Chiropractic Treatment Research Articles

Systematic review and meta-analysis showed that complementary and alternative medicines were not effective for infantile colic.

Osteopathy and chiropractic techniques are used for babies for different reasons, but it is unclear how effective they are. The aim of this study was to evaluate their effectiveness in reducing crying time and increasing sleeping time in babies with infantile colic. A systematic review and meta-analysis was conducted on infantile colic studies that used complementary and alternative medicine techniques as interventions. The outcome measures were hours spent crying and/or sleeping. We used the PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Web of Science, Scopus, Osteopathic Medicine Digital Database and Google Scholar databases from inception to 11 November 2022. The methodological quality of the randomised control trials ranged from fair to high. We focused on five studies with 422 babies. Complementary treatments failed to decrease the crying time (mean difference -1.08, 95% CI -2.17 to 0.01, I2 = 92%) and to increase sleeping time (mean difference 1.11, 95% CI -0.20 to 2.41; I2 : 91%), compared with no intervention. The quality of the evidence was rated as very low for both outcome measures. Osteopathy and chiropractic treatment failed to reduce the crying time and increase sleeping time in babies with infantile colic, compared to no additional intervention.

Meeting Future Demand for Chiropractic Services in Hong Kong: A Strategic Manpower Planning Approach.

Chiropractic treatment in Hong Kong has demonstrated high effectiveness in cases where traditional therapies have failed, with minimal associated adverse events. The growing aging population, prevalence of disabilities, and musculoskeletal conditions have increased the demand for rehabilitation services. Over the past few years, the chiropractic profession has raised awareness of treatment benefits. Providing high-quality training and education, licensing/regulation, interprofessional collaboration, increased accessibility, and research are factors influencing the chiropractic workforce and meeting the population's health needs. To achieve the number of chiropractors required by Hong Kong for adequate service according to international standards, future efforts could include increased licensing/registration efficiency, expanded coverage of public/private insurance, system integration/interprofessional collaboration, public education, and local research to build evidence and to support workforce growth and acceptance.

A preliminary investigation into the effects of equine chiropractic treatment on behavioural and physical indicators associated with diagnosed pain

A preliminary investigation into the effects of equine chiropractic treatment on behavioural and physical indicators associated with diagnosed pain

Abstract Number: LBA15 Transient Ischemic Attack Uncovering An Absent ICA

Introduction Absence of the Internal Carotid Artery (ICA) is a rare cerebrovascular anomaly signified by agenesis, aplasia, or hypoplasia of the ICA and its’ bony canal. Agenesis refers to complete absence whereas aplasia refers to some partial remanent of the ICA or the carotid canal however, these terms are often used interchangeably. There are 6 types of ICA agenesis/aplasia of which type A consists of collateral flow supplied to the MCA via the P‐comm and ACA via the A‐comm. The prevalence of such a condition is reported at around .01% of the population. Patients are usually asymptomatic due to robust collaterals but, in some cases, can present with focal neurologic deficits. Here, we present a case of a patient who endured a transient ischemic attack and was subsequently found to have type A Right ICA aplasia on cerebrovascular imaging. Methods Case Report Results A 24‐year‐old Right‐handed Female with no past medical history except for tobacco use presented with transient left arm monoparesis. The patient had received chiropractic treatment involving hyperextension of her neck to the left just prior to symptom onset which transiently caused her left arm to become plegic and she resolved back to her neurologic baseline within 10 minutes. Neurologic exam was normal and non‐contrast head CT was negative however, demonstrated significant hypoplasia of the right carotid canal (Figure 1‐A). Contrast enhanced CT Angiogram of the head and neck demonstrated lack of contrast opacification of the Right Internal Carotid artery with absent Right carotid bulb and opacification of only the Right ECA (Figure 1‐B). MRI of the brain did not demonstrate any acute infarction. Gadolinium enhanced MRA of the Head and Neck confirmed absence of the Right internal carotid (Figure 2‐A) with prominent Right P‐comm and absent Right A1 segment (Figure 2‐B). Due to this variant anatomy, the postulated mechanism of patient’s TIA was thought to be related to transiently decreased cerebral perfusion caused by partial mechanical compression of her vertebral arteries asymmetrically affecting the Right MCA distribution due to sole supply from the Right posterior communicating artery. Conclusions This case illustrates a fascinating variation from normal embryologic angiogenesis and highlights the importance of collateral blood flow through the circle of Willis in patient’s with congenitally absent internal carotid arteries. Particularly, this patient’s presentation demonstrates the risk that vascular compromise of posterior circulation vessels may play in patients with Type A ICA agenesis/aplasia and their subsequent risk of incurring transient ischemic events.

Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes

ObjectiveThe purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care. MethodsThis study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages. ResultsThere was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care. ConclusionThis sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.

Abstract Number ‐ 223: Spontaneous Revascularization of Completely Occluded Internal Carotid Artery: Case Report

Introduction Occlusion of the internal carotid artery (ICA), caused by atherosclerotic thrombosis, arterial embolism, or dissection, is associated with high morbidity and mortality of acute stroke. Commonly, these lesions are managed with aggressive medical treatment due to their chronic and usually irreversible nature. Spontaneous recanalization of the occluded ICA has been described in rare instances. Methods We present a report here on three cases with spontaneous recanalization of complete occluded carotid arteries. Results Our first patient was a 62‐year‐old male with a history of hypertension, who presented with transient left eye vision loss. CT angiography of the head and neck (CTA HN) demonstrated left ICA complete occlusion while the left middle cerebral artery (MCA) and anterior cerebral arteries (ACA) were patent. He was treated with apixaban. At the two‐month follow‐up, the repeat CTA HN demonstrated complete recanalization of the left ICA. The etiology of the occlusion remained cryptogenic. Our second patient was a 71‐year‐old male with a prior history of right carotid endarterectomy, peripheral vascular disease, coronary artery disease, hypertension, and dyslipidemia, who presented with acute right MCA stroke. Work‐up with CTA HN demonstrated right ICA complete occlusion. He was treated medically with aspirin and clopidogrel. Six months later, he presented with a two‐week history of intermittent confusion and left‐sided weakness. His MRI brain was negative foracute stroke. Interestingly, CTA HN demonstrated that the right ICA had complete recanalization. The cause of carotid thrombosis remained cryptogenic. Our third patient was a 46‐year‐old female with a history of hypertension, hyperlipidemia, remote low‐speed vehicle collision, and cervical spine chiropractic treatment (the last neck manipulation was about two years prior), presenting with sudden onset dizziness, right‐sided neck pain, and left homonymous hemianopia. Brain MRI showed acute right posterior cerebral artery (PCA) stroke. CTA HN revealed occlusion of the right ICA with a flare‐up appearance suggestive of a carotid dissection. She also had a right fetal PCA. She was treated medically with rivaroxaban. Four months later, a follow‐up MR angiogramof the neck showed a fully revascularized right ICA. Her hypercoagulable workup revealed that she had a rare form of breast cancer. Conclusions Although ICA occlusion is generally considered chronic and irreversible, our case series suggests that the lesion can have spontaneous recanalization with medical treatment. Further studies of characterizing carotid occlusion to predict recanalization are warranted.

Implications for Nursing and Multidisciplinary Collaboration in the Management of Gastroparesis Patients Receiving Chiropractic Care: A Case Series

Background: Gastroparesis, partial paralysis of the stomach, is a chronic and sometimes disabling neuromuscular disorder diagnosed by delayed emptying of solid food in the absence of a mechanical obstruction. The management of gastroparesis is less than optimal because the pathogenesis has not been clearly defined. Significance: With gastroparesis becoming an increasing concern, nurses need to communicate, collaborate and educate providers and patients regarding complementary therapies that can alleviate patient symptoms and suffering, improve outcomes and quality of life, and decrease inappropriate healthcare system use. Methodology: Through a case series presentation, two case reports describe the successful outcome of chiropractic treatment and implications for nursing care as part of a multidisciplinary team model, for the symptom management of gastroparesis. Results: Both cases were treated for musculoskeletal complaints of cervical, thoracic, and lumbar segmental dysfunction with myofascial involvement and expressed improvements in their musculoskeletal complaints and gastroparesis symptoms following treatments. The improvement of gastroparesis is thought to be a side effect of the treatment. Conclusion and Recommendations: This case series provides evidence that incorporating nurses and chiropractors as part of a multidisciplinary team model offers a unique approach to patient care, symptom management, and improved patient outcomes.

