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1.
Complement Ther Med ; 45: 172-178, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331556

RESUMO

BACKGROUND: Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity. METHODS: A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients. RESULTS: Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting. CONCLUSION: Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.


Assuntos
Quiroprática/estatística & dados numéricos , Exercício/fisiologia , Promoção da Saúde/estatística & dados numéricos , Adulto , Austrália , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Prevalência , Inquéritos e Questionários
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.
Australas J Ageing ; 38(4): 249-257, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30977304

RESUMO

OBJECTIVE: To examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older. METHODS: A national cross-sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older. RESULTS: In total, 73.5% of participants report "often" treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72-2.94), working in a non-urban area (OR 1.85; 95% CI 1.35-2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26-2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15-1.96). CONCLUSIONS: The majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group.

4.
Chiropr Man Therap ; 27: 8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30792850

RESUMO

Background: Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and females are known to be more susceptible to multiple joint pain sites, however the association of multisite joint pain with physical and psychosocial functions in this population are unknown. Methods: Cross-sectional data from 579 women were analyzed. Women were asked "Which of your joints have been troublesome on most days of the past month?" Pain qualities were measured using the McGill Pain Questionnaire (Short Form) and PainDETECT, and health was assessed using the SF-36 and sociodemographic variables. Statistical analysis using generalized ordinal logistic regression included comparison of three joint pain groups: no joint pain, 1-4 sites of joint pain and ≥ 5 sites of joint pain. Results: Two thirds of respondents had multisite pain (>1 site), and one third had ≥5 joint pain sites. Compared to women with fewer joint pain sites, women with >5 joint pain sites (multisite joint pain) had significantly poorer physical and emotional health-related quality of life, more severe pain, a higher probability of neuropathic pain, and a longer duration of pain. More than half of women in the multisite joint pain group were still employed, statistically significantly more than women with no joint pain. In the final model, pain duration, the number of medications, pain intensity (discomforting and distressing) and the physical component of health-related quality of life were significantly associated with increased number of joint pain sites. Conclusions: Over one-third of older women in our sample had >5 painful joints in the last month. These women demonstrated significantly poorer psychosocial health, and increased medication use, than women with no or fewer sites of joint pain. Many women with multisite joint pain were still in the workforce, even when nearing retirement age. This study has important implications for future research into musculoskeletal pain, particularly in regards to womens health and wellbeing, and for clinical practice where there should be increased awareness of the implications of concurrent, multisite joint pain.


Assuntos
Artralgia/epidemiologia , Artralgia/psicologia , Idoso , Idoso de 80 Anos ou mais , Artralgia/patologia , Austrália/epidemiologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Articulações/patologia , Modelos Logísticos , Saúde Mental , Pessoa de Meia-Idade , Manejo da Dor/psicologia , Medição da Dor , Qualidade de Vida , Inquéritos e Questionários
5.
Aust J Rural Health ; 27(1): 34-41, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30719793

RESUMO

OBJECTIVE: To determine the prevalence and clinical management characteristics of chiropractors practising in urban and rural or remote Australia. DESIGN: A cross-sectional analysis of the Australian Chiropractic Research Network project data. SETTING: Nationally representative sample of registered chiropractors practising in Australia. PARTICIPANTS: Chiropractors who participated in the Australian Chiropractic Research Network project and answered a question about practising in urban or rural or remote areas in the practitioner questionnaire. MAIN OUTCOME MEASURE: The demographics, practice characteristics and clinical management of chiropractors. RESULTS: The majority of chiropractors indicated that they practise in urban areas only, while 22.8% (n = 435) practice in rural or remote areas only and 4.0% (n = 77) practice in both urban and rural or remote areas. Statistically significant predictors of chiropractors who practice in rural or remote areas, as compared to urban areas, included more patient visits per week, practising in more than one location, no imaging facilities on site, often treating degenerative spinal conditions or migraine, often treating people aged over 65 years, frequently treating Aboriginal and Torres Strait Islander people and frequently using biomechanical pelvic blocking or the sacro-occipital technique. CONCLUSION: A substantial number of chiropractors practice in rural or remote Australia and these rural or remote-based chiropractors are more likely to treat a wide range of musculoskeletal cases and include an Indigenously diverse group of patients than their urban-located colleagues. Unique practice challenges for rural or remote chiropractors include a higher workload and a lack of diagnostic tools. Chiropractors should be acknowledged and considered within rural or remote health care policy and service provision.


