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Montgomery LRC, Kamper SJ, Hartvigsen J, French SD, Hestbaek L, Troelsen J, Swain MS. Correction to: Exceeding two hours sedentary time is not associated with moderate to severe spinal pain in 11 to 13-year-olds: a cross-sectional analysis. Eur J Pediatr 2024; 183:1963-1964. [PMID: 38277001 DOI: 10.1007/s00431-023-05415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Laura R C Montgomery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Sydney Musculoskeletal Health, The University of Sydney, Northern Sydney and Sydney Local Health Districts, Sydney, Australia.
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
- Centre for Pain, Health and Lifestyle, New Lambton Heights, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jens Troelsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Michael S Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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2
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Reibke PS, Godskesen H, Jensen RK, French SD, Bussières A, Christensen HW, Jensen TS. The effect of clinical guidelines on the utilisation of radiographs in chiropractic clinics in Denmark - an interrupted time series analysis. Chiropr Man Therap 2023; 31:47. [PMID: 37993957 PMCID: PMC10666323 DOI: 10.1186/s12998-023-00518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/28/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND In Denmark, chiropractors have a statutory right to use radiography and the government-funded national Health Insurance provides partial reimbursement. Danish National Clinical Guidelines recommends against routine use of imaging for uncomplicated spinal pain; however, it is not clear if clinical imaging guidelines recommendations have had an effect on the utilisation of spinal radiography. This study aimed to describe the utilisation rate of radiographs in Danish chiropractic clinics in the period from 2010 to 2020 and to assess the impact of clinical guidelines and policy changes on the utilisation of radiographs in Danish chiropractic clinics. METHODS Anonymised data from January 1st, 2010, to December 31st, 2020, were extracted from the Danish Regions register on health contacts in primary care. Data consisted of the total number of patients consulting one of 254 chiropractic clinics and the total number of patients having or being referred for radiography. Data were used to investigate the radiography utilisation per month from 2010 to 2020. An 'interrupted time series' analysis was conducted to determine if two interventions, the dissemination of 1) Danish clinical imaging guidelines recommendations and policy changes related to referral for advanced imaging for chiropractors in 2013 and 2) four Danish clinical guidelines recommendations in 2016, were associated with an immediate change in the level and/or slope of radiography utilisation. RESULTS In total, 336,128 unique patients consulted a chiropractor in 2010 of which 55,449 (15.4%) had radiography. In 2020, the number of patients consulting a chiropractor had increased to 366,732 of which 29,244 (8.0%) had radiography. The pre-intervention utilisation decreased by two radiographs per 10,000 patients per month. Little absolute change, but still statistically significant for Intervention 1, in the utilisation was found after the dissemination of the clinical guidelines and policy changes in 2013 or 2016. CONCLUSIONS The proportion of Danish chiropractic patients undergoing radiography was halved in the period from 2010 to 2020. However, the dissemination of clinical imaging guidelines recommendations and policy changes related to referrals for advanced imaging showed little meaningful change in the monthly utilisation of radiographs in the same period.
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Affiliation(s)
| | | | - Rikke Krüger Jensen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - André Bussières
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | | | - Tue Secher Jensen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- Chiropractic Knowledge Hub, Odense, Denmark.
- Diagnostic Center - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark.
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Bernard-Giglio M, French SD, Myburgh C, de Luca K. Drivers, barriers, and response to care of Australian pregnant women seeking chiropractic care for low back and pelvic girdle pain: a qualitative case study. Chiropr Man Therap 2023; 31:43. [PMID: 37789336 PMCID: PMC10546639 DOI: 10.1186/s12998-023-00516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Pregnancy-related low back and/or pelvic girdle pain is common, with a prevalence rate of up to 86% in pregnant women. Although 19.5% of Australian pregnant women visit a chiropractor for pelvic girdle pain, little is known about the experience of pregnant women who seek this care. The aim of this study was to describe and explore the experiences of Australian pregnant women who seek chiropractic care for their current pregnancy-related low back and/or pelvic girdle pain. METHODS A qualitative case study approach with purposive sampling from 27 chiropractic practices was used. A grounded theory approach was informed by a constructivist and interpretivist stance, which provided understanding and meaning to the pregnant women's experiences. Online unstructured interviews were recorded, transcribed, and anonymised. A thematic analysis was subsequently conducted on the primary data. Codes and major themes were developed with the use of critical self- reflection (memos), survey finding triangulation and respondent validation. RESULTS Sixteen potential respondents expressed interest in participating. After eligibility screening and data saturation, nine interviews were undertaken. Four key themes were identified: "Care drivers: what drives care seeking?", "Care barriers: what barriers are encountered?", "Chiropractic treatment: what does treatment consist of?" and "Response to care: what response was there to care?". CONCLUSION Four key themes: care drivers, care barriers, chiropractic treatment, and response to care support an emergent substantive-level theory in women's care seeking experiences for pregnancy-related back pain and chiropractic care. This theory is that chiropractic care for pregnant women experiencing low back pain and pelvic girdle pain may improve pain and function, while reducing pregnancy-related biopsychosocial concerns. The findings may inform antenatal health providers and the chiropractic profession about pregnant women's experience seeking chiropractic care as well as directing future research.
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Affiliation(s)
- Maria Bernard-Giglio
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQ University, Brisbane, Australia
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain 1. J Physiother 2023; 69:205-207. [PMID: 37684144 DOI: 10.1016/j.jphys.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 09/10/2023] Open
Affiliation(s)
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
| | | | - Peter O'Sullivan
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Marie Pirotta
- Marie Pirotta, School of Allied Health, Curtin University, Perth, Australia
| | - Michael J Yelland
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Leo Zeller
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Alice L Bhasale
- Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, Australia
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Jenkins HJ, Downie A, Wong JJ, Young JJ, Roseen EJ, Nim CG, McNaughton D, Øveras CK, Hartvigsen J, Mior S, French SD. Patient and provider characteristics associated with therapeutic intervention selection in a chiropractic clinical encounter: a cross-sectional analysis of the COAST and O-COAST study data. Chiropr Man Therap 2023; 31:39. [PMID: 37735450 PMCID: PMC10512629 DOI: 10.1186/s12998-023-00515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Chiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chiropractic care, and patient and provider characteristics associated with intervention selection. METHODS Data were obtained from the Chiropractic Observation and Analysis STudy (COAST) and Ontario (O-COAST) studies: practice-based, cross-sectional studies in Victoria, Australia (2010-2012) and Ontario, Canada (2014-2015). Chiropractors recorded data on patient diagnosis and intervention selection from up to 100 consecutive patient visits. The frequency of interventions selected overall and for each diagnostic category (e.g., different musculoskeletal regions) were descriptively analysed. Univariable multi-level logistic regression (provider and patient as grouping factors), stratified by diagnostic category, was used to assess the association between patient/provider variables and intervention selection. RESULTS Ninety-four chiropractors, representative of chiropractors in Victoria and Ontario for age, sex, and years in practice, participated. Data were collected on 7,966 patient visits (6419 unique patients), including 10,731 individual diagnoses (mean age: 43.7 (SD: 20.7), 57.8% female). Differences in patient characteristics and intervention selection were observed between chiropractors practicing in Australia and Canada. Overall, manipulation was the most common intervention, selected in 63% (95%CI:62-63) of encounters. However, for musculoskeletal conditions presenting in the extremities only, soft tissue therapies were more commonly used (65%, 95%CI:62-68). Manipulation was less likely to be performed if the patient was female (OR:0.74, 95%CI:0.65-0.84), older (OR:0.79, 95%CI:0.77-0.82), presenting for an initial visit (OR:0.73, 95%CI:0.56-0.95) or new complaint (OR:0.82, 95%CI:0.71-0.95), had one or more comorbidities (OR:0.63, 95%CI:0.54-0.72), or was underweight (OR:0.47, 95%CI:0.35-0.63), or obese (OR:0.69, 95%CI:0.58-0.81). Chiropractors with more than five years clinical experience were less likely to provide advice/education (OR:0.37, 95%CI:0.16-0.87) and exercises (OR:0.17, 95%CI:0.06-0.44). CONCLUSION In more than 10,000 diagnostic encounters, manipulation was the most common therapeutic intervention for spine-related problems, whereas soft tissue therapies were more common for extremity problems. Different patient and provider characteristics were associated with intervention selection. These data may be used to support further research on appropriate selection of interventions for common musculoskeletal complaints.
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Affiliation(s)
- Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, USA
| | - Casper Glissmann Nim
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Spine Centre of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - David McNaughton
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Cecilie K Øveras
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Pocovi NC, Ayre J, French SD, Lin CWC, Tiedemann A, Maher CG, Merom D, McCaffrey K, Hancock MJ. Physiotherapists should apply health coaching techniques and incorporate accountability to foster adherence to a walking program for low back pain: a qualitative study. J Physiother 2023; 69:182-188. [PMID: 37271689 DOI: 10.1016/j.jphys.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/19/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
QUESTIONS What motivates individuals to start a walking program for the prevention of low back pain? What strategies optimise short-term and long-term adherence to a walking program? What strategies can physiotherapists incorporate into clinical practice to facilitate commencement of and adherence to a walking program? DESIGN Qualitative study. PARTICIPANTS Twenty-two adults recently recovered from an episode of non-specific low back pain who participated in a 6-month, progressive and individualised walking program that was prescribed by a physiotherapist trained in health coaching. METHODS Semi-structured focus groups conducted online following completion of the walking program. Interview questions explored: primary motivations for starting a walking program, identification of which elements were useful in optimising adherence to the program, and identification of the barriers to and facilitators of engagement with the program. Audio recordings were transcribed and thematic analysis was conducted. RESULTS Three major themes were identified. Theme one identified that strong motivators to start a walking program were anticipated improvements in low back pain management and the added general health benefits of a more active lifestyle. Theme two identified that fear of high-impact exercises led to avoidance; however, walking was considered a safe exercise option. Theme three identified accountability, enjoyment of exercise and health benefits were critical to adherence. CONCLUSION Participants recently recovered from low back pain reflected positively on a physiotherapist-prescribed walking program. Participants described what elements of the program were crucial to starting exercise and optimising adherence. These findings have informed a list of practical recommendations for physiotherapists to improve patient commencement and adherence to exercise.
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Affiliation(s)
- Natasha C Pocovi
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Julie Ayre
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Sydney, Australia
| | - Kirsten McCaffrey
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain : A new clinical care standard provides evidence-based guidance to help clinicians deliver best care for people with low back pain. Chiropr Man Therap 2023; 31:17. [PMID: 37322536 DOI: 10.1186/s12998-023-00485-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Affiliation(s)
- Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia.
