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.

Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators.

OBJECTIVE: The purpose of this work was to create an exploratory database of manipulation treatment force variability as a function of the intent of an experienced clinician sub-specializing in the care of children to match treatment to childhood category. Data of this type are necessary for realistic planning of dose-response and safety studies on therapeutic benefit. METHODS: The project evaluated the transmitted peak forces of procedures applied to mannequins of different stature for younger and older children. Common procedures for the cervical, thoracic, and lumbar spine and sacroiliac joint were administered to estimate variability by a single experienced practitioner and educator in pediatric manipulation attempting to modulate for childhood category. Results described for peak components in the cardinal axes and for peak total forces were cataloged and compared with consensus estimates of force from the literature. RESULTS: Mean force values for both components and total force peaks monotonically increased with childhood category analogous to consensus expectations. However, a mismatch was observed between peak values measured and consensus predictions that ranged by a factor of 2 to 3.5, particularly in the upper categories. Quantitative data permit a first estimate of effect size for future clinical studies. CONCLUSIONS: The findings of this study indicate that recalibration of spinal manipulation performance of experienced clinicians toward arbitrary target values similar to consensus estimates is feasible. What is unclear from the literature or these results is the identity of legitimate target values that are both safe and clinically effective based on childhood categories in actual practice.

Best Practices for Chiropractic Care of Children: A Consensus Update.

OBJECTIVE: Chiropractic care is the most common complementary and integrative medicine practice used by children in the United States, and it is used frequently by children internationally as well. The purpose of this project was to update the 2009 recommendations on best practices for chiropractic care of children. METHODS: A formal consensus process was completed based on the existing recommendations and informed by the results of a systematic review of relevant literature from January 2009 through March 2015. The primary search question for the systematic review was, "What is the effectiveness of chiropractic care, including spinal manipulation, for conditions experienced by children (<18 years of age)?" A secondary search question was, "What are the adverse events associated with chiropractic care including spinal manipulation among children (<18 years of age)?" The consensus process was conducted electronically, by e-mail, using a multidisciplinary Delphi panel of 29 experts from 5 countries and using the RAND Corporation/University of California, Los Angeles, consensus methodology. RESULTS: Only 2 statements from the previous set of recommendations did not reach 80% consensus on the first round, and revised versions of both were agreed upon in a second round. CONCLUSIONS: All of the seed statements in this best practices document achieved a high level of consensus and thus represent a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents.