Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors

BACKGROUND

Individual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to elucidate this by first describing individual goals set by Danish and Canadian participants in a self-management intervention for people with back pain using the ICF framework; then, determining what proportion of these goals met criteria for being specific, measurable, acceptable, and time bound, and finally, by investigating differences between countries, sexes, and age groups.

METHODS

In a cross-sectional study conducted August 2018 to June 2020, 394 Danish and 133 Canadian (Alberta Province) participants defined their individual goals of participating in a self-management programme involving patient education and supervised exercises. The goals were linked to the ICF framework. Distribution of goals was compared between countries, sexes, and age groups.

RESULTS

Goals most often related to the ICF component of 'Activity and Participation'. The most prevalent goals were "Walking" (DK: 20%; CA: 15%) and "Maintaining a body position" (DK: 17%; CA: 22%). Only few goals differed between populations, age and sex. All elements of SMART goal setting were recorded for 88% of Danish and 94% of Alberta participants.

CONCLUSIONS

People with low back pain attending a self-management programme established goals according to the SMART criteria and focused primarily on activity. Goals were similar across countries and showed few differences across sex and age groups. The high number of different goals points to the need for individualised person-centred care.

Presenters at chiropractic research conferences 2010-2019: is there a gender equity problem?

BACKGROUND

Presenting at professional and scientific conferences can be an important part of an individual's career advancement, especially for researchers communicating scientific findings, and can signal expertise and leadership. Generally, women presenting at conferences are underrepresented in various science disciplines. We aimed to evaluate the gender of presenters at research-oriented chiropractic conferences from 2010 to 2019.

METHODS

We investigated the gender of presenters at conferences hosted by chiropractic organisations from 2010 to 2019 that utilised an abstract submission process. Gender classification was performed by two independent reviewers. The gender distribution of presenters over the ten-year period was analysed with linear regression. The association of conference factors with the gender distribution of presenters was also assessed with linear regression, including the gender of organising committees and abstract peer reviewers, and the geographic region where the conference was hosted.

RESULTS

From 39 conferences, we identified 4,340 unique presentations. Women gave 1,528 (35%) of the presentations. No presenters were classified as gender diverse. Overall, the proportion of women presenters was 30% in 2010 and 42% in 2019, with linear regression demonstrating a 1% increase in women presenting per year (95% CI = 0.4-1.6%). Invited/keynote speakers had the lowest proportion of women (21%) and the most stagnant trajectory over time. The gender of conference organisers and abstract peer reviewers were not significantly associated with the gender of presenters. Oceanic conferences had a lower proportion of women presenting compared to North America (27% vs. 36%).

CONCLUSIONS

Overall, women gave approximately one-third of presentations at the included conferences, which gradually increased from 2010 to 2019. However, the disparity widens for the most prestigious class of keynote/invited presenters. We make several recommendations to support the goal of gender equity, including monitoring and reporting on gender diversity at future conferences.

The impact and public health response of chiropractors to the COVID-19 pandemic: a survey across four continents

BACKGROUND

The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of COVID-19 on chiropractors internationally, and examines the public health response of chiropractors to the COVID-19 pandemic practising under a musculoskeletal spine-care versus subluxation-based care paradigm.

METHODS

A survey was distributed to chiropractors in Australia, Canada, Denmark, Hong Kong, United Kingdom and United States (Oct. 2nd-Dec. 22nd, 2020) via professional bodies/publications, and social media. Questions were categorised into three domains: socio-demographic, public health response and business/financial impact. Multivariable logistic regression explored survey items associated with chiropractors practising under different self-reported paradigms.

RESULTS

A total of 2061 chiropractors representing four global regions completed the survey. Our recruitment method did not allow the calculation of an accurate response rate. The vast majority initiated COVID-19 infection control changes within their practice setting, including increased disinfecting of treatment equipment (95%), frequent contact areas (94%) and increased hand hygiene (94%). While findings varied by region, most chiropractors (85%) indicated that they had implemented regulator advice on the use of personal protective equipment (PPE). Suspension of face-to-face patient care during the peak of the pandemic was reported by 49% of the participants with 26% implementing telehealth since the pandemic began. Chiropractors practising under a musculoskeletal spine-care paradigm were more likely to implement some/all regulator advice on patient PPE use (odds ratio [OR] = 3.25; 95% confidence interval [CI]: 1.57, 6.74) and practitioner PPE use (OR = 2.59; 95% CI 1.32, 5.08); trust COVID-19 public health information provided by government/World Health Organisation/chiropractic bodies (OR = 2.47; 95% CI 1.49, 4.10), and initiate patient telehealth in response to COVID-19 (OR = 1.46; 95% CI 1.02, 2.08) compared to those practising under a subluxation-based paradigm.

CONCLUSIONS

Chiropractors who responded to our survey made substantial infectious control changes in response to COVID-19. However, there was regional variation in the implementation of the advised practitioner and patient use of PPE and limited overall use of telehealth consultations by chiropractors during COVID-19. Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.

A Reference Database of Standardised Continuous Lumbar Intervertebral Motion Analysis for Conducting Patient-Specific Comparisons

Lumbar instability has long been thought of as the failure of lumbar vertebrae to maintain their normal patterns of displacement. However, it is unknown what these patterns consist of. Research using quantitative fluoroscopy (QF) has shown that continuous lumbar intervertebral patterns of rotational displacement can be reliably measured during standing flexion and return motion using standardised protocols and can be used to assess patients with suspected lumbar spine motion disorders. However, normative values are needed to make individualised comparisons. One hundred and thirty-one healthy asymptomatic participants were recruited and performed guided flexion and return motion by following the rotating arm of an upright motion frame. Fluoroscopic image acquisition at 15fps was performed and individual intervertebral levels from L2-3 to L5-S1 were tracked and analysed during separate outward flexion and return phases. Results were presented as proportional intervertebral motion representing these phases using continuous means and 95%CIs, followed by verification of the differences between levels using Statistical Parametric Mapping (SPM). A secondary analysis of 8 control participants matched to 8 patients with chronic, non-specific low back pain (CNSLBP) was performed for comparison. One hundred and twenty-seven asymptomatic participants’ data were analysed. Their ages ranged from 18 to 70 years (mean 38.6) with mean body mass index 23.8 kg/m² 48.8% were female. Both the flexion and return phases for each level evidenced continuous change in mean proportional motion share, with narrow confidence intervals, highly significant differences and discrete motion paths between levels as confirmed by SPM. Patients in the secondary analysis evidenced significantly less L5-S1 motion than controls (p < 0.05). A reference database of spinal displacement patterns during lumbar (L2-S1) intersegmental flexion and return motion using a standardised motion protocol using fluoroscopy is presented. Spinal displacement patterns in asymptomatic individuals were found to be distinctive and consistent for each intervertebral level, and to continuously change during bending and return. This database may be used to allow continuous intervertebral kinematics to drive dynamic models of joint and muscular forces as well as reference values against which to make patient-specific comparisons in suspected cases of lumbar spine motion disorders.

