1.42, 95% CI 1.11-1.82) than those with a high score. CONCLUSIONS Moderate intake of animal protein foods and adequate intake of plant protein foods were inversely associated with an elevated hs-CRP level in US adults, especially in those with diabetes. Further investigation is required to establish ideal density-based amounts or proportions of protein food subgroups.
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Affiliation(s)
- Masako Matsunaga
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA.
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Dongmei Li
- Department of Clinical & Translational Research, University of Rochester Medical Center, Rochester, New York, USA
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Fraix M, Badran S, Graham V, Redman-Bentley D, Hurwitz EL, Quan VL, Yim M, Hudson-McKinney M, Seffinger MA. Osteopathic manipulative treatment in individuals with vertigo and somatic dysfunction: a randomized, controlled, comparative feasibility study. J Osteopath Med 2021; 121:71-83. [PMID: 33125033 DOI: 10.7556/jaoa.2020.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context There is a paucity of research assessing the efficacy of osteopathic manipulative treatment (OMT) in patients with vertigo. Objective To assess the feasibility of conducting a randomized, controlled trial comparing OMT and vestibular rehabilitation therapy (VRT), alone or in combination, in patients with vertigo and somatic dysfunction. Methods Volunteers with vertigo who were also diagnosed with somatic dysfunction (SD) were prospectively enrolled in a blinded, randomized, controlled cohort comparative effectiveness study and assigned to 1 of 4 groups: OMT alone, VRT alone, a combination of OMT and VRT (OMT/VRT), or a nonintervention control group. Participants between 18 and 79 years of age were included if they had experienced symptoms of vertigo for at least 3 months' duration, demonstrated somatic dysfunction, and could participate in computerized dynamic posturography (CDP) testing, tolerate manual therapy and exercises, and communicate effectively in English or Spanish. A total of 3 treatments lasting 45 minutes each were administered 1 week apart to each participant. OMT in this study consisted of counterstrain, myofascial release, balanced ligamentous tension, soft tissue, HVLA, and articulatory techniques. Comparisons were made between composite scores (CS) assessed with computerized dynamic posturography (CDP), dizziness handicap inventory (DHI), optometric evaluation, and osteopathic structural examinations collected before the first treatment, after the third/final treatment, and 3 months after the final treatment. (ClinicalTrials.gov number NCT01529151). Results A total of 23 patients were included in the study: 7 in the OMT group, 5 in the VRT group, 6 in the OMT/VRT group, and 5 in the control group. The OMT/VRT group demonstrated significant improvement in DHI score (P=0.0284) and CS (P=0.0475) between pre- and 3-month posttreatment measures. For total severity, improvements were significant in the OMT group both from pretreatment to immediate posttreatment measures (P=0.0114) and from pretreatment to 3-month posttreatment measures (P=0.0233). There was a statistical difference between the OMT and control groups from pretreatment to 3-month posttreatment DHI scores (P=0.0332). Also, there was a statistical difference in DHI score between VRT and control from pre- to 3-month posttreatment scores (P=0.0338). OMT/VRT statistically and clinically improved visual acuity in patients' right eyes from pre- to posttreatment (P=0.0325). In all participants, vergence dysfunction was prevalent (5; 21.7%) in addition to vertical heterophoria (15; 65.2%). Conclusion A combination of OMT and VRT significantly reduced vertigo and improved balance 3 months after treatment (P<0.05). There was a high prevalence in vergence and vertical heterophoria, which are not typical screening measurements used by physical therapists and physicians to assess vertigo patients. With a small sample size, this study demonstrated the feasibility of an interdisciplinary team evaluating and treating patients with vertigo in a community setting. A larger study is needed to assess the efficacy of OMT/VRT in vertigo patients.
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Affiliation(s)
- Marcel Fraix
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | - Sondos Badran
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | | | - Donna Redman-Bentley
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | | | - Valerie L Quan
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | - Michelle Yim
- The Dignity Health California Hospital Medical Center , Los Angeles , CA , USA
| | - Mary Hudson-McKinney
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
| | - Michael A Seffinger
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific , Pomona , CA , USA
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Herman PM, Edgington SE, Sorbero ME, Hurwitz EL, Goertz CM, Coulter ID. Visit Frequency and Outcomes for Patients Using Ongoing Chiropractic Care for Chronic Low-Back and Neck Pain: An Observational Longitudinal Study. Pain Physician 2021; 24:E61-E74. [PMID: 33400439 PMCID: PMC8667562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic spinal pain is prevalent and long-lasting. Although provider-based nonpharmacologic therapies, such as chiropractic care, have been recommended, healthcare and coverage policies provide little guidance or evidence regarding long-term use of this care. OBJECTIVE To determine the relationships between visit frequency and outcomes for patients using ongoing chiropractic care for chronic spinal pain. STUDY DESIGN Observational 3-month longitudinal study. SETTING Data collected from patients of 124 chiropractic clinics in 6 United States regions. METHODS We examined the impact of visit frequency and patient characteristics on pain (pain 0-10 numeric rating scale) and functional outcomes (Oswestry Disability Index [ODI] for low-back pain and Neck Disability Index [NDI] for neck pain, both 0-100 scale) using hierarchical linear modeling (HLM) in a large national sample of chiropractic patients with chronic low back pain (CLBP) and/or chronic neck pain (CNP). This study was approved by the RAND Human Subjects Protection Committee and registered under ClinicalTrials.gov Identifier: NCT03162952. RESULTS One thousand, three hundred, sixty-two patients with CLBP and 1,214 with CNP were included in a series of HLM models. Unconditional (time-only) models showed patients on average had mild pain and function, and significant, but slight improvements in these over the 3-month observation period: back and neck pain decreased by 0.40 and 0.44 points, respectively; function improved by 2.7 (ODI) and 3.0 points (NDI) (all P < 0.001). Adding chiropractic visit frequency to the models revealed that those with worse baseline pain and function used more visits, but only visits more than once per week for those with CLBP were associated with significantly better improvement. These relationships remained when other types of visits and baseline patient characteristics were included. LIMITATIONS This is an observational study based on self-reported data from a sample representative of chiropractic patients, but not all patients with CLBP or CNP. CONCLUSIONS This 3-month window on chiropractic patients with CLBP and/or CNP revealed that they were improving, although slowly; may have reached maximum therapeutic improvement; and are possibly successfully managing their chronic pain using a variety of chiropractic visit frequencies. These results may inform payers when building coverage policies for ongoing chiropractic care for patients with chronic pain.
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Affiliation(s)
| | | | | | - Eric L Hurwitz
- RAND Corporation, Santa Monica, CA; Office of Public Health Studies, University of Hawaii, M?noa, Honolulu, HI
| | | | - Ian D Coulter
- RAND Corporation, Santa Monica, CA; 2University of California Los Angeles, School of Dentistry, Los Angeles, CA; Southern California University of Health Sciences, Whittier, CA
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Paradoxical association between atrial fibrillation/flutter and high cholesterol over age 75 years: The Kuakini Honolulu Heart Program and Honolulu-Asia Aging Study. J Electrocardiol 2020; 65:37-44. [PMID: 33482619 DOI: 10.1016/j.jelectrocard.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Several studies have indicated high cholesterol is paradoxically associated with low prevalence of atrial fibrillation/flutter (AF). However, the etiology is uncertain. One potential explanation might be the confounding effect of age exemplifying prevalence-incidence (Neyman's) bias. However, this bias has not often been discussed in depth in the literature. Therefore, we conducted a cross-sectional analysis to test the hypothesis that there is a paradoxical association between lipid profile and AF prevalence. METHODS This is a cross-sectional study design, using data from the Kuakini Honolulu Heart Program. Participants were 3741 Japanese-American men between 71 and 93 years old living in Hawaii. Serum total cholesterol (TC) level was measured and categorized into quartiles. AF was diagnosed by 12‑lead Electrocardiogram. We categorized age into quartiles (71-74, 75-77, 78-80 and 81+ years). RESULTS We observed opposite associations between AF and TC among different age groups. For participants age ≥75, higher TC levels were paradoxically associated with lower prevalence of AF after multivariable adjustment, i.e. the odds ratios of AF comparing the highest TC quartile with the lowest TC quartile for age 75-77, 78-80 and 81+ years were 0.17 (95% confidence interval [CI], 0.06-0.52), 0.28 (95% CI, 0.07-1.09) and 0.14 (95% CI, 0.03-0.62), respectively. Conversely, for those who were 71-74 years old, the odds ratio of AF was 2.09 (95% CI, 0.76-5.75) between the highest and the lowest TC quartiles. CONCLUSIONS There is a paradoxical association of TC with AF in Japanese-American men age ≥75, but not <75 years. The paradox might be explained by Neyman's bias.
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Affiliation(s)
- Tagayasu Anzai
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Andrew Grandinetti
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Alan R Katz
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Yan Yan Wu
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Road, Honolulu, HI, USA.
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, 347 N Kuakini St, Honolulu, HI, USA; Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA.
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Herman PM, Edgington SE, Hurwitz EL, Coulter ID. Predictors of visit frequency for patients using ongoing chiropractic care for chronic low back and chronic neck pain; analysis of observational data. BMC Musculoskelet Disord 2020; 21:298. [PMID: 32404152 PMCID: PMC7222295 DOI: 10.1186/s12891-020-03330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic spinal pain is prevalent, expensive and long-lasting. Several provider-based nonpharmacologic therapies have now been recommended for chronic low-back pain (CLBP) and chronic neck pain (CNP). However, healthcare and coverage policies provide little guidance or evidence regarding the long-term use of this care. To provide one glimpse into the long-term use of nonpharmacologic provider-based care, this study examines the predictors of visit frequency in a large sample of patients with CLBP and CNP using ongoing chiropractic care. METHODS Observational data were collected from a large national sample of chiropractic patients in the US with non-specific CLBP and CNP. Visit frequency was defined as average number of chiropractic visits per month over the 3-month study period. Potential baseline predictor variables were entered into two sets of multi-level models according to a defined causal theory-in this case, Anderson's Behavioral Model of Health Services Use. RESULTS Our sample included 852 patients with CLBP and 705 with CNP. Visit frequency varied significantly by chiropractor/clinic, so our models controlled for this clustering. Patients with either condition used an average of 2.3 visits per month. In the final models visit frequency increased (0.44 visits per month, p = .008) for those with CLBP and some coverage for chiropractic, but coverage had little effect on visits for patients with CNP. Patients with worse function or just starting care also had more visits and those near to ending care had fewer visits. However, visit frequency was also determined by the chiropractor/clinic where treatment was received. Chiropractors who reported seeing more patients per day also had patients with higher visit frequency, and the patients of chiropractors with 20 to 30 years of experience had fewer visits per month. In addition, after controlling for both patient and chiropractor characteristics, the state in which care was received made a difference, likely through state-level policies and regulations. CONCLUSIONS Chiropractic patients with CLBP and CNP use a range of visit frequencies for their ongoing care. The predictors of these frequencies could be useful for understanding and developing policies for ongoing provider-based care.
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Affiliation(s)
| | | | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Association between central sleep apnea and atrial fibrillation/flutter in Japanese-American men: The Kuakini Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). J Electrocardiol 2020; 61:10-17. [PMID: 32464488 DOI: 10.1016/j.jelectrocard.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/18/2020] [Accepted: 05/09/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION While several studies have indicated that central sleep apnea (CSA) is associated with atrial fibrillation and atrial flutter (AF) in older populations, few studies have focused on older Asian populations. METHODS We conducted a cross- sectional analysis using data from the 1999-2000, 7th exam cycle of the Kuakini Honolulu-Asia Aging Study. Participants were 718 Japanese-American men between 79 and 97 years old, who had overnight polysomnography. Obstructive Apnea-Hypopnea Index (OAHI) was the measure of the number of obstructive apneas and hypopneas with >4% oxygen desaturation. Additionally, the Central Apnea Index (CAI) was the measure of the number of central apneas. Obstructive sleep apnea (OSA) was categorized as none (OAHI <5), mild (OAHI 5-14), moderate (OAHI 15-29) and severe (OAHI ≥30). CSA was defined by CAI of 5 or more. Cheyne-Stokes Breathing (CSB) was defined as a minimum consecutive 5-minute period of a crescendo-decrescendo respiratory pattern associated with CSA. RESULTS AF prevalence was 5.5% (39 of 709). The prevalence proportions of severe OSA, CSA, and CSB were 20.2% (143 of 709), 6.4% (43 of 673) and 3.2% (22 of 673), respectively. In multivariable-adjusted logistic regression models, CSA and CSB were significantly associated with AF prevalence: odds ratio (OR) 5.15, 95% confidential interval (CI), 2.21-12.52 and OR 6.26, 95% CI, 2.05-19.14, respectively. However, OSA was not significantly associated with AF prevalence. CONCLUSION AF prevalence is associated with CSA and CSB but not OSA in older Japanese-American men. This information could help target AF prevention strategies in this population.
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Affiliation(s)
- Tagayasu Anzai
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Andrew Grandinetti
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Alan R Katz
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Eric L Hurwitz
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Yan Yan Wu
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Kamal Masaki
- University of Hawai'i at Mānoa, Department of Geriatric Medicine, John A. Burns School of Medicine, 347 N Kuakini St, Honolulu, HI, USA; Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA.
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Herman PM, Whitley MD, Ryan GW, Hurwitz EL, Coulter ID. The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain. BMC Musculoskelet Disord 2019; 20:519. [PMID: 31699077 PMCID: PMC6839252 DOI: 10.1186/s12891-019-2904-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective-i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered. METHODS We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain. RESULTS The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate. CONCLUSIONS This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials.
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Affiliation(s)
| | | | - Gery W Ryan
- RAND Corporation, Santa Monica, CA, United States
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, United States
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Lee TH, Hurwitz EL, Cooney RV, Wu YY, Wang CY, Masaki K, Grandinetti A. Late life insulin resistance and Alzheimer's disease and dementia: The Kuakini Honolulu heart program. J Neurol Sci 2019; 403:133-138. [DOI: 10.1016/j.jns.2019.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 01/24/2023]
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Durand Z, Nechuta S, Krishnaswami S, Hurwitz EL, McPheeters M. Prevalence and Risk Factors Associated With Long-term Opioid Use After Injury Among Previously Opioid-Free Workers. JAMA Netw Open 2019; 2:e197222. [PMID: 31314119 PMCID: PMC6647548 DOI: 10.1001/jamanetworkopen.2019.7222] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Using opioids for acute pain can lead to long-term use and associated morbidity and mortality. Injury has been documented as a gateway to long-term opioid use in some populations, but data are limited for injured workers. OBJECTIVE To evaluate the prevalence and risk factors of long-term opioid use after injury among workers in Tennessee who were opioid free at the time of injury. DESIGN, SETTING, AND PARTICIPANTS This cohort study identified injured workers aged 15 to 99 years who reported only 1 injury to the Tennessee Bureau of Workers' Compensation from March 2013 to December 2015 and had no opioid prescription in the 60 days before injury. Participants were matched to their prescription history in Tennessee's prescription drug monitoring program. Analysis was conducted from November 2017 to March 2018. Logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% CIs for associations of demographic, injury, and opioid use variables with long-term use. MAIN OUTCOMES AND MEASURES The primary outcome was long-term opioid use, defined as having an opioid supplied for 45 or more days in the 90 days after injury. RESULTS Among 58 278 injured workers who received opioids after injury (18 977 [32.5%] aged 15-34 years, 27 514 [47.2%] aged 35-54 years, and 11 787 [20.2%] aged 55-99 years; 32 607 [56.0%] men), 46 399 (79.6%) were opioid free at the time of injury. Among opioid-free injured workers, 1843 (4.0%) began long-term opioid use. After controlling for covariates, long-term use was associated with receiving 20 or more days' supply in the initial opioid prescription compared with receiving less than 5 days' supply (OR, 28.94; 95% CI, 23.44-35.72) and visiting 3 or more prescribers in the 90 days after injury compared with visiting 1 prescriber (OR, 14.91; 95% CI, 12.15-18.29). However, even just 5 days' to 9 days' supply was associated with an increase in the odds of long-term use compared with less than 5 days' supply (OR, 1.83; 95% CI, 1.56-2.14). CONCLUSIONS AND RELEVANCE In this study of injured workers, injury was associated with long-term opioid use. The number of days' supply of the initial opioid prescription was the strongest risk factor of developing long-term use, highlighting the importance of careful prescribing for initial opioid prescriptions.
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Affiliation(s)
- Zoe Durand
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville
- University of Hawai‘i at Mānoa, Office of Public Health Studies, Honolulu
| | - Sarah Nechuta
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Eric L. Hurwitz
- University of Hawai‘i at Mānoa, Office of Public Health Studies, Honolulu
| | - Melissa McPheeters
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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Roth CP, Coulter ID, Kraus LS, Ryan GW, Jacob G, Marks JS, Hurwitz EL, Vernon H, Shekelle PG, Herman PM. Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 5: Using Patient Records: Selection, Protection, and Abstraction. J Manipulative Physiol Ther 2019; 42:327-334. [PMID: 31257004 DOI: 10.1016/j.jmpt.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this paper is to describe the 4-step process (consent, selection, protection, and abstraction) of acquiring a large sample of chiropractic patient records from multiple practices and subsequent data abstraction. METHODS From April 2017 to December 2017, RAND acquired patient records from 99 chiropractic practices across the United States. The records included patients enrolled in a survey e-study (prospective sample) and a random sample of all clinic patients (retrospective sample) with chronic back or neck pain. Clinic staff were trained to collect the sample, scan, and transfer the records. We designed an online data collection tool for abstraction. Protocols were instituted to protect patient confidentiality. Doctors of chiropractic were selected and trained as abstractors, and a system was established to monitor data collection. RESULTS In compliance with data protection protocols, 3603 patient records were scanned, including 1475 in the prospective sample and 2128 in the random sample. A total of 1716 patients (prospective sample) consented to having their records scanned, but only 1475 could be retrieved. Of records scanned, 19% were unusable owing to illegibility, no care during the period of interest, or poor scanning. The abstractor interrater reliability for appropriateness of care decisions was fair to moderate (κ .38-.48). CONCLUSION The acquisition, handling, and abstraction of a large sample of chiropractic records was a complex task with challenges that necessitated adapting planned approaches. Of the records abstracted, many revealed incomplete provider documentation regarding the details of and rationale for care. Better documentation and more standardized record keeping would facilitate future research using patient records.
