Chiropractic & Manual Therapies最新文献

Background: Although distinct, confidence and competence play a valuable role in healthcare education. For chiropractic students, both may be important in mastering motor skills required to perform spinal manipulative therapy (SMT). However, little is known about how individual factors influence students' confidence and competence. Better understanding of these associations would enable the development of tailored training. Therefore, this study aimed to investigate associations between demographics, anthropometrics, and prior SMT experience and confidence and competence in performing SMT with specific force-time characteristics in chiropractic students.

Methods: This secondary analysis of a cross-sectional study involved 149 chiropractic students who performed SMT targeting specific peak thrust forces (200 N, 400 N, 800 N). Students were assessed for competence in force-time characteristics (preload, peak thrust force, time to peak force) using the force-sensing table technology, and self-reported their confidence in performing each characteristic. Demographics, anthropometrics, and SMT experience were collected and multivariable linear and logistic regressions were used to assess associations.

Results: Confidence was higher in male students, students in later years of study, and those with more SMT experience. Competence in time to peak force was higher among males and third-year students, whereas males and taller students were more likely to reach the 800 N peak thrust force. No other associations were found for competencies.

Conclusions: While certain demographic and experiential factors are associated with increased confidence, these do not consistently translate to competence in SMT force-time characteristics. Targeted training approaches that account for individual student factors to better support them in developing their SMT motor skills are needed.

Background: The most common cause of muscle pain is myofascial pain syndrome. Myofascial pain syndrome caused by sensitive areas called trigger points (TrP). Some physiotherapy modalities have acceptable effects for this disorder, but it is necessary to check the effects of placebo, appropriate dose, and long-term effects for each intervention. The aim of this study is to investigate the effect of intramuscular electrical stimulation (IMES) compared to dry needling (DN) on sonographic and clinical parameters in upper trapezius muscle TrP.

Methods: This is a randomized, single-blind control trial. The study period was from December 2, 2020, to April 10, 2021. Thirty volunteer patients with active upper trapezius TrP were randomly allocated into two groups: (1) IMES, (2) DN. Participants received interventions in three sessions. Primary outcome measurements were neck range of motion (ROM) and TrP circumference. Secondary outcome measurements were pain by visual analog scale (VAS), pain pressure threshold (PPT), disability, TrP longitudinal and transverse diameter, TrP stiffness, and muscle blood flow by vascular resistance index (RI). All outcome measurements were evaluated before, after, and one month after the intervention. If the data were normal, the repeated measure ANOVA test was used; if data were not normal, the Friedman test and the Kruskal-Wallis test was used. A significance level of 0.05 has considered.

Results: ROM increment was significantly more in the IMES group. TrP circumference decrement was significantly more in the IMES group. VAS changes did not show significant difference between two groups. The PPT improvement was significantly more in the IMES group. Disability changes were not significant. Longitudinal diameter changes were significantly more in the IMES group. TrP stiffness changes were not significant. The vascular RI decreased significantly in IMES group.

Conclusion: It seems that both IMES and DN have promising effects for improving upper trapezius TrPs. However, IMES is more effective in some clinical and ultrasound parameters. In order to investigate the effects of this intervention more precisely more studies are necessary.

Trial registration: This study was prospectively registered at Iranian registry of clinical trials (IRCT: IRCT20170616034567N2).

Background: Manual therapy and exercise are recommended for patients with neck pain. In a recent randomized controlled trial, home stretching exercises with or without manual therapy were offered to subjects with persistent or recurrent neck pain. No difference in pain or disability between the treatment groups were found after the two-week intervention period. We aimed to investigate whether these patients had a better outcome after individual tailoring of the treatment content two months after the initial structured intervention period.

Methods: This manuscript is a secondary analysis of a previous clinical trial where 131 patients with persistent or recurrent neck pain received treatments over two weeks (the intervention period). Pain and disability were assessed for two months following the intervention period. During this period, the treating therapists could recommend further individualized tailored treatment, including any treatment modality, regardless of the intervention group and whether the participants responded to the intervention (responders) or not (non-responders). Responders from the intervention period were defined as reporting a minimal clinical improvement on the numeric rating scale (NRS-11) at a 20-percentage points improvement (2 increments), regardless of group belonging in the original trial. All other participants were considered non-responders. We also evaluated the number of treatments, differences in disability, quality and affective component of pain, and quality of life during the individualized care period.