Assuntos
Quiroprática/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Recursos Humanos/estatística & dados numéricos , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
6.
J Can Chiropr Assoc ; 62(1): 5-17, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30270924

RESUMO

Objective: To determine effects of thrust manipulation plus one conservative intervention for non-surgical shoulder pain and disability due to rotator cuff dysfunction. Methods: This review followed PRISMA guidelines. The databases searched were PubMed, PEDro, ICL, CINAHL, and AMED. Included were randomized trials with at least one group assigned to receive thrust manipulation and one adjunct conservative therapy. The PEDro scale was used to assess methodological quality and GRADE for analysis. Results: The search yielded 2088 articles with one meeting eligibility criteria. The trial examined thrust manipulation with exercise compared to sham. Statistically significant improvements in pain and disability were reported within but not between groups. Evidence quality according to the PEDro scale was good; GRADE was moderate. Conclusion: Few trials have been conducted studying thrust manipulation plus another conservative intervention for rotator cuff conditions rendering available evidence of thrust manipulation plus exercise insufficient to determine effects of this combined treatment.

7.
Complement Ther Med ; 39: 56-61, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30012393

RESUMO

OBJECTIVES: A range of health-care professionals including chiropractors provide treatment for sports-related health problems. This study reports analyses from the first national workforce survey to determine practitioner and practice-related factors associated with the frequent treatment of athletes or sports people by Australian chiropractors. DESIGN AND SETTING: A 21-item questionnaire collecting information pertaining to practitioner and practice-related characteristics was distributed to all Australian registered chiropractors, as part of the Australian Chiropractic Research Network (ACORN) project and attracted a response rate of 43% (n = 2005). Statistical analyses compared the frequency of treating athletes or sports people against a wide range of relevant practitioner and practice characteristics. RESULTS: Of the respondents, 49.5% (n = 936) reported frequently treating athletes or sports people, and these chiropractors were more likely to be male as well as report more patient care hours and patient visits per week than those chiropractors who did not frequently treat athletes or sports people. Chiropractors who frequently treat athletes or sports people were also more likely to perform multi-modal management, have multi-disciplinary practitioner relations, use diagnostic equipment and discuss nutrition and medication use as part of their patient care than those chiropractors who did not frequently treat athletes or sports people. CONCLUSIONS: Nearly half of participating Australian chiropractors treat athletes or sports people frequently. The current and potential role of chiropractors in sports medicine appears significant. Further research is needed to examine the role, practices and outcomes of such chiropractic care helping to, provide treatment and policy development in this area of clinical management.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/terapia , Pessoal de Saúde/estatística & dados numéricos , Manipulação Quiroprática , Medicina Esportiva/estatística & dados numéricos , Adulto , Austrália , Feminino , Humanos , Masculino , Manipulação Quiroprática/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
Australas J Ageing ; 37(3): 210-216, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29947165

RESUMO

OBJECTIVE: To explore qualitative insights into the pain experience of older women with quantitatively derived pain profiles. METHODS: The sequential mixed methods design involved applying quantitative pain profiles, derived from an earlier latent class analysis, to qualitative comments by a sample of older Australian women with arthritis. Data from a substudy of the Australian Longitudinal Study on Women's Health, mid-aged cohort, born 1946-1951, were used. Inductive content analysis was conducted to explore qualitative insights into the experience of pain. RESULTS: The average age of women was 64.6 years (±1.4). Within each derived pain profile, themes generated from the qualitative comments of women were concordant with the profile descriptors: 'I manage my pain' for the uni-dimensional, mild pain profile (comments from 56 women); 'I live with pain every day' and 'I rely on medication regularly' for the moderate multidimensional pain profile (comments from 39 women); and 'multiple pains', 'I suffer with pain' and 'I am unable and adjust' for the severe multidimensional pain profile (comments from 31 women). CONCLUSION: Women with different pain profiles used different language and strategies in managing their pain experience, information which can guide clinicians to provide more tailored support for self-management and care of arthritis pain.


Assuntos
Adaptação Psicológica , Artralgia/psicologia , Artrite/psicologia , Efeitos Psicossociais da Doença , Percepção da Dor , Qualidade de Vida , Saúde da Mulher , Fatores Etários , Idoso , Envelhecimento/psicologia , Analgésicos/uso terapêutico , Artralgia/diagnóstico , Artralgia/tratamento farmacológico , Artralgia/fisiopatologia , Artrite/diagnóstico , Artrite/tratamento farmacológico , Artrite/fisiopatologia , Austrália , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Pesquisa Qualitativa
9.
J Chiropr Educ ; 32(2): 115-125, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29509506

RESUMO

OBJECTIVE:: To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice. METHODS:: An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests. RESULTS:: A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student's chiropractic institution (Pillai's trace =.638, F[16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice. CONCLUSIONS:: Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.

10.
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
11.
Best Pract Res Clin Rheumatol ; 31(2): 192-202, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-29224696

RESUMO

The term 'spinal pain' collectively includes the cervical, thoracic and lumbosacral regions of the spine. The majority of older people experience spinal pain, and with an increasing proportion of older people, the prevalence of spinal conditions are expected to increase in the coming decades. Musculoskeletal conditions of the spine in the older patient commonly include osteoarthritis and spinal stenosis, and the result of these degenerative diseases includes pain, stiffness and a decreased ability to engage in everyday activities. More than just the burden of pain, spinal pain has a significant considerable impact on the wellbeing and independence of older people within the community. Spinal pain is poorly managed, and knowledge of safe and effective treatment strategies are lacking because of the exclusion of older people in clinical research. Spinal pain in older people is a global health problem; the physical and personal impact of spinal directly threatens efforts to support healthy ageing.


Assuntos
Doenças Musculoesqueléticas/epidemiologia , Medição da Dor/métodos , Dor/etiologia , Estenose Espinal/etiologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Humanos , Doenças Musculoesqueléticas/etiologia , Resultado do Tratamento
12.
J Manipulative Physiol Ther ; 40(7): 527-534, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-29079255

RESUMO

OBJECTIVES: The aim of this study was to perform a systematic review of the literature of the effectiveness and safety of manual therapy interventions on pain and disability in older persons with chronic low back pain (LBP). METHODS: A literature search of 4 electronic databases was performed (PubMed, EMBASE, OVID, and CINAHL). Inclusion criteria included randomized controlled trials of manual therapy interventions on older persons who had chronic LBP. Effectiveness was determined by extracting and examining outcomes for pain and disability, with safety determined by the report of adverse events. The PEDro scale was used for quality assessment of eligible studies. RESULTS: The search identified 405 articles, and 38 full-text articles were assessed. Four studies met the inclusion criteria. All trials were of good methodologic quality and had a low risk of bias. The included studies provided moderate evidence supporting the use of manual therapy to reduce pain levels and alleviate disability. CONCLUSIONS: A limited number of studies have investigated the effectiveness and safety of manual therapy in the management of older people with chronic LBP. The current evidence to make firm clinical recommendations is limited. Research with appropriately designed trials to investigate the effectiveness and safety of manual therapy interventions in older persons with chronic LBP is required.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Dor Lombar/terapia , Manipulações Musculoesqueléticas/métodos , Segurança do Paciente , Idoso , Dor Crônica/diagnóstico , Dor Crônica/terapia , Feminino , Avaliação Geriátrica , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento
13.
J Manipulative Physiol Ther ; 40(7): 459-466, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-29037787

RESUMO

OBJECTIVES: The aims of this study were to (1) report the prevalence and explore the influence of spinal pain on quality of life and (2) assess the relationship between spinal pain and the type and number of comorbidities. METHODS: This cross-sectional study comprised 579 community-dwelling, older Australian women. Women had "spinal pain" if they marked "yes" to neck pain, upper back pain, mid-back pain, and/or lower back pain. Descriptive statistics and binary logistic regression were performed to report the prevalence and explore the relationship between spinal pain and the type and number of comorbidities. RESULTS: A majority of women (55.8%) who returned surveys had spinal pain. Women with spinal pain had significantly lower physical and mental quality of life scores than women without spinal pain (Medical Outcomes Study: 36 Item Short Form Survey [SF-36] physical component summary: 40.1 ± 11.1 vs 49.0 ± 9.0, and SF-36 mental component summary: 50.0 ± 10.5 vs 53.9 ± 8.2, respectively). Having spinal pain was significantly associated with overweight and obesity (odds ratio 1.98 [95% confidence interval 1.3-2.96] and 2.12 [1.37-3.28]), diabetes (1.93 [1.01-3.67]), pulmonary comorbidity (1.66 [1.04-2.65]), and cardiovascular comorbidity (1.57 [1.07-2.28]). More than half of the women with spinal pain reported 2 or more comorbidities, with comorbidities significantly more common among women with spinal pain than among women without spinal pain. The odds of having spinal pain increased with an increasing number of comorbidities (2 comorbidities: 2.44 [1.47-4.04], 3 comorbidities: 3.07 [1.66-5.67], 4 comorbidities: 5.05 [1.64-15.54]). CONCLUSIONS: Spinal pain is common in community-dwelling, older Australian women and is associated with greater disability and poorer quality of life. Diabetes, cardiovascular disease, pulmonary disease, and obesity appear to have a relationship with spinal pain. There was an incremental increase in the risk of spinal pain associated with increasing comorbidity count.


