Relationship Between Location of Pregnancy-Related and Postpartum-Related Back Pain and Limitations of Daily Activities and Work Participation.

OBJECTIVE: The aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum. METHODS: This was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns. RESULTS: We surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum. CONCLUSION: The results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancy-related combined pain continued to experience symptoms postpartum.

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process.

OBJECTIVE: The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination. METHODS: A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale. RESULTS: Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included. CONCLUSION: An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.

Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Postpartum Ontario Population.

OBJECTIVE: The purpose of this study was to determine the point prevalence of low back pain (LBP), pelvic girdle pain (PGP), and/or combination pain (COMBO pain) and period prevalence (presence or absence of any of those pains), as well as to identify risk factors at 1, 3, and 6 months postpartum in a Canadian population. METHODS: Participants from a previous pregnancy study participated in a postpartum survey administered over the telephone at 1, 3, and 6 months following delivery. The survey included questions about LBP, PGP, or COMBO pain during the postpartum period, as well as questions related to risk factors (Canadian Task Force Classification II-3). RESULTS: At 1, 3, and 6 months postpartum, responses from 46, 58, and 64 participants, respectively, demonstrated that 15%-21% of women experienced LBP and up to 4% of women experienced COMBO pain (point prevalence). At no time point was PGP reported to occur alone. Period prevalence of back pain for the participants returned to pre-pregnancy levels at each time point. Back pain during pregnancy was the only risk factor identified for back pain at 3 and 6 months postpartum. CONCLUSION: This study demonstrated that 76% to 80% of respondents were pain free at 1, 3, and 6 months postpartum. Pregnancy-related back pain was the only risk factor associated with postpartum-related pain at the 1 to 3 and 3 to 6 month time interval. Identification of site-specific postpartum-related back pain may assist in determination of management and treatment plans for this population.

Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain. METHODS: A search strategy was developed. Interventions were those manual or other nonpharmacologic therapies commonly used by chiropractors (not requiring additional certifications). The outcomes were self-reported changes in pain or disability self-reported outcomes. We used the Scottish Intercollegiate Guideline Network checklists. Strength of the evidence (excluding cohort studies) was determined using an adapted version of the US Preventive Services Task Force criteria as described in the UK report. RESULTS: Of the 1611 published articles, 16 were included. These were 5 SRs, 10 randomized controlled trials (RCTs), and 1 cohort study. Postpartum LBP (1 RCT): moderate, favorable strength for spinal manipulation therapy/mobilization. Postpartum PGP (4 RCTs): moderate, unclear strength for exercise; and inconclusive, unclear strength for patient education. Postpartum LBP or PGP (3 SRs and 4 RCTs): inconclusive, unclear strength for exercise, self-management, and physiotherapy; while osteopathic manipulative therapy was inconclusive, favorable. CONCLUSION: No treatment option was identified as having sufficient evidence to make a clear recommendation. This SR identified a scarcity of literature regarding chiropractic care and back pain for postpartum women, as well as inconsistency among the terms LBP, PGP, and combination pain.

Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic. METHODS: We included procedures that were commonly used by chiropractors and not requiring additional certifications. Outcomes were self-reported changes in pain or disability. We used the Scottish Intercollegiate Guideline Network checklists to assess outcomes. For strength of evidence, we used the adapted version of the US Preventive Services Task Force criteria as described in the UK report. RESULTS: Fifty articles were included from 18 SRs, 30 randomized controlled trials (RCTs), and 2 cohort studies. Pregnancy LBP (7 SRs and 12 RCTs): moderate, favorable evidence for electrotherapy and osteopathic manipulative therapy; inconclusive, favorable strength for chiropractic care, exercise, and support devices; and inconclusive, unclear strength for spinal manipulative therapy. Pregnancy PGP (4 SRs and 4 RCTs): inconclusive, favorable strength for exercise; and inconclusive, unclear evidence for patient education, information, and support devices. Pregnancy LBP or PGP (13 SRs and 12 RCTs): moderate, unclear evidence for complementary and alternative medicine; moderate, unclear evidence for exercise; inconclusive, favorable evidence for multimodal care, patient education, and physiotherapy; and inconclusive, unclear strength for spinal manipulative therapy, osteopathic manipulative therapy, and support devices. CONCLUSION: Although there is a lack of conclusive evidence, many of the interventions have moderate or unclear but favorable evidence.

