Journal of the Canadian Chiropractic Association最新文献

Introduction: Brief action planning (BAP) is a collaborative tool to support patients' self-management goal setting and action planning. BAP facilitates patient self-reflection, and provides opportunity to establish goals of their own priority.

Case presentation: A 55 year-old female with recentonset low back pain with L5 nerve root distribution, described severe pain in the low back and sharp pain and tingle-sensations down to her right foot. Pain worsened with sitting, coughing, and bending. She was diagnosed with lumbar and other intervertebral disc disorder with radiculopathy (ICD 10: M51.1).

Treatment: Initial treatment included reassurance, education, promotion of movement, and manual therapies. Symptoms worsened at the eighth visit (five weeks) where she also demonstrated pain-catastrophizing behaviours and an over-reliance on passive treatment strategies (i.e., psychosocial factors or yellow flags). BAP was introduced into her treatment plan to set achievable goals for her care.

Outcome: Decreased pain and disability were reported after incorporating BAP into care. Reduced pain-catastrophizing and reduced over-dependence on passive strategies were also demonstrated. Clinical gains were sustained at the 10-week follow-up assessment.

Key clinical message: We describe the utilization of brief action planning as a technique for improving adherence to evidence-based clinical practice guideline recommendations in a patient with acute low back pain and radiculopathy, and late-onset psychosocial factors.

Objective: This study aims to gather information on conditions seen, treatments rendered, and referrals made during a Canadian Memorial Chiropractic College outreach to the Dominican Republic serving those in need.

Methods: Data was extracted from templated patient files retrospectively.

Results: Spinal, extremity and other/whole body chief complaints accounted for 71.79%, 24.64% and 3.57% respectively in patients ranging in age from 1.5 to 106 years whose data was collected. Mechanical pain accounted for 95.07% of all cervical, 96.81% of thoracic and 91.27% of lumbar spine diagnoses. Various non-mechanical conditions were also encountered.Manual therapy was performed in 96.10% of cases. Twenty referrals were made to urgent care, six to a World Spine Care clinic and 46 for further investigation, including local medical doctors or surgery.

Conclusion: This study reports empirical data collected from an 11-day outreach to the Dominican Republic that provided otherwise unattainable chiropractic care for musculoskeletal complaints.

Purpose: The inter-rater reliability of the Quebec Task Force (QTF) classification system for Whiplash-Associated Disorders (WAD) remains unknown. Our objective was to determine the inter-rater reliability of the WAD classification between an experienced chiropractic clinician and two chiropractic residents.

Methods: We conducted an inter-rater reliability study using baseline clinical data from 80 participants assessed for inclusion in a randomized clinical trial of the conservative management of WAD grades I and II. We reported reliability using Cohen's kappa (k) and 95% confidence intervals (CI).

Results: The mean duration of WAD symptoms was 7.6 days (s.d.=5.2). In our study, the interrater reliability of the WAD grade classification varied from k=0.04 (95% CI -0.04 to 0.12) to k=0.80 (95% CI 0.67 to 0.94).

Conclusion: Inter-rater reliability of the WAD classification varied greatly across raters and may be associated with the experience of the raters and with their understanding of the criteria. Our results suggest that clinicians may benefit from training to standardize how they classify WAD. Furthermore, our results need to be tested in a different sample of patients and with a range of clinicians from different clinical disciplines.

Background: Due to their occupational status, military personnel are a high-risk group for low back pain (LBP).

Purpose: The aim of this study was to investigate the effect of neuromuscular exercises on the severity of pain, functional disability, proprioception, and balance in military personnel with LBP.

Methods: Military personnel with LBP were randomly assigned into two groups: intervention (n=15) and control (n=15). The intervention group performed 60 minutes of neuromuscular exercises three times per week for eight weeks while the control group continued their routine physical activities.

Results: The mean post-intervention pain intensity, disability, and proprioception error significantly decreased in the intervention group. Whereas their mean post-interventions static and dynamic balance scores significantly increased.

Conclusions: The results indicate eight weeks of neuromuscular exercise decreased pain intensity and improved functional ability, static and dynamic balance, and proprioception among military staff suffering chronic low back pain.

Background: Radiographic guidelines aim to increase the diagnostic yield of clinically relevant imaging findings whilst minimising risk. This study assessed the appropriateness of radiographic referrals made by student chiropractors and explored the association between guideline appropriate imaging and clinically significant radiographic findings.

Methods: Radiographic referral and report findings (n=437) from 2018 were extracted from Macquarie University chiropractic clinics. Appropriateness of radiographic referrals was assessed according to current radiographic guidelines. Radiographic findings were assessed for clinical significance. The association between guideline appropriate radiographic referral and clinically significant radiographic findings was assessed using logistic regression analysis and odds ratios were estimated.