Assuntos
Comorbidade , Avaliação da Deficiência , Avaliação Geriátrica , Qualidade de Vida , Doenças da Coluna Vertebral/diagnóstico , Idoso , Análise de Variância , Austrália , Dor nas Costas/epidemiologia , Dor nas Costas/fisiopatologia , Estudos Transversais , Feminino , Humanos , Vida Independente , Estudos Longitudinais , Dor Lombar/epidemiologia , Dor Lombar/fisiopatologia , Pessoa de Meia-Idade , Análise Multivariada , Cervicalgia/epidemiologia , Cervicalgia/fisiopatologia , Psicometria , Medição de Risco , Fatores Socioeconômicos , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/psicologia
14.
Chiropr Man Therap ; 25: 1, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28070268

RESUMO

PURPOSE: Although many conservative management options are available for patients with non-surgical shoulder conditions, there is little evidence of their effectiveness. This review investigated one manual therapy approach, thrust manipulation, as a treatment option. METHODS: A systematic search was conducted of the electronic databases from inception to March 2016: PubMed, PEDro, ICL, CINAHL, and AMED. Two independent reviewers conducted the screening process to determine article eligibility. Inclusion criteria were manuscripts published in peer-reviewed journals with human participants of any age. The intervention included was thrust, or high-velocity low-amplitude, manipulative therapy directed to the shoulder and/or the regions of the cervical or thoracic spine. Studies investigating secondary shoulder pain or lacking diagnostic confirmation procedures were excluded. Methodological quality was assessed using the PEDro scale and the Cochrane risk-of-bias tool. RESULTS: The initial search rendered 5041 articles. After screening titles and abstracts, 36 articles remained for full-text review. Six articles studying subacromial impingement syndrome met inclusion criteria. Four studies were randomized controlled trials (RCTs) and 2 were uncontrolled clinical studies. Five studies included 1 application of a thoracic spine thrust manipulation and 1 applied 8 treatments incorporating a shoulder joint thrust manipulation. Statistically significant improvements in pain scores were reported in all studies. Three of 4 RCTs compared a thrust manipulation to a sham, and statistical significance in pain reduction was found within the groups but not between them. Clinically meaningful changes in pain were inconsistent; 3 studies reported that scores met minimum clinically important difference, 1 reported scores did not, and 2 were unclear. Four studies found statistically significant improvements in disability; however, 2 were RCTs and did not find statistical significance between the active and sham groups. CONCLUSIONS: No clinical trials of thrust manipulation for non-surgical shoulder conditions other than subacromial impingement syndrome were found. There is limited evidence to support or refute thrust manipulation as a solitary treatment for this condition. Studies consistently reported pain reduction, but active treatments were comparable to shams. High-quality studies of thrust manipulation with safety data, longer treatment periods and follow-up outcomes are needed.