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
- College of Emergency Nursing Australasia, Melbourne, VIC, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, WA, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
- Arana Hills Medical Centre, Brisbane, QLD, Australia
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Elizabeth Marles
- Australian Commission On Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Alice L Bhasale
- Australian Commission On Safety and Quality in Health Care, Sydney, NSW, Australia
| | - Christina Lane
- Australian Commission On Safety and Quality in Health Care, Sydney, NSW, Australia
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Hunter DJ, Bowden JL, Hinman RS, Egerton T, Briggs AM, Bunker SJ, French SD, Pirotta M, Shrestha R, Schofield DJ, Schuck K, Zwar NA, Silva SSM, Heller GZ, Bennell KL. Effectiveness of a New Service Delivery Model for Management of Knee Osteoarthritis in Primary Care: A Cluster Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2023; 75:1320-1332. [PMID: 36205225 PMCID: PMC10952211 DOI: 10.1002/acr.25037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/25/2022] [Accepted: 10/04/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and health costs of a new primary care service delivery model (the Optimising Primary Care Management of Knee Osteoarthritis [PARTNER] model) to improve health outcomes for patients with knee osteoarthritis (OA) compared to usual care. METHODS This study was a 2-arm, cluster, superiority, randomized controlled trial with randomization at the general practice level, undertaken in Victoria and New South Wales, Australia. We aimed to recruit 44 practices and 572 patients age ≥45 years with knee pain for >3 months. Professional development opportunities on best practice OA care were provided to intervention group general practitioners (GPs). All recruited patients had an initial GP visit to confirm knee OA diagnosis. Control patients continued usual GP care, and intervention patients were referred to a centralized care support team (CST) for 12-months. Via telehealth, the CST provided OA education and an agreed OA action plan focused on muscle strengthening, physical activity, and weight management. Primary outcomes were patient self-reported change in knee pain (Numerical Rating Scale [range 0-10; higher score = worse]) and physical function (Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale [range 0-100; higher score = better] at 12 months. Health care cost outcomes included costs of medical visits and prescription medications over the 12-month period. RESULTS Recruitment targets were not reached. A total of 38 practices and 217 patients were recruited. The intervention improved pain by 0.8 of 10 points (95% confidence interval [95% CI] 0.2, 1.4) and function by 6.5 of 100 points (95% CI 2.3, 10.7), more than usual care at 12 months. Total costs of medical visits and prescriptions were $3,940 (Australian) for the intervention group versus $4,161 for usual care. This difference was not statistically significant. CONCLUSION The PARTNER model improved knee pain and function more than usual GP care. The magnitude of improvement is unlikely to be clinically meaningful for pain but is uncertain for function.
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Affiliation(s)
- David J. Hunter
- Kolling Institute, The University of Sydney and Royal North Shore HospitalSydneyNew South WalesAustralia
| | - Jocelyn L. Bowden
- Kolling Institute, The University of Sydney and Royal North Shore HospitalSydneyNew South WalesAustralia
| | | | | | | | | | | | - Marie Pirotta
- The University of MelbourneMelbourneVictoriaAustralia
| | | | | | - Karen Schuck
- Kolling Institute, The University of Sydney and Royal North Shore HospitalSydneyNew South WalesAustralia
| | - Nicholas A. Zwar
- University of New South Wales, Sydney, New South Wales, Australia, and Bond UniversityGold CoastQueenslandAustralia
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain. ANZ J Surg 2023. [PMID: 37243309 DOI: 10.1111/ans.18517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- College of Emergency Nursing Australasia, Melbourne, Victoria, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Arana Hills Medical Centre, Brisbane, Queensland, Australia
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Marles
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Alice L Bhasale
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain. Med J Aust 2023; 218:354-356. [PMID: 37120763 DOI: 10.5694/mja2.51915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/27/2023] [Accepted: 02/16/2023] [Indexed: 05/01/2023]
Affiliation(s)
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW
| | - Julie Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, VIC
- College of Emergency Nursing Australasia, Melbourne, VIC
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW
| | | | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, VIC
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, QLD
- Arana Hills Medical Centre, Brisbane, QLD
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, QLD
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, QLD
| | - Elizabeth Marles
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW
| | - Alice L Bhasale
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, NSW
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11
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain. J Med Imaging Radiat Oncol 2023. [PMID: 37125441 DOI: 10.1111/1754-9485.13532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Aline Archambeau
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Julie Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- College of Emergency Nursing Australasia, Melbourne, Victoria, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Arana Hills Medical Centre, Brisbane, Queensland, Australia
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Marles
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Alice L Bhasale
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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12
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain. Intern Med J 2023; 53:664-667. [PMID: 37126539 DOI: 10.1111/imj.16090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Aline Archambeau
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- College of Emergency Nursing Australasia, Melbourne, Victoria, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- General and Musculoskeletal Medicine Practitioner, Arana Hills Medical Centre, Brisbane, Queensland, Australia
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Marles
- Primary Care, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Alice L Bhasale
- Clinical Care Standards, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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13
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Maher CG, Archambeau A, Buchbinder R, French SD, Morphet J, Nicholas MK, O'Sullivan P, Pirotta M, Yelland MJ, Zeller L, Saad N, Marles E, Bhasale AL, Lane C. Introducing Australia's clinical care standard for low back pain. Emerg Med Australas 2023; 35:370-373. [PMID: 37120762 DOI: 10.1111/1742-6723.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Christopher G Maher
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Aline Archambeau
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Julie Morphet
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- College of Emergency Nursing Australasia, Melbourne, Victoria, Australia
| | - Michael K Nicholas
- Pain Management Research Institute, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Peter O'Sullivan
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Yelland
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Arana Hills Medical Centre, Brisbane, Queensland, Australia
| | - Leo Zeller
- Metro North Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Nivene Saad
- Metro South Health, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Marles
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Alice L Bhasale
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
| | - Christina Lane
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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14
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Pocovi NC, Graham PL, Lin CWC, French SD, Latimer J, Merom D, Tiedemann A, Maher CG, van Dongen JM, Clavisi O, Hancock MJ. Effectiveness and cost-effectiveness of a progressive, individualised walking and education program for prevention of low back pain recurrence in adults: statistical analysis plan for the WalkBack randomised controlled trial. Trials 2023; 24:197. [PMID: 36927497 PMCID: PMC10019396 DOI: 10.1186/s13063-023-07119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Exercise for the prevention of low back pain recurrences is recommended, but under-researched. The effectiveness and cost-effectiveness of a walking program for preventing low back pain recurrence remains unknown. This a priori statistical analysis plan describes the methods of analysis for the WalkBack trial. METHODS WalkBack is a prospectively registered, pragmatic, randomised controlled trial. The aim is to investigate the effectiveness and cost-effectiveness of a 6-month progressive and individualised walking and education program (intervention) for the prevention of low back pain recurrences, compared to a no-treatment control group. The primary outcome is days to the first recurrence of an episode of activity-limiting low back pain. Key secondary outcomes include days to any recurrence of low back pain, days to a care-seeking recurrence of low back pain, disability level, health-related quality of life, costs associated with low back pain and adverse events. All participants will be followed for a minimum of 12 months. Analysis will follow the intention-to-treat principle. Cox regression is planned to assess the effects for the outcomes of time to activity-limiting, minimal and care-seeking recurrence. Hazard ratios and median survival times with 95% confidence intervals will be calculated. The effect of the intervention on continuous outcomes will be estimated with repeated-measure linear mixed models. An economic evaluation will be performed from the societal perspective for recurrence prevented (yes/no) and quality-adjusted life years. The proportion of adverse events between groups will be compared using Fisher's exact test. DISCUSSION The WalkBack trial will provide evidence on the effectiveness and cost-effectiveness of a walking intervention to prevent low back pain recurrences. This statistical analysis plan provides transparency on the analysis of the trial. TRIAL REGISTRATION WalkBack - Effectiveness and cost-effectiveness of a progressive individualised walking and education program for the prevention of a recurrence of low back pain. ACTRN12619001134112 . Date Registered: 14/08/2019.
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Affiliation(s)
- Natasha C Pocovi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Petra L Graham
- School of Mathematical and Physical Sciences, Macquarie University, Sydney, Australia
| | | | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jane Latimer
- The University of Sydney, Sydney Musculoskeletal Health, Gadigal Country, Sydney, Australia
| | - Dafna Merom
- School of Health Sciences, Western Sydney University, Sydney, Australia
| | - Anne Tiedemann
- The University of Sydney, Sydney Musculoskeletal Health, Gadigal Country, Sydney, Australia
| | - Christopher G Maher
- The University of Sydney, Sydney Musculoskeletal Health, Gadigal Country, Sydney, Australia
| | - Johanna M van Dongen
- Department of Health Sciences, Vrije University of Amsterdam, Amsterdam, Netherlands
| | | | - Mark J Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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15
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Pocovi NC, Kent P, Lin CWC, French SD, de Campos TF, da Silva T, Hancock MJ. Recurrence of low back pain: A difficult outcome to predict. Development and validation of a multivariable prediction model for recurrence in patients recently recovered from an episode of non-specific low back pain. Musculoskelet Sci Pract 2023; 64:102746. [PMID: 36948043 DOI: 10.1016/j.msksp.2023.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Recurrence of low back pain (LBP) is common. If clinicians could identify an individual's risk of recurrence, this would enhance clinical decision-making and tailored patient care. OBJECTIVE/DESIGN To develop and validate a simple tool to predict the probability of a recurrence of LBP by 3- or 12-months following recovery. METHODS Data utilised for the prediction model development came from a prospective inception cohort study of participants (n = 250) recently recovered from LBP, who had sought care from chiropractic or physiotherapy services. The outcome measure was a recurrence of activity-limiting LBP. Candidate predictor variables (e.g., basic demographics, LBP history, levels of physical activity, etc) collected at baseline were considered for inclusion in a multivariable Cox model. The model's performance was tested in a separate validation dataset of participants (n = 261) involved in a randomised controlled trial investigating exercise for the prevention of LBP recurrences. RESULTS The final model included the number of previous episodes, total sitting time, and level of education. In the development sample, discrimination was acceptable (Harrell's C-statistic = 0.61, 95% CI, 0.59-0.62), but in the validation sample, discrimination was poor (0.56, 95% CI, 0.54-0.58). Calibration of the model in the validation dataset was acceptable at 3 months but was less precise at 12 months. CONCLUSION The developed prediction model, which included number of previous episodes, total sitting time, and level of education, did not perform adequately in the validation sample to recommend its use in clinical practice. Predicting recurrence of LBP in clinical practice remains challenging.
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Affiliation(s)
- N C Pocovi
- Department of Health Sciences, Macquarie University, Sydney, Australia.
| | - P Kent
- School of Allied Health, Curtin University, Perth, Australia
| | - C-W C Lin
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - S D French
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - T F de Campos
- Department of Health Sciences, Macquarie University, Sydney, Australia; St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, Australia
| | - T da Silva
- Masters and Doctoral Programs in Physiotherapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - M J Hancock
- Department of Health Sciences, Macquarie University, Sydney, Australia
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16
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Jenkins HJ, Moloney NA, French SD, Maher CG, Dear BF, Magnussen JS, Hancock MJ. General practitioner experiences using a low back pain management booklet aiming to decrease non-indicated imaging for low back pain. Implement Sci Commun 2022; 3:71. [PMID: 35765064 PMCID: PMC9238090 DOI: 10.1186/s43058-022-00317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Imaging is overused in the management of low back pain, resulting in overdiagnosis, increased healthcare utilisation, and increased costs. Few effective interventions to decrease inappropriate use have been developed and have typically not been developed using behaviour change theory. An intervention to reduce non-indicated imaging for low back pain was developed using behavioural change theory, incorporating a novel low back pain management booklet to facilitate patient education and reassurance. The aim of this study was to assess the adoption and feasibility of use of the developed intervention within clinical practice and to determine appropriate implementation strategies to address identified barriers to use.
