Journal of the Canadian Chiropractic Association最新文献

Objective: To describe the clinical presentation and management of a patient with degenerative cervical myelopathy (DCM) during pregnancy.

Case presentation: A 34-year-old female, who was 21-weeks pregnant, presented for chiropractic evaluation with acute left upper-back pain.

Intervention and outcome: For the initial symptoms, the patient completed multidisciplinary treatment with progressive improvement in pain. At the nine-week follow-up visit, the patient described a rapid onset of extremity paresthesia and balance change. The physical examination revealed hyperreflexia. DCM was established as the working diagnosis based on clinical examination. Spinal cord compression was confirmed by MRI (magnetic resonance imaging). The patient had a cesarean delivery and anterior cervical discectomy and fusion (ACDF) surgery was performed at four-weeks postpartum.

Summary: Symptoms associated with DCM may be wide-ranging. DCM diagnosis is commonly delayed and timely recognition and management is essential. This case highlights the importance of awareness of DCM and appropriate management for this condition.

Objective: Use of musculoskeletal ultrasonography has been growing in many healthcare fields. Our aim is to evaluate the use and attitudes toward musculoskeletal ultrasound within a chiropractic educational clinic.

Methods: A survey questionnaire was distributed to interns (n=168), who were provided access to musculoskeletal ultrasound services for patients in our clinic. We collected self-reported usage and attitudes toward musculoskeletal ultrasound among interns in our clinic. Descriptive statistics summarized the data.

Results: The response rate was 60.1% (101/168). Overall, 31.7% (n=32) of respondents reported access of musculoskeletal ultrasound services. Ninety-one percent (n=29) reported the experience as beneficial. Identified benefits included: improved anatomic understanding, exclusion or confirmation of diagnoses, increased confidence, and patient reassurance. Of those that did not report use, 96% (n=66) reported interest in future use. Frequently reported limiting factors included: absence of indications for imaging, and patient ineligibility.

Conclusion: Our findings support musculoskeletal ultrasound implementation in an educational clinic to enhance student learning and confidence.

Spinal manipulative therapy (SMT) is commonly used by chiropractors, and much attention has been given to teaching students how to master it. Currently, over 20 chiropractic educational institutions use some type of force-sensing device (FSD) to teach students how to modulate their SMT force-time characteristics. Modulating SMT forces is believed to improve SMT's effectiveness, increase comfort during SMT, and reduce adverse events, contributing to improved clinical outcomes. In this commentary, we highlight the transition we are currently living in and discuss the strengths, uncertainties and opportunities of using FSDs to modulate SMT force-time characteristics within research, education, and clinical practice. Given that additional high-quality research is needed to determine if the ability to modulate SMT force-time characteristics indeed influences clinical effectiveness, increases patient comfort, and reduces adverse events, a collaborative effort is needed to address these critical research gaps. Specifically, having similar FSDs across educational institutions allows the collection of multicenter data, sharing research findings across different settings, and provides a unique opportunity for advancing educational and clinical research.

Objective: The purpose of this review was to summarize the available literature on the use of spinal manipulative therapy for the management of fibromyalgia.

Methods: A narrative review of the literature was performed through February 29, 2024, using keywords and Boolean operators, such as "manipulation AND fibromyalgia." Databases searched include MEDLINE, ICL, PEDro, the Cochrane Library, Google Scholar, as well as clinical trials registries. Online literature mapping was also used to identify relevant studies. All publications involving spinal manipulation for fibromyalgia management were included, excluding editorials, commentaries, conference proceedings, and trade magazine articles.

Results: A total of 38 publications met the inclusion criteria. These results consisted of nine case reports, three case series, four pilot studies, four randomized controlled trials, 14 systematic reviews, and four clinical practice guidelines with publication dates ranging from 1997 to 2023.

Conclusion: Higher-quality controlled studies are limited and report mixed results for treating fibromyalgia with spinal manipulation, while lower-quality studies are more likely to report benefit following treatment. Systematic reviews report a lack of established efficacy or inconclusive evidence, while clinical practice guidelines vary widely from strong recommendations against its use to suggesting that it be considered as a component of multi-modal treatment.

The Canadian Memorial Chiropractic College (CMCC) began delivering the GLA:D® Canada program for knee and hip osteoarthritis (OA) in 2018. Little is known about the program participants or their outcomes. This study aimed to describe participant characteristics and outcomes (via a secondary dataset analysis) of CMCC patients in the GLA:D^® Canada registry from inception to June 30, 2023. Results revealed improvements in mean scores for knee-related pain, function, quality of life, and hip-related pain. Health related quality of life and self-efficacy in managing symptoms were similar for participants with knee and hip OA. Demographic and outcome data were similar between CMCC and other GLA:D^® programs in Canada and internationally. The data from this analysis may provide further investigative opportunities to better understand the experience of GLA:D^® patients, clinical and educational faculty and students at CMCC, and should be conducted to optimize the program for an academic chiropractic setting.

Objective: To describe the utility of a tricompartmental offloading knee brace as an adjunct intervention for managing persistent PFP conditions.

Clinical features: Three cases of active adult females with persistent PFP following non-response to conventional and guideline aligned management strategies are presented.

Intervention and outcomes: Patients were managed using a tricompartmental offloading knee brace alongside individualized exercise programs for up to 12 weeks. Subjective and objective measures of pain and function were measured at three distinct time points. Each patient reported decreased pain, increased activity tolerance, and demonstrated improvements in both strength and functional performance over the course of the intervention period.

Summary: The use of tricompartmental offloading knee bracing alongside exercise therapy may be effective for the management of persistent PFP and should be considered for active adult females if unresponsive to both conventional and guideline aligned treatments.

Objectives: To explore the challenges and opportunities for research capacity development in the sports chiropractic field.

Methods: A qualitative description study was conducted using semi-structured interviews with 20 sports chiropractic researchers from eight countries and focus group interviews with 12 sports chiropractic leaders from Canada.

Results: Challenges and opportunities for research capacity development were identified within four main themes - 1) affiliations and collaborations, 2) human resources, 3) financial resources, and 4) operational resources. Profession-specific challenges included being "siloed", a lack of knowledge of the chiropractic profession, and its negative perception. Profession-specific opportunities included creating a sports chiropractic research chair/centre and engaging sports chiropractors in practice- and field-based research networks.

Conclusions: These results can inform strategies to advance research capacity development for the sports chiropractic field and develop context-specific indicators for ongoing research capacity assessment.