15.
Clin Rheumatol ; 36(3): 625-634, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27383742

RESUMO

The objectives were to identify subgroups of women with arthritis based upon the multi-dimensional nature of their pain experience and to compare health and socio-demographic variables between subgroups. A latent class analysis of 227 women with self-reported arthritis was used to identify clusters of women based upon the sensory, affective, and cognitive dimensions of the pain experience. Multivariate multinomial logistic regression analysis was used to determine the relationship between cluster membership and health and sociodemographic characteristics. A three-class cluster model was most parsimonious. 39.5 % of women had a unidimensional pain profile; 38.6 % of women had moderate multidimensional pain profile that included additional pain symptomatology such as sensory qualities and pain catastrophizing; and 21.9 % of women had severe multidimensional pain profile that included prominent pain symptomatology such as sensory and affective qualities of pain, pain catastrophizing, and neuropathic pain. Women with severe multidimensional pain profile have a 30.5 % higher risk of poorer quality of life and a 7.3 % higher risk of suffering depression, and women with moderate multidimensional pain profile have a 6.4 % higher risk of poorer quality of life when compared to women with unidimensional pain. This study identified three distinct subgroups of pain profiles in older women with arthritis. Women had very different experiences of pain, and cluster membership impacted significantly on health-related quality of life. These preliminary findings provide a stronger understanding of profiles of pain and may contribute to the development of tailored treatment options in arthritis.


Assuntos
Artrite/complicações , Depressão/complicações , Dor/diagnóstico , Qualidade de Vida , Idoso , Artrite/psicologia , Depressão/psicologia , Autoavaliação Diagnóstica , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Dor/etiologia , Dor/psicologia , Índice de Gravidade de Doença , Avaliação de Sintomas
16.
Pain Med ; 17(7): 1308-1316, 2016 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-26874882

RESUMO

OBJECTIVE: To estimate the prevalence and examine the associations of neuropathic-like pain in a community-based sample of older Australian women with arthritis. DESIGN: Population based cross-sectional survey. SETTING: Participants were recruited from the 1946-1951 cohort of the Australian Longitudinal Study of Women's Health. SUBJECTS: Women with self-reported arthritis (n = 147). METHODS: Primary outcome measure was self-reported neuropathic-like pain, defined as scores ≥12 via the painDETECT screening tool. Descriptive statistics summarized health and socio-demographic characteristics, and comparisons made using student's t-test or Wilcoxon Rank Sum test, and Chi-square tests. Independent health and demographic variables were examined by univariable logistic regression, and significant variables included in multiple variable logistic regression modelling. RESULTS: Thirty-nine women (26.5%) were screened as having neuropathic-like pain. Women with neuropathic-like pain were more likely to have poorer health, worse pain, higher pain catastrophizing, more fatigue, and more depression than women with nociceptive pain. Neuropathic-like pain was significantly associated with higher scores on the SF-MPQ sensory scale and pain catastrophizing scale, and with more medication use. CONCLUSIONS: Neuropathic-like pain in women with arthritis was common and is associated with greater disability and poorer quality of life.

17.
J Chiropr Educ ; 29(2): 151-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26090697

RESUMO

OBJECTIVE: To investigate the motivations, challenges and perceptions of the educational environment of emerging researchers in chiropractic. METHODS: A descriptive web-based survey of higher-degree chiropractic research students was performed between October and November 2013. The survey consisted of open and closed questions and the Dundee Ready Education Environment Measure. RESULTS: Twenty-two students currently enrolled in a higher-degree research program participated. Students were most commonly enrolled in a doctor of philosophy program at a part-time rate. Motivations of research were desire to improve the clinical care aspects of chiropractic for the public and belief that chiropractic research is lacking. The greatest challenges were the negative attitudes towards chiropractic, finding enough time to do everything required, and feelings of isolation. The higher-degree research educational environment was perceived to be more positive than negative, with the stimulating nature of research a positive feature. A negative feature of the educational environment was poor undergraduate preparation for higher-degree research. CONCLUSION: This study is the first study to describe higher-degree chiropractic research students. Primary motivations included building research, while challenges included not only negative attitudes toward the chiropractic profession but also negative attitudes toward researchers from within the profession. The higher-degree research educational environment was perceived to be positive. By acknowledging the issues that surround emerging researchers in chiropractic, the profession is better placed to foster academics and build research capacity.