Methods
Fourteen general medical practitioners were recruited and trained to use the booklet with low back pain patients over a minimum 5-month period. Quantitative data on use of the booklet were collected and analysed descriptively. Qualitative data on use of the booklet and training session were collected in general medical practitioner interviews and thematically analysed. Barriers to use were identified and mapped to suitable implementation strategies using the Behaviour Change Wheel.
Results
Practitioners used the booklet with 73 patients. The booklet was used with 63% of patients presenting with low back pain. Facilitators for using the booklet included patient’s requesting imaging and lower practitioner confidence in managing low back pain. Barriers included accessible storage and remembering to use the booklet. Implementation strategies were identified to increase adoption and feasibility of use, including development of a digital version of the booklet.
Conclusions
General medical practitioners reported that the low back pain management booklet and training were useful for clinical practice, particularly with patients requesting imaging. Barriers to use were identified and implementation strategies to address these barriers will be incorporated into future effectiveness studies. This study forms one of a series of studies to thoroughly develop and test an intervention to reduce non-indicated imaging for low back pain; a successful intervention would decrease healthcare costs and improve patient management.
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17
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Hartvigsen J, Kamper SJ, French SD. Low-value care in musculoskeletal health care: Is there a way forward? Pain Pract 2022; 22 Suppl 2:65-70. [PMID: 36109843 PMCID: PMC9545107 DOI: 10.1111/papr.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low-value care that wastes resources and harms patients is prevalent in health systems everywhere. METHODS As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions. RESULTS Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks. CONCLUSION Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.
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Affiliation(s)
- Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense M, Denmark.,Chiropractic Knowledge Hub, Odense M, Denmark
| | - Steven J Kamper
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
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18
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Vader K, Donnelly C, French SD, Grady C, Hill JC, Tripp DA, Williams A, Miller J. Implementing a new physiotherapist-led primary care model for low back pain: a qualitative study of patient and primary care team perspectives. BMC Prim Care 2022; 23:201. [PMID: 35948876 PMCID: PMC9367061 DOI: 10.1186/s12875-022-01817-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/30/2022] [Indexed: 12/24/2022]
Abstract
Background Low back pain (LBP) is one of the most common reasons for primary care visits and is the leading contributor to years lived with disability worldwide. The purpose of this study was to understand the perspectives of patients and primary care team members related to their experiences with a new physiotherapist-led primary care model for LBP. Methods We conducted an interpretive description qualitative study. Data were collected using a combination of semi-structured interviews and focus group discussions and analyzed using thematic analysis. Participants included adults (> 18 years of age) with LBP and primary care team members who participated in a physiotherapist-led primary care model for LBP in Kingston, Ontario, Canada. Results We conducted 18 semi-structured interviews with patients with LBP (10 women; median age of 52) as well as three focus group discussions with a total of 20 primary care team members representing three teams. Four themes (each with sub-themes) were constructed: 1) enhanced primary care delivery for LBP (improved access and engagement in physiotherapy care, improved communication and care integration between the physiotherapist and primary care team, less inappropriate use of healthcare resources); 2) positive patient experiences and perceived outcomes with the new model of care (physiotherapist built therapeutic alliance, physiotherapist provided comprehensive care, improved confidence in managing LBP, decreased impact of pain on daily life); 3) positive primary care team experiences with the new model of care (physiotherapist fit well within the primary care team, physiotherapist provided expertise on LBP for the primary care team, satisfaction in being able to offer a needed service for patients); and 4) challenges implementing the new model of care (challenges with prompt access to physiotherapy care, challenges making the physiotherapist the first contact for LBP, and opportunities to optimize communication between the physiotherapist and primary care team). Conclusions A new physiotherapist-led primary care model for LBP was described by patients and primary care team members as contributing to positive experiences and perceived outcomes for patients, primary care team members, and potentially the health system more broadly. Results suggest that this model of care may be a viable approach to support integrated and guideline adherent management of LBP in primary care settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01817-5.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada.
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
| | - Simon D French
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada.,Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Colleen Grady
- Centre for Studies in Primary Care, Queen's University, Kingston, Canada
| | | | - Dean A Tripp
- Departments of Psychology, Anesthesiology, & Urology, Queen's University, Kingston, Canada
| | - Ashley Williams
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
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19
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de Luca K, Yanz M, Downie A, Kendall J, Skou ST, Hartvigsen J, French SD, Ferreira ML, Bierma-Zeinstra SMA. A mixed-methods feasibility study of a comorbidity-adapted exercise program for low back pain in older adults (COMEBACK): a protocol. Pilot Feasibility Stud 2022; 8:133. [PMID: 35780222 PMCID: PMC9250189 DOI: 10.1186/s40814-022-01097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of low back pain increases with age and has a profound impact on physical and psychosocial health. With increasing age comes increasing comorbidity, and this also has pronounced health consequences. Whilst exercise is beneficial for a range of health conditions, trials of exercise for low back pain management often exclude older adults. It is currently unknown whether an exercise program for older adults with low back pain, tailored for the presence of comorbidities, is acceptable for participants and primary healthcare providers (PHCPs). Therefore, this mixed-methods study will assess the feasibility of an 8-week comorbidity-adapted exercise program for older people with low back pain and comorbid conditions. METHODS The 3-phased feasibility study will be performed in a primary healthcare setting. PHCPs will be trained to deliver a comorbidity-adapted exercise program for older people with low back pain and comorbidities. Healthcare-seeking adults > 65 will be screened for eligibility over telephone, with a recruitment target of 24 participants. Eligible participants will attend an initial appointment (diagnostic phase). During this initial appointment, a research assistant will collect patient demographics, self-reported outcome measurement data, and perform a physical and functional examination to determine contraindications and restrictions to an exercise program. During the development phase, PHCPs will adapt the exercise program to the individual and provide patient education. During the intervention phase, there will be two supervised exercise sessions per week, over 8 weeks (total of 16 exercise sessions). Each exercise session will be approximately 60 min in duration. A qualitative evaluation after the last exercise program session will explore the feasibility of the exercise program for participants and PHCPs. Progression criteria will determine the suitability for a fully powered randomised controlled trial. DISCUSSION This mixed-methods feasibility study will assess an exercise program for older adults with low back pain and comorbidities. Once assessed for feasibility, the exercise program may be tested for effectiveness in a larger, fully powered randomised controlled trial. This information will add to the sparse evidence base on appropriate options for managing back pain in older adults. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry registration number: ACTRN12621000379819p (06/04/2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000379819p ). TRIAL SPONSOR Macquarie University, Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.
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Affiliation(s)
- Katie de Luca
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia. .,Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia.
| | - Megan Yanz
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Aron Downie
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Julie Kendall
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Centre for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Centre for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Institute of Bone and Joint Research, The Kolling Institute, The University of Sydney, Sydney, Australia
| | - Sita M A Bierma-Zeinstra
- Department of General Practice and Department of Orthopaedics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
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20
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To D, Hall A, Bussières A, French SD, Lawrence R, Pike A, Patey AM, Brake-Patten D, O'Keefe L, Elliott B, De Carvalho D. Exploring factors influencing chiropractors' adherence to radiographic guidelines for low back pain using the Theoretical Domains Framework. Chiropr Man Therap 2022; 30:23. [PMID: 35534902 PMCID: PMC9082849 DOI: 10.1186/s12998-022-00433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background The inappropriate use of lumbar spine imaging remains common in primary care despite recommendations from evidence-based clinical practice guidelines to avoid imaging in the absence of red flags. This study aimed to explore factors influencing ordering behaviours and adherence to radiographic guidelines for low back pain (LBP) in chiropractors in Newfoundland and Labrador (NL), Canada. Methods We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors’ statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours. Results Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging (Knowledge). Many chiropractors based their decision for imaging on clinical presentation, but some relied on “gut feeling” (Memory, attention, and decision processes). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers (Social/professional role and identity). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients (Beliefs about consequences). Communication was identified as a skill required to manage LBP without imaging (Skills) and a strategy to enable appropriate imaging ordering behaviours (Behavioural regulation). Chiropractors suggested that access to patients’ previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours (Behavioural regulation). Conclusion We identified potential influences, in six theoretical domains, on participating chiropractors’ LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00433-5.
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Affiliation(s)
- Daphne To
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Rebecca Lawrence
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, ON, Canada
| | | | | | - Barbara Elliott
- Patient Engagement Partner, North Bay, ON, Canada.,Faculty of Education and Professional Studies - School of Nursing, Nipissing University, North Bay, ON, Canada
| | - Diana De Carvalho
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
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21
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de Luca K, Briggs AM, French SD, Ferreira ML, Cross M, Blyth F, March L. Disability burden due to musculoskeletal conditions and low back pain in Australia: findings from GBD 2019. Chiropr Man Therap 2022; 30:22. [PMID: 35505334 PMCID: PMC9063272 DOI: 10.1186/s12998-022-00434-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019. METHODS Global Burden of Disease (GBD) 2019 study meta-data on all musculoskeletal conditions and LBP specifically were accessed and aggregated. Counts and age-standardised rates, for both sexes and across all ages, for prevalence, YLDs and attributable risk factors are reported. RESULTS In 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113-7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722-921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327-3,061,066) prevalent cases of LBP and 298,624 (95% UI: 209,364-402,395) YLDs due to LBP. LBP was attributed to 44% of YLDs due to musculoskeletal conditions. In 2019, 22.3% and 39.8% of YLDs due to musculoskeletal conditions and LBP, respectively, were attributed to modifiable GBD risk factors. CONCLUSIONS The ongoing high burden due to musculoskeletal conditions impacts Australians across the life course, and in particular females and older Australians. Strategies for integrative and organisational interventions in the Australian healthcare system should support high-value care and address key modifiable risk factors for disability such as smoking, occupational ergonomic factors and obesity.
