An academic institution recognized for creating leaders in spinal health
Our Mission
Deliver world class chiropractic education, research and patient care
CMCC is dedicated to pursuing innovation in education, research and patient care. In this way, the institution effectively prepares its students to become tomorrow’s leaders in diagnosis and treatment of muskuloskeletal issues.
CMCC’s achievements in these academic years demonstrate the success of this approach in paving the way toward increased collaboration with other health care professions, and helping to define the profession within the changing Canadian health care landscape.
10 An International Consensus on Gaps in Mechanisms of Forced-Based Manipulation Research: Findings from a Nominal Group Technique
Keter DL, Bent JA, Bialosky JE, Courtney CA, Esteves JE, Funabashi M, Howarth SJ, Injeyan HS, Mazzieri AM, Nim CG, Cook CE
11 Definition and Classification for Adverse Events Following Spinal and Peripheral Joint Manipulation and Mobilization: A Scoping Review
Funabashi M, Gorrell LM, Pohlman KA, Bergna A, Heneghan NR
12 Effect of Seated Cervical Spinal Manipulation on Autonomic Nervous System Activity as Measured by Heart Rate Variability and Plasma Norepinephrine Levels: A Randomized Pre- and Poststudy
Budgell BS, Injeyan HS, TeodorczykInjeyan J
13 Effects of Distinct Force Magnitude of Spinal Manipulative Therapy on Blood Biomarkers of Inflammation: A Proof of Principle Study in Healthy Young Adults
Duarte FCK, Funabashi M, Starmer D, Partata WA, West DWD, Kumbhare DA, Injeyan S
14 Investigating Force-Time Characteristics of Prone Thoracic SMT and Self-Reported Patient Outcome Measures: A Feasibility Study
Choi G, Giuliano D, Tibbles A, Howarth SJ, Tran S, Lee J, Funabashi M
15 Investigation of the Factors Influencing Spinal Manipulative Therapy Force Transmission Through the Thorax: A Cadaveric Study
Mikhail J, Funabashi M, Sobczak S, Descarreaux M, Pagé
16 Kinematics of the Head and Associated Vertebral Artery Length Changes During High-Velocity, Low-Amplitude Cervical Spine Manipulation
Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, Herzog W
17 Mitigating Bias in the Measurement of Heart Rate Variability in Physiological Studies of Spinal Manipulation: A Comparison Between Authentic and Sham Manipulation
Injeyan HS, Budgell BS
18 Patient and Provider Characteristics Associated with Therapeutic Intervention Selection in a Chiropractic Clinical Encounter: A Cross-Sectional Analysis of the COAST and O-COAST Study Data Jenkins JH, Downie A, Wong JJ, Young JJ, Roseen EJ, Nim CG, McNaughton D, Øveras CK, Hartvigsen J, Mior S, French SD
20 Clinical Biomarker of Sterile Inflammation, HMGB1, in Patients with Chronic Non-Specific Low Back Pain: A Pilot Cross-Sectional Study
Teodorczyk-Injeyan JA, Khella H, Injeyan HS
21 Ultrasonographic Assessment of Skeletal Muscles After Experimentally Induced Neurogenic Inflammation (Facet Injury) in Rats
Ahmadi B, Issa S, Duarte FCK, Srbely J, Bartlewski PM
Cultural Competency
23 Assessing Cultural Competency Among Canadian Chiropractors: A Cross-Sectional Survey of Canadian Chiropractic Association Members
Bakaa N, Southerst D, Côté P, Macedo L, Carlesso LC, MacDermid J, Mior S
24 Diversity of the Chiropractic Profession in Canada: A Cross-Sectional Survey of Canadian Chiropractic Association Members
Southerst D, Bakaa N, Côté P, Macedo L, Carlesso L, MacDermid J, Mior S
25 Integrating Indigenous Healing Practices Within Collaborative Care Models in Primary Healthcare in Canada: A Rapid Scoping Review
Corso M, DeSouza A, Brunton G, Yu H, Cancelliere C, Mior S, Taylor-Vaisey A, MacLeod-Beaver K, Côté P
Chiropractic Utilization and Evidence-based Guidelines
27 Adherence to Spinal Imaging Guidelines and Utilization of Lumbar Spine Diagnostic Imaging for Low Back Pain at a Canadian Chiropractic College: A Historical Clinical Cohort Study
Smith A, Kumar V, Cooley J, Ammendolia C, Lee J, Hogg-Johnson S, Mior S
28 Developing Key Performance Indicators for the Canadian Chiropractic Profession: A Modified Delphi Study
Blanchette MA, Mior S, Thistle S, Stuber K
29 From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development
Schneider CH, Parambath S, Young JJ, Jain S, Slater H, Sharma S, KopanskyGiles D, March L, Briggs AM
30 Physical Activity Counselling and Exercise Prescription Practices of Chiropractors in Canada and Internationally: An Exploratory Survey O'Brien MW, Pellerine LP, Howitt SD, DeGraauw C, Fowles JR
31 Prevalence and Characteristics of Healthcare Utilization with Different Providers Among Canadians with Chronic Back Problems: A Population-Based Study
Wong JJ, Wang D, Hogg-Johnson S, Mior SA, Côté P
Chiropractic Scholarship of Teaching and Learning
33 Evaluating the Baseline Auscultation Abilities of Second-Year Chiropractic Students Using Simulated Patients and High-Fidelity Manikin Simulators: A Pilot Study da Silva-Oolup SA, Giuliano D, Stainsby B, Thomas J, Starmer D
Chiropractic and Sport
35 Canada-Based Sports Chiropractors' Attitudes, Beliefs, and Practical Application of Sport Psychology in the Injury Rehabilitation Process: A Mixed-Methods Study
Leonardelli C, Howitt S, DeGraauw L
36 Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes Howitt SD, Welsh P, DeGraauw C
37 Identifying and Prioritizing Research to Inform a Research Agenda for Canadian Chiropractors Working in Sport – The Canadian Sports Chiropractic Perspective Lee AD, DeGraauw L, Muir BJ, Belchos M, Oh D, Szabo K, Murnaghan K, DeGraauw C, Howitt S
38 Identifying Sports Chiropractic Global Research Priorities: An International Delphi Study of Sports Chiropractors Belchos M, Lee AD, de Luca K, Perle SM, Myburgh C, Mior S
39 Investigating the Research Capacity and Productivity of Canadian Sports Chiropractors
Lee AD, Muir BJ, Oh D, Chung K, Debusschere R, Kissel J, Richer N, Poulin C, Murnaghan K, Stuber K
MSK Assessment
41 A Systematic Review and Meta Analysis of Measurement Properties for the Flexion Relaxation Ratio in People with and without Non Specific Spine Pain De Carvalho D, Mackey S, To D, Summers A, Frey M, Romme K, Hogg-Johnson S, Howarth SJ
42 An Investigation of the Flexion Relaxation Ratio in Adults with and without a History of Self-Reported Low Back Pain and Transient Sitting-Induced Pain Mackey S, Howarth SJ, Frey M1, De Carvalho D
43 Assessing Construct Validity of the Beighton Score as a Measure of Generalized Joint Hypermobility in Varsity Athletes Parks A, Kazemi M, Frost D, Howarth SJ
44 Characteristics Associated with Comorbid Lumbar Spinal Stenosis Symptoms in People with Knee or Hip Osteoarthritis: An Analysis of 9,136 Good Life with OsteoArthritis in Denmark (GLA:D®) Participants Young JJ, Kongsted A, Jensen KR, Roos EM, Ammendolia C, Skou ST, Grønne DT, Hartvigsen J
45 Convergent and Discriminative Validity of the PROMIS Physical Function 4 Questionnaire for Assessing Pain-Related Disability in Low Back Pain Patients Seeking Chiropractic Care
Sandal LF, Young JJ, Søgaard K, Hartvigsen J
46 Induced Leg Length Inequality Affects Pelvis Orientation During Upright Standing Immediately Following a Sit-to-Stand Transfer: A Pre-Post Measurement Study
Vella SP, Swain M, Downie A, Howarth SJ, Funabashi M, Engel RM
47 The Reliability of Pressure Pain Threshold in Individuals with Low Back or Neck Pain: A Systematic Review
Bhattacharyya A, Hopkinson LD, Nolet PS, Srbely J
Outcomes of Various Chiropractic Therapies
49 Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process
Weis CA, Pohlman K, Barrett J, Clinton S, da Silva-Oolup S, Draper C, Lee J, Kumar R, O'Beirne M, Stuber K, Hawk C
50 Conservative Management of Cervical Radiculopathy: A Systematic Review
Plener J, Csiernik B, To D, da Silva-Oolup S, Hofkirchner C, Cox J, Cancelliere C, Chow N, Hogg-Johnson S, Ammendolia C
51 Effectiveness of Multimodal Rehabilitation Interventions for Management of Cervical Radiculopathy in Adults: An Updated Systematic Review from the Ontario Protocol for Traffic Injury Management (Optima) Collaboration
Mallard F, Wong JJ, Lemeunier N, Côté P
52 Effectiveness of Postsurgical Rehabilitation following Lumbar Disc Herniation Surgery: A Systematic Review
Yu H, Cancelliere C, Mior S, Pereira P, Nordin M, Brunton G, Wong JJ, Shearer HM, Connell G, Ead L, Verville L, Rezai M, Myrtos D, Wang D, Marchand AA, Romanelli A, Germann D, To D, Young JJ, Southerst D, Candelaria H, Hogg-Johnson S, Côté P
53 Exercise Rehabilitation for Neurogenic Thoracic Outlet Syndrome: A Scoping Review
Luu D, Seto R, Deoraj K
54 Measurement Properties and Minimal Important Change of the World Health Organization Disability Assessment Schedule 2.0 in Persons with Low Back Pain: A Systematic Review
Wong JJ, DeSouza A, Hogg-Johnson S, De Groote W, Southerst D, Belchos M, Lemeunier N, Alexopulos S, Varmazyar H, Mior SA, Stern PJ, Nordin MC, TaylorVaisey A, Cieza A, Côté P
55 Minimal Important Difference of the 12Item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in Persons with Chronic Low Back Pain
Wong JJ, Hogg-Johnson S, De Groote W, Ćwirlej-Sozańska A, Garin O, Ferrer M, Acuña AP, Côté P
56 Multivariable Prediction Models for the Recovery of and Claim Closure Related to Post-Collision Neck Pain and Associated Disorders
Stupar M, Côté P, Carroll LJ, Brison RJ, Boyle E, Shearer HM, Cassidy JD
57 Relationship Between Location of Pregnancy-Related and PostpartumRelated Back Pain and Limitations of Daily Activities and Work Participation Weis CA, Padkapayeva K, Smith P, Barrett J, Landsman V
58 Systematic Review Procedures for the World Health Organization (WHO) Evidence Syntheses on Benefits and Harms of Structured and Standardized Education/Advice, Structured Exercise Programs, Transcutaneous Electrical Nerve Stimulation (TENS), and Needling Therapies for the Management of Chronic Low Back Pain in Adults
Cancelliere C, Verville L, Southerst D, Yu H, Hayden JA, Ogilvie R, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Wong JJ, Shearer HM, Connell G, Hincapié CA
59 Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults
Yu H, Wang D, Verville L, Southerst D, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Shearer HM, Wong JJ, Connell G, Myrtos D, da Silva-Oolup S, Young JJ, Funabashi M, Romanelli A, Lee JGB, Stuber K, Guist B, Laguna JM, Hofstetter L, Murnaghan K, Hincapié CA, Cancelliere C
60 Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary Low Back Pain in Adults
Southerst D, Cancelliere C, Hincapié CA, Laguna JM, Lalji R, Hofstetter L, Yu H, Verville L, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Wong JJ, Connell G, Shearer HM, DeSouza A, Lee JGB, To D, Stuber K, Funabashi M, Myrtos D, Romanelli A, Guist B, Young JJ, da SilvaOolup S, Stupar M, Wang D, Murnaghan K
61 Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults
Verville L, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Connell G, Shearer HM, Wong JJ, Hofstetter L, Romanelli A, Guist B, To D, Stuber K, da Silva-Oolup S, Stupar M, Myrtos D, Lee JGB, DeSouza A, Laguna JM, Murnaghan K, Cancelliere C
62 Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults Verville L, Ogilvie R, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G,Nordin M, Connell G, Wong JJ, Shearer HM, Lee JGB, Wang D1, Hayden JA, Cancelliere C
63 What's the Harm? Results of an Active Surveillance Adverse Event Reporting System for Chiropractors and Physiotherapists
Pohlman KA, Funabashi M, O'Beirne M, Cassidy JD, Hill MD, Hurwitz EL, Kawchuk G, Mior S, Ibrahim Q, Thiel H, Westaway M, Yager J, Vohra S
Interprofessional Education / Collaboration
65 An Interprofessional Approach to Collaborative Management of LowBack Pain in Primary Care: A Scholarly Analysis of a Successful Educational Module for Prelicensure Learners
Peranson J, Weis CA, Slater M, Plener J, Kopansky-Giles D
66 Enhancing Comprehensive Primary Care by Integrating Chiropractic Led Musculoskeletal Care into Interprofessional Teams through Supporting Education, Competency Attainment, and Optimizing Integration
Kopansky-Giles D, Alleyne J, Mior S, De Carvalho D, Quesnele J, Hogg-Johnson S, Rahbar P, Logeman M
67 Impact of Interactive Multi-Media Learning for Physicians in Musculoskeletal Education
- A Pilot Study
Wadey V, Okoro T, Sathiyamoorthy T, Snowdon D, McDonald-Blumer H, Cividino A, Kopansky-Giles D, Levy D, Freeman R, Herold J, Archibald D
Delivery / Telehealth
69 Agreement and Concurrent Validity Between Telehealth and In-Person Diagnosis of Musculoskeletal Conditions: A Systematic Review
Oh D, To D, Corso M, Murnaghan K, Yu H, Cancelliere C
70 Care at a Distance: Understanding Lived Experiences of People with MSK Disorders Receiving Non-Pharmacological Interventions Delivered through Synchronous Telehealth: A Systematic Rapid Review
Atkinson-Graham M, Brunton G, Cancelliere C, Corso M, de Zoete A, Rubinstein SM, Murnaghan K, Mior S
71 CMCC Faculty Publications 2022-2023
75 CMCC Faculty Publications 2023-2024
79 Faculty Presentations: 2022-23
82 Faculty Presentations: 2023-24
Dr. Christine Bradaric-Baus President
Dr. Kim Ross Dean, Research and Assessment Undergraduate Education
Welcome to the 2022-2024 CMCC Research Report
The Canadian Memorial Chiropractic College (CMCC) is committed to advancing chiropractic knowledge through research and academic inquiry. Our scientists, clinicians, educators, and graduate students play a key role in expanding and refining the understanding of chiropractic care. This growing body of knowledge informs our curriculum, supports practitioners, and fosters collaboration to improve patient outcomes for musculoskeletal disorders.
CMCC has a strong history of contributing to chiropractic research and graduate education, earning recognition for its scholarly work worldwide. Research is a fundamental part of our mission, supporting excellence in education, clinical practice, and innovation. Our research team— comprising full-time scientists, clinical and teaching faculty, adjunct researchers, and CMCC’s endowed Research Chair—continues to produce high-quality, peer-reviewed publications on spinal manipulation and chiropractic care.
Recognizing the importance of research, CMCC actively seeks to expand its programs and secure innovative
funding sources. Over the past two years, our research initiatives have focused on 10 key areas, pursued independently or in collaboration with other institutions:
1. Spinal Manipulation
2. Chemistry of Musculoskeletal (MSK) Injury
3. Cultural Competency
4. Chiropractic Utilization and Evidence-Based Guidelines
5. Scholarship of Teaching and Learning (SOTL) in Chiropractic
6. Chiropractic and Sports Science
7. MSK Assessment
8. Outcomes of Various Chiropractic Therapies
9. Interprofessional Education and Collaboration
10. Telehealth and Chiropractic Care Delivery
We are pleased to present the 2022-2024 Research Report, which highlights the depth and variety of our academic contributions. This collection of 50 abstracts showcases the collaborative efforts and dedication of CMCC’s research community. Each study represents progress in advancing chiropractic education, evidencebased practice, and patient care.
Our research efforts are made possible through the generous support of CMCC donors and national and provincial funding agencies. Their contributions have been essential in sustaining our commitment to scientific discovery and innovation.
As we reflect on the past two years, it is clear that the work of our researchers has meaningful implications for the healthcare community. This research strengthens our understanding of chiropractic care and helps bridge the gap between scientific discovery and clinical application. We invite you to explore this collection
Research Activity
Publications and Presentations
of scholarly work and join us in shaping the future of chiropractic research and education.
Dr. Christine Bradaric-Baus, President
Dr. Kim Ross, Dean, Research and Assessment, Undergraduate Education
CMCC Research Report 2022–24
A Spinal Manipulation
Spinal Manipulation
An International Consensus on Gaps in Mechanisms of Force-Based Manipulation Research: Findings from a Nominal Group Technique
Keter DL 1 2, Bent JA 3, Bialosky JE 4 5, Courtney CA 6, Esteves JE 7 8 9 , Funabashi M 10 11, Howarth SJ 10 , Injeyan HS 10 , Mazzieri AM 12 13, Nim CG 14 15, Cook CE 16 1DepartmentofVeteransAffairsMedicalCenter, 2YoungstownStateUniversity, 3DukeUniversityHospitalSystem, 4UniversityofFlorida, 5Brooks-PHHP Research Collaboration, 6NorthwesternUniversity, 7Clinical-BasedHumanResearchDepartment,FoundationCOME Collaboration, 8Malta ICOM Educational, 9UniversityCollegeofOsteopathy, 10CanadianMemorialChiropracticCollege, 11Université duQuébecàTrois-Rivières, 12InstituteofSportsandRemedialMassage, 13TheSchoolofSoftTissueTherapy, 14UniversityHospitalof Southern Denmark, 15UniversityofSouthernDenmark, 16DukeUniversity
Abstract
Force-Based Manipulation (FBM) including light touch, pressure, massage, mobilization, thrust manipulation, and needling techniques are utilized across several disciplines to provide clinical analgesia. These commonly used techniques demonstrate the ability to improve pain-related outcomes; however, mechanisms behind why analgesia occurs with these hands-on interventions has been understudied. Neurological, neuroimmune, biomechanical, neurovascular, neurotransmitter, and contextual factor interactions have been proposed to influence response; however, the specific relationships to clinical pain outcomes has not been well established. The purpose of this study was to identify gaps present within mechanismbased research as it relates to FBM. An international multidisciplinary nominal group technique (NGT) was performed and identified 37 proposed gaps across eight domains. Twenty-three of these gaps met consensus across domains supporting the complex multisystem mechanistic response to FBM. The strength of support for gaps within the biomechanical domain had less overall support than the others. Gaps assessing the influence of contextual factors had strong support as did those associating mechanisms with clinical outcomes (translational studies). The importance of literature investigating how FBM differs with individuals of different pain phenotypes (pain mechanism phenotypes and clinical phenotypes) was also presented aligning with other analgesic techniques trending toward patient-specific pain management (precision medicine) through the use of pain phenotyping.
Spinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.
Methods
An electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis.
Results
From 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or
serious) of the classification while 26 described multiple categories (e.g., moderate, severe).
Conclusion
A vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.
Effect of Seated Cervical Spinal Manipulation on Autonomic Nervous System Activity as Measured by Heart
Rate Variability and Plasma Norepinephrine Levels: A Randomized Pre- and Poststudy
Budgell BS1, Injeyan HS1, Teodorczyk-Injeyan J1
1CanadianMemorialChiropracticCollege
Abstract
Objective
The objective of this study was to determine whether seated cervical manipulation produced changes in autonomic nervous system activity, as measured by heart rate variability and plasma norepinephrine levels.
Methods
Ninety-five healthy young adults (ages 20-48 years) were recruited into a single-blinded physiological study, with 47 randomized to a seated cervical manipulation and 44 randomized to a sham procedure. Heart rate variability in the frequency domain, and plasma norepinephrine levels were measured prior to, immediately following, and 5 minutes following the intervention.
Results
Electrocardiograms were obtained from 39 subjects in the sham group and 43 subjects in the manipulation group. No statistically significant changes were found in measures of heart rate variability in the frequency domain in either the manipulation or sham groups. Blood samples were obtained from 22 subjects in the sham group and 27 subjects in the manipulation group. Plasma norepinephrine levels, as measured by spectrophotometry, declined in both groups from pre- to immediately postintervention, and they remained at decreased levels 5 minutes after the interventions. There were no statistically significant differences between groups in pre- or postintervention norepinephrine levels.
Conclusion
Measures of heart rate variability and plasma norepinephrine levels did not show that seated cervical manipulation produced short-term changes in autonomic nervous system activity compared to a sham procedure in healthy young adults.
Originallypublished in the Journal ofManipulative and PhysiologicalTherapeutics, 2023May;46(4):220-228.
Effects of Distinct Force Magnitude of Spinal Manipulative Therapy on Blood Biomarkers of Inflammation: A Proof of Principle Study in Healthy Young Adults
The purpose of this preliminary study was to determine the influence of thoracic spinal manipulation therapy (SMT) of different force magnitudes on blood biomarkers of inflammation in healthy adults.
Methods
Nineteen healthy young adults (10 female, age: 25.6 ± 1.2 years) were randomized into the following 3 groups: (1) control (preload only), (2) single thoracic SMT with a total peak force of 400N, and (3) single thoracic SMT with a total peak force of 800N. SMT was performed by an experienced chiropractor, and a force-plate embedded treatment table (Force Sensing Table Technology) was used to determine the SMT force magnitudes applied. Blood samples were collected at pre intervention (baseline), immediately post intervention, and 20 minutes post intervention. A laboratory panel of 14 different inflammatory biomarkers (pro, anti, dual role, chemokine, and growth factor) was assessed by multiplex array. Change scores from baseline of each biomarker were used for statistical analysis. Two-way repeated-measures analysis of variance was used to investigate the interaction and main effects of intervention and time on cytokines, followed by Tukey's multiple comparison test (P ≤ .05).
Results
A between-group (800N vs 400N) difference was observed on interferon-gamma, interleukin (IL)-5, and IL-6, while a withingroup difference (800N: immediately vs 20 minutes postintervention) was observed on IL-6 only.
Conclusion
In this study, we measured short-term changes in plasma cytokines in healthy young adults and found that select plasma
pro-inflammatory and dual-role cytokines were elevated by higher compared to lower SMT force. Our findings aid to advance our understanding of the potential relationship between SMT force magnitude and blood cytokines and provide a healthy baseline group with which to compare similar studies in clinical populations in the future.
Originallypublished in the Journal ofManipulative and PhysiologicalTherapeutics, 2022Jan;45(1):20-32.
Reproduced withpermission from Elsevier.
Access online:doi.org/10.1016/j.jmpt.2022.03.012, Epub 2022 Jun 25.
Investigating Force-Time Characteristics of Prone Thoracic SMT and Self-Reported Patient Outcome Measures: A Feasibility Study
Spinal manipulative therapy (SMT) is commonly used to treat musculoskeletal conditions, including thoracic spine pain. Applying patient-specific force-time characteristics are believed to be important to improve SMT's effectiveness. Investigating SMT as part of a multimodal approach is fundamental to account for the complexity of chiropractic clinical practice. Therefore, pragmatic investigations balancing minimal disruptions to the clinical encounter at the same time as ensuring a robust data quality with rigorous protocols are needed. Consequently, preliminary studies are required to assess the study protocol, quality of data recorded and the sustainability of such investigation. Therefore, this study examined the feasibility of investigating SMT force-time characteristics and clinical outcome measures in a clinical setting.
Methods
In this mixed-methods study, providers recorded thoracic SMT force-time characteristics delivered to patients with thoracic spinal pain during regular clinical encounters. Self-reported clinical outcomes of pain, stiffness, comfort during the SMT (using an electronic visual analogue scale), and global rating of change scale were measured before and after each SMT application. Feasibility was quantitatively assessed for participant recruitment, data collection and data quality. Qualitative data assessed participants' perceptions on the impact of data collection on patient management and clinical flow.
Results
Twelve providers (58% female, 27.3 ± 5.0 years old) and twelve patients (58% female, 37.2 ± 14.0 years old) participated in the study. Enrolment rate was greater than 40%, data collection rate was 49% and erroneous data was less than 5%. Participant acceptance was good with both providers and patients reporting positive experience with the study.
Conclusions
Recording SMT force-time characteristics and self-reported clinical outcome measures during a clinical encounter may be feasible with specific modification to the current protocol. The study protocol did not negatively impact patient management. Specific strategies to optimize the data collection protocol for the development of a large clinical database are being developed.
Spinal manipulative therapy (SMT) clinical effects are believed to be linked to its force-time profile characteristics. Previous studies have revealed that the force measured at the patient-table interface is most commonly greater than the one applied at the clinician-patient interface. The factors explaining this force amplification remains unclear.
Objective
To determine the difference between the force applied to a cadaveric specimen's thoracic spine and the resulting force measured by a force-sensing table, as well as to evaluate the relationship between this difference and both the SMT force-time characteristics and the specimens' characteristics.
Methods
Twenty-five SMTs with different force-time profiles were delivered by an apparatus at the T7 vertebra of nine human cadaveric specimens lying prone on a treatment table equipped with a force plate. The difference between the force applied by the apparatus and the resulting force measured by the force plate was calculated in absolute force (Fdiff) and as the percentage of the applied force (Fdiff%). Kinematics markers were inserted into T6 to T8 spinous and transverse processes to evaluate vertebral displacements during the SMT thrusts. Mixed-effects linear models were run to evaluate the variance in Fdiff and Fdiff% explained by SMT characteristics (peak force, thrust duration and force application rate), T6 to T8 relative and total displacements, and specimens' characteristics (BMI, height, weight, kyphosis angle, thoracic thickness).
Results
Sixty percent of the trials showed lower force measured at the force plate than the one applied at T7. Fdiff¸ was
significantly predicted (R2 marginal = 0.54) by peak force, thrust duration, thoracic thickness and T6-T7 relative displacement in the z-axis (postero-anterior). Fdiff% was significantly predicted (R2 marginal = 0.56) by force application rate, thoracic thickness and total T6 displacements. For both dependant variables, thoracic thickness showed the highest R2marginal out of all predictors.
Conclusion
Difference in force between the clinician-patient and the patient-table interfaces is influenced by SMT forcetime characteristics and by thoracic thickness. How these differences in force are associated with vertebral displacements remains unclear. Although further studies are needed, clinicians should consider thorax thickness as a possible modulator of forces being transmitted through it during prone SMT procedures.
Cervical spine manipulation (CSM) is a frequently used treatment for neck pain. Despite its demonstrated efficacy, concerns regarding the potential of stretch damage to vertebral arteries (VA) during CSM remain. The purpose of this study was to quantify the angular displacements of the head relative to the sternum and the associated VA length changes during the thrust phase of CSM.
Methods
Rotation and lateral flexion CSM procedures were delivered bilaterally from C1 to C7 to three male cadaveric donors (Jan 2016-Dec 2019). For each CSM the force-time profile was recorded using a thin, flexible pressure pad (100-200 Hz), to determine the timing of the thrust. Three dimensional displacements of the head relative to the sternum were recorded using an eight-camera motion analysis system (120-240 Hz) and angular displacements of the head relative to the sternum were computed in Matlab. Positive kinematic values indicate flexion, left lateral flexion, and left rotation. Ipsilateral refers to the same side as the clinician's contact and contralateral, the opposite. Length changes of the VA were recorded using eight piezoelectric ultrasound crystals (260-557 Hz), inserted along the entire vessel. VA length changes were calculated as D = (L1 - L0)/L0, where L0 = length of the whole VA (sum of segmental lengths) or the V3 segment at CSM thrust onset; L1 = whole VA or V3 length at peak force during the CSM thrust.
Results
Irrespective of the type of CSM, the side or level of CSM application, angular displacements of the head and associated VA length changes during the thrust phase of CSM were small. VA length changes during the thrust phase were largest with ipsilateral rotation CSM
(producing contralateral head rotation): [mean ± SD (range)] whole artery [1.3 ± 1.0 (- 0.4 to 3.3%)]; and V3 segment [2.6 ± 3.6 (- 0.4 to 11.6%)].
Conclusions
Mean head angular displacements and VA length changes were small during CSM thrusts. Of the four different CSM measured, mean VA length changes were largest during rotation procedures. This suggests that if clinicians wish to limit VA length changes during the thrust phase of CSM, consideration should be given to the type of CSM used.
The purpose of this study was to identify sources and strategies for the mitigation of bias in studies of spinal manipulation and heart rate variability.
Methods
A small-scale study compared the effects of a single session of sham and authentic cervical manipulation on heart rate variability as measured by power spectrum analysis. The participants were a sample of 31 healthy young students from the Canadian Memorial Chiropractic College, randomized into 2 study arms. The effectiveness of blinding was evaluated, and 2 alternative methods of data analysis were explored to mitigate risk of bias. Following execution of the study, the stages of implementation and data processing were scored against version 2 of the Cochrane risk-of-bias tool for randomized trials for risk of bias.
Results
The risk of bias arising from (1) the randomization process, (2) missing outcome data, and (3) selection of reported results was judged to be low. Risk of bias in (1) deviations from intended interventions (particularly due to the failure of masking) and (2) the measurement of the outcome, for example, through cleaning of the data, were judged to be high.
Conclusion
The use of power spectrum analysis of heart rate variability based on 5-minute recordings of echocardiogram preand post-intervention contained multiple sources of bias that were challenging to mitigate. Based upon these findings, power spectrum analysis of heart rate variability using these parameters may be ill-suited to the study of physiological effects of spinal manipulative therapy.
Originallypublished in the Journal ofManipulative and PhysiologicalTherapeutics, 2022Feb;45(2):104-113.
Reproduced with permission from Elsevier.
Access online:doi.org/10.1016/j.jmpt.2022.03.019
Patient and Provider Characteristics Associated with Therapeutic Intervention Selection in a Chiropractic Clinical Encounter: A Cross-Sectional Analysis of the COAST and O-COAST Study Data
Jenkins JH1, Downie A1, Wong JJ2, Young JJ3,4, Roseen EJ5, Nim CG4, McNaughton D1, Øveras CK6, Hartvigsen J4, Mior S2,7, French SD1 1MacquarieUniversity, 2OntarioTechUniversity, 3KrembilResearchInstitute, 4UniversityofSouthernDenmark, 5BostonUniversity Chobanian&AvedisionSchoolofMedicineandBostonMedicalCenter, 6NorwegianUniversityofScienceandTechnology(NTNU), 7CanadianMemorialChiropracticCollege
Abstract
Background
Chiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chiropractic care, and patient and provider characteristics associated with intervention selection.
Methods
Data were obtained from the Chiropractic Observation and Analysis STudy (COAST) and Ontario (O-COAST) studies: practice-based, cross-sectional studies in Victoria, Australia (2010-2012) and Ontario, Canada (20142015). Chiropractors recorded data on patient diagnosis and intervention selection from up to 100 consecutive patient visits. The frequency of interventions selected overall and for each diagnostic category (e.g., different musculoskeletal regions) were descriptively analysed. Univariable multi-level logistic regression (provider and patient as grouping factors), stratified by diagnostic category, was used to assess the association between patient/provider variables and intervention selection.
Results
Ninety-four chiropractors, representative of chiropractors in Victoria and Ontario for age, sex, and years in practice, participated. Data were collected on 7,966 patient visits (6419 unique patients), including 10,731 individual diagnoses (mean age: 43.7 (SD: 20.7), 57.8% female). Differences in patient characteristics and intervention selection were observed between chiropractors practicing in Australia and Canada. Overall, manipulation was
the most common intervention, selected in 63% (95% CI:62-63) of encounters. However, for musculoskeletal conditions presenting in the extremities only, soft tissue therapies were more commonly used (65%, 95% CI:62-68). Manipulation was less likely to be performed if the patient was female (OR:0.74, 95% CI:0.65-0.84), older (OR:0.79, 95% CI:0.77-0.82), presenting for an initial visit (OR:0.73, 95% CI:0.56-0.95) or new complaint (OR:0.82, 95% CI:0.710.95), had one or more comorbidities (OR:0.63, 95% CI:0.54-0.72), or was underweight (OR:0.47, 95% CI:0.350.63), or obese (OR:0.69, 95% CI:0.58-0.81). Chiropractors with more than five years clinical experience were less likely to provide advice/education (OR:0.37, 95% CI:0.160.87) and exercises (OR:0.17, 95% CI:0.06-0.44).
Conclusion
In more than 10,000 diagnostic encounters, manipulation was the most common therapeutic intervention for spinerelated problems, whereas soft tissue therapies were more common for extremity problems. Different patient and provider characteristics were associated with intervention selection. These data may be used to support further research on appropriate selection of interventions for common musculoskeletal complaints.
The present study explores whether the inflammatory biomarker of sterile inflammation, high mobility box 1 (HMGB1), contributes to the inflammatory/nociceptive pathophysiology that characterizes chronic non-specific low back pain (LBP). Patients with chronic LBP (N = 10, >3 pain score on a 11-point Visual Analogue Scale, VAS) and asymptomatic participants (N = 12) provided peripheral blood (PB) samples. The proportion of classical CD14++ monocytes within PB leukocytes was determined by flow cytometry. The plasma and extracellular HMGB1 levels in unstimulated adherent cell (AC) cultures were measured using specific immunoassays. HMGB1 localization in ACs was assessed by immunofluorescent staining. The relative gene expression levels of tumor necrosis factor α (TNFα), interleukin-1 beta (IL-1β) and HMGB1 were determined by quantitative polymerase chain reaction (qRT-PCR) in relation to the pain intensity (11-point VAS scores) in patients with LBP. The extracellular release of HMGB1 in the LBP patient AC cultures was significantly elevated (p = 0.001) and accompanied by its relocation into the cytoplasm from the nuclei. The number of CD14++ monocytes in the patients' PB was significantly (p = 0.03) reduced, while the HMGB1 plasma levels remained comparable to those of the controls. The mRNA levels of TNFα, IL-1β and HMGB1 were overexpressed relative to the controls and those of HMGB1 and IL-1β were correlated with the VAS scores at a significant level (p = 0.01-0.03). The results suggest that HMGB1 may play an important role in the pathophysiology of chronic nonspecific LBP.
Originallypublished in: Life (Basel). 2023 Feb8;13(2):468.
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Access online:doi.org/10.3390/life13020468
Ultrasonographic Assessment of Skeletal Muscles After Experimentally Induced Neurogenic Inflammation (Facet Injury) in Rats
This study set out to examine ultrasonographic attributes of non-neurosegmentally (pectoral-forelimb) and neurosegmentally linked (hindlimb) myotomes in an experimental model that leads to neurogenic inflammation in segmentally linked myotomes, and to evaluate quantitative correlations among ultrasonographic attributes of the muscles, relative content of various inflammatory mediators, and nociceptive thresholds (hot and mechanical) in rats. Twelve male Wistar Kyoto rats were randomly divided into two equinumerous groups: surgery group, in which the left lumbar (L4-L6) facet joints were compressed for 3 min with modified Kelly forceps under general anesthesia, and sham-operated rats. All ultrasonograms were obtained with the Vevo 2100 Visual Sonic scanner connected to a 24-MHz transducer at four different time points: pre-surgery and 7, 14, and 21 days after surgical procedures. Digital ultrasonographic images of quadriceps femoris, hamstring, and pectoral-brachial muscle groups were analyzed using a polygonal meter region of interest placed on the largest cross-sectional area of the muscles displayed in Image ProPlus® analytical software to compute numerical pixel values and pixel heterogeneity (standard deviation of mean pixel values). On day 21, pain behavior tests (hot plate and von Frey) were performed and then all animals were euthanized. Protein expression of inflammatory mediators in biceps brachii and rectus femoris muscles was measured by Western blot. The most prominent differences in muscle echotextural attributes between the two subsets of rats occurred 14 days post-surgery in pectoral-brachial and quadriceps femoris muscles. The expression of calcitonin-gene-related peptide was directly related to both echotextural variables only in biceps brachii (pixel intensity: r = 0.65, P = 0.02; and heterogeneity: r = 0.66, P = 0.02, respectively). Our findings have revealed the occurrence of echotextural changes in skeletal muscles of rats during myositis; however, the accumulation of
inflammatory mediators and the outcomes of sensory tests did not relate to the changes in first-order echotextural characteristics of affected hindlimb muscles.
There is a paucity of research assessing cultural competency among Canadian chiropractors. Therefore, the aims of this study were to (1) measure cultural competency among Canadian chiropractors, (2) understand chiropractors' perspectives of challenges and attitudes regarding the delivery of chiropractic services to equityseeking communities, and (3) assess contextual factors associated with cultural competency.
Methods
We conducted a cross-sectional survey of members of the Canadian Chiropractic Association (CCA) (May-July 2021). The survey instrument consisted of 57 questions related to demographics, cultural competency, perceptions about health disparities, and challenges in delivery of rehabilitation. Cultural competency was measured using the Cultural Awareness and Sensitivity and Cultural Competence Behaviours subscales of the Cultural Competence Assessment Instrument. We conducted a multivariate linear regression to assess factors that may be associated with cultural competency.
CResults
A total of 3143 CCA members responded (response rate of 41%). Mean scores for the Cultural Awareness and Sensitivity subscale were 5.8/7 (95% CI 5.7; 5.8) and 4.2/7 (95% CI 4.1; 4.2) for the Cultural Competence Behaviour subscale. Most chiropractors (72-78%) reported observing important cultural health disparities across various care-related outcomes. Cost of services and language were identified as barriers to providing care to equityseeking communities. Cultural Awareness and Sensitivity scores were weakly associated with gender (men), years of clinical practice, cultural health disparities, the
statement "I think some people have an agenda to look for discrimination even where it does not exist (DEI attitudes)," race (Caucasian), and prior DEI training, (R2 = 0.15, p < 0.0001). Cultural Competence Behaviour scores were weakly associated with race (Caucasian), cultural health disparities, prior DEI training, increased years of clinical experience, and higher Cultural Awareness and Sensitivity scores (R2 = 0.19, p < 0.0001).
