Chiropractic & Manual Therapies最新文献

{"title":"Frequency and indication of non-musculoskeletal examinations: a cross-sectional survey of Quebec chiropractors.","authors":"Danikel Giroux, Chloé Branconnier, André Bussières, Jean Théroux, Marc-André Blanchette","doi":"10.1186/s12998-023-00522-z","DOIUrl":"10.1186/s12998-023-00522-z","url":null,"abstract":"<p><strong>Background: </strong>Approximately 1% of low back pain is estimated to be caused by serious systemic diseases, including cancer, infection, or abdominal aortic dissection. This study aimed to determine the frequency of execution of non-MSK physical examination procedures among Quebec chiropractors and to identify the clinical context that prompts them to use these physical examination procedures.</p><p><strong>Methods: </strong>Cross-sectional survey containing 44 questions administered to a random sample of Quebec chiropractors using a succession of online, postal and phone questionnaires. The 4-part survey questionnaire contained six demographic questions, 28 single-choice questions to determine the frequency of execution of non-MSK physical examination procedures, seven short clinical vignettes for which the respondents had to select the non-MSK examinations that would be required, and two questions inquiring about the proportion of new patients for which participants' felt non-MSK examinations were necessary and whether appropriate assessments were performed. The questionnaire was pilot tested, and feedback received integrated prior to administration. We conducted descriptive statistics, Pearson correlations, and an ANOVA.</p><p><strong>Results: </strong>The survey was completed by 182 chiropractors (response rate: 36.4%). The most commonly non-musculoskeletal examination performed daily were blood pressure (12.1%) and cranial nerves (4.9%). The most common tests never performed were oxygen saturation (68.7%), cardiac auscultation (69.2%), tibio-brachial index (71.4%), breast (86.8%), rectal (96.7%), testicular (95.6%), and vaginal (99.9%) exams. Female chiropractors and Quebec University in Trois-Rivières graduates reported that a significantly higher proportion of their new patients required a non-musculoskeletal physical examination compared to male participants (37.2% vs 28.3%) or Canadian Memorial Chiropractic College graduates (33.9% vs 19.9%). Reason for not performing a physical examination included the belief that another healthcare professional was better positioned to perform and/or interpret the related tests (76.4%).</p><p><strong>Conclusions: </strong>Vital signs and cranial nerve examinations were the most frequency performed non-musculoskeletal examinations reported by chiropractors. Apart from the genitourinary exam almost never performed, most participants chose non-musculoskeletal examinations deemed appropriate for the patient's presentation.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"32 1","pages":"6"},"PeriodicalIF":1.9,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10903024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991536","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":"Re: Stress and musculoskeletal pain in physiotherapists during the pandemic depend on a plethora of influencing factors.","authors":"Nathan Weiss, Eva Skillgate, Iben Axén","doi":"10.1186/s12998-023-00525-w","DOIUrl":"10.1186/s12998-023-00525-w","url":null,"abstract":"","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"32 1","pages":"5"},"PeriodicalIF":1.9,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10873924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747570","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":"Stress and musculoskeletal pain in physiotherapists during the pandemic depend on a plethora of influencing factors.","authors":"Josef Finsterer, Carla Alexandra Scorza, Fulvio Alexandre Scorza, Antonio-Carlos Guimaraes de Almeida","doi":"10.1186/s12998-023-00526-9","DOIUrl":"10.1186/s12998-023-00526-9","url":null,"abstract":"","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"32 1","pages":"4"},"PeriodicalIF":1.9,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10870614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747571","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":"A qualitative analysis of free-text patient satisfaction responses in Care Response, a database of patient-reported outcome and experience measures.","authors":"Kenneth J Young, Helen C Young, Jonathan Field","doi":"10.1186/s12998-023-00528-7","DOIUrl":"10.1186/s12998-023-00528-7","url":null,"abstract":"<p><strong>Background: </strong>Databases have become important tools in improving health care. Care Response is a database containing information on tens of thousands of chiropractic patients internationally. It has been collecting patient-reported outcomes and patient satisfaction information for more than 10 years. The purpose of this study was to contribute to the understanding of patient perceptions and priorities for chiropractic care by analysing free text entered into the patient reported experience measure (PREM) questionnaires within the Care Response system.