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Affiliation(s)
- Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQUniversity, Brisbane, Australia.
| | - Andrew M Briggs
- Curtin School of Allied Health and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Global Alliance for Musculoskeletal Health, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Marita Cross
- Global Alliance for Musculoskeletal Health, Sydney, Australia.,Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Fiona Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lyn March
- Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
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Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. Patients with low back pain presenting for chiropractic care who want diagnostic imaging are more likely to receive referral for imaging: a cross-sectional study. Chiropr Man Therap 2022; 30:16. [PMID: 35379281 PMCID: PMC8978373 DOI: 10.1186/s12998-022-00425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is unclear if the use of imaging for low back pain (LBP) is impacted by patient beliefs. This study aimed to: (1) describe beliefs about the importance of imaging and whether patients wanted imaging when presenting for chiropractic care for LBP; (2) describe associations between baseline patient characteristics and imaging beliefs and whether patients wanted imaging; and (3) determine whether patients who believed imaging to be important in the management of LBP, or who wanted to receive imaging, were more likely to receive an imaging referral. METHODS Cross-sectional observational data was collected between November 2016 to December 2019 from 10 primary care chiropractic clinics in Denmark. Consecutive patients aged 18 or older and presenting with a new episode of LBP were included (N = 2818). Beliefs about the importance of imaging (two questions) and whether imaging was wanted (one question) were collected at the initial visit, together with baseline participant characteristics and whether an imaging referral was provided. Associations between imaging beliefs/desire to receive imaging and participant characteristics were explored using multivariable logistic regression analysis. The relationships between imaging beliefs and desire to receive imaging with subsequent imaging referral were assessed using multivariable logistic regression analysis adjusted for pre-selected confounder variables. RESULTS Approximately one third of participants believed imaging to be important for the management of LBP (29.5% (95%CI 27.8, 31.3) or 41.5% (95%CI 39.6, 43.3) depending on the two imaging beliefs questions). Approximately one quarter (26.1%, 95%CI 24.5, 27.7) of participants wanted to receive an imaging referral. Participants were more likely to believe in the importance of imaging or want an imaging referral if they had a longer duration of LBP, history of previous imaging for LBP, or a lower completed education level. Participants who wanted imaging at the initial consult were more likely to receive an imaging referral (Odds ratio; 95%CI 1.6; 1.2, 2.1). CONCLUSIONS Approximately one third of patients presenting for chiropractic care in Denmark believed imaging to be important in the management of LBP. One quarter wanted imaging at the initial consult. Patients' desire for imaging appeared to impact the use of diagnostic imaging.
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Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Doktor
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. Reply to the letter to the editor: "What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care? A matched observational study." Jenkins et al., Chiropractic & Manual Therapies 2021;29:46. Chiropr Man Therap 2022; 30:12. [PMID: 35232463 PMCID: PMC8887092 DOI: 10.1186/s12998-022-00421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Room 2232, Level 2, 75 Talavera Rd, Sydney, 2109, Australia.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Simon D French
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Doktor
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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French SD, O’Connor DA, Green SE, Page MJ, Mortimer DS, Turner SL, Walker BF, Keating JL, Grimshaw JM, Michie S, Francis JJ, McKenzie JE. Improving adherence to acute low back pain guideline recommendations with chiropractors and physiotherapists: the ALIGN cluster randomised controlled trial. Trials 2022; 23:142. [PMID: 35164841 PMCID: PMC8842895 DOI: 10.1186/s13063-022-06053-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/27/2022] [Indexed: 12/29/2022] Open
Abstract
Background Acute low back pain is a common condition, has high burden, and there are evidence-to-practice gaps in the chiropractic and physiotherapy setting for imaging and giving advice to stay active. The aim of this cluster randomised trial was to estimate the effects of a theory- and evidence-based implementation intervention to increase chiropractors’ and physiotherapists’ adherence to a guideline for acute low back pain compared with the comparator (passive dissemination of the guideline). In particular, the primary aim of the intervention was to reduce inappropriate imaging referral and improve patient low back pain outcomes, and to determine whether this intervention was cost-effective. Methods Physiotherapy and chiropractic practices in the state of Victoria, Australia, comprising at least one practising clinician who provided care to patients with acute low back pain, were invited to participate. Patients attending these practices were included if they had acute non-specific low back pain (duration less than 3 months), were 18 years of age or older, and were able to understand and read English. Practices were randomly assigned either to a tailored, multi-faceted intervention based on the guideline (interactive educational symposium plus academic detailing) or passive dissemination of the guideline (comparator). A statistician independent of the study team undertook stratified randomisation using computer-generated random numbers; four strata were defined by professional group and the rural or metropolitan location of the practice. Investigators not involved in intervention delivery were blinded to allocation. Primary outcomes were X-ray referral self-reported by clinicians using a checklist and patient low back pain-specific disability (at 3 months). Results A total of 104 practices (43 chiropractors, 85 physiotherapists; 755 patients) were assigned to the intervention and 106 practices (45 chiropractors, 97 physiotherapists; 603 patients) to the comparator; 449 patients were available for the patient-level primary outcome. There was no important difference in the odds of patients being referred for X-ray (adjusted (Adj) OR: 1.40; 95% CI 0.51, 3.87; Adj risk difference (RD): 0.01; 95% CI − 0.02, 0.04) or patient low back pain-specific disability (Adj mean difference: 0.37; 95% CI − 0.48, 1.21, scale 0–24). The intervention did lead to improvement for some key secondary outcomes, including giving advice to stay active (Adj OR: 1.96; 95% CI 1.20, 3.22; Adj RD: 0.10; 95% CI 0.01, 0.19) and intending to adhere to the guideline recommendations (e.g. intention to refer for X-ray: Adj OR: 0.27; 95% CI 0.17, 0.44; intention to give advice to stay active: Adj OR: 2.37; 95% CI 1.51, 3.74). Conclusions Intervention group clinicians were more likely to give advice to stay active and to intend to adhere to the guideline recommendations about X-ray referral. The intervention did not change the primary study outcomes, with no important differences in X-ray referral and patient disability between groups, implying that hypothesised reductions in health service utilisation and/or productivity gains are unlikely to offset the direct costs of the intervention. We report these results with the caveat that we enrolled less patients into the trial than our determined sample size. We cannot recommend this intervention as a cost-effective use of resources. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12609001022257. Retrospectively registered on 25 November 2009 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06053-x.
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Montgomery LRC, Kamper SJ, Hartvigsen J, French SD, Hestbaek L, Troelsen J, Swain MS. Exceeding 2-h sedentary time per day is not associated with moderate to severe spinal pain in 11- to 13-year-olds: a cross-sectional analysis. Eur J Pediatr 2022; 181:653-659. [PMID: 34510234 DOI: 10.1007/s00431-021-04258-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Neck, mid-back and low back pain, collectively known as spinal pain, become more common with increasing age across childhood and adolescence. A common belief among the general community is that sedentary time, including screen time, in adolescents is associated with spinal pain. We aimed to investigate whether exceeding 2-h of sedentary time per day is associated with moderate to severe spinal pain in a sample of Danish adolescents aged 11-13 years. We performed a cross-sectional analysis of the SPACE study baseline data (2010). Adolescents self-reported their spinal pain (outcome) via the Young Spine Questionnaire and duration of engagement in sedentary behaviours (exposure). We provide estimates of associations as odds ratios with 95% confidence intervals, stratified by age and sex. The sample comprised 1,303 adolescents (48.7% female, mean age 12.5 years, range 10.9-14.3 years). Approximately 9 out of 10 adolescents exceeded 2-h sedentary time on weekdays outside of school (88.9%) and weekend days (89.9%). Close to one-quarter, 23.3% (95%CI: 21.0-25.6), of participants experienced moderate to severe spinal pain. We found no association between exceeding 2-h sedentary time per day and experiencing moderate to severe spinal pain; odds ratios ranged from 0.34 (95%CI: 0.04-3.20) to 4.65 (95%CI: 0.26-82.44).Conclusion: We found no association between exceeding 2- or 5-h of sedentary time per day and moderate to severe spinal pain in this sample of 11-13-year-old Danish adolescents. Our cross-sectional analysis does not consider the longitudinal or complex sequences of events necessary to address predictive or causal questions. What is Known: • Up to a third of adolescents experience moderate to severe spinal pain, predisposing them to chronic spinal pain in adulthood. • Frequent and excessive sedentary time is associated with poor overall health in adolescents; there is conflicting evidence to suggest whether it is also related to spinal pain. What is New: • We found no association between sedentary time and moderate to severe spinal pain in 11- to 13-year-old Danes.
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Affiliation(s)
- Laura R C Montgomery
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia.
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
- Centre for Pain, Health and Lifestyle, New Lambton Heights, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jens Troelsen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Michael S Swain
- Sydney Local Health District, Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Auais M, Sousa TAC, Feng C, Gill S, French SD. Understanding the relationship between psychological factors and important health outcomes in older adults with hip fracture: A structured scoping review. Arch Gerontol Geriatr 2022; 101:104666. [DOI: 10.1016/j.archger.2022.104666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
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Jenkins ND, Hoogendijk EO, Armstrong JJ, Lewis NA, Ranson JM, Rijnhart JJM, Ahmed T, Ghachem A, Mullin DS, Ntanasi E, Welstead M, Auais M, Bennett DA, Bandinelli S, Cesari M, Ferrucci L, French SD, Huisman M, Llewellyn DJ, Scarmeas N, Piccinin AM, Hofer SM, Muniz-Terrera G. Trajectories of Frailty With Aging: Coordinated Analysis of Five Longitudinal Studies. Innov Aging 2022; 6:igab059. [PMID: 35233470 PMCID: PMC8882228 DOI: 10.1093/geroni/igab059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is an urgent need to better understand frailty and its predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in 5 independent cohorts to evaluate longitudinal trajectories of frailty and the effect of 3 previously identified critical risk factors: sex, age, and education. RESEARCH DESIGN AND METHODS We derived a frailty index (FI) for 5 cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term. RESULTS Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the Invecchiare in Chianti cohort to 0.009 in the Longitudinal Aging Study Amsterdam (LASA). Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the Health and Retirement Study cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves. DISCUSSION AND IMPLICATIONS Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions.
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Affiliation(s)
- Natalie D Jenkins
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC–Location VU University Medical Center, Amsterdam, The Netherlands
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Nathan A Lewis
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Janice M Ranson
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Judith J M Rijnhart
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC–Location VU University Medical Center, Amsterdam, The Netherlands
| | - Tamer Ahmed
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Ahmed Ghachem
- Research Centre on Aging, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Donncha S Mullin
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK,Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Eva Ntanasi
- Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Miles Welstead
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK,Lothian Birth Cohorts, University of Edinburgh, Edinburgh, UK
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Matteo Cesari
- IRCCS Istututi Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | | | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC–Location VU University Medical Center, Amsterdam, The Netherlands
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, UK,Alan Turing Institute, London, UK
| | - Nikolaos Scarmeas
- Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece,Department of Neurology, Columbia University, New York City, New York, USA
| | - Andrea M Piccinin
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK,Address correspondence to: Graciela Muniz-Terrera, PhD, Edinburgh Dementia Prevention, University of Edinburgh, Outpatients Department, Level 2, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK. E-mail:
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Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study. Chiropr Man Therap 2021; 29:46. [PMID: 34814923 PMCID: PMC8611826 DOI: 10.1186/s12998-021-00403-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care. Methods A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. Data was collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks. Results 2162 patients were included, with 24.1% referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two-weeks (0.4, 95%CI: 0.1, 0.8) and one-year (0.4, 95%CI: 0.0, 0.7), and disability at two-weeks (5.7, 95%CI: 1.4, 10.0), but the changes are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed. Conclusions Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.