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Affiliation(s)
- Carol P Roth
- RAND Corporation, Health, Santa Monica, California
| | | | - Lisa S Kraus
- RAND Corporation, Health, Santa Monica, California
| | - Gery W Ryan
- RAND Corporation, Health, Santa Monica, California
| | - Gary Jacob
- RAND Corporation, Health, Santa Monica, California
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Santibenchakul S, Tschann M, Carlson ADP, Hurwitz EL, Salcedo J. Advanced Prescription of Emergency Contraceptive Pills Among Adolescents and Young Adults. South Med J 2019; 112:180-184. [PMID: 30830233 DOI: 10.14423/smj.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine healthcare providers' adherence to professional recommendations for advanced prescription of emergency contraceptive pills (ECPs). METHODS We conducted a retrospective chart review of 432 visits by 282 unique nonpregnant women 14 to 25 years of age seen at an obstetrics and gynecology teaching clinic to determine the percentage of visits during which advanced prescriptions of ECPs were provided when indicated. A logistic regression model, which accounted for nonindependent observations through generalized estimating equations, was used to identify factors associated with the provision of ECP advanced prescriptions. RESULTS Approximately one-fifth of eligible visits (19.9%) and eligible patients (19.1%) had documentation of an ECP advanced prescription when indicated. Healthcare providers in this clinical setting were more likely to prescribe ECPs to adolescents and women whose primary contraceptive methods were associated with higher failure rates in typical use, such as condoms. Compared with women aged 20 to 25 years, the adjusted odds ratio of receiving an advanced prescription for ECPs was 5.94 (95% confidence interval [CI] 2.85-12.41) for adolescents. Compared with users of depot medroxyprogesterone acetate, the adjusted odds ratio was 4.25 (95% CI 1.62-11.15) for condom users, and 3.90 (95% CI 1.54-9.86) for users of other short-term hormonal contraceptives. CONCLUSIONS Despite clear professional recommendations for ECP advanced prescriptions for all women at risk for unintended pregnancy, a substantial gap exists between this standard of care and routine clinical service provision in an obstetrics and gynecology teaching clinic.
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Affiliation(s)
- Somsook Santibenchakul
- From the Office of Public Health Studies and the Department of Obstetrics, Gynecology & Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, the Home Visiting Services Unit, Maternal and Child Health Branch, the Hawaii State Department of Health, Honolulu, and the Department of Obstetrics & Gynecology, University of Texas Rio Grande Valley, Edinburg
| | - Mary Tschann
- From the Office of Public Health Studies and the Department of Obstetrics, Gynecology & Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, the Home Visiting Services Unit, Maternal and Child Health Branch, the Hawaii State Department of Health, Honolulu, and the Department of Obstetrics & Gynecology, University of Texas Rio Grande Valley, Edinburg
| | - Alyssa Dee P Carlson
- From the Office of Public Health Studies and the Department of Obstetrics, Gynecology & Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, the Home Visiting Services Unit, Maternal and Child Health Branch, the Hawaii State Department of Health, Honolulu, and the Department of Obstetrics & Gynecology, University of Texas Rio Grande Valley, Edinburg
| | - Eric L Hurwitz
- From the Office of Public Health Studies and the Department of Obstetrics, Gynecology & Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, the Home Visiting Services Unit, Maternal and Child Health Branch, the Hawaii State Department of Health, Honolulu, and the Department of Obstetrics & Gynecology, University of Texas Rio Grande Valley, Edinburg
| | - Jennifer Salcedo
- From the Office of Public Health Studies and the Department of Obstetrics, Gynecology & Women's Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, the Home Visiting Services Unit, Maternal and Child Health Branch, the Hawaii State Department of Health, Honolulu, and the Department of Obstetrics & Gynecology, University of Texas Rio Grande Valley, Edinburg
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Coulter ID, Crawford C, Vernon H, Hurwitz EL, Khorsan R, Booth MS, Herman PM. Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel. Pain Physician 2019; 22:E55-E70. [PMID: 30921975 PMCID: PMC6800035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Mobilization and manipulation therapies are widely used by patients with chronic nonspecific neck pain; however, questions remain around efficacy, dosing, and safety, as well as how these approaches compare to other therapies. OBJECTIVES Based on published trials, to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic nonspecific neck pain. STUDY DESIGN A systematic literature review and meta-analysis. METHODS We identified studies published between January 2000 and September 2017, by searching multiple electronic databases, examining reference lists, and communicating with experts. We selected randomized controlled trials comparing manipulation and/or mobilization therapies to sham, no treatment, each other, and other active therapies, or when combined as multimodal therapeutic approaches. We assessed risk of bias by using the Scottish Intercollegiate Guidelines Network criteria. When possible, we pooled data using random-effects meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation was applied to determine the confidence in effect estimates. This project was funded by the National Center for Complementary and Integrative Health under award number U19AT007912 and ultimately used to inform an appropriateness panel. RESULTS A total of 47 randomized trials (47 unique trials in 53 publications) were included in the systematic review. These studies were rated as having low risk of bias and included a total of 4,460 patients with nonspecific chronic neck pain who were being treated by a practitioner using various types of manipulation and/or mobilization interventions. A total of 37 trials were categorized as unimodal approaches and involved thrust or nonthrust compared with sham, no treatment, or other active comparators. Of these, only 6 trials with similar intervention styles, comparators, and outcome measures/timepoints were pooled for meta-analysis at 1, 3, and 6 months, showing a small effect in favor of thrust plus exercise compared to an exercise regimen alone for a reduction in pain and disability. Multimodal approaches appeared to be effective at reducing pain and improving function from the 10 studies evaluated. Health-related quality of life was seldom reported. Some 22/47 studies did not report or mention adverse events. Of the 25 that did, either no or minor events occurred. LIMITATIONS The current evidence is heterogeneous, and sample sizes are generally small. CONCLUSIONS Studies published since January 2000 provide low-moderate quality evidence that various types of manipulation and/or mobilization will reduce pain and improve function for chronic nonspecific neck pain compared to other interventions. It appears that multimodal approaches, in which multiple treatment approaches are integrated, might have the greatest potential impact. The studies comparing to no treatment or sham were mostly testing the effect of a single dose, which may or may not be helpful to inform practice. According to the published trials reviewed, manipulation and mobilization appear safe. However, given the low rate of serious adverse events, other types of studies with much larger sample sizes would be required to fully describe the safety of manipulation and/or mobilization for nonspecific chronic neck pain. KEY WORDS Chronic neck pain, nonspecific, chiropractic, manipulation, mobilization, systematic review, meta-analysis, appropriateness.
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Affiliation(s)
- Ian D. Coulter
- RAND Corporation, Santa Monica, CA
- University of California Los Angeles, School of Dentistry, Los Angeles, CA
- Southern California University of Health Sciences, Whittier, CA
| | | | - Howard Vernon
- RAND Corporation, Santa Monica, CA
- Canadian Memorial Chiropractic College, Division of Research, Toronto, ON, Canada
| | - Eric L. Hurwitz
- RAND Corporation, Santa Monica, CA
- Office of Public Health Studies, University of Hawaii, Mānoa, Honolulu, HI
| | - Raheleh Khorsan
- Southern California University of Health Sciences, Whittier, CA
- Yo San University of Traditional Chinese Medicine, Los Angeles, CA
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25
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Durand Z, Nechuta S, Krishnaswami S, Hurwitz EL, McPheeters M. Prescription opioid use by injured workers in Tennessee: a descriptive study using linked statewide databases. Ann Epidemiol 2019; 32:7-13. [PMID: 30853149 DOI: 10.1016/j.annepidem.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/14/2019] [Accepted: 02/02/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE This is the first study in Tennessee to measure opioid use in injured workers and among the first nationally to use a prescription drug monitoring program to do so. We conducted a retrospective cohort study to evaluate the prevalence of opioid use after injury and associated characteristics among workers reporting one injury to Tennessee Workers' Compensation. METHODS Injured workers identified in Workers' Compensation records 2013-2015 were linked to their prescription history in Tennessee's prescription drug monitoring database. RESULTS Among 172,256 injured workers, the prevalence of receiving an opioid after injury was 22.8% in 1 week, 29.7% in 1 month, and 33.3% in 6 months. Receiving an opioid was associated with having a fracture (odds ratio, 4.9; 95% confidence interval, 4.64-5.11 vs. other injuries). Hydrocodone short-acting was the most commonly received opioid (69.5% of injured workers), and the mean of each worker's maximum dose was 42.8 morphine milligram equivalents (SD 39.26). Ten percent of injured workers who received opioids also received a benzodiazepine. CONCLUSIONS Injured workers have a high prevalence of opioid use after injury, but prescribing patterns generally tend to follow Tennessee prescribing guidelines.
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Affiliation(s)
- Zoe Durand
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN; Office of Public Health Studies, University of Hawai`i at Mānoa, Honolulu.
| | - Sarah Nechuta
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Shanthi Krishnaswami
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai`i at Mānoa, Honolulu
| | - Melissa McPheeters
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
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26
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Kizhakkeveettil A, Whedon J, Schmalzl L, Hurwitz EL. Yoga for Quality of Life in Individuals With Chronic Disease: A Systematic Review. Altern Ther Health Med 2019; 25:36-43. [PMID: 30982785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Chronic diseases, including heart disease, stroke, cancer, and chronic pulmonary disease are the leading causes of death and disability worldwide. Compounding symptoms and loss of function, people living with chronic disease often experience reduced quality of life (QoL). Various physical and mental practices have been shown to relieve stress and improve QoL. Yoga is a physical and mental practice that may be a viable approach for improving QoL in people with chronic disease. OBJECTIVE The objective of this study was to examine and summarize the evidence for the effectiveness of yoga on QoL in patients with chronic disease. DESIGN The study design was a a systematic review with qualitative synthesis. METHODS We included randomized controlled trials that evaluated the effect of yoga on QoL or health-related QoL (HRQoL) for individuals with chronic disease. We included only studies that used at least 1 previously validated measure of QoL or HRQoL and specified a minimum duration of follow-up of at least 1 wk. INTERVENTIONS We included both movement-based and breath-based yoga practices. Studies that included yoga as part of a larger intervention program (eg, mindfulness-based stress reduction training) or studies that did not provide findings specific to yoga were excluded. PRIMARY OUTCOME MEASURES The primary outcome analyzed was improvement in QoL as measured by a validated QoL or HRQoL scale. RESULTS Among the 1488 studies that were identified on initial search, 7 articles met all inclusion criteria. Five studies reported a statistically significant advantage over usual care alone for improvement of QoL in patients with chronic disease, but the clinical significance of the differences was clear in only 1 trial. We found considerable heterogeneity among the included studies and study quality was generally low. CONCLUSIONS More high-quality research is needed to determine the value of yoga as an adjunctive approach to improving QoL in patients with chronic disease.
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27
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Jessop H, Li D, Katz AR, Hurwitz EL. Asthma prevalence disparities and differences in sociodemographic associations with asthma, between Native Hawaiian/Other Pacific Islander, Asian, and White adults in Hawaii - Behavioral Risk Factor Surveillance System (BRFSS), 2001-2010. Ethn Health 2019; 24:1-23. [PMID: 28359207 DOI: 10.1080/13557858.2017.1297775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Despite high asthma prevalence, relatively little is known about the epidemiology of asthma in Hawaii or among Native Hawaiian/Other Pacific Islanders (NHOPI). We sought to better characterize racial/ethnic differences in asthma prevalence and in sociodemographic factors associated with asthma among Hawaii adults. DESIGN We conducted multivariable logistic regression using 2001-2010 Behavioral Risk Factor Surveillance System data from Hawaii, and computed adjusted prevalence and ratios. RESULTS Asthma prevalence markedly varied between self-identified census categories of race in Hawaii, with NHOPI having the highest estimates of both lifetime (20.9%, 95% confidence interval [CI]: 19.5%-22.4%) and current (12.2%, CI: 11.2%-13.3%) asthma. Highest asthma prevalence among NHOPI persisted after controlling for potential confounders and within most sociodemographic categories. Among females Asians reported the lowest asthma prevalence, whereas among males point estimates of asthma prevalence were often lowest for Whites. Females often had greater asthma prevalence than males of the same race, but the degree to which gender modified asthma prevalence differed by both race and sociodemographic strata. Gender disparities in asthma prevalence were greatest and most frequent among Whites, and for current asthma among all races. Sociodemographic factors potentially predictive of adult asthma prevalence in Hawaii varied by race and gender. CONCLUSION Asthma disproportionately affects or is recognized more often among women and NHOPI adults in Hawaii, and occurs less or is under-reported among Asian women. The sociodemographic characteristics included in this study's model did not explain asthma disparities between races and/or gender. This investigation provides a baseline with which to plan additionally needed prevention programs, epidemiological investigations, and surveillance for asthma in Hawaii.
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Affiliation(s)
- H Jessop
- a Office of Public Health Studies , University of Hawaii , Honolulu , USA
| | - D Li
- b Clinical and Translational Science Institute , University of Rochester School of Medicine and Dentistry , Rochester , USA
| | - A R Katz
- a Office of Public Health Studies , University of Hawaii , Honolulu , USA
| | - E L Hurwitz
- a Office of Public Health Studies , University of Hawaii , Honolulu , USA
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Santibenchakul S, Tschann M, Carlson ADP, L Hurwitz E, Salcedo J. Promotion of Long-Acting Reversible Contraception Among Adolescents and Young Adults. J Midwifery Womens Health 2018; 64:194-200. [PMID: 30570219 DOI: 10.1111/jmwh.12934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Intrauterine devices and contraceptive implants are recommended as first-line contraceptives by health care professional societies. However, uptake among US women lags substantially behind other developed countries. Little information is available on the extent to which clinicians document discussion about long-acting reversible contraception (LARC) in this patient population. We sought to determine the frequency with which clinicians document LARC discussion with eligible women aged 14 to 25 years in a training clinic and evaluate factors associated with LARC discussion and uptake. METHODS We conducted a retrospective chart review of all visits of nonpregnant women aged 14 to 25 years seen at an obstetrics and gynecology resident physician clinic during a calendar year. A logistic regression model was used to assess demographic factors associated with LARC education and uptake. RESULTS Among 450 visits by eligible patients, LARC discussion was documented during 47.8% (215/450) of visits. Among visits with documentation of LARC counseling, 45.6% (98/215) had documentation of a LARC placement plan. Among patients who decided to initiate LARC, 40.8% (40/98) had a device placed at the same visit. LARC placement was documented during 8.9% (40/450) of visits. Clinicians documented LARC counseling for women aged 14 to 19 years more frequently than for women aged 20 to 25 years. Compared with women who did not use any method of contraception, clinicians documented LARC counseling less frequently for women who used short-term hormonal contraception. DISCUSSION Clinicians in a training clinic did not document LARC counseling for more than half of eligible patients. Every clinical visit is an opportunity to assess risk of unintended pregnancy and ensure that contraceptive needs are addressed.
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29
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Ferrer A, Katz AR, Hurwitz EL, Pham T. Hepatitis B Prevalence and Risk Factors in a Foreign-Born Asian and Pacific Islander Population at a Community Health Center in Hawai'i. Asia Pac J Public Health 2018; 30:727-736. [PMID: 30244586 DOI: 10.1177/1010539518800359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hawai'i has one of the highest rates of liver cancer in the United States. This is in large part due to undiagnosed chronic hepatitis B (CHB) infection among foreign-born Asian and Pacific Islanders (APIs). In order to estimate the prevalence of CHB infection among foreign-born APIs in Hawai'i, the Hawai'i State Department of Health conducted a cross-sectional study from August 2013 through August 2015 of patients of a federally qualified health center serving the largest population of medically underserved APIs in the state. Among 1261 patients surveyed, the prevalence of CHB infection (based on HBsAg seropositivity) was 5.6% (71/1259). No significant differences were detected by place of birth, age, or gender; however, the adjusted prevalence ratio of CHB infection was 6.0 times higher among persons reporting household contact with hepatitis B virus compared with those without such contact. Our findings underscore the need for targeted screening of at-risk individuals and their household contacts.
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Affiliation(s)
- Aileen Ferrer
- 1 Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Alan R Katz
- 1 Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Eric L Hurwitz
- 1 Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Thaddeus Pham
- 2 Adult Viral Hepatitis Prevention Program, Communicable Disease and Public Health Nursing Division, Hawai'i State Department of Health, Honolulu, HI, USA
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30
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Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Booth MS, Herman PM. Response to letter to the editor entitled "thrust manipulation may not decrease the intensity of chronic low back pain" concerning "manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis" by Coulter et al. TSJ; doi: 10.1016/j.spinee.2018.01.013. Spine J 2018; 18:1964. [PMID: 30442418 DOI: 10.1016/j.spinee.2018.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Ian D Coulter
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA; UCLA School of Dentistry, Box 951668, Los Angeles, CA 90095-1668, USA; Southern California University of Health Sciences, 16200 Amber Valley Dr, Whittier, CA 90604, USA.
| | - Cindy Crawford
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA
| | - Eric L Hurwitz
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA; Office of Public Health Studies, University of Hawai`i, Mānoa, 1960 East-West Road, Biomed D104AA, Honolulu, HI 96822, USA
| | - Howard Vernon
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA; Canadian Memorial Chiropractic College, Division of Research, 6100 Leslie St., Toronto, ON, Canada M2H 3J1
| | - Raheleh Khorsan
- UCI Department of Urban Planning and Public Policy, 300 Social Ecology I, Irvine, CA 92697-7075, USA
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Haldeman S, Nordin M, Chou R, Côté P, Hurwitz EL, Johnson CD, Randhawa K, Green BN, Kopansky-Giles D, Acaroğlu E, Ameis A, Cedraschi C, Aartun E, Adjei-Kwayisi A, Ayhan S, Aziz A, Bas T, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dudler J, Dunn R, Eberspaecher S, Emmerich J, Farcy JP, Fisher-Jeffes N, Goertz C, Grevitt M, Griffith EA, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Kane EJ, Laplante J, Lemeunier N, Mayer J, Mior S, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Rajasekaran S, Shearer H, Smuck M, Sönmez E, Tavares P, Taylor-Vaisey A, Torres C, Torres P, van der Horst A, Verville L, Vialle E, Kumar GV, Vlok A, Watters W, Wong CC, Wong JJ, Yu H, Yüksel S. The Global Spine Care Initiative: World Spine Care executive summary on reducing spine-related disability in low- and middle-income communities. Eur Spine J 2018; 27:776-785. [PMID: 30151809 DOI: 10.1007/s00586-018-5722-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Spinal disorders, including back and neck pain, are major causes of disability, economic hardship, and morbidity, especially in underserved communities and low- and middle-income countries. Currently, there is no model of care to address this issue. This paper provides an overview of the papers from the Global Spine Care Initiative (GSCI), which was convened to develop an evidence-based, practical, and sustainable, spinal healthcare model for communities around the world with various levels of resources. METHODS Leading spine clinicians and scientists around the world were invited to participate. The interprofessional, international team consisted of 68 members from 24 countries, representing most disciplines that study or care for patients with spinal symptoms, including family physicians, spine surgeons, rheumatologists, chiropractors, physical therapists, epidemiologists, research methodologists, and other stakeholders. RESULTS Literature reviews on the burden of spinal disorders and six categories of evidence-based interventions for spinal disorders (assessment, public health, psychosocial, noninvasive, invasive, and the management of osteoporosis) were completed. In addition, participants developed a stratification system for surgical intervention, a classification system for spinal disorders, an evidence-based care pathway, and lists of resources and recommendations to implement the GSCI model of care. CONCLUSION The GSCI proposes an evidence-based model that is consistent with recent calls for action to reduce the global burden of spinal disorders. The model requires testing to determine feasibility. If it proves to be implementable, this model holds great promise to reduce the tremendous global burden of spinal disorders. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA. .,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA.,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Arthur Ameis
- Certification Program in Insurance Medicine and MedicoLegal Expertise, Faculty of Medicine, University of Montreal, Toronto, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ellen Aartun
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Afua Adjei-Kwayisi
- Ridge Regional Hospital, Ghana World Spine Care, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Amer Aziz
- Orthopaedics and Spine Department, Ghurki Trust Teaching Hospital Lahore Pakistan, Lahore, Punjab, Pakistan
| | - Teresa Bas
- Department of Surgery, Hospital Universitario and Politecnico La Fe, Valencia University, Valencia, Spain
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health, Madrid, Spain.,Physical Medicine and Rehabilitation Department, University Complutense, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Jean Dudler
- Department of Rheumatology, HFR Fribourg - Hospital Cantonal, Fribourg, FR, Switzerland
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa.,Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | | | - Juan Emmerich
- University of La Plata, La Plata, Buenos Aires, Argentina
| | - Jean Pierre Farcy
- Department of Orthopedic Surgery (retired), New York University, Piermont, NY, USA
| | - Norman Fisher-Jeffes
- Groote Schuur Hospital, Cape Town, Western Cape, South Africa.,Panorama Medi Clinic, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA.,The Spine Institute for Quality, Davenport, IA, USA
| | | | | | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | - Julie Laplante
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | | | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | | | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Alexander van der Horst
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Central Hospital, Windhoek, Namibia
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | | | | | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, ON, Canada
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey
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Kopansky-Giles D, Johnson CD, Haldeman S, Chou R, Côté P, Green BN, Nordin M, Acaroğlu E, Ameis A, Cedraschi C, Hurwitz EL, Ayhan S, Borenstein D, Brady O, Brooks P, Davatchi F, Dunn R, Goertz C, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Lemeunier N, Mayer J, Mior S, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Torres C, Torres P, Vlok A, Wong CC. The Global Spine Care Initiative: resources to implement a spine care program. Eur Spine J 2018; 27:915-924. [PMID: 30151804 DOI: 10.1007/s00586-018-5725-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. METHODS Contents from the Global Spine Care Initiative (GSCI) Classification System and GSCI care pathway papers provided a foundation for the resources list. A seed document was developed that included resources for spine care that could be delivered in primary, secondary and tertiary settings, as well as resources needed for self-care and community-based settings for a wide variety of spine concerns (e.g., back and neck pain, deformity, spine injury, neurological conditions, pathology and spinal diseases). An iterative expert consensus process was used using electronic surveys. RESULTS Thirty-five experts completed the process. An iterative consensus process was used through an electronic survey. A consensus was reached after two rounds. The checklist of resources included the following categories: healthcare provider knowledge and skills, materials and equipment, human resources, facilities and infrastructure. The list identifies resources needed to implement a spine care program in any community, which are based upon spine care needs. CONCLUSION To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA.
