Twelfth World Federation of Chiropractic Global Education Conference: "Technology and Innovation: Shaping the Future of Chiropractic Education".

This conference was convened by the World Federation of Chiropractic from October 30 to November 2, 2024, in Kuala Lumpur, Malaysia. The 2024 program focused on the delivery of technology in chiropractic education.

Burnout amongst chiropractic faculty, practitioners, and trainees: a scoping review.

OBJECTIVE: The purpose of this scoping review was to summarize the literature pertaining to burnout and chiropractic. METHODS: A literature review was performed in accordance with Preferred Reporting of Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). A literature review was performed by combining the term "chiropractic" with terms relevant to professional burnout (e.g., "work-related stress," "emotional exhaustion"). We included all publications addressing burnout within the chiropractic profession, including all study designs in only peer-reviewed literature. RESULTS: Our search yielded 126 citations and 10 met the inclusion criteria. The studies identified consisted of eight surveys and two narrative reviews published from 2011 to 2024. Six of the studies utilized the Maslach Burnout Inventory to assess burnout. Chiropractic students reported greater burnout than the general population. Factors reported to increase burnout risk include higher workload, insurance mandates, and physical demands of daily practice. Factors reported to be protective against burnout included longer duration in clinical practice and philosophy-based practices. CONCLUSIONS: Research on burnout within the chiropractic profession is limited and may not be generalizable. However, the reported factors contributing to burnout are well-documented. Future research should be conducted to improve understanding of the prevalence and causes of burnout in chiropractic.

Evaluation of chiropractic students' knowledge and attitudes following pain interventions: A randomized educational trial at 2 institutions.

OBJECTIVE: To examine chiropractic students' attitudes regarding knowledge of pain neuroscience, chronic pain, and patient-centered care before and after educational interventions. Secondarily, this study aimed to compare measures of these skills between cohorts at different timepoints throughout training programs. METHODS: Using stratified randomization, 281 Year 3 chiropractic students at 2 institutions were allocated into 1 of 3 educational interventions and served as active-control comparison groups: pain neuroscience education, chronic pain education, or patient-centered care. Participants completed validated surveys regarding their experience with the education interventions immediately pre- and post-lecture and 12 weeks after completion. For further comparison, surveys were also completed by 160 Year 1 students and 118 Year 2 students at 1 of the institutions. Independent sample t tests and 1-way analysis of variance were used for data analysis. RESULTS: All Year 3 lecture groups showed immediate improvements (pain neuroscience education: 3.99 + 3.09/100, p = .18 [95% CI: 10.10 to -1.77]; chronic pain education: 0.42 + 0.74/7, p = .02 [95% CI: 0.72 to 0.07]; patient-centered care: 0.25 + 0.12/6, p = .05 [95% CI: 0.12-0.51]), but these were not sustained at the 12-week follow-up (pain neuroscience education: -6.25 + 4.36/100, p = .15 [95% CI: 14.93 to -2.42]; chronic pain education: 0.33 + 0.16/7, p = .19 [95% CI, 0.66 to 0.01]; patient-centered care: 0.13 + 0.13/6, p = .30 [95% CI: 0.41 to -0.13]). Compared to active controls, only the patient-centered care group showed an immediate statistically significant difference. CONCLUSIONS: While this study found that immediate improvement in targeted competencies is possible with focused interventions, they were not sustained long term.

Expanding concussion care in Canada: the role of chiropractors and policy implications.

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada.

Élargir les soins pour la commotion cérébrale au Canada: le rôle des chiropraticiens et les répercussions sur les politiquesLes commotions cérébrales sont de plus en plus reconnues comme étant une préoccupation de santé publique. Le présent document évalue les lignes directrices canadiennes sur les soins pour la commotion cérébrale, en préconisant l'inclusion d'un plus large éventail de professionnels de la santé (PS) dans l'évaluation, le diagnostic et la gestion des commotions cérébrales. Il met l'accent sur le rôle des chiropraticiens, en plus des médecins (MD) et des infirmières et infirmiers praticien(ne) s (IP), en soulignant leur vaste formation aux troubles musculosquelettiques et neurologiques. Les chiropraticiens sont bien placés pour gérer les symptômes comme les maux de tête, les douleurs du cou et les étourdissements, et pour utiliser des interventions complètes et fondées sur des données probantes, notamment l'éducation des patients, l'exercice thérapeutique, la thérapie manuelle, la rééducation vestibulaire et la physiothérapie de la colonne vertébrale cervicale, et les protocoles de retour à l'exercice (RE). Le document traite également des variations régionales des rôles des chiropraticiens, en mettant l'accent sur la « Loi Rowan ¼ de l'Ontario, et soutient que la limitation des aspects des soins de commotion cérébrale (évaluation, diagnostic, autorisation RE) aux médecins et aux IP peut entraîner des inefficacités et des inégalités en matière de soins de santé. Les conclusions sont importantes pour les décideurs et les responsables de la santé, ce qui indique la nécessité de mettre à jour les lignes directrices sur les soins pour la commotion cérébrale qui intègrent et utilisent divers PS. Cela pourrait mener à une amélioration des résultats pour les patients, de l'efficacité des soins de santé et de l'équité dans la gestion des commotions cérébrales au Canada.

