Journal of the Canadian Chiropractic Association最新文献

Purpose: To describe characteristics and course of chiropractic patients' self-reported musculoskeletal (MSK) symptoms following interruption of chiropractic treatment during the COVID-19 lockdown.

Methods: Using a retrospective case series design, patient demographic, clinical and patient-reported clinical outcomes variables were abstracted from electronic health records of patients attending a chiropractic teaching clinic. We measured self-perceived changes in symptoms cross-sectionally at each of two time points: before and after the COVID-19 lockdown.

Results: 133 of 184 patients were eligible. Most had comorbidities and treatment for multiple MSK diagnoses pre-lockdown. Based on patients' self-perception, 17% improved (vs 77% pre-lockdown), 23% did not change (vs 17% pre-lockdown) and 43% worsened (vs 5% pre-lockdown) in MSK symptoms during lockdown. Those reporting worsening post-lockdown had more treatments, longer period of treatment time pre-lockdown, and more severe pain (mean: 7/10) post-lockdown. Upon clinic reopening, 47% of patients returned for care, more often reporting worsened MSK symptoms and higher average pain score (6.2/10) than non-returning patients (3.9/10).

Summary: Some patients experiencing interruptions in chiropractic care during COVID-19 lockdown returned with worsened MSK symptoms, while others showed improvement and did not return to clinic. Our study helps generate future research hypotheses regarding the contribution of chiropractic treatment (e.g., during pandemics).

A 69-year-old male presented to a chiropractic clinic four days post-injury with lateral ankle pain and swelling. Using the Ottawa ankle rules as a guideline for the need for radiographs, this case was deemed necessary for x-ray evaluation. The radiographic examination demonstrated a Weber B fracture of the distal fibula with a noted widening of the medial clear space of the ankle, which indicated the additional lesion of the deltoid ligament. This patient was referred to an orthopedist to have an open reduction and internal fixation (ORIF) surgery.

Background: Early detection and early intervention of musculoskeletal sports injuries is a promising, but underexplored area. Poor conceptual clarity of secondary prevention strategies currently hampers research and clinical application.

Methods: We conducted a scoping review, aimed at summarizing secondary prevention strategies of musculoskeletal sports injuries into recommendations for researchers, athletes, and clinicians. We searched seven databases for the terms: sport, injury, and early detection/intervention.

Results: Nine studies reported early detection/intervention strategies. Strength testing is a promising approach to early injury detection. We recommend caution in interpretating early imaged abnormalities due to heterogeneous findings. Observing early symptoms appears the most adopted pragmatic approach. Early rehabilitation and passive therapies seem effective as early interventions. Early load reduction is likely difficult to implement, due to performance expectations.

Conclusions: The evidence for early detection/intervention is limited. Further research into assessing early detection/intervention strategies and their use in practice, is necessary to formulate concrete recommendations.

Background: Chronic back problems (cBP) are the leading cause of disability in Canada, with chiropractors as second most-consulted professionals for cBP care. However, little is known about chiropractor supply, demand, and gaps between them. We will determine the prevalence of cBP, chiropractic utilization, the chiropractic availability across Canadian health regions; compute a demand-supply measure; and investigate characteristics associated with the demand-supply.

Methods: We designed an ecological study with 102 Canadian health regions as the unit of analysis. We will estimate derived and observed demand using the Canadian Community Health Survey data (2015/2016, 2021/2022), and supply using Canadian Chiropractic Association membership data (2021/2022). We will use spatial analyses to map the prevalence of cBP (derived demand), chiropractic utilization for cBP (observed demand), and chiropractor availability (supply) across health regions. Poisson regression models will assess the population factors associated with supply and demand-supply disparities.

Conclusion: The identification of geographical disparities in chiropractic care and the exploration of contextual factors associated with demand-supply dynamics may inform healthcare planning and resource allocation for the management of chronic back problems in Canada.

Background: Coflex interlaminar stabilization (CIS) is a second-generation interspinous implant that promotes intersegmental flexion following decompression for moderate to severe lumbar spinal stenosis. We describe the management of a patient with persistent spinal pain syndrome-2 (PSPS-2) status-post CIS implant presenting to a chiropractor's office.

