Chiropractic in 2017 and beyond Exploring prescription rights and solutions to the opioid crisis Improving Canadaâ€™s response to disability
A publication about chiropractic from the Canadian Memorial Chiropractic College
Functional Integrated Acupuncture Fall 2017 Mark Scappaticci BSC (HONS), DC, R.AC, FRCCSS(C) Course ID 63687 - Certificate Program
A biomedical approach to the management of sport injuries and acute and chronic pain. Improve patient outcomes with specialized needling techniques and soft tissue treatment of the head, neck, shoulder, back, upper and lower extremities. Module 1 Online self-study: Traditional Chinese Medicine
Module 2 October 20-22 Acute and Chronic Pain Management (Practical 3 day lab of instruction and assessment)
Module 3 November 10-12 Sport Injury Management (Practical 3 day lab of instruction and assessment)
Chiropractors certified in acupuncture can register for module 2 or 3. Discounted rate available for CMCC Year IV students and the Class of â€™17. Open to chiropractors, physiotherapists and RMTs.
Dr. Scappaticci (Class of â€™92) is a Fellow of the Royal College of Chiropractic Sports Sciences (Canada) and has played a role in 4 summer Olympic and 2 winter Olympic games. He is a consulting chiropractor with the Toronto Blue Jays and Toronto Maple Leafs as well as teams and athletes within the NHL, NFL, NBA, and MLB.
Visit our catalogue for more information at https://cmcc.ca/ce Continuing Education 416 482 2340 ext. 191 email@example.com
From the Chair This issue of Primary Contact is packed with inspiring stories and developments at CMCC and I hope that you will dive right in and share the justified optimism we are feeling about the defining contributions of chiropractic in health care. In these pages you’ll read about a recent student and faculty opportunity to share some of their defining moments in the first CMCCtalks: Turning Points forum, a “Ted-talk” style event, on a path to broadening learning and engagement and enhancing quality in practice. An update from the UOIT-CMCC Centre for the study of Disability Prevention and Rehabilitation at CMCC illustrates productivity in a variety of fields including research with the Canadian Military and the Traffic Injury Guidelines project. These and other impactful contributions of CMCC research are helping to improve the quality of life in Canada and abroad. Amidst the growing alarm over the opioid crisis in Canada, a chiropractic response to dealing with chronic pain is offered. Optimism grows. Additionally, I am pleased to report that the CMCC Board of Governors and Dr. David Wickes have agreed to a five year presidential contract extension.
Volume 55 / Issue 2 02 From the President 04 CMCC News 05 In the Community 06 Dr. Brian Budgell’s book translated for Chinese universities
07 Subluxation and Semantics 08 CMCC Sim Lab credited for life saving training
09 CMCCtalks: Turning Points inspires and connects
10 Chiropractic in 2017 – prescription rights and solutions to the opioid crisis
13 Backs in Motion
As you know, CMCC operates without government funding and many groundbreaking innovations are made possible by the generous support of members and donors. Thank you for supporting Backs in Motion, our premiere fundraising run for chiropractic education, research and patient care, and please watch for new opportunities to get involved with what’s coming next at CMCC.
14 Improving Canada’s response
I invite you to read on and share our optimism.
18 Outreach Abroad
23 In Memoriam
David Gryfe, DC, FRCCSS(C)
To contact any member of the Board, please email firstname.lastname@example.org.
From the President "I think the extreme complexity of medicine has become more than an individual clinician can handle. But not more than teams of clinicians can handle." Atul Gawande
David Wickes, DC, MA
I recently returned from a major conference (DC2017) in Washington, DC, that combined the 14th Biennial WFC Congress, the 24th Annual ACC Research Agenda Conference and the American Chiropractic Associationâ€™s National Chiropractic Leadership Conference. Over 1,200 persons attended this conference, so CMCC got plenty of attention while our faculty and researchers provided 20 platform presentations, 15 poster presentations, and five workshops. I also was able to attend the Manitoba Chiropractic Associationâ€™s annual general meeting in March and host a luncheon there for alumni and friends. I also made a quick trip to Madrid to work with several chiropractic institutions on the development of a means for student
exchanges to enhance their clinical experiences. At their semi-annual meeting, our Board of Governors approved the 2017-2021 CMCC Strategic Plan, so we are hitting the ground running as we implement strategies to help us achieve excellence in our six themes of excellence: teaching and learning, support and service, clinical care, collaboration and communication, institutional leadership and management, and research, scholarship and innovation. Youâ€™ll soon start hearing about the changes planned in all aspects of CMCC, including advances in technology-enhanced learning. For the first time, our new students will be using iPad tablets for learning and testing, and our faculty will be
Go green You can reduce your carbon footprint and read Primary Contact in a digital format (PDF) instead of receiving a paper copy. Email us at email@example.com and we’ll make the switch for you.
