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Hunnisett, Adrian G. W., and Christina Cunliffe. "A comparison of the academic outcome of chiropractic students on full-time and full-time equivalent chiropractic education routes." Journal of Chiropractic Education 34, no. 2 (August 8, 2019): 140–46. http://dx.doi.org/10.7899/jce-18-4.
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Objective To compare the academic equivalence of full-time (FT) and full-time equivalent (FTE) delivery routes for chiropractic training and to assess nontraditional education delivery as a viable method for training chiropractors. Methods A retrospective analysis of student summative assessment data was undertaken on a total of 196 FT and FTE students studying for the master's in chiropractic degree at a UK chiropractic college between 2009 and graduating by 2017. The analysis consisted of within-group comparison and between-group comparisons using the Kruskal-Wallis test and the Mann-Whitney U test. Results The demographics of the 2 student groups varied in terms of gender and age distribution. The analysis of summative data indicated no differences between the 2 routes of delivery. There was also no difference in the distribution of final degree classification outcome between the 2 routes. Conclusions While it is possible that demographic differences influence the outcomes in each training route, this preliminary study indicates that, based only on analysis of overall achievement, there is no difference in either FT or FTE programs in training chiropractors, allowing them to register with the UK regulatory body. It suggests that a nontraditional mode of delivery is an achievable route to qualification as a chiropractor, enabling a greater number of students to consider chiropractic as a career choice while managing other life commitments.
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Rogers, Casey, Madeleine Hackney, Lisa Zubkoff, and Katharina Echt. "ACTIVITY GOAL SETTING ON CHRONIC LOWER BACK PAIN FOR OLDER VETERANS RECEIVING CHIROPRACTIC CARE." Innovation in Aging 6, Supplement_1 (November 1, 2022): 797–98. http://dx.doi.org/10.1093/geroni/igac059.2878.
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Abstract There is currently no literature addressing the impact that chiropractic services have on older adults achieving individualized specific goals throughout a course of care for chronic low back pain. This study aims to explore the impact of setting a self-determined, “what matters most” activity/goal of rehabilitation care with relevant activities as part of standard chiropractic care on the self-rated pain and disability of older Veterans. Participants were randomized into two groups. The first, an experimental group where participants identified a goal and received standard chiropractic care. The second, a control group that received standard chiropractic care only. Participants underwent six sessions of care. Outcome assessment tools were utilized at pre- and post-treatment for both groups as primary measures and an individualized goal setting measurement tool was utilized for those randomized to the experimental group. After treatment, all participants had self-reported improvement in their condition and all participants assigned to a “goal setting group” achieved their desired goal. Despite some outcome measures remaining unchanged, this self-reported improvement may be important in the future of chiropractic services for the older Veteran population suffering with chronic low back pain in achieving self-determined goals of importance.
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Derby, Dustin C., Robert E. Percuoco, and Amy Everetts. "Scarlet letters: The association of alternative admissions track plan status with key programmatic outcomes in a chiropractic training program." Journal of Chiropractic Education 34, no. 1 (March 1, 2020): 8–14. http://dx.doi.org/10.7899/jce-19-6.
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Objective: In 2012, the Council on Chiropractic Education (CCE) enacted new admission standards with related provisions under a new Policy 7, the Alternative Admissions Track Plan (AATP). The current study examined the relationships between typically admitted students and their AATP counterparts on three student success outcome measures: Graduation at the 150th percentile time frame, National Board of Chiropractic Examiners (NBCE) Part I pass rates, and completion of all four NBCE examinations within 6-months after graduation. Methods: The authors used three random samples (n = 1050) drawn from a relational database, containing program outcome variables and student characteristics. Assessment of the outcome measures occurred using Pearson χ2 test of independence and the Φ coefficient effect size measure. Results: Significant relationships with small effect sizes and weak associations were found between AATP status and graduation at the 150th percentile (p < .01, Φ = .118) and NBCE Part I pass rates (p < .01, Φ = .114). No significant association between AATP status and NBCE Completion rates 6-months after graduation (p = .144, Φ = .045) was found. Conclusion: The weak associations between variables indicate that AATP status did not meaningfully relate to the outcome variables. There likely are other subtle characteristics and attributes that influence successful completion of key programmatic outcomes. The weak associations found in the current study suggest that when governed under the same academic policies with equal access to support resources, there does not appear to be a meaningful association between the programmatic success of AATP and non-AATP students on key outcomes.
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Lady, Suzanne D., and Leslie A. K. Takaki. "Development of a clinical skills remediation program for chiropractic students at a university." Journal of Chiropractic Education 32, no. 2 (July 25, 2018): 152–58. http://dx.doi.org/10.7899/jce-17-23.
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Objective: An important goal of chiropractic educational institutions is to ensure that all graduates reach an acceptable level of clinical competency and thus institutions are equipped to offer traceable remediation when skills fall below certain benchmarks. Methods: Working with key individuals in the faculty, administration, and assessment department, a process of remediation was created and materials were produced that could be used by faculty and assessment staff to focus on a student's lack of knowledge, technique, or documentation in specific clinical skill areas. The primary goal was to create an individualized remediation plan that suits the specific needs of the student. Results: Utilization of the remediation center continues to increase. Referrals to the center for fiscal years 2015, 2016, and 2017 were 60, 125, and 126 students, respectively. Retesting rates after remediation continue to be high, with 98.3%, 95.2%, and 95.8% for fiscal years 2015, 2016, and 2017, respectively. Conclusion: We developed and implemented a chiropractic remediation program to satisfy the need for objectively identifying and remediating clinical skill deficiencies. This remediation program experienced an increase in use in its initial 3 years of operation, indicating more inclusion of the program across the departments, clinics, and assessment. The outcome of remediation is still not clear because there are no consistent assessment measures in place to determine pre- and postremediation student performance.
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Hecimovich, Mark D., Jo-Anne Maire, and Barrett Losco. "Effect of Clinician Feedback Versus Video Self-Assessment in 5th-Year Chiropractic Students on an End-of-Year Communication Skills Examination." Journal of Chiropractic Education 24, no. 2 (October 1, 2010): 165–74. http://dx.doi.org/10.7899/1042-5055-24.2.165.
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Purpose: To compare the effect of two learning opportunities, clinician feedback and video self-assessment, on 5th-year chiropractic students' patient communication skills, specifically those required for history taking. Methods: A cohort of 51 final-year students was divided into two groups. The first group received immediate feedback from a clinical supervisor following a history-taking encounter with a patient. The second group performed self-assessments of their videotaped history-taking encounter. An end-of-year Viva Voce examination was used to measure the effectiveness of the students' history-taking skills, using two subscores, one for behavior and another for content, as well as an overall total score. An unpaired t-test was performed to determine whether any significant difference occurred between the two groups of students. Each group was then subdivided into two subgroups based on gender, and a two-way analysis of variance was performed to determine whether the type of feedback or the students' gender had any significant effect on the outcome of the Viva Voce. Results: There were no significant differences between the two groups of students in terms of their final scores in the Viva Voce. After dividing each group into their gender subgroups and further analysis of the results, neither the mode of feedback nor the students' gender had any significant effect on the outcome of the Viva Voce. Conclusion: This study suggests that, for a mixed cohort, video self-assessment and clinician feedback are equivalent in their ability to enhance students' communication skills relating to history taking.
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Amorin-Woods, Lyndon Gene, Gregory F. Parkin-Smith, Vincenzo Cascioli, and Dianne Kennedy. "Manual care of residents with spinal pain within a therapeutic community." Therapeutic Communities: The International Journal of Therapeutic Communities 37, no. 3 (September 12, 2016): 159–68. http://dx.doi.org/10.1108/tc-06-2015-0019.
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Purpose The purpose of this paper is to examine the outcomes of chiropractic manipulative and manual therapy (MMT) provided to residents experiencing spinal pain in a substance misuse therapeutic community (TC). Design/methodology/approach Clinical audit to explore the potential benefits of the interventions offered to residents experiencing spinal pain in a TC. Residents seeking care underwent an assessment by either general practitioner or chiropractic intern. Eligible participants could choose one of the four interventions: usual care without any additional treatment (Group 1), usual care with simple analgesics (Group 2), usual care plus MMT without simple analgesics (Group 3), or usual care plus MMT with simple analgesics (Group 4). Outcome measures were the RAND-36-item short form health-related quality-of-life survey and the patient satisfaction questionnaire (PSQ). Data were collected at baseline and after six weeks for each participant, with those participants choosing MMT receiving up to six treatments over the study period. Two cycles of six weeks of data collection was used. Data were analysed for statistically significant (repeated measures ANOVA with Bonferroni correction) and clinically meaningful changes in scores. Findings Of 71 self-presenting residents seeking care, 68 were eligible to participate. Of these, 32 chose usual care with simple analgesics (Group 2) and 36 chose usual care plus the package of MMT but without simple analgesics (Group 3). None chose usual care without additional treatment or usual care plus the package of MMT with analgesics, thus offering only the data from two groups for analysis. Group allocation was non-random and based on patient choice. Between-group analysis of the cumulative and component RAND-36 data indicated a significant difference between the two groups (p=0.034), particularly in the physical outcomes (p=0.012), indicating that Group 3 had improved scores over Group 2. Group 3 showed a significant change in RAND-36 scores (p<0.01) when compared with Group 2 (p=0.23) over the six-week treatment period. The PSQ scores of the two groups showed a statistically significant difference (p=0.0093), suggesting that Group 3 had greater patient satisfaction with care. The outcomes suggest that the package of MMT in Group 3, delivered by an appropriately trained clinician may have added to therapeutic effect that extended beyond physical outcomes but also influenced psychological outcomes. Research limitations/implications The results of this clinical outcome-based audit suggest that the addition of a package of chiropractic MMT to usual care may be of benefit over usual care with simple analgesics for residents of a TC with spinal pain. The results intimate that benefits may extend across both the physical and psychological components of the pain experience, although a confirmatory study is recommended to substantiate these insights. Originality/value As far as the authors are aware, this trial is the first of this type in a TC, with the insights and experience gained supporting a definitive trial.
