Chiropractic & Manual Therapies最新文献

{"title":"Immediate effects of spinal manipulation, exercise therapy, and open-label placebo on lifting performance and pain in individuals with chronic non-specific back pain: a motion laboratory-based crossover randomized controlled trial.","authors":"Fredrik Borg, Filip Gedin, Erika Franzén, Wilhelmus Johannes Andreas Grooten","doi":"10.1186/s12998-026-00680-w","DOIUrl":"10.1186/s12998-026-00680-w","url":null,"abstract":"<p><strong>Background: </strong>Chronic non-specific back pain (CBP) is a leading cause of disability worldwide and is commonly associated with limitations in movements such as lifting. Although spinal manipulation (SMT) and exercise therapy (ET) are recommended treatments for CBP, their effects on objectively measured movement performance remain insufficiently explored. Open-label placebo (OLP) has gained attention for engaging placebo-related mechanisms ethically. This study aimed to investigate the immediate effects of SMT, ET, and OLP on lifting performance and pain in individuals with CBP, and to evaluate the add-on effects of OLP.</p><p><strong>Methods: </strong>A motion laboratory-based crossover randomized controlled trial included 50 individuals with CBP. Participants were recruited between April and July 2025 and attended a single laboratory session between September and October 2025. Participants performed lifting tasks using light and heavy loads before and after SMT, ET, and OLP interventions in randomized order. Three-dimensional motion capture was used to assess temporal, spatial, and spatiotemporal aspects of lifting performance. Subjective outcomes included pain intensity, perceived effectiveness, willingness to undergo each treatment, and treatment preference. Data were analyzed using linear mixed-effects models and functional data analysis.</p><p><strong>Results: </strong>Overall lifting performance changed to a small degree following the interventions. No significant between-group differences were observed at the primary endpoint. Significant within-group changes were observed following SMT, including altered intersegmental coordination during the light lift, characterized by a greater relative contribution of back movement early in the lifting phase, reduced thorax-pelvis tilt during the heavy lift, and reduced pain. OLP was associated with reduced thorax-pelvis tilt and increased hip and knee flexion during the light lift. Subjective evaluations did not consistently correspond to objective biomechanical changes.</p><p><strong>Conclusion: </strong>SMT, ET, and OLP demonstrated limited immediate effects on overall lifting performance in individuals with CBP. However, some within-group changes in thorax-pelvis movement and intersegmental coordination suggest that certain aspects of movement quality may respond to short-term interventions even when conventional biomechanical outcomes remain largely unchanged. The findings suggest the value of integrating subjective and objective outcomes, while advanced biomechanical analyses may provide insight into subtle movement changes in CBP.</p><p><strong>Trial registration: </strong>The trial is registered at ClinicalTrials.gov (ID NCT06891625).</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary accuracy, inter- and intra-rater reliability of a 4-point cervical artery dissection diagnostic decision support tool in an ambulatory setting using real and simulated cases: a quality improvement project.","authors":"Tyler H Snodgrass, Zachary A Cupler, Christopher J Farrell, Lindsay R Rae","doi":"10.1186/s12998-026-00679-3","DOIUrl":"https://doi.org/10.1186/s12998-026-00679-3","url":null,"abstract":"<p><strong>Background: </strong>Cervical artery dissection (CeAD) is a rare but life-threatening condition that commonly presents with non-specific symptoms such as neck and head pain, complicating early recognition in ambulatory care settings. The CeAD diagnostic decision support tool (DDST) is a 4-item assessment designed to identify patients that should be referred for advanced diagnostic work-up to rule out CeAD; however, its utility in ambulatory settings has not been established.</p><p><strong>Methods: </strong>This quality improvement project aimed to evaluate the accuracy, inter-rater reliability, and intra-rater reliability of chiropractors applying the CeAD DDST using clinical vignettes simulating a typical ambulatory encounter before deploying the DDST broadly as part of the clinical workflow. Five experienced chiropractors assessed 40 standardized clinical vignettes. CeAD-positive cases (n = 10) were derived from published imaging-confirmed ambulatory care case reports. CeAD-negative cases (n = 30) were developed using generative artificial intelligence and refined by senior authors to reflect common conditions encountered in chiropractic practice. Raters independently assessed cases with the DDST (score 0-4), with a cutoff score of ≥ 3 recommending referral for advanced diagnostic work-up in two rounds, beginning November 11, 2025 and January 07, 2026, with a two-week capture period. Accuracy, inter-rater reliability, and intra-rater reliability were assessed.