Chiropractic & Manual Therapies最新文献

Background: The prevalence of headache disorders is imposing a growing burden on public health. Although most patients are seen in primary care, there is an absence of validated questionnaires designed to describe how clinicians manage patients with headache in primary care. The aim of this study was to develop a standardised headache questionnaire for use by primary care clinicians, covering diagnostic procedures, management strategies, and treatment modalities, and to assess the prevalence of consultations for headache in primary care.

Methods: The Danish Headache Questionnaire was developed through a three-phase process: a development phase, a content validation phase via iterative feedback, and a phase to create a generic English version. The Danish Headache Questionnaire includes a survey that covers diagnostic procedures, management strategies, and treatment modalities, and a logbook for tracking the prevalence of consultations for headaches. The questionnaire was tested by Danish chiropractors in primary care from 2020 to 2022.

Results: The Danish Headache Questionnaire underwent several modifications. The survey was expanded to include questions about the Danish profession-specific guideline for managing headaches, different headache types, medical history, radiographic imaging, and potential side effects. The logbook was revised to allow for the documentation of multiple headaches and included a separate form for recording the total number of consultations. The generic version was adapted by removing or adjusting profession-specific terms and questions to suit other clinical environments. The final Danish Headache Questionnaire is available in a generic and a chiropractic-specific format, and was translated to English through a cross-cultural adaptation process.

Conclusions: The Danish Headache Questionnaire has good content validity and is a feasible tool for assessing clinicians' knowledge in managing patients with headaches and gathering data on headache prevalence in primary care. The generic version promotes a uniform approach and enables comparative analysis across different settings. The Danish Headache Questionnaire may be a valuable instrument guiding teaching a standardised assessment and for clinical assessment in primary care. Furthermore, it may have the potential to fill in gaps of knowledge which could improve the management of headache disorders in primary care.

Introduction: Limited adoption of first line treatments for low back pain (LBP) in primary care settings may contribute to an overreliance on pain medications by primary care providers (PCPs). While chiropractic care typically includes recommended nonpharmacologic approaches (e.g., manual therapy, exercise instruction, advice on self-care), implementation strategies to increase adoption of chiropractic care for LBP in primary care clinics are understudied, particularly in underserved communities.

Methods: We will use a stepped-wedge cluster randomized controlled pilot trial design to evaluate the feasibility of a multi-level implementation strategy to increase adoption of chiropractic care for LBP in primary care clinics at community health centers. Key barriers and facilitators identified by site champions and other key stakeholders will help us to develop and tailor implementation strategies including educational materials and meetings, developing a network of local chiropractors, and modifying the electronic health record to facilitate referrals. Three primary care clinics will be randomized to receive the implementation strategy first, second, or third over a fourteen-month study period. At our first clinic, we will have a four-month pre-implementation period, a two-month implementation deployment period, and a subsequent eight-month follow-up period. We will stagger the start of our implementation strategy, beginning in a new clinic every two months. We will evaluate the proportion of patients with LBP who receive a referral to chiropractic care in the first 21 days after their index visit with PCP. We will also evaluate adoption of other guideline concordant care (e.g., other nonpharmacologic treatments) and non-guideline concordant care (e.g., opioids, imaging) over the study period.

Discussion: LBP is currently the leading cause of disability worldwide. While there are several treatment options available for individuals with LBP, patients in underserved populations do not often access recommended nonpharmacologic treatment options such as chiropractic care. The results from this study will inform the development of practical implementation strategies that may improve access to chiropractic care for LBP in the primary care context. Furthermore, results may also inform policy changes needed to expand access to chiropractic care in underserved communities. CLINTRIALS.GOV NCT#: NCT06104605.

Background: Chronic low back pain (CLBP) presents a significant challenge for manual therapists. Recent advancements in pain research have highlighted the limitations of the traditional biomedical and biopsychosocial models, prompting the exploration of alternatives. The biopsychosocial-enactive (BPS-E) model has emerged as a promising alternative. This study aims to explore the application of the BPS-E model by manual therapists in managing CLBP and to initiate a meaningful dialogue about its use.

Methods: This study adhered to the Standards for Reporting Qualitative Research. Guided by constructivist grounded theory, we conducted semi-structured interviews with ten manual therapists who are experts in the BPS-E model. Data collection, conceptualization, and analysis were systematically carried out to identify key themes and insights.

