Feasibility Using Amazon Mechanical Turk for Online Surveys of Attitudes and Perceptions of Chiropractic Health Care in the United States.

OBJECTIVE: The purpose of this study was to determine the feasibility and utility of using Amazon Mechanical Turk (MTurk) for online surveys of US adults about their perceptions of chiropractors and to report differences between people who have positive versus negative attitudes toward chiropractic care. METHODS: A 74-item, unvalidated survey was developed through iterative review to assess attitudes of respondents to chiropractic, including a query stratifying respondents based on previous and future use of chiropractic (have used, would consider; have used, would not consider; have not used, would consider; have not used, would not consider). The electronic survey was delivered using Qualtrics; respondents were recruited using MTurk, a crowdsourcing website. Descriptive statistics, including frequencies and cross tabulations, were performed. RESULTS: A total of 1300 responses were obtained. Consistent with previous reports, 32.2% of the respondents reported having seen a chiropractor in the past. Chiropractic care was perceived as being effective for musculoskeletal complaints. Respondents who would not consider future chiropractic care shared a common set of beliefs related to training of chiropractors, scope of chiropractic practice, and safety and reputation of chiropractic. These respondents reported increased likelihood of chiropractor use with the recommendation of a primary care physician. CONCLUSION: Recruiting survey participants using MTurk is feasible, affordable, and quick and offers high utility to academic researchers. Using this resource, we ascertained preliminary data about attitudes and perceptions from individuals who would or would not consider chiropractic, stratified by their previous use.

The meaning of it all: evaluating knowledge of Minimal Clinically Important Difference (MCID) among chiropractic students.

INTRODUCTION: Patient-reported outcome measures are frequently used to monitor patient progress during chiropractic care, yet student interns utilizing such assessments are unfamiliar with what magnitude of change (MCID) is considered beneficial to the patient. OBJECTIVE: This work seeks to determine chiropractic intern knowledge of MCID. METHODS: A five-item survey was administered to 104 chiropractic student interns. RESULTS: Nearly one-third of the interns correctly defined the MCID acronym, and approximately one-third of the interns knew at least one MCID value for the outcome assessments in the EHR. Surprisingly, 20% of the interns reported knowledge of at least one MCID value, but answered incorrectly pertaining to the MCID acronym. CONCLUSION: Student interns value patient perception, but have limited knowledge of MCID values. Addressing this gap will improve their understanding of patient progress and inform their treatment decisions both in the outpatient clinic and in their practices following graduation.

INTRODUCTION: Les mesures de résultats rapportés par les patients sont fréquemment utilisées pour suivre les progrès du patient pendant les soins chiropratiques, mais les stagiaires qui utilisent ces évaluations ne sont pas familiers avec l'ampleur des changements (différence minimale cliniquement importante ­ DMCI) considérée comme bénéfique pour le patient. OBJECTIF: Cette étude vise à déterminer les connaissances, chez les stagiaires en chiropratique, de la DMCI. MÉTHODOLOGIE: Une enquête comportant cinq points a été menée chez 104 stagiaires en chiropratique. RÉSULTATS: Près d'un tiers des stagiaires ont correctement défini l'acronyme DMCI (MCID en anglais), et environ un tiers d'entre eux était au courant au moins d'une valeur de DMCI pour les évaluations de résultats dans le DSE. Étonnamment, 20 % des stagiaires ont indiqué connaître au moins une valeur de DMCI, mais n'ont pas su reconnaître l'acronyme DMCI. CONCLUSION: Les stagiaires accordent de l'importance à la perception des patients, mais ont une connaissance limitée des valeurs de DMCI. Combler cette lacune permettra d'améliorer leur compréhension des progrès des patients et d'informer leurs décisions de traitement tant en consultation externe que dans leurs pratiques après l'obtention du diplôme.

Positive outcomes increase over time with the implementation of a semiflipped teaching model.

The flipped teaching model can engage students in the learning process and improve learning outcomes. The purpose of the present study was to assess the outcomes of a semiflipped teaching model over time. Neurophysiology students spent the majority of class time listening to traditional didactic lectures, but they also listened to 5 online lectures and spent 8-10 class periods completing an active learning assignment. At the end of the term, students completed a survey to assess the outcomes of the active learning assignments. The positive outcomes were greater the second time the course was taught in a semiflipped manner. While completely flipping a course takes a tremendous amount of time, instructors can still obtain positive outcomes by implementing a semiflipped teaching model.

Multimodal chiropractic care of pain and disability for a patient diagnosed with benign joint hypermobility syndrome: a case report.

OBJECTIVE: The purpose of this case report is to describe multimodal chiropractic care of a female patient diagnosed with benign joint hypermobility syndrome (BJHS) and a history of chronic spine pain. CLINICAL FEATURES: A 23-year-old white female presented for chiropractic care with chronic low back pain, neck pain, and headaches. The patient was diagnosed with BJHS, including joint hypermobility of her thumbs, elbows, right knee, and lumbopelvic region. A 6-year history of low back pain and varicose veins in her posterior thighs and knees were additional significant diagnostic findings of BJHS. INTERVENTIONS AND OUTCOMES: The treatment consisted of spinal and extremity manipulation, Graston technique, and postisometric relaxation combined with sensory motor stimulation and scapular stabilization exercises. The patient was seen 15 times over an 18-week period. After 18 weeks of care, the Revised Oswestry Low Back Questionnaire and Headache Disability Index demonstrated clinically important improvements with her low back pain and headache; but little change was noted in her neck pain as measured by the Neck Disability Index. CONCLUSION: This patient with BJHS who had decreased disability and spine pain improved after a course of multimodal chiropractic care.

Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain, and dizziness in older adults.