"The trouble is the field of science, medicine, universities, biotech companies - you name it - have been so splintered, layers, subdivided, hacked that people can spend their entire career studying one tiny little cog of life." Craig Venter
receiving iPads to help them with teaching and assessment. In the next edition of Primary Contact you’ll see how our anatomists are using a new virtual dissection table to enhance the gross anatomy experience, and how our clinicians are using new state-ofthe-art technologies to assess human performance and guide rehabilitation. This year’s CMCC Backs in Motion 5km/10km walk/run event was a spectacular success. Hundreds of volunteers from our students, employees, Board and alumni were joined by almost 400 runners and walkers, raising tens of thousands of dollars and getting lots of exposure for our campus and clinic. Many of our Board members stayed after the Board meeting and participated in the 5km and 10km events. We thank all
of you for supporting us and hope you will help us make next year’s event even better. Life would be boring without some occasional challenges. Following an investigative report in Manitoba that exposed some bad practices by a few chiropractors, I was interviewed on national television and although it was unfortunate that we had to be reactive to the situation, CMCC received accolades from the CCA for the way we handled the interview and for “providing a steady, believable presence and clarity about our profession and our expertise.” All of us need to work together to deliver a message about our profession and its evidence based approach to patient care. In this edition of Primary Contact you will find an article about
another controversy in chiropractic – the possible inclusion of prescription drugs or of advanced imaging methods in our scopes of practice across the provinces. We’ve tried to look at both sides and hope you find the article not only thought provoking but also timely in light of the national opioid crisis. I hope you are able to get some quality time to spend with family and friends over the summer. I’m looking forward to seeing many of you at Homecoming on June 2-3. Please remember that although we celebrate the 5-year anniversary classes each Homecoming, everyone is invited to attend the great education programs on extremity adjusting and flexion-distraction spine care. See you soon!
CMCC News Caring for the older patient Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update, written by Dr. Cheryl Hawk and team, including Drs. Paul Dougherty and Brian Gleberzon, was published this March in the Journal of Manipulative and Physiological Therapeutics (JMPT). Editor Dr. Claire Johnson praised the team for bringing together all relevant information into one concise document for ease of use. To access the document, visit: http://www. jmptonline.org/article/S01614754(16)30227-5/fulltext Practice OpportUnity 2017 On Wednesday, February 15, students and chiropractors came together for Practice OpportUnity ’17. A discussion panel, keynote speaker and trade show provided examples of life and work as a chiropractor. Students heard from keynote speaker Dr. Andrew Robb (Class
of ’07) who shared his formula for success, outlining the attributes that he has used to thrive in practice. OCA Practice Realities Panel members Drs. Theresa Lisk, Shima Shahidy, Raquel Marques and moderator Dr. Shawn Thistle discussed their first years in practice and shared tips for new graduates. The tradeshow brought together 28 vendors and 30 chiropractic exhibitors, demonstrating business products and showcasing practice opportunities for new graduates. A special thank you to the sponsors of Practice OpportUnity ‘17:
Gold: Ontario Chiropractic Association Silver: Canadian Chiropractic Association, CIBC Commercial Banking, The Co-operators Group Insurance Bronze: Footmaxx, The Orthotic Group, Ultimate Glucosamine, Council of the Nova Scotia College of Chiropractors, Lifemark
Media sponsor: Canadian Chiropractor Thanks to all those who helped to make this annual event a success. CMCC at ACC RAC The Association of Chiropractic Colleges (ACC) Research Agenda Conference (RAC) was held March 15 through 18 in Washington, coinciding with the World Federation of Chiropractic Congress. The joint theme this year was Impact Spinal Health. CMCC faculty and students contributed significantly to the content and success of the conference, submitting 20 platform presentations, giving 15 presentations and hosting five workshops. Work by Dr. Mohsen Kazemi with Year III students Khushboo Vora and Mary Bogumil, entitled Concussion Knowledge Among Sport Chiropractors, won second place among papers at the FICS
(International Federation of Sports Chiropractic) conference that preceded the WFC meeting.
The Effect of a Training Program on Speed Development for Students Delivering Prone Thoracic Manipulations, by Drs. Steven Lester, David Starmer and Year IV students Leah Barbaro, Brittany Fraser, Justine Landry and Kailee Stock were singled out for an ACC RAC education award. Dr. Carol Ann Weiss hosted a well-received workshop on best chiropractic practices for pregnancy and post-partum populations. Congratulations to everyone who attended the event and shared their work. Danish chiropractors visit On Tuesday, March 14, CMCC hosted Dr. Michael Christensen, Vice President of the Danish Chiropractic Association (Dansk Kiropractor Forening (DFK), and Mr. Christian Ankerstjerne, Head of Communications for the association. The two were in North
Dr. Michael Christensen tries CMCC’s Force Sensing Table Technology ™
America for ACC RAC and WFC and took time out to visit Palmer, NYCC and CMCC before heading to Washington.
with medical doctors which later splits into chiropractic and medical streams. The country graduates about 40 chiropractors per year.
They were particularly interested in CMCC’s research program, how we integrate research into the curriculum, our clinical internship program and the broader challenges chiropractic faces in Canada. In Denmark, chiropractors share a common educational foundation
In touring CMCC, Christensen remarked that the research facilities mirrored those of SDU, the University of Southern Denmark, with which CMCC has a Memorandum of Understanding to explore collaboration in education and research.
In the Community Catching our hearts Malpass Family Chiropractic held their second annual fundraiser for Sanfilippo Children’s Research Foundation in their clinic in Ancaster, Ontario this past February.
buildup that affects all the organs and bones and eventually leads to premature death. Clinic owner Dr. Sandra Malpass (Class of ’86) was inspired by two of her young patients with Sanfilippo, one of whom passed away last year.
donated by the Ancaster Business Improvement Association. Prizes ranged from Toronto Maple Leaf Tickets to an overnight hotel stay to clothing and gift certificates. Last year’s fundraiser, “Show your love,” also raised over $5,000.
The February fundraiser raised over $5,000 for the foundation to find a treatment or cure for Sanfilippo syndrome, a devastating genetic disorder that leaves those affected without the enzyme to break down sugar, resulting in a
The fundraiser, entitled: “Anyone can catch your eye, but it takes someone special to catch your heart,” allowed patients and friends to purchase paper hearts and their names were entered in a draw to win a prize of the many generously
For more information on the foundation or how to donate, please visit www.alifeforelisa.org or www.canadahelps.org/en/charities/ the-sanfilippo-childrens-researchfoundation/
Dr. Brian Budgell’s book translated for Chinese universities
Writing a biomedical research paper – a guide to structure and style, a book by Dr. Brian Budgell, Director of CMCC Life Sciences Laboratories has now been translated into Chinese for use in a growing number of universities. First published in 2008 by medical publishing giant Springer-Verlag, it has been used at several universities in Japan. Budgell says the book arose from a series of workshops he developed for the post-graduate medical research program at the Kyoto University School of Medicine where he presented researchers with techniques to improve clarity and publication success rate. Springer translated the text for publication in Chinese and it has an initial printing of 4,000 copies.
"If we want to enhance the cultural authority of chiropractic, then we must take writing more seriously" To date, Budgell has eight peerreviewed publications in linguistics, three books, one invited entry in the Encyclopedia of Applied Linguistics, numerous conference presentations and has lectured on biomedical writing on four continents. This year, some of his work will be presented at the Ninth Annual Conference of the Canadian Association for the Study of Discourse and Writing, at Ryerson University in Toronto, and at Corpus Linguistics Conference 2017, at the University of Birmingham in England. Budgell feels that the quality of modern chiropractic research may
be underestimated, in part because the writing is not sufficiently convincing. In an environment where chiropractic researchers compete for publication in impactful journals, he advises that every word counts. He therefore feels that at both the undergraduate and post-graduate level, more emphasis needs to be placed on communication skills. “Better papers are accepted by better journals and so are seen by a larger number of more influential readers. If we want to enhance the cultural authority of chiropractic, then we must take writing more seriously.”
Subluxation and Semantics
In terms of linguistics within chiropractic, Dr. Brian Budgell believes the profession stands out among health professions for its introspection and concern about the terms used to describe the essence of chiropractic. “Is it spinal manipulation or adjustment? Should we be saying subluxation, restriction, fixation or one of the many other terms used to describe the hallmark chiropractic lesion. “As chiropractors, we may have something invested in one term versus another, however,” he says, “a professional linguist would likely tell us there is no right answer. Shared understanding is what we should strive for.” What he often sees instead, “is an effort to dominate the conversation in terms of words per minute.” “This last observation is, I think, very much a cultural thing, and I can
draw on two distinct examples to illustrate this,” says Budgell. “One was my experience, as a young man, working with Canadian aboriginal youths. In conversation, I was struck by the time delay between my sentences and theirs. Instead of interrupting or jumping in with a quick and thoughtless response, they seemed to take a second or two to think and construct their responses. The second example was my daily experience in Japan, where I lived for about 17 years in total. In part, the difference in conversational patterns may be imposed by the structural differences between Japanese and English. In English, we have some examples of words which are spelled differently but pronounced the same way – to, too, two. This sort of thing is not uncommon, but happily context usually allows us to resolve meanings without any explicit definition. In Japanese, however,
there are fewer sounds to work with, and so there are many more words which sound exactly the same. For example the Japanese word ‘ko’ has more than 100 completely different meanings. As a consequence, when Japanese people converse, they are often compelled to stop and explain – by ‘ko,’ what I really mean is … This can certainly make conversations drag on, but at the end of the day there is better shared understanding and, by all accounts, much less overt discord in Japanese society.” “There may be a lesson here for the angst which chiropractors sometimes experience,” he says. “Instead of worrying about which word to choose, we might want to pause and spend more time thinking about and clarifying what we have to say. It is the underlying concepts which are important; not our choice of synonyms.”
CMCC Sim Lab credited for life saving training is that when confronted with a sudden emergency, the skills developed during simulation are available. “Students rarely get a life-like experience through emergency care courses,” says Dr. David Starmer, Sim Lab Coordinator. “We offer what is called high fidelity simulation, meaning a very realistic experience, using technology that includes programmable responsive manikins.”
“Hey Doc! Just want to send you a huge THUMBS UP! for the Sim Lab training you took us through. Today I had a patient in full syncope during the physical exam portion of an intake (of an elbow complaint). Full loss of heart beat and breathing, and gray pallor. (The Sim Lab) training kicked in – we called 911, I gave CPR and the patient “came to” before the EMS arrived and took over…. I wish I never needed to use it, but now that I did I am utterly thankful for having been trained by you and given the skills to stay calm and focussed and feel the shock later, when it was all over.” Dr. Kenneth Stelsoe, Class of ’14, was among the first cohort of students to use the Sim Lab, introduced in 2010. The Lab, used for both research and teaching, is composed of the Treatment Skills Development Lab, through which students can hone their technique skills on Force Sensing Tables, and the Clinical Skills Diagnostic Lab, through which students learn emergency preparedness skills.
