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Areas of Capsaicin-Induced Secondary Hyperalgesia and Allodynia Are Reduced by a Single Chiropractic Adjustment

Areas of Capsaicin-Induced Secondary Hyperalgesia and Allodynia Are Reduced by a Single Chiropractic Adjustment: A Preliminary Study

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2004 (Jul); 27 (6): 381–387

Parvaneh Mohammadian, PhD, Antonio Gonsalves, DC,
Chris Tsai, DC Thomas Hummel, MD, Thomas Carpenter, DC

School of Medicine,
University of California,
Los Angeles, Calif 90024, USA.


INTRODUCTION:   The aim of the study was to investigate the hypoalgesic effects of a single spinal manipulation treatment on acute inflammatory reactions and pain induced by cutaneous application of capsaicin.

METHODS:   Twenty healthy subjects participated in the experiment, which consisted of 2 sessions. In both sessions, following control measurements, topical capsaicin was applied to the right or left forearm to induce cutaneous inflammatory reactions. The cream was removed after 20 minutes. Then subjects received either spinal manipulation treatment (SMT) or “nonspinal manipulation treatment” (N-SMT), respectively. In control as well as pretreatment and posttreatment intervals, the following tests were performed: measurement of the areas of mechanical hyperalgesia and stroking allodynia, assessment of spontaneous pain, and measurement of blood flow.

RESULTS:   The results confirmed that topical capsaicin induced inflammatory reactions based on occurrence of hyperalgesia and allodynia, augmented pain perception, and increased blood flow following capsaicin application compared with the control session. When compared with N-SMT, spontaneous pain was rated significantly lower post-SMT (P < .014). In addition, areas of both secondary hyperalgesia and allodynia decreased after SMT (hyperalgesia: P <.007; allodynia: P <.003). However, there was no significant treatment effect for local blood flow.

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The Influence of Expectation on Spinal Manipulation Induced Hypoalgesia: An Experimental Study in Normal Subjects

The Influence of Expectation on Spinal Manipulation Induced Hypoalgesia: An Experimental Study in Normal Subjects

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2008 (Feb 11); 9: 19

Joel E Bialosky, Mark D Bishop,
Michael E Robinson, Josh A Barabas,
and Steven Z George

University of Florida Department of Physical Therapy,
Gainesville, Florida, USA.


BACKGROUND:   The mechanisms thorough which spinal manipulative therapy (SMT) exerts clinical effects are not established. A prior study has suggested a dorsal horn modulated effect; however, the role of subject expectation was not considered. The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT.

METHODS:   Sixty healthy subjects agreed to participate and underwent quantitative sensory testing (QST) to their leg and low back. Next, participants were randomly assigned to receive a positive, negative, or neutral expectation instructional set regarding the effects of a specific SMT technique on pain perception. Following the instructional set, all subjects received SMT and underwent repeat QST.

RESULTS:   No interaction (p = 0.38) between group assignment and pain response was present in the lower extremity following SMT; however, a main effect (p < 0.01) for hypoalgesia was present. A significant interaction was present between change in pain perception and group assignment in the low back (p = 0.01) with participants receiving a negative expectation instructional set demonstrating significant hyperalgesia (p < 0.01).

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Chiropractic and Spinal Pain Management

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Individual Expectation: An Overlooked, But Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain

Individual Expectation: An Overlooked, But Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain

The Chiro.Org Blog


SOURCE:   Phys Ther. 2010 (Sep); 90 (9): 1345–1355

Joel E. Bialosky Mark D. Bishop Joshua A. Cleland

Department of Physical Therapy,
University of Florida,
Gainesville, FL 32610-0154, USA


Physical therapists consider many factors in the treatment of patients with musculoskeletal pain. The current literature suggests expectation is an influential component of clinical outcomes related to musculoskeletal pain for which physical therapists frequently do not account. The purpose of this clinical perspective is to highlight the potential role of expectation in the clinical outcomes associated with the rehabilitation of individuals experiencing musculoskeletal pain. The discussion focuses on the definition and measurement of expectation, the relationship between expectation and outcomes related to musculoskeletal pain conditions, the mechanisms through which expectation may alter musculoskeletal pain conditions, and suggested ways in which clinicians may integrate the current literature regarding expectation into clinical practice.


