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Providing Information at the Initial Consultation to Patients with Low Back Pain Across General Practice, Chiropractic and Physiotherapy – A Cross-sectorial Study of Danish Primary Care

By |November 2, 2022|Chiropractic Management, Low Back Pain|

Providing Information at the Initial Consultation to Patients with Low Back Pain Across General Practice, Chiropractic and Physiotherapy – A Cross-sectorial Study of Danish Primary Care

The Chiro.Org Blog


SOURCE:   Scand J Prim Health Care 2022 (Oct 31); 1–9

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Lars Morsø, Jesper Lykkegaard, Merethe Kirstine Andersen, Anders Hansen, Mette Jensen Stochkendahl, Simon Dyrløv Madsen, Berit Schiøttz Christensen

Department of Clinical Research,
Research Unit OPEN,
University of Southern Denmark,
Odense, Denmark



Objective:   Clinical guidelines for managing low back pain (LBP) emphasise patient information, patient education and physical activity as key components. Little is known about who actually receives information. This study investigates to what extent information at the first consultation with general practitioner (GP), chiropractor (DC) and physiotherapist (PT) in Danish primary care is provided to

Design and setting:   This cross-sectorial study was conducted as a prospective survey registration of LBP consultations at the three primary health care professions in Denmark.

Intervention:   Clinicians ticked off a paper survey chart during or after consultations with patients who visited the clinic for LBP (Approval number: ID # 11.220).

Subjects:   33 GPs, 43 DCs and 61 PTs registered first-time consultations.

Main outcome measures:   The primary outcome was provision of information, overall and across care settings.

Results:   The overall proportion of patients provided with information was 72%, but this varied among professions (GP, 44%; DC, 76%; and PT, 74%). Provision of information increased to 78% if patients had increased emotional distress or back-related leg pain below the knee. The strongest association with provision of information was having two or three signs of elevated distress (OR 2.58 and 5.05, respectively, p= 0.00) or physical disability (OR 2.55, p= 0.00).

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LOW BACK PAIN Section

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The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

By |October 10, 2022|Chiropractic Management, Low Back Pain, Return To Work, Whiplash|

The Importance, Measurement and Practical Implications of Worker’s Expectations for Return to Work

The Chiro.Org Blog


SOURCE:   Disabil Rehabil 2015; 37 (20): 1808–1816

Amanda E Young, Elyssa Besen, YoonSun Choi

Liberty Mutual Research Institute for Safety,
Center for Disability Research,
Hopkinton, MA, USA.



Purpose: &nbsp Workers’ own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

Method: &nbsp A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

Results: &nbsp A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

Conclusions: &nbsp Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker’s movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker’s expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker’s concerns. Once underling issues are identified, work can be put into resolving these so that the worker’s return to the workplace is not impeded.

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LOW BACK PAIN Section

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One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

By |October 6, 2022|Chiropractic Management, Whiplash|

One- and Two-year Follow-up of a Randomized Trial of Neck-specific Exercise with or without a Behavioural Approach Compared with Prescription of Physical Activity in Chronic Whiplash Disorder

The Chiro.Org Blog


SOURCE:   J Rehabil Med 2016 (Jan); 48 (1): 56–64

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Maria Landén Ludvigsson, MSc, Gunnel Peterson MSc, Åsa Dedering, PhD and Anneli Peolsson, PhD

Department of Medical and Health Sciences,
Division of Physiotherapy,
Linköping University,
SE-581 83 Linköping, Sweden.



Objective:   To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash.

Patients   A total of 216 volunteers with chronic whiplash-associated disorders, grades 2 or 3.

Methods:   Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years.

Results:   Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p ≤ 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant.

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EXERCISE AND CHIROPRACTIC Section

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Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

By |October 3, 2022|Bell's Palsy, Chiropractic Management|

Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review

The Chiro.Org Blog


SOURCE:   Am J Case Rep 2022 (Sep 19); 23: e937511

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Eric Chun-Pu Chu, Robert J Trager, Alan Te-Chang Chen

New Chiropractic and Physiotherapy Centre,
EC Healthcare,
Kowloon, Hong Kong.



BACKGROUND   Bell’s palsy, also called facial nerve palsy, occasionally   co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation.

CASE REPORT   A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck.

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CONDITIONS Section

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Return to Work a Bumpy Road: A Qualitative Study on Experiences of Work Ability and Work Situation in Individuals with Chronic Whiplash-associated Disorders

By |September 29, 2022|Rehabilitation, Whiplash|

Return to Work a Bumpy Road: A Qualitative Study on Experiences of Work Ability and Work Situation in Individuals with Chronic Whiplash-associated Disorders

The Chiro.Org Blog


SOURCE:   BMC Public Health 2021 (Apr 23); 21 (1): 785

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A Peolsson, A Hermansen, G Peterson, E Nilsing Strid

Department of Health, Medicine and Caring Sciences,
Unit of Physiotherapy,
Linköping University,
Linköping, Sweden.



Background:   Work resumption is a big challenge in the rehabilitation process for individuals with whiplash-associated disorders (WAD). To better meet the needs of individuals with WAD in their return to work process, more knowledge on their experiences and perspectives is needed. The aim of this study was to explore the experiences of work ability and the work situation of individuals who participated in a neck-specific exercise programme for chronic WAD.

Methods:   This qualitative study has an exploratory and descriptive design based on data collected through open-ended interviews with 17 individuals with chronic WAD. Data were analysed inductively using conventional content analysis.

Results:   Analysis of the data yielded the following five categories related to the participants’ narratives on their experiences of work ability and their work situation: Return to work – a process of setbacks and bureaucracy; The need to be understood by health care professionals, and to receive a treatment plan; Individual resources are important for work ability; The consequences of reduced work ability; and Working conditions are important for work ability.

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WHIPLASH Section

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What Does Best Practice Care for Musculoskeletal Pain Look Like? Eleven Consistent Recommendations From High-quality Clinical Practice Guidelines: Systematic Review

By |September 21, 2022|Best Practice Care|

What Does Best Practice Care for Musculoskeletal Pain Look Like? Eleven Consistent Recommendations From High-quality Clinical Practice Guidelines: Systematic Review

The Chiro.Org Blog


SOURCE:   British J Sports Medicine 2020 (Jan); 54 (2): 79–86
Ivan Lin, Louise Wiles, Rob Waller, Roger Goucke, Yusuf Nagree, Michael Gibberd, Leon Straker, et. al.

WA Centre for Rural Health,
University of Western Australia,
Geraldton, Western Australia, Australia.


    FROM:  Lancet Digit Health 2022


Objectives:   To identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).

Design:   Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.

Eligibility criteria:   Included MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.

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BEST PRACTICES Section

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