Journal of the Canadian Chiropractic Association最新文献

Chronic musculoskeletal (MSK) pain is a leading cause of disability affecting patients and healthcare systems worldwide. Its burden is expected to rise sharply due to the aging global population. Given that chronic MSK pain is the most common condition treated by chiropractors daily, chiropractic is ideally positioned to assume a unique leadership role in the future health delivery system of managing this growing clinical challenge. Central sensitization (CS) is linked to an increasing number of chronic pain conditions characterized by increased sensory, sympathetic, and motor excitability. Accumulating evidence suggests that spinal manipulation may achieve its therapeutic benefits by modulating CS, thereby making it a potentially effective non-invasive approach to treating and managing chronic MSK pain. This review aims to provide a discussion of some of the scientific foundations underpinning the pathophysiologic mechanisms of chronic MSK pain and spinal manipulative therapy, as they relate to the contemporary neurophysiologic paradigm of chiropractic medicine and practice.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

Despite advancements in research and guidelines of healthcare, there are still situations where clinicians may lack experience or face limited evidence to inform decision-making. In these situations, healthcare providers should provide care within their scope of practice considering all available evidence-based options, the patient's preferences, and the clinical context through a clinical expertise lens. This decision-making tool serves as a guide for patient-centred clinical decision-making in chiropractic care. It integrates clinical expertise with the pillars of evidence-based practice, taking into account the best available research evidence, patient preferences, and the clinical context. Examples are provided on using the tool within chiropractic care for conditions with large bodies of supporting evidence (e.g., low back pain), and conditions with little to no evidence (e.g., Parkinson's disease), to illustrate the broad applicability of how to use (and how not to use) this tool in the field of chiropractic care.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence-Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

Supporting chiropractors to deliver Evidence Based Care (EBC) is an important role that professional organizations fulfill in the practice ecosystem. This is a journey that can be accelerated when there is a shared understanding of the elements of Evidence Based Practice (EBP) and the benefits that accrue when applied comprehensively to patient care. The Ontario Chiropractic Association (OCA) undertook a significant project to advance this understanding and enhance these benefits. This paper describes the principles, processes and outputs of our work, which is a series of papers examining the EBP framework in detail. It details why this work is necessary for the chiropractic profession, how it was accomplished, and introduces the themes of each of the six other papers in the series. We aim to support chiropractors in delivering comprehensive care through the application of the evidence-based framework enabling them to practice within the full chiropractic scope of practice in compliance with applicable regulations and legislations.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

Objective: To explore contemporary iterations of the evidence pyramid as applied in evidence-based practice.

Methods: We searched for articles published in PubMed, Web of Science, and Scopus databases between 2016 and 2024 that assessed the evidence pyramid and its application in clinical practice. Title/abstract and full-text screening were conducted by one reviewer to determine eligibility, followed by data extraction and analysis to summarize themes.

Results: Of 83 full-text articles identified, 28 were included. Extracted information centred on three common themes: (1) use of the evidence pyramid as a guide, not a rigid tool; 2) importance of the clinical question; and (3) necessity of clinical expertise to integrate research findings into clinical decision-making.

Conclusion: Preliminary findings of our review suggest that, when applying the evidence pyramid in practice, clinicians should consider context (i.e., the clinical question, best available evidence, patient preferences, and clinical circumstances), to optimize clinical decision-making and patient outcomes.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

Objective: This review aimed to explore clinical expertise within evidence-based practice (EBP) by examining contemporary definitions of clinical expertise, how it can be acquired and developed over time, and its role within EBP.

Methods: PubMed, Web of Science, and Scopus databases were searched for literature on clinical expertise published between January 2016 and August 2024. Titles and abstracts were screened for relevance. Full-text review was conducted for papers deemed potentially relevant.

Results: 23 articles were included in this review. Clinical expertise receives different treatments across literature. However, a commonality is that clinical expertise requires proficiency, skill, and clinical judgement that can be acquired only through clinical experience, collaboration, and hands-on clinical practice. Operating within Haynes' model of EBP, clinical expertise is central to integrating patient preferences and bridging the gap between standardized objective evidence and personalized care.

Conclusions: Clinical expertise represents the core of integrating EBP to inform clinical decision-making and is developed through experience and keeping current with research.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

Background: Person-centred care (PCC) is widely recognized as a cornerstone of high-quality healthcare, linked to improved outcomes and stronger therapeutic relationships. Its core principles of respect, empowerment, and responsiveness to individual needs, are closely aligned with core elements of the chiropractic approach. Yet, translating PCC into consistent practice remains a challenge.

Discussion: This commentary explores the value and complexity of PCC in chiropractic, examining barriers such as time constraints, training gaps, patient expectations, and inadequate systemic supports.

Conclusion: This paper argues that while chiropractic is well-positioned to embrace PCC, doing so requires a shift from viewing PCC as an inherent feature of the profession to embracing it as an intentional, ethical, and relational commitment. Strategies for advancing PCC are discussed across clinician, patient, and organizational levels to support its consistent and equitable implementation.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

Objective: To summarize key factors of knowledge translation (KT) and offer actionable recommendations to improve uptake and application of evidence-based practice (EBP) in chiropractic care.

Methods: We conducted a narrative review searching for KT literature in PubMed, Web of Science, and Scopus from January 2016 to August 2024. Titles and abstracts were screened for eligibility and relevant articles underwent full-text review. We used an expert consensus approach to form our recommendations.

Results: We identified KT barriers and facilitators at individual, collegial, and organizational levels. Recommendations include advocating for individual clinicians to pursue continuous education and mentorship, and for professional organizations to support KT funding and foster supportive and collaborative environments for individual clinicians to engage in KT.

Conclusions: To bridge the knowledge-to-action (KTA) gap in the chiropractic profession, chiropractors should engage in learning environments to develop necessary EBP skills, while associations should focus on supporting and incentivizing chiropractors to enhance their KT abilities.

Author’s note: This paper is one of seven in a series exploring contemporary perspectives on the application of the evidence-based framework in chiropractic care. The Evidence Based Chiropractic Care (EBCC) initiative aims to support chiropractors in their delivery of optimal patient-centred care. We encourage readers to review all papers in the series.

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.