Managing patients with acute and chronic non-specific neck pain: are Danish chiropractors compliant with guidelines?

BACKGROUND: Non-specific neck pain represents a quarter of all chiropractic patient visits in Denmark. Evidence informed practice can help ensure providers use best available treatment, speed up patient recovery rate and reduce healthcare utilization. It is generally believed that Danish chiropractors treat according to best practice, but we do not know if this is true for management of neck-pain. The objective of this study was to investigate how Danish chiropractors treat patients with acute and chronic non-specific neck pain and determine if management is compliant with recent Canadian guideline recommendations. METHODS: An online survey was sent to 554 members of the Danish chiropractic association. A three-part questionnaire was administered asking participants to: 1) rank the frequency of use of a list of treatment modalities; 2) rank treatment modalities they normally use for acute and chronic non-specific neck pain cases; and 3) provide demographic data. Treatment modalities ranked as "used often" were considered in further analysis and compared to the Canadian Guideline recommendations for neck pain. Chi-squared test was used to investigate differences between treatment and guideline compliance for chronic and acute patients. RESULTS: A 65% (362/544) response rate was achieved. The sample demographics were representative of a recent Danish study of the entire chiropractic profession. Danish chiropractors use a wide range of treatment modalities, including spinal manipulation, manual therapy, exercises and information/patient education on most of their acute neck pain patients. The use of other treatment modalities and especially exercises was more commonly used with chronic cases. Guideline compliance was 10% for recommendations for acute patients and 43% for chronic patients. CONCLUSIONS: Danish chiropractors use a wide range of treatment options for managing adult patients with acute and chronic non-specific neck-pain. However, there were important differences in treatments chiropractors offered for acute and chronic patients, particularly for the use of exercise therapy, which was mainly reserved for chronic patients. Danish chiropractors' compliance with guidelines for neck-pain patients was low, but is neither worse nor better than what is seen for other complaints or health disciplines. Our findings suggest a need for active knowledge translation strategies and robust implementation research.

Selecting and training opinion leaders and best practice collaborators: experience from the Canadian Chiropractic Guideline Initiative.

OBJECTIVES: To describe the process for selecting and training chiropractic opinion leaders (OLs) and best practice collaborators (BPCs) to increase the uptake of best practice. METHODS: In Phase 1, OLs were identified using a cross-sectional survey among Canadian chiropractic stakeholders. A 10-member committee ranked nominees. Top-ranked nominees were invited to a training workshop. In Phase 2, a national e-survey was administered to 7200 Canadian chiropractors to identify additional OLs and BPCs. Recommended names were screened by OLs and final selection made by consensus. Webinars were utilized to train BPCs to engage peers in best practices, and facilitate guideline dissemination. RESULTS: In Phase 1, 21 OLs were selected from 80 nominees. Sixteen attended a training workshop. In Phase 2, 486 chiropractors recommended 1126 potential BPCs, of which 133 were invited to participate and 112 accepted. CONCLUSIONS: OLs and BPCs were identified across Canada to enhance the uptake of research among chiropractors.

OBJECTIFS: Décrire le processus permettant de choisir et former les leaders d'opinion (LO) et collaborateurs des pratiques d'exemplaire (CPE) en chiropratique dans le but de favoriser l'adoption des pratiques d'excellence. MÉTHODOLOGIE: Lors de la première phase, on a désigné les LO au moyen d'une enquête transversale parmi les intervenants canadiens de la chiropratique. Un comité composé de dix membres a classé les candidats. Les candidats les mieux classés ont été invités à un atelier de formation. Lors de la deuxième phase, 7 200 chiropraticiens canadiens se sont soumis à une enquête nationale en ligne visant à désigner d'autres LO et CPE. Les noms recommandés ont été présélectionnés par les LO et le choix final s'est fait d'un commun accord. On s'est servi de webinaires pour former les LO à encourager leurs pairs à adopter des pratiques d'excellence et faciliter la diffusion des lignes directrices. RÉSULTATS: Lors de la première phase, on a choisi 21 LO parmi 80 candidats. Seize d'entre eux ont assisté à un atelier de formation. Lors de la deuxième phase, 486 chiropraticiens ont recommandé 1 126 LO potentiels, parmi lesquels 133 ont été invités à participer et 112 ont accepté. CONCLUSIONS: On a désigné des LO et CPE à l'échelle du pays pour favoriser l'adoption de la recherche parmi les chiropraticiens.