The evolution of teaching chiropractic skills: part 1 - a narrative review of lessons learned during the 120 collective years of four tutors in the technique trenches at the Canadian Memorial Chiropractic College.

"The only constant is change" - Heraclitus, Greek Philosopher The objective of this article, Part 1 of a two part series, is to provide a narrative review of the evolution of teaching chiropractic manual skills by four tutors who taught in the technique trenches at the Canadian Memorial Chiropractic College collectively for 120 years. Based on their collective memories, this narrative review describes the evolution of: central demonstrations; inconsistency between tutors with respect to demonstrating and grading chiropractic manual skills; determining course content; policy on students providing high velocity, low amplitude thrusts on each other during class time and testing; quantitative versus qualitative grading; remediation; acknowledgment of risk and; changes to technique class due to Covid. The results of a unique survey evaluating students' perception of these changes is presented. The intent of this article is for faculty at other accredited educational programs to learn from our experiences and potentially strengthen their pedagogical approach to teaching chiropractic manual skills.

L'évolution de l'enseignement des compétences en chiropratique: la première partie - un examen narratif des leçons apprises au cours des 120 années collectives de quatre tuteurs dans les tranchées techniques au Canadian Memorial Chiropractic CollegeLa seule constante est le changement ¼ - Héraclite, philosophe grecL'objectif de cet article, la première partie d'une série en deux parties, est de fournir une revue narrative de l'évolution de l'enseignement des compétences manuelles en chiropratique par quatre tuteurs qui ont enseigné dans les tranchées techniques au Canadian Memorial Chiropractic College, pendant 120 ans. En se fondant sur leurs souvenirs collectifs, cet examen narratif décrit l'évolution : des démonstrations centrales; de l'incohérence entre les tuteurs en ce qui concerne la démonstration et la notation des compétences manuelles chiropratiques; de la détermination du contenu du cours; de la politique sur les étudiants qui se poussent les uns les autres avec une grande vitesse et une faible amplitude pendant le temps de la classe et des tests; de la notation quantitative par rapport à la notation qualitative; de la remédiation; de la reconnaissance du risque et; des changements apportés à la classe technique en raison de la COVID. Les résultats d'un sondage unique évaluant la perception des élèves à l'égard de ces changements sont présentés dans cet article. L'objectif de cet article est de permettre aux professeurs d'autres programmes d'enseignement accrédités d'apprendre de nos expériences et de renforcer leur approche pédagogique de l'enseignement des compétences manuelles en chiropratique.

Contralateral hip joint degeneration associated with a cam-type deformity of the proximal femur in a retired chiropractor: 10-year follow-up.

Cam-type deformities of the proximal femur have long been associated with femoroacetabular impingement (FAI); an orthopedic condition recognized in the etiology of early osteoarthritis (OA) in the non-dysplastic adult hip. However, the optimal clinical management (including the long-term prognosis) of patients with cam-type deformities with or without FAI symptoms remains uncertain. In this imaging case review (ICR), we present the 10-year follow-up of a retired chiropractor with bilateral cam-type femoral deformities who initially underwent total right hip joint arthroplasty for advanced hip joint OA, and subsequently developed advanced hip joint OA on the contralateral side.