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
- World Spine Care, Santa Ana, CA, USA
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA
- World Spine Care Europe, Holmfirth, UK
| | | | - Arthur Ameis
- Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal Faculty of Medicine, Toronto, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'I, Mānoa, Honolulu, HI, USA
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
- Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA
- The Spine Institute for Quality, Davenport, IA, USA
| | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Carlos Torres
- University of Ottawa, Ottawa, ON, Canada
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
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Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, Green BN, Kopansky-Giles D, Cedraschi C, Aartun E, Acaroğlu E, Ameis A, Ayhan S, Blyth F, Borenstein D, Brady O, Davatchi F, Goertz C, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Lemeunier N, Mayer J, Mior S, Mmopelwa T, Modic M, Mullerpatan R, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Sönmez E, Torres C, Torres P, Watters W, Yu H. The Global Spine Care Initiative: classification system for spine-related concerns. Eur Spine J 2018; 27:889-900. [PMID: 30151807 DOI: 10.1007/s00586-018-5724-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this report is to describe the development of a classification system that would apply to anyone with a spine-related concern and that can be used in an evidence-based spine care pathway. METHODS Existing classification systems for spinal disorders were assembled. A seed document was developed through round-table discussions followed by a modified Delphi process. International and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. RESULTS Thirty-six experts from 15 countries participated. After the second round, there was 95% agreement of the proposed classification system. The six major classifications included: no or minimal symptoms (class 0); mild symptoms (i.e., neck or back pain) but no interference with activities (class I); moderate or severe symptoms with interference of activities (class II); spine-related neurological signs or symptoms (class III); severe bony spine deformity, trauma or pathology (class IV); and spine-related symptoms or destructive lesions associated with systemic pathology (class V). Subclasses for each major class included chronicity and severity when different interventions were anticipated or recommended. CONCLUSIONS An international and interprofessional group developed a comprehensive classification system for all potential presentations of people who may seek care or advice at a spine care program. This classification can be used in the development of a spine care pathway, in clinical practice, and for research purposes. This classification needs to be tested for validity, reliability, and consistency among clinicians from different specialties and in different communities and cultures. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA. .,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA.,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ellen Aartun
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | | | - Arthur Ameis
- Faculty of Medicine, Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal, Toronto, ON, Canada
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA.,The Spine Institute for Quality, Davenport, IA, USA
| | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Rajani Mullerpatan
- Mahatma Gandhi Mission Institute of Health Sciences, MGM School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Erkin Sönmez
- Department of Neurological Surgery, School of Medicine, Başkent University, Ankara, Turkey
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - William Watters
- Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
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34
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Johnson CD, Haldeman S, Nordin M, Chou R, Côté P, Hurwitz EL, Green BN, Kopansky-Giles D, Randhawa K, Cedraschi C, Ameis A, Acaroğlu E, Aartun E, Adjei-Kwayisi A, Ayhan S, Aziz A, Bas T, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dudler J, Dunn R, Eberspaecher S, Emmerich J, Farcy JP, Fisher-Jeffes N, Goertz C, Grevitt M, Griffith EA, Hajjaj-Hassouni N, Hartvigsen J, Hondras M, Kane EJ, Laplante J, Lemeunier N, Mayer J, Mior S, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Rajasekaran S, Shearer H, Smuck M, Sönmez E, Tavares P, Taylor-Vaisey A, Torres C, Torres P, van der Horst A, Verville L, Vialle E, Kumar GV, Vlok A, Watters W, Wong CC, Wong JJ, Yu H, Yüksel S. The Global Spine Care Initiative: methodology, contributors, and disclosures. Eur Spine J 2018; 27:786-795. [PMID: 30151808 DOI: 10.1007/s00586-018-5723-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this report is to describe the Global Spine Care Initiative (GSCI) contributors, disclosures, and methods for reporting transparency on the development of the recommendations. METHODS World Spine Care convened the GSCI to develop an evidence-based, practical, and sustainable healthcare model for spinal care. The initiative aims to improve the management, prevention, and public health for spine-related disorders worldwide; thus, global representation was essential. A series of meetings established the initiative's mission and goals. Electronic surveys collected contributorship and demographic information, and experiences with spinal conditions to better understand perceptions and potential biases that were contributing to the model of care. RESULTS Sixty-eight clinicians and scientists participated in the deliberations and are authors of one or more of the GSCI articles. Of these experts, 57 reported providing spine care in 34 countries, (i.e., low-, middle-, and high-income countries, as well as underserved communities in high-income countries.) The majority reported personally experiencing or having a close family member with one or more spinal concerns including: spine-related trauma or injury, spinal problems that required emergency or surgical intervention, spinal pain referred from non-spine sources, spinal deformity, spinal pathology or disease, neurological problems, and/or mild, moderate, or severe back or neck pain. There were no substantial reported conflicts of interest. CONCLUSION The GSCI participants have broad professional experience and wide international distribution with no discipline dominating the deliberations. The GSCI believes this set of papers has the potential to inform and improve spine care globally. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA. .,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA.,World Spine Care Europe, Holmfirth, UK
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA.,Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, North York, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Arthur Ameis
- University of Montreal Faculty of Medicine Certification Program in Insurance Medicine and MedicoLegal Expertise, Toronto, ON, Canada
| | | | - Ellen Aartun
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Afua Adjei-Kwayisi
- Ghana World Spine Care, Ridge Regional Hospital, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Amer Aziz
- Orthopaedics and Spine Department, Ghurki Trust Teaching Hospital Lahore Pakistan, Lahore, Punjab, Pakistan
| | - Teresa Bas
- Department of Surgery, Hospital Universitario and Politecnico La Fe, Valencia University, Valencia, Spain
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health and Physical Medicine and Rehabilitation Department, University Complutense, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Jean Dudler
- Department of Rheumatology, HFR Fribourg - Hospital Cantonal, Fribourg, FR, Switzerland
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | | | - Juan Emmerich
- University of La Plata, La Plata, Buenos Aires, Argentina
| | | | - Norman Fisher-Jeffes
- Panorama Medi Clinic, Cape Town, Western Cape, South Africa.,Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic and The Spine Institute for Quality, Davenport, IA, USA
| | | | | | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Maria Hondras
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | - Julie Laplante
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - John Mayer
- U.S. Spine and Sport Foundation, San Diego, CA, USA
| | - Silvano Mior
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- MGM School of Physiotherapy, Mahatma Gandhi Mission Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaounde, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | | | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | | | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Carlos Torres
- Department of Medical Imaging, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Alexander van der Horst
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Central Hospital, Windhoek, Namibia
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | | | - Gomatam Vijay Kumar
- Head of Neurosurgery, AMRI Hospitals, Salt Lake, Kolkata, West Bengal, India
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic, Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Jessica J Wong
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Selcen Yüksel
- Department of Biostatistics, Ankara Yildirim Beyazit University Medical School, Ankara, Turkey
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35
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Haldeman S, Johnson CD, Chou R, Nordin M, Côté P, Hurwitz EL, Green BN, Cedraschi C, Acaroğlu E, Kopansky-Giles D, Ameis A, Adjei-Kwayisi A, Ayhan S, Blyth F, Borenstein D, Brady O, Brooks P, Camilleri C, Castellote JM, Clay MB, Davatchi F, Dunn R, Goertz C, Griffith EA, Hondras M, Kane EJ, Lemeunier N, Mayer J, Mmopelwa T, Modic M, Moss J, Mullerpatan R, Muteti E, Mwaniki L, Ngandeu-Singwe M, Outerbridge G, Randhawa K, Shearer H, Sönmez E, Torres C, Torres P, Verville L, Vlok A, Watters W, Wong CC, Yu H. The Global Spine Care Initiative: care pathway for people with spine-related concerns. Eur Spine J 2018; 27:901-914. [PMID: 30151811 DOI: 10.1007/s00586-018-5721-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. METHODS The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. RESULTS After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment; invasive treatment; psychological and social intervention; prevention and public health; specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records. CONCLUSION A care pathway for the management of individuals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, University of California, Irvine, Irvine, CA, USA
- World Spine Care, Santa Ana, CA, USA
| | - Claire D Johnson
- National University of Health Sciences, Lombard, IL, USA.
