Quality of Reporting Using Good Reporting of A Mixed Methods Study Criteria in Chiropractic Mixed Methods Research: A Methodological Review.

OBJECTIVE: The purpose of this review was to examine the reporting in chiropractic mixed methods research using Good Reporting of A Mixed Methods Study (GRAMMS) criteria. METHODS: In this methodological review, we searched MEDLINE, Embase, CINAHL, and the Index to Chiropractic Literature from the inception of each database to December 31, 2020, for chiropractic studies reporting the use of both qualitative and quantitative methods or mixed qualitative methods. Pairs of reviewers independently screened titles, abstracts, and full-text studies, extracted data, and appraised reporting using the GRAMMS criteria and risk of bias with the Mixed Methods Appraisal Tool (MMAT). Generalized estimating equations were used to explore factors associated with reporting using GRAMMS criteria. RESULTS: Of 1040 citations, 55 studies were eligible for review. Thirty-seven of these 55 articles employed either a multistage or convergent mixed methods design, and, on average, 3 of 6 GRAMMS items were reported among included studies. We found a strong positive correlation in scores between the GRAMMS and MMAT instruments (r = 0.78; 95% CI, 0.66-0.87). In our adjusted analysis, publications in journals indexed in Web of Science (adjusted odds ratio = 2.71; 95% CI, 1.48-4.95) were associated with higher reporting using GRAMMS criteria. Three of the 55 studies fully adhered to all 6 GRAMMS criteria, 4 studies adhered to 5 criteria, 10 studies adhered to 4 criteria, and the remaining 38 adhered to 3 criteria or fewer. CONCLUSION: Our findings suggest that reporting in chiropractic mixed methods research using GRAMMS criteria was poor, particularly among studies with a higher risk of bias.

Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review.

Objective: To examine the risk of bias in chiropractic mixed methods research. Methods: We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias. Results: Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias. Conclusion: Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research.

Objectif: examiner le risque de biais dans la recherche sur les méthodes mixtes chiropratiques. Méthodologie: nous avons effectué une analyse secondaire d'un examen méta-épidémiologique d'études de méthodes mixtes chiropratiques. Nous avons examiné le risque de biais avec The Mixed Methods Appraisal Tool, MMAT (l'outil d'évaluation des méthodes mixtes), et utilisé des équations d'estimation généralisées pour explorer les facteurs associés au risque de biais. Résultats: parmi 55 études admissibles, une moyenne de 62 % (6,8 [2,3]/11) des items du MMAT ont été remplis. Dans notre analyse ajustée, les études publiées depuis 2010 versus celles d'avant 2010 (rapport de cotes [aOR] ajusté = 2,26; intervalle de confiance [IC] à 95 %, 1,39 à 3,68), et celles publiées dans des revues avec un indice de citations versus aucun indice de citations (aOR = 2,21; IC à 95 %, 1,33 à 3,68) étaient associées à un risque de biais plus faible. Conclusion: nos résultats suggèrent des opportunités d'amélioration de la qualité de la conduite parmi les études publiées sur les méthodes mixtes chiropratiques. La conformité des auteurs aux critères MMAT peut réduire les biais méthodologiques dans les futures recherches sur les méthodes mixtes.

Quality of reporting in chiropractic mixed methods research: a methodological review protocol.

BACKGROUND: Mixed methods designs are increasingly used in health care research to enrich findings. However, little is known about the frequency of use of this methodology in chiropractic research, or the quality of reporting among chiropractic studies using mixed methods. OBJECTIVE: To quantify the use and quality of mixed methods in chiropractic research, and explore the association of study characteristics (e.g., authorship, expertise, journal impact factor, country and year of publication) with reporting quality. METHODS: We will conduct a systematic search of MEDLINE, EMBASE, CINAHL, and the Index to Chiropractic Literature to identify all chiropractic mixed methods studies published from inception of each database to December 31, 2020. Articles reporting the use of both qualitative and quantitative methods, or mixed qualitative methods, will be included. Pairs of reviewers will perform article screening, data extraction, risk of bias with the Mixed Methods Appraisal Tool (MMAT), and appraisal of reporting quality using the Good Reporting of A Mixed Methods Study (GRAMMS) guideline. We will explore the correlation between GRAMMS and MMAT scores, and construct generalized estimating equations to explore factors associated with reporting quality. DISCUSSION: This will be the first methodological review to examine the reporting quality of published mixed methods studies involving chiropractic research. The results of our review will inform opportunities to improve reporting in chiropractic mixed methods studies. Our results will be disseminated in a peer-reviewed publication and presented publicly at conferences and as part of a doctoral thesis.