18.
Rheumatol Int ; 35(9): 1461-72, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25869349

RESUMO

The objective of the study was to perform a systematic review to identify and appraise outcome measures and measures of pain that are used to assess the experience of pain by older people with osteoarthritis, and to assess whether these measures are effective at capturing the multidimensional nature of the experience of this pain. A systematic review of five electronic databases from January 1996 to March 2013 was done. Inclusion criteria were cohort/observational and cross-sectional studies; specific diagnosis of OA; employed outcome measures of pain and/or health and/or quality of life which included questions about pain; and considered older adults. Articles were reviewed for methodological quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. A total of 14 publications met the inclusion criteria, and 11 discrete studies were included in the review. The studies used 21 different outcome measures, utilizing 13 measures of pain. Sensory, affective and cognitive dimensions of pain were captured by the measures, albeit studies predominantly measured intensity or severity alone. Measures of pain used in epidemiological studies do not adequately capture the multidimensional nature of the experience of pain in osteoarthritis. There is a fraught complexity in the multidimensionality of the experience of pain in osteoarthritis, and studies exploring osteoarthritis pain in older people should attempt to capture this multidimensionality by employing multiple valid and reliable outcome measures that capture specific dimensions of the pain experience.


Assuntos
Osteoartrite/fisiopatologia , Medição da Dor/métodos , Dor/diagnóstico , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Humanos , Dor/fisiopatologia
19.
Arch Phys Med Rehabil ; 93(2): 259-67, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22289235

RESUMO

OBJECTIVE: To determine the short-term effectiveness of full kinematic chain manual and manipulative therapy (MMT) plus exercise compared with targeted hip MMT plus exercise for symptomatic mild to moderate hip osteoarthritis (OA). DESIGN: Parallel-group randomized trial with 3-month follow-up. SETTING: Two chiropractic outpatient teaching clinics. PARTICIPANTS: Convenience sample of eligible participants (N=111) with symptomatic hip OA were consented and randomly allocated to receive either the experimental or comparison treatment, respectively. INTERVENTIONS: Participants in the experimental group received full kinematic chain MMT plus exercise while those in the comparison group received targeted hip MMT plus exercise. Participants in both groups received 9 treatments over a 5-week period. MAIN OUTCOME MEASURES: Western Ontario and McMasters Osteoarthritis Index (WOMAC), Harris hip score (HHS), and Overall Therapy Effectiveness, alongside estimation of clinically meaningful outcomes. RESULTS: Total dropout was 9% (n=10) with 7% of total data missing, replaced using a multiple imputation method. No statistically significant differences were found between the 2 groups for any of the outcome measures (analysis of covariance, P=.45 and P=.79 for the WOMAC and HHS, respectively). CONCLUSIONS: There were no statistically significant differences in the primary or secondary outcome scores when comparing full kinematic chain MMT plus exercise with targeted hip MMT plus exercise for mild to moderate symptomatic hip OA. Consequently, the nonsignificant findings suggest that there would also be no clinically meaningful difference between the 2 groups. The results of this study provides guidance to musculoskeletal practitioners who regularly use MMT that the full kinematic chain approach does not appear to have any benefit over targeted treatment.


Assuntos
Exercício , Manipulação Quiroprática/métodos , Osteoartrite do Quadril/terapia , Análise de Variância , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Índice de Gravidade de Doença
20.
J Chiropr Med ; 10(2): 86-92, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22014862

RESUMO

OBJECTIVE: Our objective is to document the methodology of a randomized controlled clinical trial that demonstrates sound research methodology. The chiropractic treatment performed may be useful to allow practitioners to adopt a similar approach when treating hip osteoarthritis. METHODS: This study is a registered, ethics-approved, single-blinded, randomized controlled clinical trial. Recruitment included a controlled media release, phone screening, and physical assessment to rule out nonosteoarthritic hip pain. Primary outcome measures were the McMaster Overall Therapy Effectiveness Tool and the Western Ontario and McMaster Universities Osteoarthritis Index, which were assessed at baseline and after 1, 3, 6, and 9 months. Participants were randomly allocated to 1 of 2 intervention groups: protocol A or B. Protocol A received preadjustive stretches of hip musculature, followed by hip manipulation. Protocol B received the above intervention, followed by an additional assessment and chiropractic treatment of the lower limb kinetic chain. Participants received 9 treatments and then after 3 months were offered an additional 6 treatments. Statistics will be performed by an independent biostatistician. RESULTS: This article provides a valid and reliable protocol for a randomized controlled trial for the treatment of hip osteoarthritis with chiropractic care. Data should be analyzed for statistical significance to provide evidence for the efficacy of the interventions. CONCLUSIONS: This study is an example of sound research methodology, which was scored as excellent on the Physiotherapy Evidence Database scale. Findings may be important in the scope of treatment, providing evidence for conservative management options for hip osteoarthritis.

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