Prevalence of Low Back Pain, Pelvic Girdle Pain, and Combination Pain in a Pregnant Ontario Population.

OBJECTIVE: The purpose of the current pilot study is to determine the point and period prevalence of site-specific back pain, low back pain (LBP), pelvic girdle pain (PGP), and combined pain (Combo Pain) in pregnant women at a large urban centre in Ontario. METHODS: Point and period prevalence for LBP, PGP, and Combo Pain were determined using a questionnaire and accompanying pain diagram. Women were included in the study if they were healthy, of child-bearing age (18-45 years), currently experiencing a singleton pregnancy (any trimester), and proficient in the English language. RESULTS: Data collected from 287 women were included in the analysis. Three-quarters of women suffered from some sort of pregnancy-related back pain. The point and period prevalences for women who were experiencing LBP, PGP, and Combo Pain were 15.7%, 17.8%, and 15.3% and 33.4%, 27.9%, and 30.7%, respectively. Secondary analyses demonstrated that increasing GA and suffering from both pains at some point prior to pregnancy (Prior Both) increased the risk of experiencing PGP and Combo Pain during pregnancy, respectively. CONCLUSION: The current study demonstrates that 76% of sampled women experienced pregnancy-related back pain and the prevalence of site-specific pain (LBP, PGP, and Combo Pain) increases with increased gestation. Risk factors include advanced GA and experiencing both types of pain prior to pregnancy (Prior Both). Furthermore, it is suggested that a standard definition of pain by location should be developed and employed so that future studies can elucidate appropriate prevention strategies and treatment options for each.

Ultrasound Assessment of Abdominal Muscle Thickness in Women With and Without Low Back Pain During Pregnancy.

OBJECTIVE: The aim of this preliminary study was to determine the differences in abdominal musculature thickness, within 1 month of delivery, in women who experienced back pain during pregnancy compared with those who did not. METHODS: B-mode ultrasound imaging was used to measure abdominal muscle thickness on 76 postpartum participants who participated in a larger study; 47 women experienced back pain during pregnancy, and 29 did not. Participant data were stratified by group, and primary comparisons were based on these grouping across the abdominal muscles, including rectus abdominis (upper and lower fibers), external oblique, internal oblique, and transversus abdominis. Means and standard deviations were also used to set parameters for future studies. RESULTS: In the present study, there was no difference in any abdominal muscle thickness between groups. Women with low back pain were significantly shorter (165.19 ± 6.64 cm) than women who did not have from back pain during pregnancy (169.38 ± 7.58 cm). All other demographics, such as age, weight, and date tested postpartum, were not significantly different between groups. CONCLUSION: The results of this study showed no variation in abdominal muscle thickness in women who had back pain during pregnancy and those who did not.

The Effect of Phase of Menstrual Cycle on Joint Mobility in the Cervical Spine and Extremities in Nulliparous Women: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to investigate the range of motion (ROM) of various joints in women throughout the menstrual cycle to determine whether there would be a difference in the ROM between the luteal and follicular phases during extension at the fifth metacarpophalangeal joint and bilateral rotation of the cervical spine in young adult nulliparous women. METHODS: Sixteen nulliparous women of childbearing age (mean age, 26 years) were recruited from the academic institution where the study was being performed. Participants were randomized into and tested during either the luteal or follicular phases of the menstrual cycle. In the following month, participants were tested in the opposite phases of the menstrual cycle. All testing was performed by a doctor of chiropractic. Differences in ROM were measured in single joint movements (fifth digit hyperextension) and in multijoint movements (bilateral cervical rotation) using an electromagnetic sensor system. RESULTS: No significant effects of phase were found on peak ROM of the fifth digit or during cervical spine rotation (left, right, or bilaterally), irrespective of trial. CONCLUSION: There is no difference in ROM of the cervical spine or the fifth metacarpophalangeal joint, regardless of the phase of menses, suggesting there is likely no hormonal influence on these structures during the follicular or luteal phases.

Ultrasound Assessment of Abdominal Muscle Thickness in Postpartum vs Nulliparous Women.