Non-Surgical Management of Upper Cervical Instability via Improved Cervical Lordosis: A Case Series of Adult Patients

Injury to the head and neck resulting from whiplash trauma can result in upper cervical instability (UCIS), in which excessive movement at C1 on C2 is observed radiologically. In some cases of UCIS there is also a loss of normal cervical lordosis. We postulate that improvement or restoration of the normal mid to lower cervical lordosis in patients with UCIS can improve the biomechanical function of the upper cervical spine, and thus potentially improve symptoms and radiographic findings associated with UCIS. Nine patients with both radiographically confirmed UCIS and loss of cervical lordosis underwent a chiropractic treatment regimen directed primarily at the restoration of the normal cervical lordotic curve. In all nine cases, significant improvements in radiographic indicators of both cervical lordosis and UCIS were observed, along with symptomatic and functional improvement. Statistical analysis of the radiographic data revealed a significant correlation (R2 = 0.46, p = 0.04) between improved cervical lordosis and reduction in measurable instability, determined by C1 lateral mass overhang on C2 with lateral flexion. These observations suggest that enhancing cervical lordosis can contribute to improvement in signs and symptoms of upper cervical instability secondary to traumatic injury.

Nutrigenomics: SNPs correlated to physical activity, response to chiropractic treatment, mood and sleep.

Nutrigenomics, a rapidly evolving field that bridges genetics and nutrition, explores the intricate interactions between an individual's genetic makeup and how they respond to nutrients. At its core, this discipline focuses on investigating Single Nucleotide Polymorphisms (SNPs), the most common genetic variations, which significantly influence a person's physiological status, mood regulation, and sleep patterns, thus playing a pivotal role in a wide range of health out-comes. Through decoding their functional implications, researchers are able to uncover genetic factors that impact physical fitness, pain perception, and susceptibility to mood disorders and sleep disruptions. The integration of nutrigenomics into healthcare holds the promise of transformative interventions that cater to individual well-being. Notable studies shed light on the connection between SNPs and personalized responses to exercise, as well as vulnerability to mood disorders and sleep disturbances. Understanding the intricate interplay between genetics and nutrition informs targeted dietary approaches, molding individual health trajectories. As research advances, the convergence of genetics and nourishment is on the brink of reshaping healthcare, ushering in an era of personalized health management that enhances overall life quality. Nutrigenomics charts a path toward tailored nutritional strategies, fundamentally reshaping our approach to health preservation and preventive measures.

Factors Associated With Compliance With Self-Management Home Therapies for Spine Pain: A Survey of Participants Attending a Chiropractic Teaching Clinic in South Africa

ObjectiveThe purpose of this study was to determine factors that affect compliance with various prescribed home therapies based on reported feedback from participants with spine pain. MethodsThis was a descriptive, quantitative, cross-sectional survey. A purposive sampling method was used to recruit 121 participants with neck and back pain attending the Durban University of Technology Chiropractic Day Clinic located in KwaZulu-Natal, South Africa. Data were collected using a self-administered questionnaire. Descriptive statistics, including frequencies and percentages, were used to summarize the data, and odds ratios (ORs) were calculated. ResultsMost participants presented with chronic pain, reporting an average severity of 6 out of 10 and little disability from the pain. Home therapy included stretches (92.2%), heat therapy (49.1%), and ice therapy (38.8%). Almost two-thirds (62.1%) of participants reported being fully compliant with the prescribed home therapy, while 32.8% reported partial compliance. The main factors that potentially affected compliance were laziness and forgetfulness. Participants who reported having depression were less compliant (OR, 0.181), while those with chronic pain were more compliant (OR, 3.74). Those who believed that home therapy would alleviate their pain were also more compliant (OR, 3.83). ConclusionThe study found that a majority of participants with spine pain were compliant with prescribed chiropractic home treatment. Key factors that potentially influenced compliance were identified.

