Minimal clinical datasets for spine-related musculoskeletal disorders in primary and outpatient care settings: a scoping review.

OBJECTIVES: Effective measurement and monitoring of health status in patients with spine-related musculoskeletal (MSK) disorders are essential for providing appropriate care and improving outcomes. Minimal clinical datasets are standardized sets of key data elements and patient-centered outcomes that can be measured and recorded during routine clinical care. Our scoping review aimed to identify and map current evidence on minimal clinical datasets for measuring and monitoring health status in patients with spine-related MSK disorders in primary and outpatient healthcare settings. STUDY DESIGN AND SETTING: We followed the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. MEDLINE, CINAHL, Cochrane Library, Index to Chiropractic Literature, MANTIS, ProQuest Dissertations and Theses Global, and medRxiv preprint repository were searched from database inception to August 1, 2021. Two reviewers independently screened titles and abstracts, full-text articles, and charted the evidence. Findings were synthesized and summarized descriptively. RESULTS: After screening 5,583 citations and 301 full-text articles, 104 studies about 32 individual minimal clinical datasets were included. Most minimal clinical datasets were developed for patient populations with spine-involving inflammatory arthritis, nonspecific or degenerative spinal pain, and MSK disorders in general. The minimal clinical datasets varied substantially in terms of the author-reported time-to-complete (1-48 minutes) and the number of items (5-100 items). Fifty percent of the datasets involved healthcare professionals in their development process, and only 28% involved patients. Health domain items were most frequently linked to the components of activities and participation (43.9%) and body functions (28.6%), according to the International Classification of Functioning, Disability, and Health. There is no standardized definition of minimal clinical datasets to measure and monitor health status of patients with spine-related MSK disorders in routine clinical practice. Common core elements identified were practicality, feasibility in a busy routine practice, time efficiency, and the capability to be used across different healthcare settings. CONCLUSION: Due to the absence of a standard definition for minimal clinical datasets for patients with spine-related MSK disorders, there is a lack of consistency in the selection of key data elements and patient-centered outcomes that should be included. More research on the implementation and feasibility of minimal clinical datasets in routine care settings is warranted and needed. It is essential to involve all relevant partners in the development process of minimal clinical datasets to ensure successful implementation and adoption in routine primary care.

Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: a cadaveric study.

BACKGROUND: Spinal manipulative therapy (SMT) clinical effects are believed to be linked to its force-time profile characteristics. Previous studies have revealed that the force measured at the patient-table interface is most commonly greater than the one applied at the clinician-patient interface. The factors explaining this force amplification remains unclear. OBJECTIVE: To determine the difference between the force applied to a cadaveric specimen's thoracic spine and the resulting force measured by a force-sensing table, as well as to evaluate the relationship between this difference and both the SMT force-time characteristics and the specimens' characteristics. METHODS: Twenty-five SMTs with different force-time profiles were delivered by an apparatus at the T7 vertebra of nine human cadaveric specimens lying prone on a treatment table equipped with a force plate. The difference between the force applied by the apparatus and the resulting force measured by the force plate was calculated in absolute force (Fdiff) and as the percentage of the applied force (Fdiff%). Kinematics markers were inserted into T6 to T8 spinous and transverse processes to evaluate vertebral displacements during the SMT thrusts. Mixed-effects linear models were run to evaluate the variance in Fdiff and Fdiff% explained by SMT characteristics (peak force, thrust duration and force application rate), T6 to T8 relative and total displacements, and specimens' characteristics (BMI, height, weight, kyphosis angle, thoracic thickness). RESULTS: Sixty percent of the trials showed lower force measured at the force plate than the one applied at T7. Fdiff¸ was significantly predicted (R2marginal = 0.54) by peak force, thrust duration, thoracic thickness and T6-T7 relative displacement in the z-axis (postero-anterior). Fdiff% was significantly predicted (R2marginal = 0.56) by force application rate, thoracic thickness and total T6 displacements. For both dependant variables, thoracic thickness showed the highest R2marginal out of all predictors. CONCLUSION: Difference in force between the clinician-patient and the patient-table interfaces is influenced by SMT force-time characteristics and by thoracic thickness. How these differences in force are associated with vertebral displacements remains unclear. Although further studies are needed, clinicians should consider thorax thickness as a possible modulator of forces being transmitted through it during prone SMT procedures.