OBJECTIVE: The purpose of this study was to determine the effect size in measurable change of abdominal musculature morphology using ultrasonography in postpartum women within 1 month of a healthy, vaginal delivery. METHODS: One hundred fifty-six participants were recruited for this study. B-mode ultrasound imaging was used to measure abdominal muscle thickness on 80 nulliparous women and 76 mothers who had delivered within the past 4 weeks. Measures were taken for the upper and lower rectus abdominus, external and internal obliques, and transversus abdominus at rest. RESULTS: Statistically significant differences were found in the thickness of the rectus abdominus muscle at both sites; upper (P < .0001) and lower (P < .0001) as well as the internal oblique (P < .0001). All 3 muscles were thinner in postpartum participants (8.29 ± 1.83 mm, 8.89 ± 2.29 mm, and 7.06 ± 1.82 mm, respectively) within the first month of delivery than in controls (10.82 ± 1.93 mm, 11.13 ± 2.38 mm, and 8.36 ± 1.87 mm, respectively). Large effect sizes were found for the influence of pregnancy on the rectus muscle segments (1.35 for the upper rectus abdominus and 1.00 for the lower rectus abdominus) and a medium effect size for the internal oblique (0.71). No significant differences were observed in the remaining 2 muscles. CONCLUSION: This study showed that there are differences in morphology of the abdominal muscles in pregnant women vs nonpregnant controls. The large effect sizes reported may provide the basis for future studies examining relationships between morphology, functional change, and back pain during pregnancy.

An interprofessional approach to collaborative management of low-back pain in primary care: A scholarly analysis of a successful educational module for prelicensure learners.

OBJECTIVE: In 2008, an interprofessional education (IPE) working group was formed to develop a module on interdisciplinary low-back pain management to fill a curricular gap at our institution. This article describes the program evaluation outcomes and highlights factors contributing to its successful implementation over 8 years through reference to Brigg's Presage-Process-Product (3-P) Model of Teaching and Learning. METHODS: Program evaluation occurred through administration of a pre- and postmodule Health Professional Collaborative Competency Perception Scale, with scores compared using paired t tests. Descriptive statistics were analyzed from 5-point Likert scales for module session components. RESULTS: A total of 853 students from 9 health care occupations (medicine, chiropractic, physiotherapy, pharmacy, nursing, nurse practitioner, occupational therapy, physiotherapy assistants, and occupational therapist assistants) participated in 51 iterations of the module from 2011 to 2019, averaging 16 participants each session. All Health Professional Collaborative Competency Perception Scale items significantly improved from pre- to postintervention (p < .001) for learners from 6 health professions. Module components were rated highly, with the majority of learners rating these as 4 (helpful) or 5 (very helpful) for their learning. Participants also improved their scores in perceived history and physical exam comfort, knowledge of pharmacotherapy, management options, and attitudes regarding an interprofessional approach to back pain (p < .001). CONCLUSION: This article describes the presage, process factors, and products of this model IPE program that provides learners from various health care professions with an opportunity to gain a deeper understanding of the interdisciplinary management of low-back pain, as demonstrated through improvement in collaborative competencies.

Hip pain in an elite cyclist with Non-Hodgkin's Follicular Lymphoma: a case report.

OBJECTIVE: We present a case of an elite cyclist that hesitated to follow the medical advice from her practitioners, as she was determined to train and compete resulting in delayed diagnosis and management of a rare hip pathology. CASE PRESENTATION: A 51-year old elite female cyclist had a history of years of hip pain with insidious onset. The chiropractor in this case observed a lack of response to treatment, and advised the patient to get an MRI with suspicion of a labral tear. She eventually agreed to further investigations and was diagnosed with Non-Hodgkin's follicular lymphoma and a labral tear. SUMMARY: Elite athletes are not immune to serious pathology. Chiropractors should be vigilant and ensure to investigate any patients with a lack of response to conservative management. Chiropractors should be aware of the risk of athletic patients that continue to train and compete when advised not to.

OBJECTIF: Nous présentons le cas d'une cycliste d'élite qui a hésité à suivre les conseils médicaux de ses praticiens, car elle était déterminée à s'entraîner et à participer à des compétitions, ce qui a retardé le diagnostic et la prise en charge d'une pathologie rare de la hanche. PRÉSENTATION DU CAS: Une cycliste d'élite de 51 ans avait des antécédents de douleurs à la hanche depuis des années; le début de ses douleurs avait été insidieux. Le chiropraticien a observé une absence de réponse au traitement et a conseillé à la patiente de subir un examen par IRM en soupçonnant une déchirure du labrum. La patiente a fini par accepter de subir des examens complémentaires. Un lymphome folliculaire non hodgkinien et une déchirure labrum ont été diagnostiqués. RÉSUMÉ: Les athlètes d'élite ne sont pas à l'abri d'une pathologie grave. Les chiropraticiens doivent être vigilants et s'assurer d'examiner tous les patients réfractaires à un traitement conservateur. Les chiropraticiens doivent être conscients du risque que représentent les patients sportifs qui continuent à s'entraîner et à participer à des compétitions alors qu'on leur a conseillé de ne pas le faire.

Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update.

BACKGROUND: The purpose of this study is to update a previous critical review of adverse events in pregnant and postpartum populations. METHODS: The following databases were searched: PubMed, CINAHL, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews/Cochrane Central Register of Controlled Trials and MEDLINE. We included all study design types as it was determined a priori that there would not be enough high-quality research on spinal manipulative therapy (SMT) in these populations to make any determinations. The Scottish Intercollegiate Guidelines Network (SIGN) and CARE (CAse REport) checklists were used for quality rating. RESULTS: This update found one case study that demonstrated a serious adverse event in the cervical spine following SMT and a handful of minor and transient adverse events in the low back following SMT. CONCLUSIONS: There was limited evidence of adverse events following SMT in these populations. Although we are calling for improved reporting of such events in future studies, it may be that such injuries are rare.

CONTEXTE: La présente étude vise à mettre à jour les résultats d'un examen critique des effets défavorables des manipulations vertébrales chez la femme enceinte et la femme en postpartum. MÉTHODOLOGIE: On a interrogé les bases de données suivantes : PubMed, CINAHL, Index to Chiropractic Literature, Cochrane Database of Systematic Reviews/ Cochrane Central Register of Controlled Trials et MEDLINE. On a retenu toutes les études parce qu'il avait été établi antérieurement que le nombre de recherches de bonne qualité sur les manipulations vertébrales (MV) chez la femme enceinte et la femme en postpartum était insuffisant pour trancher toute question. On s'est servi des listes de vérification Scottish Intercollegiate Guidelines Network (SIGN) et CARE (CAse REport) pour évaluer la qualité des études. RÉSULTATS: Une étude de cas faisait état d'un grave effet indésirable à la colonne cervicale après des MV et d'une poignée d'effets indésirables mineurs et transitoires à la colonne lombaire. CONCLUSIONS: Il existe peu de preuves que les MV ont des effets indésirables chez les populations à l'étude. Il faudrait plus de données. Mais il est permis d'affirmer que ces effets indésirables sont rares.

Physical activity throughout pregnancy: guideline critical appraisal and implementation tool.

OBJECTIVE: The 2019 Canadian guideline for physical activity throughout pregnancy provides evidencebased recommendations to promote maternal, fetal, and neonatal health. We aimed to 1) critically appraise the 2019 Canadian guideline for physical activity throughout pregnancy; and 2) develop a guideline summary for clinicians to facilitate the uptake of recommendations into practice. METHODS: We used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to critically appraise the quality and reporting of this guideline. Four reviewers independently scored between 1 (strongly disagree) to 7 (strongly agree) for 23 items organized into six quality domains. RESULTS: AGREE II quality domain scores ranged from 47%-64% and the overall quality of the guideline was rated as 83% (high quality). CONCLUSION: Based on its methodological quality, we recommend the use of this guideline. Our guideline summary includes six recommendations and other safety precautions that are relevant for clinicians in Canada.

OBJECTIF: L'édition de 2019 des Directives canadiennes en matière d'exercice physique pendant la grossesse fournit des recommandations fondées sur des données probantes visant à favoriser la santé de la mère, du fœtus et du nouveau-né. Notre objectif était 1) d'examiner d'une façon critique l'édition de 2019 de ces lignes directrices; et 2) de faire un résumé à l'intention des cliniciens pour faciliter leur adoption dans l'exercice. MÉTHODOLOGIE: On a utilisé la grille Appraisal of Guidelines for Research and Evaluation II (AGREE II) pour évaluer la qualité et le contenu des lignes directrices. Quatre examinateurs indépendants ont attribué une cote allant de 1 (fortement en désaccord) et 7 (fortement d'accord) à 23 éléments répartis dans six groupes d'aspects de la qualité. RÉSULTATS: Les cotes attribuées aux aspects de qualité de la grille AGREE II ont varié de 47 à 64 %. La cote attribuée à la qualité globale des lignes directrices s'est élevée à 83 % (grande qualité). CONCLUSION: Compte tenu de la qualité de la méthode avec laquelle elles ont été élaborées, on recommande l'adoption de ces lignes directrices. Nous résumons six recommandations et des consignes de sécurité pertinentes pour les cliniciens canadiens.

Rare subtype of multiple myeloma presenting as sacroiliac joint pain in an avid golfer: a case report.

OBJECTIVE: Kappa (κ) light chain multiple myeloma can be disguised as low back pain (LBP), and as such may present to a primary contact provider such as a chiropractor. The rarity and non-specific nature of the clinical presentation of this condition typically lead to a delayed diagnosis. CASE PRESENTATION: A 53-year old male avid golfer presented to a chiropractor with a chief complaint of LBP. He was diagnosed with sacroiliac joint dysfunction. His pain was initially improving with chiropractic management. The character of his pain changed, and the chiropractor referred for further imaging. He was subsequently diagnosed with κ light chain multiple myeloma. SUMMARY: This case presentation highlights that spinal malignancy is a possible cause of LBP. It reminds the clinician to investigate signs and symptoms that could lead to a suspicion of malignancy, to monitor patient progression, and consider further evaluations if the expected response to treatment is not achieved.

OBJECTIF: Un myélome multiple à chaîne légère (kappa) (κ) peut se cacher derrière des lombalgies qu'un fournisseur de soins primaires, comme un chiropraticien, peut ne pas reconnaître. En raison de la rareté et de la nature imprécise des symptômes cliniques, ce type de myélome est souvent diagnostiqué tardivement. EXPOSÉ DU CAS: Un fervent golfeur de 53 ans s'est présenté dans une clinique de chiropratique en se plaignant de lombalgies. Le chiropraticien a diagnostiqué une trouble de l'articulation sacroiliaque. Au début, le traitement de chiropraxie a soulagé la douleur. Mais comme sa nature évoluait, le chiropraticien a recommandé un examen par imagerie, qui a révélé un myélome multiple à chaîne légère k. RÉSUMÉ: Les tumeurs de la colonne vertébrale peuvent être une cause de lombalgies. Le présent exposé de cas rappelle au clinicien de rechercher les causes des signes et des symptômes pouvant faire soupçonner un cancer, de surveiller l'état du patient et d'envisager des examens plus approfondis si le traitement ne donne pas les résultats attendus.

Taping protocol for two presentations of pregnancy-related back pain: a case series.

BACKGROUND: Back pain is common during pregnancy and can have an adverse impact on the quality of life for some, yet treatment options for this population are limited. We document a chiropractic treatment that involves using kinesiology tape (tape) to help alleviate pregnancy-related back pain in two patients. CASE PRESENTATION AND MANAGEMENT: Two pregnant women reported to two different chiropractic offices with varying presentations of pregnancy-related back pain. A trial of chiropractic care was rendered in both chiropractic offices, which included the application of tape. OUTCOME AND DISCUSSION: In both case presentations, the addition of tape in the lumbosacral and/or abdominal regions, decreased pain intensity from 9-10/10 to 4/10 or less on the Numeric Rating Scale (NRS). Including a taping protocol to a plan of management in women with pregnancy-related LBP or PGP may be a safe and effective option to alleviate pain in this population.

CONTEXTE: Les maux de dos sont fréquents pendant la grossesse et peuvent avoir un impact négatif sur la qualité de vie de certaines femmes, mais les options de traitement pour cette population sont limitées. Nous documentons un traitement chiropratique qui implique l'utilisation de ruban de kinésiologie (ruban) pour aider à soulager les douleurs dorsales liées à la grossesse chez deux patientes. PRÉSENTATION ET GESTION DE CAS: Deux femmes enceintes se sont présentées à deux cabinets de chiropractie différents présentant des maux de dos différents liés à la grossesse. Un essai de soins chiropratiques comprenant l'application de ruban a été effectué dans les deux cabinets de chiropractie. RÉSULTATS ET DISCUSSION: Dans les deux présentations de cas, l'ajout de ruban dans les régions lombo-sacrées et/ou abdominales a diminué l'intensité de la douleur qui est passée de 9­10/10 à 4/10 ou moins sur l'échelle d'évaluation numérique (EEN). Le fait d'inclure un protocole d'utilisation de ruban à un plan de prise en charge chez les femmes présentant une lombalgie ou des douleurs pelviennes liées à la grossesse peut constituer une option sûre et efficace pour soulager la douleur chez cette population.