Results: The core theme identified was "The person-centred approach," with three subthemes: "Opportunities in implementing the model", "Utilizing and Integrating Diverse Skills for Holistic Care", and "Challenges in implementing the model".

Conclusion: This study provides insights into how manual therapists incorporate the BPS-E model in their practice, demonstrating its advantages over the traditional biopsychosocial model. The findings highlight the need for further research and training to effectively implement the BPS-E model in clinical settings. This research begins an essential discussion on the potential of the BPS-E model to enhance care for CLBP patients.

Background: Evidence has been reported that spinal manipulation therapy (SMT) leads to spine segmental hypoalgesia through neurophysiological and peripheral mechanisms related to regulating inflammatory biomarker function. However, these studies also showed substantial inter-individual variability in the biomarker responses. Such variability may be due to the incomplete understanding of the fundamental effects of force-based manipulations (e.g., patient-specific force-time characteristics) on a person's physiology in health and disease. This study investigated the short-term effects of distinct SMT force-time characteristics on blood oxidative stress and pro-resolution of inflammation biomarkers.

Methods: Nineteen healthy adults between 18 and 45 years old were recruited between February and March 2020 before the COVID-19 pandemic and clustered into three groups: control (preload only), target total peak force of 400 N, and 800 N. A validated force-sensing table technology (FSTT^®) determined the SMT force-time characteristics. Blood samples were collected at pre-intervention, immediately after SMT, and 20 min post-intervention. Parameters of the oxidant system (total oxidant status, lipid peroxidation and lipid hydroperoxide), the antioxidant system (total antioxidant capacity and bilirubin), and lipid-derived resolvin D1 were evaluated in plasma and erythrocytes through enzyme-linked immunosorbent assay and colorimetric assays.

Results: The COVID-19 global pandemic impacted recruitment, and our pre-established target sample size could not be reached. As a result, there was a small sample size, which decreased the robustness of the statistical analysis. Despite the limitations, we observed that 400 N seemed to decrease systemic total oxidant status and lipid peroxidation biomarkers. However, 800 N appeared to transitorily increase these pro-oxidant parameters with a further transitory reduction in plasma total antioxidant capacity and resolvin D1 mediator.

Conclusion: Despite the small sample size, which elevates the risk of type II error (false negatives), and the interruption of recruitment caused by the pandemic, our findings appeared to indicate that different single SMT force-time characteristics presented contrasting effects on the systemic redox signalling biomarkers and pro-resolution of inflammation mediators in healthy participants. The findings need to be confirmed by further research; however, they provide baseline information and guidance for future studies in a clinical population.

Background: There is limited high-quality research examining conservative treatments for back-related leg pain (BRLP). This feasibility study was done in preparation for a full-scale trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP.

Methods: Participants were randomized to 12 weeks of individualized supported self-management delivered by physical therapists and chiropractors or medical care consisting of guideline-based pharmacologic care. Supported self-management was based on a behavioral model that used a whole person approach to enhance participants capabilities, opportunities, and motivations to engage in self-care. It combined BRLP education with psychosocial strategies (e.g., relaxed breathing, progressive muscle relaxation, guided imagery, communication skills) and physical modalities such as exercise and spinal manipulation therapy. Providers were trained to address participants' individualized needs and use behavior change and motivational communication techniques to develop a therapeutic alliance to facilitate self-management. Feasibility was assessed using pre-specified targets for recruitment and enrollment, intervention delivery, and data collection over the six-month study period. In addition, areas for potential refinement and optimization of processes and protocols for the full-scale trial were assessed.

Results: We met or exceeded nearly all feasibility targets. Forty-two participants were enrolled over a six-month period in 2022 and very few individuals declined participation due to preferences for one treatment. All but one participant received treatment and 95% of participants attended the minimum number of visits (self-management = 6, medical care = 2). At 12 weeks, 95% of participants in the self-management group reported engaging in self-management practices learned in the program and 77% of medical care participants reported taking medications as prescribed. Satisfaction with the self-management intervention was high with 85% of participants reporting satisfaction with the program overall. Self-management intervention providers delivered all required activities at 72% of visits. Providers also noted some challenges navigating the shared decision-making process and deciding what self-management tools to prioritize. Over the six-month study period, completion rates were 91% for monthly surveys and 86% for weekly surveys.

Conclusion: We were able to demonstrate that a full-scale randomized trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP is feasible and identified important areas for optimization.

