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New WHO Guideline on Chronic LBP: Global Impact

By |November 7, 2024|Guidelines, Low Back Pain|

New WHO Guideline on Chronic LBP: Global Impact
World Health Organization Guideline:
Yes to Chiropractic; No to Most Drugs

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic ~ February 2024

WHAT YOU NEED TO KNOW

  • “Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults.

  • The chiropractic profession was represented by several noted DCs in all aspects of development and review.

  • Within the short list of recommended interventions, most DCs provide at least three. Thus, it is not hard to conclude that doctors of chiropractic should be the first choice for chronic low-back pain management.

On Dec. 7, 2023, the World Health Organization (WHO) released its “Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.” [1] The purpose of the 244-page document is to “provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP in adults” that will improve outcomes. “Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults.

The guideline reviews both the benefits and the harms of nonsurgical interventions in the management of chronic primary LBP. In addition to spinal manipulative therapy, the guideline is also in favor of structured exercise, acupuncture, massage, NSAIDs and topical cayenne pepper (Capsicum frutescens).

NSAIDs continue to be the only recommended pharmacotherapy. Among the medication interventions the guideline recommends against are opioids, antidepressants (tricyclic, serotonin and noradrenaline reuptake inhibitor), skeletal muscle relaxants, injectable local anaesthetics and pharmacological weight-loss medications.

Acetaminophen, benzodiazepines and cannabis-related pharmaceutical preparations received “no recommendation,” while listing potential harmful effects including “cardiovascular, renal and gastrointestinal harms and increased mortality risk” for acetaminophen; “potential harms including memory impairment, misuse, overdose deaths from respiratory depression, somnolence, fatigue and light-headedness potentially leading to falls” for benzodiazepines; and “evidence of possible adverse events, including harms associated with its nonmedicinal use” for cannabis-related pharmaceutical preparations.

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Postgraduate Training Opportunities for Chiropractors: A Description of United States Programs

By |October 27, 2024|Chiropractic Care, Chiropractic Education|

Postgraduate Training Opportunities for Chiropractors: A Description of United States Programs

The Chiro.Org Blog

SOURCE:   J Chiropractic Education 2024 (Mar 4); 38 (1): 104–114Samuel M Schut

Chiropractic resident at the VA Connecticut Healthcare System
50 Campbell Ave,
West Haven, CT 06516

Samuel M Schut

Chiropractic resident at the VA Connecticut Healthcare System
50 Campbell Ave,
West Haven, CT 06516

Objective:   The objective of this study was to describe and compare the current postgraduate training opportunities (PTOs) in the United States (US) for which doctors of chiropractic are eligible, namely, residencies, fellowships, and board certifications.

Methods:   An internet search of publicly available English-language websites on Google.com was executed using a cache-cleared private browser and key search phrases. Following webpage data extraction, e-mail and telephone follow-up were completed with officials from institutions offering doctor of chiropractic programs possessing accreditation by the Council on Chiropractic Education (CCE) in the US. Additional programs identified were annotated and incorporated into the data set if they met the inclusion criteria. Descriptive statistics were generated following data aggregation.

Results:   Three-hundred internet search results were screened, 70 of which were assessed for eligibility and 47 included for descriptive analysis. Among the 16 CCE-accredited institutions solicited, 13 returned correspondence (81.3% response rate), resulting in the addition of 2 programs to the data set ascertained by the initial web search. There were 49 PTOs for chiropractors. Of programs available, residencies represented 49.0% (24/49) of programs, and fellowships represented 12.2% (6/49) of programs. There were 19 board specialty diplomate programs, constituting 38.8% of PTOs.

Conclusion:   This work details preliminary descriptive information on the current state of US-based PTOs for chiropractors.

Keywords:   Chiropractic; Education; Fellowships and Scholarships; Internship and Residency.

From the FULL TEXT Article:

INTRODUCTION

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Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors

By |October 16, 2024|Acute Low Back Pain, Chiropractic Care, Nonpharmacologic Therapies|

Effect of Chiropractic Care on Low Back Pain for Active-duty Military Members: Mediation Through Biopsychosocial Factors

The Chiro.Org Blog

SOURCE:   PLoS One 2024 (Oct 1); 19 (10): e0310642

Zacariah K. Shannon • Cynthia R. Long • Elizabeth A. Chrischilles • Christine M. Goertz • Robert B. Wallace • Carri Casteel • Ryan M. Carnahan

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA, USA.


