What are the temporal and physical characteristics of locally applied vibration that modulate balance in older adults? - A systematic review of the literature.

BACKGROUND: Compromised balance is known to contribute to falls, which are associated with increased morbidity and mortality for older adults. Evidence suggests that the application of local vibration to the lower limbs of older adults has the potential to modulate balance. RESEARCH QUESTION: To identify the temporal and mechanical parameters of vibration applied locally to the lower limbs of older adults that modulate measures of balance, and to define the short- and long-term effects of vibration on balance in this population. METHODS: The PRISMA 2020 guidelines were used to conduct a systematic search including the PUBMED, EMBASE, and Scopus databases to identify peer-reviewed literature where vibration was applied to the lower limbs of older adults to modulate balance. Data was extracted using a study-specific data extraction form and risk of bias assessed. Where possible, effect sizes were calculated. RESULTS: Of 7777 records screened, ten randomised controlled trials and 43 prospective laboratory-based studies met the inclusion criteria. Vibration frequencies ranged from 1 to 272 Hz, most studies (n=41) used ≤100 Hz. Amplitude ranged from 0.2 to 3.0 mm, most studies (n=28) used ≤1 mm. Effects of short-term vibration (applied for seconds to hours) were measured during and/or immediately after application. Short-term suprathreshold perceived muscle/tendon vibration had a 'large' destabilising effect size on balance in healthy older adults, but little or no effect on older fallers. Short-term subthreshold vibration to the soles of the feet had a 'small' stabilising effect size. Suprathreshold muscle, tendon or sole vibration applied for 10-30 min over days to weeks improved balance measures, but most (8 of 10) had increased risk of bias. SIGNIFICANCE: The heterogeneity of methodology, populations, and vibration and balance parameters precluded conclusions about the relative effects of lower limb vibration in older adults. However, these results suggest that the application of local vibration to the lower limbs of older adults can modulate balance in the short- and long-term.

Human Factors in Sensory Feedback for Haptic Gloves.

Manual therapy training requires close proximity between the clinical teacher and students, which limits the training of people in remote and rural regions. Video-based online training can provide visual but not tactile information, which is also essential for manual therapies. This project describes the development and testing of an inexpensive sensor glove developed using commercially available sensors, suitable for monitoring the shape and force applied by the hand of a person delivering a spinal manipulation. Its focus was the development of software to provide the human user with tactile information that is usually acquired intuitively in face-to-face teaching. Though rigorous assessment of the glove's application showed errors at low levels of force in actual force measurement and interpretation by users, these errors were reduced at higher levels of force. Trainers of spinal manipulation reported the device to be very useful and suitable for the purpose. We conclude that this glove has the potential for being used for online training of students.Clinical Impact: The outcome of this study shows the feasibility of developing an inexpensive haptic glove using proprietary software for online training of students of manual therapy.

Future Research by the Australian Chiropractic Profession: Analysis of Comments and Suggestions From a Nationwide Survey of Academics and Practitioners.