Texture analysis in the classification of T2 -weighted magnetic resonance images in persons with and without low back pain

Magnetic resonance imaging findings often do not distinguish between people with and without low back pain (LBP). However, there are still a large number of people who undergo magnetic resonance imaging to help determine the etiology of their back pain. Texture analysis shows promise for the classification of tissues that look similar, and machine learning can minimize the number of comparisons. This study aimed to determine if texture features from lumbar spine magnetic resonance imaging differ between people with and without LBP. In total, 14 participants with chronic LBP were matched for age, weight, and gender with 14 healthy volunteers. A custom texture analysis software was used to construct a gray-level co-occurrence matrix with one to four pixels offset in 0° direction for the disc and superior and inferior endplate regions. The Random Forests Algorithm was used to select the most promising classifiers. The linear mixed-effect model analysis was used to compare groups (pain vs. pain-free) at each level controlling for age. The Random Forest Algorithm recommended focusing on intervertebral discs and endplate zones at L4-5 and L5-S1. Differences were observed between groups for L5-S1 superior endplate contrast, homogeneity, and energy (p = .02). Differences were observed for L5-S1 disc contrast and homogeneity (p < .01), as well as for the inferior endplates contrast, homogeneity, and energy (p < .03). Magnetic resonance imaging textural features may have potential in identifying structures that may be the target of further investigations about the reasons for LBP.

A consensus approach toward the standardization of spinal stiffness measurement using a loaded rolling wheel device: results of a Delphi study

BACKGROUND

Spinal stiffness assessment has the potential to become an important clinical measure. Various spinal stiffness-testing devices are available to help researchers objectively evaluate the spine and patient complaints. One of these is VerteTrack, a device capable of measuring posteroanterior displacement values over an entire spinal region. This study aimed to develop a best-practice protocol for evaluating spinal stiffness in human participants using VerteTrack.

METHODS

Twenty-five individuals with research experience in measuring spinal stiffness, or who were trained in spinal stiffness measurement using the VerteTrack device, were invited to participate in this 3-Round Delphi study. Answers to open-ended questions in Round 1 were thematically analyzed and translated into statements about VerteTrack operation for spinal stiffness measurements. Participants then rated their level of agreement with these statements using a 5-point Likert scale in Rounds 2 and 3. A descriptive statistical analysis was performed. Consensus was achieved when at least 70% of the participants either strongly agreed, agreed, (or strongly disagreed, disagreed) to include a statement in the final protocol.

RESULTS

Twenty participants completed Round 1 (80%). All these participants completed Rounds 2 and 3. In total, the pre-defined consensus threshold was reached for 67.2% (123/183) of statements after three rounds of surveys. From this, a best-practice protocol was created.

CONCLUSIONS

Using a Delphi approach, a consensus-based protocol for measuring spinal stiffness using the VerteTrack was developed. This standard protocol will help to improve the accuracy, efficiency, and safety of spinal stiffness measurements, facilitate the training of new operators, increase consistency of these measurements in multicenter studies, and provide the synergy and potential for data comparison between spine studies internationally. Although specific to VerteTrack, the resulting standard protocol could be modified for use with other devices designed to collect spinal stiffness measures.

Effects of muscle activity on lumbar spinal stiffness in asymptomatic adults: An investigation using a novel rolling device

BACKGROUND

Device-based measurement of lumbar spinal stiffness has the potential to identify patients with low back pain who are more likely to improve with spinal manipulative therapy. This study evaluates how voluntary contraction of spine muscles may impact stiffness measures.

OBJECTIVE

To determine how the contraction of different spinal muscles may influence spinal stiffness at all lumbar levels.

DESIGN

Experimental study.

METHOD

A mechanical device was used to measure spinal stiffness (N/mm) from L1 to L5 in 12 asymptomatic participants, while muscle activity from four pairs of thoracolumbar muscles was recorded. A baseline measurement was collected with the participants holding their breath at normal exhalation. Participants stiffness was then measured while performing (1) an isometric hip extension, (2) an isometric shoulder flexion, and (3) a deep held inhalation. Mixed-model ANOVAs were used to evaluate the effects of the perturbations on spinal stiffness at each lumbar level. Friedman's test was then computed to evaluate the differences in muscle activity between the perturbations.

RESULTS

Globally, the designed perturbations generated activity in different muscles with different magnitudes (P-values≤0.05). Increased spinal stiffness was observed at each spinal level during the hip extension, and at L5 during the held inhalation (P-values<0.05). A differential effect of the spinal levels on the spinal stiffness was observed during the hip extension and held inhalation (P-values<0.05).

CONCLUSION

This study provides evidence that the magnitude of muscle activity influences spinal stiffness, but not equally between lumbar levels.

Correction to: Leadership and capacity building in chiropractic research: report from the first CARL cohort

An amendment to this paper has been published and can be accessed via the original article.

Leadership and capacity building in chiropractic research: report from the first CARL cohort

The Chiropractic Academy for Research Leadership (CARL) was formed in 2016 in response to a need for a global network of early career researchers and leaders in the chiropractic profession. Thirteen fellows were accepted competitively and have since worked together at residentials and virtually on many research and leadership projects. In 2020, the CARL program ended for this first cohort, and it is now timely to take stock and reflect on the achievements and benefits of the program. In this paper we present the structure of CARL, the scientific and leadership outputs as well as the personal value of CARL for the participating fellows. As a result of the success of the first CARL cohort, organizations from Europe, North America, and Australia have supported a second cohort of 14 CARL fellows, who were competitively accepted into the program in early 2020.

The feasibility of implementing an English language version of GLA:D Back

BACKGROUND

Evidenced-based clinical guidelines for the treatment of low back pain (LBP) consistently suggest educating patients about their back pain, its natural course, and providing advice to keep active and continue working. Despite this evidence, clinicians routinely do not follow these recommendations resulting in ineffective and fragmented care. GLA:D® Back, a standardized care package, was originally developed in Denmark to assist clinicians in implementing evidence-based care. This study will evaluate the feasibility of implementing the English version of the Danish GLA:D® Back program in Alberta, Canada.

METHODS

Thirty-five clinicians from nineteen clinics in Alberta, Canada, participated. Feasibility of program implementation, our primary objective, was evaluated within 3 months. Feasibility success was defined as 50% clinician/clinic adoption in addition to 66-88 enrolled participants registered in the database. Our secondary objectives included collecting data pertaining to clinician confidence, attitudes and behaviour of treating patients, perceived barriers and facilitators of program in addition to collecting patient-data regarding pain, function, general health and self-efficacy.

RESULTS

The majority of the clinics (15/19, 79%) offered GLA:D® Back to their patients within the study period. Of the participating clinicians, GLA:D® Back was delivered by (25/35, 71%) of clinicians. In total, 78 patients were enrolled in the program and (69/78, 88%) participants attended the final assessment. Secondarily, clinicians demonstrated a biomedical and behavioural orientation along with high confidence when treating LBP patients while patient outcomes trended toward improvement.

CONCLUSION

The English translation of the Danish GLA:D Back program was feasible for Albertan clinicians to implement into practice in both urban and rural settings.

Comparing the effectiveness of group-based exercise to other non-pharmacological interventions for chronic low back pain: A systematic review

Background

Low back pain (LBP) is the leading cause of disability worldwide with a substantial financial burden on individuals and health care systems. To address this, clinical practice guidelines often recommend non-pharmacological, non-invasive management approaches. One management approach that has been recommended and widely implemented for chronic LBP is group-based exercise programs, however, their clinical value compared with other non-pharmacological interventions has not been investigated systematically.

Objective

To compare the effectiveness of group-based exercise with other non-pharmacological interventions in people with chronic LBP.

Methods

Four electronic databases were searched by two independent reviewers. Only randomized controlled trials that compared group-based exercise with other non-pharmacological interventions for chronic LBP were eligible. Study quality was assessed using the Cochrane Handbook for systematic reviews of Interventions by two independent reviewers.

Results

Eleven studies were eligible. We identified strong evidence of no difference between group exercise and other non-pharmacologic interventions for disability level and pain scores 3-month post-intervention in people with chronic LBP. We could not find any strong or moderate evidence for or against the use of group-based exercise in the rehabilitation of people with chronic LBP for other time-points and health measurement outcomes. We found no statistically significant differences in disability and quality of life and pain between the group and individual non-pharmacological interventions that included exercise.

Conclusion

With this equivocal finding, group-based exercise may be a preferred choice given potential advantages in other domains not reviewed here such as motivation and cost. Further research in this area is needed to evaluate this possibility.

Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

BACKGROUND

Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them.

METHODS

Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them. Responses were analyzed using descriptive statistics.

RESULTS

A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. Most clinicians (97%) believed benign AEs occur, and 82% reported their own patients have experienced one. For patients, 55% reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness. While most clinicians (61.5%) reported trying a mitigation strategy with their patients, only 21.2% of patients perceived their clinicians had tried any mitigation strategy. Clinicians perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT. Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage.

CONCLUSIONS

This is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.

Misinformation about spinal manipulation and boosting immunity: an analysis of Twitter activity during the COVID-19 crisis

Background

Social media has become an increasingly important tool in monitoring the onset and spread of infectious diseases globally as well monitoring the spread of information about those diseases. This includes the spread of misinformation, which has been documented within the context of the emerging COVID-19 crisis. Understanding the creation, spread and uptake of social media misinformation is of critical importance to public safety. In this descriptive study, we detail Twitter activity regarding spinal manipulative therapy (SMT) and claims it increases, or “boosts”, immunity. Spinal manipulation is a common intervention used by many health professions, most commonly by chiropractors. There is no clinical evidence that SMT improves human immunity.

Methods

Social media searching software (Talkwalker Quick Search) was used to describe Twitter activity regarding SMT and improving or boosting immunity. Searches were performed for the 3 months and 12 months before March 31, 2020 using terms related to 1) SMT, 2) the professions that most often provide SMT and 3) immunity. From these searches, we determined the magnitude and time course of Twitter activity then coded this activity into content that promoted or refuted a SMT/immunity link. Content themes, high-influence users and user demographics were then stratified as either promoting or refuting this linkage.

Results

Twitter misinformation regarding a SMT/immunity link increased dramatically during the onset of the COVID crisis. Activity levels (number of tweets) and engagement scores (likes + retweets) were roughly equal between content promoting or refuting a SMT/immunity link, however, the potential reach (audience) of tweets refuting a SMT/immunity link was 3 times higher than those promoting a link. Users with the greatest influence on Twitter, as either promoters or refuters, were individuals, not institutions or organizations. The majority of tweets promoting a SMT/immunity link were generated in the USA while the majority of refuting tweets originated from Canada.

Conclusion

Twitter activity about SMT and immunity increased during the COVID-19 crisis. Results from this work have the potential to help policy makers and others understand the impact of SMT misinformation and devise strategies to mitigate its impact.

The use of internet analytics by a Canadian provincial chiropractic regulator to monitor, evaluate and remediate misleading claims regarding specific health conditions, pregnancy, and COVID-19

BACKGROUND

Internet analytics are increasingly being integrated into public health regulation. One specific application is to monitor compliance of website and social media activity with respect to jurisdictional regulations. These data may then identify breaches of compliance and inform disciplinary actions. Our study aimed to evaluate the novel use of internet analytics by a Canadian chiropractic regulator to determine their registrants compliance with three regulations related to specific health conditions, pregnancy conditions and most recently, claims of improved immunity during the COVID-19 crisis.

METHODS

A customized internet search tool (Market Review Tool, MRT) was used by the College of Chiropractors of British Columbia (CCBC), Canada to audit registrants websites and social media activity. The audits extracted words whose use within specific contexts is not permitted under CCBC guidelines. The MRT was first used in October of 2018 to identify words related to specific health conditions. The MRT was again used in December 2019 for words related to pregnancy and most recently in March 2020 for words related to COVID-19. In these three MRT applications, potential cases of word misuse were evaluated by the regulator who then notified the practitioner to comply with existing regulations by a specific date. The MRT was then used on that date to determine compliance. Those found to be non-compliant were referred to the regulator's inquiry committee. We mapped this process and reported the outcomes with permission of the regulator.

RESULTS

In September 2018, 250 inappropriate mentions of specific health conditions were detected from approximately 1250 registrants with 2 failing to comply. The second scan for pregnancy related terms of approximately1350 practitioners revealed 83 inappropriate mentions. Following notification, all 83 cases were compliant within the specified timeframe. Regarding COVID-19 related words, 97 inappropriate mentions of the word "immune" were detected from 1350 registrants with 7 cases of non-compliance.

CONCLUSION

Internet analytics are an effective way for regulators to monitor internet activity to protect the public from misleading statements. The processes described were effective at bringing about rapid practitioner compliance. Given the increasing volume of internet activity by healthcare professionals, internet analytics are an important addition for health care regulators to protect the public they serve.

Potential mechanisms for lumbar spinal stiffness change following spinal manipulative therapy: a scoping review

INTRODUCTION

In individuals having low back pain, the application of spinal manipulative therapy (SMT) has been shown to reduce spinal stiffness in those who report improvements in post-SMT disability. The underlying mechanism for this rapid change in stiffness is not understood presently. As clinicians and patients may benefit from a better understanding of this mechanism in terms of optimizing care delivery, the objective of this scoping review of current literature was to identify if potential mechanisms that explain this clinical response have been previously described or could be elucidated from existing data.

METHODS

Three literature databases were systematically searched (MEDLINE, CINAHL, and PubMed). Our search terms included subject headings and keywords relevant to SMT, spinal stiffness, lumbar spine, and mechanism. Inclusion criteria for candidate studies were publication in English, quantification of lumbar spinal stiffness before and after SMT, and publication between January 2000 and June 2019.

RESULTS

The search identified 1931 articles. Of these studies, 10 were included following the application of the inclusion criteria. From these articles, 7 themes were identified with respect to potential mechanisms described or derived from data: 1) change in muscle activity; 2) increase in mobility; 3) decrease in pain; 4) increase in pressure pain threshold; 5) change in spinal tissue behavior; 6) change in the central nervous system or reflex pathways; and 7) correction of a vertebral dysfunction.

CONCLUSIONS

This scoping review identified 7 themes put forward by authors to explain changes in spinal stiffness following SMT. Unfortunately, none of the studies provided data which would support the promotion of one theme over another. As a result, this review suggests a need to develop a theoretical framework to explain rapid biomechanical changes following SMT to guide and prioritize future investigations in this important clinical area.

NTG-101: A Novel Molecular Therapy that Halts the Progression of Degenerative Disc Disease

The tremendous cost, pain and disability associated with degenerative disc disease (DDD) makes the development of a biological agent that can mitigate the course of DDD, a critical unmet need. We have identified and reported that a single injection of a combination of recombinant human (rh) Transforming growth factor beta 1 (TGF-β1) and Connective tissue growth factor (CTGF) proteins into the injured intervertebral disc (IVD) nucleus pulposus (NP) can mediate DDD in a pre-clinical rodent model. In this study, we developed and evaluated the efficacy of a novel molecular therapy (NTG-101) containing rhTGF-β1 and rhCTGF proteins suspended in an excipient solution using in vivo models of DDD including rat-tail and chondrodystrophic (CD) canines. Needle puncture injury in CD-canine NPs resulted in loss of hydration, disc height and showed radiographic evidence of DDD like humans. However, NTG-101-injected IVDs maintained disc height and demonstrated retention of viscoelastic properties as compared to IVDs injected with phosphate buffer saline (PBS, 1X, pH = 7.2). In addition, a single intra-discal injection of NTG-101 into the injured IVD-NPs resulted in sustained expression of healthy extra-cellular matrix (ECM) proteins (aggrecan, collagen 2A1) and reduced expression of inflammation associated proteins and molecules (IL-1β, IL-6, IL-8, MMP-13, Cox-2 and PGE2) as compared to vehicle controls. In conclusion, we demonstrated that a single intra-discal injection of the novel formulation, NTG-101 confers a robust anti-inflammatory, anti-catabolic and pro-anabolic effects in pre-clinical models of DDD thereby restoring homeostasis. These findings suggest the therapeutic potential of NTG-101 for clinical use.

The identity, role, setting, and future of chiropractic practice: a survey of Australian and New Zealand chiropractic students

OBJECTIVE:

To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice.

METHODS:

An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests.

RESULTS:

A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student's chiropractic institution (Pillai's trace =.638, F[16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice.

CONCLUSIONS:

Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.

Non-invasive spinal vibration testing using ultrafast ultrasound imaging: A new way to measure spine function

Ultrafast ultrasound imaging is used to capture driven spinal vibrations as a new method for non-invasive spinal testing in living subjects. Previously, it has been shown that accelerometer-based vibration testing in cadaveric models can reveal the presence, location and magnitude of spinal pathology. However, this process remains an invasive procedure as current non-invasive sensors are inadequate. In this paper, the ability of non-invasive ultrafast ultrasound to quantify in vivo vertebral vibration response across a broad range of frequencies (10–100Hz) in anesthetized pig models is investigated. Close agreement with invasive accelerometer measurements is achieved using the non-invasive ultrasound method, opening up unique opportunities to investigate spinal pathologies.

