Chiropractic & Manual Therapies最新文献

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.

Background: Cervical neural tension reflects the biomechanical and physiological responses of spinal nerves to positional changes. Although clinical tests exist for the lower cervical spinal nerve, tension patterns in the upper and mid-cervical nerves remain underexplored, limiting the diagnostic accuracy for conditions such as occipital neuralgia.

Methods: This cadaveric study quantified tensile load changes at the cervical spinal nerve level (C1-C5) during passive cervical spine rotation in five formalin-embalmed cadavers. Tension was measured on the cervical spinal nerves (C1-C5) using force gauges attached proximal to the division between the dorsal and ventral rami. C1 measurements were obtained from a single specimen. Two movement conditions were used: cervical flexion-rotation for C1-C3 and neutral-plane rotation for C4-C5.

Results: Ipsilateral increases in neural tension were observed in C1-C3 during flexion-rotation movements. By contrast, C4-C5 exhibited a consistent pattern of contralateral load increase during rotation in the neutral plane. Statistically significant variations in the tensile load were observed at the C5 level under different rotation conditions, specifically at C5 left (p = 0.003) and C5 right (p = 0.006). Post-hoc analyses of C5 measurements during neutral-plane rotation revealed significant differences between right and left rotation (p = 0.018) and between left rotation and neutral rotation (p = 0.018) on the left side, as well as between right rotation and left rotation and neutral rotation (p = 0.026, p = 0.024) on the right side. Intraclass correlation coefficients (ICC) indicated good-to-excellent reliability (ICC > 0.75), particularly at C2-C5.

Conclusions: Cervical rotation influenced neural tension, with distinct patterns observed between the upper cervical segments (tested under flexion-rotation) and the middle cervical segments (tested under neutral plane rotation). These exploratory findings suggest that replacing lateral neck flexion with rotation in the upper-limb tension test may represent a promising direction for future research. Additionally, the flexion-rotation test may provide a basis for clinical validation as a potential indicator of greater occipital nerve tension. These results lay the groundwork for refining neurodynamic assessments and warrant further in vivo investigation.

Background: Frailty and low back pain (LBP) may negatively affect each other in older adults, yet no systematic review has summarized their cross-sectional, temporal, or causal associations. Exploring these associations could provide valuable insights for reducing frailty risk in older adults with LBP. This systematic review aimed to consolidate evidence on the association between frailty and LBP in older adults.

Methods: Four databases (EMBASE, CINHAL, MEDLINE, and SPORTDiscus) were systematically searched from their inception until July 31, 2024. Studies investigating the association between LBP, regardless of chronicity, or LBP-related disability and frailty in older adults were included. LBP was defined as pain occurring between the 12th ribs and inferior gluteal folds. Due to the lack of consensus on the definitions of older adults or frailty, studies were included based on the authors' definitions. Three pairs of independent reviewers screened abstracts and full texts, extracted data, assessed risk of bias, and determined the certainty of evidence.

Results: Out of 1,690 articles identified, six cross-sectional studies and one prospective study were included. Low-certainty evidence from four cross-sectional studies suggested that both acute and chronic LBP, with odds ratios from 1.34 to 7.50, separately showed significant correlation with frailty. Pre-frail or frail older adults reported higher chronic LBP intensity, scoring 0.5 to 0.8 points more on the numeric rating scale, and greater LBP-related disability, with scores 1.7 to 7.2 points higher on the Roland Morris Disability Questionnaire, compared to non-frail counterparts. However, there was low-certainty evidence that acute LBP intensity was unrelated to frailty. Very low-certainty evidence from the prospective study indicated that higher acute LBP intensity and disability were associated with transitioning from non-frail to prefrail or frail status.

Conclusions: Our systematic review revealed that older adults with higher LBP intensity or associated disability were more likely to have prefrail or frail status, albeit with low-certainty evidence. However, the findings are limited by the small number of studies, especially prospective research. Future high-quality research should clarify the causation between LBP intensity or disability and frailty in community-dwelling older adults. Research should also explore potential mediators or moderators influencing the LBP-frailty association. These findings could help develop effective prevention and rehabilitation strategies to mitigate the impacts of LBP on frailty, or vice versa.