OBJECTIVE: The purpose of this study was to identify and compare the research priorities of Australian practicing chiropractors and academics across listed research domains and to seek their views on existing chiropractic research strategies. Concurrent objectives were to gain insight into the perspectives on characteristics of research and solicit ideas and suggestions for future research from both groups. METHODS: This study used a mixed-method research design to collect data using an online survey portal. Australian chiropractic academics (n = 220) and practicing chiropractors who were also members of a nationally representative, practice-based research network database (n = 1680) were invited to participate. Data were collected (February 19, 2019, to May 24, 2019). The free-text data were analyzed primarily via semantic coding and verbatim referential units in cases where the category was an exact match for the textual data. Content analyses of the qualitative data were presented in a tabulated and narrative manner as identified domains. Selected representative examples were provided verbatim. RESULTS: The response rate for the survey was 44% for full-time equivalent academics, 8% for casuals and part-time chiropractic academics, and 21.5% for Australian Chiropractic Research Network database chiropractic practitioners. Open-text data comprised a narrower focus on musculoskeletal (MSK) conditions and opposition or reservations by academics and some practitioners toward the research agenda of those espousing traditional concepts and terminology. Comments from both groups illustrate the strongly held views that characterize divergent factions of the chiropractic profession. Some practitioners were highly critical of the narrow focus and epistemological paradigm of Australian university-based research, while others were strongly supportive of the traditional focus of the Australian Spinal Research Foundation. Australian academics at the 4 university-based programs held the view that MSK and spinal pain, for which some evidence already exists, should be the priority of future research, building on what is known. Practitioners believed that future research should be directed toward expanded areas such as basic science, younger populations, and non-MSK conditions. Respondents were sharply divided on attitudes toward traditional chiropractic terminology, concepts, and philosophy and the utility of future research on these topics. CONCLUSION: Our qualitative findings suggest there is a division in the Australian chiropractic profession regarding research direction and priorities. This divide exists between academics and researchers and within field practitioners. This study highlights the attitudes, opinions, and perceptions of important stakeholder groups, which should be considered by decision-makers when formulating research policy, strategy, and prioritization of funding.

A cross-sectional study of Australian chiropractors' and students' readiness to identify and support patients experiencing intimate partner violence.

OBJECTIVE: To explore Australian chiropractors' and final year students' readiness to identify and support patient's experiencing intimate partner violence (IPV). METHODS: This cross-sectional study used the Chiro-PREMIS, an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to explore chiropractors' and final year students' readiness. Survey responses were analyzed through a lens of Miller's framework for developing clinical competence and chiropractic graduate competencies. RESULTS: One hundred forty participants completed the online survey (n = 99 chiropractors and n = 41 students). Reports of practice over the 4 weeks prior to completing the survey showed 21% of chiropractors and 20% of students consulted with patients who had disclosed they were involved in IPV. Thirty-three percent of chiropractors and 27% of students suspected a patient was involved, but that patient did not disclose. Participants report meager training in IPV. Many are unclear about appropriate questioning techniques, documentation, referrals, identifying available resources, and legal literacy. Overall, participants do not "know" about IPV, they do not "know how" to and may not be able to "show how" or "do" when it comes to managing IPV-related clinical scenarios. Further studies are needed to confirm if chiropractors have the appropriate clinical capabilities. CONCLUSION: With proper preparation, chiropractors have an opportunity to make a positive contribution to this social problem. We anticipate chiropractic-specific discourse surrounding these escalating growing social concerns will highlight the intent of the chiropractic profession to make a substantial contribution to the health care of the Australian public. More studies are needed.

The importance of setting and therapeutic relationships when delivering chiropractic care to those living with disadvantage.

BACKGROUND: Chiropractic is a mostly privatised health profession within Australia, with people experiencing disadvantage typically having limited access due to financial barriers. However, some universities within Australia offer community outreach clinics where students provide chiropractic care to people living with disadvantage. This demographic experiences higher rates of chronic conditions including musculoskeletal complaints and requires subsidisation to access privatised care. This need also offers opportunity for the chiropractic profession to work within community healthcare teams. A mixed-methods observational study was used to investigate how the unique setting of a student chiropractic community clinic may influence the experience and outcomes of those who attend. METHODS: Three patient-reported outcome measures (PROMs) investigated client outcomes: Measure Yourself Medical Outcome Profile (MYMOP); European Five Domain Five Level Quality of Life Questionnaire (EQ-5D-5L); and the Patient Enablement Instrument. The PROMs data were analysed descriptively and inferentially. Interviews were conducted with clients who had received chiropractic care, chiropractic students, clinical supervisors and staff of the centre. Interview data were coded using thematic analysis, and themes were formed using Bronfenbrenner's socio-ecological systems framework and non-participant observations. RESULTS: Thirty-seven participants completed baseline PROMs and 17 completed follow-ups after four treatments. Seventy-two percent of participants nominated their primary complaint as chronic. Significant change was noted in general health and wellbeing for the MYMOP, pain and disability for the EQ-5D-5L and index scores for the EQ-5D-5L suggested improved health and wellbeing. Most clients experienced higher levels of enablement post treatment. Twelve participants were interviewed (four were clients), with five themes emerging from the interview data. Clients reported their lived experiences impacted their health problems and attending the clinic offered benefits beyond improvement of pain and disability. CONCLUSIONS: Interview data suggested that these benefits were due to a combination of therapy, the setting and the relationships formed within that setting. Complementing this, PROM data suggested clients experienced better levels of health and wellbeing and decreased levels of pain and disability. Findings indicated that people who experienced disadvantage may receive broader benefits from attending community centres offering chiropractic care. Services such as chiropractic may be complementary in meeting the healthcare needs of those experiencing disadvantage.