Results: The proportion of guideline appropriate imaging was 55.8% (95%CI: 51.2-60.4). An association between guideline appropriate radiographs and clinically significant findings was found (OR: 2.2; 95%CI: 1.3-4.1).

Conclusions: Approximately half of all radiographic referrals made by chiropractic students were guideline concordant. Guideline appropriate imaging was associated with an increase in clinically significant radiographic findings.

Whiplash-associated disorder (WAD) is the most common complaint and purported cause of chronic disability associated with motor vehicle collisions in North America. However, its construct validity remains controversial. This narrative review of the literature summarises the evidence underlying the most commonly theorised biological and psychosocial mechanisms of WAD pathogenesis. While the face validity of WAD is good, empirical evidence supporting the various constructs suggesting a causal link between a trauma mechanism and the development of symptoms is poor. Because individual expectations of recovery are outcome-predictive, future research is necessary to develop a better understanding of how to enhance expectancies in order to help affected motorists gain a greater sense of control over their health and wellbeing.

Introduction: Musculoskeletal (MSK) conditions are primary reasons prohibiting Canadian Armed Forces (CAF) personnel from being deployed, with back pain the second most common activity-limiting condition. CAF provides a spectrum of services, including chiropractic care. There is a paucity of data related to chiropractic interprofessional care (IPC) within CAF healthcare settings.

Methods: A qualitative study, using an Interpretative Phenomenological Analysis (IPA) approach, involving 25 key informant interviews explored factors that impact chiropractic IPC. We used a systematic but not prescriptive process, based on a thematic analysis, to interconnect data to develop meaning and explanation. Initially, we explained and interpreted participant's experiences and meanings. Next, we used extant literature and theory, together with expert knowledge, to explain and interpret the meanings of participants' shared accounts.

Results: We present findings central to the domain, Role Clarity, as described in the IPC Competency Framework. Our findings call for strengthening IPC specific to MSK conditions in the CAF, including an examination of gatekeeping roles, responsibilities and outcomes.

Conclusion: It is timely to investigate models of care that nurture and sustain inter-provider relationships in planning and coordinating evidence-based chiropractic care for MSK conditions, within the CAF, and its extended referral networks.

Objective: The aims of this study were to determine the best aspects of being a chiropractor from the practitioners' perspective and to determine job satisfaction among respondents.

Methods: An anonymous online survey was distributed to members of the chiropractic profession from August to September 2019. The survey included 25 statements regarded as being "a positive aspect of being a chiropractor."

Results: Three hundred and sixty-nine chiropractors responded. Respondents believe that the best aspects of being a chiropractor are that chiropractors can reduce pain, help move or build strength, flexibility, and power in patients. In addition, chiropractors 'being trained to diagnose' and 'being able to transform peoples' quality of life' were highly scored. Job satisfaction overall was rated as high (median score of 9/10). However, there are some aspects that are not highly regarded as best aspects by the profession such as the respect of the public and other health professionals.

Objective: The 2019 Canadian guideline for physical activity throughout pregnancy provides evidencebased recommendations to promote maternal, fetal, and neonatal health. We aimed to 1) critically appraise the 2019 Canadian guideline for physical activity throughout pregnancy; and 2) develop a guideline summary for clinicians to facilitate the uptake of recommendations into practice.

Methods: We used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to critically appraise the quality and reporting of this guideline. Four reviewers independently scored between 1 (strongly disagree) to 7 (strongly agree) for 23 items organized into six quality domains.

Results: AGREE II quality domain scores ranged from 47%-64% and the overall quality of the guideline was rated as 83% (high quality).

Conclusion: Based on its methodological quality, we recommend the use of this guideline. Our guideline summary includes six recommendations and other safety precautions that are relevant for clinicians in Canada.

Objective: To explore the feasibility of collecting aggregated patient data from the electronic records of a group of private practices and to determine the suitability of the data for comparative effectiveness or other practice-based research (PBR).

Methods: Assess the type and quality of healthrelated variables contained in a commercially available electronic records system (Vitalogics) in use in consenting chiropractor's offices. Descriptively analyze baseline patient records to identify demographic variables, vital signs, case types and diagnoses.

Results: Of the 46,000 individual patient records that were analyzed, only a fraction had usable demographic data while more than half contained ICD-9 codes, including records for non-insurance case-types. None contained outcome variables.

Conclusion: We did not find that the electronic record system we examined had the types of demographic and outcomes variables that would be useful for comparative effectiveness research. The addition of special fields to code chief complaint and health status indicators not typically included in an electronic records system would be most useful.