Background: A significant body of research has examined how the attire of physicians and nurses affects patients' perceptions, preferences, and outcomes. However, limited research has focused on the clothing worn by other health professionals, such as chiropractors. The present study aims to explore patients' preferences and perceptions of chiropractors' attire.

Methods: Using a cross-sectional image-based procedure, new patients to a university clinic were questioned regarding their preferences for four different attires (casual, formal, scrub, and white coat) worn by both a male and a female chiropractor. Patients also reported their perceptions in terms of chiropractors' knowledge, trustworthiness, competence, professionalism, and comfortable for each photograph.

Results: From August 10, 2022, to January 23, 2023, 75 new patients participated in the study. Results indicated a strong preference for scrubs for both male and female chiropractors. Chiropractors in scrubs were also seen as more knowledgeable, trustworthy, competent, and professional, and comfortable. This was closely followed by those wearing white coats and formal attire. Notably, the white coat worn by the female chiropractor received significantly more positive ratings than when worn by her male counterpart.

Conclusion: In conclusion, our findings suggest that chiropractors' attire influences patients' perceptions and should be considered in the development of dress codes for public and private clinics. Further research is essential to understand better how the gender and age of care providers affect patient evaluations.

Background: Blinding is essential for mitigating biases in trials of low back pain (LBP). Our main objectives were to assess the feasibility of blinding: (1) participants randomly allocated to active or placebo spinal manual therapy (SMT), and (2) outcome assessors. We also explored blinding by levels of SMT lifetime experience and recent LBP, and factors contributing to beliefs about the assigned intervention.

Methods: A two-parallel-arm, single-centre, placebo-controlled, blinding feasibility trial. Adults were randomised to active SMT (n = 40) or placebo SMT (n = 41). Participants attended two study visits for their assigned intervention, on average seven days apart. The primary outcome was participant blinding (beliefs about assigned intervention) using the Bang blinding index (BI) at two study visits. The Bang BI is arm-specific, chance-corrected, and ranges from - 1 (all incorrect beliefs) to 1 (all correct beliefs), with 0 indicating equal proportions of correct and incorrect beliefs. Secondary outcomes included factors contributing to beliefs about the assigned intervention.

Results: Of 85 adults screened, 81 participants were randomised (41 [51%] with SMT lifetime experience; 29 [39%] with recent LBP), and 80 (99%) completed follow-up. At study visit 1, 50% of participants in the active SMT arm (Bang BI: 0.50 [95% confidence interval (CI), 0.26 to 0.74]) and 37% in the placebo SMT arm (0.37 [95% CI, 0.10 to 0.63]) had a correct belief about their assigned intervention, beyond chance. At study visit 2, BIs were 0.36 (0.08 to 0.64) and 0.29 (0.01 to 0.57) for participants in the active and placebo SMT arms, respectively. BIs among outcome assessors suggested adequate blinding at both study visits (active SMT: 0.08 [- 0.05 to 0.20] and 0.03 [- 0.11 to 0.16]; placebo SMT: - 0.12 [- 0.24 to 0.00] and - 0.07 [- 0.21 to 0.07]). BIs varied by participant levels of SMT lifetime experience and recent LBP. Participants and outcome assessors described different factors contributing to their beliefs.

Conclusions: Adequate blinding of participants assigned to active SMT may not be feasible with the intervention protocol studied, whereas blinding of participants in the placebo SMT arm may be feasible. Blinding of outcome assessors seemed adequate. Further methodological work on blinding of SMT is needed.

Trial registration number: NCT05778396.

Objectives: To describe the structure and development of a new international, chiropractic, practice-based research network (PBRN), the Chiropractic International Research Collaborative (CIRCuit), as well as the demographic, practice, and clinical management characteristics of its clinician participants. An electronic survey was used to collect information on their demographics, practice, and clinical management characteristics from clinicians from 17 October through 28 November 2022. Descriptive statistics were used to report the results.

Background: PBRNs are an increasingly popular way of facilitating clinic-based studies. They provide the opportunity to collaboratively develop research projects involving researchers, clinicians, patients and support groups. We are unaware of any international PBRNs, or any that have a steering group comprised of equal numbers of clinicians representing the different international regions.

Results: 77 chiropractors responded to the survey (0.7% of EBCN-FB members). 48 were men (62%), 29 women (38%). Thirty-six (47%) were in North America, 18 (23%) in Europe, and 15 (19%) in Oceania. Participants reported predominantly treating musculoskeletal issues, often with high-velocity, low-amplitude spinal manipulation (95%), but also with soft tissue therapy (95%), exercise (95%), and other home care (up to 100%).