Leadership and capacity building in international chiropractic research: introducing the chiropractic academy for research leadership (CARL)

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.

Research resource environment in Canada. Gathering knowledge in advance to inform chiropractic research priorities

OBJECTIVE

To better understand the research resources and environment within the Canadian chiropractic profession.

METHODS

All members of the Canadian Chiropractic Association (n=7200) were invited to access an electronic survey on research capacity, activity, and resources. Canadian chiropractic stakeholder organizations received an invitation to participate in a related survey.

RESULTS

505 CCA members completed the survey (7.0% completed response rate, 65% males, 19% with graduate degrees). Researchers (26 full-time and 67 part-time) produced over 530 authorships in the past five years. Clinical research and systematic reviews were the most common areas of involvement. Regular meetings were rarely reported between researchers and chiropractic stakeholder organizations. Stakeholders indicated using research for member education, negotiation with government or funders, direct inquiries, and increased credibility. Fewer than half of the organizations regularly evaluated their research needs.

CONCLUSIONS

Chiropractic research resources in Canada are growing, but inconsistent communication and coordination between researchers and knowledge users persists.

Treatment-based Classification System for Patients With Low Back Pain: The Movement Control Approach

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumbar spine requires both local mobility and global stability. Local mobility means that the lumbar spine and its adjacent regions possess adequate nerve and joint(s) mobility and soft tissue compliance (ie, the malleability of tissue to undergo elastic deformation). Global stability means that the muscles of the lumbar spine and its adjacent regions can generate activation that is coordinated with various joint movements and incorporated into activities of daily living. Local mobility and global stability are housed within the bio-behavioral and socio-occupational factors that should be addressed during movement rehabilitation. This schema is converted into a practical physical examination to help the rehabilitation provider to construct a clinical rationale as to why the movement impairment(s) exist. The examination findings are used to guide treatment. We suggest a treatment prioritization that aims to consecutively address neural sensitivity, joint(s) and soft tissue mobility, motor control, and endurance. This prioritization enables rehabilitation providers to better plan the intervention according to each patient's needs. We emphasize that treatment for patients with low back pain is not a static process. Rather, the treatment is a fluid process that changes as the clinical status of the patient changes. This movement control approach is based on clinical experience and indirect evidence; further research is needed to support its clinical utility.

Informing a research agenda for the Canadian chiropractic profession

Our research group recently published a Delphi study that identified Canadian chiropractic profession research priority areas. At the same time, the Canadian Chiropractic Research Foundation (CCRF) was developing their own research priority areas. In this commentary, we discuss the results of the Delphi study, compare and contrast these results to the research priorities of the CCRF, and report new data from a survey about where members of the chiropractic profession think that available research funding should be spent. Ongoing dialogue is needed with all Canadian chiropractic stakeholders to turn these research priorities into action.

The comfort and safety of a novel rolling mechanical indentation device for the measurement of lumbar trunk stiffness in young adults

BACKGROUND

The measurement of Posterior-Anterior (P-A) spinal stiffness is a common component of the physical examination of patients presenting with spinal disorders. The aim of this assessment is to provoke pain and/or to determine the degree of resistance or compliance of these structures and the associated soft-tissues to loading. This information, combined with other patient-specific history and examination findings, is integrated into the clinical reasoning process and is used to guide treatment decisions. Unfortunately, there are inter-rater reliability and standardisation issues associated with the manual performance of this type of assessment. In an attempt to remedy these issues researchers have developed mechanical devices for the measurement of spinal stiffness. The aim of this research is to investigate the comfort and safety of a novel device for measuring P-A trunk stiffness in a sample of young adults.

METHODS

A sample of young adults from a general population was recruited in May 2016 from Sydney, Australia. Demographic, anthropometric and clinical variables were collected prior to participants undergoing a lumbar P-A trunk stiffness assessment involving a mechanical indentation device called the VerteTrack. The primary outcomes for the study were key feasibility items; overall assessment time, perceived comfort measured both during and after the procedure, and adverse events. Univariate ordinal logistic regression was used to identify key variables associated with a participant's subjective report of comfort both during and after the VerteTrack assessment.

RESULTS

Eighty four participants (35% female) with a median age of 23 years (IQR = 3) took part in the research. The mean assessment time for the Vertetrack assessment was 11.6 min (SD = 2.1). Increasing load (p < 0.001) and increasing number of days with lower back pain (p = 0.009) were associated with decreased comfort ratings during the procedure. The vast majority 63/84 (75%) of participants rated the overall assessment experience as comfortable. There were two minor, short-lived adverse events recorded leading to an adverse event rate of 2.4% (2/84).

CONCLUSIONS

The results of this study suggest that the VerteTrack device is well-tolerated and can be used safely and efficiently when measuring P-A stiffness of the lumbar trunk in young adults.

TRIAL REGISTRATION

Not applicable.

12th International Conference on Conservative Management of Spinal Deformities – SOSORT 2015 Annual Meeting

O1 The functional properties of paraspinal muscles in adolescents with idiopathic scoliosis (AIS): A systematic review of the literature

Eric Parent, Alan Richter

O2 The importance of the lateral profile in the treatment of idiopathic scoliosis

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Paolo Pizzetti, Andrea Poscia, Lorenzo Aulisa

O3 Radiological outcome in Adolescent idiopathic scoliosis patients 20 years after treatment

Ane Simony, Steen Bach Christensen, Mikkel O Andersen

O4 Junctional Kyphosis, how can we detect and monitor it during growth?

Alessandra Negrini, Sabrina Donzelli, Laura Maserati, Fabio Zaina, Jorge H Villafane, Stefano Negrini

O5 Usefulness of the clinical measure of trunk imbalance in adolescent idiopathic scoliosis

Carole Fortin, Erin Grunstein, Hubert Labelle, Stefan Parent, Debbie Ehrmann Feldman

O6 Can ultrasound imaging be used to determine curve flexibility when designing spinal orthoses?