The association between self-reported cardiovascular disorders and troublesome neck pain: a population-based cohort study.

OBJECTIVE: The purpose of this population-based cohort study was to investigate the association between self-reported cardiovascular disorders and troublesome neck pain. METHODS: Using data from the Saskatchewan Health and Back Pain Survey (1995), we formed a cohort of 922 randomly sampled Saskatchewan adults with no or mild neck pain. We used the Comorbidity Questionnaire to measure the point prevalence of self-reported cardiovascular disorders and classified them into 3 levels of severity: (1) absent, (2) present but does not or mildly impacts on my health, and (3) present and moderately or severely impacts on my health. Six and 12 months later, we measured the presence of troublesome neck pain (grades II-IV) using the Chronic Pain Questionnaire. Multivariable Cox regression was used to estimate the association between cardiovascular disorders and the troublesome neck pain while controlling for confounders. RESULTS: The follow-up rate was 73.8% (680/922) at 6 months and 62.7% (578/922) at 1 year. No association was found between self-reported cardiovascular disorders that had no or mild impact on health and the onset of troublesome neck pain. We found a crude association between self-reported cardiovascular disorders that moderately or severely impacted health and the onset of troublesome neck pain (crude hazard rate ratio, 4.3; 95% confidence interval, 1.8-10.0). The association was positively confounded by age, sex, and education (adjusted hazard rate ratio, 5.9; 95% confidence interval, 2.3-14.9). CONCLUSIONS: Our analysis suggests that self-reported cardiovascular disorders that moderately or severely impact one's health are a risk factor for developing troublesome neck pain.

The association between a lifetime history of a work-related neck injury and future neck pain: a population based cohort study.

OBJECTIVE: The purpose of this study was to investigate the association between a lifetime history of a work-related neck injury and the development of troublesome neck pain in the general population. METHODS: We formed a cohort of randomly sampled Saskatchewan adults with no or mild neck pain in September 1995. At baseline, participants were asked if they had ever injured their neck at work. Six and 12 months later, participants were asked if they had troublesome neck pain defined as grades II to IV on the Chronic Pain Grade Questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of work-related neck injury and the onset of troublesome neck pain while controlling for age and sex. RESULTS: Our cohort included 866 individuals at risk for developing troublesome neck pain. Of those, 73.8% (639/866) were followed up at 6 months, and 63.0% (546/866), at 1 year. We found a positive association between a history of a work-related neck injury and the onset of troublesome neck pain (age- and sex-adjusted hazard rate ratio [HRR], 2.4; 95% confidence interval, 1.3-4.7). CONCLUSION: Our analysis suggests that a lifetime history of work-related neck injury is associated with an increased risk of troublesome neck pain. Occupational neck injuries can lead to recurrent episodes of neck pain.

Oral squamous cell carcinoma: an atypical presentation mimicking temporomandibular joint disorder.

A 50-year-old female presented to a chiropractic clinic with left jaw pain consistent with temporomandibular joint disorder. Examination revealed a large ulcerated mass on the posterolateral margin of the tongue which was later diagnosed as squamous cell carcinoma. Squamous cell carcinoma is the most common of the oral cancers. These cancers are often detected late making treatment more complicated and reducing the chance of survival. In the early stages squamous cell carcinoma can be asymptomatic. Symptoms can be similar to that of temporomandibular joint disorder making examination of the patient's mouth important to rule out oral cancers. Oral cancers should be considered when patients present to a chiropractor with pain in the area of the temporomandibular joint. Risk factors such as chronic tobacco and alcohol use should raise concern in these patients. Suspicious lesions should be referred immediately for further investigation.