Chiropractic & Manual Therapies最新文献

Background: Many health care professionals use spinal mobilization (MOB) and manipulation (MAN) to treat musculoskeletal disorders. Research shows advantages of learning these techniques using a manikin. However, the force-time characteristics of MOB and MAN applied to manikins may differ from those delivered clinically to humans. This study reports on differences between the force-time characteristics of MOB and MAN delivered by experienced physiotherapists to the thoracic spine of both humans and a manikin.

Methods: Data were collected September-October 2023. Experienced physiotherapists applied prone MOB (Grade 3 central posterior-to-anterior, 30 s) and a single prone MAN to the T6 vertebra of three healthy human volunteers and a manikin with each volunteer-manikin pair representing one of three different patient scenarios (vignettes): vignette 1: 30-year-old male, 185 cm; vignette 2: 50-year-old male, 175 cm, and vignette 3: 65-year-old female, 165 cm. The applied forces were measured using a flexible pressure pad (100 Hz) and were compared descriptively between humans and the manikin.

Results: Data were analyzed from 13 physiotherapists (seven females, age (median, IQR): 40 (36-45) years, experience as physiotherapist: 14 (12-21) years). Peak forces on the manikin were higher than on the humans. Specifically, for MOB, average mean peak force differences (95% confidence interval) were: vignette 1: 58N (36, 80); vignette 2: 99N (74, 124); and vignette 3: 50N (31, 68). Similarly, for MAN, average peak force differences were: vignette 1: 128N (79, 177); vignette 2: 147N (94, 199); and vignette 3: 137N (101, 172). For MAN, greater mean peak forces were applied on vignette 1 than vignette 3 on the human 355N vs 284N and on the manikin 483N vs 421N.

Conclusion: In this study force-time characteristics of MOB and MAN performed by experienced physiotherapists on the thoracic spine of a manikin were different from those delivered to healthy humans: the forces applied to the manikin were higher for all vignettes for both techniques. However, forces were modulated to the vignette, both on the human and manikin.

Background: Lumbar spinal stenosis (LSS) can be disabling and is a leading reason for spinal surgery in older adults. While nonsurgical treatments are recommended as first-line treatment, it remains unclear which patients will benefit most.

Purpose: To identify patient characteristics associated with larger improvements or larger treatment effects among adults receiving nonsurgical LSS interventions.

Design: Secondary analysis of a randomized controlled trial.

Setting: Outpatient research clinics.

Subjects: 216 older adults with symptomatic LSS.

Methods: Participants, recruited from November 2013 to June 2016, were randomized to receive: (1) manual therapy with an individualized exercise program (MTE); (2) a group exercise (GE) program; or (3) medical care (MC). We evaluated the association of baseline characteristics with 2-month change in primary outcomes: symptoms and function on the Swiss Spinal Stenosis questionnaire (SSSQ); and walking capacity in meters (m) on the self-paced walking test (SPWT). Baseline characteristics included sociodemographic and clinical variables. To explore heterogeneity of treatment effects, we evaluated unadjusted stratified estimates when comparing MTE to GE/MC. Additionally, we included an interaction term in models to test for statistical interaction.

Results: At baseline, participants (mean age = 72, 54% female, 23% non-white) had moderate LSS-related symptoms/impairment (mean SSSQ score = 31.3) and limited walking capacity on SPWT (mean = 451 m). The overall improvement on SSSQ was 2.5 points with larger improvements observed among younger, non-white, non-smoking participants, and those with worse baseline LSS or back-related symptoms/impairment. Overall improvement on the SPWT was 205 m with larger improvements observed among younger participants, those with higher baseline physical activity levels and participants without knee osteoarthritis. For SSSQ, the treatment effect was larger among adults aged < 70 versus older adults (MTE vs. GE/MC; mean difference [MD] = - 4.06, 95% CI = - 6.29 to - 1.83 vs. MD = - 0.47. 95% CI = - 2.63 to 1.69, respectively; p-for-interaction = 0.02). For walking capacity, the treatment effect was larger among adults with hip osteoarthritis compared to those without (MTE vs. GE/MC; MD = 500 m, 95% CI = 71 to 929, vs MD = 13 m, 95% CI = - 120 to 147, respectively; p-for-interaction = 0.007).