FROM:   Schneider, Spine 2015

This study evaluates biopsychosocial factors as mediators of the effect of chiropractic care on low back pain (LBP) intensity and interference for active-duty military members. Data from a multi-site, pragmatic clinical trial comparing six weeks of chiropractic care plus usual medical care to usual medical care alone for 750 US active-duty military members with LBP were analyzed using natural-effect, multiple-mediator modeling. Mediation of the adjusted mean effect difference on 12-week outcomes of PROMIS-29 pain interference and intensity by 6-week mediators of other PROMIS-29 physical, mental, and social health subdomains was evaluated. The effect difference on pain interference occurring through PROMIS-29 biopsychosocial factors (natural indirect effect = -1.59, 95% CI = -2.28 to -0.88) was 56% (95% CI = 35 to 96) of the total effect (-2.82, 95% CI = -3.98 to -1.53). The difference in effect on pain intensity occurring through biopsychosocial factors was smaller (natural indirect effect = -0.32, 95% CI = -0.50 to -0.18), equaling 26% (95% CI = 15 to 42) of the total effect (-1.23, 95% CI = -1.52 to -0.88). When considered individually, all physical, mental, and social health factors appeared to mediate the effect difference on pain interference and pain intensity with mental health factors having smaller effect estimates. In contrast with effects on pain interference, much of the effect of adding chiropractic care to usual medical care for US military members on pain intensity did not appear to occur through the PROMIS-29 biopsychosocial factors. Physical and social factors appear to be important intermediate measures for patients receiving chiropractic care for low back pain in military settings. Further study is needed to determine if the effect of chiropractic care on pain intensity for active-duty military occurs through other unmeasured factors, such as patient beliefs, or if the effect occurs directly.

Trial registration   registered on clinical trials.gov (NCT01692275)

From the FULL TEXT Article:

Introduction

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Our Blog is a Tool. Learn How to Use It Now

By |September 17, 2024|Announcement|

Our Blog is a Tool.
Learn How to Use It Now

The Chiro.Org Blog

A Chiro.Org Editorial

Every Blog post is an announcement of new material that was just added to one of our many Sections.

I have been compiling (and archiving) peer-reviewed articles since early 1996, and to date we have thousands of Abstracts, and many hundreds of Full-Text articles on a wide variety of subjects.

When enough material, relating to a particular topic was collected,
it was gathered into a new Topical Page in one of our many Sections.

Each Topical page is located in the Section most associated with that topic.
Thus, our Attention Deficit Page is located (is a part of) our Pediatrics Section
You get the idea.

Almost ALL of our Sections contain some, or many Topical collections.
The LINKS Section is the most extreme example, because it contains 86 different topical pages.

All of the following are “active” Sections that are
constantly adding new (and important) materials:

Acupuncture
Alternative Healing Abstracts
Case Studies
Chiropractic Assistants
Chiropractic Research
Chronic Neck Pain
Conditions That Respond Well
Cost-Effectiveness of Chiropractic
Documentation
Global Burden of Disease
Headache and Chiropractic
Initial Provider/First Contact and Chiropractic
The LINKS
Low Back Pain and Chiropractic
Medicare Info
Non-pharmacologic Therapy and Chiropractic
Nutrition
Pediatrics
Radiology
The SEARCH Section
Stroke and Chiropractic
What is the Chiropractic Subluxation?
Whiplash and Chiropractic

These other Sections are “archival” in nature, and contain valuable tools:

Chiropractic History
ChiroZine
Free Images
New DC’s
Office Forms
R.C. Schafer’s Rehab Monographs
The Wilk Antitrust Lawsuit

How Blog Posts Work

The following is a Graphic “screen grab” of a Blog Post from our Home Page.
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Mechanisms of Manipulation: A Systematic Review of the Literature on Immediate Anatomical Structural or Positional Changes in Response to Manually Delivered High-velocity, Low-amplitude Spinal Manipulation

By |September 14, 2024|About Chiropractic Adjusting|

Mechanisms of Manipulation: A Systematic Review of the Literature on Immediate Anatomical Structural or Positional Changes in Response to Manually Delivered High-velocity, Low-amplitude Spinal Manipulation

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2024 (Sep 11); 32: 28

  OPEN ACCESS   

Kenneth J. Young • Charlotte Leboeuf-Yde • Lindsay Gorrell • Cecilia Bergström • David W. Evans Iben Axén et al.