According to Stelsoe, when he went through the training, though he found it engaging, he didn’t expect to ever use it. It may have been even more surprising when his patient, an active man who regularly cycled 20 km to work every day, just dropped to the floor while Stelsoe was writing his notes. “He was the last presentation I would ever imagine this happening to. After motion palpation of his elbow, he just dropped to the floor. No warnings, no indicators. You simply could not have predicted it.” Shocking as the experience was, Stelsoe came away feeling reassured and well-prepared; however, he added: “I do hope this was my only one!” Since the opening of the Sim Lab, there have been several reports of CMCC graduates putting these emergency skills to use. It’s happened on an airplane, on the street, at a neighbour’s, in the gym, and in chiropractic offices. The benefit of having been through intense, realistic simulation training
Within the lab, they go as far as creating a simulated clinic environment with a receptionist, associates, and multiple patients, and rollout a scenario that takes place in real time. “The manikins respond to treatment and similarly, can deteriorate,” says Starmer. “Once we’ve gone through a scenario, we provide feedback about the response time and quality of care. We can also record and play back the student’s performance and allow them to go through it again after time to reflect and debrief. In the cases where CMCC grads have used their training and saved lives, it is almost like their 3rd time with the emergency scenario. They have an easier time remaining calm and remembering their training, while dealing with complex situations.” The success of the simulated emergency training has allowed CMCC to make it available through its Continuing Education program. For information on future sessions, please visit www.ce.cmcc.ca and search for “medical emergencies.”
CMCCtalks: Turning Points inspires and connects
CMCCtalks: Turning Points shared little known, life changing events in the lives of CMCC faculty and students. Fashioned after Ted Talks, Turning Points presented sometimes moving, sometimes insightful stories with the added impact that they came from within CMCC. Presenting to a capacity crowd, eight speakers and three performers shared their stories January 26, in an event organized by the Student Canadian Chiropractic Association (SCCA). The stories centered around turning points in individuals’ lives; the different ways life changes for people, both personally and professionally. “We wanted people to know that while the path isn’t always smooth, it can still work out in the end,” says Year III student Nardine
Bekhit, a member of the SCCA Outreach Committee and coorganizer of the event, which she put together with Manuel Gil, also a Year III student.
seem a bit more human,” she says. “Some of that doesn’t come out when they are lecturing, so it was nice to foster that relationship between students and faculty.”
Dr. Scott Dunham, newly appointed Director, Curriculum and Faculty Development and a speaker at the event, also served as faculty supervisor, assisting the SCCA along the way. He was impressed with the work of Gil and Bekhit, shouldering the load of launching a large scale event.
While Bekhit will step aside to focus on her Year IV in clinic, she says she will be there to provide guidance for those running next year’s event. “You get to have an impact on the lives of students in the short and long-term. While it does keep you busy it definitely pays off in the end.”
Bekhit says those in attendance said that they enjoyed seeing a different style of event, and one so motivational in nature. She added that many students appreciated learning a bit more about their teachers, and felt more connected to them afterwards.
CMCCtalks featured Ravi Samlal, Drs. Pierre Côté, Scott Dunham, Pat Tavares, Simon Wang, David Wickes and Andrew Wilson and Year IV student Julie Yaworski as well as musical performances by Year III students Lydia English and Rebecca Rizk and a spoken word performance by another Year III student, Bijaan Lalani.
“Hearing their stories makes them
The role of chiropractic in 2017 – considering prescription rights and solutions to the opioid crisis
Chiropractic is guided by diverse philosophies and models of care. As we enter 2017, the profession is considering its identity as one that could help bring a solution to the opioid crisis and as one which could reduce health care costs through the rights to prescribe analgesics. What are the implications of medication prescription rights for chiropractors and the profession’s potential role in reducing Canada’s
struggle with opioid addiction? Should chiropractors prescribe? Drs. Mark Erwin (Class of ’84) and Stephen Burnie (Class of ’05) have co-authored a journal article with Dr. Peter Emary, et al., examining the implications of a potential change of scope within chiropractic to include limited medication prescription right, presently incorporated into chiropractic scope of practice in some jurisdictions
worldwide, such as USA, Denmark and Australia. In Burnie’s words, “This article speaks to an issue that is somewhat controversial in our profession but very topical, and an area where scope of practice changes may be coming. We feel it is imperative to start discussing the implications of prescribing rights so that our profession can work through the inherent issues it may come with.”
"Limited prescription rights would be of great convenience to a patient who would benefit from added relief between treatments or supplementary pain relief, particularly in the acute phase."
The paper, entitled “A commentary on the implications of medication prescription rights for the chiropractic profession,” was published in the Chiropractic and Manual Therapies journal and can be found online on its site at www.chiromt.biomedcentral.com/ articles/10.1186/s12998-016-0114-y. “Limited prescription rights would be of great convenience to a patient who would benefit from added relief between treatments or supplementary pain relief, particularly in the acute phase,” continues Dr. Burnie. “The practice would potentially save the patient time and reduce costs to the medical system by ensuring they don’t have to see a general practitioner for the same condition they are being treated for with chiropractic. Chiropractors are also in an ideal position to know when not to prescribe and to understand when manual treatment, exercise and other interventions would be more beneficial and less harmful. As MSK specialists, no one is better positioned to weigh the pros and cons of prescription for MSK issues.” Prescription rights and chiropractic in the 21st century Earlier in his career, CMCC President Dr. David Wickes held positions at National University of Health Sciences in Lombard, Illinois and University of Western States in Portland, Oregon, where chiropractic scope of practice included the ability to order tests
such as EKGs and advanced imaging, and where student education included a foundation in non-pharmaceutical natural medicine. Additionally, through his administrative career, he has studied a variety of models of care and studied the effects of differing scopes of practice. Drawing on this history, he weighs in on the present question of chiropractic scope of practice in Canada, and considers the question of prescription rights:
The debate At one side of the debate is the growing interest by many chiropractors in having access to at least a limited prescription drug armamentarium as part of the management of musculoskeletal disorders. Perhaps even a further outlier would be the push by some US-based DCs to have access to many prescription drugs used to treat those non-MSK disorders traditionally managed by medical primary care physicians. At the other end of the debate spectrum is the time-honoured philosophical stance that chiropractic was founded as a drugless profession and must remain so. However, it’s far more complicated that just these opposing views. Competition amongst various health care providers whose scopes of practice seem to be growing whilst chiropractic’s remains unchanged in many jurisdictions has led to economic concerns.
