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1.
J Can Chiropr Assoc ; 63(1): 36-43, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31057176

RESUMO

Objective: To evaluate student perceptions of chiropractic cultural authority, role in healthcare and use of terms at two chiropractic institutions, the Canadian Memorial Chiropractic College (CMCC) and Parker University (Parker). Methods: A unique survey was developed and administered electronically to Year 2-3 students (n=387) at CMCC and as a paper-based surveys to trimester 4-5 (comparison with Year 2) and 6-7 (comparison with Year 3) (n=277) students at Parker. Responses were anonymous. The survey assessed the likelihood that students at both chiropractic programs would use eight different chiropractic terms. The survey also assessed their preference toward different options with respect to chiropractic's cultural authority. Results: Response rates were 36.2% and 78.1% at CMCC and Parker, respectively. Students at both institutions reported that chiropractic cultural authority was 'neuromusculoskeletal' (NMSK); however, CMCC students was more favorable toward 'musculoskeletal' (MSK) care compared to Parker students, whereas students at Parker favored 'wellness' (59.7%) compared to CMCC students (46.4%). Students at CMCC were more likely to use 'impingement' and 'joint dysfunction' whereas Parker students were more likely to use 'innate intelligence' and 'vertebral subluxation'. Both institutions were equally likely to use 'spinal lesion'. Conclusion: This survey found significant cultural authority differences between institutions. While this adds to the emerging need in the literature to evaluate the impact of curriculum and co-curriculum within chiropractic training programs on professional identity, explanations were not evaluated.

2.
Chiropr Man Therap ; 27: 19, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31015956

RESUMO

Background: Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods: This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who 'often' treated patients with LBRLP compared to those who treated LBRLP 'never/rarely/sometimes'. Multiple logistic regression models identified independent factors associated with chiropractors who 'often' treated patients with LBRLP. Results: A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them 'often' treating LBRLP. Chiropractors who 'often' treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who 'often' treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions: Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.


Assuntos
Quiroprática/organização & administração , Dor Lombar/terapia , Manejo da Dor , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Perna (Membro)/fisiopatologia , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor/fisiopatologia , Inquéritos e Questionários , Adulto Jovem
3.
Eur J Pain ; 23(7): 1378-1389, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31034102

RESUMO

BACKGROUND: Low back pain (LBP) is a global public health challenge, which causes high healthcare costs and the highest burden on society in terms of years lived with disability. While patients' expectations for improvement may have effects on LBP treatment outcomes, it remains unclear if psychological profiles modify this relationship. Therefore, the objectives of this study were to investigate if (a) patients' expectations predicted short-term outcome, and (b) psychological profile, pain intensity and self-rated health modified the relationship between expectations and outcome. METHODS: Data were collected between April 2012 and January 2016 during the inclusion into a randomized controlled trial. Potentially eligible participants were identified through 40 chiropractic clinics located across Sweden. Patients' expectations, psychological profile, pain intensity, activity limitation and self-rated health were collected from patients with recurrent persistent LBP during their first chiropractic visit (n = 593). Subjective improvement was measured at the fourth visit. RESULTS: Patients with a high expectation of improvement had 58% higher risk to report an improvement at the fourth visit (RR = 1.58, 95% CI: 1.28, 1.95). Controlling for potential confounders only slightly decreased the strength of this association (RR = 1.49, 95% CI: 1.20, 1.86). Baseline pain intensity, psychological profile and self-rated health did not modify the effect of expectation on outcome. CONCLUSIONS: Baseline patients' expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients' expectations at the first visit to best inform prognosis. SIGNIFICANCE: This study confirms the importance of patients' expectations in a clinical setting. Patients' expectations predict the short-term outcome of chiropractic care for LBP. Pain intensity, psychological profile and self-rated health did not modify this relationship.

4.
BMC Complement Altern Med ; 19(1): 60, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866915

RESUMO

BACKGROUND: This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report. METHODS: Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study. RESULTS: Of the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity. CONCLUSIONS: Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed. TRIAL REGISTRATION: PROSPERA registration number: CRD42018091835.


Assuntos
Manipulações Musculoesqueléticas , Adolescente , Paralisia Cerebral/terapia , Criança , Pré-Escolar , Cólica/terapia , Constipação Intestinal/terapia , Humanos , Lactente , Recém-Nascido , Doenças Musculoesqueléticas/terapia
5.
Chiropr Man Therap ; 26: 5, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29441194

RESUMO

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.


Assuntos
Centros Médicos Acadêmicos , Pesquisa Biomédica/educação , Fortalecimento Institucional/organização & administração , Quiroprática/educação , Terapias Complementares/educação , Pesquisadores/educação , Austrália , Canadá , Quiroprática/tendências , Terapias Complementares/tendências , Comportamento Cooperativo , Dinamarca , Pesquisa sobre Serviços de Saúde , Humanos , Liderança , Mentores
6.
JAMA Netw Open ; 1(1): e180105, 2018 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-30646047

RESUMO

Importance: It is critically important to evaluate the effect of nonpharmacological treatments on low back pain and associated disability. Objective: To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone. Design, Setting, and Participants: A 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source. Interventions: The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies. Main Outcomes and Measures: Coprimary outcomes were low back pain intensity (Numerical Rating Scale; scores ranging from 0 [no low back pain] to 10 [worst possible low back pain]) and disability (Roland Morris Disability Questionnaire; scores ranging from 0-24, with higher scores indicating greater disability) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction (Numerical Rating Scale; scores ranging from 0 [not at all satisfied] to 10 [extremely satisfied]), and medication use. The coprimary outcomes were modeled with linear mixed-effects regression over baseline and weeks 2, 4, 6, and 12. Results: Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, -1.1; 95% CI, -1.4 to -0.7), disability (mean difference, -2.2; 95% CI, -3.1 to -1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13-0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54-0.97). No serious related adverse events were reported. Conclusions and Relevance: Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care. Trial Registration: ClinicalTrials.gov Identifier: NCT01692275.


Assuntos
Quiroprática/métodos , Terapia Combinada/métodos , Dor Lombar/terapia , Adolescente , Adulto , Avaliação da Deficiência , Feminino , Hospitais Militares , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Medição da Dor , Resultado do Tratamento , Estados Unidos , Adulto Jovem
7.
J Can Chiropr Assoc ; 62(3): 130-142, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30662067

RESUMO

Objectives: To: 1) develop/adapt and validate an instrument to measure patient safety attitudes and opinions of community-based spinal manipulative therapy (SMT) providers; 2) implement the instrument; and 3) compare results among healthcare professions. Methods: A review of the literature and content validation were used for the survey development. Community-based chiropractors and physiotherapists in 4 Canadian provinces were invited. Results: The Agency for Healthcare Research and Quality's (AHRQ) Medical Office Survey on Patient Safety Culture was the preferred instrument. The survey was modified and validated, measuring 14 patient safety dimensions. 276 SMT providers volunteered to respond to the survey. Generally, SMT providers had similar or better patient safety dimension scores compared to the AHRQ 2016 medical offices database. Discussion: We developed the first instrument measuring patient safety attitudes and opinions of community-based SMT providers. This instrument provides understanding of SMT providers' opinions and attitudes on patient safety and identifies potential areas for improvement.

8.
Trials ; 18(1): 575, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29191232

RESUMO

BACKGROUND: Patient safety performance can be assessed with several systems, including passive and active surveillance. Passive surveillance systems provide opportunity for health care personnel to confidentially and voluntarily report incidents, including adverse events, occurring in their work environment. Active surveillance systems systematically monitor patient encounters to seek detailed information about adverse events that occur in work environments; unlike passive surveillance, active surveillance allows for collection of both numerator (number of adverse events) and denominator (number of patients seen) data. Chiropractic manual therapy is commonly used in both adults and children, yet few studies have been done to evaluate the safety of chiropractic manual therapy for children. In an attempt to evaluate this, this study will compare adverse event reporting in passive versus active surveillance systems after chiropractic manual therapy in the pediatric population. METHODS/DESIGN: This cluster randomized controlled trial aims to enroll 70 physicians of chiropractic (unit of randomization) to either passive or active surveillance system to report adverse events that occur after treatment for 60 consecutive pediatric (13 years of age and younger) patient visits (unit of analysis). A modified enrollment process with a two-phase consent procedure will be implemented to maintain provider blinding and minimize dropouts. The first phase of consent is for the provider to confirm their interest in a trial investigating the safety of chiropractic manual therapy. The second phase ensures that they understand the specific requirements for the group to which they were randomized. Percentages, incidence estimates, and 95% confidence intervals will be used to describe the count of reported adverse events in each group. The primary outcome will be the number and quality of the adverse event reports in the active versus the passive surveillance group. With 80% power and 5% one-sided significance level, the sample size was calculated to be 35 providers in each group, which includes an 11% lost to follow-up of chiropractors and 20% of patient visits. DISCUSSION: This study will be the first direct comparison of adverse event reporting using passive versus active surveillance. It is also the largest prospective evaluation of adverse events reported after chiropractic manual therapy in children, identified as a major gap in the academic literature. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02268331 . Registered on 10 October 2014.


Assuntos
Manipulação Quiroprática/efeitos adversos , Doenças Musculoesqueléticas/terapia , Segurança do Paciente , Vigilância da População/métodos , Indicadores de Qualidade em Assistência à Saúde , Adolescente , Fatores Etários , Canadá , Criança , Feminino , Humanos , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/fisiopatologia , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Estados Unidos
9.
J Manipulative Physiol Ther ; 39(7): 487-493, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27530089

RESUMO

OBJECTIVE: The purpose of this cross-sectional survey was to evaluate attitudes and opinions of doctors of chiropractic (DCs) specializing in pediatric care toward patient safety. METHODS: The Medical Office Survey on Patient Safety Culture of the Agency for Healthcare Research and Quality was adapted for providers who use spinal manipulation therapy and sent out to 2 US chiropractic organizations' pediatric council members (n = 400) between February and April 2014. The survey measured 12 patient safety dimensions and included questions on patient safety items and quality issues, information exchange, and overall clinic ratings. Data analyses included a percent composite average and a nonrespondent analysis. RESULTS: The response rate was 29.5% (n = 118). Almost one- third of respondents' patients were pediatric (≤17 years of age). DCs with a pediatric certification were 3 times more likely to respond (P < .001), but little qualitative differences were found in responses. The patient safety dimensions with the highest positive composite percentages were Organizational Learning (both administration and clinical) and Teamwork (>90%). Patient Care Tracking/Follow-up and Work Pressure and Pace were patient safety dimensions that had the lowest positive composite scores (<85%). The responses also indicated that there was concern regarding information exchange with insurance/third-party payors. Two quality issues identified for improvement were (1) updating a patient's medication list and (2) following up on critically abnormal results from a laboratory or imaging test within 1 day. The average overall patient safety rating score indicated that 83% of respondents rated themselves as "very good" or "excellent." CONCLUSIONS: Compared with 2014 Agency for Healthcare Research and Quality physician referent data from medical offices, pediatric DCs appear to have more positive patient safety attitudes and opinions. Future patient safety studies need to prospectively evaluate safety performance with direct feedback from patients and compare results with these self-assessed safety attitudes, as well as make further use of this survey to develop a comparable database for spinal manipulation providers.


Assuntos
Atitude do Pessoal de Saúde , Quiroprática , Segurança do Paciente , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pediatria , Adulto Jovem
10.
J Manipulative Physiol Ther ; 39(5): 369-380, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27157678

RESUMO

OBJECTIVE: The purpose of this pilot sham-controlled clinical trial was to estimate the treatment effect and safety of toggle recoil spinal manipulation for blood pressure management. METHODS: Fifty-one participants with prehypertension or stage 1 hypertension (systolic blood pressure ranging from 135 to 159 mm Hg or diastolic blood pressure ranging from 85 to 99 mm Hg) were allocated by an adaptive design to 2 treatments: toggle recoil spinal manipulation or a sham procedure. Participants were seen by a doctor of chiropractic twice weekly for 6 weeks and remained on their antihypertensive medications, as prescribed, throughout the trial. Blood pressure was assessed at baseline and after study visits 1, 6 (week 3), and 12 (week 6), with the primary end point at week 6. Analysis of covariance was used to compare mean blood pressure changes from baseline between groups at each end point, controlling for sex, age, body mass index, and baseline blood pressure. RESULTS: Adjusted mean change from baseline to week 6 was greater in the sham group (systolic, -4.2 mm Hg; diastolic, -1.6 mm Hg) than in the spinal manipulation group (systolic, 0.6 mm Hg; diastolic, 0.7 mm Hg), but the difference was not statistically significant. No serious and few adverse events were noted. CONCLUSIONS: Six weeks of toggle recoil spinal manipulation did not lower systolic or diastolic blood pressure when compared with a sham procedure. No serious adverse events from either treatment were reported. Our results do not support a larger clinical trial. Further research to understand the potential mechanisms of action involving upper cervical manipulation on blood pressure is warranted before additional clinical investigations are conducted.


Assuntos
Vértebras Cervicais , Hipertensão/terapia , Manipulação da Coluna/métodos , Pressão Sanguínea , Feminino , Humanos , Masculino , Projetos Piloto , Resultado do Tratamento
11.
Trials ; 17: 70, 2016 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-26857706

RESUMO

BACKGROUND: Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone. METHODS/DESIGN: This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation. DISCUSSION: Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability. TRIAL REGISTRATION: The trial discussed in this article was registered in ClinicalTrials.gov with the NCT01692275 Date of registration: 6 September 2012.


Assuntos
Protocolos Clínicos , Dor Lombar/terapia , Manipulação Quiroprática , Militares , Adolescente , Adulto , Coleta de Dados , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Garantia da Qualidade dos Cuidados de Saúde , Estatística como Assunto
12.
J Evid Based Complementary Altern Med ; 21(2): 110-4, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26739669

RESUMO

An outline of the minimum core competencies expected from a certified pediatric doctor of chiropractic was developed using a Delphi consensus process. The initial set of seed statements and substatements was modeled on competency documents used by organizations that oversee chiropractic and medical education. These statements were distributed to the Delphi panel, reaching consensus when 80% of the panelists approved each segment. The panel consisted of 23 specialists in chiropractic pediatrics (14 females) from across the broad spectrum of the chiropractic profession. Sixty-one percent of panelists had postgraduate pediatric certifications or degrees, 39% had additional graduate degrees, and 74% were faculty at a chiropractic institution and/or in a postgraduate pediatrics program. The panel were initially given 10 statements with related substatements formulated by the study's steering committee. On all 3 rounds of the Delphi process the panelists reached consensus; however, multiple rounds occurred to incorporate the valuable qualitative feedback received.


Assuntos
Competência Clínica/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Manipulação Quiroprática , Certificação , Feminino , Humanos , Masculino , Pediatria
13.
Man Ther ; 21: 183-90, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26319101

RESUMO

BACKGROUND: Low back pain (LBP) is a major health problem in industrialized societies. Spinal manipulation (SM) is often used for treating LBP, though the therapeutic mechanisms remain elusive. Research suggests that sensorimotor changes may be involved in LBP. It is hypothesized that SM may generate its beneficial effects by affecting sensorimotor functions. OBJECTIVES: To compare changes in sensorimotor function, as measured by postural sway and response to sudden load, in LBP patients following the delivery of high-velocity low amplitude (HVLA)-SM or low-velocity variable amplitude (LVVA)-SM versus a sham control intervention. DESIGN: A three-arm (1:1:1 ratio) randomized controlled trial. METHODS: A total of 221 participants who were between 21 and 65 years, having LBP intensity (numerical rating scale) ≥4 at either phone screen or the first baseline visit and ≥2 at phone screen and both baseline visits, and Quebec Task Force diagnostic classifications of 1, 2, 3 or 7 were enrolled to receive four SM treatments over two weeks. Study outcomes were measured at the first and fifth visits with the examiners blinded from participant group assignment. RESULTS: The LVVA-SM group demonstrated a significant increase in medial-to-lateral postural excursion on the soft surface at the first visit when compared to the control group. No other significant between-group differences were found for the two sensorimotor tests, whether during the first visit or over two weeks. CONCLUSIONS: It appears that short-term SM does not affect the sensorimotor functions as measured by postural sway and response to sudden load in this study.


Assuntos
Dor Lombar/fisiopatologia , Dor Lombar/terapia , Manipulação da Coluna/métodos , Equilíbrio Postural/fisiologia , Córtex Sensório-Motor/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
14.
J Evid Based Complementary Altern Med ; 21(2): 105-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26438719

RESUMO

A reporting and learning system is a method of monitoring the occurrence of incidents that affect patient safety. This cross-sectional survey asked pediatric chiropractors about factors that may limit their participation in such a system. The list of potential barriers for participation was developed using a systematic approach. All members of the 2 pediatric councils associated with US national chiropractic organizations were invited to complete the survey (N = 400). The cross-sectional survey was created using an online survey tool (REDCap) and sent directly to member emails addressed by the respective executive committees. Of the 400 potential respondents, 81 responded (20.3%). The most common limitations to participating were identified as time pressure (96%) and patient concerns (81%). Reporting and learning systems have been utilized to increase safety awareness in many high-risk industries. To be successful, future patient safety studies with pediatric chiropractors need to ensure these barriers are understood and addressed.


Assuntos
Manipulação Quiroprática/estatística & dados numéricos , Segurança do Paciente/normas , Pediatria/estatística & dados numéricos , Pediatria/normas , Médicos/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino
15.
Trials ; 15: 406, 2014 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-25344427

RESUMO

BACKGROUND: Systematic procedures addressing the limitations of eligibility determination are needed to improve the quality of participant recruitment and enrollment in randomized clinical trials. This paper describes an eligibility determination process developed by and in use at a chiropractic research center engaged in community recruitment for clinical trials studying spinal pain conditions. METHODS: A team of investigators developed a case review process for application across clinical trials involving chiropractic care. Study personnel representing key study roles including research clinicians, study coordinators, a project manager, and at least one investigator convene in person to determine eligibility for participants following baseline study visit examinations. The research clinician who performed the eligibility examination presents the case and a moderator leads the case review panel through a structured discussion including diagnosis, eligibility criteria, definition review, and clinical precautions. Panel members provide clinical recommendations and determine final eligibility using a structured and moderated voting process. RESULTS: Through the case review process for three externally funded clinical trials for participants with neck and low back pain, we presented 697 cases, rendering 472 participants eligible for enrollment and excluding 225 individuals. The most common reasons for case review exclusions across the three trials included neck or back pain not meeting diagnostic classifications, safety concerns related to treatment or testing, referral for further evaluation or treatment, and compliance concerns. CONCLUSIONS: The case review process uses the expertise of study coordinators, research clinicians, project managers, and investigators to render eligibility decisions consistent with study aims for the duration of the trial. This formal eligibility determination process includes steps designed to mitigate the potential for participant misclassification from clinician advocacy or misunderstanding of eligibility criteria, and helps ensure that participants can safely take part in study procedures. TRIAL REGISTRATION: The three trials discussed in this article were registered in ClinicalTrials.gov with the ID numbers of NCT00830596 (27 January 2009), NCT01312233 (04 March 2011), and NCT01765751 (30 May 2012).