Chiropractic students' experiences on the use of virtual radiography simulation: a pilot observational study.

BACKGROUND: Virtual radiography provides students with an opportunity to practise their clinical skills in patient positioning and evaluating radiographic images. The purpose of this pilot study was to introduce Projection VR™, a software radiography simulation program, into a student chiropractic program and evaluate its potential application as a teaching and learning tool. METHODS: Undergraduate chiropractic students, enrolled in a radiographic course (unit within the chiropractic program), were invited to attend a scheduled laboratory where they were introduced to, and undertook purposefully designed activities using the radiography simulation. At the end of this activity, students were asked to complete an online survey (see Virtual Radiography Survey) to describe their experiences of the educational value of the software program. Descriptive statistics were used to evaluate outcomes. Content analysis was performed for free-text comments provided by respondents with key themes provided by the predetermined quantitative categories of the questionnaire. RESULTS: Responses were received from 44 out of the 47 students who attended the scheduled laboratory (response rate 92%). Overall students were positive about this simulation identifying that it was easy to use (95%) and that they could control the equipment as needed (95%). The main reported benefits included students being enabled to repeat tasks until they were satisfied with the results (98%) and being able to quickly assess images and determine if changes needed to be made (98%). Participants reported improvement in their understanding of the effect of exposure factors on patient radiation dose (93%) as well as their technical image evaluation (84%) and problem-solving skills (80%). CONCLUSIONS: The results of this study suggest that virtual radiography is a valuable complementary resource in providing chiropractic students with radiographic knowledge and skills.

Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans.

Introduction: Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness. Methods: Six electronic databases were systematically searched, records identified and assessed including a risk of bias. Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken. Results: Eighteen studies were retrieved and assessed; the overall quality of evidence was moderate to high. Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia. All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits. Conclusion: Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness.

Combined Chiropractic and Podiatric Treatment for Chronic Low Back Pain Concomitant With a Unilateral Pronated Foot: Protocol for a Multicenter Pilot Randomized Controlled Trial.

Objective: The purpose of this article is to describe a protocol to examine the feasibility of combining podiatric orthotic treatment with multimodal chiropractic treatment to treat chronic low back pain (CLBP) in those with a functional short leg on the same side as a unilateral pronated foot. Methods: This is a protocol for a multicenter feasibility 2-arm parallel randomized controlled trial. One hundred and thirty-two adults with CLBP and a functional short leg on the same side as a unilateral pronated foot are to be recruited in Melbourne, Australia, and Madrid and Seville, Spain. Forty-four participants at each site are to be randomized to multimodal chiropractic treatment including spinal manipulation or to multimodal chiropractic treatment also involving spinal manipulation, together with podiatric custom-made orthoses. Chiropractic visits are to comprise 12 treatments over 4 weeks. Outcome measures will be recruitment, compliance, costs, CLBP-related disability, and perceived low back pain. Results: Feasibility results will be reported in text format and the clinical data reported using descriptive statistics focusing on any clinically significant results. Conclusion: This protocol describes a feasibility study for assessing the combination of podiatric orthotic treatment with multimodal chiropractic treatment to treat CLBP in those with a functional short leg on the same side as a unilateral pronated foot.