Examen du cas par imagerieDégénérescence controlatérale de l'articulation de la hanche associée à une déformation en came du fémur proximal chez un chiropraticien à la retraite: Suivi sur 10 ansLes déformations de type came du fémur proximal ont longtemps été associées à un conflit fémoro-acétabulaire (CFA); une affection orthopédique reconnue dans l'étiologie de l'arthrose précoce de la hanche adulte non dysplasique. Cependant, la gestion clinique optimale (notamment le pronostic à long terme) des patients présentant des déformations de type came avec ou sans symptômes du syndrome du conflit fémoro-acétabulaire (CFA) avec ou sans facteur rhumatoïde reste incertaine. Dans cet examen de cas par imagerie (ECI), nous présentons le suivi sur 10 ans d'un chiropraticien à la retraite avec des déformations fémorales bilatérales de type came qui a initialement subi une arthroplastie totale de l'articulation de la hanche droite pour l'arthrose de l'articulation de la hanche avancée, et a développé par la suite une arthrose de l'articulation de la hanche avancée du côté controlatéral.

Exploration of chiropractic students' motivation toward the incorporation of new evidence on chiropractic maintenance care: a mixed methods study.

Objectives: This sequential explanatory mixed-method study aimed to explore chiropractic students' attitudes toward incorporating maintenance care (MC) focused evidence. Methods: Attitudes towards using an evidence-based clinical protocol for maintenance care (MC), the MAINTAIN instrument, were assessed via surveys, monologue responses, dialogues, and qualitative feedback. Participants from a single chiropractic educational institution completed questionnaires evaluating their perspectives on patient-centeredness, chronic pain, and evidence incorporation. Descriptive statistics summarized quantitative data, while content analysis was used for qualitative data. Results: 74.4% (n=419) of students participated, mostly male (57.5%), with an average GPA of 3.15 (out of a maximum of 4.0). Qualitative analysis identified the need to clarify MC terminology and factors motivating students to adopt new evidence, such as quality and alignment with healthcare beliefs. Conclusions: This study's findings emphasize the importance of refining healthcare training strategies, including defining terminology and addressing motivators for evidence incorporation, as evidence for MC for low back pain evolves.

L'exploration de la motivation des étudiants en chiropratique en vue de l'incorporation de nouvelles preuves sur les soins de chiropratique d'entretien: une étude sur les méthodes mixtes. Objectifs: Cette étude explicative séquentielle de méthode mixte visait à explorer les attitudes des élèves en chiropratique à l'égard de l'intégration des soins d'entretien (SE). Méthodes: Les attitudes à l'égard de l'utilisation d'un protocole clinique fondé sur des données probantes pour les soins d'entretien (SE), l'instrument d'ENTRETIEN, ont été évaluées au moyen d'enquêtes, de réponses monologues, de dialogues et de commentaires qualitatifs. Les participants d'un seul établissement d'enseignement chiropratique ont rempli des questionnaires évaluant leur point de vue sur la centralité du patient, la douleur chronique et l'incorporation de données probantes. Les statistiques descriptives ont résumé les données quantitatives, tandis que l'analyse du contenu a servi à recueillir des données qualitatives. Résultats: 74,4 % (n=419) des étudiants ont participé à l'étude, principalement des hommes (57,5 %), avec une moyenne de 3,15 (sur un maximum de 4,0). L'analyse qualitative a permis de déterminer la nécessité de clarifier la terminologie des SE et des facteurs qui incitent les élèves à adopter de nouvelles données probantes, comme la qualité et l'harmonisation avec les croyances en matière de soins de santé. Conclusions: Les conclusions de cette étude soulignent l'importance de peaufiner les stratégies de formation en soins de santé, notamment en définissant la terminologie et en répondant aux motivations pour l'incorporation de données probantes, à mesure que les preuves concernant les SE pour les lombalgies évoluent.

An unusual presentation of Herpes zoster and associated differentials.

This case study documents the case of a 27-year-old female who presented with a complaint of left anterolateral thigh numbness, initially diagnosed as meralgia paresthetica with a differential diagnosis of lumbar radiculopathy. Over a span of two weeks, the patient endured emotional trauma and subsequently developed lesions in the area of complaint. The patient was diagnosed at a medical clinic with herpes zoster and was prescribed anti-viral medication which resulted in complete resolution. This case highlights the importance of considering herpes zoster as a differential diagnosis for nerverelated symptoms. Features of lumbar radiculopathy, meralgia paresthetica, varicella zoster and herpes zoster are discussed, as well as the defining characteristics and treatment options. Practitioners must remain vigilant in suspicion of viral infections such as herpes zoster even with lower incidence due to approved vaccines.