Minimal clinical data sets for spine-related musculoskeletal disorders in primary care and outpatient settings: a scoping review protocol.

INTRODUCTION: Lack of standardised clinical data collection may lead to reduced quality in musculoskeletal (MSK)-related clinical care and research. Little is known about the availability and characteristics of minimal clinical data sets for spine-related MSK disorders in primary care and outpatient settings and their utility for improving healthcare quality. Our objective is to undertake a scoping review aiming to identify and map current literature on minimal clinical data sets for measuring and monitoring health status in patients with spine-related MSK disorders in primary and outpatient healthcare settings. METHODS AND ANALYSIS: The 2020 Joanna Briggs Institute methodology for scoping reviews will guide review conduct. The review will consider studies that describe and report on minimal clinical data sets for spine-related MSK disorders designed for primary care and outpatient clinical practice settings. Quantitative and qualitative study designs will be eligible, including consensus-based studies, interventional, observational, feasibility and linguistic validation studies. Studies published in English, German, French, Italian and Spanish will be included, with no limit on date of publication. MEDLINE, CINAHL, Cochrane Library, Index to Chiropractic Literature, MANTIS, ProQuest Dissertations & Theses Global and medRxiv preprint repository will be searched from database inception to 25 July 2021. Two reviewers will independently screen identified titles, abstracts and relevant full-text records, and then extract data using review-specific data extraction forms. Findings will be synthesised and presented as a descriptive summary using PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). ETHICS AND DISSEMINATION: Ethics review and approval is not required for this scoping review. Our target audience for this review will be clinicians, researchers, patients and other relevant stakeholders involved in the measurement and health status monitoring of patients with spine-related MSK disorders. Results will be shared through peer-reviewed publication and presentations at relevant conferences. PROTOCOL REGISTRATION NUMBER: https://osf.io/fkw5b.

Assessing forces during spinal manipulation and mobilization: factors influencing the difference between forces at the patient-table and clinician-patient interfaces.

BACKGROUND: Spinal manipulative therapy (SMT) and mobilization (MOB) effects are believed to be related to their force characteristics. Most previous studies have either measured the force at the patient-table interface or at the clinician-patient interface. The objectives of this study were to determine 1) the difference between the force measured at the patient-table interface and the force applied at the clinician-patient interface during thoracic SMT and MOB, and 2) the influence of the SMT/MOB characteristics, participants' anthropometry and muscle activity (sEMG) on this difference. METHODS: An apparatus using a servo-linear motor executed 8 SMT/MOB at the T7 vertebrae in 34 healthy adults between May and June 2019. SMT and MOB were characterized by a 20 N preload, total peak forces of 100 N or 200 N, and thrust durations of 100 ms, 250 ms, 1 s or 2 s. During each trial, thoracic sEMG, apparatus displacement as well as forces at the patient-table interface and the clinician-patient interface were recorded. The difference between the force at both interfaces was calculated. The effect of SMT/MOB characteristics on the difference between forces at both interfaces and correlations between this difference and potential influencing factors were evaluated. RESULTS: Force magnitudes at the patient-table interface were, in most trials, greater than the force at the clinician-patient interface (up to 135 N). SMT/MOB characteristics (total peak force, thrust duration and rate of force application) affected the difference between forces at both interfaces (all p-values< 0.05). No factor showed significant correlations with the difference between forces at both interfaces for the 8 SMT/MOB. CONCLUSIONS: The results revealed that the force measured at the patient-table interface is greater than the applied force at the clinician-patient interface during thoracic SMT and MOB. By which mechanism the force is amplified is not yet fully understood.