Edmond Lou, Rui Zheng, Doug Hill, Andreas Donauer, Melissa Tilburn, Jim Raso

O7 Reliability of the Schroth curve type classification in adolescents with idiopathic scoliosis (AIS)

Sanja Schreiber, Eric Parent, Greg Kawchuk, Douglas Hedden

O8 Can Trunk Appearance Perception Scale (TAPS) be used as a descriptive tool of scoliosis severity?

Judith Sánchez-Raya, Antonia Matamalas Adrover, Elisabetta D’Agata, Joan Bagó Granell

O9 Magnitude of the Cobb angle on an X-ray in relation to the angle of trunk rotation in children who come to the “Troniny” Scoliosis Treatment Centre

Marek Kluszczynski, Anna Kluszczyńska, Jacek Wąsik, Marta Motow-Czyż, Adam Kluszczyński

O10 Cobb angel measurement without X-ray, a novel method

Ane Simony, Karen Hojmark Hansen; Hanne Thomsen; Mikkel Meyer Andersen; Morten Vuust

O11 The postural tone magnitude and distribution in patients diagnosed with an adolescent idiopathic scoliosis: a preliminary study

Irmina Blicharska, Jacek Durmała, Bartosz Wnuk, Małgorzata Matyja

O12 From studies on the function of the respiratory system in children with body posture defects

Andrzej Szopa, Małgorzata Domagalska-Szopa, Weronika Gallert-Kopyto, Tomasz Łosień, Ryszard Plintla

O13 Scoliosis as the “first” sign of various diseases

Franz Landauer, Karl Vanas

O14 The effectiveness of core stabilization exercises versus conventional exercises in addition to brace wearing in patients with adolescent idiopathic acoliosis

Gozde Gur, Necdet Sukru Altun, Yavuz Yakut

O15 The effect of physiotherapy techniques on the body balance in patients with scoliosis treated with corrective appliances

Piotr Gawda, Piotr Majcher

O16 New combine method treating AIS – preliminary results

Lior Neuhaus Sulam

O17 Does a 4-week intensive course of ScolioGold therapy reduce angle of trunk rotation in scoliotic patients: a retrospective case series.

Michael Bradley, David Glynn, Alex Hughes, Erika Maude, Christine Pilcher

O18 Schroth physiotherapy method without bracing is an effective treatment for scoliosis in improving curves and avoiding surgery and should be offered as a treatment option for scoliosis in Canada: case series

Andrea Lebel, Victoria Ashley Lebel, Judit Orbán

O19 Rotation of the trunk and pelvis and coupled movements in the sagittal plane in double support stance in adolescent girls with idiopathic scoliosis

Agnieszka Stępień, Krzysztof Graff

O20 Curve progression analysis in Risser 0 patients orthotically managed with compliance monitors

D. Speers

O21 Conservative treatment in Scheuermann’s kyphosis: comparison between lateral curve and variation of the vertebral geometry

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Giuseppe Mastantuoni, Andrea Poscia, Lorenzo Aulisa

O22 The plaster cast in the conservative treatment of idiopathic scoliosis can still play a positive role?

Angelo Gabriele Aulisa, Vincenzo Guzzanti, Francesco Falciglia, Andrea Poscia, Lorenzo Aulisa

O23 Bracing for Adolescent Idiopathic Scoliosis (AIS) and Scheuermann Kyphosis : The issue of overtreatment in Greece

Nikos Karavidas

O24 Efficacy of Milwaukee brace for correction of scheurmann kyphosis

Mohammadreza Etemadifar

O25 The three dimensional analysis of the Sforzesco brace correction

Sabrina Donzelli, Fabio Zaina, Monia Lusini, Salvatore Minnella, Luca Balzarini, Stefano Respizzi, Stefano Negrini

O26 Quality of Life in adolescents with idiopathic scoliosis: A comparison measured by the Kidscreen 27 between scoliotic patients and healthy controls

Kathrin Güttinger

O27 The degree of illness acceptance in young women with idiopathic scoliosis treated with orthopedic braces: a preliminary study

Jacek Durmała, Irmina Blicharska, Agnieszka Drosdzol–Cop, Violetta Skrzypulec–Plinta

O28 Which are the personality traits of the patients with Adolescent Idiopathic Scoliosis?

Elisabetta D’Agata, Judith Sánchez-Raya

O29 How many Scolioses do exist in the same person? A zoom vision on the perception of the patient

Judith Sánchez-Raya, Elisabetta D’Agata

P1 The algorithm for the automatic detection of the pelvic obliquity based on analysis of the PA viev of the x-ray image

Sławomir Paśko, Wojciech Glinkowski

P2 Monitoring of spine curvatures and posture during pregnancy using surface topography – case study and method assessment

Jakub Michoński, Katarzyna Walesiak, Anna Pakuła, Robert Sitnik, Wojciech Glinkowski

P3 Spinal rotation under static and dynamic conditions: a prospective study comparing normative data vs. scoliosis

Helmut Diers

P4 The principle of non-surgical treatment of idiopathic scoliosis right-sided breast depending on the volatility of the formation of the intervertebral discs and vertebral bodies

Piotr Majcher, Piotr Gawda

P5 Unexpected late progression of adolescent idiopathic scoliosis treated with short-term, aggressive, full-time bracing and Schroth physiotherapy with excellent preliminary result: case study

Andrea Lebel, Victoria Ashley Lebel

P6 Visible posture in relation to the neuroanatomical and neurodynamical features in spinal deformations

Piet van Loon, Ruud van Erve, Andre Grotenhuis

P7 Immediate effects of scoliosis-specific corrective exercises on the Cobb angle after 1 week and after 1 year of practice

Karina Zapata, Eric Parent, Dan Sucato

P8 Retrospective analysis of idiopathic scoliosis medical records coming from one out-patient clinic for compatibility with Scoliosis Research Society criteria of brace treatment studies

Krzysztof Korbel, Mateusz Kozinoga, Łukasz Stoliński, Tomasz Kotwicki

P9 Adult female with severe progressive scoliosis possibly secondary to benign tumor removal at age 3 treated with scoliosis specific Schroth physiotherapy after refusing surgery: case study

Andrea Lebel, Victoria Ashley Lebel

P10 New aspects of scoliosis therapy planning and monitoring

Helmut Diers

P11 Outcome of intensive outpatient rehabilitation in an adult patient with M. Scheuermann evaluated by radiologic imaging – a case report

Hagit Berdishevsky

P12 The effectiveness of a Scoliosis Specific Home Exercise Program and bracing to reduce an idiopathic scoliosis curve with more than 90 % success in less than a year of exercises. Case report.