Effects of manual therapies on stability in people with musculoskeletal pain: a systematic review.

INTRODUCTION: Chronic musculoskeletal pain is associated with reduced balance performance and falls risk. Manual therapies are commonly used interventions for musculoskeletal pain. There is emerging evidence that manual therapies may improve balance. The aim of this systematic review was to examine the effectiveness of manual therapies for musculoskeletal pain on measures of static and dynamic stability. METHODS: Six electronic databases were searched using pre-defined eligibility criteria and two independent reviewers assessed all identified records. Risk of bias was assessed using the 12-item Cochrane Risk of Bias assessment by two authors independently and any discrepancies resolved through consensus. Meta-analysis was conducted when three or more studies used the same outcome measures including gait speed, timed up and go test, step test and sit-to-stand test. RESULTS: Twenty-six studies were included in the analysis. Both spinal and extremity musculoskeletal pain conditions were represented. Manual therapies included manipulation, mobilisation and massage. The most common intervention compared to manual therapy was exercise. Outcome measures included both clinical and objective measures of stability. Overall the risk of bias was reported as generally low or unclear. CONCLUSION: Improvement in stability measures were reported in studies comparing manual therapy in the short term, but not long-term follow-up. There was no clear association between significant pain reduction and measures of stability. Further prospective studies are recommended to investigate whether manual therapies should be part of an integrative healthcare plan for risk of falls management and when a transition from manual therapy to more active interventions should occur for long term management.

Chiropractic treatment of older adults with neck pain with or without headache or dizziness: analysis of 288 Australian chiropractors' self-reported views.

Background: Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors' caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes? Methods: An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data. Results: Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors' patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly: manipulation of the thoracic spine (82.0%); activator adjustment of the neck (77.3%); and massage of the neck (76.5%). The average number of visits required to resolve headache symptoms was reported to be highest among those with migraine (M 11.2, SD 8.8). The majority of chiropractors (57.3%) reported a moderate response to treatment in reported dizziness amongst older adults with neck pain. Approximately 82% of older adult patients were estimated to use at least one other health service concurrently to chiropractic care to manage their neck pain. Conclusion: This is the first known study to investigate chiropractic care of older adults living with neck pain. Chiropractors report using well-established conservative techniques to manage neck pain in older adults. Our findings also indicate that this target group of patients may frequently integrate chiropractic care with other health services in order to manage their neck pain. Further research should provide in-depth investigation of older patients' experience and other patient-reported outcomes of chiropractic treatment.

Chiropractors` experience and readiness to work in Indigenous Australian Communities: a preliminary cross-sectional survey to explore preparedness, perceived barriers and facilitators for chiropractors practising cross-culturally.

BACKGROUND: Indigenous people make up approximately 3% of the total Australian population and score poorer on all health indices, including back pain. Chiropractors are well placed to alleviate back pain, yet there is no research that considers chiropractors' readiness to treat Indigenous patients. This study explores chiropractors` experience working with Indigenous Australians, describes perceived barriers and facilitators to chiropractors' participation in Indigenous Healthcare and their willingness to engage in cultural competency training. METHODS: This study used a non-representative cross-sectional design and a convenience sample. Participants were recruited via email invitation to complete an online survey and encouraged to send the invitation on to colleagues. A 17-item online-survey measured demographic data, perceived barriers and facilitators related to caring for Indigenous Australians, participants` level of comfort when working in Indigenous health, and their willingness to participate in cultural competency programs to enhance their skills, knowledge and cultural capacity when engaging with Indigenous Australians. Analysis of the data included descriptive statistics as well as thematic analysis of qualitative free text. RESULTS: One hundred and twenty-five chiropractors participated in the survey. The majority of participants (86%, n = 108) were employed in private practice. 62% of respondents were members of the Chiropractors' Association of Australia, 41% were Chiropractic and Osteopathic College of Australasia members. 60% of chiropractors considered that they had, or do treat Indigenous patients yet only 4% of respondents asked their patients if they identified as Indigenous. A majority of participants expressed a high level of 'comfort' or confidence in working with Indigenous people while only 17% of respondents had undertaken some form of cultural proficiency training. A majority of respondents (62.7%, n = 74) expressed an interest in working with Indigenous Australians and a majority (91%, n = 104) were willing to participate in training to develop Indigenous cultural competency. CONCLUSIONS: The study points to a need for chiropractors to have access to cultural proficiency training in order to develop the capability and confidence to engage respectfully with their Indigenous patients. This preliminary study has provided the researchers with valuable insights aiding the development and implementation of an Indigenous cultural proficiency program for chiropractors.