OBJECTIVE: The purpose of this study was to collect preliminary information on the effect of a limited and extended course of chiropractic care on balance, chronic pain, and associated dizziness in a sample of older adults with impaired balance. METHODS: The authors conducted a randomized pilot study targeting a sample size of 30, comparing 2 schedules of chiropractic care to a no-treatment group. Group 1 (limited schedule) was treated for 8 weeks, group 2 (extended schedule) was treated for 8 weeks and then once per month for 10 months, and group 3 received no treatment. Assessments were made at baseline and 1, 2, 6, and 12 months later. The primary outcome was changed in the Berg Balance Scale (BBS) from baseline to 1 year. Changes in the Pain Disability Index and Dizziness Handicap Index were also measured. RESULTS: Thirty-four patients were enrolled, 13 in group 1, 15 in group 2, and 6 in group 3. Only 5 had baseline BBS scores less than 45, indicating increased risk for falls. There were no treatment-related adverse events. Nine patients dropped out by 1 year. No significant differences within or between groups in median BBS from baseline to 12 months were observed. Median Pain Disability Index scores improved more from baseline to 1 year in group 2 compared with groups 1 and 3 (P = .06, Kruskal-Wallis test). For the 9 patients with dizziness, a clinically significant improvement in Dizziness Handicap Index scores of groups 1 and 2 was observed at 1 month and remained lower than baseline thereafter; this was not true of group 3. CONCLUSION: Further investigation of the possible benefit of chiropractic maintenance care (extended schedule) for balance and pain-related disability is feasible and warranted, as well as both limited and extended schedules for patients with idiopathic dizziness.

Chiropractic management of tendinopathy: a literature synthesis.

OBJECTIVE: Chronic tendon pathology is a soft tissue condition commonly seen in chiropractic practice. Tendonitis, tendinosis, and tendinopathy are terms used to describe this clinical entity. The purpose of this article is to review interventions commonly used by doctors of chiropractic when treating tendinopathy. METHODS: The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. A literature search was performed using the PubMed; Cumulative Index to Nursing and Allied Health Literature; Index to Chiropractic Literature; Manual, Alternative, and Natural Therapy Index System; National Guidelines Clearinghouse; Database of Abstracts of Reviews of Effects; and Turning Research Into Practice databases. The inclusion criteria were manual therapies, spinal manipulation, mobilization, tendonitis, tendinopathy, tendinosis, cryotherapy, bracing, orthotics, massage, friction massage, transverse friction massage, electrical stimulation, acupuncture, exercise, eccentric exercise, laser, and therapeutic ultrasound. RESULTS: There is evidence that ultrasound therapy provides clinically important improvement in the treatment of calcific tendonitis. There is limited evidence of the benefit of manipulation and mobilization in the treatment of tendinopathy. Limited evidence exists to support the use of supervised exercise, eccentric exercise, friction massage, acupuncture, laser therapy, use of bracing, orthotics, and cryotherapy in the treatment of tendinopathy. CONCLUSION: Chiropractors often provide a number of conservative interventions commonly used to treat tendinopathy.

Feasibility study of short-term effects of chiropractic manipulation on older adults with impaired balance.

OBJECTIVE: The purpose of this study was to collect preliminary information on the effects of chiropractic spinal manipulation on reducing risk of falls in older adults with impaired balance, as assessed by the Berg Balance Scale (BBS). This information is necessary to develop a line of investigation into the role of chiropractic care on reduction of fall risk in this population. METHODS: Randomized, 2-group pretest/posttest design feasibility study with a target sample size of 10 (5 per group), conducted within the outpatient health center of a chiropractic college. Inclusion criteria were as follows: aged 60 years or older, able to stand on one leg <5 seconds, and able to attend all sessions. Patients were assigned to chiropractic care (CMT) or supervised exercise (EX) and scheduled for 2 visits per week for 8 weeks. RESULTS: A total of 26 people responded to recruitment; and 11 were enrolled: 6 in the CMT and 5 in the EX group. Two patients dropped out at the baseline visit when they were assigned to the EX group. One CMT patient dropped out in the seventh week because of a fall at home resulting in a leg fracture. All remaining patients were compliant with treatment protocols. Five of 6 CMT patients and 4 of 5 EX patients had baseline BBS scores <45, indicating increased risk of falls. At visit 16, 2 CMT and 1 of the 3 remaining EX patients had BBS scores <45. One mild and transient adverse event was noted. CONCLUSION: Further investigation of the possible role of chiropractic care in reducing fall risk in this population appears feasible.

How much health promotion and disease prevention is enough?: should chiropractic colleges focus on efficacy training in screening for family violence?

INTRODUCTION: Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. METHODS: A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. RESULTS: Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. CONCLUSION: As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.

Treatment of a case of subacute lumbar compartment syndrome using the Graston technique.

OBJECTIVE: To discuss subacute lumbar compartment syndrome and its treatment using a soft tissue mobilization technique. CLINICAL FEATURES: A patient presented with low back pain related to exercise combined with prolonged flexion posture. The symptoms were relieved with rest and lumbar extension. The patient had restrictive lumbar fascia in flexion and rotation and no neurological deficits. INTERVENTION AND OUTCOME: The restrictive lumbar posterior fascial layers and adjoining restrictive fascia (thoracic, gluteal, hamstring) were treated with a form of instrument-assisted soft tissue mobilization called the Graston technique. Restoration of fascial extensibility and resolution of the complaint occurred after 6 treatment visits. CONCLUSIONS: The posterior spinal fascial compartments may be responsible for intermittent lower back pain. Functional clinical tests can be employed to determine whether the involved fascia is abnormally restrictive. Treatment directed at the restrictive fascia using this soft tissue technique may result in improved fascial functional testing and reduction of symptoms.