From the Full-Text Article:

Background

Physical therapy interventions for musculoskeletal pain conditions often address impairments with the implication that pain and function will improve in response to stretching a tight muscle or strengthening a weak muscle. Realistically, the mechanisms through which physical therapy interventions alter musculoskeletal pain are likely multifaceted and dependent upon a variety of factors related to the therapist, the patient, and the environment. [1] The current literature indicates factors other than the correction of physical impairments influence clinical outcomes in the conservative management of patients experiencing musculoskeletal pain. For example, psychological factors such as fear are useful in directing treatment. [2, 3] Similarly, factors related to patient expectations are associated with both clinical outcomes, [4, 5] satisfaction with treatment, [6, 7] and influence of behavior. [8, 9]

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A Regional Interdependence Model of Musculoskeletal Dysfunction

A Regional Interdependence Model of Musculoskeletal Dysfunction: Research, Mechanisms, and Clinical Implications

The Chiro.Org Blog


SOURCE:   J Man Manip Ther. 2013 (May); 21 (2): 90-102

Derrick G Sueki, Joshua A Cleland,
and Robert S Wainner

Department of Physical Therapy,
Mount St Mary’s College,
Los Angeles, CA, USA.


The term regional interdependence or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient’s primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas.

The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research.

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Prevalence of Low Back Pain in Adolescents
with Idiopathic Scoliosis

Prevalence of Low Back Pain in Adolescents with Idiopathic Scoliosis: A Systematic Review

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2017 (Apr 20); 25: 10

Jean Théroux, Norman Stomski, Christopher J. Hodgetts,
Ariane Ballard, Christelle Khadra, Sylvie Le May and
Hubert Labelle

Research Center,
Sainte-Justine University Hospital Center
School of Health Profession,
Murdoch University


Background   Adolescent idiopathic scoliosis is the most common spinal deformity occurring in adolescents and its established prevalence varies from 2 to 3%. Adolescent idiopathic scoliosis has been identified as a potential risk factor for the development of low back pain in adolescents. The purpose of this study was to systematically review studies of the prevalence of low back pain in adolescents with idiopathic scoliosis in order to establish the quality of the evidence and determine whether the prevalence estimates could be statistically pooled.

Methods   Systematic electronic searches were undertaken in PubMed, CINAHL, and CENTRAL without any restrictions. Studies were eligible for inclusion if they reported the prevalence of low back pain in adolescents with idiopathic scoliosis. Studies were excluded if they detailed the prevalence of pain in post-surgical subjects or were published in languages other than English or French. Data were reported qualitatively, since there was insufficient evidence for statistical pooling.

Results   The electronic search strategies yielded 1811 unique studies. Only two studies fulfilled the eligibility criteria. The prevalence of low back pain in adolescents with idiopathic scoliosis ranged from 34.7 to 42.0%. However, these prevalence estimates should be viewed cautiously as the included studies were at high risk of bias.

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with Idiopathic Scoliosis

Elevated Production of Inflammatory Mediators Including Nociceptive Chemokines in Patients With Neck Pain: A Cross-Sectional Evaluation

Elevated Production of Inflammatory Mediators Including Nociceptive Chemokines in Patients With Neck Pain: A Cross-Sectional Evaluation

The Chiro.Org Blog


J Manipulative Physiol Ther. 2011 (Oct);   34 (8):   498–505

Julita A. Teodorczyk-Injeyan, PhD, John J. Triano, DC, PhD, Marion McGregor, DC, PhD,
Linda Woodhouse, PT, PhD, H. Stephen Injeyan, PhD, DC

Associate Professor,
Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada


OBJECTIVE:   This study investigated whether the production of inflammatory mediators and chemotactic cytokines (chemokines) is altered in patients with chronic and recurrent neck pain (NP).