</p><p><strong>Results: </strong>Accuracy in identification ranged from 72.5% to 95.0% across raters and rounds. False positives and negatives were present across raters in both rounds, with false positives being more prevalent. Inter-rater reliability was moderate to substantial in both rounds (Round 1: κ = 0.609, 95% CI 0.432-0.806, Round 2: κ = 0.540, 95% CI 0.365-0.735). Intra-rater reliability ranged from moderate to almost perfect agreement (range 0.457-0.931).</p><p><strong>Conclusions: </strong>The CeAD DDST demonstrated moderate to good accuracy and reliability among chiropractors in a simulated ambulatory setting. The presence of false negatives and inter-rater reliability falling below recommended benchmarks preclude recommendation for implementation at this time. Iterative refinement informed by end-user input and prospective ambulatory testing is warranted prior to clinical adoption of the CeAD DDST. Future evaluations should include prospective studies using real clinical data to better represent real-world settings.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiropractic patient compensation claims in Norway from 2013 to 2024.","authors":"Christoffer Børsheim, Cathrine H Feier, Carlos Gevers-Montoro, Mark Thomas, Anika Young, Jan Hartvigsen","doi":"10.1186/s12998-026-00684-6","DOIUrl":"10.1186/s12998-026-00684-6","url":null,"abstract":"<p><strong>Background: </strong>Compensation claims represent a selective subset of adverse events in healthcare and provide insight into patient safety. Compensation claims vary between countries and jurisdictions due to administrative, legal, and clinical differences. This study aimed to describe compensation claims related to chiropractic consultations in Norway from 2013 to 2024.</p><p><strong>Methods: </strong>We conducted a retrospective registry study using data from the Norwegian System of Patient Injury Compensation and national chiropractic consultation data. All completed claims associated with chiropractic care between 2013 and 2024 were included regardless of whether they were approved or rejected. Claim frequencies were calculated per 100,000 consultations and per first-assessment consultations. Descriptive analyses were used to summarise results.</p><p><strong>Results: </strong>A total of 147 claims were filed during the study period, of which 17 (12%) were approved. Over 24 million chiropractic consultations were recorded for the period, corresponding to an average annual claim approval rate of 0.1 per 100,000 consultations and 0.5 per 100,000 first-assessment consultations. Most claims involved musculoskeletal conditions (89%). High approval proportions were observed for claims related to central nervous system and circulatory disturbances (60%). The most common reasons for rejection were lack of causation and absence of healthcare failure. Total compensation amounted to 21.7 million Norwegian Kroner (~ 2.2 million Euros).</p><p><strong>Conclusions: </strong>Compensation claims related to chiropractic care in Norway are rare relative to consultation volume, and only a small proportion were approved. Most claimants presented with common musculoskeletal conditions, while approved cases often involve serious events temporally associated with chiropractic consultations. These findings contribute updated national evidence on compensation claims in chiropractic practice and may inform quality improvement and policy.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of asymmetrical load magnitude and location on postural sway metrics in healthy young adults.","authors":"Abdul Rafi, Dean L Smith, William P Berg, Mark S Walsh","doi":"10.1186/s12998-026-00682-8","DOIUrl":"10.1186/s12998-026-00682-8","url":null,"abstract":"<p><strong>Background: </strong>Asymmetrical load carriage is a common component of daily activities. Carrying a backpack, handbag, or groceries on one side for example alters the center of mass of the system and may challenge postural stability. Such asymmetrical demands on postural control may be a meaningful stressor to evaluate and address during clinical management.