Background: Neck pain and headaches often co-occur, and the presence of degenerative cervical Magnetic Resonance Imaging (MRI) findings has been associated with the presence of headaches. However, previous studies have not provided conclusive evidence about their association, and imaging studies examining the associations between headache severity and MRI findings have been suggested. This study aims to investigate the associations between independent variables, single MRI findings, and an aggregate score of MRI findings, and the outcome variable, headache severity.

Methods: This cross-sectional study examined patients with neck pain and headaches in specialist care. MRI findings and outcome measures were collected at the time of clinical entrance between 2011 and 2014. The headache severity was assessed using the Neck Disability Index questionnaire. Ten degenerative MRI findings were routinely evaluated, and an overall score was derived by aggregating single findings across levels C2-C7. Univariate and multivariable ordinal logistic regression analyses assessed the associations expressed as odds ratios (OR) and 95% confidence interval (95% CI).

Results: A total of 574 patients were included. Higher headache severity was significantly associated with female sex and younger age. The presence of single cervical MRI findings was linked to lower odds of severe headaches (ORs < 1), and having two or three findings further decreased the likelihood (OR 0.40, 95% CI 0.23-0.68) compared to having none. A sensitivity analysis assessed the OR estimates for the aggregate score as robust.

Conclusions: This study showed that, among patients with persistent neck pain referred to secondary care, degenerative MRI findings in the cervical spine were inversely associated with headache severity. The association between an aggregated score of MRI findings and headache severity was stronger than that of single findings. These findings reflect associations observed within a selected clinical population and warrant further investigation in populations with differing symptom profiles.

Background: This study reviews the 20-year history (2005-2025) of Chiropractic & Manual Therapies as an open-access, peer-reviewed journal. Originally launched in 1992 as COMSIG Review, the journal has undergone multiple title changes and is currently financially supported by three chiropractic societies. This review critically examines 20 years (2005-2025) as an open-access online journal and makes recommendations for future growth.

Methods: Data on all published articles in the journal Chiropractic & Manual Therapies for the period April 11, 2005, until April 10, 2025 were manually entered into SPSS Version 30.0.0.0 between the dates May 7, 2025 and May 16, 2025. The analysis examined article type, publication year, access numbers, citation counts, and Altmetric scores for each published article. Conclusions were then drawn, and recommendations made.

Results: Of the 800 articles published, research articles comprised the majority (59.1%) of publication type, yet systematic reviews demonstrated significantly higher citation rates and online engagement. There has been strong growth in research outputs over the 20 years. Systematic reviews, debate articles and narrative reviews showed notable higher accesses and impact, than other article types. Open access has broadened global reach with 7.49 million accesses over the 20 years examined. The current Impact Factor is 2.3 (2024), the highest for any chiropractic journal worldwide.

Conclusion: Findings highlight the journal's substantial contribution to the chiropractic and manual therapy literature and offer insights for future editorial direction and impact enhancement. The journal's unique role as a society-supported publication has enabled exploration of emerging and controversial topics that have attracted high numbers of accesses indicating popularity and reach.

Background: The United States spends more money on the care of back and neck pain than any other health condition. Despite this, the cost-effectiveness for many recommended treatments is unclear. Our primary objective for this project was to estimate the cost-effectiveness of spinal manipulative therapy (SMT), supervised exercise therapy (ET), and home exercise and advice (HEA) for spinal pain in the U.S.

Methods: We analyzed cost and clinical outcome data from eight randomized trials conducted in the U.S. using an individual participant data meta-analysis approach. We calculated cost-effectiveness from the societal and healthcare perspective of various comparisons between SMT, ET, and HEA. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life years as the main outcome.

Results: The trials included a total of 1803 participants and 1488 (83%) provided complete data. Incremental cost-effectiveness ratios and probabilities of cost-effectiveness varied substantially between studies; thus, we did not conduct meta-analysis and report findings from individual trials. Cost-effectiveness findings were favorable for SMT compared to HEA for acute neck pain (ICERs below $50k/QALY) and when added to HEA for chronic back-related leg pain and chronic neck pain in older adults (better outcomes and lower costs). However, SMT was not likely cost-effective compared to HEA for chronic back pain in adults or when added to HEA for older adults (higher costs and worse outcomes). Findings for SMT were favorable when compared to ET in adults with chronic back pain and when added to ET for chronic neck pain in adults (better outcomes and lower costs) and chronic back pain in adolescents (ICERs below $50k/QALY). However, SMT is not likely cost-effective when compared to ET for chronic neck pain in adults (ICERs below $70k/QALY for exercise) and findings were inconsistent across outcomes in older adults with chronic back pain. Finally, ET may be cost-effective compared to HEA for adults with chronic neck pain (ICERs largely between $100-$200k/QALY), but not for chronic back pain or when added to HEA for older adults with chronic neck or back pain (higher costs and worse outcomes).