METHODS:   Cross-sectional data evaluating blood and serum samples were obtained from 27 NP patients and 13 asymptomatic (control) subjects recruited from a chiropractic outpatient clinic. Cell cultures were activated by lipopolysaccharide (LPS) and phytoheamagglutinin for 24 to 48 hours. The levels of tumor necrosis factor α (TNF-α), monocyte chemotactic protein 1, also known as CCL2 (CCL2/MCP-1), and macrophage inflammatory protein 1α or CCL3 (CCL3/MIP-1α) were determined by specific immunoassays. Serum levels of nitric oxide metabolites were evaluated simultaneously, in vanadium III-reduced samples, by Griess reaction.

RESULTS:   Low levels of constitutive (spontaneous) TNF-α production were present in 7 of the 27 cultures from patients with NP. Both LPS-induced TNF-α production and inducer (LPS/phytoheamagglutin)-stimulated production of CCL2 were significantly elevated (P = .00) in patients compared with controls. In patients, the constitutive synthesis of CCL3 occurred significantly more frequently (P = .00) and ranged from 30 to more than 2000 pg/mL. Finally, serum levels of nitric oxide were significantly elevated (P = .00) in NP patients.

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Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

Elevated Production of Nociceptive CC-chemokines and sE-selectin in Patients with Low Back Pain and the Effects of Spinal Manipulation: A Non-randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Clin J Pain. 2017 (Apr 19) [Epub]

Julita A. Teodorczyk-Injeyan, PhD,
Marion McGregor, PhD, DC,
John J. Triano, DC, PhD,
H. Stephen Injeyan, PhD, DC

Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada


BACKGROUND:   The involvement of inflammatory components in the pathophysiology of low back pain is poorly understood. It has been suggested that spinal manipulative therapy (SMT) may exert anti-inflammatory effects.

PURPOSE:   To determine the involvement of inflammation-associated chemokines (CC series) in the pathogenesis of non-specific low back pain and to evaluate the effect of SMT on that process.

METHODS:   Patients presenting with non-radicular, non-specific low back pain (minimum pain score 3 on 10 point visual analogue scale, VAS) were recruited according to stringent inclusion criteria. They were evaluated for appropriateness to treat using a high velocity low amplitude manipulative thrust (HVLT) in the lumbar-lumbosacral region. Blood samples were obtained at baseline and following the administration of a series of 6 HVLTs on alternate days over the period of two weeks. The in vitro levels of CC chemokines (CCL2, CCL3 and CCL4) production and plasma levels of an inflammatory biomarker, soluble E-selectin, were determined at baseline and at the termination of treatments two weeks later.

RESULTS:   Compared with asymptomatic controls baseline production of all chemokines was significantly elevated in acute (P=0.004 – <0.0001), and that of CCL2 and CCL4 in chronic LBP patients (P<0.0001). Furthermore, CCL4 production was significantly higher (P<0.0001) in the acute versus chronic LBP group. sE-selectin levels were significantly higher (P=0.003) in chronic but not in acute LBP patients. Following SMT, patient reported outcomes showed significant (P<0.0001) improvements in VAS and ODI scores. This was accompanied by a significant decline in CCL 3 production (P<0.0001) in both groups of patients. Change scores for CCL4 production differed significantly (P<0.0001) only for the acute LBP cohort, and no effect on the production of CCL2 or plasma sE-selectin levels was noted in either group.