Methods: The development of CIRCuit is described narratively. Members of the Evidence-Based Chiropractic Network Facebook group (EBCN-FB) were invited to become clinician participants by participating in the survey.

Conclusions: This paper describes the development of a new PBRN for chiropractors. It offers a unique opportunity to facilitate the engagement of clinical chiropractors with research, as well as for academics to readily be able to access an international cohort of clinicians to collaboratively develop and conduct research. Although the results of the survey are not statistically generalisable, the initial cohort of CIRCuit clinician participants use similar techniques on similar types of conditions as the profession at large. The international structure is unique among PBRNs and offers the opportunity to help develop innovative research projects.

Background: Some chiropractors use spinal x-rays to inform care, but the relationship between radiographic findings and outcomes is unclear. This study examined the association between radiographic findings and 30% improvement in back-related disability in older adults after receiving 12 weeks of chiropractic spinal manipulation and home exercise instruction.

Methods: This IRB-approved secondary analysis used randomized trial data of community-dwelling adults age ≥ 65 with chronic spinal pain and disability. Data were collected during the parent trial between January 2010-December 2014. The primary outcome of the parent study was ≥ 30% improvement in Oswestry Disability Index (ODI) at 12 weeks, a clinically important response to care. In this secondary analysis, two chiropractic radiologists independently assessed digital lumbar radiographs for pre-specified anatomic, degenerative, and alignment factors; differences were adjudicated. The unadjusted association between baseline radiographic factors and 30% ODI improvement was determined using chi-square tests.

Results: From the parent trial, 120 adults with baseline lumbar radiographs were included in this study. Mean age was 70.4 years (range 65-81); 59.2% were female. Mean baseline disability (ODI = 25.6) and back pain (5.2, 0-10 scale) were moderate. Disc degeneration (53.3% moderate, 13.3% severe), anterolisthesis (53.3%), retrolisthesis (36.6%) and scoliosis (35.0%) were common among the participant sample. After 12-weeks of treatment, 51 (42.5%) participants achieved 30% improvement in back disability. No alignment, degenerative, or anatomic factors were associated with ODI improvement at 12 weeks (all p > 0.05), regardless of severity of radiographic findings.

Conclusion: We found no association between a predetermined subset of radiographic findings and improvement in back-related disability among this sample of older adults. As such, this study provides preliminary data suggesting that imaging may be unhelpful for predicting response to chiropractic spinal manipulation and home exercise.

Background: Spinal manipulation (MAN) and mobilization (MOB) are biomechanically different yet both elicit pain reduction and increased range of motion. Previous investigations have focused on quantifying kinetics (e.g., applied forces) or, recipient kinematics (i.e., movements) during MAN and MOB. While these studies provide valuable information, they do not report on the strategies adopted by providers when performing the complex motor tasks of MAN and MOB. This review sought to synthesise the literature reporting on provider kinematics during the delivery of MAN and MOB.

Methods: This scoping literature review is reported following the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. MEDLINE (Ovid), PsychINFO, Cochrane Library, Web of Science, Embase, Scopus, PEDro, ICL and CINAHL databases were searched from inception to September 2023 for terms relating to provider kinematics during the delivery of MAN and MOB. Data were extracted and reported descriptively, including: general study characteristics, number and characteristics of individuals who delivered/received MAN and/or MOB, region treated, equipment used and kinematic parameters of the individual delivering the procedure.

Results: Of 4,844 records identified, five (0.1%) fulfilled the eligibility criteria and were included in the analysis. Of these, provider kinematics were reported for the delivery of MAN in four (80%) and for the delivery of MOB in one (20%) article. Practitioners applied the procedure in all (100%) and students in one (20%) study. Spinal regions treated were: lumbar (n = 4), thoracic (n = 2) and cervical (n = 1). Data were reported heterogeneously but were most commonly captured using either video or motion capture equipment (n = 4, 80%). The direction of applied force was fully reported in one (20%) and only partially reported (one spinal region) in another study.

Conclusions: There are a small number of studies reporting heterogeneously on provider kinematics during the delivery of MAN and MOB. Clear reporting of the procedure from a biomechanical perspective and of the measurement equipment used could enable future meta-analysis of provider kinematic data, the use of provider kinematic data in the development of technique skills curricula and could feasibly be used to mitigate risk of injury for providers.