Conclusion
This study provides the first description of cultural competency within the chiropractic profession in Canada. Findings suggest a gap between knowledge and behaviour and uncover several barriers and challenges that may inform the development of profession-specific training in cultural competence.
Little is known about the diversity of the chiropractic profession with respect to gender, sexual orientation, race, ethnicity and community of practice. This knowledge is important as profession representation of key equity seeking groups may impact quality of care and access for vulnerable communities. The aim of this cross-sectional survey was to explore the diversity of the chiropractic profession in Canada.
Methods
All registered members of the Canadian Chiropractic Association (N = 7721) were invited to participate in a webbased survey between May and June 2021. Survey questions explored diversity with respect to personal demographics (age, sex, gender, sexual orientation, race, ethnicity, language) and practice characteristics (community setting, practice type). Where possible, survey data was compared to data from the 2016 Census of the Canadian population.
Results
We received a total of 3143 survey responses (response rate—41%). The average age of our sample was 44.7 years (standard deviation 12.7). Forty-five percent were female with the same proportion (45.2%) self-identifying as women. Ninety-one percent of the sample selfidentified as heterosexual. With respect to race, 80% of respondents were Caucasian. Seventy percent of chiropractors in our sample identified with Canadian ancestry and 29% with European ancestry. In comparison to the Canadian population, some visible minorities were underrepresented. The greatest discrepancy between the Canadian population and our sample was in the proportion of Black and Indigenous chiropractors. With respect to ethnicity, chiropractors identifying themselves with Canadian ancestry were overrepresented in our sample compared to others, specifically those with
North American Indigenous and South, Central and Latin American ancestry. Sixty-one percent of chiropractors practiced in major cities and most work in interdisciplinary clinics (42% Complementary and Alternative Medicine and 33% rehabilitation).
Conclusions
This study provides an initial description of diversity within the chiropractic profession in Canada. Women represent less than 50% of the profession nationally. Overall, there is little racial and ethnic diversity in the chiropractic profession compared to the Canadian population, with Black and Indigenous peoples being underrepresented. Future work should focus strategies to foster the development of a more diverse chiropractic workforce.
Originallypublishedin:ChiropracticManualTherapies 2022 Dec 9;30(1):52.
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Access online:doi.org/10.1186/s12998-022-00463-z
Integrating Indigenous Healing Practices Within Collaborative Care Models in Primary Healthcare in Canada: A Rapid Scoping Review
In November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada.
Eligibility criteria
We included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models.
Sources of evidence
We searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021.
Charting methods
Our data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics.
Results
We identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used
functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear.
Conclusions
We found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.
Originallypublished in: BMJOpen. 2022 Jun 16;12(6):e059323.
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Access online:doi.org/10.1136/bmjopen-2021-059323
D Chiropractic Utilization and Evidence-based Guidelines
Chiropractic Utilization and Evidence-based Guidelines
Adherence to Spinal Imaging Guidelines and Utilization of Lumbar Spine Diagnostic Imaging for Low Back Pain at a Canadian Chiropractic College: A Historical Clinical Cohort Study
Smith A1, Kumar V1, Cooley J2, Ammendolia C3,4, Lee J1, Hogg-Johnson S1,4,5,6, Mior S1,4,5 1CanadianMemorialChiropracticCollege,2MurdochUniversity,3MountSinaiHospital,4UniversityofToronto,5OntarioTechUniversity,6University ofToronto
Abstract
Background
Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of 12.3% in imaging of LBP patients attending a chiropractic teaching clinic. A new imaging guideline for spinal disorders has been published and used in teaching. Thus, the aims of our study were to assess the adherence to the new guideline and X-ray utilization in new episodes of LBP.
Methods
We conducted a historical clinical cohort study using patient electronic health record audits at seven teaching clinics over a period of 20 months. Records of patients who were at least 18 years of age, presented with a new onset of LBP, and consented to data collection were included. Abstracted data included patient demographics, the number and type of red flags, and the decision to image. Rate of guideline adherence (proportion of those not recommended for imaging, given no red flags) and rate of image utilization were descriptively analyzed.
DResults
We included 498 patients in this study. At least 81% of included patients had one or more red flags reported. The most commonly reported individual red flag was age ≥ 50 (43.8%) followed by pain at rest (15.7%). In those referred for imaging, age ≥ 50 (93.3%) was the most frequently reported red flag. No red flag(s) were identified in 93
patient records, and none were referred for imaging of their LBP, yielding an adherence rate of 100% (95% CI 96, 100%). A total of 17 of 498 patients were recommended for imaging for their low back pain, resulting in an imaging utilization rate of 3.4% (95% CI 1.8, 5.0%).
Conclusion
The imaging utilization rate was 3.4%, lower than 12.3% previously reported at a chiropractic teaching clinic. None without red flags were referred for imaging, yielding a 100%, adherence rate to current LBP imaging guidelines. Future research should consider currency of guideline, accuracy of red flags and factors influencing clinicians' decision, when assessing imaging adherence rates.
The purpose of this study is to develop a list of performance indicators to assess the status of the chiropractic profession in Canada.
Method
We conducted a 4-round modified Delphi technique (March 2018-January 2020) to reach consensus among experts and stakeholders on key status indicators for the chiropractic profession using online questionnaires. During the first round, experts suggested indicators for preidentified themes. Through the following two rounds, the importance and feasibility of each indicator was rated on an 11-point Likert scale, and their related potential sources of data identified. In the final round, provincial stakeholders were recruited to rate the importance of the indicators within the 90th percentile and identified those most important to their organisation.
Results
The first round generated 307 preliminary indicators of which 42 were selected for the remaining rounds, and eleven were preferentially selected by most of the provincial stakeholders. Experts agreed the feasibility of all indicators was high, and that data could be collected through a combination of data obtained from professional liability insurance records and survey(s) of the general population, patients, and chiropractors.
Conclusions
A set of performance indicators to assess the status of the Canadian chiropractic profession emerged from a scientific and stakeholder consensus.
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Access online:doi.org/10.1186/s12998-022-00439-z
From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development
Global policy to guide action on musculoskeletal (MSK) health is in a nascent phase. Lagging behind other noncommunicable diseases (NCDs) there is currently little global policy to assist governments to develop national approaches to MSK health. Considering the importance of comparison and learning for global policy development, we aimed to perform a comparative analysis of national MSK policies to identify areas of innovation and draw common themes and principles that could guide MSK health policy.
Methods
Multi-modal search strategy incorporating a systematic online search targeted at the 30 most populated nations; a call to networked experts; a specified question in a related eDelphi questionnaire; and snowballing methods. Extracted data were organised using an a priori framework adapted from the World Health Organization (WHO) Building Blocks and further inductive coding. Subsequently, texts were open coded and thematically analysed to derive specific subthemes and principles underlying texts within each theme, serving as abstracted, transferable concepts for future global policy.
Results
The search yielded 165 documents with 41 retained after removal of duplicates and exclusions. Only three documents were comprehensive national strategies addressing MSK health. The most common conditions addressed in the documents were pain (non-cancer), low back pain, occupational health, inflammatory conditions, and osteoarthritis. Across eight categories, we derived 47 sub-themes with transferable principles that could guide global policy for: service delivery; workforce; medicines
and technologies; financing; data and information systems; leadership and governance; citizens, consumers and communities; and research and innovation.
Conclusion
There are few examples of national strategic policy to address MSK health; however, many countries are moving towards this by documenting the burden of disease and developing policies for MSK services. This review found a breadth of principles that can add to this existing work and may be adopted to develop comprehensive system-wide MSK health approaches at national and global levels.
Originallypublished in: International Journal of Health PolicyManagement 2023:12:7031.
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Physical activity and exercise (PAE) counselling and exercise prescriptions increase patient physical activity. However, the perceptions/practices of chiropractors are poorly understood.
Methods
We surveyed the practices among chiropractors working in Canada (n=50) and Internationally (n=37). Chiropractors completed self-reflection questionnaires regarding their current practices and perceptions towards providing PAE counselling to patients. Chiropractor responses were obtained via Canadian provincial survey and educational workshops.
Results
Chiropractor respondents included PAE content and exercise prescriptions in most patient appointments (67±27% and 59±35%, respectively), but the largest barriers (2.5/4.0) and least confidence were in their patients to follow through (52±21%). Canadian respondents reported higher knowledge (~0.4/4.0 higher), greater self-confidence (10-20% higher), and provided more PAE recommendations (8%) and prescriptions (16%) than International respondents. Chiropractor respondents were least comfortable advising patients with cancer.
Conclusion
Chiropractor respondents may serve as health promotors to address patient inactivity, and the challenges identified should be addressed through educational training.
Originallypublishedin:JournaloftheCanadian Chiropractic Association 2023Aug;67(2):105-116.
Reproduced withpermission from The Journal of the CanadianChiropractic Association.
Access online:pubmed.ncbi.nlm.nih.gov/37840580/
Prevalence and Characteristics of Healthcare Utilization with Different Providers Among Canadians with Chronic Back Problems: A Population-Based Study
Wong JJ1,2,3, Wang D1,2, Hogg-Johnson S1,2,3, Mior SA1,2,3, Côté P1,2,3 1OntarioTechUniversity, 2CanadianMemorialChiropracticCollege, 3UniversityofToronto
Abstract
Introduction
Understanding healthcare utilization by Canadians with back problems informs healthcare planning nationally.
Research question
What is the prevalence of utilization of healthcare providers (medical doctors, chiropractors, physiotherapists, nurses), and associated characteristics among Canadians with chronic back problems (2001-2016)?
Material and methods
This population-based study used Canadian Community Health Survey data (2001-2016) restricted to respondents with chronic back problems (aged ≥12 years). We used self-reported consultation with healthcare providers (medical doctors, chiropractors, physiotherapists, nurses) from 2001-2010, and self-reported regular healthcare provider from 2015-2016. We calculated the 12-month prevalence of utilization with providers, and used modified Poisson regression to assess sociodemographic, healthrelated and behavioural factors associated with utilization of different providers.
Results
From 2001 to 2010 and 2015/2016, respectively, prevalence of utilization of medical doctors was 87.9% (95% CI 87.6-88.2) and 86.7% (95% CI 85.9-87.5); chiropractors 24.0% (95% CI 23.6-24.4) and 14.5% (95% CI 13.8-15.3); physiotherapists 17.2% (95% CI 16.9-17.6) and 10.7% (95% CI 10.0-11.4); nurses 14.0% (95% CI 13.7-14.2) and 6.6% (95% CI 6.1-7.0). Females were more likely to see any provider than males. Persons of lower socioeconomic status were less likely to consult chiropractors or physiotherapists (2001-2016), or nurses (2001-2010). Immigrants were less likely to consult chiropractors or nurses. Persons
aged >65 years were less likely to consult chiropractors or physiotherapists, and those with fair/poor general health were less likely to consult chiropractors, but more likely to consult other providers.
Discussion and conclusion
Medical doctors were most commonly consulted by Canadians with back problems, then chiropractors and physiotherapists. Characteristics of healthcare utilization varied by provider. Findings inform the need to strengthen healthcare delivery for Canadians with back problems.
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Access online:doi.org/10.1016/j.bas.2024.102812
E Chiropractic Scholarship of Teaching and Learning
EChiropractic Scholarship of Teaching and Learning
Evaluating the Baseline Auscultation Abilities of Second-Year Chiropractic Students Using Simulated Patients and High-Fidelity Manikin Simulators: A Pilot Study
da Silva-Oolup SA1, Giuliano D1, Stainsby B1, Thomas J1, Starmer D1 1CanadianMemorialChiropracticCollege
Abstract
Objective
To assess the ability of 2nd-year students to identify normal and abnormal findings during cardiac and lung auscultation using high-fidelity manikin simulators and standardized patients. A secondary objective was to assess students' perceived competence and confidence in their abilities.
Methods
This was a descriptive pilot study of randomly selected 2nd-year students at 1 chiropractic training program. Participants were asked to perform cardiac and lung auscultation on high-fidelity manikins (2 stations) and standardized human patients (2 stations) with normal and abnormal auscultation sounds. Participants described the auscultated sound as "abnormal" or "normal" and were also asked to score their confidence in describing the sound and competence in performing auscultation on a 100-mm visual analog scale. Descriptive statistics were calculated for all study variables.
Results
Thirty-two students (23 women and 9 men) were included. For lung auscultation, 15.6% were incorrect on the human subject and 6.2% were incorrect on the manikin. For cardiac auscultation, 62.5% were incorrect on the human subject and 40.6% were incorrect on the manikin. Confidence mean scores ranged from 34.8 to 60. Competence mean scores ranged from 34.8 to 50.
Conclusion
Results identified that 2nd-year students from 1 institution were correct in identifying an abnormal sound during
lung auscultation but reported low levels of perceived competence or confidence in their responses. They performed poorly on cardiac auscultation and reported low perceived confidence and competence in their abilities to perform cardiac auscultation and identify sounds.
To understand Canada-based sports chiropractors' attitudes, beliefs, and practical application of sport psychology in the sports injury rehabilitation process.
Methods
A cross-sectional, mixed-methods study design was employed. A questionnaire was emailed to 144 eligible participants including Fellows and Residents of the Royal College of Chiropractic Sports Sciences (Canada) (RCCSS(C)). Fifty-two surveys were returned fully completed. Fifteen respondents completed semi-structured interviews to further examine attitudes and beliefs in sport psychology training, delivery, and referrals.
Results
Approximately two-thirds of Canada-based sports chiropractors felt that athletes were affected psychologically 100% of the time when injured. Sports chiropractors reported using some basic psychological techniques during the sports injury rehab process and expressed interest in having more training in more advanced techniques and practical application of these skills, as well as developing a referral network with sport psychology professionals in Canada.
Conclusions
Sports chiropractors in Canada reported receiving entry level training in sports psychology and understood the importance of addressing the psychological aspects of sports injury. Further research is warranted to explore the effectiveness of current and future sports psychology education interventions for sports chiropractors.
The purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care.
Methods
This study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages.
Results
There was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care.
Conclusion
This sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.
Originallypublished in: Journal ofManipulative and PhysiologicalTherapeutics 2023Mar-Apr;46(3):182-189.
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Access online:doi.org/10.1016/j.jmpt.2023.11.001
Identifying and Prioritizing Research to Inform a Research Agenda for Canadian Chiropractors Working in Sport –
To identify and prioritize research to inform research agenda development for Canadian chiropractors working in sport.
Methods
Clinicians, researchers and leaders from the Canadian sports chiropractic field were invited to participate in 1) a survey to refine a list of research priorities, 2) a Delphi procedure to determine consensus on these priorities, and 3) a prioritization survey.
Results
The top three research priorities were 1) effects of interventions on athletic outcomes, 2) research about sports healthcare teams, and 3) clinical research related to spinal manipulative and mobilization therapy. The three highest ranked conditions to research were 1) low back pain, 2) neck pain, and 3) concussion. Collaborations with sports physicians and universities/ colleges were rated as important research collaborations to pursue.
Conclusions
These results represent the Canadian sports chiropractic perspective to research priority setting and will be used alongside stakeholder input to set the first research agenda for the Canadian sports chiropractic field.
Originallypublishedin:JournaloftheCanadian Chiropractic Association 2022Dec;66(3):227-243.
Identifying Sports Chiropractic Global Research Priorities: An International Delphi
Study of Sports Chiropractors
Belchos M1,2, Lee AD1, de Luca K3, Perle SM4,5, Myburgh C6,7, Mior S1,2 1CanadianMemorialChiropracticCollege, 2OntarioTechUniversity, 3CQUniversity, 4AECCUniversityCollege, 5MurdochUniversity, 6UniversityofSouthernDenmark,7UniversityofJohannesburg
Abstract
Objectives
Developing a research agenda is one method to facilitate broad research planning and prioritise research within a discipline. Despite profession-specific agendas, none have specifically addressed the research needs of the specialty of sports chiropractic. This study determined consensus on research priorities to inform a global sports chiropractic research agenda.
Methods
A Delphi consensus methodology was used to integrate expert opinions. Clinicians, academics and leaders from the international sports chiropractic specialty were recruited using purposive sampling to participate in (1) a Delphi panel involving three voting rounds to determine consensus on research priorities and (2) a priority importance ranking of the items that reached consensus.
Results
We identified and contacted 141 participants, with response rates for rounds 1, 2 and 3, of 44%, 31% and 34%, respectively. From the original 149 research priorities, 66 reached consensus in round 1, 63 in round 2 and 45 items in round 3. Research priorities reaching consensus were collapsed by removing redundancies, and priority ranking identified 20 research priorities, 11 related to collaboration and 6 to research themes.
Conclusions
The top-ranked items for research priorities, research themes and collaborations included the effects of interventions on performance, recovery and return to play; clinical research in sport; and collaborations with researchers in chiropractic educational institutions, respectively.
Originallypublished in:BMJOpenSport & Exercise Medicine 2023 Dec11;9(4):e001755.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1136/bmjsem-2023-001755
Investigating the Research Capacity and Productivity of Canadian Sports Chiropractors
Lee AD1, Muir BJ1, Oh D1, Chung K2, Debusschere R2, Kissel J1, Richer N3, Poulin C4, Murnaghan K1, Stuber K1,5 1CanadianMemorialChiropracticCollege, 2PrivatePractice, 3LavalUniversity, 4UniversitéduQuébecàTrois-Rivières, 5ParkerUniversity Research Center
Abstract
Objectives
To investigate the research capacity and productivity of Canadian sports chiropractors.
Methods
A cross-sectional survey (phase one) and scoping review (phase two) investigated the research capacity and productivity (from 2015-2020) of the Canadian sports chiropractic field.
Results
Most respondents (72%) reported obtaining research training from fellowship and master's programs, with only 2 (1%) PhD qualifications identified. Approximately, 30% reported active involvement in research, with 28% being part-time clinician researchers. Access to human and technological research resources were limited. We identified 67 publications and 16 conference presentations within a five-year period, with clinical, population health, and basic science research as the areas most studied.
Conclusion
The research effort of Canadian sports chiropractors is primarily conducted by clinicians involved in research on a part-time basis. Its research outputs predominantly reflect the research requirements of the RCCSS(C) Sports Sciences Residency Program, highlighting its contribution in developing capacity and producing research for the Canadian sports chiropractic field.
Originallypublishedin:TheJournaloftheCanadian Chiropractic Association 2023Dec;67(3):202-225.
Reproduced withpermission from the Canadian Chiropractic Association.
Access online: PMID: 38283160 /PMCID: PMC10814703
G MSK Assessment
A Systematic Review and Meta Analysis of Measurement Properties for the Flexion Relaxation Ratio in People with and without Non Specific Spine Pain
De Carvalho D1, Mackey S1, To D2, Summers A1, Frey M1, Romme K1, Hogg-Johnson S2, Howarth SJ2 1MemorialUniversityofNewfoundland,
2CanadianMemorialChiropracticCollege,
Abstract
This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a threelevel random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test-retest reliability and lumbar FRR has moderate to high test-retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference - 1.16 [95% CI - 2.00, - 0.32] and - 1.21 [- 1.84, - 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.