</p><p><strong>Objective: </strong>To determine the influence of lateral asymmetrical load on postural metrics, whether greater loads produce larger responses, and whether location of the load affects the response.</p><p><strong>Methods: </strong>Twenty-four healthy young adults (21.13 ± 1.48 years) participated in this repeated-measures study during November 2025. Participants completed five standing conditions including no load, handheld as well as shoulder loads at 15% and 20% body mass using the same backpack. Postural metrics were assessed using a force plate. Outcome measures included average mediolateral center of pressure location (COP X), average anteroposterior center of pressure location (COP Y), 95% ellipse area of postural sway, and total path length. Repeated measures analyses of variance with planned contrasts were performed to evaluate differences among conditions.</p><p><strong>Results: </strong>Loaded conditions demonstrated greater mediolateral shift in COP X (toward the side of load), greater 95% ellipse sway area, and greater path length compared with the no load condition. Greater magnitude loading (e.g. 20% vs. 15%) amplified both COP X and path length. Hand loading increased mediolateral shift in COP X more than shoulder loading whereas shoulder loading increased 95% sway area more than the hand. Load location did not affect path length. Lateral loading had no statistically significant effect on COP Y.</p><p><strong>Conclusions: </strong>Both load magnitude and load location influence postural control metrics during asymmetrical load carriage. Clinicians may use this information to guide patients toward safer load carrying strategies when attempting to reduce postural instability and musculoskeletal strain.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical comparison of lumbar rotational manipulations in two different positions using force measurement and finite element analysis.","authors":"Jiasi Shen, Xilin Gao, Hongen Zheng, Xinyi Zhang, Zhen Li, Yue Fan, Wei Zhang, Ping Wang","doi":"10.1186/s12998-026-00683-7","DOIUrl":"10.1186/s12998-026-00683-7","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the biomechanical characteristics of lateral decubitus and sitting lumbar rotational manipulations (LRM) by combining experimental force measurements with finite element analysis (FEA), with a particular focus on regional stress and displacement distributions and areas of stress concentration that may have relevance for future clinical and safety studies.</p><p><strong>Methods: </strong>Twenty healthy volunteers were randomly assigned to receive either lateral decubitus or sitting LRM. Practitioner-generated forces were recorded using instrumented gloves, and preliminary cluster analysis was performed to explore distinct operational patterns. The measured loading parameters were then used to define the loading conditions in a validated lumbar finite element model to compare stress and displacement distributions in the intervertebral discs and facet cartilage across the two techniques and five clusters.</p><p><strong>Results: </strong>Preliminary cluster analysis identified two clusters for the lateral decubitus technique (shoulder-hip coordinated and hip-dominant) and three for the sitting technique (shoulder-waist coordinated, shoulder-dominant, and gentle-loading). No significant left-right differences in practitioner-generated forces were observed for the lateral decubitus technique (all P > 0.05). For the sitting technique, the force applied at the shoulder was lower on the left than on the right (62.56 ± 15.58 vs. 77.70 ± 7.72 N; t = -10.088, P < 0.001), whereas the force applied at the waist was higher on the left than on the right [32.80 (27.75-38.20) vs. 26.06 (22.66-33.54) N; Z = 2.129, P = 0.042]. FEA showed distinct mechanical patterns between the two techniques. Across the two lateral decubitus clusters, the maximum intervertebral disc stress ranged from 7.87 to 13.40 MPa and the maximum deformation from 7.22 to 12.31 mm, with the main mechanical effects concentrated at L3/4-L4/5. Across the three sitting clusters, the maximum disc stress ranged from 5.87 to 8.09 MPa and the maximum deformation from 11.68 to 16.44 mm, with greater displacement mainly involving L1/2-L2/3. A similar contrast was observed in the facet cartilage, with the lateral decubitus technique generally producing higher peak stress but lower deformation than the sitting technique.</p><p><strong>Conclusion: </strong>Lateral decubitus and sitting LRM produced distinct regional biomechanical patterns. Lateral decubitus manipulation was characterized by a higher-stress/lower-displacement profile predominantly involving the lower lumbar spine, whereas sitting manipulation showed a lower-stress/higher-displacement profile with greater involvement of the upper lumbar spine. These findings provide a quantitative biomechanical basis for further investigation of technique-specific loading characteristics, tissue safety, and individualized clinical application.