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Background:Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain.Methods:We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings.Results:Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52–0.83) and refills (IRR = 0.27; 95% CI, 0.17–0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04–0.47), six months (OR = 0.14; 95% CI, 0.05–0.40), nine months (OR = 0.19; 95% CI, 0.07–0.57), and 12 months (OR = 0.22; 95% CI, 0.08–0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors.Conclusion:We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.

The Effect of Chiropractic Treatment on Limb Lameness and Concurrent Axial Skeleton Pain and Dysfunction in Horses.

Simple SummaryThe use of chiropractic techniques is common in horses and a strong body of evidence exists for effectively treating back pain and stiffness. Chronic limb lameness can induce complex interactions with the neck, back and pelvis in affected horses, which can be a challenging clinical issue with limited available conservative treatment options. We used a comprehensive array of tests to measure lameness, pain, stiffness, and muscle hypertonicity to evaluate the global effects of chiropractic care in horses with chronic lameness. Four chiropractic treatment sessions were applied over 3 weeks. Improvements in subjective measures of lameness, back muscle pain, and neck or back stiffness were noted. Further studies are needed to better identify the type and severity of lameness that may be amendable to chiropractic treatment.Chiropractic care is a common treatment modality used in equine practice to manage back pain and stiffness but has limited evidence for treating lameness. The objective of this blinded, controlled clinical trial was to evaluate the effect of chiropractic treatment on chronic lameness and concurrent axial skeleton pain and dysfunction. Two groups of horses with multiple limb lameness (polo) or isolated hind limb lameness (Quarter Horses) were enrolled. Outcome measures included subjective and objective measures of lameness, spinal pain and stiffness, epaxial muscle hypertonicity, and mechanical nociceptive thresholds collected on days 0, 14, and 28. Chiropractic treatment was applied on days 0, 7, 14, and 21. No treatment was applied to control horses. Data was analyzed by a mixed model fit separately for each response variable (p < 0.05) and was examined within each group of horses individually. Significant treatment effects were noted in subjective measures of hind limb and whole-body lameness scores and vertebral stiffness. Limited or inconsistent therapeutic effects were noted in objective lameness scores and other measures of axial skeleton pain and dysfunction. The lack of pathoanatomical diagnoses, multilimb lameness, and lack of validated outcome measures likely had negative impacts on the results.

Chiropractic Treatments and Scoliosis-specific Exercise Therapy as An Alternative to Bracing for Adolescent Idiopathic Scoliosis: A Narrative Review

This narrative review aimed to investigate the efficacy of chiropractic treatments and scoliosis-specific exercise (SSE) for adolescent idiopathic scoliosis (AIS) as an alternative treatment for bracing. We searched the PubMed, Index to Chiropractic Literature, Spine Journal, BioMed Central, Google Scholar, and Research Gate databases to identify the most current reviews (2018-2021). A total of 156 papers were identified, of which six were finally included in the analysis, after excluding 150 that were either duplicate studies or failed to meet the inclusion criteria. However, one paper was included despite failure to meet the inclusion criteria because we believed the findings were significant, and hence, it was worth reviewing. All the reviewed papers reported the benefits of exercise and chiropractic as part of AIS management. Only one study showed that SSE alone slows curve progression, whereas the other six papers (four papers investigating chiropractic intervention alone and two investigating SSE alone) showed significant curve reduction after analyzing the X-ray findings. The other outcomes included increased flexibility, greater trunk rotation angle, and improved quality of life. The quality of the evidence in these studies ranged from very low to moderate. Despite the lack of high-quality research, the evidence reviewed illustrates the benefits of chiropractic treatments and Schroth therapy for AIS patients. The findings also suggest that SSEs and chiropractic manipulations can be used either alone or in combination as an alternative to bracing.