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA.
| | - Roger Chou
- Department of Medical Informatics and Clinical Epidemiology and Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY, USA
- World Spine Care Europe, Holmfirth, UK
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI, USA
| | - Bart N Green
- National University of Health Sciences, Lombard, IL, USA
- Qualcomm Health Center, Stanford Health Care, San Diego, CA, USA
| | - Christine Cedraschi
- Division of General Medical Rehabilitation and Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | | | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, North York, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Arthur Ameis
- Faculty of Medicine Certification Program in Insurance Medicine and MedicoLegal Expertise, University of Montreal, Toronto, ON, Canada
| | - Afua Adjei-Kwayisi
- Ridge Regional Hospital, Ghana World Spine Care, Accra, Greater Accra, Ghana
| | - Selim Ayhan
- ARTES Spine Center, Acibadem University, Ankara, Turkey
| | - Fiona Blyth
- Concord Clinical School, University of Sydney, Concord, NSW, Australia
| | - David Borenstein
- Arthritis and Rheumatism Associates, The George Washington University Medical Center, Potomac, MD, USA
| | | | - Peter Brooks
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Toorak, Melbourne, VIC, Australia
| | | | - Juan M Castellote
- National School of Occupational Medicine, Carlos III Institute of Health and Physical Medicine and Rehabilitation, University of Complutense, Madrid, Madrid, Spain
| | - Michael B Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Robert Dunn
- Department of Orthopaedic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Christine Goertz
- Palmer College of Chiropractic, Davenport, IA, USA
- The Spine Institute for Quality, Davenport, IA, USA
| | | | - Maria Hondras
- Department of Anesthesiology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Edward J Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, CA, USA
| | | | - John Mayer
- U.S. Spine & Sport Foundation, San Diego, CA, USA
| | - Tiro Mmopelwa
- ARTES Ankara Spine Centre, Life Gaborone Hospital, Gaborone, Botswana
| | - Michael Modic
- Cleveland Clinic, Lerner College of Medicine, Cleveland, OH, USA
| | - Jean Moss
- Canadian Memorial Chiropractic College, President Emerita, Toronto, ON, Canada
| | - Rajani Mullerpatan
- Mahatma Gandhi Mission Institute of Health Sciences, MGM School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Elijah Muteti
- Moi University/Moi Teaching & Referral Hospital, Eldoret, Kenya
| | | | - Madeleine Ngandeu-Singwe
- Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Center Region, Cameroon
| | - Geoff Outerbridge
- World Spine Care and Canadian Memorial Chiropractic College, Chelsea, QC, Canada
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Heather Shearer
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Erkin Sönmez
- Department of Neurological Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Carlos Torres
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paola Torres
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Leslie Verville
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Adriaan Vlok
- Division of Neurosurgery, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - William Watters
- Department of Orthopedic Weill Cornell Medical School and Institute of Academic Medicine, Houston Methodist Hospital, Houston, TX, USA
- Department of Orthopedic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
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Green BN, Johnson CD, Haldeman S, Griffith E, Clay MB, Kane EJ, Castellote JM, Rajasekaran S, Smuck M, Hurwitz EL, Randhawa K, Yu H, Nordin M. A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. PLoS One 2018; 13:e0197987. [PMID: 29856783 PMCID: PMC5983449 DOI: 10.1371/journal.pone.0197987] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/11/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. METHODS A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. RESULTS Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. CONCLUSION Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.
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Affiliation(s)
- Bart N. Green
- Qualcomm Health Center, Stanford Health Care, San Diego, California, United States of America
- Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America
| | - Claire D. Johnson
- Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America
| | - Scott Haldeman
- Department of Neurology, University of California, Irvine, California, United States of America
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, United States of America
- World Spine Care, Santa Ana, California, United States of America
| | - Erin Griffith
- Emergency Medicine, Carlsbad, California, United States of America
| | - Michael B. Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
| | - Edward J. Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, California, United States of America
| | - Juan M. Castellote
- National School of Occupational Medicine, Carlos III Institute of Health, Complutense University of Madrid, Madrid, Spain
| | | | - Matthew Smuck
- Section of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
| | - Eric L. Hurwitz
- Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, Hawaii, United States of America
| | - Kristi Randhawa
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada
| | - Margareta Nordin
- World Spine Care, Santa Ana, California, United States of America
- Department of Orthopedic Surgery, New York University, New York, New York, United States of America
- Department of Environmental Medicine, New York University, New York, New York, United States of America
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Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, Herman PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J 2018; 18:866-879. [PMID: 29371112 PMCID: PMC6020029 DOI: 10.1016/j.spinee.2018.01.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/07/2017] [Accepted: 01/11/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Mobilization and manipulation therapies are widely used to benefit patients with chronic low back pain. However, questions remain about their efficacy, dosing, safety, and how these approaches compare with other therapies. PURPOSE The present study aims to determine the efficacy, effectiveness, and safety of various mobilization and manipulation therapies for treatment of chronic low back pain. STUDY DESIGN/SETTING This is a systematic literature review and meta-analysis. OUTCOME MEASURES The present study measures self-reported pain, function, health-related quality of life, and adverse events. METHODS We identified studies by searching multiple electronic databases from January 2000 to March 2017, examining reference lists, and communicating with experts. We selected randomized controlled trials comparing manipulation or mobilization therapies with sham, no treatment, other active therapies, and multimodal therapeutic approaches. We assessed risk of bias using Scottish Intercollegiate Guidelines Network criteria. Where possible, we pooled data using random-effects meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates. This project is funded by the National Center for Complementary and Integrative Health under Award Number U19AT007912. RESULTS Fifty-one trials were included in the systematic review. Nine trials (1,176 patients) provided sufficient data and were judged similar enough to be pooled for meta-analysis. The standardized mean difference for a reduction of pain was SMD=-0.28, 95% confidence interval (CI) -0.47 to -0.09, p=.004; I2=57% after treatment; within seven trials (923 patients), the reduction in disability was SMD=-0.33, 95% CI -0.63 to -0.03, p=.03; I2=78% for manipulation or mobilization compared with other active therapies. Subgroup analyses showed that manipulation significantly reduced pain and disability, compared with other active comparators including exercise and physical therapy (SMD=-0.43, 95% CI -0.86 to 0.00; p=.05, I2=79%; SMD=-0.86, 95% CI -1.27 to -0.45; p<.0001, I2=46%). Mobilization interventions, compared with other active comparators including exercise regimens, significantly reduced pain (SMD=-0.20, 95% CI -0.35 to -0.04; p=.01; I2=0%) but not disability (SMD=-0.10, 95% CI -0.28 to 0.07; p=.25; I2=21%). Studies comparing manipulation or mobilization with sham or no treatment were too few or too heterogeneous to allow for pooling as were studies examining relationships between dose and outcomes. Few studies assessed health-related quality of life. Twenty-six of 51 trials were multimodal studies and narratively described. CONCLUSION There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option.
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Affiliation(s)
- Ian D Coulter
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA; UCLA School of Dentistry, Box 951668, Los Angeles, CA 90095-1668, USA; Southern California University of Health Sciences, 16200 Amber Valley Dr, Whittier, CA 90604, USA.
| | - Cindy Crawford
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA
| | - Eric L Hurwitz
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA; Office of Public Health Studies, University of Hawai'i, Mānoa, 1960 East-West Rd, Biomed D104AA, Honolulu, HI 96822, USA
| | - Howard Vernon
- RAND Corporation, 1776 Main St, Santa Monica, CA 90407-2138, USA; Division of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON, Canada M2H 3J1
| | - Raheleh Khorsan
- UCI Department of Urban Planning and Public Policy, 300 Social Ecology I, Irvine, CA 92697-7075, USA
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Hurwitz EL, Vassilaki M, Li D, Schneider MJ, Stevans JM, Phillips RB, Phelan SP, Lewis EA, Armstrong RC. Variations in Patterns of Utilization and Charges for the Care of Headache in North Carolina, 2000-2009: A Statewide Claims' Data Analysis. J Manipulative Physiol Ther 2018; 39:229-39. [PMID: 27166404 DOI: 10.1016/j.jmpt.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 11/01/2015] [Accepted: 01/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of the study was to compare patterns of utilization and charges generated by medical doctors (MDs), doctors of chiropractic (DCs), and physical therapists (PTs) for the treatment of headache in North Carolina. METHODS Retrospective analysis of claims data from the North Carolina State Health Plan for Teachers and State Employees from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the North Carolina State Health Plan using International Classification of Diseases, Ninth Revision, diagnostic codes for headache. The claims were separated by individual provider type, combination of provider types, and referral patterns. RESULTS The majority of patients and claims were in the MD-only or MD plus referral patterns. Chiropractic patterns represented less than 10% of patients. Care patterns with single-provider types and no referrals incurred the least charges on average for headache. When care did not include referral providers or services, MD with DC care was generally less expensive than MD care with PT. However, when combined with referral care, MD care with PT was generally less expensive. Compared with MD-only care, risk-adjusted charges (available 2006-2009) for patients in the middle risk quintile were significantly less for DC-only care. CONCLUSIONS Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care.
