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Evidence-based Practice, Research Utilization, and Knowledge Translation in Chiropractic

By |August 2, 2016|Evidence-based Practice|

Evidence-based Practice, Research Utilization, and Knowledge Translation in Chiropractic:
A Scoping Review

The Chiro.Org Blog

SOURCE:   BMC Complement Altern Med. 2016 (Jul 13); 16 (1): 216

André E. Bussières, Fadi Al Zoubi, Kent Stuber,
Simon D. French, Jill Boruff, John Corrigan,
and Aliki Thomas

School of Physical and Occupational Therapy,
Faculty of Medicine,
McGill University,
Montréal, Canada.

BACKGROUND:   Evidence-based practice (EBP) gaps are widespread across health disciplines. Understanding factors supporting the uptake of evidence can inform the design of strategies to narrow these EBP gaps. Although research utilization (RU) and the factors associated with EBP have been reported in several health disciplines, to date this area has not been reviewed comprehensively in the chiropractic profession. The purpose of this review was to report on the current state of knowledge on EBP, RU, and knowledge translation (KT) in chiropractic.

METHODS:   A scoping review using the Arksey and O’Malley framework was used to systematically select and summarize existing literature. Searches were conducted using a combination of keywords and MeSH terms from the earliest date available in each database to May 2015. Quantitative and thematic analyses of the selected literature were conducted.

RESULTS:   Nearly 85% (56/67) of the included studies were conducted in Canada, USA, UK or Australia. Thematic analysis for the three categories (EBP, RU, KT) revealed two themes related to EBP (attitudes and beliefs of chiropractors; implementation of EBP), three related to RU (guideline adherence; frequency and sources of information accessed; and perceived value of websites and search engines), and three related to KT (knowledge practice gaps; barriers and facilitators to knowledge use; and selection, tailoring, and implementation of interventions). EBP gaps were noted in the areas of assessment of activity limitation, determination of psychosocial factors influencing pain, general health indicators, establishing a prognosis, and exercise prescription. While most practitioners believed EBP and research to be important and a few studies suggested that traditional and online educational strategies could improve patient care, use of EBP and guideline adherence varied widely.

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Chiropractic Identity: A Neurological, Professional, and Political Assessment

By |July 31, 2016|Chiropractic Education|

Chiropractic Identity: A Neurological, Professional, and Political Assessment

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SOURCE:   J Chiropractic Humanities 2016 (Jul 20); 20: 1–11

Anthony L. Rosner, PhD, LLD (Hon)

Private Practice
Watertown, MA

Objective   The purpose of this article is to propose a focused assessment of the identity of chiropractic and its profession, triangulating multiple viewpoints converging upon various aspects and definitions of neurology, manual medicine, and alternative or mainstream medicine.

Discussion   Over 120 years since its inception, chiropractic has struggled to achieve an identity for which its foundations could provide optimal health care. Despite recognition of the benefits of spinal manipulation in various government guidelines, advances in US military and Veterans Administration, and persistently high levels of patient satisfaction, the chiropractic profession remains underrepresented in most discussions of health care delivery. Distinguishing characteristics of doctors of chiropractic include the following:

(1)   they embrace a model of holistic, preventive medicine (wellness);

(2)   they embrace a concept of neurological imbalance in which form follows function, disease follows disturbed biochemistry, and phenomenology follows physiology;

(3)   they diagnose, and their institutions of training are accredited by a body recognized by the US Department of Education;

(4)   they manage patients on a first-contact basis, often as primary care providers in geographical areas that are underserved;

(5)   the spine is their primary — but not exclusive — area of interaction;

(6)   they deliver high-velocity, low-amplitude adjustments with a superior safety record compared with other professions; and

(7)   they use a network of institutions worldwide that have shown increasing commitments to research.

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Effect of Two Consecutive Spinal Manipulations in a Single Session on Myofascial Pain Pressure Sensitivity

By |July 26, 2016|Myofascial Trigger Points|

Effect of Two Consecutive Spinal Manipulations in a Single Session on Myofascial Pain Pressure Sensitivity: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   J Can Chiropr Assoc. 2016 (Jun); 60 (2): 137–145

Michelle A. Laframboise, BKin (Hons), DC, FRCCSS(C),
Howard Vernon, BA, DC, PhD, and
John Srbely, BSc, DC, PhD

Canadian Memorial Chiropractic College,
6100 Leslie Street,
Toronto, Canada;
Division of Graduate Studies,
Sports Sciences,
Canadian Memorial Chiropractic College.

OBJECTIVE:   To investigate the summative effect of two consecutive spinal manipulative therapy (SMT) interventions within the same session on the pain pressure sensitivity of neurosegmentally linked myofascial tissues.

METHODS:   26 participants were recruited and assessed for the presence of a clinically identifiable myofascial trigger point in the right infraspinatus muscle. Participants were randomly assigned to test or control group. Test group received two consecutive real cervical SMT interventions to C5-C6 segment while controls received one real SMT followed by one validated sham SMT intervention to C5-C6 segment. Participants received the two consecutive SMT interventions 30 minutes apart. Pain pressure threshold (PPT) readings were recorded at pre-SMT1 and 5, 10, 15, 20 and 25 minutes post-SMT1 and post-SMT2. PPT readings were normalized to pre-SMT1 values and averaged.

RESULTS:   Repeated measures ANOVA demonstrated a significant main effect of SMT intervention [F(1,24)=8.60, p<0.05] but not group [F(1.24)=0.01] (p=0.91). Post-hoc comparisons demonstrated a statistically significant (p<0.05) increase in SMT2 versus SMT1 (18%) in the test group but not in controls (4%) (p=0.82).