Results: For responders to a randomized trial of manual therapy and stretching exercises, a significant worsening in pain was associated with an increasing number of treatments during a two-month individualized care period. Among non-responders to the initial intervention period, improvement in neck pain disability was observed with individually tailored treatments.

Conclusions: For responders to a randomized trial of manual therapy and stretching, worsening pain in the individualized care period was associated with increasing numbers of individually tailored treatments. Among non-responders to the initial intervention period, improvement in neck pain disability was observed with individually tailored treatments.

Trial registration: The trial was registered at ClinicalTrials.gov, registration number NCT03576846, on 23rd of June 2018.

Background: Since the 1990s, spine disorders have remained the leading cause of global disability, disproportionately affecting economically marginalized individuals, rural populations, women, and older people. Back pain related disability is projected to increase the most in remote regions where lifestyle and work are increasingly sedentary, yet resources and access to comprehensive healthcare is generally limited. To help tackle this worldwide health problem, World Spine Care Canada, and the Global Spine Care Initiative (GSCI) launched a four-phase project aiming to address the profound gap between evidence-based spine care and routine care delivered to people with spine symptoms or concerns in communities that are medically underserved. Phase 1 conclusions and recommendations led to the development of a model of care that included a triaging system and spine care pathways that could be implemented and scaled in underserved communities around the world.

Methods: The current research protocol describes a site-specific customization and pre-implementation study (Phase 2), as well as a feasibility study (Phase 3) to be conducted in Cross Lake, an Indigenous community in northern Manitoba, Canada.

Design: Observational pre-post design using a participatory mixed-methods approach. Relationship building with the community established through regular site visits will enable pre- and post-implementation data collection about the model of spine care and provisionally selected implementation strategies using a community health survey, chart reviews, qualitative interviews, and adoption surveys with key partners at the meso (community leaders) and micro (clinicians, patients, community residents) levels. Recruitment started in March 2023 and will end in March 2026. Surveys will be analyzed descriptively and interviews thematically. Findings will inform co-tailoring of implementation support strategies with project partners prior to evaluating the feasibility of the new spine care program.

Discussion: Knowledge generated from this study will provide essential guidance for scaling up, sustainability and impact (Phase 4) in other northern Canada regions and sites around the globe. It is hoped that implementing the GSCI model of care in Cross Lake will help to reduce the burden of spine problems and related healthcare costs for the local community, and serve as a scalable model for programs in other settings.

Background: Research on perception of chiropractic is abundant in Western contexts, yet sparse in Asia. This study aims to bridge this gap by examining the perceptions of chiropractic among Taiwanese adults, focusing on demographics, utilisation, beliefs, and understanding.

Methods: An adapted survey with 27 close-ended items was administered to assess Taiwanese adults' perception of chiropractic. The electronic survey, using Qualtrics, was delivered worldwide via Taiwanese Facebook groups from January 31 to March 31, 2024. Descriptive statistics, including frequencies and cross tabulations, were performed.

Results: A total of 769 individuals were surveyed, with 475 participants providing complete data. Over half of the participants (62%) had never visited a chiropractor, but in those who had visited a chiropractor 78% reported satisfaction. Of 475 participants, 45% considered chiropractic care safe while 34% were unsure. Though almost half (42%) were unclear about what chiropractors do, most participants (67%) expressed interest in learning more. Among the 151 participants with prior experience of chiropractic care, the demographic profile was 54% women, and individuals aged 28 to 37 (44%), and those with an undergraduate degree (52%) were most common.

Conclusion: Overall, our study found a positive perception and high acceptance of chiropractic among the Taiwanese population; however, generalisability may be limited due to the risk of selection bias. An understanding of the chiropractic profession was notably limited. Hence, efforts are needed to enhance awareness of chiropractic accreditation, clinical competencies, and its potential role in public healthcare in Taiwan.

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.