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between a rock and a hard place: balancing roles of clinician and co-researcher in a primary health care setting - A qualitative study.","authors":"Anna Allen-Unhammer, Nina Køpke Vøllestad, Anne Marit Mengshoel","doi":"10.1186/s12998-026-00681-9","DOIUrl":"https://doi.org/10.1186/s12998-026-00681-9","url":null,"abstract":"<p><strong>Background: </strong>The participation of clinicians in clinical research is necessary, but balancing research and clinical duties can be challenging. We explored chiropractors' experiences of participating in a clinical trial on spinal manipulation of the neck in primary health care (PHC).</p><p><strong>Methods: </strong>A qualitative design was adopted, underpinned by social interactionism. Five virtual focus group interviews were performed between August-November 2023, including 15 chiropractors, who were involved in a clinical trial in PHC. Thematic analysis was applied.</p><p><strong>Results: </strong>The interviewees were motivated to participate in the clinical trial to contribute to professional development through investigating the use of spinal manipulation. However, patient recruitment and adherence to the treatment protocol were more difficult than anticipated, especially when patients realised that the treatment would be determined by randomisation and because the chiropractors had to deliver the sham/placebo interventions. The interviewed chiropractors continually negotiated conflicting obligations of clinicians, co-researchers, and breadwinners, shifting loyalties between these roles in response to situational demands.</p><p><strong>Conclusions: </strong>The clinicians' motivations to take part in the trial varied but were in general rooted in a wish to contribute to strengthening the chiropractic profession. The negotiation of multiple roles and shifting loyalties rendered them moral agents. Our findings illustrate the social and relational nature of participating as a co-researcher in a trial conducted in a chiropractic PHC context. Our study also highlights a need for better support systems for research in PHC. This calls for political and organisational will to establish systems that provide necessary support to researchers and clinical co-researchers.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The profile of young people seeking chiropractic care: a secondary analysis of data.","authors":"Melissa Neave, Michael Swain, Aron Downie, Katie de Luca, Sheilah Hogg-Johnson, Silvano Mior, Simon French","doi":"10.1186/s12998-026-00677-5","DOIUrl":"10.1186/s12998-026-00677-5","url":null,"abstract":"<p><strong>Background: </strong>Chiropractic care for children has increased significantly in recent years and is now a commonly utilised healthcare option. Despite this, chiropractic's role in paediatric healthcare remains contentious. We performed a secondary analysis of two cross-sectional studies of chiropractic practice in Australia and Canada to describe the characteristics of paediatric patients presenting to chiropractors and to examine the reasons for seeking care, diagnosed conditions, and treatments provided across three age strata.</p><p><strong>Methods: </strong>The Chiropractic Observation and Analysis Study (COAST) and the Ontario Chiropractic Observation and Analysis Study (O-COAST) are cross sectional observational studies conducted in Victoria, Australia (2010-2012) and Ontario, Canada (2014-2015), designed to provide a better understanding of chiropractic practice and trends. Patient encounters of individuals under 18 years of age were identified and extracted from respective datasets. Paediatric patients were categorised into three age strata based on neurodevelopmental and musculoskeletal maturation stages: 0-23 months, 2-9 years and 10-17 years. Descriptive data regarding patient characteristics, reason for encounter, and treatment received from the chiropractor were tabulated for analysis.</p><p><strong>Results: </strong>Of all 670 paediatric encounters, 20% were for 0-23 months, 33% were for 2-9 years and 47% for 10-17 years. \"Health maintenance\" was the most common reason for encounter in each age stratum. Non-musculoskeletal problems were most common in the 0-23 months stratum. Chiropractors most frequently diagnosed \"back problems\" in each age stratum. Manual adjustment was the most common treatment delivered overall.