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Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Doktor
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia
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Wong JJ, Hogg-Johnson S, Bussières AE, French SD, Mior SA. The association between chiropractors' view of practice and patient encounter-level characteristics in Ontario, Canada: a cross-sectional study. Chiropr Man Therap 2021; 29:41. [PMID: 34583730 PMCID: PMC8477501 DOI: 10.1186/s12998-021-00398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chiropractors have diverse views of practice, but the impact on their patient profiles and treatment approaches remains unclear. We assessed the association between chiropractors’ view of practice (unorthodox versus orthodox) and patient encounter-level characteristics among chiropractors who practice in Ontario, Canada. Methods We conducted a cross-sectional study using Ontario Chiropractic Observation and Analysis STudy (O-COAST) data. In O-COAST, Ontario chiropractors were randomly recruited from a list of registered chiropractors in 2015 and recorded up to 100 consecutive patient encounters. We classified chiropractors’ response regarding their views of practice as unorthodox when viewing “vertebral subluxation as an encumbrance to health that is corrected to benefit overall well-being”; other views were considered orthodox. Patient encounter-level characteristics included: (1) non-musculoskeletal reason-for-encounter; (2) subluxation as diagnosis; (3) duration of encounter (log-transformed for modeling); (4) unimodal manipulative treatment; and (5) patient health characteristics (good health status, some activity limitations). We conducted multilevel logistic regression to assess the association between view of practice and aforementioned characteristics, accounting for potential confounders and clustering of encounters within chiropractors. The multilevel models had two levels (level 1—patient encounter level; level 2—chiropractor level), with level 1 patient encounters nested within level 2 chiropractors. Results We included 40 chiropractors (mean age = 43.4 years, SD = 11.5) and 3,378 chiropractor-patient encounters. The 2,332 unique patients identified had a mean age of 48.5 years (SD = 18.5). Chiropractors with unorthodox views had higher odds of having patients with a non-musculoskeletal reason-for-encounter (adjusted odds ratio (aOR) 16.5, 95% CI 3.2–84.0) and subluxation as diagnosis (aOR 63.0, 95% CI 4.2–949.1). Encounters of chiropractors with unorthodox views were 0.6 times shorter than those with orthodox views (95% CI 0.4–0.9). Chiropractor level explained 32%, 75%, and 49% of the variability in non-musculoskeletal reason-for-encounter, subluxation as diagnosis, and encounter duration, respectively. We observed no association between unorthodox view and unimodal manipulative treatment or patient health characteristics. Conclusions Chiropractors’ unorthodox view of practice was associated with treating non-musculoskeletal conditions, subluxation as diagnosis, and shorter duration of encounter. Chiropractor level explained a high proportion of variability in these outcomes. Findings have implications for understanding chiropractic practice and informing interprofessional collaboration. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00398-x.
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Affiliation(s)
- Jessica J Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada. .,Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - André E Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.,Département Chiropratique, Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, 17 Wally's Walk, North Ryde, NSW, 2019, Australia
| | - Silvano A Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University and Canadian Memorial Chiropractic College, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada.,Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
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Lin JLL, Quartarone S, Aidarus N, Chan CY, Hubbert J, Orkin J, Fayed N, Major N, Soscia J, Lim A, French SD, Moretti ME, Cohen E. Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned. Healthc Policy 2021; 17:104-122. [PMID: 34543180 PMCID: PMC8437255 DOI: 10.12927/hcpol.2021.26574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Complex Care for Kids Ontario (CCKO) is a multi-year strategy aimed at expanding a hub-and-spoke model to deliver coordinated care for children with medical complexity (CMC) across Ontario. Objective: This paper aims to identify the facilitators, barriers and lessons learned from the implementation of the Ontario CCKO strategy. Method: Alongside an outcome evaluation of the CCKO strategy, we conducted a process evaluation to understand the implementation context, process and mechanisms. Semi-structured interviews were conducted with 38 healthcare leaders, clinicians and support staff from four regions involved in CCKO care delivery and/or governance. Results: Facilitators to CCKO implementation were sustained engagement of system-wide stakeholders, inter-organizational partnerships, knowledge sharing and family engagement. Barriers to CCKO implementation were resources and funding, fragmentation of care, aligning perspectives between providers and clinical staff recruitment and retention. Conclusion: A flexible approach is required to implement a complex, multi-centre policy strategy. Other jurisdictions considering such a model of care delivery would benefit from attention to contextual variations in implementation setting, building cross-sector engagement and buy-in, and offering continuous support for modifications to the intervention as and when required.
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Affiliation(s)
- Jia Lu Lilian Lin
- PhD Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Samantha Quartarone
- Clinical Research Project Coordinator, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Nasra Aidarus
- Senior Program Manager, Provincial Council for Maternal and Child Health, Toronto, ON
| | - Carol Y Chan
- Clinical Research Project Manager, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jackie Hubbert
- Clinical Director, Labatt Family Heart Centre and Critical Care Services, The Hospital for Sick Children, Toronto, ON
| | - Julia Orkin
- Medical Officer, Integrated Community Partnerships and Complex Care Program, The Hospital for Sick Children; Associate Professor, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Nora Fayed
- Assistant Professor, School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - Nathalie Major
- Medical Director, Champlain Complex Care Program, Children's Hospital of Eastern Ontario; Assistant Professor, Department of Paediatrics, University of Ottawa, Ottawa, ON
| | - Joanna Soscia
- Nurse Practitioner and Clinical Practice Lead, Complex Care Program, The Hospital for Sick Children, Toronto, ON
| | - Audrey Lim
- Medical Lead, Complex Care Program, McMaster Children's Hospital - Hamilton Health Sciences; Associate Professor, Department of Pediatrics, McMaster University, Hamilton, ON
| | - Simon D French
- Professor, Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Myla E Moretti
- Health Economist and Senior Research Associate, Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON
| | - Eyal Cohen
- Professor, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist and Program Head, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
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Funabashi M, French SD, Kranenburg HAR, Hebert JJ. Serious adverse events following lumbar spine mobilization or manipulation and potential associated factors: a systematic review protocol. JBI Evid Synth 2021; 19:1489-1496. [PMID: 33323774 DOI: 10.11124/jbies-20-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The objectives of this review are to describe the serious adverse events reported in the literature following lumbopelvic mobilization and manipulation, and identify patient, provider, and/or treatment factors that may be associated with serious adverse events after these interventions. INTRODUCTION Spinal mobilization and manipulation are types of conservative care commonly used to treat people with low back pain and other musculoskeletal conditions of the lumbar spine and pelvis. Although most adverse events following these interventions are benign and transient, serious adverse events have been reported mostly following spinal manipulative therapy. Given the significant impact serious adverse events can have on patients' lives, identifying factors that may be associated with serious adverse events following spinal mobilization and manipulation of the low back and pelvis would allow for a more specific pre-treatment screening, potentially reducing the occurrence of serious adverse events following these popular interventions and contributing to a safer treatment delivery. INCLUSION CRITERIA This review will consider interventional and observational studies that report serious adverse events following lumbopelvic spinal mobilization or manipulation experienced by people of any age. Examples of serious adverse events include disc herniation, cauda equina syndrome, and vertebral fracture. METHODS MEDLINE, Embase, CINAHL, PubMed, The Cochrane Database of Systematic Reviews/Central Register of Controlled Trials, and Index to Chiropractic Literature (ICL) databases will be searched as well as OpenGrey and ProQuest Dissertations and Theses. Two independent reviewers will screen titles and abstracts of identified references as well as the full text of identified studies, and extract data following a standardized data extraction form. Data will be summarized, categorized, and a comprehensive narrative summary will be presented. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019122339.
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Affiliation(s)
- Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada.,Department of Chiropractic, University of Québec at Trois-Rivières, Trois-Rivières, QB, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - H A Rik Kranenburg
- Research and Innovation Group in Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, Netherlands.,Department of Rehabilitation, University of Groningen, Groningen, Netherlands
| | - Jeffrey J Hebert
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada.,School of Psychology and Exercise Science, Murdoch University, Perth, WA, Australia
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de Luca K, Hogg-Johnson S, Funabashi M, Mior S, French SD. The profile of older adults seeking chiropractic care: a secondary analysis. BMC Geriatr 2021; 21:271. [PMID: 33892643 PMCID: PMC8066480 DOI: 10.1186/s12877-021-02218-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/15/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care. METHODS A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors. RESULTS A total of 6781 chiropractor-adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment. CONCLUSIONS From 6781 chiropractor-adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.
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Affiliation(s)
- Katie de Luca
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | | | - Martha Funabashi
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Silvano Mior
- Department of Research, Canadian Memorial Chiropractic College, Toronto, Canada.,Centre for Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College, Toronto, Canada
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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de Luca K, McDonald M, Montgomery L, Sharp S, Young A, Vella S, Holmes MM, Aspinall S, Brousseau D, Burrell C, Byfield D, Dane D, Dewhurst P, Downie A, Engel R, Gleberzon B, Hollandsworth D, Nielsen AM, O'Connor L, Starmer D, Tunning M, Wanlass P, D French S. COVID-19: how has a global pandemic changed manual therapy technique education in chiropractic programs around the world? Chiropr Man Therap 2021; 29:7. [PMID: 33522933 PMCID: PMC7849220 DOI: 10.1186/s12998-021-00364-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Manual therapy is a cornerstone of chiropractic education, whereby students work towards a level of skill and expertise that is regarded as competent to work within the field of chiropractic. Due to the COVID-19 pandemic, chiropractic programs in every region around the world had to make rapid changes to the delivery of manual therapy technique education, however what those changes looked like was unknown. Aims The aims of this study were to describe the immediate actions made by chiropractic programs to deliver education for manual therapy techniques and to summarise the experience of academics who teach manual therapy techniques during the initial outbreak of COVID-19 pandemic. Methods A qualitative descriptive approach was used to describe the immediate actions made by chiropractic programs to deliver manual therapy technique education during the COVID-19 pandemic. Chiropractic programs were identified from the webpages of the Councils on Chiropractic Education International and the Council on Chiropractic Education – USA. Between May and June 2020, a convenience sample of academics who lead or teach in manual therapy technique in those programs were invited via email to participate in an online survey with open-ended questions. Responses were entered into the NVivo software program and analysed using a reflexive thematic analysis by a qualitative researcher independent to the data collection. Results Data from 16 academics in 13 separate chiropractic programs revealed five, interconnected themes: Immediate response; Move to online delivery; Impact on learning and teaching; Additional challenges faced by educators; and Ongoing challenges post lockdown. Conclusion This study used a qualitative descriptive approach to describe how some chiropractic programs immediately responded to the initial outbreak of the COVID-19 pandemic in their teaching of manual therapy techniques. Chiropractic programs around the world provided their students with rapid, innovative learning strategies, in an attempt to maintain high standards of chiropractic education; however, challenges included maintaining student engagement in an online teaching environment, psychomotor skills acquisition and staff workload. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00364-7.
