Chiropractic & Manual Therapies最新文献

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.

Background: Musculoskeletal (MSK) pain affects quality of life and burdens healthcare systems, increasing the need for effective self-management tools. Mobile health apps offer a potential solution, but their adoption in clinical practice remains limited due to concerns about usability, patient engagement, and data security. Denmark is highly digitalized, with various digital health initiatives already in place. However, little is known about chiropractors' engagement with health apps. This study examines how Danish chiropractors utilize and perceive health apps in their practice, identifying key barriers and facilitators to adoption and providing insights for broader implementation in primary care settings to improve self-management support for patients with MSK pain.

Methods: A two-staged sequential mixed-methods exploratory study was conducted, comprising a quantitative survey distributed to active members of the Danish Chiropractic Association in June 2022 followed by 11 qualitative semi-structured interviews with a purposively sampled subset of respondents, conducted from November 2022 to May 2023. The quantitative data were analysed for frequencies and proportions, while qualitative data were analysed using framework analysis. Integration of both datasets was performed to identify patterns and insights.

Results: Out of 650 chiropractors, 294 (45%) responded to the survey, with 288 included in the analysis. The results indicated that while over half of the chiropractors used health apps personally, only 15% utilized them in patient care. Key barriers included limited knowledge, time constraints, and narrow scope of use, while facilitators included app user-friendliness and positive patient feedback. Qualitative insights revealed varied attitudes towards mHealth, with some chiropractors perceiving apps as valuable tools for patient support, while others expressed scepticism regarding their relevance and effectiveness.

Conclusion: This study provides valuable insights into the current state of health app integration within Danish chiropractic practice, highlighting the need for targeted education and policy changes to facilitate the adoption of digital health tools. It emphasizes the importance of addressing both patient and provider perspectives to enhance self-management strategies for MSK pain through mHealth solutions. The findings contribute to the broader discourse on digital health integration in healthcare, particularly within the chiropractic profession.

Background: Patient-centred care (PCC) is considered an essential concept in twentyfirst-century healthcare; however, health care providers' attitudes can be an important barrier or facilitator to its actual implementation. Chiropractic is frequently referred to as providing PCC. However, the attitudes of practising chiropractors towards patient-centred care have not previously been evaluated.

Objectives: To explore attitudes and orientation of chiropractors towards patient-centered care.

Methods: We used a sequential explanatory mixed methods with quantitative priority study design. Data were collected from May 2018 to April 2019 from a convenience sample of Canadian chiropractors located across Canada. Quantitative data were collected by a survey consisting of demographic and clinical practice questions, and the Patient-Practitioner Orientation Scale (PPOS) to measure practitioner attitudes towards care delivered (range 1-6, scores < 4.57 = doctor-centred attitudes). Qualitative data were collected using semi-structured interviews. Quantitative data were analyzed with descriptive statistics and bivariate analysis; whilst qualitative data were analyzed using thematic analysis.

Results: We included 31 chiropractors in the study, with seven completing interviews. The mean for PPOS Overall score was 4.35 (95% CI [4.18, 4.52]) and was found to be significantly associated with years in practice and number of patients seen per week. The average PPOS Sharing and PPOS Caring scores were 4.20 (95% CI 3.95-4.45) and 4.50 (95% CI 4.35-4.66), respectively. Number of patients seen per week and per hour were significant predictors of the PPOS Sharing score; whilst years in practice was a significant predictor of PPOS Caring and Overall scores. Interview data supported the association between greater exposure to patients and more patient-centred attitudes among chiropractors.

Conclusions: In our sample of Canadian chiropractors, doctor-centred attitudes towards care prevailed, comparable to that reported for other health professions. The significant association between patient-centred attitudes and patient load and clinical experience suggests that chiropractors may learn such attitudes through experience. Future research to further explore chiropractors' attitudes and orientation towards care using the PPOS or a similar instrument are required.

Introduction: A proactive patient safety culture is crucial in healthcare to minimize preventable harm and improve patient outcomes. This scoping review explores key themes, trends, and gaps in patient safety culture research within the chiropractic profession.

Methods: A comprehensive literature search was conducted across 5 databases from inception to December 2024. Peer-reviewed, English-language studies focusing on chiropractic patient safety culture were included. Following scoping review methodology, articles were screened, data were extracted, and both qualitative and quantitative analyses were conducted. External consultants from patient safety-focused chiropractic groups were sought to review findings. Trends and themes were identified, and findings were compared against established patient safety frameworks to highlight research gaps and future directions.

Results: Of the 3,039 screened articles, 65 met the inclusion criteria, spanning from 1990 to 2024, with 2 identified as randomized trials. Eight major themes were organized: (1) adverse event research, (2) clinical trial safety reporting, (3) patient safety attitudes, (4) clinical decision making, (5) informed consent, (6) reporting and learning systems, (7) office sanitization, and (8) general safety topics. Mapping these studies onto the Patient Safety Culture Pyramid framework revealed that 95% addressed safety performance, 81% covered safety processes, and only 23% explored beliefs and values. Comparisons with the WHO Global Patient Safety Action Plan framework highlighted advancements in clinical process safety while revealing research gaps in patient engagement, policy development, leadership, and interprofessional collaboration. Key recommendations include standardizing adverse event reporting, improving communication strategies, and developing structured approaches to patient and provider safety. External consultation provided minimal feedback requiring modifications.

Conclusion: This review underscores significant advancements and gaps in chiropractic patient safety culture research, particularly in leadership, policy, and interprofessional engagement. Future research should focus on implementing and evaluating evidence-based safety interventions to enhance transparency, improve patient outcomes, and build public trust in chiropractic care. Direct stakeholder engagement, including with patients, is necessary to determine the most effective strategies for integrating patient safety within the global chiropractic profession.

Suicide remains a major cause of preventable death worldwide. A recent guidance document from NHS England (Staying Safe from Suicide, 2025) highlights the limitations of traditional suicide risk prediction methods and advocates for a relational, person-centred approach. While not mental health specialists, chiropractors and osteopaths often work closely with individuals facing musculoskeletal chronic pain, disability, financial stress, and social isolation, all of which are risk factors for psychological distress. This commentary explores how the NHS guidance offers key lessons for chiropractic and osteopathic practice. Valuable contributions to suicide prevention efforts can be made by fostering strong therapeutic relationships, adopting a biopsychosocial view of health, and encouraging help-seeking behaviours where needed. Through small, relational actions, practitioners can support patient wellbeing while working within the boundaries of their professional scope of practice.

Low back pain (LBP) is one of the most disabling conditions in older adults and among the costliest in terms of healthcare expenditures. Many factors contribute to the disability and high costs of LBP in older adults, but one of the most preventable is the spread of misinformation and unhelpful attitudes, beliefs, and behaviors. These are often perpetuated by family, friends, social media, pharmaceutical companies, other industries, and healthcare providers. Myths about back pain foster false attitudes, beliefs, and behaviors that lead to inappropriate, costly, and sometimes harmful treatments. Such myths can result in psychological consequences, including fear of movement, poor self-efficacy, low motivation, anxiety, stress, and depression- all of which further perpetuate disability. Injections, surgeries, and medications for non-specific LBP are usually ineffective and are associated with significant side effects in older adults. The purpose of this paper is to dispel ten common myths of LBP in older adults, with the goals of changing attitudes, beliefs, and behaviors to reflect a more positive and evidence-based approach among practitioners and public. The aim is also to motivate practitioners to educate their older patients based on the best available evidence. This can improve outcomes, reduce costs, reduce disability, and improve quality of life among older adults with back pain.

Background: Veteran Response to Dosage in Chiropractic Therapy (VERDICT) was a pragmatic randomized trial testing chiropractic dosage effects in 766 veterans with chronic low back pain (CLBP) of ≥ 3 months. This cross-sectional analysis compares baseline characteristics of younger (18-to-64 years) and older veterans (≥ 65 years).

Methods: Data were collected from February 22, 2021 to May 21, 2025 via electronic health records and REDCap questionnaires. Descriptive statistics and tests of group differences were performed using SAS.

Results: VERDICT enrolled 188 older veterans (25%; mean 72 years) and 578 younger veterans (75%; mean 44 years). More female (24.7% vs. 10.6%, p < .001), Black (18.9% vs. 12.2%), and Hispanic (11.8% vs. 3.7%, p = .001) veterans comprised the younger cohort. Employment differed (p < .001) with older veterans retired (78.2% vs. 14.2%) and younger veterans employed (59% vs. 16.5%). About 14% lived rurally and period of military service was similar. Pain profiles were similar between younger and older veterans for > 5 years duration (78.4% vs. 73.4%), high-impact chronic pain (64.5% vs. 62.2%), mean pain interference [63.8(4.8) vs. 63.2(5.0)], and mean back-related disability (primary outcome) [11.9(5.2) vs. 13.3(4.9)]. Younger veterans scored significantly higher than older veterans for depression (44.8% vs. 31.4%, p = .001), anxiety (41.5% vs. 20.7%, p < .001), post-traumatic stress (38.4% vs. 17.6%, p < .001), sleep disturbance (57.1% vs. 34.6%, p < .001), and high-risk alcohol use (25.4% vs. 18.1%, p = .05). Previous chiropractic use was similar (younger 75.4% vs. older 80.3%). Medications in past 3 months differed with younger veterans reporting cannabis (25.8% vs. 12.8%, p < .001) and muscle relaxants (31.7% vs. 17.6%, p < .001) and more older veterans reporting acetaminophen (63.3% vs. 49.3%, p < .001) and gabapentin (34% vs. 20.1%, p < .001). NSAIDs use was highest among both younger (62.8%) and older (56.9%) veterans. While two-thirds had tried exercise in the past 3 months, only 16% reported exercising for their pain condition, with older veterans more likely to report providers encouraging physical activity.