Ontario chiropractor's knowledge of exercise guidelines for pregnant patients.

OBJECTIVE: To describe the Ontario chiropractors' knowledge regarding the current guidelines for exercise during pregnancy through a knowledge score and exploring its distribution across different strata of interest including gender, experience, location of practice and type of practice. METHODS: A previously used survey was modified and sent to 500 randomly selected Ontario chiropractors. Demographic and continuing education questions were included, and the knowledge score was calculated using 10 items. RESULTS: The differences between the knowledge score values across the four strata of interest were not statistically significant. The average knowledge score in the sample of respondents was low (5.2 out of 10) and highly variable (SD=1.8). CONCLUSION: The average knowledge score of the respondents was found to be low and highly variable but not statistically or practically different across various strata of interest. A well-designed curriculum or post-graduate courses may be beneficial for practicing chiropractors in Ontario.

OBJECTIF: Décrire les connaissances des chiropraticien(ne)s de l'Ontario sur les lignes directrices actuelles en matière d'exercice pendant la grossesse au moyen d'un score de connaissances et explorer leur répartition dans différentschamps d'intérêt, notamment le sexe, l'expérience, le lieu de pratique et le type de pratique. MÉTHODOLOGIE: Un sondage (ayant déjà servi) a été modifié et envoyé à 500 chiropraticien(ne)s choisi(e) s au hasard domicilié(e)s en Ontario. Des questions démographiques et de formation continue ont été ajoutées, et le score de connaissances a été calculé selon 10 critères. RÉSULTATS: Les différences entre les valeurs du score de connaissances parmi les quatre champs d'intérêt n'étaient pas statistiquement importante. Le score moyen de connaissances dans l'échantillon des personnes interrogées était faible (5,2 sur 10) et très variable (SD= 1,8). CONCLUSION: Le score moyen de connaissances des personnes interrogées s'est avéré faible et très variable, mais pas statistiquement ou pratiquement différent parmi les différentes champs d'intérêt. Un programme d'études ou des cours universitaires supérieurs bien conçus peuvent être bénéfiques pour les chiropraticien(ne)s de l'Ontario.

Development and evaluation of a multimedia CD-ROM for exercise during pregnancy and postpartum.

OBJECTIVE: To meet the need for an interactive product on exercise during pregnancy and postpartum, we developed and evaluated a personally tailored multimedia CD-ROM. METHODS: Pregnant and postpartum women, who were randomly assigned to either the experimental group (PregXercise CD-ROM) or the control group (CD-ROM with neutral content), navigated through the CD-ROM for 1 h. Main outcomes were exercise self-efficacy and knowledge. RESULTS: In analyses of covariance, compared with the control group, the experimental group had significant increases in self-efficacy and knowledge. CONCLUSION: The multimedia CD-ROM delivering information about exercise motivation, guidelines, and prescription was effective in improving exercise self-efficacy and knowledge. PRACTICE IMPLICATIONS: Our preliminary results illustrate that healthcare professionals and researchers may use interactive multimedia for improving exercise behavior and related outcomes with pregnant and postpartum women.

Attitudes Toward Chiropractic: A Survey of Canadian Obstetricians.

We assessed the attitudes of Canadian obstetricians toward chiropractic with a 38-item cross-sectional survey. Ninety-one obstetricians completed the survey, for a response rate of 14% (91 of 659). Overall, 30% of respondents held positive views toward chiropractic, 37% were neutral, and 33% reported negative views. Most (77%) reported that chiropractic care was effective for some musculoskeletal complaints, but 74% disagreed that chiropractic had a role in treatment of non-musculoskeletal conditions. Forty percent of respondents referred at least some patients for chiropractic care each year, and 56% were interested in learning more about chiropractic care. Written comments from respondents revealed concerns regarding safety of spinal manipulation and variability among chiropractors. Canadian obstetricians' attitudes toward chiropractic are diverse and referrals to chiropractic care for their patients who suffer from pregnancy-related low back pain are limited. Improved interprofessional relations may help optimize care of pregnant patients suffering from low back pain.

Adverse events from spinal manipulation in the pregnant and postpartum periods: a critical review of the literature.

BACKGROUND: The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively. METHODS: A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable. RESULTS: Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality. CONCLUSIONS: There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.