Chiropractic & Manual Therapies最新文献

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.

Background: Continuing education (CE) for chiropractors is mandated by state licensing boards to ensure ongoing learning and to maintain professional excellence. While incorporating research into CE programs is crucial for practitioners to remain dynamic and evidence-based, conducting research and academic pursuits is necessary for further development of the profession. We hypothesized that fewer U.S. states would provide CE credit for the completion of research or higher-education teaching activities within the chiropractic profession compared to other health professions.

Methods: Internet searches of publicly available state board websites for each profession was undertaken with a cross-sectional study design between 12/19/2024 and 03/01/2025. Data extraction focused on whether CE was granted for research (publication and/or peer review) as well as academic pursuits (higher education and/or CE instruction). Descriptive statistics determined the frequency of states allowing CE while Fisher's Exact test and one-way ANOVA was performed to compare states granting CE credits for research and teaching as well as comparisons among the professions.

Results: Only 16 US states allow DCs to claim research activities for CE credit while 50% allow teaching for CE credit. This is significantly lower (p < 0.001) than ATs, DOs, and MDs where teaching and research activities are accepted for CE credit in all states.

Conclusions: Precluding research and higher-education teaching opportunities for CE presents a potential barrier to chiropractic academic and research development at present and in the future.

This commentary brings the 2021-2023thematic series Spinal Manipulation/Mobilization: Past, Present, Future to a close. The 23 papers published in the series contribute to our understanding of spinal manipulation/mobilization(SMT) in a few important domains. They provide evidence on the biomechanics, clinical science, research methods, and policy implications of SMT. They present suggested training, research and policy changes that can be made to improve health care delivery and outcomes.

Background: The evidence on age-related differences in outcomes in patients seeking chiropractic care for low back pain is limited. The aims of this study were to (i) to explore differences in patient characteristics and symptoms between older, middle-aged and younger patients with LBP seeking chiropractic care, (ii) to investigate whether age was associated with changes in physical function at 2, 13 and 52 weeks follow-up and (iii) to evaluate if other specific demographic variables were associated with changes in physical function over time.

Methods: This observational cohort study (November 2016 to December 2018) used data from the Danish Chiropractic Low Back Pain Cohort (ChiCo). Participants ≥ 18 years seeking chiropractic care for new onset low back pain were categorised into three age groups: young adults (< 40 years), middle-aged adults (40-59 years), and older adults (≥ 60 years). Disability was assessed at baseline and at 2, 13 and 52 weeks follow-up using the Roland Morris Disability Questionnaire. Associations between age groups and disability outcomes were analysed using linear regression, while associations with demographics, and social and psychological factors were examined using backward stepwise linear regression.

Results: 2777 participants were included. At baseline, there were no significant differences in disability scores between age groups. Older patients reported more non-musculoskeletal comorbidities and prescription pain medication use, compared to younger and middle-aged patients. Younger patients showed higher depression and anxiety levels compared to middle-aged and older patients. Younger and middle-aged patients more frequently reported multiple musculoskeletal comorbidities than older patients. At all follow-ups, older patients had slightly higher disability scores and showed less improvement over time compared to younger and middle-aged patients, indicating a modest association between age and poorer outcomes. Higher baseline disability, more musculoskeletal comorbidities, worse self-reported health, and higher depression scores were more consistently associated with less improvement in disability over time.

Conclusion: Older chiropractic patients with low back pain had slightly higher disability scores compared to younger and middle-aged patients, but age was not the strongest factor associated with disability outcomes. Baseline disability, depression, self-perceived general health, and MSK comorbidities were more consistently linked to higher disability scores across all follow-up time points.

Background: Low back pain (LBP) is common among older adults, and it is a frequent reason for seeking chiropractic care. The STarT Back Screening Tool (SBT) was developed to stratify patients with LBP into low, medium, and high-risk treatment pathways, so that the treatment can be matched to each participant's risk profile. But its prognostic performance varies across settings and populations. No studies have focused on the SBT's utility as a stratified-care tool in older adults with LBP in a chiropractic setting. Therefore, our aim was to evaluate the ability of the SBT to predict three-, six-, and 12-month disability and pain outcomes in older adults (≥55 years) with a new episode of LBP consulting chiropractors in the Netherlands, Sweden, and Australia.