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Affiliation(s)
- Katie de Luca
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia.
| | - Marcus McDonald
- Discipline of Chiropractic, RMIT University, Melbourne, Australia
| | - Laura Montgomery
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Stephen Sharp
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Anika Young
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Simon Vella
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | | | - Sasha Aspinall
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Danica Brousseau
- Department of Chiropractic, Université du Québec à Trois-Rivieres, Trois-Rivières, Canada
| | - Chris Burrell
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, UK
| | - Dawn Dane
- Central Queensland University, Brisbane, Australia
| | - Philip Dewhurst
- School of Chiropractic, AECC University College, Bournemouth, UK
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Roger Engel
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Brian Gleberzon
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | | | - Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Laura O'Connor
- Department of Chiropracti, Durban University of Technology, Durban, KwaZulu-Natal, South Africa
| | - David Starmer
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Michael Tunning
- Associate Dean of Clinical Sciences, Palmer College of Chiropractic, Davenport, USA
| | - Paul Wanlass
- Interim Chair, Principles and Practice Department, Southern California University of Health Sciences, Los Angeles College of Chiropractic, Los Angeles, USA
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
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De Carvalho D, Bussières A, French SD, Wade D, Brake-Patten D, O'Keefe L, Elliott B, Budgell K, O'Reilly S, To D, Hall A. Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada. Chiropr Man Therap 2021; 29:4. [PMID: 33461555 PMCID: PMC7812732 DOI: 10.1186/s12998-020-00361-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain (LBP) rarely requires routine imaging of the lumbar spine in the primary care setting, as serious spinal pathology is rare. Despite evidence-based clinical practice guidelines recommending delaying imaging in the absence of red flags, chiropractors commonly order imaging outside of these guidelines. The purpose of this study was to survey chiropractors to determine the level of knowledge, adherence to, and beliefs about, clinical practice guidelines related to the use of lumbar radiography for LBP in Newfoundland and Labrador (NL), Canada. Methods A cross-sectional survey of chiropractors in NL (n = 69) was conducted between May and June 2018, including questions on demographics, awareness of radiographic guidelines, and beliefs about radiographs for LBP. We assessed behavioural simulation using clinical vignettes to determine levels of adherence to LBP guideline recommendations. Results The response rate was 77% (n = 53). Half of the participants stated they were aware of current radiographic guideline recommendations, and one quarter of participants indicated they did not use guidelines to inform clinical decisions. The majority of participants agreed that x-rays of the lumbar spine are useful for patients with suspected pathology, are indicated when a patient is non-responsive to 4 weeks of conservative treatment for LBP, and when there are neurological signs associated with LBP. However, a small proportion indicated that there is a role for full spine x-rays (~ 21%), x-rays to evaluate patients with acute LBP (~ 13%), and that patient expectations play a role in decision making (4%). Adherence rate to radiographic guidelines measured using clinical vignettes was 75%. Conclusions While many chiropractors in this sample reported being unsure of specific radiographic guidelines, the majority of respondents adhered to guideline recommendations measured using clinical vignettes. Nonetheless, a small proportion still hold beliefs about radiographs for LBP that are discordant with current radiographic guidelines. Future research should aim to determine barriers to guideline uptake in this population in order to design and evaluate tailored knowledge translation strategies to reduce unnecessary LBP imaging. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-020-00361-2.
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Affiliation(s)
- Diana De Carvalho
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | - Barbara Elliott
- Patient Engagement Partner, North Bay, ON, Canada.,Faculty of Education and Professional Studies - School of Nursing, Nipissing University, North Bay, ON, Canada
| | | | - Sara O'Reilly
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Daphne To
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Jenks AD, Hoekstra T, Axén I, de Luca K, Field J, Newell D, Hartvigsen J, French SD, Koes B, van Tulder MW, Rubinstein SM. BAck complaints in the elders - chiropractic (BACE-C): protocol of an international cohort study of older adults with low back pain seeking chiropractic care. Chiropr Man Therap 2020; 28:17. [PMID: 32238185 PMCID: PMC7110664 DOI: 10.1186/s12998-020-00302-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Low back pain is a common condition among older adults that significantly influences physical function and participation. Compared to their younger counterparts, there is limited information available about the clinical course of low back pain in older people, in particularly those presenting for chiropractic care. Improving our understanding of this patient population and the course of their low back pain may provide input for studies researching safer and more effective care than is currently provided. Objectives The primary objectives are to examine the clinical course over one year of pain intensity, healthcare costs and pain, functional status and recovery rates of low back pain in people 55 years and older who visit a chiropractor for a new episode of low back pain. Methods An international prospective, multi-center cohort study with one-year follow-up. Chiropractic practices are to be recruited in the Netherlands, Sweden, United Kingdom and Australia. Treatment will be left to the discretion of the chiropractor. Inclusion/Exclusion criteria: Patients aged 55 and older who consult a chiropractor for a new episode of low back pain, meaning low back pain for the first time or those patients who have not been to a chiropractor in the previous six months. This is independent of whether they have seen another type of health care provider for the current episode. Patients who are unable to complete the web-based questionnaires because of language restrictions or those with computer literacy restrictions will be excluded as well as those with cognitive disorders. In addition, those with a suspected tumor, fracture, infection or any other potential red flag or condition considered to be a contraindication for chiropractic care will be excluded. Data will be collected using online questionnaires at baseline, and at 2 and 6 weeks and at 3, 6, 9 and 12 months. Discussion This study, to our knowledge, is the first large-scale, prospective, multicenter, international cohort study to be conducted in a chiropractic setting to focus on older adults with low back pain consulting a chiropractor. By understanding the clinical course, satisfaction and safety of chiropractic treatment of this common debilitating condition in the aged population, this study will provide input for informing future clinical trials. Trial registration Nederlandse Trial Registrar NL7507.
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Affiliation(s)
- Alan D Jenks
- Department of Health Sciences and Amsterdam Movement Science, Faculty of Science, Vrije Universiteit, De Boelelaan 1085, room WN U601, 1081HV, Amsterdam, The Netherlands.
| | - Trynke Hoekstra
- Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | - Iben Axén
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katie de Luca
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | | | | | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Simon D French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Bart Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Maurits W van Tulder
- Department of Health Sciences and Amsterdam Movement Science, Faculty of Science, Vrije Universiteit, De Boelelaan 1085, room WN U601, 1081HV, Amsterdam, The Netherlands.,Department of Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Sidney M Rubinstein
- Department of Health Sciences and Amsterdam Movement Science, Faculty of Science, Vrije Universiteit, De Boelelaan 1085, room WN U601, 1081HV, Amsterdam, The Netherlands
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Bowden JL, Egerton T, Hinman RS, Bennell KL, Briggs AM, Bunker SJ, Kasza J, French SD, Pirotta M, Schofield DJ, Zwar NA, Hunter DJ. Protocol for the process and feasibility evaluations of a new model of primary care service delivery for managing pain and function in patients with knee osteoarthritis (PARTNER) using a mixed methods approach. BMJ Open 2020; 10:e034526. [PMID: 32024793 PMCID: PMC7045031 DOI: 10.1136/bmjopen-2019-034526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This protocol outlines the rationale, design and methods for the process and feasibility evaluations of the primary care management on knee pain and function in patients with knee osteoarthritis (PARTNER) study. PARTNER is a randomised controlled trial to evaluate a new model of service delivery (the PARTNER model) against 'usual care'. PARTNER is designed to encourage greater uptake of key evidence-based non-surgical treatments for knee osteoarthritis (OA) in primary care. The intervention supports general practitioners (GPs) to gain an understanding of the best management options available through online professional development. Their patients receive telephone advice and support for OA management by a centralised, multidisciplinary 'Care Support Team'. We will conduct concurrent process and feasibility evaluations to understand the implementation of this new complex health intervention, identify issues for consideration when interpreting the effectiveness outcomes and develop recommendations for future implementation, cost effectiveness and scalability. METHODS AND ANALYSIS The UK Medical Research Council Framework for undertaking a process evaluation of complex interventions and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks inform the design of these evaluations. We use a mixed-methods approach including analysis of survey data, administrative records, consultation records and semistructured interviews with GPs and their enrolled patients. The analysis will examine fidelity and dose of the intervention, observations of trial setup and implementation and the quality of the care provided. We will also examine details of 'usual care'. The semistructured interviews will be analysed using thematic and content analysis to draw out themes around implementation and acceptability of the model. ETHICS AND DISSEMINATION The primary and substudy protocols have been approved by the Human Research Ethics Committee of The University of Sydney (2016/959 and 2019/503). Our findings will be disseminated to national and international partners and stakeholders, who will also assist with wider dissemination of our results across all levels of healthcare. Specific findings will be disseminated via peer-reviewed journals and conferences, and via training for healthcare professionals delivering OA management programmes. This evaluation is crucial to explaining the PARTNER study results, and will be used to determine the feasibility of rolling-out the intervention in an Australian healthcare context. TRIAL REGISTRATION NUMBER ACTRN12617001595303; Pre-results.
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Affiliation(s)
- Jocelyn L Bowden
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, St Leonards, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Thorlene Egerton
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | | | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Marie Pirotta
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah J Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Nicholas A Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, St Leonards, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Hartvigsen J, French SD. So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies. Chiropr Man Therap 2020; 28:4. [PMID: 32000811 PMCID: PMC6990530 DOI: 10.1186/s12998-019-0295-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/26/2019] [Indexed: 12/29/2022] Open
Abstract
This commentary brings the 2017–2019 thematic series What is Chiropractic? to a close. The 18 papers published in the series contribute to a better understanding of what chiropractic is, where chiropractors practice and function, who seeks their care, what chiropractors do, and how they interact with other healthcare professionals. Several papers in the series highlighted deeply rooted disagreements within chiropractic about fundamental issues pertaining to ideology, acceptance of scientific evidence as the basis for clinical practice and the future of chiropractic. If the chiropractic profession is to remain relevant in today’s evidence-based healthcare environment, there is an urgent for the profession to undertake further research to describe what chiropractic is, what chiropractors do, and provide evidence for the value of these activities to patients and healthcare decision makers.
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Affiliation(s)
- Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Nordic Institute of Chiropractic, Campusvej 55, 5230, Odense M, Denmark.
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, 2109, Australia
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Al Zoubi FM, French SD, Patey AM, Mayo NE, Bussières AE. Professional barriers and facilitators to using stratified care approaches for managing non-specific low back pain: a qualitative study with Canadian physiotherapists and chiropractors. Chiropr Man Therap 2019; 27:68. [PMID: 31857892 PMCID: PMC6909494 DOI: 10.1186/s12998-019-0286-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/01/2019] [Indexed: 12/28/2022] Open
Abstract
Background Recent clinical practice guidelines for the management of non-specific low back pain (LBP) recommend using stratified care approaches. To date, no study has assessed barriers and facilitators for health professionals in using stratified care approaches for managing non-specific LBP in the Canadian primary care setting. This study aimed to identify and contrast barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors. Methods Individual telephone interviews, underpinned by the Theoretical Domains Framework (TDF), explored beliefs and attitudes about, and identified barriers and facilitators to the use of stratified care approaches for managing non-specific LBP in a purposive sample of 13 chiropractors and 14 physiotherapists between September 2015 and June 2016. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using directed content analysis. Results Three and seven TDF domains were identified as likely relevant for physiotherapists and chiropractors, respectively. Shared key beliefs (and relevant domains of the TDF) for both physiotherapists and chiropractors included: lack of time, cost, and expertise (Environmental Context and Resources); and consulting more experienced colleagues and chronic patients with important psychological overlay (Social Influences). Unique key domains were identified among physiotherapists: incompatibility with achieving other objectives (Goals), and chiropractors: confidence in using stratified care approaches (Beliefs about Capabilities); intention to use stratified care approaches (Intentions); awareness and agreement with stratified care approaches (Knowledge); assessment of readiness for change and intentional planning behaviour (Behavioural Regulation); and improving the management of non-specific LBP patients and the uptake of evidence-based practice (Beliefs about Consequences). Conclusions Several shared and unique barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors were identified. Findings may help inform the design of tailored theory-based knowledge translation interventions to increase the uptake of stratified care approaches in clinical practice.