Conclusions: Similar pain profiles were reported among older and younger veterans seeking chiropractic care for CLBP within a clinical trial. However, potentially important age differences were noted in demographics, mental health and substance use, and CLBP treatments.

Trial registration: ClinicalTrials.gov: NCT04087291. Date of Registration: 9/12/2019. Enrollment Duration: 2/22/2021 (first participant enrolled) through 5/10/2024 (last participant enrolled).

Background: A comprehensive description of the profile of chiropractic practices and services provided can help guide curriculum design, inform quality improvement and guideline initiatives, and facilitate workforce planning. This cross-sectional study aimed to describe the sociodemographic characteristics, professional activities, work organization, clinical practice patterns, and interprofessional referrals of chiropractors in France.

Methods: A 37-item online questionnaire was administered between February and April 2023 to all registered chiropractors practicing or having a chiropractic-related professional activity in France, for whom an email address was available (n = 1067). We computed means and standard deviations for continuous variables and percentages for categorical variables. Representativeness of the results was estimated by comparing survey participants' demographic information with members of the Association Française de Chiropraxie (AFC).

Results: The response rate was 46.4% (67.7% females; mean age = 34.9 ± 9.7 years), a sample comparable to AFC members. Most participants graduated in the past 15 years (81%) from the Institut Franco-Européen de Chiropraxie (IFEC) (94.5%). Just over one fifth of respondents had an additional university degree, and a similar proportion were involved in at least one chiropractic-related professional activity, mainly as lecturers in the IFEC or supervising clinicians in its outpatient clinics. Over half of the respondents (53.5%) had their main practice location in one of the four most populated regions in France, with 27.4% working in a multidisciplinary setting. Chiropractors reported regularly referring patients to general practitioners and physiotherapists, but less commonly received referrals. Middle-aged adults most commonly sought care, and spinal pain was the primary complaint reported by chiropractors. Chiropractors generally provided advice and education, manual therapy, and exercises. Two-thirds of respondents reported feeling moderate (30.6%) to intense or very intense (31.7%) competition with other manual therapy practitioners.

Conclusion: The French chiropractic workforce appears predominantly composed of female practitioners who graduated in the past 15 years. Practice patterns and continuing education choices suggest that evidence-based information is part of their practice. While chiropractors commonly reported referring patients to other care providers, fewer reported receiving referrals. Patients seeking chiropractic care were similar to those described in other countries.

Objectives: To comprehensively map the literature on the use of manual therapy (MT) in the management of traumatic brain injury (TBI).

Background: TBI is a leading cause of long-term disability worldwide, often resulting in persistent physical, cognitive, and emotional symptoms. MT, which is commonly used by chiropractors, osteopaths and physiotherapists (COPs), has been proposed as a nonpharmacological intervention for post-TBI symptom management. However, the scope of supporting evidence remains unclear.

Design: Scoping Review.

Methods: Four databases and Google Scholar were searched for peer-reviewed studies published in English or French from 2010 onwards. The inclusion criteria targeted all severities of TBI, with MT interventions delivered by COPs. Data extraction and assessment of methodological reporting were conducted independently by two reviewers via standardised tools.

Results: Forty-two articles were included, comprising primarily case reports, case series, and randomised controlled trials. Most studies have investigated mild, sport-related TBI and described MT interventions targeting headache, neck pain, and dizziness-often delivered within multimodal care frameworks. A subset of studies has also explored the impact of MT on cognitive, emotional, or sleep-related symptoms, suggesting potential benefits beyond physical outcomes. Moderate to severe TBI has rarely been examined. Reporting limitations were common, particularly regarding adverse events.

Conclusion: The literature reflects a growing interest in the use of MT for mild, sport related TBI, primarily for managing physical symptoms. Further research is needed to explore broader applications across different populations and TBI severities, investigate underlying MT mechanisms and improve the reporting of safety outcomes.