Response of Practicing Chiropractors during the Early Phase of the COVID-19 Pandemic: A Descriptive Report.

OBJECTIVE: The coronavirus disease-2019 (COVID-19) pandemic has strained all levels of healthcare and it is not known how chiropractic practitioners have responded to this crisis. The purpose of this report is to describe responses by a sample of chiropractors during the early stages of the COVID-19 pandemic. METHODS: We used a qualitative-constructivist design to understand chiropractic practice during the COVID-19 pandemic, as described by the participants. A sample of chiropractic practitioners (doctors of chiropractic, chiropractors) from various international locations were invited to participate. Each described the public health response to COVID-19 in their location and the actions that they took in their chiropractic practices from April 20 through May 4, 2020. A summary report was created from their responses and common themes were identified. RESULTS: Eighteen chiropractic practitioners representing 17 locations and 11 countries participated. A variety of practice environments were represented in this sample, including, solo practice, mobile practice, private hospital, US Veterans Administration health care, worksite health center, and group practice. They reported that they recognized and abided by changing governmental regulations. They observed their patients experience increased stress and mental health concerns resulting from the pandemic. They adopted innovative strategies, such as telehealth, to do outreach, communicate with, and provide care for patients. They abided by national and World Health Organization recommendations and they adopted creative strategies to maintain connectivity with patients through a people-centered, integrated, and collaborative approach. CONCLUSION: Although the chiropractors in this sample practiced in different cities and countries, their compliance with local regulations, concern for staff and patient safety, and people-centered responses were consistent. This sample covers all 7 World Federation of Chiropractic regions (ie, African, Asian, Eastern Mediterranean, European, Latin American, North American, and Pacific) and provides insights into measures taken by chiropractors during the early stages of the COVID-19 pandemic. This information may assist the chiropractic profession as it prepares for different scenarios as new evidence about this disease evolves.

The diagnostic accuracy of the Kemp's test: a systematic review.

BACKGROUND: The objective of this review was to evaluate the existing literature regarding the accuracy of the Kemp's test in the diagnosis of facet joint pain compared to a reference standard. METHODS: Several databases were searched. All diagnostic accuracy studies comparing the Kemp's test with an acceptable reference standard were included. Included studies were scored for quality and internal validity. RESULTS: Five articles met the inclusion criteria of this review. Two studies had a low risk of bias, and three had a low concern regarding applicability. Pooling of data from studies using similar methods revealed that the test's negative predictive value was the only diagnostic accuracy measure above 50% (56.8%, 59.9%). CONCLUSIONS: Currently, the literature supporting the use of the Kemp's test is limited and indicates that it has poor diagnostic accuracy. It is debatable whether clinicians should continue to use this test to diagnose facet joint pain.

CONTEXTE: L'objectif de cette étude était d'évaluer la documentation scientifique publiée traitant de l'exactitude du test de Kemp dans le diagnostic de la douleur des facettes articulaires par rapport à une référence normative. MÉTHODOLOGIE: Des recherches ont été faites dans plusieurs bases de données. Toutes les études sur l'exactitude des diagnostics comparant le test de Kemp à une référence normative acceptable ont été incluses. Les études retenues ont été notées sur une échelle de qualité et de validité interne. RÉSULTATS: Cinq articles ont satisfait les critères d'inclusion dans cette étude. Deux études présentaient un faible risque de biais, alors que trois autres avaient un manque d'intérêt quant à l'applicabilité. Les données recueillies d'études utilisant des méthodologies semblables ont révélé que la valeur négative prédictive du test présentait l'unique mesure de l'exactitude de diagnostic supérieure à 50 % (56,8 % ; 59,9 %). CONCLUSIONS: À l'heure actuelle, il n'y a pas suffisamment de documents scientifiques appuyant l'utilisation du test de Kemp, ce qui laisse prévoir une faible précision diagnostique du test. Il y a lieu de se demander si les cliniciens devraient poursuivre l'utilisation de ce test par le diagnostic des douleurs de facettes articulaires.