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Affiliation(s)
- Fadi M Al Zoubi
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC Canada
| | - Simon D French
- 3Department of Chiropractic, Macquarie University, Sydney, NSW Australia.,4School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
| | - Andrea M Patey
- 5Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Nancy E Mayo
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC Canada
| | - André E Bussières
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC Canada.,6Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC Canada
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Auais M, Al-Zoubi F, Matheson A, Brown K, Magaziner J, French SD. Understanding the role of social factors in recovery after hip fractures: A structured scoping review. Health Soc Care Community 2019; 27:1375-1387. [PMID: 31446636 PMCID: PMC7039329 DOI: 10.1111/hsc.12830] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 05/25/2023]
Abstract
Poor recovery among older adults with hip fractures can occur despite successful surgical repair and rehabilitation, suggesting other factors might play a role in recovery, such as social factors. The aim of this scoping review was to provide an overview of the literature on the role of social factors in older adult's recovery after hip fracture. This review followed the York Framework and its modifications and recent reporting guidelines. Two independent researchers searched main medical databases (CINAHL, EMBASE, Medline, PsycINFO and the Cochrane libraries) from inception to June 2017, for studies investigating social factors and recovery post hip fracture. Studies were excluded if they were qualitative, perspective papers or if participants were < 65 years or they were not living in the community. We screened 2,503 unique abstracts in total and 19 studies fulfilled the inclusion criteria. Social factors investigated in the included studies were social support, socioeconomic factors and living arrangement. We classified outcomes in the studies into three subgroups: physical functional recovery, mortality and other outcomes (pain, hospital length of stay and quality of life). We found evidence that social support and socioeconomic factors (e.g. socioeconomic status) were significantly associated with an increase in functional recovery, a decrease in mortality and other outcomes, but conflicting evidence was found for the effect of one's living arrangement. Only two included studies were randomised controlled trials. To conclude, social factors, such as social support and socioeconomic status, affect physical functional recovery and mortality in older adults with hip fractures. However, this is an under researched area that lacks rigorously designed studies and would benefit from more studies with rigorous designs.
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Affiliation(s)
- Mohammad Auais
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Fadi Al-Zoubi
- School of Physical and Occupational Therapy, Montreal, QC, Canada
| | - Alyssa Matheson
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Kelcie Brown
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Simon D. French
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
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Ahmed T, French SD, Belanger E, Guerra RO, Zunzunegui MV, Auais M. Gender Differences in Trajectories of Lower Extremity Function in Older Adults: Findings From the International Mobility in Aging Study. J Am Med Dir Assoc 2019; 20:1199-1205.e4. [DOI: 10.1016/j.jamda.2019.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/03/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
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Cancelliere C, Sutton D, Côté P, French SD, Taylor-Vaisey A, Mior SA. Implementation interventions for musculoskeletal programs of care in the active military and barriers, facilitators, and outcomes of implementation: a scoping review. Implement Sci 2019; 14:82. [PMID: 31419992 PMCID: PMC6698020 DOI: 10.1186/s13012-019-0931-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/31/2019] [Indexed: 11/29/2022] Open
Abstract
Background Musculoskeletal disorders are common in the active military and are associated with significant lost duty days and disability. Implementing programs of care to manage musculoskeletal disorders can be challenging in complex healthcare systems such as in the military. Understanding how programs of care for musculoskeletal disorders have been implemented in the military and how they impact outcomes may help to inform future implementation interventions in this population. Methods We conducted a scoping review using the modified Arksey and O’Malley framework to identify literature on (1) implementation interventions of musculoskeletal programs of care in the active military, (2) barriers and facilitators of implementation, and (3) implementation outcomes. We identified studies published in English by searching MEDLINE, CINAHL, Embase, and CENTRAL (Cochrane) from inception to 1 June 2018 and hand searched reference lists of relevant studies. We included empirical studies. We synthesized study results according to three taxonomies: the Effective Practice and Organization of Care (EPOC) taxonomy to classify the implementation interventions; the capability, opportunity, motivation-behavior (COM-B) system to classify barriers and facilitators of implementation; and Proctor et al.’s taxonomy (Adm Policy Ment Health 38:65–76, 2011) to classify outcomes in implementation research. Results We identified 1785 studies and 16 were relevant. All but two of the relevant studies were conducted in the USA. Implementation interventions were primarily associated with delivery arrangements (e.g., multidisciplinary care). Most barriers or facilitators of implementation were environmental (physical or social). Service and client outcomes indicated improved efficiency of clinical care and improved function and symptomology. Studies reporting implementation outcomes indicated the programs were acceptable, appropriate, feasible, or sustainable. Conclusion Identification of evidence-based approaches for the management of musculoskeletal disorders is a priority for active-duty military. Our findings can be used by military health services to inform implementation strategies for musculoskeletal programs of care. Further research is needed to better understand (1) the components of implementation interventions, (2) how to overcome barriers to implementation, and (3) how to measure implementation outcomes to improve quality of care and recovery from musculoskeletal disorders.
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Affiliation(s)
- Carol Cancelliere
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada. .,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada. .,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada.
| | - Deborah Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada.,Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada.,Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada.,Canada Research Chair in Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada
| | - Simon D French
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
| | - Silvano A Mior
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Science building, Room 3000, Oshawa, Ontario, L1H 7K4, Canada.,UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada.,Division of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3J1, Canada
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Dhopte P, French SD, Quon JA, Owens H, Bussières A. Guideline implementation in the Canadian chiropractic setting: a pilot cluster randomized controlled trial and parallel study. Chiropr Man Therap 2019; 27:31. [PMID: 31346409 PMCID: PMC6636122 DOI: 10.1186/s12998-019-0253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Feasibility and pilot studies are recommended prior to embarking on large-scale costly confirmatory trials. The objectives were to determine the feasibility of conducting a cluster randomized controlled trial (C-RCT) to evaluate a complex knowledge translation (KT) intervention to improve the management of people with neck pain, and to identify challenges and potential solutions to conducting a fully powered C-RCT in the chiropractic setting. Methods Pilot C-RCT involving a nationally representative sample of chiropractors and patients. We invited 400 chiropractors and 150 patients to participate. Clinicians were randomized to receive either an online theory-based KT educational and brief action plan (BAP) intervention (intervention group) or a copy of a clinical practice guideline (control group). Study-related challenges were ascertained via mid-study phone interviews and end-of-study feedback questionnaires. Analyses focused on descriptive estimates of likely recruitment, retention, and adherence rates, and documentation of potential barriers. Results In total, 47 chiropractors (12%) agreed to participate and were randomized after resampling. Fifteen withdrew from the study, leaving a total of 32 (8%) participants. Eleven chiropractors in the intervention group completed the webinars and e-learning modules, two partially completed them and three did not register. Participating chiropractors recruited a total of 29 patients. Sixty-three percent (n = 7) of intervention and 56% (n = 10) of control group patients completed all outcome measures at both baseline and 3-months follow-up, attended follow-up visits and performed home exercises. Patients in the intervention group reported significant reductions in pain (mean 1.6, 95% CI 0.26–2.94, P = 0.027) and disability scores (9.8, 95% CI 3.68–15.91, P = 0.033) from baseline to 3-month follow-up. Key barriers to participation reported by chiropractors included lack of time, difficulties in recruiting patients, problems with the administration of study questionnaires, concern that the clinician-patient relationship might be jeopardized, and lack of assistance from office staff. Over half (55%) of the respondents in the intervention group encountered some difficulty registering or completing the educational modules. Conclusion Recruitment of clinicians and patients for a trial of a complex intervention can be challenging, and retention of participants after enrolment may be low. Future trials of this nature likely require multiple recruitment strategies to achieve desired sample sizes. Moreover, time-constraint issues are perceived particularly by clinicians as a major barrier to both study enrolment before, and protocol adherence during, their actual participation in a trial. Trial registration The study was registered at, NCT02483091, on 17th June 2015. Electronic supplementary material The online version of this article (10.1186/s12998-019-0253-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prakash Dhopte
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, Montreal, Quebec H3G 1Y5 Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), 6363 chemin Hudson, bureau 061,Pavillon Lindsay de l'IURDPM, Montréal, QC H3S 1M9 Canada
| | - Simon D French
- 3Department of Chiropractic, Macquarie University, 24/1 Lakeside Rd, Eastwood NSW, 2122 Australia
| | - Jeffrey A Quon
- 4School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada.,5International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, 818 West 10th Avenue, Vancouver, BC Canada.,6Spine Program, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada.,The Cambie Chiropractic Centre, 2786 W 16th Ave suite 101, Vancouver, BC V6K 4M1 Canada
| | - Heather Owens
- 8CISSS Laval-Jewish Rehabilitation Hospital, CRIR-Feil Oberfeld Research Centre, 3205 Place Alton Goldbloom, Laval, Qc H7V 1R2 Canada
| | - André Bussières
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, Montreal, Quebec H3G 1Y5 Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), 6363 chemin Hudson, bureau 061,Pavillon Lindsay de l'IURDPM, Montréal, QC H3S 1M9 Canada.,9Département chiropratique, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, Qc G8Z 4M3 Canada
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Beliveau PJH, McIsaac MA, Mior SA, French SD. An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST. J Manipulative Physiol Ther 2019; 42:353-365. [PMID: 31262578 DOI: 10.1016/j.jmpt.2018.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/20/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate weight-loss interventions offered by Canadian doctors of chiropractic to their adult patients. METHODS This paper reports a secondary analysis of data from the Ontario Chiropractic Observation and Analysis STudy (Nc = 42 chiropractors, Np = 2162 patient encounters). Multilevel logistic regression was performed to assess the odds of chiropractors initiating or continuing weight management interventions with patients. Two chiropractor variables and 8 patient-level variables were investigated for influence on chiropractor-directed weight management. In addition, the interaction between the effects of patient weight and comorbidity on weight management interventions by chiropractors was assessed. RESULTS Around two-thirds (61.3%) of patients who sought chiropractic care were either overweight or had obesity. Very few patients had weight loss managed by their chiropractor. Among patients with body mass index equal to or greater than 18.5 kg/m2, guideline recommended weight management was initiated or continued by Ontario chiropractors in only 5.4% of encounters. Chiropractors did not offer weight management interventions at different rates among patients who were of normal weight, overweight, or obese (P value = 0.23). Chiropractors who graduated after 2005 who may have been exposed to reforms in chiropractic education to include public health were significantly more likely to offer weight management than chiropractors who graduated between 1995 and 2005 (odds ratio 0.02; 95% CI [0.00-0.13]) or before 1995 (odds ratio 0.08; 95% CI [0.01-0.42]). CONCLUSION The prevalence of weight management interventions offered to patients by Canadian chiropractors in Ontario was low. Health care policy and continued chiropractic educational reforms may provide further direction to improve weight-loss interventions offered by doctors of chiropractic to their patients.