The positive and negative impacts of the COVID-19 pandemic on the European Council on Chiropractic Education accredited programs: A mixed methods audit and thematic analysis.

The objectives of this study were to: (1) determine the impact of COVID-19 on the operations within the 9 sections of the European Council on Chiropractic Education (ECCE) 'Standards'; (2) identify specific rapid changes to the programs; and (3) identify positive changes that will continue post-pandemic. This was a mixed methods audit and thematic analysis of data from interviews conducted via a cloud-based video conferencing tool with program leaders of the ECCE accredited institutions. A validated questionnaire designed around ECCE's "Standards" was used, consisting of 3 sections: (1) Severity of the COVID-19 impact on each ECCE Standard section; (2) Description of program changes made for each section; (3) Identification of positive changes continuing post-pandemic. Descriptive statistics were calculated for Part 1 and compared for significant differences via the Kruskal-Wallis test. Verbal responses to Parts 2 and 3 were evaluated independently by 3 researchers using a modified "thematic analysis" approach. Final thematic categories and themes were agreed upon by the researchers. There was a 100% response rate. Outpatient teaching clinics were most severely affected, followed by teaching chiropractic technique courses. Curricular structure and duration and program management were least affected (p =.033). Four thematic categories were identified: Extreme Stress, Courses Most Severely Affected, Integrity of Examinations and Assessments, and Positive Changes That Will Continue. Final-year students were most negatively impacted due to restricted opportunities in outpatient clinics. Integrity of examinations was also a problem. Positive, innovative teaching materials and methods were quickly developed and should continue.

Bringing Chiropractic to Durri; an Evaluation of Quality of Life and Well-being in a Rural Community before and after Chiropractic Treatment

Bringing Chiropractic to Durri; an Evaluation of Quality of Life and Well-being in a Rural Community before and after Chiropractic Treatment

Postural stability, body composition and functional ability of the lower extremity in patients with lumbar degenerative spondylolisthesis

Although patients accessing rehabilitation services had been reported to have better functional ability of the lower limbs, postural stability, and low cardiovascular disease risk factors, updated data from developing countries is however vital for clinical practices. Hence, the aim of this study was to present the association between lower extremity functional ability (LEFA), stability, and body composition profiles in rehabilitative lumbar degenerative spondylolisthesis (LDS) patients considering age and gender. One hundred and twenty-four participants (45 females, 79 males), with a mean age of 56.45±11.13 years, volunteered for the study. Weight, height body fat percent (BFP), visceral fat, body mass index (BMI), resting systolic and diastolic blood pressure, and resting heart rate were measured while functional ability and stability tests were conducted on the participants. 53.4% were at least overweight; LEFA was below average, stability of both dominant and nondominant legs was very poor, blood pressure and heart rate were high. Women had high total body fat and visceral fat. Significant differences were observed in BMI (p=0.044) and BFP (p=0.035) based on age classification as well as BMI (p=0.000), BFP (p=0.000) and visceral fat (p=0.000) by gender. Overweight, high blood pressure, poor LEFA, and postural stability are crucial comorbidities of Ghanaian LDS patients in this study. Educationally and pragmatically comprehensive healthy lifestyle interventions of regular exercise regimes, adequate and quality nutrition, and occupational stress reduction would play major complementary roles in chiropractic treatment.

Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation – a case report

The purpose of this case report was to describe chiropractic management of acute lumbar disc herniation in a patient with a large abdominal aortic aneurysm. A 72-year-old male patient presented with low back pain and right lower leg numbness for 12 months. A review of full-spine X-ray and lumbar MRI revealed moderate spondylosis at L2-5, moderate lumbar scoliosis, and a 7.15 cm abdominal aortic aneurysm (AAA). Given the minimum 2-weeks of referral waiting time to receive treatment for AAA, the patient received chiropractic treatment with a hybrid rehabilitation to address the disc herniation causing severe physical disability. Through the treatments, the patient's pain was significantly alleviated with careful consideration of potential risk factors associated with AAA. In addition, the acute disc herniation was successfully managed by a series of chiropractic treatments before and after the operation for AAA. This case supports that low back pain in patients with AAA can be managed by manual therapy, in contrast to a widespread belief that manual therapy is contraindicated in AAA. More case reports of AAA patients with low back pain are warranted to assess the effectiveness and safety of manual therapy along with surgical treatment for AAA.

Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

ObjectiveThe objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis. MethodsA retrospective cohort study was conducted using data from Arkansas All Payers’ Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated. ResultsA total of 40 929 individuals were included in the final sample, with an average age of 41 years and 65% being women. Only 5% and 6% received PT and chiropractic service, respectively, within the first 30 days. Sixty-four percent had incident opioid use, and 4% had LTOU in the follow-up period. PT was not associated with incident opioid use (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.98-1.18) or LTOU (OR, 1.19; 95% CI, 0.97-1.45). Chiropractic care decreased the odds of opioid use (OR, 0.88; 95% CI, 0.80-0.97) and LTOU (OR, 0.56; 95% CI, 0.40-0.77). ConclusionIn this study we found that receipt of chiropractic care, though not PT, may have disrupted the need for opioids and, in particular, LTOU in newly diagnosed LBP.

Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis

ObjectiveThe purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adult patients with noncancer spinal pain in a Canadian community health center. MethodsIn this sequential explanatory mixed methods analysis, we conducted a retrospective study of 945 patient records (January 2014 to December 2020) and completed interviews with 14 patients and 9 general practitioners. We used Cox proportional hazards regression analyses, adjusted for patient demographics, comorbidities, visit frequency, and calendar year to evaluate the association between receipt of chiropractic care and time to first opioid prescription up to 1 year after presentation. Qualitative data were analyzed thematically and integrated with our quantitative findings. ResultsThere were 24% of patients (227 of 945) with noncancer spinal pain who received a prescription for opioids. The risk of initiating a prescription for opioids at 1 year after presentation was 52% lower in chiropractic recipients vs nonrecipients (hazard ratio [HR], 0.48; 99% confidence interval [CI], 0.29-0.77) and 71% lower in patients who received chiropractic services within 30 days of their index visit (HR, 0.29; 99% CI, 0.13-0.68). Patients whose index visit date was in a more recent calendar year were also less likely to receive opioids (HR, 0.86; 99% CI, 0.76-0.97). Interviews suggested that self-efficacy, access to chiropractic services, opioid stigma, and treatment impact were influencing factors. ConclusionPatients with noncancer spinal pain who received chiropractic care were less likely to obtain a prescription for opioids than patients who did not receive chiropractic care.

Chiropractic techniques and treatment modalities included in academic programs: A survey of chiropractic educational institutions.

The chiropractic techniques that chiropractors learn during their training strongly influence the nature of treatments provided by chiropractors and their professional identity. The objective of this project is to provide an exhaustive description of all chiropractic techniques and treatment modalities taught in chiropractic educational institutions. International experts were solicited to provide feedback on the exhaustivity and clarity of our preliminary questionnaire. Following the expert suggestions, we administered our cross-sectional survey representatives of all chiropractic education institutions listed on the World Federation of Chiropractic website. We also asked the contact information for an additional contact from each institution and surveyed them for triangulation purposes. Among the 47 chiropractic education institutions surveyed, 29 completed our survey (response rate: 62%) of which 18 (62%) had 2 respondents. Among all the chiropractic techniques and treatment modalities investigated, only the Diversified technique was included in the core curriculum of all responding institutions. A considerable proportion of the techniques or modalities studied were not included in the educational activities of the institutions, particularly within the manual tonal or reflex techniques, instrument-assisted articular techniques, as well as the other techniques or modalities categories. Surprisingly, exercise prescription was not included in the core curriculum of all the institutions. Some scientifically challenged approaches were included in the educational activities of more than 40% of the institutions. The portfolio of therapeutic teaching varies greatly between chiropractic educational institutions. A more standardized therapeutic curriculum could be beneficial to reduce public and interprofessional confusion toward therapeutic approaches in chiropractic.