Case presentation: A 77-year-old Hispanic male Army veteran presented with PSPS-2 status-post L3-L5 laminectomy and CIS for lumbar spinal stenosis. A 4-visit trial care plan ensued with flexion-distraction manipulation, drop-assist spinal manipulation, patient education, and repeated lumbar flexion-based stretches. No adverse events occurred. On re-evaluation, the numeric pain rating and Oswestry Disability were unchanged.

Summary: We describe the multimodal management of a PSPS-2 patient with a CIS implant presenting to a chiropractic clinic. While no clinically meaningful improvement was observed, no adverse events were reported. Further investigation is needed to evaluate the safety and clinical effectiveness of multimodal manual therapy and exercise-based care in patients with PSPS-2.

Chronic low back pain (CLBP) presents complex challenges, with traditional treatments offering only moderate relief. Emerging evidence suggests that impairments in dual task performance-simultaneous cognitive and motor processing-may contribute to CLBP persistence. This narrative review examined 10 studies comparing individuals with CLBP to healthy controls using various dual task paradigms. Findings indicated consistent deficits in gait variability, balance control, and muscle activation patterns among CLBP participants, especially under cognitive load. Neurocognitive impairments, including delayed anticipatory postural adjustments and altered trunk control, were also observed. These deficits likely reflect disrupted sensorimotor integration and resource competition within the central nervous system due to chronic pain. Incorporating dual task interventions into rehabilitation may enhance outcomes by addressing both cognitive and motor domains. Future research should focus on standardized assessments, pain-related cognitive interactions, and neuroimaging methods to further explore these mechanisms and support targeted treatment strategies for CLBP.

Introduction: The objective of this study was to conduct a comparative audit of geriatric courses taught at English-speaking accredited chiropractic educational programs (CEPs) worldwide.

Methods: Using purposeful sampling course coordinators or administrators were asked to provide geriatric course outlines. Data on learning objectives, course structures and topical outlines were extracted, with data presented descriptively.

Results: Thirty-four CEPs were invited to participate and data sets of 17 CEPs (Australia, Canada, Puerto Rico, United Kingdom and the United States) were analyzed. All course content was delivered by lectures, the majority assessed students with written examinations and assignments and all teaching faculty were chiropractors. The five most taught topics were neurological disorders, chiropractic care, cognitive disorders, geriatric assessment and falls.

Conclusion: We identified consistency between CEPs with respect to course delivery, assessment and faculty but there was a great deal of variability with respect to course topics. Further research to develop core competencies for geriatric chiropractic education is warranted.

Chronic pain is common in chiropractic practice and often presents without clear evidence of tissue injury. Nociplastic pain is a recently defined concept that highlights altered nociceptive processing within the nervous system. This newer understanding of pain provides insight into chronic conditions such as chronic back or neck pain, chronic headaches, and fibromyalgia. These conditions are commonly encountered in chiropractic practice but may be challenging to address using traditional models. This commentary introduces nociplastic pain, outlining potential mechanisms and relevance to chiropractic care. We advocate a collaborative, multimodal management approach that includes patient education, exercise promotion, and functional goal-setting within a biopsychosocial framework. Understanding nociplastic pain equips chiropractors to support patients with complex chronic pain through compassionate, evidence-based care that addresses the whole person.

Objective: To assess the effectiveness of educational interventions' impact on chiropractic students' attitudes toward patient-centered care and low back pain (LBP) using knowledge about pain science and stratified LBP management with the MAINTAIN instrument.

Methods: From January-August 2022, students were cluster randomized into three groups (information-only, focused-lecture, workshop series) with the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the Patient-Practitioner Orientation Scale (PPOS) measured at baseline, 4-months, and 8-months. Data were analyzed with descriptive statistics and repeated-measures ANOVA.

Results: Of 264 students, response rates declined by 8-months (16.7-31.3%). No significant within- or between-group differences were found across timepoints. A small but statistically significant shift toward doctor-centered attitudes in the instrument-only group (p=0.024) was not clinically meaningful.

Conclusions: Educational interventions did not significantly change student attitudes. Contributing factors may include focus on attitudinal change, limited research culture, implementation barriers, and student burnout.

Introduction à une nouvelle série de réflexions narratives en chiropratique.