GOriginallypublished in: ScientificReports 2024 Feb 8;14(1):3260.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1038/s41598-024-52900-z
An Investigation of the Flexion Relaxation Ratio in
Adults with and without a History of Self-Reported Low Back Pain and Transient Sitting-Induced Pain
It is unknown whether the presence of sitting-induced pain or a clinical history of low back pain (LBP) changes spine function outcomes such as the flexion relaxation ratio (FRR). The purpose of this investigation was to determine whether sitting-induced pain or a history of non-specific LBP results in a different FRR. Forty-seven participants were instrumented with surface electromyography over erector spinae at L1, and accelerometers at L1 and S2. Standing maximum lumbar flexion trials were taken preceding and following a 1-hour sitting trial. Pain ratings during sitting and history of LBP were used to group participants for analysis. FRR values taken after the sitting exposures were compared between those that did and did not develop pain during sitting. Baseline FRR values were compared in participants with and without a history of LBP. No significant differences in FRR were found for either pain groups (p = 0.11) or clinical history (p = 0.85). Lack of differences may be due to participants not currently experiencing a clinical episode of pain when the ratio was measured and/ or because 1-hour sitting exposure was not long enough to induce pain modulation. The findings suggest that neither sitting-induced pain development or clinical history need to be controlled to prevent confounding of FRR.
The Beighton Score (BS) is a tool that dichotomizes those who have generalized joint hypermobility (GJH) and those who do not. Unfortunately, the BS is often used in populations that it was not originally developed for, including athletes for screening purposes. The construct validity of the BS remains unknown in this population. This secondary analysis investigated the construct validity of the BS by comparing varsity athletes' passive shoulder and hip ranges of motion (ROMs) to their respective BS and individual forward bend tests (FBTs). There were statistically significant but weak correlations between shoulder ROMs and the BS (r=0.142, p=0.021). Mean hip ROMs were greater by 5-degrees in those with positive FBTs compared to those with negative FBTs. This difference falls within typical measurement errors that occur in practice. Therefore, our results do not support the construct validity of the BS as a measure of GJH in healthy athletes.
Originallypublishedin:JournaloftheCanadian Chiropractic Association 2023Dec;67(3):269-278.
Reproduced withpermission from the Canadian Chiropractic Association.
Access online: PMCID: PMC10814702 /PMID: 38283156
Characteristics Associated with Comorbid Lumbar
Spinal Stenosis Symptoms in People with Knee or Hip Osteoarthritis: An Analysis of 9,136 Good Life with OsteoArthritis in Denmark (GLA:D®) Participants
Previous studies have found that lumbar spinal stenosis (LSS) often co-occurs with knee or hip OA and can impact treatment response. However, it is unclear what participant characteristics may be helpful in identifying individuals with these co-occurring conditions. The aim of this crosssectional study was to explore characteristics associated with comorbid symptoms of lumbar spinal stenosis (LSS) in people with knee or hip osteoarthritis (OA) enrolled in a primary care education and exercise program.
Methods
Sociodemographic, clinical characteristics, health status measures, and a self-report questionnaire on the presence of LSS symptoms was collected at baseline from the Good Life with osteoArthritis in Denmark primary care program for knee and hip OA. Cross-sectional associations between characteristics and the presence of comorbid LSS symptoms were assessed separately in participants with primary complaint of knee and hip OA, using domainspecific logistic models and a logistic model including all characteristics.
Results
A total of 6,541 participants with a primary complaint of knee OA and 2,595 participants with a primary complaint of hip OA were included, of which 40% and 50% reported comorbid LSS symptoms, respectively. LSS symptoms were associated with similar characteristics in knee and hip OA. Sick leave was the only sociodemographic variable consistently associated with LSS symptoms. For clinical characteristics, back pain, longer symptom duration and bilateral or comorbid knee or hip symptoms were also
consistently associated. Health status measures were not consistently related to LSS symptoms.
Conclusion
Comorbid LSS symptoms in people with knee or hip OA undergoing a primary care treatment program of group-based education and exercise were common and associated with a similar set of characteristics. These characteristics may help to identify people with cooccurring LSS and knee or hip OA, which can be used to help guide clinical decision-making.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1186/s12891-023-06356-3
Convergent and Discriminative Validity of the PROMIS
Physical Function 4 Questionnaire for Assessing PainRelated Disability in Low Back Pain Patients Seeking Chiropractic Care
Sandal LF1, Young JJ1,2, Søgaard K1, Hartvigsen J1,3 1UniversityofSouthernDenmark,2CanadianMemorialChiropracticCollege, 3ChiropracticKnowledgeHub
Abstract
Study design
A prospective cohort study.
Objective
To investigate construct validity by examining the convergent and discriminative validity of the Patient-Reported Outcomes
Measurement Information System Physical Function 4a (PROMIS-PF4) questionnaire in low back pain (LBP) patients seeking care from Danish chiropractors.
Summary of background data
The Roland-Morris Disability Questionnaire (RMDQ) is often used to assess physical functioning in LBP. However, it consists of 24 items, which is time consuming to complete in clinical practice. The PROMIS-PF4 questionnaire has only four items and may be more applicable for clinical use.
Materials and methods:
Patients with LBP seeking care from chiropractors in Denmark completed the PROMIS-PF4, RMDQ, Subgroups for Targeted Treatment (STarT) Back screening tool, and Numeric Pain Rating Scale (NPRS) in advance of their first appointment with the chiropractor. Convergent validity was assessed using Spearman correlation coefficients between the PROMIS-PF4 and RMDQ and NPRS, respectively. Discriminative validity of the PROMIS-PF4 was assessed by calculating the area under the receiver operating characteristic curve (AUC) when plotting the PROMIS-PF4 t score against a reference case for RMDQ; NPRS; and high and low risk groups using the STarT Back screening tool.
Results
Among 356 patients the PROMIS-PF4 questionnaire had strong convergent validity with the RMDQ ( r =-0.76) and moderate convergent validity with the NPRS ( r =-0.42).
The PROMIS-PF4 had good and acceptable discriminative validity for disability (AUC=0.88) and high risk of persisting disability (AUC=0.72), and poor or no discriminative validity for pain intensity (AUC=0.66) and low-risk of persisting disability (AUC=0.26), respectively.
Conclusion
As hypothesized, for convergent validity the PROMIS-PF4 has stronger correlation with the RMDQ than the NPRS and good discriminative validity for identifying patients with pain-related disability and at high risk of persisting disability but not for identifying pain intensity or low-risk of persisting disability. Consequently, the PROMIS-PF4 has adequate construct validity for measuring pain-related disability in an LBP population in chiropractic care.
Originallypublished in:Spine (Phila Pa 1976). 2022Sep 15;47(18):1314-1320.
1MacquarieUniversity, 2CanadianMemorialChiropracticCollege, 3Université du Québec à Trois-Rivières
Abstract
Background
Leg length inequality (LLI) greater than 20 mm has been associated with low back pain (LBP) and its correction is clinically recommended. Much less is known about the biomechanical effects that LLI below 15 mm has on pelvis orientation.
Methods
Twenty-two adult participants (8 female) aged between 18 and 30 years without LBP were enrolled in the study and completed a series of sit-to-stand trials with no heel-lift (0 mm baseline) and heel-lifts of varying heights (5, 9 and 12 mm) placed in their right shoe. Three-dimensional kinematic data were obtained from the lower extremities, pelvis and thorax. Additional kinematic data were obtained from the left and right sides of the pelvis. The global orientation of the whole pelvis and relative orientation between the left and right sides of the pelvis were obtained in upright standing immediately upon completion of the sit-to-stand movement. Repeated measures ANOVAs were used to detect differences in sample means across the different levels of heel-lift (0, 5, 9, and 12 mm). The tests for within-subject effects determined overall significant differences between the means at the different levels of heel-lift induced LLI. Partial Eta-Squared was used to express the size for the main effect of heel-lift height. For each level of heel-lift, the estimated marginal mean and 95% confidence interval (95% CI) values of pelvis angles were illustrated graphically.
Results
Left frontal plane rotation of the pelvis increased (p = 0.001), that is, the left side of the pelvis was lower than the right side of the pelvis, and anterior tilt of the pelvis
decreased (p = 0.020) with a heel-lift height (applied on the right) as low as 5 mm. A significant main effect of heellift was only observed for the norm of rotations about all three axes for relative-pelvis orientation (p = 0.034). Posthoc analyses did not reveal any statistically significant differences between the heel-lifts and the 0 mm baseline (p≥0.072).
Conclusion
These findings suggest that correcting leg length inequality below the recommended threshold of 20 mm may influence pelvic orientation. Future work can investigate the effects of the altered orientations on spine loading and the clinical effects of corrections to minor leg length inequality.
Low-back and neck pain affect a great number of individuals worldwide. The pressure pain threshold has the potential to be a useful quantitative measure of mechanical pain in a clinical setting, if it proves to be reliable in this population. The objectives of this systematic review are to: (1) analyze the literature evaluating the reliability of pressure pain threshold (PPT) measurements in the assessment of neck and low-back pain, (2) summarize the evidence from these studies, and (3) characterize the limitations of PPT measurement.
Databases and data treatment
Relevant literature from PubMed and the Web of Science electronic databases were screened in a 3-step process according to inclusion/exclusion criteria. Relevant studies were assessed for risk of bias using the Quality Appraisal of Reliability Studies (QAREL) tool, and results of all studies were summarized and tabulated.
Results
Of 922 citations identified, 11 studies were deemed relevant for critical appraisal, and 8 studies were deemed to have low risk-of bias. Intra-rater reliability, reported in all studies (n = 637) and inter-rater reliability, reported in 2 studies (n = 200) were consistently reported to be good to excellent (ICC 0.75-0.99 and ICC 0.81-0.90, respectively). Studies were also found to have significant variation in PPT measurement procedures.
Conclusions
Though intra- and inter-rater reliability was found to be high in all studies, the variation in PPT measurement protocols could affect validity and absolute reliability. As such, it is recommended that standard guidelines be developed for clinical use.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1177/20494637231196647
H Outcomes of Various Chiropractic Therapies
Outcomes of Various Chiropractic Therapies
Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process
Weis CA1 , Pohlman K2, Barrett J3, Clinton S4, da Silva-Oolup S1, Draper C1, Lee J1 , Kumar R7, O'Beirne M6, Stuber K1 , Hawk C5
1Canadian Memorial Chiropractic College, 2Parker University, 3McMaster University, 4Andrews University, 5Texas Chiropractic College, 6University of Calgary, 7UT Southwestern Medical Center, 8University of Calgary
Abstract
Objective
The purpose of this project was to develop a bestpractices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.
Methods
A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.
HResults
Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.
Conclusion
An expert panel convened to develop the first best-practice consensus document on chiropractic care for pregnant and postpartum patients with LBP or PGP. The document
consists of 71 statements on chiropractic care for pregnant and postpartum patients with LBP and PGP.
Originallypublished in: Journal ofManipulative and PhysiologicalTherapeutics 2022Sep;45(7):469-489.
Reproduced withpermission from Elsevier.
Access online:doi.org/10.1016/j.jmpt.2021.03.002
Conservative Management of Cervical Radiculopathy: A Systematic Review
The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR).
Methods
We searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022 to identify studies that were randomized controlled trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach.
Results
Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. There is very-low certainty evidence supporting the use of acupuncture, prednisolone, cervical manipulation, and lowlevel laser therapy for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term. There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty.
Discussion
There is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.
Effectiveness of Multimodal Rehabilitation Interventions for Management of Cervical Radiculopathy in Adults: An Updated Systematic Review from
the Ontario Protocol for Traffic Injury
Management (Optima) Collaboration
Mallard F1,2, Wong JJ1,3, Lemeunier N3,4, Côté P1,3 1CanadianMemorialChiropracticCollege, 2 InstitutFranco-EuropéendeChiropraxie, 3OntarioTechUniversity, 4Université Toulouse III Paul Sabatier
Abstract
Objective
To update the systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration and to evaluate the effectiveness of multimodal rehabilitation interventions for the management of adults with cervical radiculopathy.
Study design
Systematic review and best-evidence synthesis.
Methods
Eligible studies (from January 2013 to June 2020) were critically appraised using the Scottish Intercollegiate Guidelines Network and Risk of Bias 2.0 criteria. The certainty of the evidence was assessed according to Grading of Recommendations Assessment, Development, and Evaluation.
Results
Four RCTs were deemed acceptable and 1 RCT was considered low quality. In adults with recent-onset cervical radiculopathy, multimodal rehabilitation was associated with a trivial and nonclinically important reduction in neck pain compared with mechanical cervical traction; no differences in disability were reported (1 study, 360 participants, low certainty of the evidence). In adults with cervical radiculopathy of any duration, (i) multimodal rehabilitation may be more effective than prescribed physical activity and brief cognitive-behavioural approach; specifically, a small reduction in arm pain and in function
was found (1 study, 144 participants, low certainty of the evidence); (ii) no difference in pain reduction was found between multimodal rehabilitation interventions compared with an epidural steroid injection (1 study, 169 participants, low certainty of the evidence); and (iii) compared with surgery combined with neck exercises, multimodal rehabilitation interventions lead to similar arm pain reduction and improvement in function (1 study, 68 participants, low certainty of the evidence).
Conclusion
The evidence suggests that some multimodal rehabilitation care may provide small and trivial reduction in neck pain or improvement in function to patients with cervical radiculopathy.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.2340/jrm.v54.2799
Effectiveness of Postsurgical Rehabilitation following Lumbar Disc Herniation Surgery: A Systematic Review
Yu H1,2, Cancelliere C1, Mior S1,2,3, Pereira P4,5, Nordin M6, Brunton G1, Wong JJ1,2,3, Shearer HM1,2,7, Connell G1,2, Ead L1,2, Verville L1, Rezai M1, Myrtos D2, Wang D1,2, Marchand AA8, Romanelli A2, Germann D2, To D2, Young JJ4,9, Southerst D1,2, Candelaria H10, Hogg-Johnson S1,2,3, Côté P1,2,3 1OntarioTechUniversity, 2CanadianMemorialChiropracticCollege, 3UniversityofToronto, 4UniversityofPorto, 5CentroHospitalarUniversitário S.João, 6UniversityofSouthernDenmark, 7HollandBloorviewKidsRehabilitationHospital, 8UniversitéduQuébecàTrois-Rivières,9University HealthNetwork, 10Trillium Health Partners
Abstract
Introduction
The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear.
Research question
To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH.
Material and methods
This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach.
Results
This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including
exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events.
Discussion and conclusion:
Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, wholebody magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).
Exercise rehabilitation has been proposed for the management of Neurogenic Thoracic Outlet Syndrome (NTOS). To date there have been no reviews of the literature regarding exercise rehabilitation for NTOS and their proposed clinical rationale. Understanding various exercise protocols and their clinical rationale may help guide rehabilitation clinicians in their exercise selection when managing NTOS. A scoping review was conducted on exercise rehabilitation for NTOS from inception to March 2021 in the PubMed database. Forty-seven articles consisting of literature reviews, non-randomized control trials, prospective and retrospective cohort studies, case series, case studies and clinical commentaries met the inclusion criteria. This scoping review provides a broad overview of the most common exercise protocols that have been published and examines the purported clinical rationale utilized in the management of NTOS.
Originallypublishedin:JournaloftheCanadian Chiropractic Association 2022Apr;66(1):43-60.
Reproduced withpermission from the Canadian Chiropractic Association.
Access online: PMCID: PMC9103635 /PMID: 35655698
Measurement Properties and Minimal Important Change of the World Health Organization Disability Assessment Schedule 2.0 in Persons with Low Back Pain: A Systematic Review
To determine the measurement properties and minimal important change (MIC) of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short (12 questions) and full (36 questions) versions in persons with nonspecific low back pain (LBP).
Data sources
MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, and Cochrane Central Register of Controlled Trials (inception to May 2021).
Study selection
Eligible studies assessed measurement properties or MIC of WHODAS 2.0 in persons with LBP.
Data extraction
Paired reviewers screened articles, extracted data, and assessed risk of bias using Consensus-Based Standards for Selection of Health Measurement Instruments (COSMIN) and COSMIN-Outcome Measures in Rheumatology checklists.
Data synthesis
We descriptively synthesized results stratified by measurement property and LBP duration (subacute: 6 weeks to 3 months; chronic: ≥3 months).
Results
We screened 297 citations and included 14 studies (reported in 15 articles). Methodological quality of studies was very good for internal consistency and varied between very good and doubtful for construct validity, doubtful for responsiveness, and adequate for all other properties assessed. Evidence suggests that WHODAS 2.0 full version has adequate content
validity (2 studies); WHODAS 2.0 short and full versions have adequate structural validity (3 studies), but construct validity is indeterminate (9 studies). WHODAS 2.0 short and full versions have adequate internal consistency (10 studies), and the full version has adequate test-retest and interrater reliability (3 studies) in persons with LBP. Minimal detectable change (MDC) was 10.45-13.99 of 100 for the full version and 8.6 of 48 for the short version in persons with LBP (4 studies). WHODAS 2.0 full version has no floor or ceiling effects, but the short version has potential floor effects in persons with chronic LBP (3 studies). One study estimated MIC for the full version as 4.87 of 100 or 9.74 of 100 (corresponding to 1- and 2-point change on 0- to 10-cm visual analog scale for pain, respectively), and 1 study estimated 3.09-4.68 of 48 for the short version.
Conclusions
In persons with LBP, WHODAS 2.0 full version has adequate content validity, structural validity, internal consistency, and reliability. WHODAS 2.0 short version has adequate structural validity and internal consistency. Construct validity of the short and full versions is indeterminate. Since MDC is estimated to be larger than MIC, users may consider both MIC and MDC thresholds to measure change in functioning for LBP.
Originallypublished in: Archives ofPhysical Medicine and Rehabilitation. 2023Feb;104(2):287-301.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1016/j.apmr.2022.06.005
Minimal Important Difference of the 12-Item World Health Organization Disability Assessment Schedule (WHODAS) 2.0
The World Health Organization Disability Assessment Schedule 2.0 12-item survey (WHODAS-12) is a questionnaire developed by the WHO to measure functioning across health conditions, cultures, and settings. WHODAS-12 consists of a subset of the 36 items of WHODAS-2.0 36-item questionnaire. Little is known about the minimal important difference (MID) of WHODAS-12 in persons with chronic low back pain (LBP), which would be useful to determine whether rehabilitation improves functioning to an extent that is meaningful for people experiencing the condition. Our objective was to estimate an anchor-based MID for WHODAS-12 questionnaire in persons with chronic LBP.
Methods
We analyzed data from two cohort studies (identified in our previous systematic review) conducted in Europe that measured functioning using the WHODAS-36 in adults with chronic LBP. Eligible participants were adults with chronic LBP with scores on another measure as an anchor to indicate participants with small but important changes in functioning over time [Short-form-36 Physical Functioning (SF36-PF) or Oswestry Disability Index (ODI)] at baseline and follow-up (study 1: 3-months post-treatment; study 2: 1-month post-discharge from hospital). WHODAS-12 scores were constructed as sums of the 12 items (scored 0-4), with possible scores ranging from 0 to 48. We calculated the mean WHODAS-12 score in participants who achieved a small but meaningful improvement on SF36-PF or ODI at follow-up. A meaningful improvement was an MID of 4-16 on ODI or 5-16 on SF36-PF.