Conclusions: In a sample receiving nonsurgical treatments for LSS, we identified patient-level characteristics associated with larger improvements and/or treatment effects. If confirmed in larger randomized controlled trials, these findings may guide clinical decision-making to enhance clinical outcomes.

Clinicaltrials:

Gov identifier: NCT01943435.

Background: Literature on low back pain (LBP) treatment suggests not all LBP is the same and patients with extension- or flexion-related LBP may benefit from different strategies. This study's objective was to evaluate the effect of participant positioning when delivering spinal manipulation on reported immediate comfort, in individuals with LBP.

Methods: This a randomized crossover trial. Volunteer adult participants with LBP were recruited from a chiropractic college campus clinic to receive two procedures in random order: 1. Standard side posture lumbopelvic manipulation (SPLM) and 2. Modified flexed lumbopelvic manipulation. The modified position was similar to the standard, but with increased hip and lumbopelvic flexion. Participants were not blinded. The primary outcome of self-reported comfort was recorded using a 0-10 scale. Paired t-tests were used to compare mean comfort scores, and a minimal clinically important difference of 2.0 was used. Secondary analysis examined correlations between comfort during active range of motion (AROM) and the two SPLM procedures. An exploratory analysis comparing within-participant differences was examined. All reported harms were mild in nature (e.g. discomfort).

Results: Forty participants were recruited (mean 25.5 years of age, 75% female). 20 participants started with the Standard SPLM and 20 started with the Modified Flexed SPLM. No differences in comfort were found between the Standard SPLM (N = 40) versus Modified flexed SPLM (N = 40), (mean (SD) = - 0.01 (2.3), Effect Size Cohen's d = - 0.004 95% CI (- 0.32, 0.32)). No correlations were found between the comfort during AROM and the two SPLM procedures. Observing within-participant differences for individual comfort, 14 participants had a clinically significant difference ≥ 2. Specifically, 6 participants had lower scores with Standard SPLM and 8 participants had lower scores with Modified flexed SPLM.

Conclusion: Comparing comfort during a Modified flexed SPLM to the Standard one revealed no difference for a population with LBP. However, some individuals did demonstrate a comfort preference for a Standard versus a Modified flexed position. Future studies should examine other variations of manipulation and particular subgroups of individuals with LBP (e.g. direction related) that experience discomfort during manipulation.

Background: Chiropractors are trained to help others, but do chiropractors need help themselves? While many health professions have been surveyed regarding their mental health and wellness, no such comprehensive survey has been conducted in the chiropractic profession. These data are important to improve the health of individual chiropractors, designing effective interventions and creating a strategic workforce plan.

Methods: We used a cross-sectional design to survey Canadian chiropractors and students between 02-2023 and 04-2023. We adapted the Canadian Medical Association's questionnaire with permission. The questionnaire was divided into 5 domains; we report results from the psychological domain. Descriptive statistics were tabulated and inferential statistics conducted on each psychological test stratified by gender, age, years and type of practice, and geographic location. From these data, most-at-risk and least-at-risk profiles were constructed.

Results: Anonymous data were obtained from 2109 respondents (26% response rate). The majority identified as male, white and without disability. Respondents identifying as practicing chiropractors and students represented 92.6% and 4.5% of the sample, respectively. From the mental health continuum, 57.8% of Canadian chiropractors were considered to be flourishing and only 5.3% languishing. Chiropractors reported experiencing substantial levels of mental health issues including burnout (33.2%), anxiety (22.0%), and lifetime depressed mood (36.8%). Most notably, 26.7% of responding chiropractors reported having lifetime suicidal ideation. Respondents identifying as having a disability (20%) or being students reported more unfavourable scores across all psychological measures. The most at-risk profile for a Canadian chiropractor is a young female practitioner (under 31) with less than 5 years of experience. In contrast, the least at-risk profile is an older male (over 60) with 31 or more years of practice experience.