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Affiliation(s)
- Eric L Hurwitz
- Professor, Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI.
| | - Maria Vassilaki
- Research Associate, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dongmei Li
- Associate Professor, Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Michael J Schneider
- Associate Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Joel M Stevans
- Assistant Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | | | - Shawn P Phelan
- Doctor of Chiropractic, Private Practice of Chiropractic, Wake Forest, NC
| | - Eugene A Lewis
- Doctor of Chiropractic, Private Practice of Chiropractic, Greensboro, NC
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Nordin M, Randhawa K, Torres P, Yu H, Haldeman S, Brady O, Côté P, Torres C, Modic M, Mullerpatan R, Cedraschi C, Chou R, Acaroğlu E, Hurwitz EL, Lemeunier N, Dudler J, Taylor-Vaisey A, Sönmez E. The Global Spine Care Initiative: a systematic review for the assessment of spine-related complaints in populations with limited resources and in low- and middle-income communities. Eur Spine J 2018; 27:816-827. [DOI: 10.1007/s00586-017-5446-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 10/17/2022]
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Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J 2018; 27:796-801. [PMID: 29480409 DOI: 10.1007/s00586-017-5432-9] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 12/16/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE This article summarizes relevant findings related to low back and neck pain from the Global Burden of Disease (GBD) reports for the purpose of informing the Global Spine Care Initiative. METHODS We reviewed and summarized back and neck pain burden data from two studies that were published in Lancet in 2016, namely: "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015" and "Global, regional, and national disability-adjusted life years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015." RESULTS In 2015, low back and neck pain were ranked the fourth leading cause of disability-adjusted life years (DALYs) globally just after ischemic heart disease, cerebrovascular disease, and lower respiratory infection {low back and neck pain DALYs [thousands]: 94 941.5 [95% uncertainty interval (UI) 67 745.5-128 118.6]}. In 2015, over half a billion people worldwide had low back pain and more than a third of a billion had neck pain of more than 3 months duration. Low back and neck pain are the leading causes of years lived with disability in most countries and age groups. CONCLUSION Low back and neck pain prevalence and disability have increased markedly over the past 25 years and will likely increase further with population aging. Spinal disorders should be prioritized for research funding given the huge and growing global burden. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Eric L Hurwitz
- Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, HI, USA.
| | - Kristi Randhawa
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Hainan Yu
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada
| | - Scott Haldeman
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, University of California, Irvine, CA, USA.,World Spine Care, Santa Ana, CA, USA
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Hurwitz EL, Randhawa K, Torres P, Yu H, Verville L, Hartvigsen J, Côté P, Haldeman S. The Global Spine Care Initiative: a systematic review of individual and community-based burden of spinal disorders in rural populations in low- and middle-income communities. Eur Spine J 2017; 27:802-815. [DOI: 10.1007/s00586-017-5393-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022]
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Carlson ADP, Tschann M, Santibenchakul S, Hurwitz EL, Salcedo J. Physician Adherence to Sexually Transmitted Infection Screening Guidelines in an OB/GYN Teaching Clinic in Hawai'i. Hawaii J Med Public Health 2017; 76:299-304. [PMID: 29164013 PMCID: PMC5694972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rates of chlamydia (CT) and gonorrhea (GC) have risen for the first time in the United States since 2006. Certain population groups are disproportionately affected by these sexually transmitted infections (STIs) as well as HIV. The Centers for Disease Control and Prevention (CDC) and professional societies have published screening guidelines for these STIs for women under the age of 25. We aimed to quantify physician adherence to GC/CT and HIV screening guidelines and to determine demographic factors associated with GC/CT and HIV screening recommendations among women 14-25 years old in Honolulu, Hawai'i. We conducted a retrospective chart review of all visits to an OB/GYN teaching clinic in 2014 to determine rates of STI screening recommendations and evaluate differences in screening recommendations by demographic factors such as patient age, race, insurance type, visit type, and visit number during the study period. Electronic medical records of 726 visits by 446 patients were reviewed. Among visits by patients with indications for screening, 71.0% and 21.6% received screening recommendations for GC/CT and HIV, respectively. Age group, race, and visit type were significantly associated with receiving screening recommendations. A lack of appropriate documentation regarding the assessment of risk factors for GC/CT and HIV screening was observed. Emphasis should be placed on more thorough ascertainment and documentation of patients' risk factors for STI acquisition to determine screening needs at each clinical visit based on professional guidelines, as substantial public health benefits may be gained through the identification and prompt treatment of GC/CT and HIV infections.
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Affiliation(s)
- Alyssa Dee P Carlson
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (ADCP, SS, EH)
| | - Mary Tschann
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (ADCP, SS, EH)
| | - Somsook Santibenchakul
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (ADCP, SS, EH)
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (ADCP, SS, EH)
| | - Jennifer Salcedo
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI (ADCP, SS, EH)
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Matsunaga M, Hurwitz EL, Li D. Development and Evaluation of a Dietary Approaches to Stop Hypertension Dietary Index with Calorie-Based Standards in Equivalent Units: A Cross-Sectional Study with 24-Hour Dietary Recalls from Adult Participants in the National Health and Nutrition Examination Survey 2007-2010. J Acad Nutr Diet 2017; 118:62-73.e4. [PMID: 28479136 DOI: 10.1016/j.jand.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 03/07/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Dietary indexes to assess accordance with the Dietary Approaches to Stop Hypertension (DASH) dietary pattern are useful tools in studies with health-related outcomes. However, scoring algorithms of the dietary index can affect the range of its applications. OBJECTIVE The purposes of this study were to develop a DASH dietary index with calorie-based standards in equivalent units and to evaluate the validity and reliability of the index. METHODS Calorie-based standards for nine components were determined based on recommended intakes in the DASH eating plan and dietary intakes estimated from two 24-hour dietary recalls of adult participants in the National Health and Nutrition Examination Survey 2007-2008, 2009-2010 (n=9,720). Evaluation tests included descriptive analyses of index scores among US adults stratified by sex and smoking status. Spearman's rank correlations were used to examine the relationships among components and total scores. The developed index was compared with two DASH dietary indexes that use different scoring algorithms to examine the association between total scores and blood pressure status through multivariable regression models. RESULTS The newly developed index consisted of seven food group and two nutrient components. The mean and median of total scores among US adults were 42.3 (95% CI 41.6 to 43.0) and 41.6 of 90 points, respectively. The mean total scores among adult women and non-current smokers were higher than their counterparts (P<0.001). The absolute correlation coefficients among the components and between each component and the sum of other components were ≤0.33 and ≤0.35, respectively. After adjusting for age and race/ethnicity, an association between total scores and blood pressure status was found in adult women (P<0.001), but not in adult men. The same pattern was found when the two indexes were used, but the strength of the association varied across the three indexes. CONCLUSIONS The developed index appeared to measure accordance with the DASH dietary pattern based on the dietary data from US adults. Further studies are warranted for various applications of the index.
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Kizhakkeveettil A, Rose KA, Kadar GE, Hurwitz EL. Integrative Acupuncture and Spinal Manipulative Therapy Versus Either Alone for Low Back Pain: A Randomized Controlled Trial Feasibility Study. J Manipulative Physiol Ther 2017; 40:201-213. [PMID: 28259496 DOI: 10.1016/j.jmpt.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective of this study was to assess the feasibility of conducting a large-scale randomized controlled trial (RCT) examining whether an integrative care model combining spinal manipulative therapy (SMT) and acupuncture can lead to better outcomes for low back pain (LBP) than either therapy alone. METHODS This study was conducted at a complementary and alternative medicine university health center. Participants with acute or chronic LBP were randomized to (1) acupuncture, (2) SMT, or (3) integrative acupuncture and SMT groups. Treatments were provided over 60 days by licensed doctors of chiropractic and acupuncturists. Acupuncture treatments consisted of needling of acupoints combined with electrotherapy, moxibustion, cupping, and Tui Na. SMT used specific contact points on vertebral processes, along with soft tissue therapy and physiotherapy. Primary outcome measures were the Roland-Morris LBP Disability Questionnaire and 0 to 10 Numeric Rating Scale for LBP. RESULTS Participants in all 3 groups experienced clinically meaningful improvements in the primary outcome measures; however, no between-group differences in outcomes were apparent. CONCLUSIONS This study indicated that it is feasible to conduct an RCT to compare the effectiveness of integrative acupuncture and SMT for LBP to either therapy alone. Future studies should include a larger sample to increase the power for detecting clinically meaningful differences between groups.