Une présentation inhabituelle du zona et des différentiels associésCette étude de cas documente le cas d'une femme de 27 ans qui a présenté une plainte d'engourdissement antérolatéral gauche de la cuisse, initialement diagnostiquée comme une méralgie paresthésique avec un diagnostic différentiel de radiculopathie lombaire. En l'espace de deux semaines, le patient a subi un traumatisme émotionnel et a par la suite développé des lésions dans la zone de la plainte. Le zona a été diagnostiqué chez le patient dans une clinique médicale et un traitement antiviral lui a été prescrit, ce qui a permis une guérison complète.Ce cas souligne l'importance de considérer le zona comme étant un diagnostic différentiel pour les symptômes liés aux nerfs. Les caractéristiques de la radiculopathie lombaire, de la méralgie paresthésique, du zona varicelleux et du zona font l'objet de discussions, ainsi que les caractéristiques et les options de traitement qui les définissent. Les praticiens doivent rester vigilants en cas de suspicion d'infections virales telles que le zona, même avec une incidence plus faible en raison de vaccins approuvés.

The evolution of teaching chiropractic manual skills: part 2 - a narrative review and discussion of the impact of research evidence authored by faculty of the Canadian Memorial Chiropractic College.

The objectives of this article, Part 2 of a two part series, are twofold: (i) To provide a narrative review of the research evidence authored by faculty of the Canadian Memorial Chiropractic College (CMCC) and; (ii) discussion of the impact this research evidence had on teaching chiropractic manual skills at CMCC and - theoretically - to the broader chiropractic educational community. Research evidence discussed are in the areas of: Experimental studies linked to biomechanics; Measuring Force - Integration of Force Sensing Table Technology (FSTT®) into technique labs; Characteristics of injuries sustained by chiropractic students during technique labs; Finding the clinical target for therapeutic intervention and; Recommendations toward a model technique curriculum. The intent of this article is for faculty at current and future accredited educational programs to incorporate this research evidence into their technique curricula and to potentially strengthen the pedagogical approach used to teach chiropractic manual skills.

L'évolution de l'enseignement des compétences manuelles en chiropratique: la deuxième partie - examen narratif et une discussion de l'impact des données probantes de recherche rédigées par le corps professoral du Canadian Memorial Chiropractic CollegeLes objectifs de cet article, la deuxième partie d'une série en deux parties, sont doubles : (i) fournir un examen narratif des données probantes de la recherche rédigées par le corps professoral du Canadian Memorial Chiropractic College (CMCC) et; (ii) discuter de l'impact de ces données probantes de la recherche sur l'enseignement des compétences manuelles en chiropratique au CMCC et - théoriquement - sur la communauté éducative en chiropratique plus large. Les preuves de recherche qui ont fait l'objet de discussions portent sur les domaines suivants : Les études expérimentales liées à la biomécanique; la mesure de la force - L'intégration de la Technologie de la table de détection de force (FSTT®) dans les laboratoires de techniques; les caractéristiques des blessures subies par les étudiants en chiropratique pendant les laboratoires de techniques; trouver la cible clinique pour l'intervention thérapeutique et; les recommandations pour un programme de technique modèle. L'objectif de cet article est que les professeurs des programmes d'enseignement accrédités actuels et futurs intègrent ces données de recherche dans leurs programmes d'études techniques et renforcent potentiellement l'approche pédagogique utilisée pour enseigner les compétences manuelles en chiropratique.

Exploring strategies to improve clinical decision making in a chiropractic office: a case series.

Background: Clinicians make clinical decisions using the dual process theory. The dual process theory comprises two approaches, System 1, based on heuristics, and System 2, involving an analytical and effortful thought process. However, there are inherent limitations to the dual process theory, such as relying on inaccurate memory or misinterpreting cues leading to inappropriate clinical management. As a result, clinicians may utilize mental shortcuts, termed heuristics, and be susceptible to clinical errors and biases that may lead to flawed decision making and diagnosis. Methods: This case series describes four clinical cases whereby the clinicians use distinct strategies to assess and manage complex clinical presentations. Discussion: Through the use of self-reflection and acknowledging diagnostic uncertainty, the clinicians were able to reduce common cognitive biases and provide effective and timely patient care. We discuss strategies that clinicians can implement in their daily practice to improve clinical decision-making processes and deliver quality care.

Explorer des stratégies pour améliorer la prise de décision clinique dans un bureau chiropratique: une série de cas. Contexte: Les cliniciens prennent des décisions cliniques en utilisant la théorie du double processus. La théorie du double processus comprend deux approches, le premier système qui est basé sur l'heuristique, et le deuxième système qui implique un processus de réflexion analytique et exigeant. Cependant, il existe des limites inhérentes à la théorie du double processus, telles que le fait de s'appuyer sur une mémoire inexacte ou une mauvaise interprétation des indices conduisant à une gestion clinique inappropriée. Par conséquent, les médecins peuvent utiliser des raccourcis mentaux, appelés heuristiques, et être susceptibles de tenir compte d'erreurs et de biais cliniques qui peuvent conduire à une mauvaise décision et à un mauvais diagnostic. Méthodes: Cette série de cas décrit quatre cas cliniques où les cliniciens utilisent des stratégies distinctes pour évaluer et gérer des présentations cliniques complexes. Discussion: Grâce à l'autoréflexion et à la reconnaissance de l'incertitude diagnostique, les cliniciens ont pu réduire les biais cognitifs courants et fournir des soins efficaces et opportuns aux patients. Nous discutons des stratégies que les cliniciens peuvent mettre en oeuvre dans leur pratique quotidienne pour améliorer les processus de prise de décision clinique et fournir des soins de qualité.

Sonographic evaluation of spondylolysis: technique description and feasibility study of diagnostic ultrasound for the detection of L5 pars interarticularis fractures.

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS). Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8-13 MHz) over L5/S1 facets; long-axis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors' assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared. Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt step-off defect at L5PI. Conclusion: We report the first technique description and verification of the L5PI using DUS.

L'évaluation échographique de la spondylolyse: une description de la technique et une étude de faisabilité de l'échographie diagnostique pour la détection des fractures de l'isthme interarticulaire de la L5. Objectifs: La description de la technique et la vérification de l'isthme interarticulaire de la L5 (IIL5) à l'aide d'ultrasons diagnostiques (USD). Méthodes: Un sujet masculin asymptomatique âgé de 10 ans a été scanné à l'aide d'une échographie diagnostique utilisant un transducteur linéaire (8­13 MHz) sur les facettes de la L5/S1; un glissement en direction céphalique sur grand axe pour capturer le processus d'articulation supérieur (PAS) et inférieur (PAI) de la L5. Le cortex hyperéchogène contigu avec ombrage acoustique profond entre le PAS et le PAI a été supposé être de l'IIL5. Afin de confirmer la technique in vivo représentant l'indice de l'IIL5, deux modèles de colonne vertébrale (plastique, colonne vertébrale humaine) ont été scannés pour vérifier l'hypothèse des auteurs. Un trombone métallique a été placé sur l'IIL5 puis une image d'USD a été prise. Enfin, un sujet présentant une spondylolyse connue a été imagé et l'aspect échographique de l'IIL5 a été comparé. Résultats: Les structures localisées avec le trombone métallique sur les modèles de l'IIL5 étaient équivalentes à l'image d'USD in vivo. La spondylolyse montre un défaut abrupt de décrochage à l'IIL5. Conclusion: Nous rapportons la première description technique et la vérification de l'IIL5 à l'aide d'USD.

Student loan debt and income among chiropractors: A description of consultancy data.

OBJECTIVE: To describe student loan debt and income of doctors of chiropractic (DC) who sought private student loan counseling. METHODS: A descriptive analysis of de-identified client records from a student debt consulting firm (Student Loan Planner®) was conducted. Data regarding chiropractic programs, cumulative student loan amounts, and current incomes at the time of consultation were abstracted. Descriptive statistics were reported. RESULTS: Consultations (n = 448) were completed with DCs between March 2017 and August 2023. Nearly half (44.2%) reported student loan indebtedness between $150,000 and $249,999 with another 35.7% indicating between $250,000 and $349,999. The mean student loan debt was $249,149 (SD: $82,892) with a median of $240,000 (interquartile range [IQR]: $199,507-$295,390). The mean income for DCs in this sample was $81,305 (SD: $47,495) with a median income of $75,000 (IQR: $50,000-$100,000). The mean debt-to-income ratio was 4.11 (SD: 2.93) with a median of 3.38 (IQR: 2.21-5.16). Sixteen consultees possessed a debt-to-income ratio below 1.00, whereas more than a quarter (26.3%) of consultees reported a debt-to-income ratio greater than 5.00. CONCLUSION: DCs seeking debt guidance commonly carry substantial student loan debt that far exceeds their income. Our findings highlight that the student loan debt crisis includes DCs.