Patient need and practitioner philosophy The positioning of chiropractic as a valuable component of a national strategy to address the opioid addiction crisis is a balancing act between the argument that being a drugless practitioner reduces the likelihood that a patient will become hooked on analgesics, and the realization that some patients with acute and chronic pain syndromes cannot be adequately managed by traditional chiropractic methods alone. I spent decades in the US observing the debates and heated arguments about prescription drug rights for DCs and know that there are few issues more capable of enraging the traditional, vitalistic segment of our profession. Our profession struggles with its identity, leading to confusion of the general public as well as legislators and policy makers. An inconsistent approach Even in those parts of the world in which DCs have some prescription drug privileges, there is no consistent approach. In New Mexico, the permitted formulary includes administration of bioidentical hormones and injections of homeopathic agents, whereas in Switzerland the formulary is much more consistent with a MSKfocused practice. In Oklahoma and Idaho, DCs can administer vitamins, minerals or nutritional supplements via injection, including intravenous infusion.
Finding our footing I’ve been asked what CMCC would do if, for example, Alberta enacted legislation to permit limited prescription drug use by DCs in that province. My response is that CMCC strives to prepare its graduates for successful practice in all of the provinces, so our curriculum would evolve to include the necessary training in science-based practices allowed by the various provinces and the necessary elements to ensure patient safety. I encourage the thoughtful, deliberate debate of the prescription drug issue and of the expansion of access to advanced imaging procedures and laboratory diagnostic tests. A profession that refuses to consider change and that fails to acknowledge advancements made in the scientific understanding of the body is likely to become marginalized.
Conservative care options instead of opioids
While chiropractors and chiropractic educators consider the implications of prescription rights, the Canadian Chiropractic Association (CCA) has recently signed a joint statement of action with the federal and provincial governments to address the opioid crisis (in Canada) because of the recognition of back pain as a key driver for current opioid prescribing. Dr. Brian Budgell, Director of CMCC Life Sciences Labs agrees that “while many patients turn to analgesics as a first approach to pain, opioid use is likely to be a late response to severe recurrent or chronic spinal pain. Hence, treatment options like chiropractic, which prevent chronicity or mitigate pain and disability, may well reduce the number of patients who turn to opioids.” Currently, Canada is the second highest consumer of prescription
opioids in the world and clearly recognizes the problem. The joint statement referred to above, was signed by the federal government, seven provincial health ministries, four other health professional associations (medicine, nursing, pharmacy, and dentistry) and 30 other partner organizations that have a role in reducing the impact of opioids. How chiropractic can help The CCA has been advocating on behalf of Canadian chiropractors and their patients for greater access to conservative care options as first-line treatment of MSK conditions. “By providing prompt access to clinical alternatives, like chiropractic care, evidence suggests that we can reduce reliance on opioids to treat acute and chronic MSK-related pain,” says CCA Chair Dr. David Peeace. (Indeed, according to Budgell, a number of well-designed studies have shown that spinal manipulation is a competitive treatment option for chronic neck(1) and back pain(2), and can also be cost effective(3).) CCA Chief Executive Officer Alison Dantas adds that the organization is ”looking to build an understanding of how to better integrate care that is already available in communities across Canada,” and that “integrating chiropractors into interprofessional care teams has been shown to reduce the use of pharmacotherapies and improve overall health outcomes. This effort is even more important now because the new draft Canadian prescribing guidelines strongly discourage first use of opioids.” For more information on the joint statement of action, please visit:www.canada.ca/en/healthcanada/services/substance-abuse/ opioid-conference/joint-statementaction-address-opioid-crisis.html
Footnotes: (1) Saayman, Hays and Abrahamse J Manipulative Physiol Ther. 2011 Mar-Apr;34(3):153-163) Enix et al. op Integr Health Care. 2015; 6(1):Online access only 17 p; Giles and Muller. J Manipulative Physiol Ther. 2005 Jan;28(1):3-11)
Vavrek, Sharma and Hass. J Manipulative Physiol Ther. 2014 Jun;37(5):300-311)
In the joint statement, CCA commits to: Developing evidence based professional practice recommendations and guidelines to facilitate the appropriate triage and referral of Canadians suffering from chronic and acute musculoskeletal conditions and reduce reliance on opioids. The recommendations will aim to: • better understand the burden of pain related to musculoskeletal conditions; • develop key recommendations for the appropriate role of chiropractic care (in anticipation of similar efforts for other key alternatives to opioids); and • facilitate dissemination of key recommendations.