Allied Health Research Unit,
University of Central Lancashire,
Preston, UK

Background:   Spinal manipulation (SM) has been claimed to change anatomy, either in structure or position, and that these changes may be the cause of clinical improvements. The aim of this systematic review was to evaluate and synthesise the peer-reviewed literature on the current evidence of anatomical changes in response to SM.

Methods:   The review was registered with PROSPERO (CRD42022304971) and reporting was guided by the standards of the PRISMA Statement. We searched Medline, Embase, CINAHL, AMED, Cochrane Library all databases, PEDro, and the Index to Chiropractic Literature from inception to 11 March 2022 and updated on 06 June 2023. Search terms included manipulation, adjustment, chiropractic, osteopathy, spine and spine-related structures. We included primary research studies that compared outcomes with and without SM regardless of study design. Manipulation was defined as high-velocity, low-amplitude thrust delivered by hand to the spine or directly related joints. Included studies objectively measured a potential change in an anatomical structure or in position. We developed a novel list of methodological quality items in addition to a short, customized list of risk of bias (RoB) items. We used quality and RoB items together to determine whether an article was credible or not credible. We sought differences in outcomes between SM and control groups for randomised controlled trials and crossover studies, and between pre- and post-SM outcomes for other study designs. We reported, in narrative form, whether there was a change or not.

Results:   The search retrieved 19,572 articles and 20 of those were included for review. Study topics included vertebral position (n = 3) facet joint space (n = 5), spinal stiffness (n = 3), resting muscle thickness (n = 6), intervertebral disc pressure (n = 1), myofascial hysteresis (n = 1), and further damage to already damaged arteries (n = 1). Eight articles were considered credible. The credible articles indicated that lumbar facet joint space increased and spinal stiffness decreased but that the resting muscle thickness did not change.

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Enhancing Ccomprehensive Primary Care by Integrating Chiropractic Led Musculoskeletal Care Into Interprofessional Teams Through Supporting Education, Competency Attainment, and Optimizing Integration

By |September 7, 2024|Spinal Pain Management|

Enhancing Ccomprehensive Primary Care by Integrating Chiropractic Led Musculoskeletal Care Into Interprofessional Teams Through Supporting Education, Competency Attainment, and Optimizing Integration

The Chiro.Org Blog

SOURCE:   Healthc Manage Forum 2024 (Sep); 37 (1_suppl): 55S–61S

  OPEN ACCESS   

Silvano Mior, DC, FCCS, PhD • Diana De Carvalho, DC, PhD • Jairus Quesnele, DC, FCCS, APP • Sheilah Hogg-Johnson, PhD • Pegah Rahbar, BSc, DC • Megan Logeman, BSc, PMP

Canadian Memorial Chiropractic College,
Toronto, Ontario, Canada.

Musculoskeletal (MSK) conditions are the leading cause of disability, resulting in up to 40% of visits to family physicians. Current primary care workforce shortages in Canada require other providers to maximize scopes of practice. Few MSK providers have been trained in team-based primary care settings. Study objectives included: (1) educating participating primary care teams through synchronous education, (2) educating Canadian primary care providers through asynchronous education, and (3) integrating chiropractors into primary care teams, whilst evaluating team MSK care knowledge/attitudes and integration experience. Results indicated improvements in collaborative competency, improved understanding and attitudes to chiropractic, and the importance of providing MSK care within funded primary care. Teams employed unique approaches to integrating chiropractors and indicated high demand for their services by patients and providers. Provision of MSK care without economic barrier is desirable and highly valued by teams. Chiropractors are well suited to participate in funded primary care teams in Canada.

From the FULL TEXT Article:

Introduction

Musculoskeletal (MSK) conditions are the leading cause of disability in Canada and a significant burden to people, health systems, and economies. [1] In most Canadian provinces, public funding for MSK care is limited, posing a significant barrier to patient access. In the United States, MSK complaints are the most common reason for primary care appointments, accounting for approximately 40% of encounters, [2] highlighting the importance of strengthening MSK expertise in primary care to impact patient outcomes. One solution is to provide integrated MSK care (embedding MSK care providers such as chiropractors and physiotherapists) as part of comprehensive primary care.

Currently, few MSK health providers have been formally trained in Interprofessional Collaboration (IPC), limiting integration and optimization of team-based patient-centred care. Interprofessional Education (IPE) supports the development of a competent health workforce and helps mitigate the current fragmentation of care in health service delivery. [3]

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