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Affiliation(s)
| | - Kevin A Rose
- Southern California University of Health Sciences, Whittier, CA
| | - Gena E Kadar
- Southern California University of Health Sciences, Whittier, CA
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Brady O, Nordin M, Hondras M, Outerbridge G, Kopansky-Giles D, Côté P, da Silva S, Ford T, Eberspaecher S, Acaroğlu E, Mmopelwa T, Hurwitz EL, Haldeman S. Global Forum: Spine Research and Training in Underserved, Low and Middle-Income, Culturally Unique Communities: The World Spine Care Charity Research Program's Challenges and Facilitators. J Bone Joint Surg Am 2016; 98:e110. [PMID: 28002378 DOI: 10.2106/jbjs.16.00723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The World Spine Care (WSC), established by volunteers from 5 continents, is dedicated to providing sustainable, evidence-based spine care to individuals and communities in low and middle-income countries consistent with available health-care resources and integrated within the local culture. The research committee approves and oversees the WSC's collaborative research and training projects worldwide and serves to create a sustainable research community for underserved populations focused on preventing disability from spinal disorders. The purpose of this article is to describe 4 projects overseen by the WSC research committee and to discuss several challenges and specific facilitators that allowed successful completion of initiatives. These novel projects, which involved establishing spine surgery expertise and data collection in the WSC clinics and surrounding communities, all met their aims. This was achieved by overcoming language and resource challenges, adapting to local customs, and taking time to build mutual respect and to nurture relationships with local investigators and stakeholders.
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Affiliation(s)
- O'Dane Brady
- 1World Spine Care, Santa Ana, California 2Departments of Orthopedic Surgery and Environmental Medicine, New York University, New York, NY 3Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark 4Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada 5Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada 6Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario, Canada 7UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada 8World Spine Care, Moca, Dominican Republic 9Ankara ARTES Spine Center, Ankara, Turkey 10Mahalapye District Hospital, Mahalapye, Botswana 11Department of Epidemiology, Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii 12Department of Epidemiology, School of Public Health, University of California, Los Angeles, Los Angeles, California 13Department of Neurology, University of California, Irvine, Irvine, California
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Ewald SC, Hurwitz EL, Kizhakkeveettil A. The effect of obesity on treatment outcomes for low back pain. Chiropr Man Therap 2016; 24:48. [PMID: 27999659 PMCID: PMC5151134 DOI: 10.1186/s12998-016-0129-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022] Open
Abstract
Background The objective of this study was to estimate the effect of obesity, as measured by body mass index (BMI), on treatment outcomes for low back pain (LBP). Methods Data from the University of California, Los Angeles, and Friendly Hills Healthcare Network low back pain study (collected from 1995 to 2000) were used to perform a secondary data analysis of this randomized clinical trial on adults who sought care for LBP. BMI was the primary predictor variable. Binary logistic regression modeling was performed to estimate odds ratios adjusted for the effects of confounders. Results Using normal weight as the referent population, underweight and overweight populations did not display significant odds ratios for any of the outcome variables. The obese population demonstrated odds ratios of 0.615 (0.379, 0.998) for improvement of disability and 0.550 (0.341, 0.889) for improvement of most severe back pain. Conclusion The results of this study support an association between obesity and less effective treatment outcomes whether measured by disability (Roland-Morris scale) or pain (most severe pain NRS). Overweight and underweight populations do not appear to have significantly different outcomes than normal weight populations. Trial registration This trial was designed and conducted prior to the advent of registries.
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Affiliation(s)
- Stanley C Ewald
- University of Western States, 2900 NE 132nd Avenue, Portland, OR 97230 USA
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii, 1960 East-west Road, Honolulu, HI 96822 USA
| | - Anupama Kizhakkeveettil
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA 90604 USA
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Hurwitz EL, Li D, Guillen J, Schneider MJ, Stevans JM, Phillips RB, Phelan SP, Lewis EA, Armstrong RC, Vassilaki M. Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims' Data Analysis. J Manipulative Physiol Ther 2016; 39:240-51. [PMID: 27166405 DOI: 10.1016/j.jmpt.2016.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 11/01/2015] [Accepted: 01/01/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of the study was to compare utilization and charges generated by medical doctors (MD), doctors of chiropractic (DC) and physical therapists (PT) by provider patterns of care for the treatment of neck pain in North Carolina. METHODS This was an analysis of neck-pain-related closed claim data from the North Carolina State Health Plan for Teachers and State Employees (NCSHP) from 2000 to 2009. Data were extracted from Blue Cross Blue Shield of North Carolina for the NCSHP using ICD-9 diagnostic codes for uncomplicated neck pain (UNP) and complicated neck pain (CNP). RESULTS Care patterns with single-provider types and no referrals incurred the least average charges for both UNP and CNP. When care did not include referral providers or services, for either UNP or CNP, MD care with PT was generally less expensive than MD care with DC care. However, when care involved referral providers or services, MD and PT care was on average more expensive than MD and DC care for either UNP or CNP. Risk-adjusted charges for patients in the middle quintile of risk (available 2006-2009) were lower for chiropractic patients with or without medical care or referral care to other providers. CONCLUSIONS Chiropractic care alone or DC with MD care incurred appreciably fewer charges for UNP or CNP compared to MD care with or without PT care, when care included referral providers or services. This finding was reversed when care did not include referral providers or services. Risk-adjusted charges for UNP and CNP patients were lower for DC care patterns.
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Affiliation(s)
- Eric L Hurwitz
- Professor, Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI.
| | - Dongmei Li
- Associate Professor, Clinical and Translational Science Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jenni Guillen
- Graduate Research Associate, Office of Public Health Studies, University of Hawai`i at Mānoa, Honolulu, HI
| | - Michael J Schneider
- Associate Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Joel M Stevans
- Assistant Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | | | - Shawn P Phelan
- Doctor of Chiropractic, Private Practice of Chiropractic, Wake Forest, NC
| | - Eugene A Lewis
- Doctor of Chiropractic, Private Practice of Chiropractic, Greensboro, NC
| | | | - Maria Vassilaki
- Research Associate, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Hurwitz EL, Li D, Guillen J, Schneider MJ, Stevans JM, Phillips RB, Phelan SP, Lewis EA, Armstrong RC, Vassilaki M. Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther 2016; 39:252-62. [DOI: 10.1016/j.jmpt.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 11/01/2015] [Accepted: 01/01/2016] [Indexed: 10/21/2022]
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Oshiro CES, Novotny R, Grove JS, Hurwitz EL. Race/Ethnic Differences in Birth Size, Infant Growth, and Body Mass Index at Age Five Years in Children in Hawaii. Child Obes 2015; 11:683-90. [PMID: 26561722 DOI: 10.1089/chi.2015.0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Factors at birth and infancy may increase risk of being overweight in childhood. The aim of this study was to examine the relationship of birth size and infant growth (2-24 months) with BMI at age 5 years in a multiethnic population. METHODS This was a retrospective study (using electronic medical records of a health maintenance organization in Hawaii) of singleton children born in 2004-2005, with linked maternal and birth information, infant weights (n = 597) and lengths (n = 473) in the first 2 years, and BMI measures at age 5 years (n = 894). Multiple regression models were used to estimate the association of BMI at age 5 years with birth size and infant growth. RESULTS Birth weight was positively associated with BMI at age 5 years, adjusting for gestational age, sex, race/ethnicity, and maternal prepregnancy weight, age, education, and smoking. A greater change in infant weight was associated with a higher BMI at age 5 years, though the effect of birth weight on BMI was neither mediated nor modified by infant growth rate. Birth weight, change in infant weight, and BMI at age 5 years varied by race/ethnicity. Change in infant BMI in the first 2 years was higher in other Pacific Islanders and whites (Δ = 0.966; confidence interval [CI] = 0.249-1.684; p = 0.02) than in Asian, other, and part Native Hawaiian race/ethnic groups. CONCLUSIONS Early biological measures of birth weight and infant weight gain varied by race/ethnicity and positively predicted BMI at age 5 years.
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Affiliation(s)
- Caryn E S Oshiro
- 1 Kaiser Permanente, Center for Health Research Hawaii , Honolulu, HI
| | - Rachel Novotny
- 2 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii , Mānoa, HI
| | - John S Grove
- 3 Department of Public Health Sciences, Office of Public Health Studies, University of Hawaii , Mānoa, HI
| | - Eric L Hurwitz
- 3 Department of Public Health Sciences, Office of Public Health Studies, University of Hawaii , Mānoa, HI
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Haldeman S, Nordin M, Outerbridge G, Hurwitz EL, Hondras M, Brady O, Kopansky-Giles D, Ford T, Acaroğlu E. Creating a sustainable model of spine care in underserved communities: the World Spine Care (WSC) charity. Spine J 2015; 15:2303-11. [PMID: 26096472 DOI: 10.1016/j.spinee.2015.06.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/11/2015] [Accepted: 06/12/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Scott Haldeman
- Department of Neurology, University of California, 200 S. Manchester Ave., Suite 206, Irvine, CA, 92868, USA; Department of Epidemiology, School of Public Health, University of California, 650 Charles Young Drive, South Box 951772, Los Angeles, CA, 90095, USA; World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, 92705, CA, USA
| | - Margareta Nordin
- World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, 92705, CA, USA; Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center (OIOC), New York University, 63 Downing Street, New York, NY 10014, USA.
| | - Geoff Outerbridge
- World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, 92705, CA, USA
| | - Eric L Hurwitz
- Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Biomedical Sciences D201, Honolulu, HI, 96822, USA
| | - Maria Hondras
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - O'Dane Brady
- World Spine Care, 801 North Tustin Avenue, Suite 202, Santa Ana, 92705, CA, USA
| | - Deborah Kopansky-Giles
- Chiropractic Program, Department of Family and Community Medicine, St. Michael's Hospital, 80 Bond Health Centre, Level 1 Room 12, Toronto, Ontario, Canada, M5B 1X2; Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada, M2H 3J1
| | - Timothy Ford
- World Spine Care, Mahalapye District Hospital, P.O. Box 49, Mahalapye, Botswana
| | - Emre Acaroğlu
- Ankara Spine Center, İran Caddesi 45/2 Kavaklıdere 06700, Ankara, Turkey
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