Hagit Berdishevsky

The biological basis of degenerative disc disease: proteomic and biomechanical analysis of the canine intervertebral disc

INTRODUCTION

In the present study, we sought to quantify and contrast the secretome and biomechanical properties of the non-chondrodystrophic (NCD) and chondrodystrophic (CD) canine intervertebral disc (IVD) nucleus pulposus (NP).

METHODS

We used iTRAQ proteomic methods to quantify the secretome of both CD and NCD NP. Differential levels of proteins detected were further verified using immunohistochemistry, Western blotting, and proteoglycan extraction in order to evaluate the integrity of the small leucine-rich proteoglycans (SLRPs) decorin and biglycan. Additionally, we used robotic biomechanical testing to evaluate the biomechanical properties of spinal motion segments from both CD and NCD canines.

RESULTS

We detected differential levels of decorin, biglycan, and fibronectin, as well as of other important extracellular matrix (ECM)-related proteins, such as fibromodulin and HAPLN1 in the IVD NP obtained from CD canines compared with NCD canines. The core proteins of the vital SLRPs decorin and biglycan were fragmented in CD NP but were intact in the NP of the NCD animals. CD and NCD vertebral motion segments demonstrated significant differences, with the CD segments having less stiffness and a more varied range of motion.

CONCLUSIONS

The CD NP recapitulates key elements of human degenerative disc disease. Our data suggest that at least some of the compromised biomechanical properties of the degenerative disc arise from fibrocartilaginous metaplasia of the NP secondary to fragmentation of SLRP core proteins and associated degenerative changes affecting the ECM. This study demonstrates that the degenerative changes that naturally occur within the CD NP make this animal a valuable animal model with which to study IVD degeneration and potential biological therapeutics.

The quality of reports on cervical arterial dissection following cervical spinal manipulation

BACKGROUND

Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

PURPOSE

1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports.

METHODS

A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

RESULTS

Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

CONCLUSIONS

This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Within- and between-day reliability of spinal stiffness measurements obtained using a computer controlled mechanical indenter in individuals with and without low back pain

Instrumented spinal stiffness measurements have shown high test-retest reliability. However, factors that may affect reliability have yet to be investigated. The objective of this study was to compare the: 1) within- and between-day reliability of a mechanical indentation device (MID) in measuring spinal stiffness, 2) measurement precision of averaging multiple measurements, and 3) reliability of stiffness measurements between individuals with and without low back pain (LBP). The spinal stiffness of 26 volunteers with and without LBP was measured 3 times by MID in each of two visits 1-4 days apart. Two stiffness measures were calculated from the resulting force-displacement data: global stiffness and terminal stiffness. Intraclass correlation coefficients (ICCs) were used to estimate reliability. Measurement precision was measured by minimal detectable changes, bias and 95% limits of agreement. Using the mean of three spinal stiffness measurements, the measurement precision was improved by 33.7% over a single measurement. Averaging three measurements, the within- and between-day reliability point estimates of both global and terminal stiffness were 0.99 and 0.98, respectively. The reliability estimates of spinal stiffness measurement using MID were not significantly altered by the participants' LBP status across all circumstances (95% confidence intervals overlapped). With our experimental protocol, averaging three spinal stiffness measurements using MID produces reliable stiffness measurements regardless of individuals' LBP status.

Evidence-informed management of chronic low back pain with spinal manipulation and mobilization

The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.

A new method of creating intervertebral disc disruption of various grades

BACKGROUND

The purpose of this study was to develop a model of intervertebral disc disruption capable of (1) internal disruption without excessive disruption to the disc surface, (2) user-defined disruption magnitude and location and (3) interrogation by magnetic resonance imaging. Present models of disc disruption may have some, but not all, of these features.

METHODS

Intravenous tubes were inserted into the intervertebral discs of a cadaveric porcine lumbar spine. Tube placement in the inner annulus was confirmed by magnetic resonance imaging. Each disc was then injected through the intravenous tube with nitrogen gas at pressures of 69 kPa, 172 kPa, 345 kPa and 690 kPa. Before and after injection, edge detection analysis of magnetic resonance imaging images was used to quantify tissue disruption. These values were then multiplied by the thickness of the slices and summed to determine disruption volume for individual discs. Four additional discs were injected with the addition of ink, sectioned and then inspected visually.

RESULTS

As the injection pressure increased, the gas volume within the annulus increased significantly as did visualized annular disruption. No significant difference in gas volume was observed between different discs injected with equal pressure.

INTERPRETATION

As confirmed by magnetic resonance imaging and dissection, gas volume and tissue disruption within the annulus fibrosus were proportional to the pressure of injected nitrogen. This model of disc disruption promises to provide several advantages in the investigation of disc pathology including (1) user-controlled magnitude of inner annulus disruption, (2) user-controlled tissue disruption localization, (3) minimal disruption of the exterior annulus, (4) independence between the magnitude of external and internal disruption and (5) the ability to visualize resulting disruptions with magnetic resonance imaging.

Human lumbar facet joint capsule strains: I. During physiological motions

BACKGROUND CONTEXT

The lumbar facet joint capsule is innervated with nociceptors and mechanoreceptors, and is thought to play a role in low back pain as well as to function proprioceptively.

PURPOSE

In order to examine the facet capsule's potential proprioceptive role, relationships between intracapsular strain and relative spine position were examined.

STUDY DESIGN/SETTING

Lumbar facet joint capsule strains were measured in human cadaveric specimens during displacement-controlled motions.