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Ailliet, Luc, Sidney M. Rubinstein, Trynke Hoekstra, Maurits W. van Tulder, and Henrica C. W. de Vet. "Adding Psychosocial Factors Does Not Improve Predictive Models for People With Spinal Pain Enough to Warrant Extensive Screening for Them at Baseline." Physical Therapy 96, no. 8 (August 1, 2016): 1179–89. http://dx.doi.org/10.2522/ptj.20150304.
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Abstract Background Chiropractors throughout the world by and large focus on patients with musculoskeletal complaints who are generally in good health. Currently, it is widely accepted that neck pain and low back pain are best understood as biopsychosocial phenomena. Objective The purpose of this study was to determine whether certain psychosocial factors provide added value for predicting recovery. Design This was a prospective, multicenter, chiropractic, practice-based cohort study in Belgium and the Netherlands. Methods A total of 917 participants, 326 with neck pain and 591 with low back pain, completed self-administered questionnaires at baseline and at 3, 6, and 12 months. They provided information on several demographic, biomedical, and psychosocial variables. Lasting perceived recovery was used as the outcome measure, that is, recovery at all follow-up assessments from 3 months on. Twenty-seven potential predictors of outcome were used to build the predictive model. Stepwise, backward generalized estimating equation regression models were used to take into account the clustering of participants within practices. For assessment of the added value of psychosocial variables, 2 model fit indexes were compared. Results After the addition of psychosocial variables, predictors in the final model for neck pain included occupational status, body mass index, duration of complaints, previous treatment, and participant expectations (the model fit was marginally improved from 0.684 to 0.695 for the area under the curve and from 65.0% to 66.1% for the percentage correctly predicted). In the final model for low back pain, the selected predictors included country of treatment, age, duration of complaints, previous imaging, and somatization (the area under the curve changed from 0.669 to 0.715, and the percentage correctly predicted changed from 68.6% to 69.5%). Only a minority of participants had high scores on psychological variables. Limitations The reliability and validity of lasting recovery as an outcome measure have not been tested. The cohort needs to be seen as a convenience sample. Selection bias, therefore, not be ruled out. There are no indications, however, that patients with complex psychosocial profiles were excluded from this study. Conclusions Psychosocial variables provided little added value for predicting outcome in people who had neck pain or low back pain and sought chiropractic care. Therefore, chiropractors should not screen extensively for them at baseline. With regard to the identification of the small subgroup of people with high scores on psychosocial variables and a high risk for chronic pain, further investigation is needed.
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Trager, Robert James, Clinton J. Daniels, Kevin W. Meyer, Amber C. Stout, and Jeffery A. Dusek. "Clinical decision-making for spinal manipulation for persistent spinal pain following lumbar surgery: a protocol for a systematic review and meta-analysis of individual participant data." BMJ Open 11, no. 12 (December 2021): e054070. http://dx.doi.org/10.1136/bmjopen-2021-054070.
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IntroductionThere are limited available research and guidance regarding the use of spinal manipulative therapy (SMT) in patients with low back-related symptoms following lumbar spine surgery, a condition called persistent spinal pain syndrome type 2 (PSPS-2). This publication outlines a review protocol to identify and synthesise individual participant data (IPD) to examine associations between patient, clinical and surgical variables and SMT application in adults with PSPS-2.Methods and analysisPubMed, OVID, Web of Science, Scopus, PEDro, Index to Chiropractic Literature and KoreaMed will be searched from inception to 1 January 2022 without language restrictions. Case reports, series, observational studies and cases from grey literature of adults receiving SMT for PSPS-2 will be included. Two investigators will independently screen citations, abstracts and full-text articles. A risk-of-bias assessment will be performed in duplicate to rate cases according to exposure and outcome ascertainment and data completeness. Data extraction will be performed in duplicate and missing IPD will be requested from corresponding authors. Multiple binary logistic regression will be used to identify independent predictors of the use of lumbar–SMT, lumbar–manual-thrust SMT and SMT within 1-year postsurgery. Patient, clinical and surgical variables will be summarised using descriptive statistics, while SMT-related outcomes (lumbar–SMT, lumbar–manual-thrust SMT and 1-year surgery-to-SMT interval) will be described using adjusted ORs with 95% CIs.Ethics and disseminationThis study was deemed not human subjects research by the University Hospitals’ institutional review board. The results of this review will be disseminated at conferences and/or published in a peer-reviewed journal.PROSPERO registration numberCRD42021250039.
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Holt, Kelly, Imran Khan Niazi, Imran Amjad, Nitika Kumari, Usman Rashid, Jens Duehr, Muhammad Samran Navid, Muhammad Shafique, and Heidi Haavik. "The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial." Brain Sciences 11, no. 6 (May 21, 2021): 676. http://dx.doi.org/10.3390/brainsci11060676.
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Chiropractic spinal adjustments have been shown to result in short-term increases in muscle strength in chronic stroke patients, however, the effect of longer-term chiropractic spinal adjustments on people with chronic stroke is unknown. This exploratory study assessed whether 4 weeks of chiropractic spinal adjustments, combined with physical therapy (chiro + PT), had a greater impact than sham chiropractic with physical therapy (sham + PT) did on motor function (Fugl Meyer Assessment, FMA) in 63 subacute or chronic stroke patients. Secondary outcomes included health-related quality of life and other measures of functional mobility and disability. Outcomes were assessed at baseline, 4 weeks (post-intervention), and 8 weeks (follow-up). Data were analyzed using linear mixed-effects models or generalized linear mixed models. A post-hoc responder analysis was performed to investigate the clinical significance of findings. At 4 weeks, there was a larger effect of chiro + PT, compared with sham + PT, on the FMA (difference = 6.1, p = 0.04). The responder analysis suggested the improvements in motor function seen following chiropractic spinal adjustments may have been clinically significant. There was also a robust improvement in both groups in most measures from baseline to the 4- and 8-week assessments, but between-group differences were no longer significant at the 8-week assessment. Four weeks of chiro + PT resulted in statistically significant improvements in motor function, compared with sham + PT, in people with subacute or chronic stroke. These improvements appear to be clinically important. Further trials, involving larger group sizes and longer follow-up and intervention periods, are required to corroborate these findings and further investigate the impacts of chiropractic spinal adjustments on motor function in post-stroke survivors. ClinicalTrials.gov Identifier NCT03849794.
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Price, Jonathan, Alison Rushton, Isaak Tyros, and Nicola R. Heneghan. "Effectiveness and optimal dosage of resistance training for chronic non-specific neck pain: a protocol for a systematic review with a qualitative synthesis and meta-analysis." BMJ Open 9, no. 2 (February 2019): e025158. http://dx.doi.org/10.1136/bmjopen-2018-025158.
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IntroductionThe prevalence of neck pain is increasing rapidly with a high percentage of patients going on to experience recurrent or chronic symptoms. The resulting pain and disability are commonly managed using a variety of treatments including exercise. Resistance training exercise aimed at the neck and shoulders is advocated to treat chronic non-specific neck pain (CNSNP), however the dosage of prescribed exercise varies considerably between studies. The aim of this study is to evaluate the effectiveness of resistance training in CNSNP and to determine an optimal dosage that should be prescribed in clinical practice.Methods and analysisA systematic review with qualitative synthesis and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PEDro, Zetoc, Index to Chiropractic Literature ChiroAcces, PubMed, grey literature sources and key journals will be searched. Randomised clinical trials investigating resistance training exercise in adults with CNSNP using outcome measures of pain and/or disability will be eligible for inclusion. Two reviewers will independently screen for eligibility, extract data and assess risk of bias (Cochrane risk of bias tool) with a third reviewer mediating in cases of disagreement. Data will be synthesised qualitatively to investigate intervention effectiveness and to determine the effect of exercise dosage on pain and disability. Meta-analysis using a random-effects model will be conducted where sufficient clinical homogeneity exists. The strength of the overall body of evidence will be assessed and reported using Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis study raises no ethical issues. Results will inform exercise prescription to improve management of CNSNP. Results will be published in a peer-reviewed journal and presented at conferences.PROSPERO registration numberCRD42018096187.
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Long, Cynthia R., Anthony J. Lisi, Robert D. Vining, Robert B. Wallace, Stacie A. Salsbury, Zacariah K. Shannon, Stephanie Halloran, et al. "Veteran Response to Dosage in Chiropractic Therapy (VERDICT): Study Protocol of a Pragmatic Randomized Trial for Chronic Low Back Pain." Pain Medicine 21, Supplement_2 (December 2020): S37—S44. http://dx.doi.org/10.1093/pm/pnaa289.