</p><p><strong>Conclusion: </strong>We described the reasons paediatric patients seek chiropractic care, the conditions diagnosed by chiropractors, and the techniques used across three age groups. An incongruence was identified between patients' reasons for seeking care and chiropractors' diagnoses. Understanding the characteristics of paediatric patient groups and the patterns of presentation and treatment will aid in designing relevant research, to inform clinical practice and teaching programs, and implement evidence-based health policies.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study.","authors":"Robert J Trager, Anthony N Baumann, Collin M Labak, Kelsey L Lewis, Jaime Abraham Perez, Christine M Goertz, Andres Schuster","doi":"10.1186/s12998-026-00678-4","DOIUrl":"10.1186/s12998-026-00678-4","url":null,"abstract":"<p><strong>Objectives: </strong>Cervical artery dissection (CeAD) has been proposed as a sequela of spinal manipulative therapy (SMT), however, protopathic bias arising from care-seeking for CeAD symptoms (e.g., neck pain/headache) may overestimate observed associations. Among adults experiencing new neck pain/headache, we tested the null hypothesis of no significant CeAD risk within 30 days following SMT compared to matched ibuprofen-prescribed controls.</p><p><strong>Methods: </strong>We searched United States TriNetX Linked health records/claims data (2010-2025) for adults seeking care for new episodes of neck pain/headache receiving (1) chiropractor-administered cervical SMT or (2) outpatient visit with ibuprofen prescription, excluding those with previous cerebrovascular disease and/or CeAD, using propensity matching to minimize confounding. We examined the risk ratio (RR) of CeAD (primary outcome), exploring cumulative incidence, CeAD subtypes, absolute risk difference (RD), and negative control outcomes.</p><p><strong>Results: </strong>After matching, there were 431,492 patients per cohort. In the SMT cohort, compared with the ibuprofen cohort, CeAD risk was lower while RD was minimal [95% CI] (RR = 0.53 [0.35, 0.83]; RD=-6.3 [-10.8, -2.0] events per 100,000 patients; P = 0.004). Carotid artery dissection risk was lower; vertebral artery dissection risk was not significantly different. Data quality supported balanced confounders and minimal follow-up loss (< 3%). Negative control outcomes were partially balanced.</p><p><strong>Conclusions: </strong>This study found no evidence of an increased risk of CeAD after chiropractor-administered cervical SMT compared with ibuprofen prescription in adults seeking care for new episodes of neck pain or headache. Despite the rarity of these events, all clinicians, including chiropractors, should maintain vigilance for CeAD symptoms. Additional multidisciplinary research is warranted to further address potential confounding and examine patient subgroups (e.g., migraine) and stroke.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate clinical and neuromechanical effects of cervical spine manipulation compared to cervical spine mobilization among individuals with chronic neck pain: a randomized mechanistic cross-over trial.","authors":"Salma Bouqartacha, Danja Conconi, Yves Schwendenmann, Mathieu Piché, Petra Schweinhardt, Martin Descarreaux, Lindsay M Gorrell","doi":"10.1186/s12998-026-00674-8","DOIUrl":"10.1186/s12998-026-00674-8","url":null,"abstract":"<p><strong>Background: </strong>Spinal manipulation (SM) and spinal mobilization (Smob) are conservative therapies recommended by several clinical guidelines for the treatment of chronic neck pain (CNP). The purpose of this study was to investigate differences between clinical and neuromechanical effects of SM and Smob in patients with CNP.</p><p><strong>Methods: </strong>This study was a randomized mechanistic cross-over trial. Eighty-nine individuals with mechanical neck pain participated in two sessions, 72 h apart, where they randomly received either SM or Smob during the first session and the other intervention during the second session. Recruitment took place in Zurich from August 2023 to January 2024, and in Trois-Rivières from March 2024 to June 2024. Cervical range of motion (ROM), pain intensity, grip-strength and pressure pain threshold (PPT) outcomes were assessed before and after each treatment, while muscular activity was recorded during the treatment using surface electromyographic electrodes (EMG). PPT and EMG activity were assessed for three muscles bilaterally: sternocleidomastoid (SCM), upper trapezius (UT) and tibialis anterior. Outcomes following SM and Smob were compared using linear mixed-effects model, Wilcoxon signed-rank test and McNemar test.