</p><p><strong>Methods: </strong>There were two questions of interest on the PREM for this study. One requested information about \"good points\" patients perceived about patients' care experience, and the other requested information on \"improvements\" that could make the experience better. We conducted a word frequency analysis using a word counting macro in Microsoft Word, then used those results as a starting point for a qualitative analysis. Data were collected on 30 May 2022.</p><p><strong>Results: </strong>The people who participated in the Care Response system often reported positive experiences with their chiropractors, including that they had reduced pain, improved function, and felt validated in their clinical condition. In addition, they appreciated having diagnostic and treatment procedures explained to them. They valued friendly, professional, and on-time service. The negative experiences were the opposite: being rushed through treatment, that the treatment was not worth the cost, or that they weren't treated professionally, empathetically, or with respect for them as individuals. The most important themes that emerged under \"good points\" were satisfaction (with care), value (as a person), safety, comfort, and professionalism. Their opposites, dissatisfaction, lack of value, lack of safety, lack of comfort, and lack of professionalism emerged as the most important themes under \"improvements\". We report some nuances of patient experience that have not previously been explored in the literature.</p><p><strong>Conclusions: </strong>Respondents seemed to value effective care provided in a safe, professional, friendly, and aesthetically pleasing environment. Chiropractors should note these priorities and engage with patients according to them. Education institutions should consider how good practice in these areas might be incorporated into curricula.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"32 1","pages":"2"},"PeriodicalIF":2.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10823652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576475","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":"Is blinding in studies of manual soft tissue mobilisation of the back possible? A feasibility randomised controlled trial with Swiss graduate students.","authors":"Javier Muñoz Laguna, Emanuela Nyantakyi, Urmila Bhattacharyya, Kathrin Blum, Matteo Delucchi, Felix Karl-Ludwig Klingebiel, Marco Labarile, Andrea Roggo, Manuel Weber, Thomas Radtke, Milo A Puhan, Cesar A Hincapié","doi":"10.1186/s12998-023-00524-x","DOIUrl":"10.1186/s12998-023-00524-x","url":null,"abstract":"<p><strong>Study design: </strong>Single-centre, two-parallel group, methodological randomised controlled trial to assess blinding feasibility.</p><p><strong>Background: </strong>Trials of manual therapy interventions of the back face methodological challenges regarding blinding feasibility and success. We assessed the feasibility of blinding an active manual soft tissue mobilisation and control intervention of the back. We also assessed whether blinding is feasible among outcome assessors and explored factors influencing perceptions about intervention assignment.</p><p><strong>Methods: </strong>On 7-8 November 2022, 24 participants were randomly allocated (1:1 ratio) to active or control manual interventions of the back. The active group (n = 11) received soft tissue mobilisation of the lumbar spine. The control group (n = 13) received light touch over the thoracic region with deep breathing exercises. The primary outcome was blinding of participants immediately after a one-time intervention session, as measured by the Bang blinding index (Bang BI). Bang BI ranges from -1 (complete opposite perceptions of intervention received) to 1 (complete correct perceptions), with 0 indicating 'random guessing'-balanced 'active' and 'control' perceptions within an intervention arm. Secondary outcomes included blinding of outcome assessors and factors influencing perceptions about intervention assignment among both participants and outcome assessors, explored via thematic analysis.</p><p><strong>Results: </strong>24 participants were analysed following an intention-to-treat approach. 55% of participants in the active manual soft tissue mobilisation group correctly perceived their group assignment beyond chance immediately after intervention (Bang BI: 0.55 [95% confidence interval (CI), 0.25 to 0.84]), and 8% did so in the control group (0.08 [95% CI, -0.37 to 0.53]). Bang BIs in outcome assessors were 0.09 (-0.12 to 0.30) and -0.10 (-0.29 to 0.08) for active and control participants, respectively. Participants and outcome assessors reported varying factors related to their perceptions about intervention assignment.</p><p><strong>Conclusions: </strong>Blinding of participants allocated to an active soft tissue mobilisation of the back was not feasible in this methodological trial, whereas blinding of participants allocated to the control intervention and outcome assessors was adequate. Findings are limited due to imprecision and suboptimal generalisability to clinical settings. Careful thinking and consideration of blinding in manual therapy trials is warranted and needed.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT05822947 (retrospectively registered).</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"32 1","pages":"3"},"PeriodicalIF":2.