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Conflicts of interest: No potential conflicts exist for any author listed.Abstract Background Low back pain is a leading cause of disability in veterans. Chiropractic care is a well-integrated, nonpharmacological therapy in Veterans Affairs health care facilities, where doctors of chiropractic provide therapeutic interventions focused on the management of low back pain and other musculoskeletal conditions. However, important knowledge gaps remain regarding the effectiveness of chiropractic care in terms of the number and frequency of treatment visits needed for optimal outcomes in veterans with low back pain. Design This pragmatic, parallel-group randomized trial at four Veterans Affairs sites will include 766 veterans with chronic low back pain who are randomly allocated to a course of low-dose (one to five visits) or higher-dose (eight to 12 visits) chiropractic care for 10 weeks (Phase 1). After Phase 1, participants within each treatment arm will again be randomly allocated to receive either monthly chiropractic chronic pain management for 10 months or no scheduled chiropractic visits (Phase 2). Assessments will be collected electronically. The Roland Morris Disability Questionnaire will be the primary outcome for Phase 1 at week 10 and Phase 2 at week 52. Summary This trial will provide evidence to guide the chiropractic dose in an initial course of care and an extended-care approach for veterans with chronic low back pain. Accurate information on the effectiveness of different dosing regimens of chiropractic care can greatly assist health care facilities, including Veterans Affairs, in modeling the number of doctors of chiropractic that will best meet the needs of patients with chronic low back pain.
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Woodfield, H. Charles, D. Gordon Hasick, Werner J. Becker, Marianne S. Rose, and James N. Scott. "Effect of Atlas Vertebrae Realignment in Subjects with Migraine: An Observational Pilot Study." BioMed Research International 2015 (2015): 1–18. http://dx.doi.org/10.1155/2015/630472.
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Introduction. In a migraine case study, headache symptoms significantly decreased with an accompanying increase in intracranial compliance index following atlas vertebrae realignment. This observational pilot study followed eleven neurologist diagnosed migraine subjects to determine if the case findings were repeatable at baseline, week four, and week eight, following a National Upper Cervical Chiropractic Association intervention. Secondary outcomes consisted of migraine-specific quality of life measures.Methods. After examination by a neurologist, volunteers signed consent forms and completed baseline migraine-specific outcomes. Presence of atlas misalignment allowed study inclusion, permitting baseline MRI data collection. Chiropractic care continued for eight weeks. Postintervention reimaging occurred at week four and week eight concomitant with migraine-specific outcomes measurement.Results. Five of eleven subjects exhibited an increase in the primary outcome, intracranial compliance; however, mean overall change showed no statistical significance. End of study mean changes in migraine-specific outcome assessments, the secondary outcome, revealed clinically significant improvement in symptoms with a decrease in headache days.Discussion. The lack of robust increase in compliance may be understood by the logarithmic and dynamic nature of intracranial hemodynamic and hydrodynamic flow, allowing individual components comprising compliance to change while overall it did not. Study results suggest that the atlas realignment intervention may be associated with a reduction in migraine frequency and marked improvement in quality of life yielding significant reduction in headache-related disability as observed in this cohort. Future study with controls is necessary, however, to confirm these findings. Clinicaltrials.gov registration number isNCT01980927.
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Khorsan, Raheleh, Ian D. Coulter, Cheryl Hawk, and Christine Goertz Choate. "Measures in Chiropractic Research: Choosing Patient-Based Outcome Assessments." Journal of Manipulative and Physiological Therapeutics 31, no. 5 (June 2008): 355–75. http://dx.doi.org/10.1016/j.jmpt.2008.04.007.
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Mansholt, Barbara A., Stacie A. Salsbury, Lance G. Corber, and John S. Stites. "Essential literature for the chiropractic profession: Results and implementation challenges from a survey of international chiropractic faculty." Journal of Chiropractic Education 31, no. 2 (October 1, 2017): 140–63. http://dx.doi.org/10.7899/jce-17-4.
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Objective: Scientific literature applicable to chiropractic practice proliferates in quantity, quality, and source. Chiropractic is a worldwide profession and varies in scope between states or provinces and from country to country. It is logical to consider that the focus and emphasis of chiropractic education varies between programs as well. This original research study endeavored to determine “essential literature” recommended by chiropractic faculty. The purpose of this article is (1) to share our results and (2) to promote discussion and explore means for future collaboration of chiropractic faculty through a worldwide platform. Methods: A 2-phase recruitment occurred initially at the institutional level and subsequently at the faculty level. A Web-based survey used qualitative data collection methods to gather bibliographic citations. Descriptive statistics were calculated for demographics, and citation responses were ranked per number of recommendations, grouped into categories, and tabulated per journal source and publication date. Results: Forty-one chiropractic programs were contacted, resulting in 30 participating chiropractic programs (16 US and 14 international). Forty-five faculty members completed the entire survey, submitting 126 peer-reviewed publications and 25 additional citations. Readings emphasized clinical management of spine pain, the science of spinal manipulation, effectiveness of manual therapies, teaching of chiropractic techniques, outcomes assessments, and professional issues. Conclusion: A systematic approach to surveying educators in international chiropractic institutions was accomplished. The results of the survey provide a list of essential literature for the chiropractic profession. We recommend establishing a chiropractic faculty registry for improved communication and collaboration.
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Tunning, Michael J., Dustin C. Derby, Kelly A. Krell-Mares, and Michelle R. Barber. "Building a chiropractic academy of educators: A needs assessment of selected faculty educators." Journal of Chiropractic Education 31, no. 2 (October 1, 2017): 102–8. http://dx.doi.org/10.7899/jce-16-14.
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Objective: Professional demands have led to health-care educator specialization in research or patient care. The academy movement is an avenue that attempts to return prestige and importance to improved instruction. The authors performed a needs analysis of selected faculty at 3 chiropractic colleges to assess the need for, and willingness to participate in, an academy of educators program. Methods: An expert-developed, pretested survey was deployed using SurveyMonkey. Analysis of variance and regression analysis were used to address 3 research questions related to the academy of educators program. Results: The study achieved a 53% response rate and reflected that an overwhelming majority of chiropractic faulty members (89%) reported the need for an academy of educators. The study found no significant differences between faculty ranks, years of experience, and participation willingness. Conclusion: A structured approach, such as an academy, to foster professional teaching development may create positive outcomes for an institution. Faculty educators were willing to engage in an efficient program that may improve teaching methods and create opportunities for collaborative working relationships, which signals the potential for wide acceptance of the program.
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Resnick, Diane N. "Subjective outcome assessments for cervical spine pathology: A narrative review." Journal of Chiropractic Medicine 4, no. 3 (September 2005): 113–34. http://dx.doi.org/10.1016/s0899-3467(07)60121-9.
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Emary, Peter C., Mark Oremus, Lawrence Mbuagbaw, and Jason W. Busse. "Association of chiropractic integration in an Ontario community health centre with prescription opioid use for chronic non-cancer pain: a mixed methods study protocol." BMJ Open 11, no. 11 (November 2021): e051000. http://dx.doi.org/10.1136/bmjopen-2021-051000.
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IntroductionEmerging evidence from a number of primary care centres suggests that integration of chiropractic services into chronic pain management is associated with improved clinical outcomes and high patient satisfaction as well as with reductions in physician visits, specialist referrals use of advanced imaging and prescribing of analgesics. However, formal assessments of the integration of chiropractic services into primary care settings are sparse, and the impact of such integration on prescription opioid use in chronic pain management remains uncertain. To help address this knowledge gap, we will conduct a mixed methods health service evaluation of an integrated chiropractic back pain programme in an urban community health centre in Ontario, Canada. This centre provides services to vulnerable populations with high unemployment rates, multiple comorbidities and musculoskeletal disorders that are commonly managed with prescription opioids.Methods and analysisWe will use a sequential explanatory mixed methods design, which consists of a quantitative phase followed by a qualitative phase. In the quantitative phase, we will conduct a retrospective chart review and evaluate whether receipt of chiropractic services is associated with reduced opioid use among patients already prescribed opioid therapy for chronic pain. We will measure opioid prescriptions (ie, opioid fills, number of refills and dosages) by reviewing electronic medical records of recipients and non-recipients of chiropractic services between 1 January 2014 and 31 December 2020 and use multivariable regression analysis to examine the association. In the qualitative phase, we will conduct in-depth, one-on-one interviews of patients and their general practitioners to explore perceptions of chiropractic integration and its impact on opioid use.Ethics and disseminationThis study was approved by the Hamilton Integrated Research Ethics Board at McMaster University (approval number 2021–10930). The results will be disseminated via peer-reviewed publications, conference presentations and in-person or webinar presentations to community members and healthcare professionals.
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Harcourt, B. Timothy, Manel Wijesinha, and Gary E. Harcourt. "Subjective and objective numerical outcome measure assessment (SONOMA). a combined outcome measure tool: findings on a study of reliability." Journal of Manipulative and Physiological Therapeutics 26, no. 8 (October 2003): 481–92. http://dx.doi.org/10.1016/j.jmpt.2003.07.001.
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McGregor, Marion, and Dominic Giuliano. "Manikin-Based Clinical Simulation in Chiropractic Education." Journal of Chiropractic Education 26, no. 1 (April 1, 2012): 14–23. http://dx.doi.org/10.7899/1042-5055-26.1.14.
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Objective: The purpose of this pilot investigation was to describe the development and implementation of simulation exercises and investigate the feasibility, satisfaction, and relative effectiveness of a manikin-based simulation program in chiropractic undergraduate education. Methods: This investigation consisted of (1) a qualitative review of other simulation environments and evaluation of related simulation literature to develop the educational processes to be used, (2) implementation of simulation scenarios for 95 student interns and their 11 supervising clinicians, and (3) implementation of simulation scenarios in a random sample of 35 1st-year and 24 2nd-year chiropractic students. Assessment of success was based on results from satisfaction and usability questionnaires and perceived achievement of learning outcomes. Anxiety scores were measured for all participants via a visual analog scale. The level of successful integration of 2nd-year basic science material was assessed using a t test comparing test results between students who participated in the pilot and those who did not. Results: Implementation methods were developed on the basis of qualitative investigation. Simulation program feedback from all participants indicated high levels of satisfaction, usability, and perceived achievement of learning outcomes. Anxiety levels among interns differed according to role chosen (F = 8.07, p = .00). Mean difference in course examination scores of students who participated in simulations versus those who did not was 3.25% favoring students who participated (t = 1.28, p = .10). Conclusions: High levels of student satisfaction and perceived achievement of learning outcomes were consistently achieved. A trend to successful integration of basic science knowledge provides reason for cautious optimism. More research is recommended.
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Lehman, Gregory J. "Biomechanical assessments of lumbar spinal function. how low back pain sufferers differ from normals. implications for outcome measures research. part i: kinematic assessments of lumbar function." Journal of Manipulative and Physiological Therapeutics 27, no. 1 (January 2004): 57–62. http://dx.doi.org/10.1016/j.jmpt.2003.11.007.
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Coulter, Ian D. "Manipulation and Mobilization for Treating Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis for an Appropriateness Panel." Pain Physician 2, no. 22.2 (March 11, 2019): E55—E70. http://dx.doi.org/10.36076/ppj/2019.22.e55.
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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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Woodbum, Jim, Richard Branson, Georgia Pavoloni, Chien-Chih Lin, Matthew Fritts, and Christine Goert. "Assessment of Chiropractic Outcomes for Low Back Pain and Neck Pain: A Health Plan Quality Incentive Model." Journal For Healthcare Quality 28, no. 6 (November 2006): 32–39. http://dx.doi.org/10.1111/j.1945-1474.2006.tb00642.x.
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Niesley, Michelle, Kathryn Doran, Nhu Huynh, and Marie Winters. "A model for coordinated delivery of individualized complementary and integrative medicine care for cancer survivors." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): e286-e286. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.e286.
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e286 Background: Cancer survivors may experience both physical and psychosocial sequelae as a result of cancer treatment. Many patients consult either their oncologist or primary care physician for lifestyle interventions to address survivorship issues. While studies demonstrate complementary and integrative medicine (CIM) therapies may reduce the risk of both all-cause mortality and cancer-specific mortality by 50% (Frenkel M et al. Curr Oncol Rep. 2015 May;17(5):445), the most effective method to ensure compliance with individualized dietary counseling, exercise, or nutritional supplement information to the patient is unknown. Here we present a multidisciplinary survivorship care model to increase compliance with CIM practices that positively impact survivorship outcomes. Methods: Each Patient Empowered Care (PEC) team at our hospital consists of a medical oncologist, naturopathic doctor, nurse care manager, and a nutritionist, who discuss the assessment and plan for each patient they will see that day. Additional integrative services include chiropractic care, acupuncture, and Oncology Rehab (physical, occupational, speech, and massage therapy). Naturopathic doctors recommend nutritional supplements specific to both the patient’s oncology regimen and other comorbidities, and also ensure these supplements do not interfere with metabolism of other active medications. Oncology Rehab encourages exercise via our Motion for Life program, where physical fitness programs are tailored to the patient’s individual needs. The Nutrition program provides individualized coaching and nutritional management. Patients continue CIM therapies long after oncology care has concluded. Results: Patients satisfaction and outcomes are improved by facilitating compliance with individualized lifestyle recommendations. Conclusions: This model increases compliance with CIM recommendations by facilitating transparent communication among PEC team members, while providing the patient with a single facility that individualizes their wellness regimen.
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Norton, Tim C., Paul A. Oakley, Jason W. Haas, and Deed E. Harrison. "Positive Outcomes Following Cervical Acceleration-Deceleration (CAD) Injury Using Chiropractic BioPhysics® Methods: A Pre-Auto Injury and Post-Auto Injury Case Series." Journal of Clinical Medicine 12, no. 19 (October 9, 2023): 6414. http://dx.doi.org/10.3390/jcm12196414.
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This series illustrates how rear-end impact motor vehicle collisions (MVCs) alter the cervical spine’s alignment and demonstrates therapeutic use of cervical extension traction to improve lordotic alignment and other outcomes. This is a retrospective reporting of 7 adult patients (4 males and 3 females, 28–42 years) treated for cervical hypolordosis. These subjects received Chiropractic BioPhysics® (CBP®) rehabilitation and then were involved in a rear-end MVC. All cases had radiographic assessment that quantified the buckling of the cervical spine, presumably resulting directly from the CAD trauma. After an average of 3 years and 9 months (range: 1–7.6 years) following their initial program of care, the 7 patients sought care for a second time after the MVC. At this time, compared with their previously recorded post-treatment spine radiographs, there was an average 18.7° (range: 7.6–35.4°) reduction in cervical lordosis, a 9.2 mm (range: 3.6–19.8 mm) increase in anterior head translation (AHT), an 11.3° (range: 0.2–19.9°) decrease in the atlas plane line (APL), as well as a 35.7% (range: 22–52%) average neck disability index score (NDI) measured after the MVC. After the crash, a second round of CBP rehabilitation was administered, resulting in an average 15.1° improvement in cervical lordosis, 10.9 mm reduction in AHT, 10.4° increase in APL, and a 23.7% drop in NDI after an average of 35 treatments over 9 weeks. Treatment was universally successful, as an average 80% re-establishment of the lordosis toward its pre-injury state was found. There were no adverse events reported. This case series demonstrates that motor vehicle collisions may alter the alignment of the cervical spine. Rehabilitation of the cervical curve using extension traction improved the patients’ initial pre-crash alignments toward their pre-injury alignments and was likely responsible for improvement in the patients’ conditions. Clinical trials are needed to confirm these findings.
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Thoomes, Erik, Gus Tilborghs, Nicola R. Heneghan, Deborah Falla, and Marloes de Graaf. "Effectiveness of thoracic spine manipulation for upper quadrant musculoskeletal disorders: protocol for a systematic review." BMJ Open 13, no. 9 (September 2023): e076143. http://dx.doi.org/10.1136/bmjopen-2023-076143.
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IntroductionUpper quadrant musculoskeletal disorders (UQMD), comprising of cranial, cervical, shoulder and upper extremity disorders, are among the most frequently reported disorders in clinical practice. Thoracic high velocity low amplitude thrust (Tx-HVLAT) manipulation is a form of conservative management recommended in systematic reviews as an effective treatment option for aspects of UQMD disorders such headache, shoulder pain and lateral elbow pain. However, no recent systematic reviews have assessed the effectiveness across UQMD. Therefore, this systematic review aims to update the current evidence on the effectiveness of Tx-HVLAT for patients with UQMD on (1) patient-reported outcomes, (2) performance measures or (3) psychosocial outcomes.Methods and analysisThe Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, PEDro and Index to Chiropractic Literature will be searched from inception using Medical Subject Headings (MeSH), Thesaurus and/or free-text words. Combinations will be made based on localisation, disorder, intervention and design. Following guidelines as advised by the Cochrane Back Review Group, published randomised controlled trials will be included. Two review authors will independently assess the risk of bias (ROB) using the Cochrane Back Review Group’s recommended ROB2 tool and will independently extract the data using a standardised data extraction form. Overall quality of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. For continuous data, we will calculate standardised mean differences with 95% CIs. For dichotomous outcomes, relative risks and 95% CIs will be calculated. Where possible we will present a subgroup analysis by disorder. For pooling, a random-effects model will be used.Ethics and disseminationEthics approval is not required for this systematic review. The study findings will be submitted to a relevant peer-reviewed journal for dissemination and presented at relevant conferences.PROSPERO registration numberCRD42023429996.
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Cancelliere, Carol, Jessica J. Wong, Hainan Yu, Silvano Mior, Ginny Brunton, Heather M. Shearer, David Rudoler, et al. "Rehabilitative management of back pain in children: protocol for a mixed studies systematic review." BMJ Open 10, no. 10 (October 2020): e038534. http://dx.doi.org/10.1136/bmjopen-2020-038534.