Conclusion: This is the first comprehensive evaluation of mental health and wellness in the Canadian chiropractic profession. The results demonstrate that, like other professions, there are mental health and wellness challenges among Canadian chiropractors. These data have value in designing preventative and intervention strategies for those most at-risk. Currently, this survey is being conducted in other countries to understand the mental health of the chiropractic profession in different settings. Future work will analyze the remaining domains.

Background: Low back pain (LBP) is increasingly common among adolescents, yet little is known about the healthcare utilization in this population. We aimed to describe the characteristics and treatment patterns of adolescents with LBP presenting to a specialized comprehensive pediatric health system.

Methods: This retrospective single-arm cohort design analyzed de-identified data from a suburban healthcare system. Using the TriNetX analytics platform, we queried electronic health records for adolescents aged 12-18 years with a new diagnosis of LBP between 2018 through 2022 without serious pathology such as cancer or infection. Key variables included baseline patient demographics, comorbidities, initial care setting, and the proportion and count of use of broad categories of healthcare services over a one-year follow-up window.

Results: Our query identified 6,350 adolescents with LBP (mean age [standard deviation] of 14.8 [1.8] years; 60.6% female). The most common initial setting was ambulatory (80.5%). Services received by patients included non-opioid medication (38.8%), non-pharmacological conservative care (26.1%), diagnostic imaging (29.4%), opioids (11.3%), surgery (0.3%), and interventional injection therapies (≤ 0.2%).

Conclusion: Among adolescents with newly diagnosed LBP from a specialized comprehensive pediatric healthcare system in Wisconsin from 2018 to 2022, 38.8% were prescribed non-opioid medications, 29.4% obtained diagnostic imaging, 26.1% had non-pharmacological conservative care, and 11.3% were prescribed opioids. Future studies should explore these findings in other care settings and examine optimal care pathways and associated clinical outcomes.

Background: Understanding the factors influencing surgical decisions specific to symptomatic lumbar spinal stenosis (SLSS) can help healthcare providers support patients, set expectations and improve health literacy. Therefore, the purpose of this study is to explore the experiences and perspectives of Canadian patients who choose to undergo surgery for SLSS.

Methods: We used qualitative interpretive phenomenology to understand the surgical decision-making process from individuals with lived experience of SLSS. We conducted semi-structured qualitative interviews that lasted between 30 and 90 min. Inclusion criteria were individuals 55 or older, diagnosed with SLSS, scheduled for or have undergone lumbar spine surgery, and able to speak English. Participants were recruited between October 2019 and September 2021.

Results: A total of 32 participants (Men: n = 18; Women: n = 14) were included in this study. Among those participants, 15 were interviewed preoperatively and 17 postoperatively, and all were over 55 years. We identified 5 themes that were woven through the decision-making of respondents, beginning with the experience with healthcare systems and building outwards to the broader social context: (1) Previous experience with non-surgical management, (2) Worrisome symptoms impacting functionality, (3) Perception of surgery as a final course of action, (4) Post-surgical hopes/expectations (i.e., hope that they will be pain-free after surgery), and (5) Having a social support network (i.e., advice and support from family/friends).

Conclusion: Several experiences may influence an individual's decision to undergo spine surgery, highlighting the importance of integrating a biopsychosocial model in managing SLSS. For chiropractors and manual therapists, these indicators are particularly important, as they often represent a first point of contact for patients with SLSS. Clinicians must maintainperson-centric communication to help patients understand their condition and the clinical treatment pathway for SLSS and develop post-surgical expectations.

Background: Various analgesics are frequently prescribed by physicians and used by patients with low back pain (LBP) despite limited effect on pain and disability and risk of side effects. Current knowledge on how psychological measures and self-management interventions influence analgesic use is limited. We investigated if analgesic use changed after participating in a patient education and exercise therapy program (GLA:D® Back), to what extent analgesic use and self-efficacy at baseline were potential determinants of analgesic use at the end of the program, and, to what extent improvement in self-efficacy from before to after the intervention modified the relationship between analgesic use at baseline and follow-up.

Methods: We used data from the Danish GLA:D^® Back registry collected from March 28, 2018, until October 16, 2023. Potential determinants were self-reported baseline analgesic use and self-efficacy (the Arthritis Self Efficacy Scale pain subscale). The outcome was analgesic use at 3 months follow-up. We used logistic regression to investigate associations and effect modification.

Results: Among 4721 included participants, 34% of those using analgesics at baseline (n = 942) discontinued this at 3 months follow-up. Analgesic use at baseline was associated with increased odds of analgesic use at follow-up (odds ratio [OR]: 9.79, 95% confidence interval [CI]: 7.88, 12.15), and higher levels of self-efficacy at baseline was associated with decreased odds of analgesic use at follow-up (OR: 0.85, 95% CI: 0.81, 0.89). Improved self-efficacy, obtained during the program, reduced the risk of analgesic use at follow-up from 15 to 6% and from 76 to 54% among participants with and without baseline analgesic use respectively.

Conclusions: Patients using analgesics when initiating care were more likely to use analgesics three months later, while those having high levels of self-efficacy were less likely. Improved self-efficacy during the program reduced the absolute risk of analgesic use following the intervention to a larger extent among those using analgesics at baseline compared to those without baseline use. Further investigation is needed to confirm whether these findings reflect causal effects.

Background: Clinical guidelines for managing non-specific spine pain recommend providing patient education and self-management support strategies (SMSS) as first-line treatment. However, SMSS implementation in daily chiropractic care remains challenging. This study aimed to assess the level of patient activation in their care, explore chiropractic senior interns and clinician supervisors' beliefs about evidence-based practice (EBP) and self-management support, and identify theoretical barriers and facilitators to implementing SMSS.

Methods: We used a three-phase mixed-methods convergent design. In phase 1, during the spring and summer of 2022, 250 consecutive adults with spine pain at the outpatient chiropractic clinic at the Université du Québec à Trois-Rivières, Quebec, Canada, were invited to complete the patients' activation measure (PAM). In phase 2, all senior interns (n = 39) and clinician supervisors (n = 29) were invited to complete three self-administered online questionnaires: 1) EBP Beliefs and Implementation Scales, 2) Pain Attitudes and Beliefs Scale (PABS), and 3) the Practice Style questionnaire. In phase 3, patients, interns and clinicians having completed the questionnaires were convened to semi-structured individual interviews based on the Theoretical Domains Framework (TDF).

Results: In phase 1, three quarters of patients (76.3%) reported a moderate-to-high level of activation. In phase 2, interns and clinician supervisors had similar EBP Beliefs mean scores (62.8% and 62.5%, respectively) and EBP Implementation scores (28.6% and 38.2%, respectively). For the PABS, no predominant biomedical or behavioural treatment orientations were observed among interns (mean (SD) = 34.8 (6.3) /60 vs 36.7 (3.5) /48) or clinicians (34.7 (9.1) /60 vs 34.6 (4.9) /48). Interns primarily had a pragmatic practice style, whereas clinicians were equally pragmatic and receptive. In phase 3, four key TDF domains emerged for patients (Social influences, Behavioural regulation, Emotions, and Goals); five for interns (Knowledge, Environmental Context and Resources, Skills, Memory, Attention and Decision Process, and Goals), and four for clinicians (Knowledge, Environmental Context and Resources, Social Influences and Beliefs on Consequences).

Conclusion: Although patients demonstrated moderate-to-high activation, EBP and SMSS implementation among interns and supervisor was limited. Treatment orientation, practice style, and contextual factors highlight the need for targeted educational and organizational strategies to bridge the knowledge-practice gap.