Happy to help/happy to be here: Identifying components of successful clinical placements for undergraduate nursing students.

INTRODUCTION: The clinical placement learning environment is a critical component of nursing education where Australian nursing students spend a minimum of 800h. Identifying components of successful clinical placements for undergraduate nursing students is therefore paramount. PURPOSE: To assess nursing students' views of the learning environment during clinical placement with an emphasis on the pedagogical atmosphere, leadership style of the ward manager, and premises of nursing on the unit or ward. MATERIAL AND METHODS: The study used Clinical Learning Environment, Supervision and nurse teacher (CLES+T) questionnaire to examine 150 final year undergraduate students' perceptions of the clinical placement learning environment. The questionnaire was anonymous and completed by the students at the end of their clinical placement. The statistical program SPSS v22 was used. Principal components analysis (PCA) for data reduction was run on the 42-question section of the first dimension ('pedagogical atmosphere on the ward') of the questionnaire that measured the perceptions of the learning environment of the clinical placement of the 150 final-year undergraduate nursing students. The comments sections of the factors were subjected to interpretive content analysis to create the themes for the two components. RESULTS: Principle Component Analysis revealed two components that had eigenvalues greater than one: 'Happy to Help' Component 1 and 'Happy to be Here' Component 2. These components were statistically significant (p<0.0005), using Bartlett's Test of Sphericity indicating that the data was likely factorizable. These components scored higher than any other related factors. CONCLUSIONS: Student nurses value a welcoming workplace where staff and educators are happy to help and have a positive attitude to student presence on the wards. More than any other factors these ward-based factors appear to have the strongest influence on student satisfaction.

Embedding chiropractic in Indigenous Health Care Organisations: applying the normalisation process model.

BACKGROUND: Improving the health of Indigenous Australians remains a major challenge. A chiropractic service was established to evaluate this treatment option for musculoskeletal illness in rural Indigenous communities, based on the philosophy of keeping the community involved in all the phases of development, implementation, and evaluation. The development and integration of this service has experienced many difficulties with referrals, funding and building sustainability. Evaluation of the program was a key aspect of its implementation, requiring an appropriate process to identify specific problems and formulate solutions to improve the service. METHODS: We used the normalisation process model (May 2006) to order the data collected in consultation meetings and to inform our strategy and actions. The normalisation process model provided us with a structure for organising consultation meeting data and helped prioritise tasks. Our data was analysed as it applied to each dimension of the model, noting aspects that the model did not encompass. During this process we reworded the dimensions into more everyday terminology. The final analysis focused on to what extent the model helped us to prioritise and systematise our tasks and plans. RESULTS: We used the model to consider ways to promote the chiropractic service, to enhance relationships and interactions between clinicians and procedures within the health service, and to avoid disruption of the existing service. We identified ways in which chiropractors can become trusted team members who have acceptable and recognised knowledge and skills. We also developed strategies that should result in chiropractic practitioners finding a place within a complex occupational web, by being seen as similar to well-known occupations such as physiotherapy. Interestingly, one dimension identified by our data, which we have labelled 'emancipatory', was absent from the model. CONCLUSIONS: The normalisation process model has resulted in a number of new insights and questions. We have now established thriving weekly chiropractic clinics staffed by a team of volunteer chiropractors. We identified an 'emancipatory' dimension that requires further study. We provide a worked example of using this model to establish, integrate and evaluate a chiropractic service in an Indigenous Australian community.

The sustainable training, treatment, employment program model: effects of manual therapy on musculoskeletal pain and limitation in a Filipino squatter community.

OBJECTIVE: The purpose of this study is to describe the musculoskeletal conditions and associated pain and limitation and the effects of massage treatment in a Filipino squatter community. METHODS: The study was conducted at the Hands On Philippines Education (HOPE) clinic in Bagong Barrio, Caloocan, Philippines. Baseline data were collected before the first treatment, and follow-up data were collected immediately after the second treatment. Treatment was delivered by massage students who were trained in massage by a chiropractic program faculty member through the Project HOPE charitable community-based initiative. A prospective pretest-posttest observational research design was used. The sample consisted of 290 subjects aged 16 years and older visiting the Project HOPE clinic. One hundred ninety-two subjects completed the follow-up surveys. The outcome measures were sites of pain, self-reported levels of pain, and limitation to activities of daily living at baseline and after the second massage therapy treatment. RESULTS: Three self-reported anatomical locations were identified by each subject. The most frequently reported painful sites over the last 7 days among the 166 respondents were the upper back (36.7%), lower back (18.7%), and shoulders (16.3%). The pre-post treatment analyses of pain and disability was restricted to 66 participants who provided completed outcome measures. After 2 massage therapy treatments, all pain and limitation scores decreased. A comparison of mean self-reported levels of pain and disability at baseline and immediately after the second consultation showed statistically significant decreases of pain (t65 = 16.97, P < .001) and disability (t65 = 12.4, P < .001). CONCLUSION: This study suggests that participants who visited the Filipino squatter community clinic experience a high prevalence of musculoskeletal conditions located primarily within the axial skeleton, and that, in the short term, massage therapy delivered on-site by trained therapists was helpful in reducing self-reported levels of pain and limitation to activities of daily living.

The STTEP: a Model for musculoskeletal health care in marginalized communities.

BACKGROUND AND OBJECTIVES: This article introduces the STTEP (Sustainable Training, Treatment, Employment Program) Model. The Model has been in operation since 1995. It provides a useful conceptual framework for policy makers, practitioners, and educators. The Model evolved from work carried out by chiropractors, myotherapists, and related health workers in poor communities through the charitable organization Hands On Health Australia. The STTEP Model grew from a recognition that poor communities mostly rely on heavy, repetitive physical labor for work. For these communities, there is little opportunity to access suitable and affordable health care requiring them to frequently live with the pain and disability associated with highly prevalent musculoskeletal conditions in their communities. The STTEP Model includes myotherapy and musculoskeletal health promotion for uncomplicated musculoskeletal conditions. CONCLUSIONS: The Model also supports training for community members and collaborates with community leaders to promote employment opportunities for graduates. The Model embraces an ethos of cultural sensitivity, corporate responsibility, and sustainability. Project Hope (Hands On Philippines Education), a program in the Philippines, is used to illustrate the Model in action.

Evaluating a massage therapy training and treatment programme in a remote Aboriginal community.

OBJECTIVE: To describe a massage therapy and training programme in a remote Aboriginal community in Australia and to develop the frameworks, procedures and processes necessary for future research. METHOD: Self-report health questionnaires (MYMOP and W-BQ12) and an ethnographic enquiry that included participant observation and 15 interviews with clients and key informants. RESULTS: The project was disrupted by typhoons. Baseline questionnaire responses indicate they may be suitable for this context. Qualitative analysis resulted in a conceptual model of the effects of the programme, which is consistent with a system theory approach. People's accounts were rooted in discussions of the community's history, emotional and physical distress, and limited health care resources. Community-level effects included increasing participation; strengthening local health and educational projects; and opening up new opportunities. Individual level effects included improvement in physical and emotional symptoms, improved function and the receipt of preventative care. CONCLUSION: As a result of this early stage research, future studies have a conceptual model to guide them and evidence that a mixed method and a participatory methodology may be the most appropriate design.

Low back pain risk factors in a large rural Australian Aboriginal community. An opportunity for managing co-morbidities?

BACKGROUND: Low back pain (LBP) is the most prevalent musculo-skeletal condition in rural and remote Australian Aboriginal communities. Smoking, physical inactivity and obesity are also prevalent amongst Indigenous people contributing to lifestyle diseases and concurrently to the high burden of low back pain. OBJECTIVES: This paper aims to examine the association between LBP and modifiable risk factors in a large rural Indigenous community as a basis for informing a musculo-skeletal and related health promotion program. METHODS: A community Advisory Group (CAG) comprising Elders, Aboriginal Health Workers, academics, nurses, a general practitioner and chiropractors assisted in the development of measures to assess self-reported musculo-skeletal conditions including LBP risk factors. The Kempsey survey included a community-based survey administered by Aboriginal Health Workers followed by a clinical assessment conducted by chiropractors. RESULTS: Age and gender characteristics of this Indigenous sample (n = 189) were comparable to those reported in previous Australian Bureau of Statistics (ABS) studies of the broader Indigenous population. A history of traumatic events was highly prevalent in the community, as were occupational risk factors. Thirty-four percent of participants reported a previous history of LBP. Sporting injuries were associated with multiple musculo-skeletal conditions, including LBP. Those reporting high levels of pain were often overweight or obese and obesity was associated with self-reported low back strain. Common barriers to medical management of LBP included an attitude of being able to cope with pain, poor health, and the lack of affordable and appropriate health care services. Though many of the modifiable risk factors known to be associated with LBP were highly prevalent in this study, none of these were statistically associated with LBP. CONCLUSION: Addressing particular modifiable risk factors associated with LBP such as smoking, physical inactivity and obesity may also present a wider opportunity to prevent and manage the high burden of illness imposed by co-morbidities such as heart disease and type-2 diabetes.

A community-based sports massage course for Aboriginal health workers.

OBJECTIVE: To pilot a community-based and owned sports massage course for Aboriginal health workers (AHWs). DESIGN: Descriptive, pilot educational intervention study. SETTING: Rural, Indigenous Australian community. SUBJECTS: AHWs working in a rural community. MAIN OUTCOME MEASURES: Cultural and logistical acceptability of the program to AHWs. RESULTS: The course was delivered within a culturally acceptable framework with applicability for the evaluation of sports massage skills and knowledge changes in a larger sample. CONCLUSION: The sports massage course demonstrated its applicability in this rural Aboriginal community and it has the potential to be adapted and adopted in other similar settings.

Identifying musculoskeletal conditions among rural indigenous peoples.

OBJECTIVE: To critically review the methodological properties of previous musculoskeletal studies among Indigenous populations. In particular, non-rheumatic, musculoskeletal conditions of mechanical origin are examined as these appear to be commonly related to syndromes of pain and disability. DESIGN: Systematic review. SETTING: Rural, Indigenous communities throughout the world. SUBJECTS: Indigenous peoples aged 16 and over living in rural communities. MAIN OUTCOME MEASURE: Minimum requirements for methodologically sound musculoskeletal health research according to previously published criteria. RESULTS: Due to methodological limitations in the 14 studies reviewed, only five methodologically acceptable studies were found. CONCLUSION: Given the paucity of methodologically sound musculoskeletal studies among Indigenous populations, the true prevalence of musculoskeletal conditions in these communities remains largely unknown.