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A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder

By |July 21, 2016|Veterans|

A Cross-sectional Analysis of Clinical Outcomes Following Chiropractic Care in Veterans With and Without Post-traumatic Stress Disorder

The Chiro.Org Blog

SOURCE:   Military Medicine 2009 (Jun); 174 (6): 578–583

Andrew S. Dunn; Steven R. Passmore;
Jeanmarie Burke; David Chicoine

Chiropractic Service,
VA of Western New York Healthcare System,
3495 Bailey Avenue,
Buffalo, NY 14215, USA.

This study was a cross-sectional analysis of clinical outcomes for 130 veteran patients with neck or low back complaints completing a course of care within the chiropractic clinic at the VA of Western New York in 2006. Multivariate analysis of variance (MANOVA) was utilized, comparing baseline and discharge scores for both the neck and low back regions and for those patients with and without post-traumatic stress disorder (PTSD). Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability. These findings, coupled with the theorized relationships between PTSD and chronic pain, suggest that the success of conservative forms of management for veteran patients with musculoskeletal disorders may be limited by the presence of PTSD. Further research is warranted to examine the potential contributions of PTSD on chiropractic clinical outcomes with this unique patient population.

 

From the FULL TEXT Article:

INTRODUCTION

A diagnosis of post-traumatic stress disorder (PTSD) can be conveyed when a person has been exposed to a traumatic event that could be perceived as threatening or that actually threatened the physical integrity of the individual or others, and his or her response involved fear, helplessness, or horror. [1] The person must also persistently re-experience the perception of the trauma and avoid reminders of the event while displaying symptoms of increased arousal (sleeplessness, irritability, outbursts) for at least 1 month, which disrupts their social, occupational, or other levels of functioning. [1]

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Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel With Low Back Pain

By |July 20, 2016|Veterans|

Assessment of Chiropractic Treatment for Active Duty, U.S. Military Personnel With Low Back Pain: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   Trials. 2016 (Feb 9);   17:   70

Christine M. Goertz, Cynthia R. Long, Robert D. Vining, Katherine A. Pohlman, Bridget Kane, Lance Corber, Joan Walter and Ian Coulter

Palmer College of Chiropractic,
Palmer Center for Chiropractic Research,
741 Brady Street, Davenport, IA, 52803, USA.
christine.goertz@palmer.edu

BACKGROUND:   Low back pain is highly prevalent and one of the most common causes of disability in U.S. armed forces personnel. Currently, no single therapeutic method has been established as a gold standard treatment for this increasingly prevalent condition. One commonly used treatment, which has demonstrated consistent positive outcomes in terms of pain and function within a civilian population is spinal manipulative therapy provided by doctors of chiropractic. Chiropractic care, delivered within a multidisciplinary framework in military healthcare settings, has the potential to help improve clinical outcomes for military personnel with low back pain. However, its effectiveness in a military setting has not been well established. The primary objective of this study is to evaluate changes in pain and disability in active duty service members with low back pain who are allocated to receive usual medical care plus chiropractic care versus treatment with usual medical care alone.

METHODS/DESIGN:   This pragmatic comparative effectiveness trial will enroll 750 active duty service members with low back pain at three military treatment facilities within the United States (250 from each site) who will be allocated to receive usual medical care plus chiropractic care or usual medical care alone for 6 weeks. Primary outcomes will include the numerical rating scale for pain intensity and the Roland-Morris Disability Questionnaire at week 6. Patient reported outcomes of pain, disability, bothersomeness, and back pain function will be collected at 2, 4, 6, and 12 weeks from allocation.

DISCUSSION:   Because low back pain is one of the leading causes of disability among U.S. military personnel, it is important to find pragmatic and conservative treatments that will treat low back pain and preserve low back function so that military readiness is maintained. Thus, it is important to evaluate the effects of the addition of chiropractic care to usual medical care on low back pain and disability.

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Sophisticated Research Design in Chiropractic and Manipulative Therapy: Part 3

By |July 17, 2016|Chiropractic Research|

Sophisticated Research Design in Chiropractic and Manipulative Therapy;
“What You Learn Depends on How You Ask.”
Part C:  Mixed Methods:   “Why Can’t Science And Chiropractic Just Be Friends?”

The Chiro.Org Blog

SOURCE:   Chiropractic Journal of Australia 2016; 44 (2): 1–21

Lyndon G. Amorin-Woods, BAppSci(Chiropractic), MPH

Senior Clinical Supervisor;
Murdoch University Chiropractic Clinic
School of Health Professions,
Discipline of Chiropractic
Murdoch University South Street campus,
90 South Street, Murdoch,
Western Australia 6150

Enjoy Part 1:   Quantitative Research: Size Does Matter  Enjoy Part 2:   Qualitative Research: Quality vs. Quantity

Many commentators have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, observing the way Evidence-based Practice [EBP] is sometimes implemented is controversial, not only within the chiropractic profession, but in all other healthcare disciplines, including medicine itself.   A phased approach to the development and evaluation of complex interventions can help researchers define the research process and complex interventions may require use of both qualitative and quantitative methods.   The chiropractic profession has little to fear from evidence-based practice; in fact it should be used productively to improve patient care, clinical outcomes and the standing of the profession in the eyes of the public, other health professions and legislators.

Keywords Evidence-Based Practice; Mixed Methods; Research Design

INTRODUCTION

Many scientists have recognised the limitations and inapplicability of the traditional quantitative pyramid hierarchy especially with respect to complementary and alternative (CAM) health care, including chiropractic. Over the last decade some authors have suggested refinements of the model, for instance;   in the place of an evidence hierarchy, Jonas [1] suggested the construction of an “evidence house” with “rooms” for different types of information and purposes and later presented a refined circular model. [1]

Jonas [1] observed:

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