Journal of the Canadian Chiropractic Association最新文献

"The only constant is change" - Heraclitus, Greek Philosopher The objective of this article, Part 1 of a two part series, is to provide a narrative review of the evolution of teaching chiropractic manual skills by four tutors who taught in the technique trenches at the Canadian Memorial Chiropractic College collectively for 120 years. Based on their collective memories, this narrative review describes the evolution of: central demonstrations; inconsistency between tutors with respect to demonstrating and grading chiropractic manual skills; determining course content; policy on students providing high velocity, low amplitude thrusts on each other during class time and testing; quantitative versus qualitative grading; remediation; acknowledgment of risk and; changes to technique class due to Covid. The results of a unique survey evaluating students' perception of these changes is presented. The intent of this article is for faculty at other accredited educational programs to learn from our experiences and potentially strengthen their pedagogical approach to teaching chiropractic manual skills.

Cam-type deformities of the proximal femur have long been associated with femoroacetabular impingement (FAI); an orthopedic condition recognized in the etiology of early osteoarthritis (OA) in the non-dysplastic adult hip. However, the optimal clinical management (including the long-term prognosis) of patients with cam-type deformities with or without FAI symptoms remains uncertain. In this imaging case review (ICR), we present the 10-year follow-up of a retired chiropractor with bilateral cam-type femoral deformities who initially underwent total right hip joint arthroplasty for advanced hip joint OA, and subsequently developed advanced hip joint OA on the contralateral side.

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada.

Objectives: This sequential explanatory mixed-method study aimed to explore chiropractic students' attitudes toward incorporating maintenance care (MC) focused evidence.

Methods: Attitudes towards using an evidence-based clinical protocol for maintenance care (MC), the MAINTAIN instrument, were assessed via surveys, monologue responses, dialogues, and qualitative feedback. Participants from a single chiropractic educational institution completed questionnaires evaluating their perspectives on patient-centeredness, chronic pain, and evidence incorporation. Descriptive statistics summarized quantitative data, while content analysis was used for qualitative data.

Results: 74.4% (n=419) of students participated, mostly male (57.5%), with an average GPA of 3.15 (out of a maximum of 4.0). Qualitative analysis identified the need to clarify MC terminology and factors motivating students to adopt new evidence, such as quality and alignment with healthcare beliefs.

Conclusions: This study's findings emphasize the importance of refining healthcare training strategies, including defining terminology and addressing motivators for evidence incorporation, as evidence for MC for low back pain evolves.

Background: Clinicians make clinical decisions using the dual process theory. The dual process theory comprises two approaches, System 1, based on heuristics, and System 2, involving an analytical and effortful thought process. However, there are inherent limitations to the dual process theory, such as relying on inaccurate memory or misinterpreting cues leading to inappropriate clinical management. As a result, clinicians may utilize mental shortcuts, termed heuristics, and be susceptible to clinical errors and biases that may lead to flawed decision making and diagnosis.

Methods: This case series describes four clinical cases whereby the clinicians use distinct strategies to assess and manage complex clinical presentations.

Discussion: Through the use of self-reflection and acknowledging diagnostic uncertainty, the clinicians were able to reduce common cognitive biases and provide effective and timely patient care. We discuss strategies that clinicians can implement in their daily practice to improve clinical decision-making processes and deliver quality care.

Owing to similar clinical presentations, cervical spondylotic myelopathy can mimic other neurological disorders. In this imaging case review (ICR), we describe a case of cervical spondylotic myelopathy in a patient diagnosed with amyotrophic lateral sclerosis. The key clinical features, imaging findings and differential diagnoses of cervical spondylotic myelopathy compared with amyotrophic lateral sclerosis are also presented.

The objectives of this article, Part 2 of a two part series, are twofold: (i) To provide a narrative review of the research evidence authored by faculty of the Canadian Memorial Chiropractic College (CMCC) and; (ii) discussion of the impact this research evidence had on teaching chiropractic manual skills at CMCC and - theoretically - to the broader chiropractic educational community. Research evidence discussed are in the areas of: Experimental studies linked to biomechanics; Measuring Force - Integration of Force Sensing Table Technology (FSTT®) into technique labs; Characteristics of injuries sustained by chiropractic students during technique labs; Finding the clinical target for therapeutic intervention and; Recommendations toward a model technique curriculum. The intent of this article is for faculty at current and future accredited educational programs to incorporate this research evidence into their technique curricula and to potentially strengthen the pedagogical approach used to teach chiropractic manual skills.

Background: Young students with skeletal immaturity report an increasing number of musculoskeletal symptoms associated with daily use of heavy backpacks. This cross-sectional study investigated the relationship between heavy backpack use and reports of pain.

Methods: Data were collected from 300 students aged 11 to 18 at the University of Toronto Schools.

Results: Students, on average, carried 15.9% of their body weight. 54% of students reported physiological complaints, primarily back, shoulder, neck, and leg pain. Backpack weight as a % of body weight was strongly associated with pain complaints. Younger students and those with longer commutes were more likely to report heavy backpacks (50% compared to 22.6% of older students, p< .001) and pain.

Conclusion: Carrying heavy backpacks could result in increased musculoskeletal complaints in young students. Findings suggest that even the upper bound of currently recommended guidelines (20% of body weight) may be too high, especially for younger children.

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS).

Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8-13 MHz) over L5/S1 facets; long-axis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors' assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared.

Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt step-off defect at L5PI.

Conclusion: We report the first technique description and verification of the L5PI using DUS.

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerverelated symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines.