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# 0 2# , ' ' = ' = " " 2# ' p U : Additional File 2. Rationale for appropriate answers to clinical cases given to French chiropractic students
Contra-indicated cases
Neck pain scenario 5
This is the case of an aggravation of a patient who was treated for simple cervical neck pain, returning 23 days after the first consultation. There are now signs of central nervous damages (i.e. hyperreflexia, positive sign if Babinski), and a worsening of the symptoms after four chiropractic treatments. The appropriate choice here is to refer the patient out without treating him because further treatment may aggravate the condition even more.
LBP scenario 8
This is the case of a patient who consulted for low back pain. After six visits, the symptoms were gradually worsening. Even if there was a slight improvement after the second visit (20%), the chiropractic treatment did definitely not improve the patients condition. The appropriate choice is therefore to refer the patient out to another health care practitioner for a second opinion/more relevant treatment. This patient may well have a condition that could be worse with chiropractic treatment or perhaps the patient is indeed already getting worse because of the treatment.
Non-indicated cases
Primary prevention of back disorders
This is the case of an asymptomatic 5-yr old child who never had back pain. Although the idea may appear logical to some, to our knowledge, there is no evidence which supports the concept that spinal manipulations can prevent the onset of back disorders. The appropriate answer is therefore not to accept this patient as this type of treatment is non-indicated.
Primary prevention of diseases
This is the case of a 5-yr old asymptomatic child whose mother asks the chiropractor to prevent the onset of diseases in general through chiropractic treatment. To our knowledge, there is no evidence which supports the concept that spinal manipulations can prevent diseases in general ADDIN EN.CITE Goncalves G201839[1]3939017Goncalves G, Le Scanff C, Leboeuf-Yde C1CIAMS, University of Paris-Sud, University of Paris-Saclay, F-91405 Orsay Cedex, France.0000 0001 2171 2558grid.5842.b
2CIAMS, University of Orleans, F-45067 Orleans, France.0000 0001 0217 6921grid.112485.b
Institut Franco Europeen de Chiropraxie, 24 boulevard Paul Vaillant Couturier, F-94200 Ivry sur Seine, France.Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approachChiropr Man TherapChiropr Man Therap10262018/04/11ChiropracticEarly secondary preventionPrimary preventionPublic healthinterests. CLY is a senior editorial adviser to the journal Chiropractic & ManualTherapies but played no part in the peer review of the submission.Springer Natureremains neutral with regard to jurisdictional claims in published maps andinstitutional affiliations.20182045-709X (Electronic)
2045-709X (Linking)29632661https://www.ncbi.nlm.nih.gov/pubmed/29632661PMC588546210.1186/s12998-018-0179-x[1]. The right attitude here is therefore not to accept this patient for this type of treatment, which is non-indicated.
LBP scenario 1
A short episode of LBP was successfully treated in two chiropractic consultations. There was no previous history of back pain, so it is unlikely that this condition will tend to be recurrent. Also, it looks like the patient is a competent and independent person. The right attitude here is therefore to be available for any new episode if it occurs. It is not indicated to continue treatment of this asymptomatic patient for the moment.
LBP scenario 9
The chiropractic treatment has not influenced the course of LBP in this patient. Moreover, the psycho-social profile should be taken into account in this patient who appears tired and moody, indicating a case of depression. It is therefore a non-indicated case and the chiropractor should refer this patient to another health care practitioner for a second opinion/more relevant treatment. In other words, there has been no improvement, which becomes a non-indication after a reasonable amount of time and chiropractors are not competent to diagnose and/or treat depression.
Indicated cases
Neck pain scenario 1
This is a simple case of a local pain with neither irradiation nor neuro-vascular symptoms in the arm. It is an indication to chiropractic treatment.
Neck pain scenario 2
Five days later, the symptoms were slightly worse (pain irradiation into the right shoulder, which could be due to soreness of the Trapezius). The clinical signs were unchanged. It is still an indication to chiropractic treatment.
LBP scenario 4
This short episode of LBP was successfully treated in two weeks of treatment. This is a chronic patient who has had several episodes in the past year. Therefore, it is likely that this condition will be recurrent ADDIN EN.CITE Hestbaek L200363[2, 3]6363017Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche CThe course of low back pain in a general population. results from a 5-year prospective studyJournal of Manipulative and Physiological TherapeuticsJournal of Manipulative and Physiological Therapeutics213-21926420030161475410.1016/s0161-4754(03)00006-xLemeunier N2013666666017Lemeunier N, Leboeuf-Yde C, Kjaer P, Gagey OStability of low back pain reporting over 8 years in a general population aged 40/41 years at base-line: data from three consecutive cross-sectional surveysBMC Musculoskeletal DisordersBMC Musculoskeletal Disorders142702013[2, 3] Maintenance care treatments (symptoms-guided or, possibly, clinical findings-guided) are therefore indicated for this patient ADDIN EN.CITE ADDIN EN.CITE.DATA [4, 5].
REFERENCES
ADDIN EN.REFLIST 1. Goncalves G, Le Scanff C, Leboeuf-Yde C: Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach. Chiropr Man Therap 2018, 26:10.
2. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C: The course of low back pain in a general population. results from a 5-year prospective study. Journal of Manipulative and Physiological Therapeutics 2003, 26(4):213-219.
3. Lemeunier N, Leboeuf-Yde C, Kjaer P, Gagey O: Stability of low back pain reporting over 8 years in a general population aged 40/41 years at base-line: data from three consecutive cross-sectional surveys. BMC Musculoskeletal Disorders 2013, 14(270).
4. Andreas E: Recurrent and persistent low back pain - Course and prevention. Karolinska Institutet; 2016.
5. Kongsted A, Hestbaek L, Ammendolia C, Ct P, Southerst D, Schneider M, Budgell B, Bombardier C, Hawker G, Raja Rampersaud Y et al: ECU convention 2017 research presentations. ECU convention 2017 research presentations. vol. 25: Chiropractic & Manual Therapies; 2017.
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