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Affiliation(s)
- Peter J H Beliveau
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Michael A McIsaac
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Silvano A Mior
- University of Ontario Institute of Technology-Canadian Memorial Chiropractic College Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Simon D French
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada; Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
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French SD, Green ME, Bhatia RS, Peng Y, Hayden JA, Hartvigsen J, Ivers NM, Grimshaw JM, Booth CM, Rühland L, Norman KE. Imaging use for low back pain by Ontario primary care clinicians: protocol for a mixed methods study - the Back ON study. BMC Musculoskelet Disord 2019; 20:50. [PMID: 30711002 PMCID: PMC6359752 DOI: 10.1186/s12891-019-2427-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND At any one time, one in every five Canadians has low back pain (LBP), and LBP is one of the most common health problems in primary care. Guidelines recommend that imaging not be routinely performed in patients presenting with LBP without signs or symptoms indicating a potential pathological cause. Yet imaging rates remain high for many patients who present without such indications. Inappropriate imaging can lead to inappropriate treatments, results in worse health outcomes and causes harm from unnecessary radiation. There is a need to understand the extent of, and factors contributing to, inappropriate imaging for LBP, and to develop effective strategies that target modifiable barriers and facilitators. The primary study objectives are to determine: 1) The rate of, and factors associated with, inappropriate lumbar spine imaging (x-ray, CT scan and MRI) for people with non-specific LBP presenting to primary care clinicians in Ontario; 2) The barriers and facilitators to reduce inappropriate imaging for LBP in primary care settings. METHODS The project will comprise an inception cohort study and a concurrent qualitative study. For the cohort study, we will recruit 175 primary care clinicians (50 each from physiotherapy and chiropractic; 75 from family medicine), and 3750 patients with a new episode of LBP who present to these clinicians. Clinicians will collect data in the clinic, and each participant will be tracked for 12 months using Ontario health administrative and self-reported data to measure diagnostic imaging use and other health outcomes. We will assess characteristics of the clinicians, patients and encounters to identify variables associated with inappropriate imaging. In the qualitative study we will conduct in-depth interviews with primary care clinicians and patients. DISCUSSION This will be the first Canadian study to accurately document the extent of the overuse of imaging for LBP, and the first worldwide to include data from the main healthcare professions offering primary care for people with LBP. This study will provide robust information about rates of inappropriate imaging for LBP, along with factors associated with, and an understanding of, potential reasons for inappropriate imaging.
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Affiliation(s)
- Simon D French
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. .,Department of Chiropractic, Macquarie University, Macquarie, NSW, 2109, Australia. .,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
| | - Michael E Green
- Department of Family Medicine, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - R Sacha Bhatia
- Choosing Wisely Canada, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Yingwei Peng
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jill A Hayden
- Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Noah M Ivers
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Lucia Rühland
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Hunter DJ, Hinman RS, Bowden JL, Egerton T, Briggs AM, Bunker SJ, Kasza J, Forbes AB, French SD, Pirotta M, Schofield DJ, Zwar NA, Bennell KL. Correction to: Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY. BMC Musculoskelet Disord 2018; 19:443. [PMID: 30572871 PMCID: PMC6302386 DOI: 10.1186/s12891-018-2362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
After the publication of this protocol [1], our collaborator Prima Health solutions advised us of their intent to withdraw from the study.
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Affiliation(s)
- D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia. .,Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - J L Bowden
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - T Egerton
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - A M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - S J Bunker
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - J Kasza
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A B Forbes
- Biostatistics Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - S D French
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
| | - M Pirotta
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - D J Schofield
- Department of Economics, Faculty of Business and Economics, Macquarie University, Sydney, Australia
| | - N A Zwar
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap 2018; 26:48. [PMID: 30479744 PMCID: PMC6247638 DOI: 10.1186/s12998-018-0217-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/02/2018] [Indexed: 12/26/2022] Open
Abstract
The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.
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Affiliation(s)
- Hazel J Jenkins
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Aron S Downie
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Craig S Moore
- 2Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Simon D French
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.,3School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
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Jenkins HJ, Moloney NA, French SD, Maher CG, Dear BF, Magnussen JS, Hancock MJ. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res 2018; 18:734. [PMID: 30249241 PMCID: PMC6154885 DOI: 10.1186/s12913-018-3526-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently. METHODS The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPs and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention. RESULTS Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPs to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPs of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPs, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version. CONCLUSIONS The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.
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Affiliation(s)
- Hazel J Jenkins
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. .,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
| | - Niamh A Moloney
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Chris G Maher
- Musculoskeletal Health Sydney, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Blake F Dear
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
| | - John S Magnussen
- Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Mark J Hancock
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Auais M, French SD, Beaupre L, Giangregorio L, Magaziner J. Identifying research priorities around psycho-cognitive and social factors for recovery from hip fractures: An international decision-making process. Injury 2018; 49:1466-1472. [PMID: 29739655 DOI: 10.1016/j.injury.2018.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/16/2018] [Indexed: 02/02/2023]
Abstract
UNLABELLED Hip fractures rank in the top ten disabling conditions worldwide. With an ageing population, this public health problem is expected to increase. Despite the success of surgery for hip fractures and the extensive health services utilisation, health outcomes are often poor. Considering the recovery process as multifactorial and intervening to address all relevant factors may improve recovery rates. However, we need first to fully understand the factors contributing to recovery after hip fractures, including psycho-cognitive and social factors. The purpose of this study was to identify future research priorities for understanding the role of psycho-cognitive and social factors in the recovery process for community-dwelling older adults after hip fracture and to survey world experts to confirm the identified priorities. METHODS This was a two-stage process. First, a workshop of international experts in hip fracture care (researchers and clinician-scientists) was held in 2016 in Montreal, Quebec, Canada. Using Nominal Group Technique accompanied by Multi-voting Technique, workshop attendees identified the most important future research areas for psycho-cognitive and social factors contributing to recovery after hip fractures. Second, an online survey of the International Fragility Fracture Network (FFN), which includes researchers and clinicians interested in fragility fractures, followed the meeting. The survey respondents reviewed and added to priorities from the first stage and then ranked the top priorities. RESULTS Twenty-three experts participated in the meeting (from five countries) and 152 participants (from 29 countries) responded to the survey. Top priorities for the psycho-cognitive domain were preventing and treating in-hospital delirium; comparing the effectiveness of targeted versus multifactorial interventions; studying interactions between psycho-cognitive, social, and environmental factors in the recovery process; and modifying the environment to enhance patients' cognitive reserves. Top priorities for the social domain were understanding the role of social factors in the recovery process; understanding patients' perspectives on important social factors; identifying components of social support relevant to recovery; understanding attitudes towards patients with hip fractures among all stakeholders; and understanding the social support needs for caregivers. CONCLUSION A set of future research priorities to understand the role of psycho-cognitive and social factors has been developed and confirmed through a rigorous international decision-making process. These priorities offer valuable guidance for researchers, scientific bodies, and funding agencies.
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Affiliation(s)
- Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
| | - Simon D French
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada; Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
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French SD, Downie AS, Walker BF. Low back pain: a major global problem for which the chiropractic profession needs to take more care. Chiropr Man Therap 2018; 26:28. [PMID: 29983908 PMCID: PMC6016136 DOI: 10.1186/s12998-018-0199-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/15/2018] [Indexed: 02/28/2023] Open
Abstract
An important series of papers have been published in the Lancet. These papers provide a comprehensive update for the major global problem of low back pain, and the challenges that low back pain presents to healthcare practitioners and policy makers. Chiropractors are well placed to reduce the burden of low back pain, but not all that chiropractors do is supported by robust, contemporary evidence. This commentary summarises the Lancet articles. We also make suggestions for how the chiropractic profession should most effectively help people with low back pain by implementing practices supported by high quality evidence.
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Affiliation(s)
- Simon D French
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, 2109 NSW Australia.,2School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
| | - Aron S Downie
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, 2109 NSW Australia.,3University of Sydney, Sydney, Australia
| | - Bruce F Walker
- 4School of Health Professions, Murdoch University, Perth, Australia
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Kendall JC, French SD, Hartvigsen J, Azari MF. Chiropractic treatment including instrument-assisted manipulation for non-specific dizziness and neck pain in community-dwelling older people: a feasibility randomised sham-controlled trial. Chiropr Man Therap 2018; 26:14. [PMID: 29760878 PMCID: PMC5943997 DOI: 10.1186/s12998-018-0183-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/23/2018] [Indexed: 12/18/2022] Open
Abstract
Background Dizziness in older people is a risk factor for falls. Neck pain is associated with dizziness and responds favourably to neck manipulation. However, it is unknown if chiropractic intervention including instrument-assisted manipulation of the neck in older people with neck pain can also improve dizziness. Methods This parallel two-arm pilot trial was conducted in Melbourne, Australia over nine months (October 2015 to June 2016). Participants aged 65–85 years, with self-reported chronic neck pain and dizziness, were recruited from the general public through advertisements in local community newspapers and via Facebook. Participants were randomised using a permuted block method to one of two groups: 1) Activator II™-instrument-assisted cervical and thoracic spine manipulation plus a combination of: light massage; mobilisation; range of motion exercises; and home advice about the application of heat, or 2) Sham-Activator II™-instrument-assisted manipulation (set to zero impulse) plus gentle touch of cervical and thoracic spinal regions. Participants were blinded to group allocation. The interventions were delivered weekly for four weeks. Assessments were conducted one week pre- and post-intervention. Clinical outcomes were assessed blindly and included: dizziness (dizziness handicap inventory [DHI]); neck pain (neck disability index [NDI]); self-reported concerns of falling; mood; physical function; and treatment satisfaction. Feasibility outcomes included recruitment rates, compliance with intervention and outcome assessment, study location, success of blinding, costs and harms. Results Out of 162 enquiries, 24 participants were screened as eligible and randomised to either the chiropractic (n = 13) or sham (n = 11) intervention group. Compliance was satisfactory with only two participants lost to follow up; thus, post-intervention data for 12 chiropractic intervention and 10 sham intervention participants were analysed. Blinding was similar between groups. Mild harms of increased spinal pain or headaches were reported by 6 participants. Costs amounted to AUD$2635 per participant. The data showed a trend favouring the chiropractic group in terms of clinically-significant improvements in both NDI and DHI scores. Sample sizes of n = 150 or n = 222 for dizziness or neck pain disability as the primary outcome measure, respectively, would be needed for a fully powered trial. Conclusions Recruitment of participants in this setting was difficult and expensive. However, a larger trial may be feasible at a specialised dizziness clinic within a rehabilitation setting. Compliance was acceptable and the outcome measures used were well accepted and responsive. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000653763. Registered 13 June 2013. Trial funding: Foundation for Chiropractic Research and Postgraduate Education (Denmark).
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Affiliation(s)
- Julie C Kendall
- 1School of Health and Biomedical Sciences, RMIT University, PO Box 71 Bundoora, Melbourne, VIC 3083 Australia
| | - Simon D French
- 2School of Rehabilitation Therapy, Queens University, Kingston, Canada.,3Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Jan Hartvigsen
- 4Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,5Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Michael F Azari
- 1School of Health and Biomedical Sciences, RMIT University, PO Box 71 Bundoora, Melbourne, VIC 3083 Australia
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