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Workers’ Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

Workers’ Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

The Chiro.Org Blog


SOURCE:   Orthopedics. 2016 (Jan); 39 (1): e1-8

Joshua T. Anderson, BS; Arnold R. Haas, BS, BA;
Rick Percy, PhD; Stephen T. Woods, MD;
Uri M. Ahn, MD; Nicholas U. Ahn, MD

Department of Orthopaedics (JTA, NUA),
University Hospitals Case Medical Center, Cleveland,
Case Western Reserve University School of Medicine (JTA),
Cleveland, and the Ohio Bureau of Workers’ Compensation (ARH, RP, STW),
Columbus, Ohio; and the
New Hampshire NeuroSpine Institute (UMA),
Bedford, New Hampshire


This is an interesting follow-up to a 2011 study drawn from the Ohio Bureau of Workers’ Compensation database.
[Startling New Study Reveals That Back Surgery Fails 74% of the Time]

In the 2011 study, two years AFTER surgery, only 26 percent had returned to work.
That translated to a resounding 74% failure rate!

In this current study, researchers reviewed the files of 686 workers who underwent fusion surgery for spondylolisthesis between 1993 and 2013, revealing that only 29.9% of them ever returned to work (for at least 6 months).   The failure rate (meaning return-to-work) was 70.1%.

Clearly, it’s time to consider more conservative approaches, like early referral for chiropractic care, long before they become chronic pain patients.


The Abstract:

Lumbar fusion for spondylolisthesis is associated with consistent outcomes in the general population. However, workers’ compensation is a risk factor for worse outcomes. Few studies have evaluated prognostic factors within this clinically distinct population. The goal of this study was to identify prognostic factors for return to work among patients with workers’ compensation claims after fusion for spondylolisthesis. The authors used International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes to identify 686 subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013.

Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. The criteria for return to work were met by 29.9% (n=205) of subjects. The authors used multivariate logistic regression analysis to identify prognostic factors for return to work.

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A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

A Qualitative Study of Changes in Expectations Over Time Among Patients with Chronic Low Back Pain Seeking Four CAM Therapies

The Chiro.Org Blog


SOURCE:   BMC Complement Altern Med. 2015 (Feb 5); 15: 12

Emery R Eaves, Karen J Sherman, Cheryl Ritenbaugh,
Clarissa Hsu, Mark Nichter, Judith A Turner,
and Daniel C Cherkin

Department of Family and Community Medicine &
School of Anthropology,
University of Arizona,
Tucson, AZ, USA.


BACKGROUND:   The relationship between patient expectations about a treatment and the treatment outcomes, particularly for Complementary and Alternative Medicine (CAM) therapies, is not well understood. Using qualitative data from a larger study to develop a valid expectancy questionnaire for use with participants starting new CAM therapies, we examined how participants’ expectations of treatment changed over the course of a therapy.

METHODS:   We conducted semi-structured qualitative interviews with 64 participants initiating one of four CAM therapies (yoga, chiropractic, acupuncture, massage) for chronic low back pain. Participants just starting treatment were interviewed up to three times over a period of 3 months. Interviews were transcribed verbatim and analyzed using a qualitative mixed methods approach incorporating immersion/crystallization and matrix analysis for a decontexualization and recontextualization approach to understand changes in thematic emphasis over time.

RESULTS:   Pre-treatment expectations consisted of conjecture about whether or not the CAM therapy could relieve pain and improve participation in meaningful activities. Expectations tended to shift over the course of treatment to be more inclusive of broader lifestyle factors, the need for long-term pain management strategies and attention to long-term quality of life and wellness. Although a shift toward greater acceptance of chronic pain and the need for strategies to keep pain from flaring was observed across participants regardless of therapy, participants varied in their assessments of whether increased awareness of the need for ongoing self-care and maintenance strategies was considered a “positive outcome”. Regardless of how participants evaluated the outcome of treatment, participants from all four therapies reported increased awareness, acceptance of the chronic nature of pain, and attention to the need to take responsibility for their own health.

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Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain

Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain:
A Qualitative Study

The Chiro.Org Blog


SOURCE:   BMC Fam Pract. 2017 (Mar 24); 17 (1): 164

Lauren S. Penney, Cheryl Ritenbaugh, Lynn L. DeBar,
Charles Elder and Richard A. Deyo

South Texas Veterans Health Care System,
7400 Merton Minter Blvd,
San Antonio, TX, 78229, USA


BACKGROUND:   Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.

