Guidance concerning chiropractic practice in response to COVID-19 in the U.S.: a summary of state regulators' web-based information.

INTRODUCTION: The COVID-19 pandemic led to unprecedented changes, as many state and local governments enacted stay-at-home orders and non-essential businesses were closed. State chiropractic licensing boards play an important role in protecting the public via regulation of licensure and provision of guidance regarding standards of practice, especially during times of change or uncertainty. OBJECTIVE: The purpose of this study was to summarize the guidance provided in each of the 50 United States, related to chiropractic practice during the COVID-19 pandemic. METHODS: A review of the public facing websites of governors and state chiropractic licensing boards was conducted in the United States. Data were collected regarding the official guidance provided by each state's chiropractic licensing board as well as the issuance of stay-at-home orders and designations of essential personnel by state governors. Descriptive statistics were used to report the findings from this project. RESULTS: Each of the 50 state governor's websites and individual state chiropractic licensing board's websites were surveyed. Stay-at-home or shelter-in-place orders were issued in 86% of all states. Chiropractors were classified as essential providers in 54% of states, non-essential in one state (2%), and no guidance was provided in the remaining 44% of all states. Fourteen states (28%) recommended restricting visits to only urgent cases and the remaining states (72%) provided no guidance. Twenty-seven states (54%) provided information regarding protecting against infectious disease and the remaining states (46%) provided no guidance. Twenty-two states (44%) provided recommendations regarding chiropractic telehealth and the remaining states (56%) provided no guidance. Seventeen states (34%) altered license renewal requirements and eight states (16%) issued warnings against advertising misleading or false information regarding spinal manipulation and protection from COVID-19. CONCLUSION: State guidance during the COVID-19 pandemic was heterogenous, widely variability in accessibility, and often no guidance was provided by state chiropractic licensing boards. Some state chiropractic licensing boards chose to assemble guidance for licensees into a single location, which we identified as a best practice for future situations where changes in chiropractic practice must be quickly communicated.

Correlation of Body Composition and Low Back Pain Severity in a Cross-Section of US Veterans.

OBJECTIVE: Back pain is more prevalent in the obese, but whether back pain severity is directly correlated to obesity in veterans is unknown. We sought to determine if there was a correlation between body composition and low back pain severity in a sample of veterans. The hypothesis was that veterans with higher body mass index values would report higher low back pain severity scores. METHODS: This study was a retrospective chart review of 1768 veterans presenting to a Veterans Affairs chiropractic clinic with a chief complaint of low back pain between January 1, 2009 and December 31, 2014. Spearman's rho was used to test for correlation between body composition as measured by body mass index and low back pain severity as measured by the Back Bournemouth Questionnaire. RESULTS: On average, the sample was predominantly male (91%), older than 50, and overweight (36.5%) or obese (48.9%). There was no correlation between body mass index and Back Bournemouth Questionnaire scores, r = .088, p < .001. CONCLUSIONS: The majority of veterans with low back pain in this sample were either overweight or obese. There was no correlation between body composition and low back pain severity in this sample of veterans.

Chiropractic Management of a Patient With Thoracic Pain and a Stable Thoracic Aortic Aneurysm: A Case Report.

OBJECTIVE: The purpose of this case report was to describe chiropractic management of thoracic pain in a patient with a stable thoracic aortic aneurysm. CLINICAL FEATURES: An 89-year-old man presented with axial mid- and upper back pain localized predominantly at the T8 and T1 spinal segmental levels. A review of available imaging revealed a stable aneurysmal dilatation of the ascending aorta, which measured 4.3 cm. INTERVENTION AND OUTCOME: Because the thoracic pain was musculoskeletal in nature and the thoracic aortic aneurysm was stable, mechanical manipulation was provided using the Impulse adjusting instrument. The patient's pain was measured utilizing a numeric rating scale. The patient's thoracic pain improved over the course of treatment. CONCLUSION: This patient was successfully treated for thoracic spine pain with a course of chiropractic care using a mechanical adjusting instrument.