NEWS
The Chiropractic Australia Journal Club By: Andrew Shepherd BSC Chiro Sc, M Chiropractic In 2016 chiropractor and Chiropractic Australia
In addition to these classifications there are
The paper also found evidence of the risks
member, Dr Adrian Sheridan conceived the
specifiers that can be applied for pain severity,
of overdiagnosis, consequential low-value
idea of a free and open source database of
temporal course, and psychosocial factors all
investigation and treatment procedures, and
research articles relevant to the evidence-based
of which can be measured. This system can be
increased unneeded costs. This has been seen
chiropractor. This became known as the
valuable to chiropractors as it allows us to, in a
as controversial within certain elements of the
Chiropractic Australia Journal Club.
more timely fashion, quantify and qualify pain
profession, who often rely on supposed X-ray
Over the last three years, Adrian has worked
symptoms in our patients to determine whether
findings that dictate the type and course of
tirelessly every month to find the best and most
their pain is actually their main problem and
treatment in their patients.
pertinent articles for the continuation of our
manage it either differently or collaboratively to
The problem of over-imaging is not only limited
ongoing professional education. The club has
pre-empt chronicity.
to the chiropractic profession but to other
been set up through a publically available FREE
Compare this study to:
medical and allied health professions that use
dropbox, where any practitioner can simply
“The Global Spine Care Initiative: classification
diagnostic imaging as well. The following paper:
sync the files from the club to their own Dropbox
system for spine-related concerns” (Haldeman
“How common is imaging for low back pain in
account, giving them instant access to hundreds
et al, 2018) which is another system to classify
primary and emergency care? Systematic review
of articles on anything from Acceptance
spine related disorders and grouped from class
and meta-analysis of over 4 million imaging
Commitment Therapy to X-rays and everything
0 to class V each of which have their own sub-
requests across 21 years” (Downie et al, 2019)
in between.
classes.
is a review of the proportion of LBP patients who
This has been a champion effort from
Class 0 is for no or minimal spine symptoms
Dr Sheridan.
with no interference in daily activities and
One of the highlights of the club is the selection
function; Class I is related to minimal symptoms
of a “paper of the month” which is the paper
but no or minimal interference in function; Class
most clinically relevant to everyday chiropractic
II for spine symptoms with some interference
practice. Chiropractors are busy people. For
in function but no pathology or neurological
those of us who like to keep up with the research,
deficits, Class III for spine symptoms with
it can be difficult to put aside the time so the
interference in function along with neurological
paper of the month helps to keep us informed
deficits related to focal neuropathology; Class IV
We should read research papers to stay up to
with a simple tap on the paper of the month folder
spine symptoms with stable, severe deformity
date with the facts, not just to find validation for
in Dropbox.
with or without functional and neurological
our own version of the truth. We should also try
To make this process even easier, Chiropractic
deficits and Class V for spinal symptoms with
to read a variety of research papers as we will
Australia newsletter will be publishing a
severe or systemic pathology, interference with
often start to see correlations between different
summary of the previous three papers of the
function with or without neurological deficits.
research papers as well as with our own clinical
month in each edition along with a discussion
Although not validated via field testing, this
on how each paper relates to everyday clinical
classification system can currently inform
practice. For this edition we will be looking at
clinicians of clearer pathways of care and could
some of the most interesting papers from the
potentially be used in conjunction with the
past several months.
chronic pain classification system described
Chronic pain as a symptom or a disease: the
by Treede et al (2019).
IASP Classification of Chronic Pain for the
Another important topic that has arisen over
International Classification of Diseases (ICD-11)
the past several months is the global health
(Treede et al, 2019) discusses the creation of a
initiative “Choosing Wisely” regarding the
system to classify types of chronic pain that can
overuse of imaging in mainstream and allied
be applied in a variety of contexts. The two main
health. One such paper that reviews the use
groups described here are: 1) Chronic primary
of x-ray imaging by chiropractors is “Current
pain syndromes which apply to syndromes
evidence for spinal X-ray use in the chiropractic
that can be seen as conditions in their own
profession: a narrative review” (Jenkins et al,
right, including non-specific low back pain and
2018). This paper explores the routine use
2) Chronic secondary pain syndromes which
of spinal X-rays throughout the history of the
have subclasses including cancer-related pain,
chiropractic profession. As seen in the Choosing
postsurgical/posttraumatic pain, neuropathic
Wisely campaign, the paper found that the
pain, secondary headache and orofacial
risks of exposing patients regularly to ionizing
pain, secondary visceral pain, and chronic
radiation outweighed any benefit and should
musculoskeletal pain secondary to pathology.
only be reserved for suspected pathology.
are imaged and of the trends in the proportions of patients that received imaging over time. The findings were that one in four patients with LBP received diagnostic imaging and one in three for those who presented to emergency. This overall trend has increased by 50% over the 21-year timeframe, contrary to the more recent guidelines on reducing unnecessary imaging.
experience. We can use the information we glean from this reading, not just to keep our own practices evidence-informed and up to date, but also to educate our patients and keep them in the loop. As we know,evidence-based practice is not just about the facets of research that informs us and the experience that guides us but is also about the patient’s needs and feelings. Respecting this and educating them is part of this particular facet, and can only be done well by being well read on the best current research. There is no better or simpler place to do this than in the CA Journal Club. If you haven’t done so already please take a moment to set up a Dropbox account and hook up with the Journal Club.
W W W. C H I R O P R A C T I C A U S T R A L I A . O R G . A U
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