METHODS:   Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care (medical) providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.

RESULTS:   We identified four themes around opioid use:

(1)   attitudes toward use of opioids to manage chronic pain;
(2)   the limited alternative options for chronic pain management;
(3)   the potential of A/C care as a tool to help manage pain; and
(4)   the complex system around chronic pain management.

Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived acupuncture and chiropractic (A/C) care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.

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Characteristics of Chiropractic Practitioners, Patients, and Encounters in Massachusetts and Arizona

Characteristics of Chiropractic Practitioners, Patients, and Encounters in Massachusetts and Arizona

The Chiro.Org Blog


J Manipulative Physiol Ther. 2005 (Nov); 28 (9): 645–653

Robert D. Mootz, DC, Daniel C. Cherkin, PhD,
Carson E. Odegard, DC, MPH, David M. Eisenberg, MD,
James P. Barassi, DC, Richard A. Deyo, MD, MPH

State of Washington,
Department of Labor and Industries,
Olympia 98504-4321, USA


OBJECTIVE:   To describe chiropractic care using data collected at the time of each patient visit.

METHODS:   Random samples of chiropractors licensed in Arizona and Massachusetts were recruited to participate in interviews about their training, demographics, and practice characteristics. Interviewees were then recruited to record information about patient condition, evaluation, care, and visit disposition on 20 consecutive patient visits.

RESULTS:   Data for 2,550 chiropractic patient visits were recorded. Care for low back, head and neck pain accounted for almost three quarters of visits. Extremity conditions and wellness care accounted for approximately half of the remaining visits. Spinal and soft tissue examinations were the most frequently reported diagnostic procedures (80% and 56% of visits, respectively), and high-velocity spinal manipulation techniques were the most frequently reported therapeutic procedures (almost 85% of visits). Rehabilitation exercises, thermal modalities, electric stimulation, and counseling/education/self-care were each performed during approximately 25% of visits. Approximately 85% of patients seen were self-referred, whereas only approximately 5% came from medical physicians. Approximately 35% of visits had an expected source of payment directly from the patient. Approximately 80% of visits ended with a plan for the patient to return at a specified time.

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Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

Do Older Adults with Chronic Low Back Pain Differ from Younger Adults in Regards to Baseline Characteristics and Prognosis?

The Chiro.Org Blog


SOURCE:   Eur J Pain. 2017 (Mar 14) [Epub]

Manogharan S, Kongsted A, Ferreira ML, Hancock MJ.

Faculty of Medicine and Health Science,
Macquarie University,
Sydney, NSW, Australia


BACKGROUND:   Low back pain (LBP) in older adults is poorly understood because the vast majority of the LBP research has focused on the working aged population. The aim of this study was to compare older adults consulting with chronic LBP to middle aged and young adults consulting with chronic LBP, in terms of their baseline characteristics, and pain and disability outcomes over 1 year.

METHODS:   Data were systematically collected as part of routine care in a secondary care spine clinic. At initial presentation patients answered a self-report questionnaire and underwent a physical examination. Patients older than 65 were classified as older adults and compared to middle aged (45-65 years old) and younger adults (17-44 years old) for 10 baseline characteristics. Pain intensity and disability were collected at 6 and 12 month follow-ups and compared between age groups.

RESULTS:   A total of 14,479 participants were included in the study. Of these 3,087 (21%) patients were older adults, 6,071 (42%) were middle aged and 5,321 (37%) were young adults. At presentation older adults were statistically different to the middle aged and younger adults for most characteristics measured (e.g. less intense back pain, more leg pain and more depression); however, the differences were small. The change in pain and disability over 12 months did not differ between age groups.