</p><p><strong>Results: </strong>All ROM increased significantly over time after SM and Smob with no difference between interventions. However, pain intensity analyses showed a significant time x intervention interaction indicating a greater improvement following SM (mean decrease: 0.786 NPRS points) compared with Smob (mean decrease: 0.373 NPRS points) (β = 0.413, 95% CI [0.160; 0.665], p = 0.002). Muscular response was significantly higher after SM compared to Smob for both SCM (0.144 ± 0.121 vs. 0.023 ± 0.013) and UT (0.083 ± 0.100 vs. 0.024 ± 0.025) muscles, on both sides. A higher PPT was observed for SCM and UT after both interventions. No consistent change was observed for grip-strength. Overall, results showing statistical significance did not reach clinical significance.</p><p><strong>Conclusion: </strong>Although SM and Smob both led to higher ROM, SM resulted in immediate lower subjective pain intensity and yielded higher muscular responses for participants with CNP. However, given the mechanistic nature of this study and the absence of clinically significant findings, caution is warranted when considering implications for clinical practice.</p><p><strong>Trial registration: </strong>This trial was registered with Open Science Framework (OCF) on May 23, 2023. https://doi.org/ https://doi.org/10.17605/OSF.IO/UNBJ5 .</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of interprofessional collaboration between physicians and chiropractors within Québec multidisciplinary clinics: a mixed-methods study.","authors":"Marc-André Blanchette, Lilly Nguyen, Jean-Philip Hudon-Dionne, Geneviève Lavigne, Marie-Andrée Mercier, Jason W Busse","doi":"10.1186/s12998-026-00673-9","DOIUrl":"10.1186/s12998-026-00673-9","url":null,"abstract":"<p><strong>Background: </strong>Physician referral rates to chiropractors remain low in Quebec, and few multidisciplinary clinics include both professions. Yet these settings represent a unique opportunity to study interprofessional collaboration in musculoskeletal care. This study aimed to identify facilitators and barriers to physician-chiropractor collaboration in multidisciplinary clinic settings, and to evaluate perceptions regarding the effectiveness of collaborative efforts on patient care.</p><p><strong>Methods: </strong>An explanatory sequential mixed-methods design was employed. Between February and November 2024, quantitative data were collected via surveys of 23 chiropractors and 19 physicians practising in multidisciplinary clinics including both professions. Qualitative data were collected through a semi-structured focus group with seven chiropractors and individual semi-structured interviews with five physicians. Survey data were reported with descriptive statistics, and qualitative data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Survey results indicated that nearly 70% of physicians referred patients to chiropractors at least monthly, driven primarily by established relationships or patient requests. Despite broadly positive mutual attitudes, physicians expressed concerns about the safety of cervical manipulation and professional liability. Chiropractors identified personal knowledge of other providers and physical proximity as the strongest enablers of collaboration with physicians, while clinical workload and patients' financial constraints were the primary barriers. Both professional groups attributed high value to interprofessional collaboration; most chiropractors and physicians reported that collaboration improved patient satisfaction, clinical outcomes, and overall quality of care. Qualitative analysis revealed three themes: perception, organization of care and services, and communication. Perceptual barriers included educational silos, historical professional tensions, and variability in chiropractic practices. Structural obstacles included out-of-pocket costs, exclusion from public care settings, and administrative burdens. Facilitators included personal experience with chiropractic care, co-location, clear referral pathways, and direct communication modalities.</p><p><strong>Conclusions: </strong>In multidisciplinary clinic settings, interprofessional collaboration between physicians and chiropractors is valued and perceived as beneficial by both professional groups. Despite a favourable relational environment, collaborative practice remains heavily reliant on informal, relationship-driven interactions rather than embedded organizational structures. Our findings underscore the need for education, organizational integration, and communication infrastructure to improve interprofessional musculoskeletal care.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"34 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}