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IntroductionLittle is known about effective, efficient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice.ObjectiveTo inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost–effective and safe rehabilitation interventions for children with back pain to improve their functioning and other health outcomes.Methods and analysisWe will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and EconLit for primary studies published from inception in all languages. We will include quantitative studies (randomised controlled trials, cohort and case–control studies), qualitative studies, mixed-methods studies and full economic evaluations. To augment our search of the bibliographic electronic databases, we will search reference lists of included studies and relevant systematic reviews, the WHO International Clinical Trials Registry Platform and consult with content experts. We will assess the risk of bias using appropriate critical appraisal tools. We will extract data about study and participant characteristics, intervention type and comparators, context and setting, outcomes, themes and methodological quality assessment. We will use a sequential approach at the review level to integrate data from the quantitative, qualitative and economic evidence syntheses.Ethics and disseminationEthics approval is not required. We will disseminate findings through activities, including (1) presentations in national and international conferences; (2) meetings with national and international decision makers; (3) publications in peer-reviewed journals and (4) posts on organisational websites and social media.PROSPERO registration numberCRD42019135009.
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Bernstein, David N., Allison W. McIntyre, and Judith F. Baumhauer. "Effect of assessment administration method and timing on patient‐reported outcome measures completion and scores: Overview and recommendations." Musculoskeletal Care 18, no. 4 (May 6, 2020): 535–40. http://dx.doi.org/10.1002/msc.1476.
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Lambie, Glenn W., Caitlin Frawley, Jaimie Stickl Haugen, and Dylan Wiand. "The Assessment of Clinical Rehabilitation Counseling Competencies." Journal of Applied Rehabilitation Counseling 54, no. 2 (June 1, 2023): 136–47. http://dx.doi.org/10.1891/jarc-2022-0014.
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The Assessment of Clinical Rehabilitation Counseling Competencies (ACRCC) is an evaluation tool intended to assess clinical rehabilitation counseling trainees’ developing competencies, specialty-specific skills, and learning outcomes. In response to the 2017 merger between the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the Council on Rehabilitation Education, we developed the ACRCC to align with the CACREP (2016)Standards. In our manuscript, we review (a) the developmental needs of rehabilitation counseling trainees, (b) the importance of comprehensive and specialty-specific clinical evaluation measures, (c) the development of the ACRCC, and (d) the opportunities for future research and implications for counseling preparation programs.
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Ammendolia, Carlo, Corey Hofkirchner, Joshua Plener, André Bussières, Michael J. Schneider, James J. Young, Andrea D. Furlan, et al. "Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review." BMJ Open 12, no. 1 (January 2022): e057724. http://dx.doi.org/10.1136/bmjopen-2021-057724.
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ObjectivesNeurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.DesignA systematic review.Data sourcesCENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020.Eligibility criteriaWe only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis.ResultsOf 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that: Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; manual therapy, education and exercise delivered using a cognitive-behavioural approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. The remaining 20 new trials demonstrated low-quality or very low-quality evidence for all comparisons and outcomes, like the findings of our original review.ConclusionsThere is moderate-quality evidence that a multimodal approach which includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness.PROSPERO registration numberCRD42020191860.
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Cancelliere, Carol, Jessica J. Wong, Hainan Yu, Margareta Nordin, Silvano Mior, Paulo Pereira, Ginny Brunton, et al. "Postsurgical rehabilitation for adults with low back pain with or without radiculopathy who were treated surgically: protocol for a mixed studies systematic review." BMJ Open 10, no. 3 (March 2020): e036817. http://dx.doi.org/10.1136/bmjopen-2020-036817.
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IntroductionSurgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients’ experiences with these interventions.ObjectivesTo conduct a mixed studies systematic review of quantitative and qualitative studies regarding: (1) the effectiveness and safety of postsurgical rehabilitation interventions for adults with LBP treated surgically and (2) the experiences of patients, healthcare providers, caregivers or others involved with the rehabilitation.Methods and analysisWe will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and the Rehabilitation & Sports Medicine Source for peer-reviewed empirical studies published from inception in any language. Studies using quantitative, qualitative and mixed methodologies will be included. We will also search reference lists of all eligible articles. Data extraction will include type of presurgical pathology, indication for surgery, surgical procedure, how the intervention was delivered and by whom, context and setting. We will conduct a quality assessment of each study and consider study quality in our evidence synthesis. We will use a sequential approach at the review level to synthesise and integrate data. First, we will synthesise the quantitative and qualitative studies independently, conducting a meta-analysis of the quantitative studies if appropriate and thematic synthesis of the qualitative studies. Then, we will integrate the quantitative and qualitative evidence by juxtaposing the findings in a matrix.Ethics and disseminationEthical approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) presentations at national and international conferences and scientific meetings; (2) presentations to local and international stakeholders; (3) publications in peer-reviewed journals and (4) posts on organisational websites.PROSPERO registration numberCRD42019134607.
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Murdock, Mark E., Teresa Brennan, Edward Murphy, and William Sherrier. "Restructuring of an evidence-based practice curriculum and assessment with structural mapping by course outcome verb." Journal of Chiropractic Education, August 26, 2021. http://dx.doi.org/10.7899/jce-20-22.
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Objective An evidence-based clinical practice (EBCP) subcurriculum within a chiropractic curriculum was restructured to distribute EBCP topics to courses throughout the curriculum. We posited that this would enhance student learning through early exposure, repetition, and the use of progressively more difficult levels of learning. In this paper we describe how we determined if Bloom's verb level trended upward from the beginning of the curriculum to the end and if there were any gaps in presentation of topics periodically in the curriculum. We describe how we determined if the restructured subcurriculum provided adequate integration of topics. Methods EBCP committee chairs created templates of the new structure, solicited feedback from the faculty, and faculty members volunteered to assimilate topics into courses. Support for the faculty included comprehensive PowerPoint production and in-service training. Assessment for trends and gaps was performed of the resultant learning outcomes by mapping 13 quarters against 6 Bloom's verb levels for 19 topics. Results Fourteen of the topics had increasing linear model trends indicating verb progression. Decreased attention to EBCP topics was identified in some quarters. Conclusion The graphical mapping process seemed useful to find EBCP topics that did not show progression of Bloom's verb difficulty and gaps in topics in the restructured subcurriculum.
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Enix, Dennis E., Kasey L. Sudkamp, Theodore K. Malmstrom, and Joseph H. Flaherty. "Methodology and demographics of a single blinded, randomized controlled trial of chiropractic compared to physical therapy for balance impairments in community dwelling geriatric patients with or without low back pain." Chiropractic & Manual Therapies 22, no. 1 (September 13, 2014). http://dx.doi.org/10.1186/s12998-014-0031-x.
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Abstract Background Postural control problems effect between 28% and 35% of individuals over the age 65 and increases with age. Musculoskeletal pain in the elderly impacts 20% to 49% of people between the ages of 65 and 75, is a leading falls risk factor, and a robust predictor of morbidity. Polypharmacy in the management of chronic pain is common in the geriatric population. Conservative treatment options for balance and back pain are underrepresented in scientific literature. Methods The methods and demographics for a prospective, randomized controlled single blinded clinical trial are described. This study evaluated the use of either chiropractic care or physical therapy as a treatment for patients with balance problems and with low back pain (68.5%) or without low back pain (31.5%) in the geriatric population. One hundred and sixty eight consecutively enrolled community dwelling adults between 60 and 85 years old (72.8 +/- 6.8) were randomly assigned to 6 weeks of either chiropractic care or physical therapy (12 - 18 visits). Testing occurred prior to randomization, after 6 weeks of treatment, and again 6 weeks later. Functional and self-report outcome measures for balance included the Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up and Go Test, and NeuroCom balance tests. Pain was assessed with the Visual Analog Scale, 21-Point Box Scale, and pressure algometry. Quality of life healthcare questionnaires included the Oswestry, the SF-36, and the Falls Efficacy Scale for confidence in performing everyday activities. Data analysis for this intent-to-treat design was a mixed-model analysis of variance (ANOVA) (p < 0.05) and Bonferroni correction (p < 0.017 and p < 0.025). This study was set in a university biomedical and healthcare research facility and university ethics committee approval was obtained and written informed consent was given by all study participants. Conclusion The methodology of this multimodal treatment protocol for balance disorders and low back pain in the geriatric population and patient demographics are described in this paper. Additional research in this area is needed for this growing at risk population. Trial registration NCT02031562.
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Long, Cynthia R., Stacie A. Salsbury, Robert D. Vining, Anthony J. Lisi, Lance Corber, Elissa Twist, Thad Abrams, Robert B. Wallace, and Christine M. Goertz. "Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain." Pilot and Feasibility Studies 8, no. 1 (March 7, 2022). http://dx.doi.org/10.1186/s40814-022-01008-0.
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Abstract Background Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial. Methods This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10-week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables. Results We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial. Conclusions We demonstrated the feasibility of participant recruitment, retention, and electronic data collection for conducting a pragmatic clinical trial of chiropractic care in a Veterans Health Administration facility. Using the pilot data and lessons learned, we modified and refined a protocol for a full-scale, multisite, pragmatic, National Institutes of Health-funded randomized trial of multimodal chiropractic care for veterans with chronic LBP that began recruitment in February 2021. Trial registration ClinicalTrials.gov NCT03254719
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Graham, Sarah E., Brian C. Coleman, Xiwen Zhao, and Anthony J. Lisi. "Evaluating rates of chiropractic use and utilization by patient sex within the United States Veterans Health Administration: a serial cross-sectional analysis." Chiropractic & Manual Therapies 31, no. 1 (August 10, 2023). http://dx.doi.org/10.1186/s12998-023-00497-x.
