Stefan Malmqvist, Inger Kjaermann, Knut Andersen, Anne Marie Gausel, Inger Økland, Jan Petter Larsen, Kolbjorn S Bronnick
The Norwegian Centre for Movement Disorders,
Stavanger University Hospital,
OBJECTIVE: To explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.
DESIGN: A prospective longitudinal cohort study.
PARTICIPANTS: Pregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.
SETTING: Obstetric outpatient clinic at Stavanger University Hospital, Norway.
METHODS: Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.
PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.
RESULTS: 503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.
Signe Fuglkjer, Kristina Boe Dissing and Lise Hestbaek
Department of Sports Science and Clinical Biomechanics,
Faculty of Health Sciences,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense M, Denmark.
BACKGROUND: It is difficult to gain an overview of musculoskeletal extremity complaints in childhood although this is essential to develop evidence-based prevention and treatment strategies. The objectives of this systematic review were therefore to describe the prevalence and incidence of musculoskeletal extremity complaints in children and adolescents in both general and clinical populations in relation to age, anatomical site and mode of onset.
METHODS: MEDLINE and EMBASE were electronically searched; risk of bias was assessed; and data extraction was individually performed by two authors.
RESULTS: In total, 19 general population studies and three clinical population studies were included with children aged 0–19 years. For most of the analyses, a division between younger children aged 0–12 years, and older children aged 10–19 years was used. Lower extremity complaints were more common than upper extremity complaints regardless of age and type of population, with the most frequent pain site changing from ankle/foot in the youngest to knee in the oldest. There were about twice as many non-traumatic as traumatic complaints in the lower extremities, whereas the opposite relationship was found for the upper extremities in the general population studies. There were relatively more lower extremity complaints in the general population studies than in the clinical population studies. The review showed no pattern of differences in reporting between studies of high and low risk of bias.
Michele Maiers, Mustafa Agaoglu, Richard Brown, Christopher Cassirer, Kendrah DaSilva, Reidar P. Lystad, Sarkaw Mohammad, and Jessica J. Wong
Northwestern Health Sciences University,
2501 W 84th St,
Bloomington, MN 55431 USA.
The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women’s, children’s, and adolescents’ health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve.
KEYWORDS: Ageing; Chiropractic; Opioid; Public health; children’s health; women’s health
Anthony J. Lisi, DC, Stacie A. Salsbury, PhD, RN, Elissa J. Twist, DC, MS, and Christine M. Goertz, DC, PhD
Informatics, Multi-Comorbidities and Education Center,
VA Connecticut Healthcare System,
West Haven, CT.
OBJECTIVES: Chiropractic care may have value in improving patient outcomes and decreasing opioid use, but little is known about the impetus for or process of incorporating these services into conventional medical settings. The purpose of this qualitative study was to describe organizational structures, care processes, and perceived value of chiropractic integration within U.S. private sector medical facilities.
DESIGN: Multisite, comparative organizational case study.
SETTINGS: Nine U.S. private sector medical facilities with on-site chiropractic care, including five hospitals and four clinics.
PARTICIPANTS: One hundred and thirty-five key facility stakeholders including doctors of chiropractic (DCs), non-DC clinicians, support staff, administrators, and patients.
METHODS: Researchers conducted 2-day site visits to all settings. Qualitative data were collected from audio-recorded, semi-structured, role-specified, individual interviews; standardized organizational data tables; and archival document review. A three-member, interdisciplinary team conducted thematic content analysis of verbatim transcripts using an existing conceptual framework and emergent codes.
RESULTS: These nine medical facilities had unique organizational structures and reasons for initiating chiropractic care in their settings. Across sites, DCs were sought to take an evidence-based approach to patient care, work collaboratively within a multidisciplinary team, engage in interprofessional case management, and adopt organizational mission and values. Chiropractic clinics were implemented within existing human resources, physical plant, information technology, and administrative support systems, and often expanded over time to address patient demand. DCs usually were co-located with medical providers and integrated into the collaborative management of patients with musculoskeletal and co-morbid conditions. Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success.
Program in Internal Medicine,
University of Arizona,
Tucson 85719, USA.
As the public acceptance of chiropractic continues to grow in the United States, [1-3] the private practice chiropractor may find opportunities for formal inclusion in the fast growing integration of complementary and alternative medicine (CAM) into health care delivery. The ability of chiropractors to respond confidently to integration into the overall health care system may be the next step in gaining access to more patients and improving the health care quality.
This necessity for chiropractors to become part of the evolving health care system and still maintain a strong chiropractic identity will be essential, since chiropractic’s value lies in cultivating and delivering the very elements that have made it so high in patient satisfaction: emphasis on biomechanics, manual therapy of the spine, good patient rapport, and strong patient-physician bond. [4, 5] However, there are several barriers to integration: consumer, medical, and chiropractic itself.
M. Carrington Reid, PhD, MD Kimberly T. Crone, PhD John Otis, PhD Robert D. Kerns, PhD
Clinical Epidemiology Unit,
VA Connecticut Healthcare System,
West Haven, Connecticut 06516, USA.
The most disturbing comment in this article was:
Furthermore, the vast majority of respondents reported that the pain causing them the most discomfort had been present for years: Over 90% of all respondents reported a pain duration of greater than 6 months, suggesting that chronic (as opposed to acute) pain conditions are more concerning to veterans receiving primary care.
OBJECTIVES: To characterize the nature of pain complaints among younger and older veterans receiving primary care, and to determine whether characteristics of pain vary as a function of age.
METHODS: Primary care patients at a Veterans Affairs medical center were screened for pain prior to a routine office visit, and those who endorsed a concern about pain were given a self-administered questionnaire that inquired about specific characteristics of their pain including site, duration, frequency, and average intensity of the pain.
RESULTS: Over a 7–month period, 1,290 patients were screened; 641 (50%) reported a concern about pain, and of these, 516 (82%) completed the pain survey. Among younger (age <65 years, N = 191) and older (age > or =65 years, N = 325) respondents, the mean number of sites causing pain was similar (3.6 vs 3.3). Back pain was the most frequently reported site of pain causing the most discomfort among younger (vs older) respondents (31.9% vs 17.8%), whereas older (vs younger) respondents most often endorsed leg pain (32.3% vs 19.9%). The mean duration of pain was not significantly different between older and younger (10.7 vs 10.1 years) respondents; but older (vs younger) respondents were more likely to report constant pain (63.7% vs 46.9%). Using a 0 to 10 numeric rating scale, pain intensity scores were higher among younger (vs older) respondents (5.3 vs 4.3). Rates of prescription pain medication use were not significantly different (52.4% vs 48.0%). Compensation for pain-related disability was more common among younger (vs older) respondents (40.4% vs 19.4%).