Methods: This was a secondary analysis of the Back Complaints in Older Adults - Chiropractic (BACE-C) cohort. Participants visiting chiropractors with LBP completed baseline questionnaires for demographic and clinical characteristics, including the SBT. Follow-up questionnaires assessed disability (Roland Morris Disability Questionnaire (RMDQ)) and pain intensity (11-point Numerical Rating Scale (NRS)). "No improvement" on disability and pain intensity was defined as less than 30% reduction in baseline scores. We used logistic regression models to estimate discrimination metrics including the area under the receiver operating characteristic curve (AUC). Subgroup analyses were conducted by country, sex, and LBP duration; sensitivity analyses employed alternative "no improvement" definitions and linear regression on continuous outcome scores.

Results: A total of 738 participants were included. The mean age of the study sample was 66.2 ± 7.5 years and 50.9% of the participants were female. The SBT showed poor discrimination for predicting no improvement in disability and pain intensity. All AUC values were below 0.60 regardless of whether SBT risk subgroups (i.e. low/medium/high) or the SBT sum score were used. Subgroup and sensitivity analyses did not meaningfully improve discrimination.

Conclusion: The SBT presented limited prognostic ability to predict outcomes of disability and pain intensity in older adults with LBP in a chiropractic setting. These findings suggest insufficient evidence for the prognostic ability of the SBT risk stratification tool. Future research should explore reasons behind the limited prognostic accuracy and consider potential modifications or alternative tools.

Background: Chronic low back pain is a prevalent condition that impairs productivity and quality of life. While spinal manipulative therapy reduces pain and disability, the biomechanical mechanisms underlying these effects remain unclear. This study utilized diagnostic ultrasound to measure lumbo-sacral spinous process movement (L3-S1) during Cox^® Flexion Distraction manipulation, Protocol I, providing insight into spinal intersegmental motion.

Methods: This study analyzed a convenience sample of generally healthy participants, aged 21 years and older, from both sexes and various ethnicities who reported no back pain. Participants were recruited through announcements and flyers posted around the Keiser university campus. Data was collected from June-August 2022. The participants were positioned prone on a specialized flexion distraction chiropractic table. Ultrasound imaging was performed to measure the spinous process distance from L3-S1 before the procedure, during flexion distraction utilizing standard Protocol I, and post-procedure. Ultrasound measurements were recorded by identifying the tips of the spinous processes and distances between L3-L4, L4-L5, and L5-S1, before, during, and after flexion distraction. Statistical analyses included paired t-tests to evaluate spinous process distances pre- and during Cox^® Flexion distraction, independent t-tests for gender differences, and linear regression for body mass index (BMI) and age correlations with changes in separation distance.

Results: Thirty participants (16 male, 14 female) with a mean age of 32.5 years (Standard deviation [SD] 10.4), mean weight of 69.2 Kg (SD 11.8), mean height of 169.0 cm (SD 8.9), and BMI of 23.9 underwent Cox^® Flexion Distraction Protocol I. Spinous process separation increased during treatment: L3-L4 (0.13 mm), L4-L5 (0.13 mm), and L5-S1 (0.16 mm). Paired ttests showed significant pre- and during-treatment changes (p < 0.001), with moderate correlations to BMI (R²=0.61) and age (R²=0.58). Gender differences did not reveal statistical differences in separation distances at all lumbar levels measured (p > 0.1).

Conclusion: Ultrasound imaging revealed significant separation of spinous processes at L3-L4, L4-L5, and L5-S1 during Cox^® Flexion Distraction Protocol I. Statistical analyses showed separation correlated moderately with age and BMI that was unaffected by gender. Future studies should assess this technique's relevance in patients with low back pain.

Background: Rising low back pain (LBP) prevalence and increased patient reliance on online health resources necessitate critically evaluating how chiropractic websites represent common musculoskeletal conditions. This study analyzed LBP-related content shared by South African chiropractic websites to assess the credibility of available information.

Methods: A cross-sectional content evaluation was conducted between 2 June 2024 and 21 July 2024 on 333 South African chiropractic websites, identified using a Google search cross-referenced with the Allied Health Professions Council of South Africa registry. Four key areas were evaluated, including (1) contributors to, (2) diagnostic approaches for, (3) possible treatment approaches for and 4) indicators for seeking professional treatment for LBP. Sociodemographic factors such as educational background, sex, and practice ownership structure were considered. A pilot ensured data collection standardization. Content and statistical analysis explored information, citation frequency and identified trends in chiropractic online health communication.

Results: The analysis revealed significant variability of LBP-related content across chiropractic websites. Of the 333 websites analyzed, most chiropractors were trained at UJ (58.1%) and DUT (29.2%). Sex distribution showed 55.3% were female-owned. The highest concentration of chiropractic websites was in Gauteng, the Western Cape, and KwaZulu-Natal. Regarding the 4 key areas, mechanical contributors to LBP were predominant (65.2%), diagnostic approaches (56.7%), treatment approaches (79.6%) and explicit guidance on when to seek care (47.4%) was mentioned in the websites. Only 13.5% of websites cite sources of the information shared. Chiropractors trained at UJ and DUT emphasized evidence-based treatments, while those trained internationally referenced alternative methods. Sex differences showed males focusing on diagnostic tools and treatment protocols, while females emphasized holistic care and lifestyle modifications.