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Abstract Background Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use or utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics. Methods A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005–2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic visits. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic visits, and sex. To calculate use, we determined the proportion of patients of each sex who received chiropractic services to the total patients of the same sex receiving any outpatient care within each facility. To calculate utilization, we determined the number of chiropractic care visits per patient per fiscal year. A linear mixed effects model was applied to examine the difference in chiropractic care utilization by sex. Results The percentage of female VHA on-station chiropractic patients increased from 11.7 to 17.7% from FY2005–FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were slightly higher for females (median = 4.3 visits per year, mean = 4.9) compared to males (median = 4.1 visits per year, mean = 4.6). Conclusion We report higher use and utilization of VHA chiropractic care by females compared with males, yet for both sexes rates were lower than in the private US healthcare system. This highlights the need for further assessment of the determinants and outcomes of VHA chiropractic care.
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Eindhoven, Evan, Alex Lee, Peter Stilwell, and Silvano Mior. "I expected to be pain free: a qualitative study exploring athletes’ expectations and experiences of care received by sports chiropractors." Chiropractic & Manual Therapies 30, no. 1 (May 2, 2022). http://dx.doi.org/10.1186/s12998-022-00426-4.
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Abstract Background Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes receiving sports chiropractic care. Objective To explore the athletes’ expectations and experiences with care received from sports chiropractors, and their perceptions of relevant areas of future research. Methods A qualitative study was conducted through an interpretivist lens exploring the perspectives of elite and competitive athletes receiving care from sports chiropractors in Canada. Participants were purposively recruited and interviewed until saturation was reached. Two research team members independently analyzed the interview transcripts using a conventional approach to content analysis. Content was inductively coded and discussed by the research team to generate categories. Results We interviewed 18 participants between December 2018 and March 2020, 14 were national level athletes participating in sports ranging from paddling to combat sports. Reported reasons for seeking care included acute care, injury prevention, enhancing performance and maintenance care. Generated categories were organized under topics of experience with care, expectations of care, and research agenda. Participants experienced a variety of interventions, reassurance, varying treatment times, and reported positive impact on their athletic performance. They expected musculoskeletal assessment and treatment including at and beyond the injury site, symptom improvement, good communication and expertise from the chiropractor. Some participants suggested interpersonal and interprofessional communication can be improved, in particular the level of collaboration with other members of their health care team. Overall, participants reported a high level of trust and satisfaction with care received from sports chiropractors. From our participants’ perspective, suggested areas of research should focus on injury mechanics and prevention, impact of care on performance, and interprofessional collaboration. Conclusions In general, participants were very satisfied with care. Overall, participants’ expectations and experiences aligned but changed over time. Addressing the findings of this study can be used to enhance the quality of care provided to athletes from sports chiropractors, as well as inform future research agendas. Further work assessing if athletes in other competitive levels have similar experiences and expectations is needed.
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Hobbs, Michael, Dirk Crafford, Katherine MacRae, Anneliese Hulme, Stephney Whillier, and Hazel Jenkins. "The usefulness of a novel patient management decision aid to improve clinical decision-making skills in final year chiropractic students." Chiropractic & Manual Therapies 27, no. 1 (September 19, 2019). http://dx.doi.org/10.1186/s12998-019-0278-3.
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Abstract Background The process of developing patient management plans requires a series of clinical decision-making skills that can take years in practice to develop. For the inexperienced practitioner, providing a logical, systematic patient management framework may assist in clinical scenarios and accelerate their decision-making skill development. The purpose of this study was to assess whether a novel clinical management decision aid would improve the management decision-making of chiropractic students. Methods A prospective before and after study tracked chiropractic master degree students in their final year of study across a 10-week period from February–May, 2017. Case-based assessments were performed at baseline, after initial exposure to the decision aid, and after repeated exposure over the course of the semester. Outcome measures included the results from the 3 assessments, scored out of 20 by two markers using a standardised marking rubric, then averaged and converted to percentages; and 2 feedback questionnaires, given after initial exposure and at 10 weeks. Results A total of 75 students (44 males; 31 females) participated in the study. The mean score at baseline was 8.34/20 (41.7%) (95% CI: 7.98, 8.70; SD: 1.56) and after initial exposure was 9.52/20 (47.6%) (95% CI: 9.06, 9.98; SD: 2.02). The mean score after repeated exposure was 15.04/20 (75.2%) (95% CI: 14.46, 15.62; SD: 2.54). From baseline to initial exposure, there was a statistically significant absolute increase in mean score of 1.18/20 (5.9%) (95% CI: 0.6, 1.76; p < 0.0001), or a 2.82/20 (14.1%) relative improvement. From baseline to repeated exposure, there was a statistically significant absolute increase in mean score of 6.7/20 (33.5%) (95% CI: 6.02, 7.38; p < 0.0001), or a 16.06/20 (80.3%) relative improvement. The questionnaire results were also favourable. 56/75 (75%) participants agreed that the decision aid was easy to use and 46/75 (61%) of participants agreed that the decision aid improved their ability to integrate various management techniques. Conclusion Implementing a clinical management decision aid into the teaching curriculum helped to facilitate the ability of chiropractic students to develop patient management plans.
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Innes, Stanley I., Vicki Cope, Charlotte Leboeuf-Yde, and Bruce F. Walker. "A perspective on Councils on Chiropractic Education accreditation standards and processes from the inside: a narrative description of expert opinion, part 2: Analyses of particular responses to research findings." Chiropractic & Manual Therapies 27, no. 1 (September 12, 2019). http://dx.doi.org/10.1186/s12998-019-0276-5.
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Abstract Background This is the second article reporting on a study that sought the views of people with extensive experience in Councils on Chiropractic Education (CCEs) on research that has raised concerns about variability in accreditation standards and processes for chiropractic programs (CPs) and chiropractic practice in general. Methods This qualitative study employed in-depth semi-structured interviews that consisted of open-ended questions asking experts about their thoughts and views on a range of issues surrounding accreditation, graduate competency standards and processes. The interviews were audio-recorded, and transcribed verbatim in June and July of 2018. The transcripts were reviewed to develop codes and themes. The study followed the COREQ guidelines for qualitative studies. Results The interviews revealed that these CCE experts were able to discern positive and negative elements of the accreditation standards and processes. They were, in general, satisfied with CCEs accreditation standards, graduating competencies, and site inspection processes. Most respondents believed that it was not possible to implement an identical set of international accreditation standards because of cultural and jurisdictional differences. This was thought more likely to be achieved if based on the notion of equivalence. Also, they expressed positive views toward an evidence-based CP curriculum and an outcomes-based assessment of student learning. However, they expressed concerns that an evidence-based approach may result in the overlooking of the clinician’s experience. Diverse views were found on the presence of vitalism in CPs. These ranged from thinking vitalism should only be taught in an historical context, it was only a minority who held this view and therefore an insignificant issue. Finally, that CCEs should not regulate these personal beliefs, as this was potentially censorship. The notable absence was that the participants omitted any mention of the implications for patient safety, values and outcomes. Conclusions Expert opinions lead us to conclude that CCEs should embrace and pursue the widely accepted mainstream healthcare standards of an evidence-based approach and place the interests of the patient above that of the profession. Recommendations are made to this end with the intent of improving CCE standards and processes of accreditation.
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Bakaa, Nora, Danielle Southerst, Pierre Côté, Luciana Macedo, Lisa C. Carlesso, Joy MacDermid, and Silvano Mior. "Assessing cultural competency among Canadian chiropractors: a cross-sectional survey of Canadian Chiropractic Association members." Chiropractic & Manual Therapies 31, no. 1 (January 12, 2023). http://dx.doi.org/10.1186/s12998-023-00474-4.
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Abstract Background There is a paucity of research assessing cultural competency among Canadian chiropractors. Therefore, the aims of this study were to (1) measure cultural competency among Canadian chiropractors, (2) understand chiropractors’ perspectives of challenges and attitudes regarding the delivery of chiropractic services to equity-seeking communities, and (3) assess contextual factors associated with cultural competency. Methods We conducted a cross-sectional survey of members of the Canadian Chiropractic Association (CCA) (May–July 2021). The survey instrument consisted of 57 questions related to demographics, cultural competency, perceptions about health disparities, and challenges in delivery of rehabilitation. Cultural competency was measured using the Cultural Awareness and Sensitivity and Cultural Competence Behaviours subscales of the Cultural Competence Assessment Instrument. We conducted a multivariate linear regression to assess factors that may be associated with cultural competency. Results A total of 3143 CCA members responded (response rate of 41%). Mean scores for the Cultural Awareness and Sensitivity subscale were 5.8/7 (95% CI 5.7; 5.8) and 4.2/7 (95% CI 4.1; 4.2) for the Cultural Competence Behaviour subscale. Most chiropractors (72–78%) reported observing important cultural health disparities across various care-related outcomes. Cost of services and language were identified as barriers to providing care to equity-seeking communities. Cultural Awareness and Sensitivity scores were weakly associated with gender (men), years of clinical practice, cultural health disparities, the statement “I think some people have an agenda to look for discrimination even where it does not exist (DEI attitudes),” race (Caucasian), and prior DEI training, (R2 = 0.15, p < 0.0001). Cultural Competence Behaviour scores were weakly associated with race (Caucasian), cultural health disparities, prior DEI training, increased years of clinical experience, and higher Cultural Awareness and Sensitivity scores (R2 = 0.19, p < 0.0001). Conclusion This study provides the first description of cultural competency within the chiropractic profession in Canada. Findings suggest a gap between knowledge and behaviour and uncover several barriers and challenges that may inform the development of profession-specific training in cultural competence.