Relationship between satisfaction of work-related needs and forms of motivation for the pursuit of scholarly activity by chiropractic faculty.

OBJECTIVE: This study sought to determine whether chiropractic faculty were extrinsically, introjectedly, or intrinsically motivated to pursue scholarship; if satisfaction of a faculty member's work-related needs of autonomy, competence, and relatedness correlated with intrinsic motivation to pursue scholarly activities; and to identify barriers to faculty participation in scholarship. METHODS: An anonymous online survey was administered to full-time faculty at 2 chiropractic institutions in the United States. Survey items assessed whether faculty perceived their work-related needs as met, which motivation type they displayed, and perceived barriers to performing scholarly work. Pearson correlation was used to measure the relationships between satisfaction of the work-related needs and intrinsic motivation. Content analysis was used to analyze faculty responses regarding perceived barriers. RESULTS: On average, survey items indicating extrinsic motivation received 52.2% of positive responses, those indicating intrinsic motivation received 47.8% of positive responses, and those indicating introjected motivation received 26.7%. Intrinsic motivation was positively correlated with each of the work-related needs (autonomy: r = .34, p = .067; competence: r = .52, p = .004; relatedness: r = 0.34, p = .063). Four categories of barriers were reported: time constraints, lack of knowledge, lack of support, and lack of interest. CONCLUSION: In this sample, chiropractic faculty most frequently identified with survey items indicating extrinsic motivation. Satisfaction of each of the 3 work-related needs was positively correlated with intrinsic motivation; however, competence showed a significant correlation indicating as competence is satisfied faculty are more likely to be intrinsically motivated to pursue scholarship. Perceived lack of time, knowledge, and support were reported barriers to the pursuit of scholarship.

A Survey on Variables Influencing a Patient's Preferences in Choosing Their Chiropractor in Klang Valley, Malaysia.

Objective: The aim of this study was to examine the variables influencing patients' preferences in choosing their chiropractor in Klang Valley, Malaysia. Methods: This cross-sectional study included patients from 5 different chiropractic centers in Klang Valley, Malaysia. Demographic information and variables influencing patients' decisions were obtained through an online questionnaire via quick-response code. Descriptive statistics were used to describe patients' demographics and factors influencing patients' preferences in choosing their chiropractors. Results: Data were available for 198 chiropractic patients with a mean age of 31.5 years. Approximately 90% of the participants agreed that a chiropractor with good technical and interpersonal skills and excellent service by chiropractic center staff strongly influenced their preference in choosing their chiropractor, while only 13.6% agreed that referral by other health care professionals influenced their preference in choosing their chiropractor. Conclusion: This study emphasizes the influence of a chiropractor's technical and interpersonal skills, as well as friendly staff, on a patient's preferences when choosing their chiropractor. Our findings may provide chiropractic centers and health care providers with a better understanding of the variables that influence a patient's decisions and assist them in improving their services.

National Trends in the Utilization and Expenditure of Chiropractic Care in U.S. Adults: Analysis of the 2007-2016 Medical Expenditure Panel Survey.

OBJECTIVE: This study aimed to examine the trends in the utilization and expenditure of chiropractic care in a representative sample of US adults, aged ≥18 years. METHODS: Serial cross-sectional data (2007-2016) from the Medical Expenditure Panel Survey (MEPS) were examined. Weighted descriptive statistics were analyzed to obtain national estimates of chiropractic utilization and expenditure, and time-series linear regression was used to assess trends over time. Socio-demographic characteristics and musculoskeletal diagnoses associated with chiropractic use were also reported. RESULTS: A statistically significantly increasing trend was observed for the number of adults receiving chiropractic care (p < .05), number of visits (p < .05) and utilization rate (P < .05) from 2007 to 2016. A similar trend was not found for chiropractic expenditure during this period (P > .05). The mean number of visits was 8.3 visits per year, with a mean expenditure of $86.94 USD per visit and $721.43 USD per person per year. Mean age of adult chiropractic users each year ranged between 48.6 and 51.2 years old, and users were primarily female (56.3%-60.4%), White persons (90.1%-93.5%), and privately insured (77.3%-82.8%). The most prevalent musculoskeletal diagnoses associated with chiropractic use were low back conditions (45.4%-58.1%), inflammatory/degenerative disc or joint conditions (21.2%-26.8%) and head and neck complaints (9.8%-13.7%). CONCLUSION: The findings showed statistically significant increasing trends for the number of adult chiropractic users, the number of visits, and percent utilization of chiropractic care from 2007 to 2016. Conversely, we found a statistically null trend for the total annual expenditure on chiropractic care during the same time period. Findings from this analysis imply that, while chiropractic care appears to be growing, it may still be under-utilized, and more efforts should be devoted to ensuring sustained growth and a larger role in the management of musculoskeletal health.