Assuntos
Ensaios Clínicos como Assunto/métodos , Definição da Elegibilidade , Dor Lombar/terapia , Manipulação Quiroprática , Cervicalgia/terapia , Seleção de Pacientes , Pesquisadores , Comportamento de Escolha , Técnicas de Apoio para a Decisão , Processos Grupais , Humanos , Iowa , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Manipulação Quiroprática/efeitos adversos , Cervicalgia/diagnóstico , Cervicalgia/fisiopatologia , Segurança do Paciente , Desenvolvimento de Programas , Medição de Risco , Resultado do Tratamento
16.
BMC Complement Altern Med ; 14: 292, 2014 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-25106673

RESUMO

BACKGROUND: Low back pain (LBP) is a major health issue due to its high prevalence rate and socioeconomic cost. While spinal manipulation (SM) is recommended for LBP treatment by recently published clinical guidelines, the underlying therapeutic mechanisms remain unclear. Spinal stiffness is routinely examined and used in clinical decisions for SM delivery. It has also been explored as a predictor for clinical improvement. Flexion-relaxation phenomenon has been demonstrated to distinguish between LBP and healthy populations. The primary objective of the current study is to collect preliminary estimates of variability and effect size for the associations of these two physiological measures with patient-centered outcomes in chronic LBP patients. Additionally biomechanical characteristics of SM delivery are collected with the intention to explore the potential dose-response relationship between SM and LBP improvement. METHODS/DESIGN: This is a prospective, observational study applying side-lying, high velocity, low amplitude SM as treatment for patients with LBP over a course of 6 weeks. Approximately 80 participants will be enrolled if they present with chronic LBP of 1, 2 or 3 in Quebec Task Force Classification for spinal disorders, a Roland-Morris Disability Questionnaire (RMDQ) score ≥ 6, and persistent LBP ≥ 2 with a maximum ≥ 4 using numerical rating scale. Patient-centered outcomes include LBP using visual analog scale, RMDQ, and PROMIS-29. Lumbar spine stiffness is assessed using palpation, a hand-held instrumented device, and an automated device. Flexion-relaxation is assessed using surface electromyography at the third level of the lumbar spine. Biomechanical characteristics of SM are assessed using a self-reported, itemized description system, as well as advanced kinetic measures that will be applied to estimate forces and moments at the lumbar segment level targeted by SM. DISCUSSION: Beside alterations in material properties of the passive components of the spine, increased neuromuscular activity may also contribute to a stiffened spine. Examining changes in both spinal stiffness and flexion-relaxation along the course of the treatment provides an opportunity to understand if the therapeutic effect of SM is associated with its action on active and/or passive components of the spine. TRIAL REGISTRATION: NCT01670292 on clinicaltrials.gov.


Assuntos
Dor Lombar/terapia , Manipulação da Coluna , Adulto , Idoso , Protocolos Clínicos , Feminino , Humanos , Dor Lombar/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Adulto Jovem
18.
J Chiropr Educ ; 27(1): 33-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23519131

RESUMO

OBJECTIVE: A chiropractic pediatric specialist often encounters novel clinical findings not reported currently in the literature. This project matched board certified chiropractic pediatric specialists with a mentor experienced in scientific writing to co-author a research paper to add to the literature base available on chiropractic pediatric practice. METHODS: Clinicians who had received their Diplomate in Clinical Chiropractic Pediatrics and mentors in scientific writing were teamed up. Two surveys were conducted to collect quantitative data, and focus groups were held to gather qualitative data about the overall experience of the mentor and mentee (clinicians) participating in the study. The first survey was sent to the clinicians to gather information about their research idea and their experience in research. The second survey was conducted upon project completion by clinicians and mentors. A project wiki was used as a communication strategy. RESULTS: Ten reports were submitted by authorship teams. Time spent on this project was an average of 58 hours by clinicians and 36 hours by the mentors. Mentors aided by adding content material, editing manuscripts, and educating the clinicians in the art of writing a paper. Improvements for this project included clearer mentoring guidelines and not using the wiki as a communication venue. CONCLUSION: The project ultimately fulfilled the goal of using a mentorship model to facilitate scientific writing education and ease the anxiety of authoring a first publication. The overall experience was "good"; however, there are opportunities for improvement.

19.
J Chiropr Med ; 11(3): 160-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23449823

RESUMO

OBJECTIVE: Otitis media (OM) is one of the common conditions for doctor visits in the pediatric population. Spinal manipulation therapy (SMT) may be a potential conservative treatment of OM. The purpose of this study is to review the literature for OM in children, outlining the diagnosis of OM, SMT description, and adverse event notation. METHODS: Databases (PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health, Index to Chiropractic Literature, The Allied and Complementary Medicine, and Alt Health Watch) were queried and hand searches were performed to identify relevant articles. All potential studies were independently screened for inclusion by both authors. The inclusion criteria were as follows: written in the English language, addressed OM, involved human participants 6 years or younger, and addressed SMT. Studies were evaluated for overall quality using standardized checklists performed independently by both authors. RESULTS: Forty-nine articles were reviewed: 17 commentaries, 15 case reports, 5 case series, 8 reviews, and 4 clinical trials. Magnitude of effect was lower in higher-quality articles. No serious adverse events were found; minor transient adverse effects were noted in 1 case series article and 2 of the clinical trials. CONCLUSIONS: From the studies found in this report, there was limited quality evidence for the use of SMT for children with OM. There are currently no evidence to support or refute using SMT for OM and no evidence to suggest that SMT produces serious adverse effects for children with OM. It is possible that some children with OM may benefit from SMT or SMT combined with other therapies. More rigorous studies are needed to provide evidence and a clearer picture for both practitioner and patients.

20.
Trials ; 12: 161, 2011 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-21708042

RESUMO

BACKGROUND: Low back pain (LBP) is a recognized public health problem, impacting up to 80% of US adults at some point in their lives. Patients with LBP are utilizing integrative health care such as spinal manipulation (SM). SM is the therapeutic application of a load to specific body tissues or structures and can be divided into two broad categories: SM with a high-velocity low-amplitude load, or an impulse "thrust", (HVLA-SM) and SM with a low-velocity variable-amplitude load (LVVA-SM). There is evidence that sensorimotor function in people with LBP is altered. This study evaluates the sensorimotor function in the lumbopelvic region, as measured by postural sway, response to sudden load and repositioning accuracy, following SM to the lumbar and pelvic region when compared to a sham treatment. METHODS/DESIGN: A total of 219 participants with acute, subacute or chronic low back pain are being recruited from the Quad Cities area located in Iowa and Illinois. They are allocated through a minimization algorithm in a 1:1:1 ratio to receive either 13 HVLA-SM treatments over 6 weeks, 13 LVVA-SM treatments over 6 weeks or 2 weeks of a sham treatment followed by 4 weeks of full spine "doctor's choice" SM. Sensorimotor function tests are performed before and immediately after treatment at baseline, week 2 and week 6. Self-report outcome assessments are also collected. The primary aims of this study are to 1) determine immediate pre to post changes in sensorimotor function as measured by postural sway following delivery of a single HVLA-SM or LVVA-SM treatment when compared to a sham treatment and 2) to determine changes from baseline to 2 weeks (4 treatments) of HVLA-SM or LVVA-SM compared to a sham treatment. Secondary aims include changes in response to sudden loads and lumbar repositioning accuracy at these endpoints, estimating sensorimotor function in the SM groups after 6 weeks of treatment, and exploring if changes in sensorimotor function are associated with changes in self-report outcome assessments. DISCUSSION: This study may provide clues to the sensorimotor mechanisms that explain observed functional deficits associated with LBP, as well as the mechanism of action of SM. TRIAL REGISTRATION: This trial is registered in ClinicalTrials.gov, with the ID number of NCT00830596, registered on January 27, 2009. The first participant was allocated on 30 January 2009 and the final participant was allocated on 17 March 2011.


Assuntos
Dor Lombar/terapia , Manipulação da Coluna , Atividade Motora , Equilíbrio Postural , Projetos de Pesquisa , Adulto , Idoso , Feminino , Humanos , Illinois , Iowa , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Região Lombossacral , Masculino , Manipulação da Coluna/efeitos adversos , Pessoa de Meia-Idade , Medição da Dor , Pelve , Placebos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
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