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Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2014 (Sep); 58 (3): 206–214

Greg Kawchuk, DC, MSc, PhD, Genevieve Newton, DC, PhD,
John Srbely, DC, PhD, Steven Passmore, Hons BKin, DC, PhD,
André Bussières, DC, FCCS (C), Jason W. Busse, DC, PhD,
and Paul Bruno, BHK, DC, PhD

Associate Professor and Canada Research Chair
in Spinal Function,
Faculty of Rehabilitation Medicine,
University of Alberta


Introduction

This two-part commentary aims to provide clinicians with a basic understanding of knowledge translation (KT), a term that is often used interchangeably with phrases such as knowledge transfer, translational research, knowledge mobilization, and knowledge exchange. [1] Knowledge translation, also known as the science of implementation, is increasingly recognized as a critical element in improving healthcare delivery and aligning the use of research knowledge with clinical practice. [2] The focus of our commentary relates to how these KT processes link with evidence-based chiropractic care.

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Knowledge Transfer within the Canadian Chiropractic Community. Part 1: Understanding Evidence-Practice Gaps

Knowledge Transfer within the Canadian Chiropractic Community. Part 1: Understanding Evidence-Practice Gaps

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2013 (Jun); 57 (2): 111–115

Greg Kawchuk, DC, PhD, Paul Bruno, BHK, DC, PhD,
Jason W. Busse, DC, PhD, André Bussières, DC, FCCS(C), PhD,
Mark Erwin, DC, PhD, Steven Passmore, Hons BKin, DC, PhD,
and John Srbely, DC, PhD

Associate Professor and Canada Research Chair
in Spinal Function,
Faculty of Rehabilitation Medicine,
University of Alberta


Overview

This two-part commentary aims to provide a basic understanding of knowledge translation (KT), how KT is currently integrated in the chiropractic community and our view of how to improve KT in our profession. Part 1 presents an overview of KT and discusses some of the common barriers to successful KT within the chiropractic profession. Part 2 will suggest strategies to mitigate these barriers and reduce the evidence-practice gap for both the profession at large and for practicing clinicians.


Introduction

New knowledge is created at such a rapid pace that health care professionals find it difficult, if not impossible, to keep up to date. In a single day alone, 75 clinical trials and 11 systematic reviews are published. [1] As a result, it is incredibly difficult to keep up to date with the literature in order to implement new knowledge that may optimize patient care, increase benefits, or reduce harm. In an effort to promote evidence-based practice, many researchers and funding agencies are now focusing on processes to deliver emerging evidence successfully to clinicians and other stakeholders; this process has been termed KT.

      What is KT?

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Spinal Pain in Danish School Children –
How Often and How Long?

Spinal Pain in Danish School Children –
How Often and How Long? The CHAMPS Study-DK

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2017 (Mar 27); 18 (1): 67

Kristina Boe Dissing, Lise Hestbæk, Jan Hartvigsen,
Christopher Williams, Steven Kamper, Eleanor Boyle,
and Niels Wedderkopp

Department of Sports Science and Clinical Biomechanics,
Faculty of Health Sciences,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense M, Denmark.


BACKGROUND:   Spinal pain in children and adolescents is a common condition, usually transitory, but the picture of spinal pain still needs elucidation, mainly due to variation in measurement methods. The aim of this study was to describe the occurrence of spinal pain in 8-15 year-old Danish school children, over a 3-year period. Specifically determining the characteristics of spinal pain in terms of frequency and duration.

METHODS:   The study was a 3-year prospective longitudinal cohort study including 1,400 school children. The outcomes were based on weekly text messages (SMS) to the parents inquiring about the child’s musculoskeletal pain, and on clinical data from examinations of the children.

RESULTS:   The 3-year prevalence was 55%. The prevalence was 29%, 33% and 31% for each of the three study years respectively, and increased statistically significantly with age, especially for lumbopelvic pain. Most children had few and short-lasting episodes with spinal pain, but more than one out of five children had three or more episodes during a study year and 17% of all episodes lasted for more than 4 weeks.

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How Often and How Long?