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10826218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576490","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":"Is the use of diagnostic imaging and the self-reported clinical management of low back pain patients influenced by the attitudes and beliefs of chiropractors? A survey of chiropractors in the Netherlands and Belgium","authors":"Brenda van der Vossen, Annemarie de Zoete, Sidney Rubinstein, Raymond Ostelo, Michiel de Boer","doi":"10.1186/s12998-023-00523-y","DOIUrl":"https://doi.org/10.1186/s12998-023-00523-y","url":null,"abstract":"No previous studies have examined the association between attitudes and beliefs of chiropractors and their adherence to low back pain (LBP) guidelines. The aim of this study is: (1) to assess the attitudes and beliefs towards the management of LBP of Dutch and Belgian chiropractors; and (2) to investigate the association of these attitudes and beliefs on the use of diagnostic imaging and on the adherence to diagnostic guidelines and guidelines in the management of patients with LBP. Cross-sectional study using a web-based questionnaire in chiropractic private practices in the Netherlands and Belgium. The survey included sociodemographic characteristics, use of diagnostic imaging, the Pain Attitude and Beliefs Scale-Physiotherapists (PABS.PT) and 6 vignettes (3 acute and 3 chronic LBP patients). We used Latent Profile Analysis (LPA) to categorise the chiropractors into clusters depending on their PABS.PT outcome, whereby the classes differed primarily on the biomedical score. We used linear, logistic, and mixed models to examine the associations between these clusters, and adherence to the recommendations of guidelines on: (1) diagnostic imaging use, and (2) management of LBP (i.e. advice on activity, treatment, return-to-work, and bedrest). The response rate of the Dutch and Belgian chiropractors was 61% (n = 149/245) and 57% (n = 54/95), respectively. The majority of chiropractors scored midrange of the biomedical scale of the PABS.PT. Three clusters were identified using LPA: (1) high biomedical class (n = 18), (2) mid biomedical class (n = 117) and (3) low biomedical class (n = 23). Results from the vignettes suggest that chiropractors in the high biomedical class better adhere to diagnostic imaging guidelines and to LBP guidelines when it concerns advice on return-to-work and activity compared to the other two classes. However, no differences were identified between the classes for treatment of LBP. All chiropractors adhered to the guidelines’ recommendation on bedrest. The high biomedical class demonstrated better overall adherence to the practice guidelines for the management of LBP and diagnostic imaging than the other classes. Due to the small numbers for the high and low biomedical classes, these results should be interpreted with caution.","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"18 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139396249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of health policy and systems research for strengthening rehabilitation in health systems: a call to action to accelerate progress","authors":"Walter R. Frontera, Wouter DeGroote, Abdul Ghaffar","doi":"10.1186/s12998-023-00519-8","DOIUrl":"https://doi.org/10.1186/s12998-023-00519-8","url":null,"abstract":"&lt;p&gt;During the last few decades, the field of rehabilitation has experienced substantial development, growth, and acceptance. Rehabilitation addresses the impact of a health condition on a person’s everyday life by optimizing their functioning and reducing their experience of disability. Rehabilitation expands the focus of health beyond preventative and curative care to ensure people with a health condition can remain as independent as possible and participate in education, work and meaningful life roles [16]. A definition of rehabilitation for research purposes has been recently published [7]. Scientific and clinical research have generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in various populations and health conditions.&lt;/p&gt;&lt;p&gt;We also have now a better understanding of the growing global need, demand, and recognition of rehabilitation around the world. For example, it has been estimated that 2.41 billion people in the world could benefit from rehabilitation services. This means that at least one in every three persons in the world needs rehabilitation at some point during the course of their disease or injury [2]. This figure has most likely increased due to the COVID-19 pandemic. The need for rehabilitation increased by 63% between 1990 and 2017 due to the aging population, the increasing prevalence of noncommunicable health conditions, and the shifting epidemiological profile in most countries [2]. Finally, according to the 2022 Global report on health equity for persons with disabilities, approximately 1.3 billion people or 16% of the world’s population has moderate to severe levels of disability associated with the underlying health conditions and impairments [13]. Now more than ever before, it is crucial that rehabilitation is available and accessible to populations globally according to their needs. The important contribution of rehabilitation to the functioning, including social and occupational participation and well-being of populations worldwide, can no longer be denied or delayed. Rehabilitation is critical for the attainment of the United Nations Sustainable Development Goal 3, &lt;i&gt;Ensure healthy lives and promote well-being for all at all ages&lt;/i&gt; [9].