Conclusion: This study highlights the need for improved LBP information quality and consistency on South African chiropractic websites. The structured subjective content evaluation revealed notable gaps in content depth, specificity, and evidence-based citations. Sociodemographic factors, including educational background and sex, influenced the presentation of information. Future research should prioritize developing standardized and evidence-based guidelines for chiropractic websites to improve access to online health information and patient education and ensure accurate, reliable health information delivery.

Lumbar spinal stenosis is a growing problem among older adults, associated with significant disability and socio-economic burden. Neurogenic claudication is the most common clinical syndrome caused by LSS with pain being the predominant symptom and limited walking the main impairment. Lumbar spinal stenosis can also impact sexual function in older adults, necessitating greater awareness of this association. Pain and impaired function can lead to psychosocial distress, including hopelessness, anxiety, and isolation, further compounding disability. Recent clinical practice guidelines recommend non-operative treatment as the first-line approach, including manual therapy, exercise, and education. However, these guidelines lack details on the practical application of these interventions in clinical practice. This narrative review explores the epidemiology of lumbar spinal stenosis, the evidence supporting non-operative care, and practical management strategies. It also highlights the relationship between sexual dysfunction and lumbar spinal stenosis.

Purpose: Chronic non-specific low back pain (CNLBP) is a complex and heterogeneous condition, and it is necessary to explore new treatment approaches. We evaluated whether the addition of dry cupping therapy to guideline‑based conventional therapy would further improve clinical outcomes in CNLBP.

Methods: Thirty-six patients with CNLBP were recruitedand randomly divided into two groups: the control group and the intervention group. The intervention group received cupping therapy in addition to the control group (core stabilization exercises, spinal manipulation and education) for 4 weeks. The primary outcome was the visual analog scale (VAS) for pain intensity. Secondary outcomes were the Roland Morris disability questionnaire (RMDQ), and pressure pain thresholds (PPT) at bilateral Shenshu (BL23), Qihaishu (BL24), and Dachangshu (BL25) acupuncture points.

Results: At week 4 the between‑group difference in resting pain was trivial (median difference 0.0 cm, 95% CI - 1.0 to 1.0). Neither clinically important nor statistically significant differences were detected in disability or PPTs. Both groups improved substantially from baseline.

Conclusion: In this randomized trial, adding dry cupping to conventional therapy offered no additional benefit over conventional therapy alone for pain, disability or PPT in CNLBP. Larger, multicentre trials with longer follow‑up and standardized negative pressures are warranted.

Trial registration: ChiCTR2300069398, http://www.chictr.org.cn , Registration Date: March 15, 2023.

Background: Manual therapy, including high-velocity low-amplitude spinal manipulation (HVLA-SM), is a complex motor task performed by trained individuals. The ability to modulate the magnitude of applied forces is an attribute of proficiency that is challenging for providers and students. Adopting different biomechanical strategies may facilitate force modulation by practitioners performing HVLA-SM. This study evaluated the efficacy of different biomechanical strategies on force-time characteristics of prone thoracic HVLA-SM.

Methods: A randomized crossover experimental design was used. Data were collected between October 2022 and May 2023 from chiropractic students at the Canadian Memorial Chiropractic College who performed HVLA-SM targeted to the thoracic spine of a prone-lying manikin using as much force as possible in each of six different strategies. Strategies (S1 to S6) were specifically developed to successively increase a person's ability to produce force while performing HVLA-SM. Force-time parameters for the HVLA-SM trials were recorded. Peak force was the primary outcome of interest while preload force, load rate, and time to peak force were analyzed as secondary measures.

Results: Data were collected from 97 participants (51 female). Peak force increased successively from S1 to S5 with moderate effects (- 0.45 ≤ effect size ≤ -0.72). There was no statistical difference in either peak force or load rate between S5 and S6. Load rate also did not statistically increase between S3 and S4 where different muscle groups were targeted to produce force. The strategy with the highest peak force (S6) also demonstrated the lowest preload force.

Conclusions: Strategies used in this study effectively facilitated modulation of force-time characteristics of prone thoracic HVLA-SM. Thus, training approaches may consider introducing people to different biomechanical strategies to enhance HVLA-SM force modulation.