Results
Of 70 eligible participants in study 1 (mean age = 54.1 years, SD = 14.7; 69% female), 18 achieved a small meaningful improvement based on SF-36 PF. Corresponding mean WHODAS-12 change score was - 3.22/48 (95% CI -4.79 to -1.64). Of 89 eligible participants in study 2 (mean age = 65.5 years, SD = 11.5; 61% female), 50 achieved a small meaningful improvement based on ODI. Corresponding mean WHODAS-12 change score was - 5.99/48 (95% CI7.20 to -4.79).
Conclusions
Using an anchor-based approach, the MID of WHODAS-12 is estimated at -3.22 (95% CI -4.79 to -1.64) or -5.99 (95% CI7.20 to -4.79) in adults with chronic LBP. These MID values inform the utility of WHODAS-12 in measuring functioning to determine whether rehabilitation or other health services achieve a minimal difference that is meaningful to patients with chronic LBP.
Few clinical prediction models are available to clinicians to predict the recovery of patients with post-collision neck pain and associated disorders. We aimed to develop evidence-based clinical prediction models to predict (1) self-reported recovery and (2) insurance claim closure from neck pain and associated disorders (NAD) caused or aggravated by a traffic collision.
Methods
The selection of potential predictors was informed by a systematic review of the literature. We used Cox regression to build models in an incident cohort of Saskatchewan adults (n = 4923). The models were internally validated using bootstrapping and replicated in participants from a randomized controlled trial conducted in Ontario (n = 340). We used C-statistics to describe predictive ability.
Results
Participants from both cohorts (Saskatchewan and Ontario) were similar at baseline. Our prediction model for selfreported recovery included prior traffic-related neck injury claim, expectation of recovery, age, percentage of body in pain, disability, neck pain intensity and headache intensity (C = 0.643; 95% CI 0.634-0.653). The prediction model for claim closure included prior traffic-related neck injury claim, expectation of recovery, age, percentage of body in pain, disability, neck pain intensity, headache intensity and depressive symptoms (C = 0.637; 95% CI 0.629-0.648).
Conclusions
We developed prediction models for the recovery and claim closure of NAD caused or aggravated by a traffic collision. Future research needs to focus on improving the predictive ability of the models.
The aims of this study were to (1) examine if the location of pregnancy-related back pain impacts activities of daily living and absence from work and (2) determine which types of pain were more likely to persist postpartum.
Methods
This was a secondary analysis of data from an observational cohort study. Data were collected in Ontario between 2013 and 2014. Four pain location groups were identified, including low back pain (LBP), pelvic girdle pain (PGP), combined pain, and mixed pain. Logistic regression models were used to examine the impact of pain location on activity and absence from work. Descriptive analyses explored the association between pregnancy pain location and postpartum pain patterns.
Results
We surveyed 305 pregnant participants and followed up with 80 of these participants up to 6 months postpartum. Data analysis showed approximately a 2-fold increase in interference with employment (outside the home) and self-grooming for those with combined pain compared to those only experiencing LBP. Respondents with PGP and combined PGP and LBP had approximately a 5-fold increased likelihood of absence from work compared to respondents with only LBP; those with a mixture of LBP and PGP had a 13-fold increase in likelihood. Approximately 50% of respondents reported being pain-free, 16% experienced lingering pain, and 38% experienced persistent pain within 6 months postpartum. Those with combined pain during pregnancy continued to have persistent pain up to 6 months postpartum.
Conclusion
The results suggest that the location of pregnancy-related back pain is associated with interference in daily activities, an increase in absence from work, and the persistence of postpartum pain. For this cohort, back pain did not always resolve after delivery, and those experiencing pregnancyrelated combined pain continued to experience symptoms postpartum.
Originallypublished in: Journal ofManipulative and PhysiologicalTherapeutics 2023Mar-Apr;46(3):143-151.
Reproduced withpermission from Elsevier.
Access online:doi.org/10.1016/j.jmpt.2024.02.001
Systematic Review Procedures for the World Health Organization (WHO) Evidence Syntheses on
and Harms of Structured
Benefits
and Standardized Education/ Advice, Structured Exercise Programs, Transcutaneous
Electrical Nerve Stimulation (TENS), and Needling Therapies for the Management of Chronic Low Back Pain in Adults
As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this series, we discuss methodological considerations, clinical implications and recommendations for future research.
Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.
Methods
Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence.
Results
We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved healthrelated quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95% CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = - 1.21, 95% CI - 1.50; - 0.92) and 3 months (9 RCTs; MD = - 1.56, 95% CI - 2.80; - 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = - 1.39, 95% CI2.00; - 0.77) and 3 months (8 RCTs; SMD = - 0.57, 95% CI - 0.92; - 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = - 1.10, 95% CI - 1.71; -
0.48) and 3 months (SMD = - 1.04, 95% CI - 1.66; - 0.43).
Compared with usual care, NT reduced pain (MD = - 1.35, 95% CI - 1.86; - 0.84) and functional limitations (MD =2.55, 95% CI - 3.70; - 1.40) at 3 months.
Conclusion
Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes.
Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.
Methods
Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence.
Results
We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months postintervention. Compared with no intervention, education/ advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54).
Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low.
Conclusion
Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.
To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.
Methods
We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/ sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE.
Results
Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95% confidence interval -1.54 to -0.26), and a reduction in pain catastrophizing in the short term (3 months) with TENS versus no intervention
or interventions with TENS specific effects (1 RCT) (MD = -11.20, 95% CI -17.88 to -3.52). For other outcomes, little or no difference was found between TENS and the comparison interventions. The certainty of the evidence for all outcomes was very low.
Conclusions
Based on very low certainty evidence, TENS resulted in brief and marginal reductions in pain (not deemed clinically important) and a short-term reduction in pain catastrophizing in adults with CPLBP, while little to no differences were found for other outcomes.
Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.
Methods
We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/ sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.
Results
We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95%
CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence).
Conclusions
With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.
This prospective, community-based, active surveillance study aimed to report the incidence of moderate, severe, and serious adverse events (AEs) after chiropractic (n = 100) / physiotherapist (n = 50) visit in offices throughout North America between October-2015 and December-2017. Three content-validated questionnaires were used to collect AE information: two completed by the patient (pre-treatment [T0] and 2-7 days post-treatment [T2]) and one completed by the provider immediately post-treatment [T1]. Any new or worsened symptom was considered an AE and further classified as mild, moderate, severe or serious. From the 42 participating providers (31 chiropractors; 11 physiotherapists), 3819 patient visits had complete T0 and T1 assessments. The patients were on average 50±18 years of age and 62.5% females. Neck/back pain was the most common presenting condition (70.0%) with 24.3% of patients reporting no condition/preventative care. From the patients visits with a complete T2 assessment (n = 2136 patient visits, 55.9%), 21.3% reported an AE, of which: 7.9% were mild, 6.2% moderate, 3.7% severe, 1.5% serious, and 2.0% had missing severity rating. The most common symptoms reported with moderate or higher severity were discomfort/pain, stiffness, difficulty walking and headache. This study provides valuable information for patients and providers regarding incidence and severity of AEs following patient visits in multiple community-based professions. These findings can be used to inform patients of what AEs may occur and future research opportunities can focus on mitigating common AEs.
An Interprofessional Approach to Collaborative Management of Low-Back Pain in Primary Care: A Scholarly Analysis of a Successful Educational Module for Prelicensure Learners
In 2008, an interprofessional education (IPE) working group was formed to develop a module on interdisciplinary low-back pain management to fill a curricular gap at our institution. This article describes the program evaluation outcomes and highlights factors contributing to its successful implementation over 8 years through reference to Brigg's Presage-Process-Product (3-P) Model of Teaching and Learning.
Methods
Program evaluation occurred through administration of a pre- and postmodule Health Professional Collaborative Competency Perception Scale, with scores compared using paired t tests. Descriptive statistics were analyzed from 5-point Likert scales for module session components.
Results
IA total of 853 students from 9 health care occupations (medicine, chiropractic, physiotherapy, pharmacy, nursing, nurse practitioner, occupational therapy, physiotherapy assistants, and occupational therapist assistants) participated in 51 iterations of the module from 2011 to 2019, averaging 16 participants each session. All Health Professional Collaborative Competency Perception Scale items significantly improved from pre- to postintervention (p < .001) for learners from 6 health professions. Module components were rated highly, with the majority of learners rating these as 4 (helpful) or 5 (very helpful) for their learning. Participants also improved their scores in perceived history and physical exam comfort, knowledge of pharmacotherapy, management options, and attitudes regarding an interprofessional approach to back pain (p < .001).
Conclusion
This article describes the presage, process factors, and products of this model IPE program that provides learners from various health care professions with an opportunity to gain a deeper understanding of the interdisciplinary management of low-back pain, as demonstrated through improvement in collaborative competencies.
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 teambased 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.
Originallypublished in: HealthcareManagement Forum 2024Sep;37(1_suppl):555-61S.
The aim of this educational study was to investigate the use of interactive case-based modules relating to the screening and identification of early-stage inflammatory arthritis in both online technology (OLT) and paper (PF) formats with identical content.
Methods
Forty learners from family medicine or rheumatology residency programs were recruited. Content pertaining to a "Sore Hands, Sore Feet" (SHSF) and Gait Arms Legs Spine (GALS) screening tool modules were selected, reviewed and developed based on a validated curriculum from the World Health Organization and Canadian Curriculum for MSK conditions. Both the SHSF module and GALS screening tool were assessed via a randomized control trial. Assessments were completed during an orientation with all learners; then prior to the intervention (T1); at the end of the module (T2) and 3 months following the modules (T3) to assess retention. Focus groups were conducted to determine learners' satisfaction with the different learning formats. Baseline data was collated, and analysis performed after randomization into the PF (control) and OLT (experimental) groups. Repeated measures ANOVA was used for statistical analyses.
Results
Forty participants were recruited and randomized into the PF or OLT group (n = 20 each). At 3 months, there were n = 31 participants for SHSF (PF n = 19, OLT n = 12) and n = 32 for GALS (PF n = 19, OLT n = 13). There was no significant difference between the OLT and PF groups in both analyses. A significant increase in scores from Pre- to Post-Module in SHSF (F (1, 18) = 24.62. p < .0001) and GALS (F (1, 30) = 40.08, p < .0001) were identified to
suggest learning occurred with both formats. The repeated measures ANOVA to assess retention revealed a significant decrease in scores from Post-Module to Follow-up for both learning format groups for SHSF (F (1, 29) = 4.68. p = .039), and GALS (F (1, 30) = 18.27. p < .0001) suggesting 3 months may be too long to retain this educational information.
Conclusions
Both formats led to residents' ability to screen, identify and initially manage inflammatory arthritis. The hypothesis is rejected because both OLT and PF groups demonstrated significant learning during the process regardless of format. It is important to emphasize that from T1 (premodule) to T2 (post-module), the residents demonstrated learning regardless of group to which they were assigned. However, learning retention declined from T2 (postmodule) to T3 (three-month follow-up). Regular review of knowledge may be required earlier than 3 months to retain information learned. This study may impact educational strategies in MSK health.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online: doi.org/10.1186/s12909-022-03746-4
Delivery / Telehealth J
Delivery / Telehealth
Agreement and Concurrent Validity Between Telehealth and In-Person Diagnosis of Musculoskeletal Conditions: A Systematic Review
Oh D1, To D1, Corso M1,2, Murnaghan K1, Yu H2, Cancelliere C2 1CanadianMemorialChiropracticCollege,
2OntarioTechUniversity
Abstract
Objectives
To assess the concurrent validity and inter-rater agreement of the diagnosis of musculoskeletal (MSK) conditions using synchronous telehealth compared to standard in-person clinical diagnosis.
Methods
We searched five electronic databases for cross-sectional studies published in English in peer-reviewed journals from inception to 28 September 2023. We included studies of participants presenting to a healthcare provider with an undiagnosed MSK complaint. Eligible studies were critically appraised using the QUADAS-2 and QAREL criteria. Studies rated as overall low risk of bias were synthesized descriptively following best-evidence synthesis principles.
Results
We retrieved 6835 records and 16 full-text articles. Nine studies and 321 patients were included. Participants had MSK conditions involving the shoulder, elbow, low back, knee, lower limb, ankle, and multiple conditions. Comparing telehealth versus in-person clinical assessments, interrater agreement ranged from 40.7% agreement for people with shoulder pain to 100% agreement for people with lower limb MSK disorders. Concurrent validity ranged from 36% agreement for people with elbow pain to 95.1% agreement for people with lower limb MSK conditions.
JDiscussion
In cases when access to in-person care is constrained, our study implies that telehealth might be a feasible approach for the diagnosis of MSK conditions. These conclusions are based on small cross-sectional studies
carried out by similar research teams with similar participant demographics. Additional research is required to improve the diagnostic precision of telehealth evaluations across a larger range of patient groups, MSK conditions, and diagnostic accuracy statistics.
Originallypublishedin:ChiropracticManualTherapies 2024 Jun 13:32(1):21.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1186/s12998-024-00542-3
Care at a Distance: Understanding Lived Experiences of People with MSK Disorders
Receiving Non-Pharmacological Interventions Delivered through Synchronous Telehealth:
A Systematic Rapid Review
Atkinson-Graham M1,2, Brunton G1, Cancelliere C1, Corso M1, de Zoete A4, Rubinstein SM3, Murnaghan K2, Mior S1,2 1OntarioTechUniversity, 2CanadianMemorialChiropracticCollege, 3VrijeUniversiteitAmsterdam
Abstract Background
Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders.
Objective
We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth; and (2) what clinical implications can be inferred from qualitative studies focusing on lived experiences for how telehealth is delivered in the management of MSK disorders?
Data Sources
A comprehensive search of MEDLINE, CINAHL, PsycINFO, ProQuest, and Google Scholar from June 2010 to July 2023. Eligible qualitative and mixed methods studies capturing lived experiences of adults with MSK disorders receiving non-pharmacological interventions via synchronous telehealth were included.
Study methods
Systematic rapid review conducted according to WHO guidelines. Titles and abstracts screened by reviewers independently, eligible studies critically appraised, and data was extracted. Themes summarized using the Consolidated Framework for Implementation Research (CFIR). GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) used to assess confidence in synthesis findings.
Results
We identified 9782 references, screened 8029, and critically appraised 22, and included 17 studies. There is evidence to suggest that the experience of telehealth prior to and during the pandemic was shaped by (1) patient perception of telehealth, (2) existing relationships with practitioners, (3) availability and accessibility of telehealth technologies, and (4) perceptions about the importance of the role of the physical exam in assessing and treating MSK disorders.
Conclusion
The five identified implications could be used to inform future research, policy, and strategy development.
Originallypublished in:Digital Health 2024 Mar 15:10:20552076241236573.
Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License creativecommons.org/licenses/by/4.0/
Access online:doi.org/10.1177/20552076241236573
CMCC Faculty Publications 2022-2023
In addition to those featured in Abstracts
1. Abdelkader N, Leonardelli C, Howitt S. Olympic fencer with femoroacetabular impingement syndrome uses active rehabilitation to avoid surgery: A case report. J Bodyw Mov Ther. 2023;33:1-7. PMID: 36775503. 10.1016/j.jbmt.2022.09.002.
2. Ahmadi B, Issa S, Duarte FC, Srbely J, Bartlewski PM. Ultrasonographic assessment of skeletal muscles after experimentally induced neurogenic inflammation (facet injury) in rats. Exp Biol Med (Maywood). 2022;247(21):1873-84. PMID: 36113006. PMC9742751. 10.1177/15353702221119802.
3. Bakaa N, Southerst D, Côté P, Macedo L, Carlesso LC, Mior SA, et al. Assessing cultural competency among Canadian chiropractors: a cross-sectional survey of Canadian Chiropractic Association members. Chiropr Man Therap. 2023;31(1):1. PMID: 36635694. PMC9835226. 10.1186/s12998-023-00474-4.
4. Blanchette MA, Mior SA, Thistle S, Stuber K. Developing key performance indicators for the Canadian chiropractic profession: a modified Delphi study. Chiropr Man Therap. 2022;30(1):31. PMID: 35915502. PMC9344626. 10.1186/s12998-022-00439-z.
5. Briggs AM, Betteridge N, Dreinhöfer KE, Haq SA, Huckel Schneider C, Kopansky-Giles D, et al. Towards healthy populations: A need to strengthen systems for musculoskeletal health. Semin Arthritis Rheum. 2023;58:152147. PMID: 36521288. 10.1016/j. semarthrit.2022.152147.
6. Briggs AM, Jordan JE, Sharma S, Young JJ, Chua J, Kopansky-Giles D, et al. Context and Priorities for Health Systems Strengthening for Pain and Disability in Low- and Middle-Income Countries: A Secondary Qualitative Study and Content Analysis of Health Policies. Health Policy Plan. 2022. PMID: 35876078. 10.1093/heapol/czac061.
7. Cancelliere C, Verville L, Stubbs JL, Yu H, Hincapié CA, Cassidy JD, et al. Post-Concussion Symptoms and Disability in Adults with Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neurotrauma. 2023. PMID: 36472218. 10.1089/neu.2022.0185.
9. Corso M, DeSouza A, Brunton G, Yu H, Cancelliere C, Mior SA, et al. Integrating Indigenous healing practices within collaborative care models in primary healthcare in Canada: a rapid scoping review. BMJ Open. 2022;12(6):e059323. PMID: 35710234. PMC9207893. 10.1136/bmjopen-2021-059323.
10. Csiernik B, Edgar M, DeGraauw C, Howitt S, Hogg-Johnson S. The utility of bioelectrical impedance analysis in the diagnosis of sarcopenia: a systematic review. J Can Chiropr Assoc. 2022;66(2):118-29. PMID: 36275078. PMC9512302.
11. da Silva-Oolup SA, Giuliano D, Stainsby B, Thomas J, Starmer D. Evaluating the baseline auscultation abilities of second-year chiropractic students using simulated patients and high-fidelity manikin simulators: A pilot study. J Chiropr Educ. 2022;36(2):172-8. PMID: 35914216. PMC9536226. 10.7899/jce-21-1.
12. de Luca K, Tavares P, Yang H, Hurwitz EL, Green BN, Dale H, et al. Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey. Int J Environ Res Public Health. 2023;20(7). PMID: 37047983. PMC10094294. 10.3390/ijerph20075369.
13. Duarte FCK, Chien R, Ghazinour G, Murnaghan K, West DWD, Kumbhare DA. Myofascial Pain as an Unseen Comorbidity in Osteoarthritis: A Scoping Review. Clin J Pain. 2023;39(4):188201. PMID: 36943163. 10.1097/ajp.0000000000001102.
14. Duarte FCK, Funabashi M, Starmer D, Partata WA, West DWD, Kumbhare DA, et al. Effects of Distinct Force Magnitude of Spinal Manipulative Therapy on Blood Biomarkers of Inflammation: A Proof of Principle Study in Healthy Young Adults. J Manipulative Physiol Ther. 2022;45(1):20-32. PMID: 35760595. 10.1016/j.jmpt.2022.03.012.
15. Edgar M, Howitt S, DeGraauw C, Hogg-Johnson S. Factors associated with recording the exercise vital sign (EVS) in the electronic health records of patients in chiropractic teaching clinics. J Can Chiropr Assoc. 2022;66(1):61-73. PMID: 35655693. PMC9103641.
16. Edgar MC, Lambert C, Abbas A, Young JJ, McIsaac W, Monteiro R, et al. Development of a low resource exercise rehabilitation application for musculoskeletal disorders to help underserved patients in a primary care setting. J Can Chiropr Assoc. 2022;66(2):130-45. PMID: 36275080. PMC9512304.
17. ElSayed MH, Atif HM, Eladl MA, Elaidy SM, Helaly AMN, Khella HWZ, et al. Betanin improves motor function and alleviates experimental Parkinsonism via downregulation of TLR4/MyD88/NF-KB pathway: Molecular docking and biological investigations. Biomed Pharmacother. 2023;164:114917. PMID: 37244180. 10.1016/j. biopha.2023.114917.
18. Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, et al. Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review. J Can Chiropr Assoc. 2022;66(1):7-20. PMID: 35655699. PMC9103633.
19. Erwin WM. Should you adjust that herniated disc? Thoughts from a chiropractor/molecular scientist. J Can Chiropr Assoc. 2023;67(1):7-18. PMID: 37250457. PMC10211408.
20. Frayne DH, Norman-Gerum VT, Howarth SJ, Brown SHM. Synergistic control of hand position, velocity, and acceleration fluctuates across time during simulated Nordic skiing. Hum Mov Sci. 2022;86:103014. PMID: 36208534. 10.1016/j.humov.2022.103014.
21. Funabashi M, Gorrell LM, Pohlman KA, Bergna A, Heneghan NR. Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review. PLoS One. 2022;17(7):e0270671. PMID: 35839253. PMC9286262. 10.1371/journal.pone.0270671.
22. Gorrell LM, Kuntze G, Ronsky JL, Carter R, Symons B, Triano JJ, et al. Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation. Chiropr Man Therap. 2022;30(1):28. PMID: 35650649. PMC9158147. 10.1186/s12998-022-00438-0.
23. Harmath D, Kazemi M, Côté P, Boynton E. The oneweek prevalence of overuse-related shoulder pain and activity limitation in competitive tennis players living in Toronto: a feasibility study. J Can Chiropr Assoc. 2022;66(1):33-42. PMID: 35655695. PMC9103638.
24. Howarth SJ. Regarding “does intra-lumbar flexion during lifting differ in manual workers with and without a history of low back pain? A crosssectional laboratory study” (Ergonomics 65 13801396 2022). Ergonomics. 2023:1. PMID: 37177787. 10.1080/00140139.2023.2213421.
25. Injeyan HS, Budgell BS. Mitigating Bias in the Measurement of Heart Rate Variability in Physiological Studies of Spinal Manipulation: A Comparison Between Authentic and Sham Manipulation. J Manipulative Physiol Ther. 2022;45(2):104-13. PMID: 35753877. 10.1016/j. jmpt.2022.03.019.
26. Kazemi M, Donaldson S, Hamilton M, Suich N. Food cravings during the first week of concussion. J Can Chiropr Assoc. 2022;66(3):253-64. PMID: 36818364. PMC9914828.
27. Lalji R, Hincapié CA, Macpherson A, Howitt S, Marshall C, Tamim H. Association Between First Attempt Buffalo Concussion Treadmill Test and Days to Recovery in 855 Children With Sport-Related Concussion: A Historical Cohort Study and Prognostic Factors Analysis. Clin J Sport Med. 2023. PMID: 36881442. 10.1097/ jsm.0000000000001134.
28. Lee AD, deGraauw L, Muir BJ, Belchos M, Oh D, Szabo K, et al. Identifying and prioritizing research to inform a research agenda for Canadian chiropractors working in sport - the Canadian sports chiropractic perspective. J Can Chiropr Assoc. 2022;66(3):227-43. PMID: 36818363. PMC9914826.
29. Luu D, Seto R, Deoraj K. Exercise rehabilitation for neurogenic thoracic outlet syndrome: a scoping review. J Can Chiropr Assoc. 2022;66(1):43-60. PMID: 35655698. PMC9103635.
30. Mackey S, Howarth SJ, Frey M, De Carvalho D. An investigation of the flexion relaxation ratio in adults with and without a history of self-reported low back pain and transient sitting-induced pain. J Electromyogr Kinesiol. 2022;67:102719. PMID: 36334404. 10.1016/j. jelekin.2022.102719.
31. Macri EM, Young JJ, Ingelsrud LH, Khan KM, Terluin B, Juhl CB, et al. Meaningful thresholds for patientreported outcomes following interventions for anterior cruciate ligament tear or traumatic meniscus injury: a systematic review for the OPTIKNEE consensus. Br J Sports Med. 2022. PMID: 35973755. 10.1136/ bjsports-2022-105497.
32. Mallard F, Wong JJ, Lemeunier N, Côté P. Effectiveness of Multimodal Rehabilitation Interventions for Management of Cervical Radiculopathy in Adults: An Updated Systematic Review from the Ontario Protocol for Traffic Injury Management (Optima) Collaboration. J Rehabil Med. 2022;54:jrm00318. PMID: 35797062. PMC9422871. 10.2340/jrm.v54.2799.
33. Mathieu J, Lemire J, Steiman I, Provencher B. Differentially diagnosing chronic upper limb paresthesia in a 24-year-old patient: is thoracic outlet syndrome the culprit? A case report. J Can Chiropr Assoc. 2023;67(1):85-96. PMID: 37250464. PMC10211405.
34. Millar N, Batalo B, Budgell B. Trends in the Use of Promotional Language (Hype) in Abstracts of Successful National Institutes of Health Grant Applications, 19852020. JAMA Netw Open. 2022;5(8):e2228676. PMID: 36006644. 10.1001/jamanetworkopen.2022.28676.
35. Millar N, Batalo B, Budgell B. Trends in the Use of Promotional Language (Hype) in National Institutes of Health Funding Opportunity Announcements, 1992-2020. JAMA Netw Open. 2022;5(11):e2243221. PMID: 36409499. PMC9679874. 10.1001/ jamanetworkopen.2022.43221.
36. Millar N, Budgell B. Impact of hype on clinicians’ evaluation of trials - a pilot study. J Can Chiropr Assoc. 2023;67(1):38-49. PMID: 37250465. PMC10211403.
37. Muir B, Boot B, Hamilton M. Can a structural leg length discrepancy contribute to persistent concussion symptoms? A case report. J Can Chiropr Assoc. 2022;66(3):300-9. PMID: 36818361. PMC9914830.
38. Nonoyama ML, Kukreti V, Papaconstantinou E, Kozlowski N, Tsimelkas S. Outcomes and follow-up for children intubated in an adult-based community hospital system: A retrospective chart review. Can J Respir Ther. 2022;58:69-76. PMID: 35757494. PMC9187052. 10.29390/cjrt-2022-015.
39. Oh D, Lee AD, Smith A. Symptomatic tibial tunnel ganglion cyst presenting four years following an ACL hamstring autograft reconstruction: a case report of a rare complication of ACL surgery. J Can Chiropr Assoc. 2022;66(3):293-9. PMID: 36818358. PMC9914829.
40. Ostrander T, deGraauw C, Howarth SJ, HoggJohnson S. Prevalence of shoulder problems in youth swimmers in Ontario. J Can Chiropr Assoc. 2022;66(3):244-52. PMID: 36818360. PMC9914825.
41. Pajaczkowski J. Utilization rates of Active Release Techniques® in the workplace: A descriptive study. Work. 2022. PMID: 35938265. 10.3233/wor-210030.
42. Parks A, Lee AD, Billham J. Recognition and conservative management for a spectrum of sportrelated scapholunate interosseous ligament injuries: a case series. J Can Chiropr Assoc. 2022;66(3):265-81. PMID: 36818359. PMC9914831.
43. Peterson CK, Randhawa K, Shaw L, Shobbrook M, Moss J, Edmunds LV, et al. The Councils on Chiropractic Education International Mapping Project: Comparison of Member Organizations’ Educational Standards to the Councils on Chiropractic Education International Framework Document. J Chiropr Humanit. 2022;29:1-6. PMID: 35874302. PMC9294650. 10.1016/j.echu.2022.05.001.
44. Petrolo A. Meniscal lesion or patellar tendinopathy? A case report of an adolescent soccer player with knee pain. J Can Chiropr Assoc. 2022;66(2):157-71. PMID: 36275082. PMC9512301.
45. Plener J, Ammendolia C, Hogg-Johnson S. Nonoperative management of degenerative cervical radiculopathy: protocol of a systematic review. J Can Chiropr Assoc. 2022;66(1):74-84. PMID: 35655692. PMC9103640.
46. Plener J, Csiernik B, To D, da Silva-Oolup S, Hofkirchner C, Cox J, et al. Conservative Management of Cervical Radiculopathy: A Systematic Review. Clin J Pain. 2023. PMID: 36599029. 10.1097/ ajp.0000000000001092.
47. Plener J, da Silva-Oolup S, To D, Csiernik B, Hofkirchner C, Cox J, et al. Eligibility Criteria of Participants in Randomized Controlled Trials Assessing Conservative Management of Cervical Radiculopathy: A Systematic Review. Spine (Phila Pa 1976). 2022. PMID: 36730764. 10.1097/ brs.0000000000004537.
48. Sandal LF, Young JJ, Søgaard K, Hartvigsen J. Convergent and Discriminative Validity of the PROMIS Physical Function 4 Questionnaire for Assessing Pain-related Disability in Low Back Pain Patients Seeking Chiropractic Care. Spine (Phila Pa 1976). 2022;47(18):1314-20. PMID: 35797626. 10.1097/ brs.0000000000004391.
49. Sears JM, Fulton-Kehoe D, Hogg-Johnson S. Differential underestimation of work-related reinjury risk for older workers: Challenges to producing accurate rate estimates. Am J Ind Med. 2022;65(8):627-43. PMID: 35665525. PMC9354702. 10.1002/ajim.23403.
50. Shearer HM, Verville L, Côté P, Hogg-Johnson S, Fehlings DL. Clinical course of pain intensity in individuals with cerebral palsy: A prognostic systematic review. Dev Med Child Neurol. 2022. PMID: 35871758. 10.1111/dmcn.15358.
51. Smith A, Kumar V, Cooley J, Ammendolia C, Lee J, Hogg-Johnson S, et al. Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study. Chiropr Man Therap. 2022;30(1):39. PMID: 36114583. PMC9479444. 10.1186/s12998-022-00447-z.
52. Southerst D, Bakaa N, Côté P, Macedo L, Carlesso L, Mior SA, et al. Diversity of the chiropractic profession in Canada: a cross-sectional survey of Canadian Chiropractic Association members. Chiropr Man Therap. 2022;30(1):52. PMID: 36494690. PMC9733254. 10.1186/s12998-022-00463-z.
53. Teodorczyk-Injeyan JA, Khella HWZ, Injeyan HS. Clinical Biomarker of Sterile Inflammation, HMGB1, in Patients with Chronic Non-Specific Low Back Pain: A Pilot Cross-Sectional Study. Life (Basel). 2023;13(2). PMID: 36836824. PMC9959829. 10.3390/life13020468.
54. Vella SP, Swain M, Downie A, Howarth SJ, Funabashi M, Engel RM. Induced leg length inequality affects pelvis orientation during upright standing immediately following a sit-to-stand transfer: a pre-post measurement study. BMC Musculoskelet Disord. 2023;24(1):203. PMID: 36932408. PMC10022171. 10.1186/s12891-023-06302-3.
55. Wadey V, Okoro T, Sathiyamoorthy T, Snowdon D, McDonald-Blumer H, Kopansky-Giles D, et al. Impact of interactive multi-media learning for physicians in musculoskeletal education - a pilot study. BMC Med Educ. 2022;22(1):718. PMID: 36224574. PMC9555086. 10.1186/s12909-022-03746-4.
56. Wong JJ, DeSouza A, Hogg-Johnson S, De Groote W, Southerst D, Belchos M, et al. Measurement Properties and Minimal Important Change of the World Health Organization Disability Assessment Schedule 2.0 in Persons With Low Back Pain: A Systematic Review. Arch Phys Med Rehabil. 2022. PMID: 35798195. 10.1016/j.apmr.2022.06.005.
57. Wong JJ, DeSouza A, Hogg-Johnson S, De Groote W, Varmazyar H, Mior SA, et al. Pre-rehabilitation scores of functioning measured using the World Health Organization Disability Assessment Schedule in persons with nonspecific low back pain: a scoping review. Int J Rehabil Res. 2022;45(4):30210. PMID: 36112110. PMC9631777. 10.1097/ mrr.0000000000000548.
58. Yang H, Hurwitz EL, Li J, de Luca K, Tavares P, Green B, et al. Bidirectional Comorbid Associations between Back Pain and Major Depression in US Adults. Int J Environ Res Public Health. 2023;20(5). PMID: 36901226. PMC10002070. 10.3390/ijerph20054217.
59. Young JJ, Kongsted A, Jensen RK, Roos EM, Ammendolia C, Skou ST, et al. Characteristics associated with comorbid lumbar spinal stenosis symptoms in people with knee or hip osteoarthritis: an analysis of 9,136 good life with osteoArthritis in Denmark (GLA:D®) participants. BMC Musculoskelet Disord. 2023;24(1):250. PMID: 37005607. PMC10067254. 10.1186/s12891-023-06356-3.
CMCC Faculty Publications 2023-2024
In addition to those featured in Abstracts
1. Atkinson-Graham M, Brunton G, Cancelliere C, Corso M, de Zoete A, Murnaghan K, et al. Care at a distance: Understanding lived experiences of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous telehealth: A systematic rapid review. Digit Health. 2024;10:20552076241236573. PMID: 38495858. PMC10943750. 10.1177/20552076241236573.
2. Belchos M, Lee AD, de Luca K, Perle SM, Myburgh C, Mior S. Identifying sports chiropractic global research priorities: an international Delphi study of sports chiropractors. BMJ Open Sport Exerc Med. 2023;9(4):e001755. PMID: 38116239. PMC10729262. 10.1136/bmjsem-2023-001755.
3. Bhattacharyya A, Hopkinson LD, Nolet PS, Srbely J. The reliability of pressure pain threshold in individuals with low back or neck pain: a systematic review. Br J Pain. 2023;17(6):579-91. PMID: 37969131. PMC10642499. 10.1177/20494637231196647.
4. Budgell BS, Injeyan HS, Teodorczyk-Injeyan J. Effect of Seated Cervical Spinal Manipulation on Autonomic Nervous System Activity as Measured by Heart Rate Variability and Plasma Norepinephrine Levels: A randomized Pre- and Poststudy. J Manipulative Physiol Ther. 2023;46(4):220-8. PMID: 38483415. 10.1016/j. jmpt.2024.02.003.
5. Campbell A, Wang D, Martin K, Côté P. The one-week prevalence of neck pain and low back pain in postsecondary students at two Canadian institutions. Chiropr Man Therap. 2023;31(1):23. PMID: 37525206. PMC10391772. 10.1186/s12998-023-00496-y.
6. Cancelliere C, Verville L, Southerst D, Yu H, Hayden JA, Ogilvie R, et al. Systematic Review Procedures for the World Health Organization (WHO) Evidence Syntheses on Benefits and Harms of Structured and Standardized Education/Advice, Structured Exercise Programs, Transcutaneous Electrical Nerve Stimulation (TENS), and Needling Therapies for the Management of Chronic Low Back Pain in Adults. J Occup Rehabil. 2023;33(4):618-24. PMID: 37991645. 10.1007/s10926-023-10156-w.
7. Cancelliere C, Yu H, Southerst D, Connell G, Verville L, Bussières A, et al. Improving Rehabilitation Research to Optimize Care and Outcomes for People with Chronic Primary Low Back Pain: Methodological and Reporting Recommendations from a WHO Systematic Review Series. J Occup Rehabil. 2023;33(4):673-86. PMID: 37991649. PMC10684421. 10.1007/s10926-023-10140-4.
8. Carnegie DR, Hirsch SM, Howarth SJ, Beach TAC. Can we enable individuals to reach further down without rounding their backs before beginning a lift? Examining the influence of starting foot and trunk position on reach depth. Ergonomics. 2023:1-11. PMID: 37955653. 10.1080/00140139.2023.2282953.
9. Carnegie DR, Hirsch SM, Beach TAC, Howarth SJ. Restricting lumbar spine flexion redistributes and changes total mechanical energy expenditure during lifting. J Biomech. 2024;168:112132. PMID: 38718594. 10.1016/j.jbiomech.2024.112132.
10. Choi G, Giuliano D, Tibbles A, Howarth SJ, Tran S, Lee J, et al. Investigating force-time characteristics of prone thoracic SMT and self-reported patient outcome measures: a feasibility study. Chiropr Man Therap. 2023;31(1):19. PMID: 37420257. PMC10329299. 10.1186/s12998-023-00491-3.
11. Côté P, Negrini S, Donzelli S, Kiekens C, Arienti C, Shearer H, et al. Introduction to target trial emulation in rehabilitation: a systematic approach to emulate a randomized controlled trial using observational data. Eur J Phys Rehabil Med. 2024;60(1):145-53. PMID: 38420907. 10.23736/s1973-9087.24.08435-1.
12. De Carvalho D, Mackey S, To D, Summers A, Frey M, Romme K, et al. A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain. Sci Rep. 2024;14(1):3260. PMID: 38332128. PMC10853169. 10.1038/s41598-024-52900-z.
13. De Carvalho D, Randhawa K, Verville L, HoggJohnson S, Howarth SJ, Liang C, et al. The Vehicle Seating Intervention Trial: Cross-Over Randomized Controlled Trial to Evaluate the Impact of 2 Car Seat Configurations on Spinal Posture. J Appl Biomech. 2023:1-10. PMID: 37793656. 10.1123/jab.2023-0040.
14. DeSouza A, Wang D, Wong JJ, Furlan AD, HoggJohnson S, Macedo L, et al. Prevalence of unmet rehabilitation needs among Canadians living with longterm conditions or disabilities during the first wave of the COVID-19 pandemic. Arch Phys Med Rehabil. 2023. PMID: 37541355. 10.1016/j.apmr.2023.07.010. jmpt.2022.03.012.
15. Emary PC, Stuber KJ, Mbuagbaw L, Oremus M, Nolet PS, Nash JV, et al. Quality of Reporting Using Good Reporting of A Mixed Methods Study Criteria in Chiropractic Mixed Methods Research: A Methodological Review. J Manipulative Physiol Ther. 2023. PMID: 38142381. 10.1016/j.jmpt.2023.11.004.