34th Annual Backs in Motion Celebrates with Canada 150 themed walk/run
Attendance was up this year as we welcomed over 400 runners and walkers on a beautiful day in the parkland and area surrounding CMCC. Canada 150 was the theme as we celebrated and came together in a sea of red and white. The fastest man in the 10 km race was Garrett de Jong (Class of ’16) with a time of 34:41 followed quickly by Stuart W. MacPherson (Year I, Class of ‘20) at 36:55 min and Peter Huang at 38:35 min. This is De Jong’s third first place win in the race. Congratulations! The top three fastest women were Emma Mangialardi (Year II, Class of ‘19) at 41:56, Carrie Snaychuk (Year
I, Class of ’20) at 42:05 and Eleanor Colledge at 44:42. In the 5 km race, the top three men were Wesley Rickman at 16:42 (Year IV, Class of ’17), Ryan Cassidy at 17:13 (Year I, Class of ‘20) and Aleksandr Kuternin at 17:19. The top 3 women were Joanna Chan at 20:20, with Dakota Poulter a very close second at 20:25 and Katie Wiebe at 21:15. We were happy to welcome the Sole Sisters back to the run this year, and to see some great school spirit in the form of Team “Running on Empty” with members made up of CMCC’s first year graduate students
Drs. Sarah Batley, Melissa Corso, Chris Grant, Christine Meckamalil, Mitch Savic and Justin Young, and many other CMCC groups. As always, walkers were welcome with their dogs and we counted 20 registered canine friends this year. Thank you to sponsors Silver: ObusForme Bronze: Deep Relief, Impact Cleaning Services, Metagenics, The Orthotic Group, Ultimate Glucosamine Student Challenge Sponsor: The Riddle Room Friends of CMCC: Aramark, Gatorade, Running Free, Saucony, Water Related Media Sponsor: Canadian Chiropractor
Improving Canada’s response to disability Research centre taking innovative approaches to preventing and addressing chronic musculoskeletal conditions By Sharon Aschaiek
Five years into its mission to study and address chronic musculoskeletal conditions, the UOIT-CMCC Centre for Disability Prevention and Rehabilitation (CDPR) has made many important discoveries regarding how to rehabilitate patients, promote integrated and evidence-based health care, and empower chiropractors and other health professionals to more effectively prevent and treat disability. Established in 2012 as a research partnership between Canadian Memorial Chiropractic College and the University of Ontario Institute of Technology, the CDPR focuses on solving a vexing problem: how
to address the significant negative impact of musculoskeletal (MSK) disorders, which account for almost half of disabilities experienced in Canada. For centre director Dr. Pierre Côté (Class of '89) and his team of researchers, the answer lies in collaborating with stakeholder partners in health care, education, industry and government to investigate the complex dynamics of this pervasive condition, and generate new datadriven approaches to treatment and prevention. “It’s important for us to understand the links between the physical and psychosocial determinants of chronic back and neck pain, and
to inform public health policy with epidemiological evidence,” says Côté, the Canada Research Chair in Disability Prevention and Rehabilitation. Common traffic injury guidelines One area where the CDPR has played a pivotal role in guiding the response to MSK disorders involves common injuries sustained during automobile accidents. In 2014, approximately 40,000 people were injured in car crashes in Ontario, and about 17,000 suffered what the province terms “minor injuries” – sprains, strains, whiplash, subluxation, cuts, scrapes and bruises. For those affected, these injuries cause many different
"...[vehicle] injuries cause many different problems, including sudden onset intense pain, occupational and domestic disability, sleep disruption, day time exhaustion, family stress, and psychological and emotional distress."
problems, including sudden onset intense pain, occupational and domestic disability, sleep disruption, daytime exhaustion, family stress, and psychological and emotional distress. In 2011, Côté and his colleagues at the UOIT were awarded a grant by the Ministry of Finance and the Financial Services Commission of Ontario (FSCO) to develop the first-ever evidence-based clinical practice guidelines for managing traffic injuries in Ontario. The objective was twofold: create a new protocol for insurers and healthcare providers to use when treating common traffic injuries arising from automobile collisions; and develop a clinical prediction rule to screen for patients who may be at a higher risk for developing chronic pain and disability. Over a two-year period, Côté and his team of experts conducted a comprehensive review of the scientific literature, and interviewed patients receiving health care for auto collision-related injuries. They also gathered input from experts such as clinicians, academics, scientists and auto industry executives and a retired judge. Their effort resulted in an almost 300page report detailing 22 different care pathways designed to improve the recovery of individuals with auto collision-related injuries and
facilitate their return to healthy, productive lives. Their report, which is currently under review by the FSCO, also proposed a new approach to classifying car crash injuries that better reflects the degree of disability patients experience. “We identified the best research and most relevant insights on this subject so that clinicians who treat people injured in traffic accidents can be most effective,” Côté says. The International Classification of Functioning, Disability and Health a collaboration between SDU, UOIT and CMCC What will also enable chiropractors and other healthcare professionals providing manual therapy to be more effective is a CDPR research initiative focusing on more holistically addressing disability and promoting functioning in individuals with back pain. Post-doctoral fellow Ellen Aartun is investigating how these practitioners can follow the International Classification of Functioning, Disability and Health (ICF), a functioning classification system developed by the World Health Organization that takes a bio-psycho-social approach to measuring health and disability. “In manual medicine, the focus tends to be on assessing pain, and there is less emphasis on