METHODS

Ligamentous lumbar spine specimens (n=7) were potted and actuated without inducing a moment at the point of application. Spines were tested during physiological motions of extension, flexion, left and right lateral bending. Intervertebral angulations (IVA) were measured using biaxial inclinometers mounted on adjacent vertebrae. Joint moments were determined from the applied load at T12 and the respective moment arms. Capsule plane strains were measured by optically tracking the displacements of infrared reflective markers glued to capsule surfaces. Statistical differences (p<.05) in moment, IVA and strain were assessed across facet joint levels using analysis of variance and comparison of linear regressions.

RESULTS

The developed moments and IVAs increased monotonically with increasing displacements; the relationships were highly correlated for all four motion types. Although highly variable among specimens, principal strains also increased monotonically in magnitude with increasing displacements during extension and flexion, but were more complex during lateral bending. At a given joint level, the absolute magnitudes of principal strains and IVA were largest during the same motion type.

CONCLUSIONS

Distinct patterns in principal strains and IVA were identified during physiological motions, lending biomechanical support to the theory that lumbar facet joint capsules could function proprioceptively.

Measurements of vertebral translations using bone pins, surface markers and accelerometers

OBJECTIVE: To compare invasive and non-invasive techniques for measuring the posterior-to-anterior translations of vertebrae during spinal manipulative therapy. DESIGN: This study represents a small part of a larger experiment. BACKGROUND: Despite the mechanical nature of spinal manipulative therapy, the mechanism by which it alleviates back pain is still unknown. An understanding of the deformation behaviour of the spine during spinal manipulative therapy would aid in the formulation of a hypothesis underlying its efficacy. METHODS: A clinician delivered posterior-to-anterior manipulative thrusts to the right transverse process of either T(10), T(11) or T(12) in two cadavers. Posterior-to-anterior translations of the bone pins and surface markers (embedded in and taped over T(10), T(11) and T(12), respectively) were recorded by cine cameras. Posterior-to-anterior accelerations, recorded by the accelerometers, were used to calculate posterior-to-anterior translations. Translation measurements made by using the surface markers and the accelerometers were compared to those made by using the bone pins. RESULTS: There were no significant differences between the posterior-to-anterior translations of vertebrae obtained from the surface markers, as compared to the bone pins. The accelerometers underestimated the absolute, and overestimated the relative, vertebral translations, respectively, compared to the bone pins. CONCLUSIONS: The translations measured by the surface markers were more similar to the translations derived from the bone pins than those calculated from the accelerometers. Three-dimensional surface marker arrays would therefore be more useful to determine all relative movements non-invasively.

Movements of vertebrae during manipulative thrusts to unembalmed human cadavers

OBJECTIVE

The purpose of this study was to measure the relative movements of vertebrae during manipulative thrusts to unembalmed post-rigor mortis human cadavers.

SETTING

The investigation was conducted in the gross anatomy laboratory at the University of Calgary.

SUBJECTS

Two 77-yr-old, unembalmed, post-rigor mortis, male cadavers were used.

INTERVENTIONS

The movements of vertebrae were investigated by using high-speed cinematography to record the movements of bone pins threaded into T10, T11 and T12 during spinal manipulative therapy to unembalmed post-rigor human cadavers. A single clinician delivered a series of posterior-to-anterior (p-to-a) thrusts to the right transverse process of either T10, T11 or T12, using a reinforced hypothenar contact. Relative p-to-a and lateral translations, as well as axial and sagittal rotations, in T10-T11 and T11-T12 were calculated. Corresponding p-to-a forces exerted by the clinician onto the cadaver were recorded using a pressure pad.

MAIN RESULTS

Significant relative movements were measured primarily between the targeted and immediately adjacent vertebrae during the thrusts. Vertebral pairs remained slightly 'hyper-extended' after the rapid thrusts to T11, when the p-to-a forces returned to preload levels.

CONCLUSIONS

These findings may be useful for the understanding of the deformation behavior of the vertebral column during therapeutic manipulation. A fully three-dimensional analysis of all six degrees of freedom, using a larger number of unembalmed cadavers, would be useful in clarifying the relationship between the externally applied forces and the observed relative movement patterns of the vertebrae.

A new technique of tissue stiffness (compliance) assessment: its reliability, accuracy and comparison with an existing method

OBJECTIVE

To assess the reliability and accuracy of a new method of tissue stiffness (TS) assessment, automated stiffness assessment (ASA), and compare these findings with previously published results of manual stiffness assessment (MSA).

DESIGN

Descriptive study.

SETTING

Human Performance Laboratory, University of Calgary.

INTERVENTION

ASA was used to collect stiffness measurements from three foam surfaces of different stiffness characteristics and two control surfaces. Control surface one (CS1) was rigid and could not be displaced; control surface two (CS2) was rigid but could be displaced. The three foam surfaces and CS1 had been previously tested using MSA.

MAIN OUTCOME MEASURE

Reliability and accuracy were assessed for each separate electronic component by root mean square analysis (RMS) and linear regression/calibration curves, respectively. The reliability of ASA (all electronic components working in concert) was determined by computing intraclass correlation coefficients (ICC); the accuracy of ASA was assessed by studying relative deformations of the control surfaces.

RESULTS

Each electronic component used in ASA was found to have a calculated RMS of less than 0.03% of the mean, whereas the R2-value for any of these separate components was never lower than 0.99. For ASA, the median ICC for all surfaces tested was 0.99. The mean relative deformation collected from CS1 was 0.34 +/- mm at 44.0 N of input force whereas the mean relative deformation collected from CS2 was 0.008 +/- 0.013 mm. The median ICC for MSA found in a previous investigation was 0.005 and the mean displacement recorded from the control surface with MSA was 1.28 +/- 0.57 mm at 49.10 N.

CONCLUSION

ASA seems to be extremely reliable and accurate. When ASA and MSA were used to assess identical test surfaces, the results of MSA were poor when compared with those obtained by ASA; we therefore suggest that conclusions reached in prior research employing MSA should be considered with caution. It is our recommendation that remotely controlled, electronic signal gathering procedures such as ASA be the method of choice when assessing TS.