16. Frayne DH, Norman-Gerum VT, Howarth SJ, Brown SHM. Experience influences kinematic motor synergies: an Uncontrolled manifold approach to simulated Nordic skiing. J Sports Sci. 2023:1-12. PMID: 37742214. 10.1080/02640414.2023.2260237.
17. GBD 2021 Neck Pain Collaborators (incl KopanskyGiles D). Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(3):e142-e55. PMID: 38383088. PMC10897950. 10.1016/s2665-9913(23)00321-1.
18. GBD 2021 Other Musculoskeletal Disorders Collaborators (incl Kopansky-Giles D). Global, regional, and national burden of other musculoskeletal disorders, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(11):e670-e82. PMID: 37927903. PMC10620749. 10.1016/s2665-9913(23)00232-1.
19. GBD 2021 Rheumatoid Arthritis Collaborators (incl Kopansky-Giles D). Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(10):e594-e610. PMID: 37795020. PMC10546867. 10.1016/s2665-9913(23)00211-4.
20. Green BN, Johnson CD, Crawford C, Tavares PA, Murnaghan K, Haldeman S, et al. Association between spinal and non-spinal health conditions reported in epidemiological studies: a scoping review protocol. BMJ Open. 2023;13(10):e075382. PMID: 37788930. 10.1136/bmjopen-2023-075382.
21. Howitt SD, Welsh P, DeGraauw C. Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes. J Manipulative Physiol Ther. 2023. PMID: 38142379. 10.1016/j.jmpt.2023.11.001.
22. Jenkins HJ, Downie A, Wong JJ, Young JJ, Roseen EJ, Nim CG, et al. Patient and provider characteristics associated with therapeutic intervention selection in a chiropractic clinical encounter: a cross-sectional analysis of the COAST and O-COAST study data. Chiropr Man Therap. 2023;31(1):39. PMID: 37735450. 10.1186/s12998-023-00515-y.
23. Johnson CD, Green BN, Agaoglu M, Amorin-Woods L, Brown R, Kopansky-Giles. Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic. J Chiropr Humanit. 2023;30:23-45. PMID: 37841068. PMC10569958. 10.1016/j.echu.2023.08.001.
24. Keter DL, Bent JA, Bialosky JE, Courtney CA, Esteves JE, Funabashi M, et al. An international consensus on gaps in mechanisms of forced-based manipulation research: findings from a nominal group technique. J Man Manip Ther. 2023:1-7. PMID: 37840477. 10.1080/10669817.2023.2262336.
25. Lee AD, Muir BJ, Oh D, Chung K, Debusschere R, Kissel J, et al. Investigating the research capacity and productivity of Canadian sports chiropractors. J Can Chiropr Assoc. 2023;67(3):202-25. PMID: 38283160. PMC10814703.
26. Leonardelli C, Howitt S, deGraauw L. Canadabased sports chiropractors’ attitudes, beliefs, and practical application of sport psychology in the injury rehabilitation process: a mixed-methods study. J Can Chiropr Assoc. 2023;67(3):226-45. PMID: 38283157. PMC10814706.
27. Mikhail J, Funabashi M, Sobczak S, Descarreaux M, Pagé I. Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: a cadaveric study. Chiropr Man Therap. 2023;31(1):24. PMID: 37550682. PMC10405484. 10.1186/ s12998-023-00493-1.
28. Millar N, Batalo B, Budgell B. Promotional Language (Hype) in Abstracts of Publications of National Institutes of Health-Funded Research, 1985-2020. JAMA Netw Open. 2023;6(12):e2348706. PMID: 38127350. PMC10739072. 10.1001/jamanetworkopen.2023.48706.
29. O’Brien MW, Pellerine LP, Howitt SD, deGraauw C, Fowles JR. Physical activity counselling and exercise prescription practices of chiropractors in Canada and internationally: an exploratory survey. J Can Chiropr Assoc. 2023;67(2):105-16. PMID: 37840580. PMC10575325.
30. Oh D, Nolet PS, Stern P, Galvin P. Risk factors of multiple pulmonary emboli in an elite Ironman triathlete: a case report. J Can Chiropr Assoc. 2023;67(3):279-86. PMID: 38283158. PMC10814704.
31. Parks A, Hogg-Johnson S. Autonomic nervous system dysfunction in pediatric sport-related concussion: a systematic review. J Can Chiropr Assoc. 2023;67(3):246-68. PMID: 38283159. PMC10814701.
32. Parks A, Kazemi M, Frost D, Howarth SJ. Assessing construct validity of the Beighton Score as a measure of generalized joint hypermobility in varsity athletes. J Can Chiropr Assoc. 2023;67(3):269-78. PMID: 38283156. PMC10814702.
33. Peranson J, Weis CA, Slater M, Plener J, KopanskyGiles D. An interprofessional approach to collaborative management of low-back pain in primary care: A scholarly analysis of a successful educational module for prelicensure learners. J Chiropr Educ. 2024:30-7. PMID: https://doi.org/10.7899/JCE-22-24.
34. Plener J, Mior SA, Atkinson-Graham M, HoggJohnson S, Côté P, Ammendolia C. Information is power: a qualitative study exploring the lived experiences of patients with degenerative cervical radiculopathy. Pain. 2023. PMID: 37625188. 10.1097/j. pain.0000000000003019.
35. Plener J, Mior SA, Atkinson-Graham M, HoggJohnson S, Côté P, Ammendolia C. It might take a village: developing a rehabilitation program of care for degenerative cervical radiculopathy from the patient perspective. Disabil Rehabil. 2023:1-8. PMID: 37735902. 10.1080/09638288.2023.2256653.
36. Rahman AA, Hegazy A, Elabbasy LM, Shoaeir MZ, Abdel-Aziz TM, Khella HWZ, et al. Leflunomide induced cardiac injury in adult male mice and bioinformatic approach identifying Nrf2/NF-KB signaling interplay. Toxicol Mech Methods. 2024:1-19. PMID: 38389224. 10.1080/15376516.2024.2322666.
37. Schneider CH, Parambath S, Young JJ, Jain S, Slater H, Sharma S, et al. From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development. Int J Health Policy Manag. 2023;12:7031. PMID: 37579444. PMC10125103. 10.34172/ijhpm.2022.7031.
38. Sears JM, Rundell SD, Fulton-Kehoe D, Hogg-Johnson S, Franklin GM. Using the Functional Comorbidity Index with administrative workers’ compensation data: Utility, validity, and caveats. Am J Ind Med. 2023. PMID: 37982343. 10.1002/ajim.23550.
39. Shearer HM, Côté P, Hogg-Johnson S, Fehlings DL. A good night’s sleep: pain trajectories and sleep disturbance in children with cerebral palsy. J Clin Sleep Med. 2024. PMID: 38169433. 10.5664/ jcsm.10980.
40. Southerst D, Hincapié CA, Yu H, Verville L, Bussières A, Gross DP, et al. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults. J Occup Rehabil. 2023;33(4):625-35. PMID: 37991651. PMC10684630. 10.1007/s10926-023-10120-8.
41. Stupar M, Côté P, Carroll LJ, Brison RJ, Boyle E, Shearer HM, et al. Multivariable prediction models for the recovery of and claim closure related to post-collision neck pain and associated disorders. Chiropr Man Therap. 2023;31(1):32. PMID: 37626364. PMC10464149. 10.1186/s12998-023-00504-1.
42. Verville L, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, et al. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults. J Occup Rehabil. 2023;33(4):65160. PMID: 37991646. PMC10684422. 10.1007/s10926023-10121-7.
43. Verville L, Ogilvie R, Hincapié CA, Southerst D, Yu H, Bussières A, et al. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults. J Occup Rehabil. 2023;33(4):636-50. PMID: 37991647. PMC10684665. 10.1007/s10926-023-10124-4.
44. Wang D, Martin K, Hogg-Johnson S, Papaconstantinou E, Côté P. Prevalence of problematic psychological symptoms in samples of Canadian postsecondary students. J Am Coll Health. 2024:1-16. PMID: 38713863. 10.1080/07448481.2024.2342343.
45. Weis CA, Padkapayeva K, Smith P, Barrett J, Landsman V. Relationship Between Location of Pregnancy-Related and Postpartum-Related Back Pain and Limitations of Daily Activities and Work Participation. J Manipulative Physiol Ther. 2024;46(3):143-51. PMID: 38530696. 10.1016/j. jmpt.2024.02.001.
46. Wong JJ, Côté P, Tricco AC, Watson T, Rosella LC. Characterizing high-cost healthcare users among adults with back pain in Ontario, Canada: a populationbased cohort study. Pain. 2024. PMID: 38442409. 10.1097/j.pain.0000000000003200.
47. Wong JJ, Hogg-Johnson S, De Groote W, ĆwirlejSozańska A, Garin O, Ferrer M, et al. Minimal important difference of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in persons with chronic low back pain. Chiropr Man Therap. 2023;31(1):49. PMID: 38053118. PMC10696846. 10.1186/s12998-023-00521-0.
48. Wong JJ, Wang D, Hogg-Johnson S, Mior SA, Côté P. Prevalence and characteristics of healthcare utilization with different providers among Canadians with chronic back problems: A population-based study. Brain Spine. 2024;4:102812. PMID: 38698804. PMC11063586. 10.1016/j.bas.2024.102812.
49. Yu H, Cancelliere C, Mior SA, Pereira P, Nordin M, Brunton G, et al. Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review. Brain Spine. 2024;4:102806. PMID: 38690091. PMC11059472. 10.1016/j.bas.2024.102806.
50. Yu H, Southerst D, Wong JJ, Verville L, Connell G, Ead L, et al. Rehabilitation of back pain in the pediatric population: a mixed studies systematic review. Chiropr Man Therap. 2024;32(1):14. PMID: 38720355. PMC11080233. 10.1186/s12998-024-00538-z.
51. Yu H, Wang D, Verville L, Southerst D, Bussières A, Gross DP, et al. Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults. J Occup Rehabil. 2023;33(4):661-72. PMID: 37991648. PMC10684627. 10.1007/s10926-023-10125-3.
Faculty Presentations: 2022-23
1. Weis CA, Pohlman K, Barrett J, Clinton S, da Silva-Oolup S, Draper C, et al. Best practices recommendations for chiropractic care for pregnant and postpartum patients: results of a consensus process. 22 Jun 11; Virtual: Parker Seminars Orlando 2022. (poster)
2. Weis CA, Stuber K, Murnaghan K, Wynd S. Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update. 22 Jun 11; Virtual: Parker Seminars Orlando 2022. (poster)
3. Tukhareli N. Mindful Reading: A Bibliotherapy-based Reading Program for College Students and Employees. 22 Jul 24; San Diego, CA: ACC-RAC 2022.
4. Kopansky-Giles D, Beavers, Whelan L, Leung FH, White K, Dewhurst N. Cultivating Collaborative Teams Using and Interprofessional Collaborative Competency Framework in Performance Appraisals. 22 Jul 24; San Diego, CA: ACC-RAC 2022.
5. Budgell B, Fillery M, Wynd S. Visualizing and Analyzing Research Networks: Preliminary Analysis of the Global Chiropractic Research Enterprise Database. 22 Jul 24; San Diego, CA: ACC-RAC 2022.
6. Kopansky-Giles D, Peranson J. Recognizing Our Hidden Faculty: 3-Year Outcomes of the Health Professional Educators Program in the Department of Family Medicine at the University of Toronto. 22 Jul 24; San Diego, CA: ACC-RAC 2022.
7. Kopansky-Giles D, Suri M, Mior S, White K, Jeffs L, Campbell DM. Evaluating the Integration of Interprofessional Collaboration Competencies within Simulation Training. 22 Jul 24; San Diego, CA: ACCRAC 2022.
8. Weis CA, Verville L, Matharu P, Bhatt K, Marchand AA, Cancelliere C. Exercise for the Prevention and Treatment of Low Back and/or Pelvic Girdle Pain During Pregnancy: A Systematic Review Critical Appraisal and Exercise Protocol Summary. 22 Jul 24; San Diego, CA: ACC-RAC 2022.
9. Pohlman K, Hoyt K, Jacobs C, Lawrence D, Madigan D, Stites J, Tibbles A, Monier Z, Long C. Adapting a Conference on Teaching and Integrating EBP into Curricula: PIE2021 for CIH Educators. 22 Jul 24; San Diego, CA: ACC-RAC 2022. (poster)
10. Guist B, Hollandsworth D, Choi G, Carinci M. Enhancing Student Education in Labs with Educational Technology. 22 Jul 24; San Diego, CA: ACC-RAC 2022. (workshop)
11. Budgell B, Wynd S, Fillery M. Assessing Research, Researchers, and Research Performing Organizations. 22 Jul 24; San Diego, CA: ACC-RAC 2022. (workshop)
12. Funabashi M, Tran S, Starmer D. Force Sensing Table Technology and Collaborative Research Opportunities. 22 Jul 24; San Diego, CA: ACC-RAC 2022. (workshop)
13. Weis CA, Doucet C, Brousseau D, Pohlman K. Women’s Health and Chiropractic Educational Audit and Development of Core Competencies. 22 Jul 24; San Diego, CA: ACC-RAC 2022. (workshop)
14. Duarte FC, Chien R, Ghazinour G, Murnaghan K, West DD, Kumbhare D. Myofascial Pain and Myofascial Trigger Points: An Unseen Comorbidity in Osteoarthritis. 22 Sep 22; Toronto, ON: IASP World Congress on Pain.
15. Parikh P, Goldsmith C, Gross A, Chacko N, Gelley G, Burnie S, et al. Mobilization and manipulation for neck pain: a Cochrane review update. 22 Sep 20; Toronto, ON: International Association for the Study of Pain (IASP)
16. Sovak G, Duarte FC, Rios-Garcia J, Rashed S, Budgell B. TENS-like Stimulation Downregulates Interleukin-1 Beta in dorsal root ganglion-derived cell line. 22 Sep 20; Toronto, ON: International Association for the Study of Pain (IASP)
17. Wong JJ, Desouza A, Hogg-Johnson S, De Groote W, Southerst D, Belchos M, Alexopulos S, Mior SA, et al. Psychometric properties and minimal clinically important Difference of the world health organization disability Assessment schedule in persons with low back pain: a systematic review. 22 Oct 19; Milan, Italy: Eurospine 2022. (poster)
18. Wong JJ, Desouza A, Hogg-Johnson S, De Groote W, Varmazyar H, Mior SA, Stern P, et al. Pre-rehabilitation scores of functioning measured using the World Health Organization disability assessment schedule in persons with non-specific low back pain: A scoping review. 22 Oct 19; Milan, Italy: Eurospine 2022. (poster)
19. Wong JJ, Wang D, Hogg-Johnson S, Mior SA, Côté P. Health care utilization by persons with chronic back problems in Canada from 2001 to 2016: A populationbased study. 22 Oct 19; Milan, Italy: Eurospine 2022. (poster)
20. Azad A, Dunham S, Mior SA, Hammerich K, Annamalai D, Dantas A. Improving cultural competence in Canadian chiropractic students and the profession. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
21. Burrell C, Downie A, Pohlman K, Funabashi M, Giuriato R, de Luca K. Using an active surveillance reporting system to prospectively identify adverse events at the Macquarie University chiropractic teaching clinics. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
22. Dunham S, Sgro A, Starmer D. Imposter phenomenon in chiropractic education. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
23. Dunham S, Starmer D, Ead L. Empathy in chiropractic education: A novel approach. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
24. Jacobs C, Injeyan HS, Hogg-Johnson S, Cox J, Abdulla S, To D, et al. The reliability of an electronic health record audit in a chiropractic teaching clinic: Study results and improvements. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/ Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
25. Kopansky-Giles D, Bushway D, Tibbles A. The World Health Organization Global Competency Framework for Universal Health Coverage: Are we training chiropractors to meet these competencies in support of their role as an integral part of the global health workforce? 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
26. Kopansky-Giles D, Stewart A, Zhou G, Peranson J, Rahbar P. Exploring in-person versus virtual interprofessional education in family medicine. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
27. Mior SA, Bakaa N, Annamalai D, Macedo L, Carlesso L, Macdermid JC. Cultural competency among Canadian chiropractors: A national survey. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/ Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
28. Pohlman K, Jacobs C, Hoyt K, Goldenberg JZ, LeFebvre R, Madigan D, et al. Process of integrating evidence for complementary and integrative health care educators: Confidence changes to use and teach evidence-based practice. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
29. Stites J, LeFebvre R, Pohlman K, Jacobs C. Educating educators on evidence. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
30. Verville L, Cancelliere C, Connell G, Lee JG, Munce S, Mior SA, et al. Exploring clinicians' experiences and perceptions of end-user roles in knowledge development: A qualitative study. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/ Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
31. Verville L, Cancelliere C, Connell G, Lee JG, Mior SA, Munce S, et al. Exploring clinician perceptions of a care pathway for the management of shoulder pain: A qualitative study. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
32. Wickes D. What did we learn about learning from the pandemic? 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
33. Wickes D. Evidence mapping of lecture capture research in the health professions: An updated analysis. 22 Nov 2; St. Louis, MI: 11th World Federation of Chiropractic Colleges/Association of Chiropractic Colleges Global Education Conference: Leveling Up: Creating Consistency in Chiropractic Education.
34. Bradaric-Baus C, Howarth SJ, Fillery M, Mior SA. Implementation of a faculty research hours process to increase scholarship amongst teaching faculty. 22 Dec 3; Virtual: Rise of Faculty Scholars: Building Capacity for a Stronger Future Chiropractic Educators Research Forum (CERF).
35. Bradaric-Baus C, Howarth SJ, Fillery M, Mior SA. Implementation of an internal support fund to build research capacity amongst teaching faculty. 22 Dec 3; Virtual: Rise of Faculty Scholars: Building Capacity for a Stronger Future Chiropractic Educators Research Forum (CERF).
36. Budgell B. The Global Chiropractic Research Enterprise: Lexical and social network analyses of education research from 2011 to 2022. 22 Dec 3; Virtual: Rise of Faculty Scholars: Building Capacity for a Stronger Future Chiropractic Educators Research Forum (CERF).
37. Wang S. Is Your Patient Comfortable? The Science of Pain and Discomfort During Spinal Adjustment. 23 Feb 22; Las Vegas NV: Parker Seminars 2023.
38. Wang S. Scientific Foundation of the Adjustment. How Does it Create so Many Neurophysiological Effects? 23 Feb 22; Las Vegas NV: Parker Seminars 2023.
39. Starmer D, Bradaric-Baus C, Dunham S. Optimizing Safety During Hands-on Laboratory Experience. 23 Mar 23; New Orleans, LA: ACC RAC 2023. (workshop)
40. Oberstein R, Wickes D, Mestan M, Morgan B, Bushway D. Looking Ahead: Trends, Transformation and Training in Chiropractic Education. 23 Mar 23; New Orleans, LA: ACC RAC 2023.
41. Wang S, Montag E, Hogg-Johnson S. Discomfort during chiropractic manipulation: A survey of chiropractic students' perceptions of comfort during various manipulative procedures. 23 Mar 23; New Orleans, LA: ACC RAC 2023.
42. Stuber K, Mior SA, Dolan G, Langweiler M, McCarth P. Attitudes toward patient-centeredness among Canadian chiropractors. 23 Mar 23; New Orleans, LA: ACC RAC 2023.