factors such as the patient’s social activities, family support and work environment. The ICF takes these factors into account, so it is a useful tool to manual medicine clinicians,” says Aartun, who completed her PhD at the University of Southern Denmark (SDU), with which CMCC has a memorandum of understanding to explore collaboration in education and research. Introduced in 2001, the ICF offers thousands of options for classifying every conceivable aspect of physical, mental and emotional functioning. Yet, its vastness and complexity can make it daunting for healthcare providers to use, Aartun says. To figure out how to make it more accessible to manual medicine practitioners worldwide, she is collaborating with international researchers to create a new functioning assessment schedule for musculoskeletal disorders. The first research stage, which is still under way, involves reviewing existing scientific literature to identify the clinical tests and instruments health professionals use to assess functioning in patients with MSK conditions. Next is conducting a qualitative study of chiropractic patients in Canada, Norway – Aartun’s native country, where she worked as a chiropractor in private practice for nine years –
and Botswana, which is home to a renowned centre for treating spinal conditions. Finally, next year, Aartun will convene a multidisciplinary panel of manual medicine experts to review the research data and provide input on creating a more effective functioning assessment schedule for patients with back pain. “We hope this new tool will help clinicians consider the broader factors that affect their patients’ functioning,” Aartun says. Creating guidelines for international use - neck pain assessment recommendations for France Another CDPR team member helping to advance the chiropractic profession is epidemiologist Nadège Lemeunier, who is working to develop practice guidelines for chiropractors in her home country of France. While the profession was legalized in France in 2002
and became regulated in 2011, no formal guidelines exist to direct the profession, requiring practitioners to follow guidelines from other countries. To address this gap, the Franco-European Institute of Chiropractic – where Lemeunier works as head of undergraduate research – the French Chiropractic Association and the Foundation of Donation in Chiropractic Research funded her to complete a postdoctoral fellowship at the CDPR to develop recommendations for French chiropractors to diagnose and treat neck pain. Lemeunier’s process involved updating the Assessment of Neck Pain and its Associated Disorders, a 2008 critical review of published research on the subject from 1980 to 2006. Over the course of a year, she and her team of eight CMCC graduate students browsed multiple medical research databases and
screened 27,000 relevant articles that were published between 2005 and 2016. By the end, they had identified 73 studies that met high standards for reliability and validity. In April of last year, a panel of 18 multidisciplinary and multiprofessional experts reviewed the research literature and gave feedback to help Lemeunier develop a set of voluntary neck pain assessment recommendations for chiropractors in France. Lemeunier translated these recommendations from English to French, and in April, they were posted on the website of the French National Authority for Health, an independent organization working to improve the quality and efficiency of France’s healthcare system. “These recommendations not only guide chiropractors in France, they also show how chiropractors fit
into the healthcare picture in France, and allow them to become more integrated into the health system,” Lemeunier says. Investigating chiropractic care for the Canadian Armed Forces The CDPR is also poised to make a positive impact on health care in the Canadian Armed Forces (CAF). Currently, it is collaborating with the CAF to explore how to integrate chiropractic care into the treatment of its members with MSK conditions. Funded by the Canadian Chiropractic Association and the Ontario Chiropractic Association, the project involves developing and implementing a model of collaborative chiropractic care within an interdisciplinary Canadian Forces Health Services setting at a specific CAF base. Over a two-year period, data will be collected on the clinical and administrative outcomes to determine the feasibility for incorporating chiropractic care across all CAF bases. Also under way at the centre is a UOIT-CMCC Mental Health and Wellness Study, a research initiative aimed at investigating the causes of
and solutions for mental health issues among postsecondary students. Data shows back pain is the most common physical health issue among university and college students, while a fifth report they are depressed, anxious or dealing with other mental health issues. The premise of the Mental Health and Wellness Study is that understanding the risk factors affecting students’ wellbeing is key to optimizing their performance, resilience and persistence, and more broadly, to increasing student retention rates at postsecondary schools.
Faculty of Health Sciences at UOIT will learn about identifying and addressing mental health issues. The overall objective is to develop evidence-based policies and programs to improve students’ mental and physical health, so they feel sufficiently supported to excel at school.
Preventing and managing chronic health conditions in students The CDPR will collaborate with health research organizations, universities and colleges, healthcare providers, industry organizations and government agencies to examine how to prevent and manage chronic health conditions in students. Among these partnerships is one with Canadian Mental Health Association Durham, with funding from the Ontario Trillium Foundation, the centre is conducting a one-year pilot project in which
Work Disability Prevention at UOIT The CDPR’s diverse research agenda reflects the value it places on knowledge creation and exchange as a way to advance the chiropractic profession and the healthcare field as a whole. For that reason, the centre is now aiming to instil the priority of conducting relevant, impactful research among up-and-coming manual medicine practitioners. This fall, it will roll out its new Graduate Diploma in Work Disability Prevention at the Faculty of Health Sciences at UOIT, developed in collaboration with CMCC. The first of its kind in Canada, this part-time online program is geared to chiropractors, occupational therapists, physiotherapists, kinesiologists and social workers wanting to better understand, prevent and address workplace injuries.
“These students are at the gate of entering the workforce, so we want to help them deal with and avoid physical or psychological diagnoses or complaints so they can be productive in their careers,” Côté says.
Says Côté: “We need to equip the next generation of chiropractors to excel both as clinicians and researchers who can make a difference in helping patients safely return to work, and in guiding workplaces to figure out how to prevent injuries from happening in the first place.” On April 7, Pierre Côté was named the first Chair of the WFC Disability and Rehabilitation Committee.
