ABSTRACT
Objective: The purpose of this descriptive report is to describe the development of a preparticipation risk assessment screening process for incoming students prior to participation in practical labs. Methods: A committee at the Palmer College of Chiropractic, Florida met to discuss a health history questionnaire, physical examination process, and course of action to have second-year students use their current knowledge to screen incoming students for possible clinical considerations of practice lab participation. The aim was to identify potential risk factors that may require application modification associated with performing and receiving adjustments and other hands-on lab activities within the curriculum. The preparticipation screening process, focused on general health and curriculum referenced chiropractic clinical considerations, and was created as an expansion of the existing informed consent procedures to screen incoming students prior to participating in palpation, technique, physical examination, and open adjusting labs in the chiropractic program. Any clinical considerations identified during the screening were referred to be fully evaluated by a third-year clinic intern and faculty-licensed chiropractor to maintain classroom safety standards for the students. Referred students were restricted from full classroom lab participation until recommendations from the clinic or outside licensed healthcare providers managing their concerns were received. Results: The program was implemented in April 2022. Eight out of the 48 students evaluated in the first group and 12 of the 81 in the second group had possible clinical considerations to participation and were referred appropriately for a full evaluation. In the third group, 35 out of 146 students with suspected clinical considerations to participation were identified. Of the 55 students referred out, all students are now actively participating in classroom activities. Fifteen have been cleared to return to classroom participation with no restrictions and the remaining 40 students have been released for participation with patient-specific restrictions as directed by their managing health care providers. Conclusion: The preparticipation screening process was implemented as all incoming students since the inception of the process have been screened, referred for evaluation when deemed appropriate, and cleared to participate in labs either with or without restrictions. This process has also demonstrated the possibility of identifying multiple clinical considerations for safe curricular participation while participating in doctor-patient simulated classroom activities. This process may be helpful for new students to recognize the patient history and examination procedures as an important aspect of a patient encounter prior to receiving treatment.
ABSTRACT
BACKGROUND: Patient-reported outcome measurements (PROM) are instruments that seek a patient's health or functional status. Inclusion of standardized PROMs in research studies and clinical practice provides a more comprehensive understanding of an intervention from the patient's viewpoint. This secondary analysis identified PROM usage and appropriateness of references for property measurements from clinical trials included in a recent systematic review of pediatric manual therapy. METHODS: All included manuscripts within a recent systematic review had two authors extract PROM and associated property measurement data, including the property measurements supporting citations. Inclusion criteria for the articles were published clinical trials (observational or experimental) of pediatric children receiving manual therapy (any profession) for any condition between 2001-March 2018. For each PROM's associated property measurement, two authors used the COSMIN study design checklist to appraise the quality of the cited study to evaluate the property measurement. RESULTS: Of the 50 manuscripts included in the systematic review, 20 manuscripts reported the use of 52 PROMs. Of the 52 PROMs assessed, 31 did not make a statement about the instrument's property measurement, 7 PROMs had property measurements stated but not referenced, 4 PROMs stated that the property measurement information was unknown, and 10 had property measurement data with reference(s). These 10 PROMs with referenced property measurements were from 7 unique PROMs: constipation assessment scale, satisfaction visual analog scale (VAS), crying time diary, sleep diary, fear avoidance belief questionnaire (FABQ), pain VAS, and autism treatment evaluation checklist. The assessment of the referenced property measurements found that several property measurement's dimensions had not been assessed and those that had were evaluated were done so with poor or fair standards. CONCLUSIONS: This secondary analysis finds that clinical studies of pediatric manual therapy lack consistent use of PROMs with high quality property measurements. Further research to establish and implement PROMs to be used in future research studies and in clinical settings should become a priority for professions using manual therapy in children.
ABSTRACT
Correspondence from Yu et al. identify methodological issues with the systematic review of manual therapy for pediatric manuscript. Like any research study, limitations are important for readers to keep in consideration when reviewing study findings. The primary authors maintain full confidence in the use of the review to provide practicing clinicians with a comprehensive overview of the limited and low-quality available evidence regarding manual therapies for the pediatric patient.
Subject(s)
Musculoskeletal Manipulations , Child , HumansABSTRACT
BACKGROUND: This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report. METHODS: Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study. RESULTS: Of the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity. CONCLUSIONS: Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed. TRIAL REGISTRATION: PROSPERA registration number: CRD42018091835.