Predictors of Utilization Frequency of and Expenditure Amount for Chiropractic Care in U.S. Adults: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to evaluate the prospective associations of baseline personal characteristics with utilization frequency and expenditure of chiropractic care in US adults (≥18 years). METHODS: Data are from the 1358 respondents to the 2014 to 2016 Medical Expenditure Panel Survey who utilized chiropractic care. Individual, familial, health-related, and behavioral factors were included as covariates in the multivariate analytic model. Poisson and multinominal logistic regressions were modeled to examine the associations between the predictors and chiropractic utilization and expenditure. RESULTS: The mean annual number of visits was 8.2 visits (95% confidence interval [CI]: 7.9, 8.5), with annual expenditure of $677.43 U.S. dollars (95% CI: $595.47-$759.39) and $84.84 (95% CI: $77.89-$91.78) per visit. Female sex was associated with a 19% higher number of visits (rate ratio [RR] = 1.19, 95% CI: 1.01, 1.41) than males. Publicly insured and uninsured were associated with a 44% higher (RR = 1.44, 95% CI: 1.14, 1.82) and 36% lower (RR = 0.64, 95% CI: 0.48, 0.86) visit frequency, respectively, than those privately insured. Rheumatoid arthritis was associated with 7.38 times the risk of high expenditure (95% CI: 2.61, 24.67) than medium expenditure, compared to no arthritis. Relative to physically active individuals, physical inactivity was associated with a 27% higher visit frequency (RR = 1.27, 95% CI: 1.09, 1.49) and an 82% higher risk (relative risk ratio = 1.82, 95% CI: 1.05, 3.14) of high expenditure than low expenditure. CONCLUSION: This analysis found distinct usage and expenditure patterns that vary according to specific baseline predictors. Female sex, being publicly insured, having rheumatoid arthritis, and physically inactive were associated with variance in expenditure. Results from this study may help identify chiropractic patients with tendencies for higher utilization or spending and may indirectly assist in predicting patients with slower response to care.

The Reduction of Cervical Hyperlordosis and Resolution of Craniocervical Symptoms in an Adolescent Female: A Chiropractic Biophysics Case Report With Long-Term Follow-Up.

Cervical hyperlordosis is a rare condition in the pediatric population. We present a unique case of the application of Chiropractic Biophysics® (CBP®) technique protocols to reduce a hyperlordotic cervical spine corresponding with many craniocervical symptoms, including chronic migraines and neck pain. A 15-year-old female presented with chronic headaches, neck pain, and neck stiffness among other complaints following a martial arts sprain injury several months prior. There were many positive orthopedic tests and limited range of motion. Radiographs revealed a cervical hyperlordosis and a right lateral head translation. CBP® treatment was given and involved cervical distraction traction as well as corrective exercises twice a week for 12 weeks, and then monthly for one year with a complementary home program. After 12 weeks, there was a full recovery from migraines and neck pain correlating with an 8° reduction in lordosis and correction of head translation. At 15 months, the patient remained well and achieved a 13° total reduction in the neck curve. This is the first case documenting the successful application of CBP® methods to reduce cervical spine hyperlordosis in peer-reviewed literature. We propose too much curve may be as detrimental as too little curve in the cervical spine with respect to causing adverse stresses and strains in the surrounding soft tissues leading to pathological processes and nociceptive tendencies.

Resolution of Chronic Migraine Headaches and Improvement in Cervical Spine Kyphosis Following Chiropractic BioPhysics® (CBP®) Treatment: A Case Report With a Seven-Month Follow-Up.