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Rix, Jacqueline, Philip Dewhurst, Caroline Cooke, and David Newell. "Nonacademic qualities as predictors of performance in an undergraduate healthcare program." Journal of Chiropractic Education, August 17, 2020. http://dx.doi.org/10.7899/jce-19-3.
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Objective Nonacademic qualities such as time management, study skills, stress, and motivation have been linked to academic performance. The purpose of this study was to gain an understanding of this relationship to enable early remediation in a chiropractic training program. Methods Questionnaire data were collected at the beginning of the academic year, end of semester 1, and end of semester 2. Questions were related to participants' time management, study skills, stress, and motivation. These were compared to summative assessment results. Semistructured interviews were conducted at the end of semester 1 and end of semester 2. Results Amount of time spent studying did not correlate significantly with assessment results. At the beginning of the year, 85.7% of students participated in extracurricular activities. This reduced throughout the year; students who stopped activities were significantly more successful in assessments. When stress at the beginning of the year was compared to end of semester 1, there was a significant increase (p = .012), with further significant increases from semester 1 to the end of semester 2 (p = .001). Students were very motivated at the beginning of the year, and this was maintained to the end of semester 1 (p = .257). However, at the end of semester 2, students became significantly less motivated (p = .007). End-of-year motivation correlated with poor student outcomes (p = .056). Conclusion Time management, study skills, stress, and motivation influenced academic performance in this sample of students. This study supports the notion that student assistance is needed. Additional research into student assistance would be beneficial.
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Wieser, Rainer, and Haymo Thiel. "A survey of “mental hardiness” and “mental toughness” in professional male football players." Chiropractic & Manual Therapies 22, no. 1 (April 15, 2014). http://dx.doi.org/10.1186/2045-709x-22-17.
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Abstract Background It is not uncommon for chiropractors to be associated with sports teams for injury prevention, treatment, or performance enhancement. There is increasing acceptance of the importance of sports psychology in the overall management of athletes. Recent findings indicate mental hardiness can be determined reliably using specific self-assessment questionnaires. This study set out to investigate the hardiness scores of professional footballers and examine the correlation between two questionnaires. It also included a mental hardiness rating of players by two coaches, and examined differences in hardiness and mental toughness between national and international players. Methods Two self-assessment questionnaires (modified Sports Mental Toughness Questionnaire [SMTQ-M] and Psychological Performance Inventory [PPI-A]) were completed by 20 male professional footballers. Two coaches, independently rated each player. A percentage score from each questionnaire was awarded each player and an average score was calculated ({SMTQ-M % + PPI-A %} ÷ 2). The PPI-A and SMTQ-M scores obtained for each player were analysed for correlation with Pearson’s correlation coefficient. Cohen’s kappa inter-reliability coefficient was used to determine agreement between coaches, and between the players’ hardiness scores and coaches’ ratings. The independent t-test was used to examine differences between national and international players. Results The players’ scores obtained from PPI-A and SMTQ-M correlated well (r = 0.709, p < 0.001). The coaches ratings showed significant, weak to moderate agreement (Cohen's kappa = 0.33). No significant agreement was found between player self-assessments and coaches’ ratings. The average ({SMTQ-M % + PPI-A %} ÷ 2) mean score was 77% (SD = 7.98) with international players scoring 7.4% (p = 0.04) higher than non-international players. Conclusions The questionnaires (SMTQ-M and PPI-A) correlated well in their outcome scores. These findings suggest that coaches moderately agree when assessing the level of mental hardiness of football players. There was no agreement between player self-assessment and ratings by coaches. Footballers who play or had played for national teams achieved slightly higher mental hardiness scores. Either questionnaire can offer the clinician a cost-effective, valuable measure of an individual’s psychological attributes, which could be relevant within the wider context of bio-psycho-social model of care.
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Fernandez, Matthew, Anika Young, Alice Kongsted, Jan Hartvigsen, Christian Barton, Jason Wallis, Peter Kent, et al. "GLA:D® Back Australia: a mixed methods feasibility study for implementation." Chiropractic & Manual Therapies 30, no. 1 (April 7, 2022). http://dx.doi.org/10.1186/s12998-022-00427-3.
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Abstract Background Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection. Methods Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests. Results Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement. Conclusion GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.
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Beynon, Amber, Sylvie Le May, and Jean Theroux. "Reliability and validity of physical examination tests for the assessment of ankle instability." Chiropractic & Manual Therapies 30, no. 1 (December 19, 2022). http://dx.doi.org/10.1186/s12998-022-00470-0.
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Abstract Introduction Clinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis may have important repercussions for clinical decision-making and patient outcomes. Therefore, it is important to recognize the diagnostic value of orthopaedic tests through understanding the reliability and validity of these tests. Objective To systematically review and report evidence on the reliability and validity of orthopaedic tests for the diagnosis of ankle sprains and instability. Methods PubMed, CINAHL, Scopus, and Cochrane databases were searched from inception to December 2021. In addition, the reference list of included studies, located systematic reviews, and orthopaedic textbooks were searched. All articles reporting reliability or validity of physical examination or orthopaedic tests to diagnose ankle instability or sprains were included. Methodological quality of the reliability and the validity studies was assessed with The Quality Appraisal for Reliability studies checklist and the Quality Assessment of Diagnostic Accuracy Studies-2 respectively. We identified the number of times the orthopaedic test was investigated and the validity and/or reliability of each test. Results Overall, sixteen studies were included. Three studies assessed reliability, eight assessed validity, and five evaluated both. Overall, fifteen tests were evaluated, none demonstrated robust reliability and validity scores. The anterolateral talar palpation test reported the highest diagnostic accuracy. Further, the anterior drawer test, the anterolateral talar palpation, the reverse anterior lateral drawer test, and palpation of the anterior talofibular ligament reported the highest sensitivity. The highest specificity was attributed to the anterior drawer test, the anterolateral drawer test, the reverse anterior lateral drawer test, tenderness on palpation of the proximal fibular, and the squeeze test. Conclusion Overall, the diagnostic accuracy, reliability, and validity of physical examination tests for the assessment of ankle instability were limited. Physical examination tests should not be used in isolation, but rather in combination with the clinical history to diagnose an ankle sprain. Preliminary evidence suggests that the overall validity of physical examination for the ankle may be better if conducted five days after the injury rather than within 48 h of injury.
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van Trijffel, Emiel, Robert Lindeboom, Patrick MM Bossuyt, Maarten A. Schmitt, Cees Lucas, Bart W. Koes, and Rob AB Oostendorp. "Indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain: protocol of an inter-examiner reliability study among manual therapists." Chiropractic & Manual Therapies 22, no. 1 (June 20, 2014). http://dx.doi.org/10.1186/2045-709x-22-22.
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Abstract Background Manual spinal joint mobilisations and manipulations are widely used treatments in patients with neck and low-back pain. Inter-examiner reliability of passive intervertebral motion assessment of the cervical and lumbar spine, perceived as important for indicating these interventions, is poor within a univariable approach. The diagnostic process as a whole in daily practice in manual therapy has a multivariable character, however, in which the use and interpretation of passive intervertebral motion assessment depend on earlier results from the diagnostic process. To date, the inter-examiner reliability among manual therapists of a multivariable diagnostic decision-making process in patients with neck or low-back pain is unknown. Methods This study will be conducted as a repeated-measures design in which 14 pairs of manual therapists independently examine a consecutive series of a planned total of 165 patients with neck or low-back pain presenting in primary care physiotherapy. Primary outcome measure is therapists’ decision about whether or not manual spinal joint mobilisations or manipulations, or both, are indicated in each patient, alone or as part of a multimodal treatment. Therapists will largely be free to conduct the full diagnostic process based on their formulated examination objectives. For each pair of therapists, 2×2 tables will be constructed and reliability for the dichotomous decision will be expressed using Cohen’s kappa. In addition, observed agreement, prevalence of positive decisions, prevalence index, bias index, and specific agreement in positive and negative decisions will be calculated. Univariable logistic regression analysis of concordant decisions will be performed to explore which demographic, professional, or clinical factors contributed to reliability. Discussion This study will provide an estimate of the inter-examiner reliability among manual therapists of indicating spinal joint mobilisations or manipulations in patients with neck or low-back pain based on a multivariable diagnostic reasoning and decision-making process, as opposed to reliability of individual tests. As such, it is proposed as an initial step toward the development of an alternative approach to current classification systems and prediction rules for identifying those patients with spinal disorders that may show a better response to manual therapy which can be incorporated in randomised clinical trials. Potential methodological limitations of this study are discussed.