Discussion: Cost-effectiveness findings differed between populations based on pain location, duration, and age.

Background: Australian and New Zealand osteopaths predominantly manage musculoskeletal complaints using a variety of modalities including manual therapy, exercise and lifestyle and occupational advice. There appears to be a small percentage of patients who seek osteopathy care for non-musculoskeletal issues such as conditions affecting the gastrointestinal tract. The evidence base for osteopathic treatment as part of the management of such conditions is equivocal. The aim of this study was to describe the practice of Australian and New Zealand osteopaths who report often treating patients with non-musculoskeletal complaints.

Methods: This study is a secondary analysis of data from the Australian and New Zealand osteopathy practice-based research networks (PBRNs) collected in Australia from July to December 2016 and in New Zealand from August to December 2018. Respondents to the PBRN baseline surveys were asked to provide information about their demographic, patient and clinical management characteristics. One of these characteristics was the frequency of treating patients presenting with non-musculoskeletal complaints. Descriptive and inferential statistics were used to inform regression modelling of significant predictors of often managing non-musculoskeletal complaints.

Results: Of the 1254 osteopath participants from Australia and NZ, 13.5% (n = 170) reported often treating patients presenting with non-MSK complaints. Significant predictors of often treating patients presenting with non-MSK complaints were often using visceral (ORa 3.54 95%CI 2.15-5.85) and Osteopathy in the Cranial Field (OCF) (ORa 2.05 95%CI 1.20-3.51) techniques, and often treating patients up to the age of 3 years (ORa 3.05 95%CI 1.89-4.90).

Conclusion: More than one in ten Australian and New Zealand osteopaths report often treating patients presenting with non-MSK complaints, with the dominant manual therapy approaches used being visceral techniques and OCF. This study provides a unique insight into the characteristics of osteopaths who often treat patients presenting with non-MSK complaints. Further research is required to examine if patients seek out care from an osteopath specifically for non-MSK complaints or primarily seek out care from an osteopath for MSK complaints but are managed for non-MSK complaints as a secondary consideration.

Background: There appears to be a substantial variation in the use of radiographs in chiropractic clinics, but the reasons for this variation are not well understood. This study examined the use of radiography over a one-year period in Danish chiropractic clinics and explored its associations with clinic- and chiropractor-level characteristics.

Methods: Data on the number of unique patients consulting a chiropractor and those receiving radiography between 1 January 2022 and 31 December 2022 were obtained from a Danish national registry. Information on clinics including the number of chiropractors, geographical region, multidisciplinary status, and types of other healthcare professionals employed, as well as chiropractor characteristics (age, gender, seniority, and country of education) was collected from clinic websites and a national register of Danish healthcare professionals. The proportion of patients undergoing radiography was calculated for each clinic. Associations with clinic and chiropractic characteristics were tested using chi-square or t-tests, as appropriate. Characteristics were also compared between clinics with and without in-house radiographic imaging facilities.

Results: A total of 237 chiropractic clinics and 657 chiropractors were included. The mean age of chiropractors was 47 years (SD 12.8), 53% were women and 61.8% were educated in Denmark. Clinics with radiographic facilities (n = 161, 68%) tended to be larger and more likely to be multidisciplinary than clinics without (n = 76, 32%). Among clinics with radiographic facilities, the proportion of patients receiving radiography was 9.5% (95% CI 8.4-10.6%), ranging from 0 to 39%. No associations were found between radiography use in clinics with in-house radiographic facilities and clinic or chiropractic characteristics. In clinics without radiographic facilities, only 1.1% of patients were referred for radiography via chiropractic service codes, although this is likely an underestimation, as referrals to public hospitals were not captured.

Conclusion: Although considerable variation in radiography use was observed across Danish chiropractic clinics with radiographic facilities, this was not explained by measured clinic or chiropractic characteristics. The true extent of radiography use in clinics without in-house facilities remains uncertain. Further research into clinical decision-making is needed to support evidence-based, transparent and consistent practice, potentially using qualitative methods to better understand the reasons behind the observed variation.