43. Wickes D. The Current Status of Spinal Manipulation in the Management of Musculoskeletal Disorders. 23 Apr 18; Saskatoon, SK: Chiropractic Rounds - Department of Family Medicine - Division of Chiropractic.
44. Howarth SJ, McCreath-Frangakis E, De Carvalho D. Evaluating test-retest reliability of the flexionrelaxation ratio within and between days. 23 May 1; Melbourne, Australia: SpineWeek.
45. Mikhail J, Funabashi M, Sobczak S, Descarreaux M, Pagé I. Investigation of the factors influencing spinal manipulative therapy force transmission through the thorax: A cadaveric study. 23 May 1; Melbourne, Australia: SpineWeek.
46. Funabashi M. Lecture: Are the forces in SMT safe? 23 May 1; Melbourne, Australia: SpineWeek.
47. McCreath-Frangakis E, De Carvalho D, Howarth SJ. Evaluating test-retest reliability of the flexionrelaxation ratio within and between days. 23 May 9; Waterloo, ON: Ontario Biomechanics Conference.
Faculty Presentations: 2023-24
1. Desouza A, Wang D, Wong JJ, Furlan A, Hogg-Johnson S, Mior SA, et al. The prevalence of and factors associated with unmet rehabilitation needs among Canadians with long-term conditions or disabilities during the first wave of the COVID-19 pandemic. 23 Jun 4; Cartagena, Colombia: International Society of Physical and Rehabilitation Medicine World Congress.
2. Mior SA, Wang D, Wong JJ, Hogg-Johnson S, Côté P. A population-based study of healthcare utilization among Canadians with restrictions in daily activity and paritcipation: Prevalence and associated characteristics. 23 Jun 4; Cartagena, Colombia: International Society of Physical and Rehabilitation Medicine World Congress.
3. Mior SA, Wong JJ, Wang D, Hogg-Johnson S, Côté P. Prevalence and characteristics of healthcare utilization with different providers among Canadians with chronic back problems from 2001 to 2016: A population-based study. 23 Jun 4; Cartagena, Colombia: International Society of Physical and Rehabilitation Medicine World Congress.
4. Wang D, Desouza A, Wong JJ, Furlan A, HoggJohnson S, Macedo L, et al. Were unmet rehabilitation needs associated with health deterioration early in the COVID-19 pandemic? A cross-sectional study of Canadians living with long-term conditions or disabilities. 23 Jun 4; Cartagena, Colombia: International Society of Physical and Rehabilitation Medicine World Congress.
5. Wong JJ, Côté P, Tricco A, Watson T, Laura R. Characterizing high-cost healthcare users among adults with back pain in Ontario, Canada: A populationbased cohort study. 23 Jun 4; Cartagena, Colombia: International Society of Physical and Rehabilitation Medicine World Congress.
6. Côté P. Cochrane Rehabilitation. 23 Jun 4; Cartagena, Colombia: International Society of Physical and Rehabilitation Medicine World Congress (workshop).
7. Wong JJ, Côté P, Tricco A, Watson T, Rosella L. Characterizing high-cost healthcare users among adults with back pain in Ontario, Canada: A populationbased cohort study. 23 Jun 13; Portland, OR: Society for Epidemiological Research 2023 Meeting.
8. Wong JJ, Wang D, Hogg-Johnson S, Mior SA, Côté P. Prevalence and characteristics of healthcare utilization with different providers among Canadians with chronic back problems from 2001 to 2016: A populationbased study. 23 Jun 13; Portland, OR: Society for Epidemiological Research 2023 Meeting.
9. Belchos M. Identifying sports chiropractic global research priorities: An international Delphi study. 23 Jun 17; Paris, France: FICS Global Symposium.
10. Eindhoven E. I expected to be pain free: a qualitative; study exploring athletes’ expectations and experiences of care received by sports chiropractors 23 Jun 17; Paris, France: FICS Global Symposium.
11. Lee A. Identifying and prioritizing research to inform a research agenda for Canadian chiropractors working in sport – the Canadian sports chiropractic perspective. 23 Jun 17; Paris, France: FICS Global Symposium.
12. deGraauw C. Retrospective analysis of chiropractic care in a multidisciplinary sports healthcare environment – A descriptive survey of Canadian National Team athletes. 23 Jun 17; Paris, France: FICS Global Symposium (poster).
13. Kazemi M. Concussion knowledge among North American Chiropractors 23 Jun 17; Paris, France: FICS Global Symposium (poster).
14. Kazemi M. A clinical crossover trial of the effect of manipulative therapy on pain and passive and active range of motion of the painful hip. 23 Jun 17; Paris, France: FICS Global Symposium (poster).
15. Lee A. A cross-sectional analysis of the Sports and Exercise Research Collaborative for Health PracticeBased Research Network of Canadian Chiropractors Working in Sport (SERCH-PBRN ChiroSport). 23 Jun 17; Paris, France: FICS Global Symposium (poster).
16. deGraauw C, Boot B, Howitt S. Chiropractic clinical instructors' confidence in exercise prescription and counseling following an “Exercise is Medicine” workshop. 23 Jun 24; Virtual: Keeping It Real: Practice Relevant Education Chiropractic Educators Research Forum (CERF).
17. deGraauw L, Cox J, Kissel J, Murnaghan K, HoggJohnson S. Measuring evidence-based practice knowledge, skills, attitudes, and behavior in students of manual therapy education programs: A scoping review of instruments and their measurement properties. 23 Jun 24; Virtual: Keeping It Real: Practice Relevant Education Chiropractic Educators Research Forum (CERF).
18. Moore MP, Pohlman K, Funabashi M, Salsbury S. Identifying patient safety competency themes: A qualitative evaluation from personnel in chiropractic teaching clinics. 23 Jun 24; Virtual: Keeping It Real: Practice Relevant Education Chiropractic Educators Research Forum (CERF).
19. Cancelliere C. WHO Low Back Guideline Development from Start to Finish. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
20. Cancelliere C. Critical Appraisal of Diagnostic Studies. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
21. Crowther T. EBP as Reflective Practice. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
22. Crowther T. Global Experience in EBP. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
23. Mior SA, Atkinson-Graham M. Engaging Qualitative Health Research: Applying and Appraising Qualitative Studies. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
24. Pohlman K, Dunham S, Madigan D. Introduction, Agenda and Objectives. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
25. Pohlman K, Dunham S, Madigan D. Examples from CIH Programs - Train and Integrate. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
26. Pohlman K, Dunham S, Stites J. Foundations of Evidence-Based Practice (EBP). 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
27. Ross JK. Faculty Training in the Acquisition of EBP Skills. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
28. Stites J, Lee A, Rowell R. Ground Rules and What to Expect. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
29. Stites J, Lee A, Rowell R. Modeling EBP Teaching, Feedback and Innovation. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
30. Tibbles A. Creating Institutional Processes. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
31. To D. Integrate EBP Behaviors into Clinics and Patient Care. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
32. Tukhareli N. Transforming Library Collections and Services in Response to Professional Development Needs. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
33. Tukhareli N, deGraauw L. The "Apply" E-Module: How to Teach Shared Decision Making and Empathy. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
34. Tukhareli N, Murnaghan K. From ‘Live Searches’ to LibGuides: Library Resources to Support EBP. 23 Jul 13; Toronto, ON: Process of Integrating Evidence (PIE) for CIH Educators.
35. Carnegie DR, Hirsch S, Beach TA, Howarth SJ. Kinetic adaptations to restricting spine motion during lifting. 23 Aug 8; Knoxville, TN: American Society of Biomechanics Annual Meeting.
36. Shearer H. The fundamentals of Study Designs in Clinical Epidemiology. 23 Sep 7; Milan, Italy: The 5th Cochrane Rehabilitation Methodological Meeting.
37. Sovak G, Duarte FC, Rios-Garcia J, Rashed S, Budgell B. Effect of TENS-like stimulation on NFkB cellular localization abd interleukin-1β and ERK/p-ERK levels in a dorsal root ganglion-derived cell line. 23 Sep 7; Lisbon, Portugal: NeuPSIG 2023 International Conference on Neuropathic Pain.
38. Shearer H, Fehlings D, Switzer L. Changes in Pain Intensity and Associated Factors in Young Children with Cerebral Palsy. 23 Sep 12; Chicago, IL: American Academy of Cerebral Palsy & Developmental Medicine 77th Annual Meeting.
39. Shearer H, Côté P, Hogg-Johnson S, Fehlings D. Methodological Strategies Used to Develop One-Year Pain Intensity Trajectories in Children and Youth with Cerebral Palsy. 23 Sep 12; Chicago, IL: American Academy of Cerebral Palsy & Developmental Medicine 77th Annual Meeting (poster).
40. Testani D, Shearer H, Munce S, King G, Switzer L, Fehlings D. Exploring Predictors of Participation from Pre-School to School Aged Children with Cerebral Palsy. 23 Sep 12; Chicago, IL: American Academy of Cerebral Palsy & Developmental Medicine 77th Annual Meeting (poster).
41. Bakaa N, DiPelino S, Southerst D, Mior SA, Carlesso L, Macdermid JC, et al. Factors that Influence Delivery of Canadian Chiropractic Services to Equity-Seeking Communities: A Qualitative Study. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
42. Briggs A, Kopansky-Giles D. Global Health Systems Strengthening in Musculoskeletal Health. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
43. Budgell B, Fillery M. Surprising Megatrends in Chiropractic Research: Linguistic and Social Networking Analysis of 60 Years of Chiropractic Research. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
44. Funabashi M. Defining and Classifying Adverse Events Following Joint Manipulation and Mobilization: An international E-Delphi Study. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
45. Funabashi M, Chu E, Gurden M, Christensen HW, Salsbury S. Panel Discussion: What does Clinical Risk Management Look Like for Chiropractors? 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
46. Howitt S, Welsh P, deGraauw C. Retrospective Analysis of Chiropractic Care in A Multidisciplinary Sports Healthcare Environment: A Descriptive Survey of Canadian National Team Athletes. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
47. Jenkins H, Downie A, Wong JJ, Young JJ, Roseen E, Nim CG, et al. Patient and Provider Characteristics Associated with Therapeutic Intervention Selection in a Chiropractic Clinical Encounter: A Cross-Sectional Analysis of the COAST and O-COAST Cohort Study Data. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
48. Kopansky-Giles D, Stewart A, Zhou G, NyhofYoung J, Schuler A, Plener J, et al. Using A Mixed Methods Approach to Exploring in-Person Vs Virtual interprofessional Teaching Among Health Professional Learners in Primary Care. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
49. Moore MP, Funabashi M. Patient Safety in Chiropractic Teaching Programs: A Cross-Sectional Evaluation. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
50. Myburgh C, Kazemi M, Lee A, Howarth SJ, Hill J, Mior SA. Kickstarting G-Care (Global Chiropractic Athletics Research and Education initiative); the Experiences of Chiropractors Working in Elite interdisciplinary Athletic Healthcare and Performance Management Settings. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
51. Passmore S, Bussières A, Tavares P, Kopansky-Giles D, Ward J, Ladwig J, et al. Reducing Barriers to Conservative Spine Care Minimizing Opioid Exposure in an Indigenous Community: A Global Spine Care Initiative Implementation Project in Northern Manitoba, Canada. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
52. Smith NM, Starmer D, Choi G, Howarth SJ, Tran S, Funabashi M. Characterization of Force-Time Characteristics of Prone Cervico-Thoracic Spinal Manipulative Therapy. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
53. Tavares P. Spinal Pain, Chronic Health Conditions and Health Behaviours. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
54. Verville L, Ogilvie R, Hincapié C, Southerst D, Yu H, Bussières A, et al. Systematic Review to inform A World Health Organization Clinical Practice Guideline: Benefits and Harms of Exercise Programs for Chronic Primary Low Back Pain in Adults. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress.
55. Barrigar M, Fillery M. Stage One of DEPrIVe Scale Development: Piloting and Launching Focus Groups to Explore Patient Value Formation and Care-Seeking Providers. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
56. Budgell B, Vindigni D. Global integrative Health: A Tale of 2 Philanthropies. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
57. Cancelliere C, Verville L, Stubbs J, Yu H, Hincapié C, Cassidy JD, et al. Post-concussion symptoms and disability in adults with mild traumatic brain injury: A systematic review and meta-analysis. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
58. Funabashi M, Salsbury S, Pohlman K. What Does Patient Safety Mean to You? A Qualitative Analysis of Survey Responses From 4 international Chiropractic Teaching Clinics: Safetynet Part 1. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
59. Kazemi M. A clinical crossover trial of the effect of manipulative therapy. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
60. Kopansky-Giles D, Parish J, Overton RB, Chopra A, Harris G, Shnier A, et al. Conceptualizing Clinical Expertise in Evidence-Based Practice: A Narrative Literature Review. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
61. Ostrander T. Prevalence of shoulder problems in youth swimmers. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
62. Rahbar P, Kopansky-Giles D, Leung FH, Cheong L, Plener J, Nyhof-Young J, et al. Using Field Notes to Support interprofessional Clinical Competency Assessment of Family Medicine Resident Physicians. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
63. Salsbury S, Pohlman K, Funabashi M. Who are the Key Actors in Patient Safety: A Safety Net Stakeholder Analysis from 4 International Chiropractic Teaching Clinics. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
64. Shearer H, Pohlman K, Miller A, Stevens A, Swain M. The Clinical Course of Spinal Pain in Adolescents: A Feasibility Study in Canada and the United Stated of America. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
65. Yu H, Wang D, Verville L, Southerst D, Bussières A, Gross DP, et al. Systematic Review to inform A World Health Organization Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (poster).
66. Young K, Funabashi M, Nyirö L. Journeys in Research - An Interactive Session. 23 Oct 11; Gold Coast, Australia: 17th WFC Biennial Congress (workshop).
67. Kopansky-Giles D. Integrating and Supporting Health Professional Educators in Family Medicine. 23 Nov 8; Montreal, QC: Family Medicine Forum.
68. Tukhareli N. Library as a therapeutic landscape: Promoting health and well-being to chiropractic students. 23 Dec 2; Virtual: Battling Burnout: Raising Resilience in Education Chiropractic Educators Research Forum (CERF).
69. Budgell B, Fillery M. Megatrends in Chiropractic Research. 24 Mar 21; San Diego, CA: ACC RAC.
70. Dunham S, Starmer D. Experiential learning: Evolution and pandemic changes. 24 Mar 21; San Diego, CA: ACC RAC.
71. Lee A, deGraauw L, Masoumi A, Muir B, Belchos M, Szabo K, et al. A qualitative study investigating the challenges and opportunities for building research capacity in sports-focused research in the chiropractic profession. 24 Mar 21; San Diego, CA: ACC RAC.
72. Perron F, Funabashi M, Gauthier J-L, Pagé I. Comparison of force-time characteristics of prone cervico-thoracic spinal manipulative therapy between chiropractic interns and experienced chiropractors. 24 Mar 21; San Diego, CA: ACC RAC.
73. Porter B, Lee A, Borody C, St-Onge E, Funabashi M. Improving patient safety in the chiropractic teaching clinic setting: A qualitative analysis of stakeholder suggestions. 24 Mar 21; San Diego, CA: ACC RAC.
74. Steiman I, Mior SA, Chung C, Ead L, Wang D. Impact of suspension of chiropractic treatment during the Covid-19 mandated lockdown on patients’ reported symptoms and function: a retrospective case study. 24 Mar 21; San Diego, CA: ACC RAC.
75. Wang S, McCreath-Frangakis E, Funabashi M, HoggJohnson S. Discomfort during side posture lumbopelvic manipulation in a low back pain population: Effects of a modified flexed lumbopelvic position. 24 Mar 21; San Diego, CA: ACC RAC.
76. Weis CA, Brousseau D, Doucet C, Bergström C, DrakeLand B, Kopansky-Giles D, et al. Women's health and chiropractic: Educational audit and development of core competencies. 24 Mar 21; San Diego, CA: ACC RAC.
77. Weis CA, Grondin D, Southerst D, Howarth SJ, Fillery M, Bradaric-Baus C, et al. Research capacity and culture at the Canadian Memorial Chiropractic College: A mixed methods study. 24 Mar 21; San Diego, CA: ACC RAC.
78. Dunham S, Bradaric-Baus C, D’Monte C, Starmer D, Giuliano D, Ross JK, et al. Experiential learning exercise: Lessons learned for curriculum development. 24 Mar 21; San Diego, CA: ACC RAC (poster).
79. Kopansky-Giles D, Passmore S, Bussières A, Tavares P, Ward J. Reducing barriers to conservative spine care to minimize opioid exposure in indigenous community: a global spine care initiative implementation project in northern Manitoba, Canada. 24 Mar 21; San Diego, CA: ACC RAC (poster).
80. Funabashi M, Gorrell LM, Pohlman K, Bergna A, Heneghan N, Group A. Adverse Events (AE) Following Joint Manipulation and Mobilization: An International e-Delphi Study and Focus Groups to Define and Classify these AEs. 24 Apr 9; Cleveland, OH: International Congress on Integrative Medicine and Health.
81. Kopansky-Giles D. Using a mixed methods approach to exploring In-Person vs Virtual Interprofessional Teaching among health professional learners in Primary Care. 24 Apr 12; Vancouver, BC: International Congress on Academic Medicine.
82. Peranson J, Kopansky-Giles D, Derocher M, Ramji N. Guidance for cross-profession supervision in clinical settings. 24 Apr 12; Vancouver, BC: International Congress on Academic Medicine.
83. Kopansky-Giles D, Alleyne J, Passmore S, Wade D. All hands-on deck. Integrating chiropractic on primary care teams. 24 Apr 19; Toronto, ON: Canadian Chiropractic Association National Convention and Tradeshow.
84. Plener J, Mior SA, Atkinson-Graham M, HoggJohnson S, Côté P, Ammendolia C. Information is power: A qualitative study exploring the lived experiences of patients with degenerative cervical radiculopathy. 24 May 9; Valencia, Spain: European Chiropractors’ Union Convention.
85. Plener J, Mior SA, Atkinson-Graham M, HoggJohnson S, Côté P, Ammendolia C. It might take a village: Developing a rehabilitation program of care for degenerative cervical radiculopathy from the patient perspective. 24 May 9; Valencia, Spain: European Chiropractors’ Union Convention (poster).
86. Kopansky-Giles D, Alleyne J, Azad A, Mior SA, Hogg-Johnson S, Peranson J, et al. All hands-on deck! Enhancing comprehensive primary care by integrating musculoskeletal care (chiropractic) on interprofessional teams – supporting education, competency attainment and optimizing integration. 24 May 16; Toronto, ON: Department of Family and Community Medicine Conference (poster).
87. Funabashi M, Gorrell LM, Pohlman K, Bergna A, Heneghan N. Defining and classifying adverse events following joint manipulation and mobilization: an international e-Delphi study and focus groups. 24 Feb 22; Las Vegas, NV: Parker Seminars.
88. Wang S. The Science of the Pop. Exploring Expectations, Cavitations, and Spine Biomechanics. 24 Feb 22; Las Vegas, NV: Parker Seminars.
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