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Bini, Pietro, David Hohenschurz-Schmidt, Vincenzo Masullo, Diana Pitt, and Jerry Draper-Rodi. "The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis." Chiropractic & Manual Therapies 30, no. 1 (November 23, 2022). http://dx.doi.org/10.1186/s12998-022-00459-9.
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Abstract Background Cervicogenic headache is a secondary headache, and manual therapy is one of the most common treatment choices for this and other types of headache. Nonetheless, recent guidelines on the management of cervicogenic headache underlined the lack of trials comparing manual and exercise therapy to sham or no-treatment controls. The main objective of this systematic review and meta-analysis was to assess the effectiveness of different forms of manual and exercise therapy in people living with cervicogenic headache, when compared to other treatments, sham, or no treatment controls. Methods Following the PRISMA guidelines, the literature search was conducted until January 2022 on MEDLINE, CENTRAL, DOAJ, and PEDro. Randomized controlled trials assessing the effects of manual or exercise therapy on patients with cervicogenic headache with headache intensity or frequency as primary outcome measures were included. Study selection, data extraction and Risk of Bias (RoB) assessment were done in duplicate. GRADE was used to assess the quality of the evidence. Results Twenty studies were included in the review, with a total of 1439 patients. Common interventions were spinal manipulation, trigger point therapy, spinal mobilization, scapulo-thoracic and cranio-cervical exercises. Meta-analysis was only possible for six manual therapy trials with sham comparators. Data pooling showed moderate-to-large effects in favour of manual therapy for headache frequency and intensity at short-term, small-to-moderate for disability at short-term, small-to-moderate for headache intensity and small for headache frequency at long-term. A sensitivity meta-analysis of low-RoB trials showed small effects in favor of manual therapy in reducing headache intensity, frequency and disability at short and long-term. Both trials included in the sensitivity meta-analysis studied spinal manipulation as the intervention of interest. GRADE assessment showed moderate quality of evidence. Conclusion The evidence suggests that manual and exercise therapy may reduce headache intensity, frequency and disability at short and long-term in people living with cervicogenic headache, but the overall RoB in most included trials was high. However, a sensitivity meta-analysis on low-RoB trials showed moderate-quality evidence supporting the use of spinal manipulation compared to sham interventions. More high-quality trials are necessary to make stronger recommendations, ideally based on methodological recommendations that enhance comparability between studies. Trial registration The protocol for this meta-analysis was pre-registered on PROSPERO under the registration number CRD42021249277.
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Pourahmadi, Mohammadreza, Mohammad Ali Mohseni-Bandpei, Abbasali Keshtkar, Bart W. Koes, César Fernández-de-Las-Peñas, Jan Dommerholt, and Mehrdad Bahramian. "Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: protocol for a systematic review." Chiropractic & Manual Therapies 27, no. 1 (September 26, 2019). http://dx.doi.org/10.1186/s12998-019-0266-7.
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Abstract Background Headache is the most common neurological symptoms worldwide, as over 90% of people have noted at least one headache during their lifetime. Tension-type headaches, cervicogenic headaches, and migraines are common types of headache which can have a significant impact on social, physical, and occupational functioning. Therapeutic management of headaches mainly includes physical therapy and pharmacological interventions. Dry needling is a relatively new therapeutic approach that uses a thin filiform needle without injectate to penetrate the skin and stimulate underlying tissues for the management of neuromusculoskeletal pain and movement impairments. The main objective of this systematic review and meta-analysis is to evaluate the effectiveness of dry needling in comparison to other interventions on pain and disability in patients with tension-type headache, cervicogenic headache, and migraine. Methods/design We will focus on clinical trials with concurrent control group(s) and comparative observational studies assessing the effect of dry needling in patients with tension-type headache, cervicogenic headache, and migraine. Electronic databases from relevant fields of research (PubMed/ Medline, Scopus, Embase®, PEDro, Web of Science, Ovid, AMED, CENTRAL, and Google Scholar) will be searched from inception to June 2019 using defined search terms. No restrictions for language of publication or geographic location will be applied. Moreover, grey literature, citation tracking, and reference lists scanning of the selected studies will be searched manually. Primary outcomes of this study are pain intensity and disability, and secondary outcomes are cervical spine ROM, frequency of headaches, health-related quality of life, and TrPs tenderness. Studies will be selected by three independent reviewers based on prespecified eligibility criteria. Three reviewers will independently extract data in each eligible study using a pre-piloted Microsoft Excel data extraction form. The assessment of risk of bias will be implemented using the Cochrane Back and Neck Review Group 13-item criteria and NOS. Direct meta-analysis will be performed using a fixed or random effects model to estimate effect size such as standardized mean difference (Morris’s dppc) and 95% confidence intervals. Statistical heterogeneity will also be evaluated using the I2 statistic and the χ2 test. All meta-analyses will be performed using Stata V.11 and V.14 softwares. The overall quality of the evidence for the primary outcomes will be assessed using GRADE. Discussion All analyses in this study will be based on the previous published papers. Therefore, ethical approval and patient consent are not required. The findings of this study will provide important information on the value of dry needling for the management of tension-type headache, cervicogenic headache, and migraine. Trial registration PROSPERO registration number: CRD42019124125.
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Kinsella, Rita, Anthony Nasser, Hylton B. Menz, Tania Pizzari, Natalie J. Collins, and Adam I. Semciw. "Effects of foot orthoses and footwear interventions on impairments and quality of life in people with hip pain: A systematic review." Musculoskeletal Care, October 12, 2023. http://dx.doi.org/10.1002/msc.1826.
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AbstractBackgroundFoot orthoses and footwear interventions are advocated for the management of lower limb musculoskeletal conditions including the hip, but much of the research is focused on knee disorders. The aim of this systematic review was to synthesise the literature that investigates the use of foot orthoses or footwear in people with hip‐related pain.MethodsMEDLINE, EMBASE, CINAHL, AMED and SPORTDiscus were searched from inception to March 2023. Randomised controlled trials (RCT), cohort and pre‐post studies reporting on footwear and foot orthoses interventions, in participants with hip‐related pain, were eligible for inclusion. Outcomes included pain, physical function, and quality of life (QoL). Effect sizes were calculated where sufficient data were available. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Rob‐2) and the Joanna Briggs Institute Checklist. The overall quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluations framework.ResultsOf the seven included studies (n = 266 participants), there was one RCT, one cohort and five single‐group pre‐post designs. Interventions included customised and non‐customised arch supports, heel lifts, and footwear modifications, used in the following hip conditions: trochanteric pain, non‐specific hip pain, hip osteoarthritis, and leg length dysfunction following total hip arthroplasty. Meta‐analysis was possible for outcomes in two studies, demonstrating moderate improvement in pain following foot orthoses use. Overall certainty of evidence ranged from very low to low.ConclusionSingle‐group pre‐post study designs describe positive relationships between foot orthoses and footwear use and improvements in hip pain, function, and QoL. However, these results were not supported by the only available RCT. Given this is a relatively inexpensive and non‐invasive treatment approach, further rigorous studies are warranted.
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Andersen, Victoria, Xu Wang, Mark de Zee, Lasse Riis Østergaard, Maciej Plocharski, and René Lindstroem. "The global end-ranges of neck flexion and extension do not represent the maximum rotational ranges of the cervical intervertebral joints in healthy adults - an observational study." Chiropractic & Manual Therapies 29, no. 1 (May 25, 2021). http://dx.doi.org/10.1186/s12998-021-00376-3.
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Abstract Background In clinical diagnosis, the maximum motion of a cervical joint is thought to be found at the joint’s end-range and it is this perception that forms the basis for the interpretation of flexion/extension imaging studies. There have however, been representative cases of joints producing their maximum motion before end-range, but this phenomenon is yet to be quantified. Purpose To provide a quantitative assessment of the difference between maximum joint motion and joint end-range in healthy subjects. Secondarily to classify joints into type based on their motion and to assess the proportions of these joint types. Study design This is an observational study. Subject sample Thirty-three healthy subjects participated in the study. Outcome measures Maximum motion, end-range motion and surplus motion (the difference between maximum motion and end-range) in degrees were extracted from each cervical joint. Methods Thirty-three subjects performed one flexion and one extension motion excursion under video fluoroscopy. The motion excursions were divided into 10% epochs, from which maximum motion, end-range and surplus motion were extracted. Surplus motion was then assessed in quartiles and joints were classified into type according to end-range. Results For flexion 48.9% and for extension 47.2% of joints produced maximum motion before joint end-range (type S). For flexion 45.9% and for extension 46.8% of joints produced maximum motion at joint end-range (type C). For flexion 5.2% of joints and for extension 6.1% of joints concluded their motion anti-directionally (type A). Significant differences were found for C2/C3 (P = 0.000), C3/C4 (P = 0.001) and C4/C5 (P = 0.005) in flexion and C1/C2 (P = 0.004), C3/C4 (P = 0.013) and C6/C7 (P = 0.013) in extension when comparing the joint end- range of type C and type S. The average pro-directional (motion in the direction of neck motion) surplus motion was 2.41° ± 2.12° with a range of (0.07° -14.23°) for flexion and 2.02° ± 1.70° with a range of (0.04°-6.97°) for extension. Conclusion This is the first study to categorise joints by type of motion. It cannot be assumed that end-range is a demonstration of a joint’s maximum motion, as type S constituted approximately half of the joints analysed in this study.