We present a chronic migraine (CM) patient demonstrating significant improvement in subjective and objective reported outcome measures with deeper cervical lordosis parameters and reduced forward head posture on radiographs. A 29-year-old male suffered from CM reporting significant pain and disability with aural, sensory, and motor disturbances during the migraine headaches. Aura with visual disturbances, abnormal facial and extremity sensation, sporadic motor weakness, and other signs of CM were found in the patient's history since age 10. The patient reported previous physical therapy, manual chiropractic, and over-the-counter medications. Migraine-specific prescriptions without long-term reduction in pain and disability were reported. The pain and suffering had been reported to be worsening, and he sought Chiropractic BioPhysics® (CBP®) spine and postural rehabilitation protocols. These protocols were used to increase cervical lordosis, reduce coronal imbalances, increase mobility, and create better posture. These protocols include specific prescriptions based on radiography for postural exercises, postural mirror image® (MI®)traction, and specific spinal manipulative therapy (SMT) focused on posture. All outcome measures improved with the resolution of all initial symptoms of CM. There was a 16° improvement in cervical lordosis, a 30% decrease in headache disability, and additional improvements. These improvements were maintained at a seven-month follow-up during which the patient received infrequent maintenance treatments. This successful treatment of a patient with CM with long-term follow-up adds to evidence that CBP® spinal structural rehabilitation may prove effective and serve as a possible tool for clinicians, physicians, and therapists to treat CM.

Umbrella Review of Primary Care Treatments for Adults With Chronic Low Back Pain.

OBJECTIVES: The purpose of this study was to identify, critically assess, and summarize evidence of the effectiveness of primary care treatments for adults with non-specific chronic low back pain (NSCLBP). METHODS: We conducted an umbrella review of systematic reviews focusing on primary care treatments for NSCLBP. We searched the PubMed and Cochrane library databases for systematic reviews of randomized controlled trials (RCTs) evaluating primary care treatments for adults with NSCLBP published between January 2007 and March 2021. Two reviewers independently assessed the quality of these systematic reviews using the AMSTAR checklist. We selected systematic reviews with a low or moderate risk of bias and graded the evidence based on Grading of GRADE criteria. RESULTS: Among the initial 66 systematic reviews meeting our inclusion criteria, 19 systematic reviews with low or moderate bias risk were selected for analysis. These reviews included a total of 365 studies involving 62 832 participants. The evidence suggested moderate to high support for the effectiveness of certain primary care treatments in improving pain and function in NSCLBP patients. These treatments included NSAIDs and opioids compared to placebos, spinal manipulation versus exercise/physical therapy, and MBR versus exercise/education/advice/no treatment. CONCLUSIONS: Recommendations for specific primary care treatments for NSCLBP in adults remain inconclusive. Further high-quality systematic reviews and RCTs are needed to better understand the effectiveness of these treatments. Future RCTs should prioritize the assessment of NSAIDs, opioids, spinal manipulation, and MBR, as they appear promising for improving NSCLBP outcomes in certain comparisons.

Effect of unproctored versus proctored examinations on student performance and long-term retention of knowledge.

OBJECTIVE: To compare unproctored and proctored online exams among chiropractic students. METHODS: Pre-existing data of 234 students across 4 consecutive endocrinology classes were analyzed for this study. The course was comprised of 3 lectures (50 minutes per lecture) each week. Student performance was evaluated by midterm exam and summative exam (S1). The students from 3 classes were asked to take a voluntary second summative exam (S2) approximately 7 months after the S1. Since this study was partially conducted during the COVID pandemic, some classes took the midterm and the S1 proctored in the classroom while others took them unproctored from a remote location. RESULTS: The mean midterm exam (p < .001) and S1 scores (p = .01) for the unproctored group (93.6 ± 7.0 and 88.8 ± 8.2) were significantly higher than the proctored group (88.1 ± 8.2 and 83.9 ± 11.2). The mean time taken by students was much greater for the unproctored exams than for the proctored exams (midterm: 40.7 ± 10.2 versus 16.7 ± 7.0, p < .001; S1: 47.0 ± 8.7 versus 21.5 ± 9.0, p < .001). By contrast, the mean unproctored S2 scores were lower than the proctored group (60.2 ± 14.7 versus 88.1 ± 8.2, p < .001). A linear regression test showed that the final exam was a statistically significant predictor of the recall exam (p < .01, R2 = 28.3%). CONCLUSION: The findings suggest that student performance is significantly altered by test format.