CMCC interns are welcomed back following Outreach Abroad 2017
Back row (Left to right ) Ryan Albert, Nader Abdelkader, Adrian Chow Middle row: Tomasz Kowal, Cristina Leonardelli, Gloria Cheung, Brandon Jileson, Dr. Les Wiltshire Front row: Dr. Pat Tavares, Lauren Quattrocchi, Julie Yaworski, Carly Mattson, Daphne To, Amanda Huang
CMCC welcomed back its 2017 Outreach Abroad team on April 13. The 12 interns, supervised again this year by clinicians Drs. Pat Tavares and Les Wiltshire treated over 1,100 patients during a 14 day outreach in the Dominican Republic, honing diagnostic and treatment skills, while serving communities in the rural Dominican, many of whom have had little access to healthcare. Nader Abdelkader, Ryan Albert, Gloria Cheung, Adrian Chow, Amanda Huang, Brandon Jilesen, Tomasz Kowal, Cristina Leonardelli, Carly Mattson, Lauren Quattrocchi, Daphne To and Julie Yaworski made up the team. Ryan Albert, Tomasz Kowal and Lauren Quatrocchi represented the group in recounting some impressions of
their trip, which took them through six areas across three townships, including Dajabón, Gasper Hernandez and Moca, the home of Dr. Lopez, Associate Minister of Health, Santo Domingo, with whom CMCC coordinates the trip. The positive intensity of the trip is evident when talking to the interns, who in the words of Albert, “were stretched to apply clinical knowledge to real populations and apply theoretical aspects of learning, such as diagnosing complex neurological presentations that you might not see readily in Canada. We learned to determine quickly how we could make the biggest impact on our patients in the short time we worked with them, and to pick up quickly on our Spanish!”
Quatrocchi and Kowal were clear that even the days when the group saw 175 patients, “it didn’t feel like work.” Kowal described the open concept clinic that allowed a gentle breeze through the room. Working side by side, they assessed challenging issues and were able to learn from each other as well as from their patients. “Every morning, I felt excited to get the day underway,” says Quatrocchi. Kowal, speaking to the breadth of conditions, found himself wondering, “What am I going to get today?” “Drs. Tavares and Wiltshire also ensured we each had an opportunity to work on a variety of patients," said Quatrocchi. "For example, each of us had a chance to work with a child, and we had
‘grand rounds’ before we started and during meals,” she laughs. “Dr. Wiltshire didn’t waste an opportunity to teach us. Actually, it began at the airport with a discussion about assessing the neurological signs of Parkinson’s disease. It was an amazing opportunity and we are so grateful for the confidence they were able to instil in us and for their knowledge.“ “In terms of the diversity of patients, I had a woman, a farm worker, come in with osteoarthritis,” says Quatrocchi.
“She was 106 years old and still working.” “I treated a patient who needed two people to assist him onto the table and who afterwards, was able to get up unassisted, after an adjustment,” says Kowal. “In other cases, we were able to explain medical procedures and processes, guiding patients through what they should expect in care, so they could follow up with their local hospital if they had one or perhaps visit the clinic in Moca, where World Spine Care runs a clinic year round.
“I had a patient who still had a steel rod in his arm from a previously healed fracture,” continues Quatrocchi. “His body had begun to reject it, but he was unaware that he was supposed to have it removed. Just that one conversation we had will make a big difference to him. I feel great about the patient education we were able to give.” All three students reiterated that they were surprised at what they had been able to accomplish with their assessment skills and hands. “The long term take away is priceless,” adds Kowal.
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Donations The donations listed here were received and processed between January 1, 2017 and April 30, 2017 for: Research Chair, Awards and Scholarships, Backs in Motion, Gifts in Kind, In Memoriam and general donations. We extend our sincere appreciation to those who have made gifts to CMCC. If you have a correction to this list or would like more information about making a donation, please call Donation Services at 416 482 2340 ext. 194. Aaron Waxman and Associates P.C. Dr. Sean Y. Abdulla Dr. Anthony G. Adams Dr. Vincent Adams Dr. Raphael H. Ahn Dr. Marie-Jose Aime Airport Health Professionals Dr. Robert M. Allaby Mr. Richard Allgood Dr. Thomas E. Amaolo Mr. Don Anderson Mrs. Marie Aragona-Shin Dr. Adam Armstrong Dr. Ayla Azad Dr. Jay Bacher Dr. Tommy Bacher Mr. Eric Bader Dr. Nikhil N. Bair-Patel Dr. Brian Baizley Dr. Sharon J. Barber Dr. Christopher E. Bardwell Dr. Fred N. Barnes Mr. John Barrett Dr. Meghan Barrett Mr. Giuliano Bartolucci Ms. Mara Bartolucci Mr. Christopher Barton Ms. Sharon Batch Dr. Ronald J. Batte Battis & Drake Family Chiropractic L. Battistuzzi Dr. Craig Bauman Dr. Keith C. Beaton Wayne Beattie Mr. Jean-Paul Beaurivage Dr. Jennifer R. Beggs Ms. Joanne Bell Ms. Maryann Belza Mr. Rod Bennett Ms. Marnie Berridge Dr. Condren R. Berry Ilona Binns Ms. Katherine Bishop Rosellen Bjarnason Dr. Michel L. Blanchette Dr. Kelli L. Blunt Dr. Mark E. Boden Dr. Ronald Bordessa Dr. Cameron Borody Daniela Botelho Miss Joanne Boudreau Dr. Luke A. Boudreau
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Published on Jun 12, 2017