&lt;/p&gt;&lt;p&gt;Notwithstanding the foregoing arguments, there continues to be a high unmet need for rehabilitation globally, with some low- and middle-income countries reporting unmet needs up to 50% of those who could benefit from rehabilitation. Rehabilitation services are not accessible to many people around the world [5]. Many of those in need do not have access because of the failure, at least partially, to effectively plan for rehabilitation services. Many nations and health systems have not implemented policy measures that recognize rehabilitation as an essential component of universal health coverage [6, 8]. Health policy, planning, and decision-making for rehabilitation often require more local evidence to adequa","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"17 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal important difference of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in persons with chronic low back pain.","authors":"Jessica J Wong, Sheilah Hogg-Johnson, Wouter De Groote, Agnieszka Ćwirlej-Sozańska, Olatz Garin, Montse Ferrer, Àngels Pont Acuña, Pierre Côté","doi":"10.1186/s12998-023-00521-0","DOIUrl":"10.1186/s12998-023-00521-0","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization Disability Assessment Schedule 2.0 12-item survey (WHODAS-12) is a questionnaire developed by the WHO to measure functioning across health conditions, cultures, and settings. WHODAS-12 consists of a subset of the 36 items of WHODAS-2.0 36-item questionnaire. Little is known about the minimal important difference (MID) of WHODAS-12 in persons with chronic low back pain (LBP), which would be useful to determine whether rehabilitation improves functioning to an extent that is meaningful for people experiencing the condition. Our objective was to estimate an anchor-based MID for WHODAS-12 questionnaire in persons with chronic LBP.</p><p><strong>Methods: </strong>We analyzed data from two cohort studies (identified in our previous systematic review) conducted in Europe that measured functioning using the WHODAS-36 in adults with chronic LBP. Eligible participants were adults with chronic LBP with scores on another measure as an anchor to indicate participants with small but important changes in functioning over time [Short-form-36 Physical Functioning (SF36-PF) or Oswestry Disability Index (ODI)] at baseline and follow-up (study 1: 3-months post-treatment; study 2: 1-month post-discharge from hospital). WHODAS-12 scores were constructed as sums of the 12 items (scored 0-4), with possible scores ranging from 0 to 48. We calculated the mean WHODAS-12 score in participants who achieved a small but meaningful improvement on SF36-PF or ODI at follow-up. A meaningful improvement was an MID of 4-16 on ODI or 5-16 on SF36-PF.</p><p><strong>Results: </strong>Of 70 eligible participants in study 1 (mean age = 54.1 years, SD = 14.7; 69% female), 18 achieved a small meaningful improvement based on SF-36 PF. Corresponding mean WHODAS-12 change score was - 3.22/48 (95% CI -4.79 to -1.64). Of 89 eligible participants in study 2 (mean age = 65.5 years, SD = 11.5; 61% female), 50 achieved a small meaningful improvement based on ODI. Corresponding mean WHODAS-12 change score was - 5.99/48 (95% CI - 7.20 to -4.79).</p><p><strong>Conclusions: </strong>Using an anchor-based approach, the MID of WHODAS-12 is estimated at -3.22 (95% CI -4.79 to -1.64) or -5.99 (95% CI - 7.20 to -4.79) in adults with chronic LBP. These MID values inform the utility of WHODAS-12 in measuring functioning to determine whether rehabilitation or other health services achieve a minimal difference that is meaningful to patients with chronic LBP.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"31 1","pages":"49"},"PeriodicalIF":2.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10696846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138488800","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":"Testing the association between shoulder pain prevalence and occupational, physical activity, and mental health factors in two generations of Australian adults.","authors":"Christopher J Hodgetts, Angela Jacques, Lee Daffin, Yvonne C Learmonth","doi":"10.1186/s12998-023-00520-1","DOIUrl":"10.1186/s12998-023-00520-1","url":null,"abstract":"<p><strong>Background: </strong>Shoulder pain is common among the adult population, but it appears to reduce in prevalence around retirement age. Associations between shoulder pain and work-place exposures, physical activity, or mental health status are unclear and may change with age. This study aimed to determine the prevalence of self-reported shoulder pain in Australian adults across two generations and test the association with occupational factors, physical activity, and mental health.</p><p><strong>Methods: </strong>In this cross-sectional study we used data from a longitudinal Australian pregnancy cohort (the Raine Study). We analysed data from the children (Gen2) at the 22-year follow-up (N = 1128) and parents (Gen1) at the 26-year follow-up (N = 1098). Data were collected on self-reported shoulder pain, occupational factors (employment status and work description), physical activity, and mental health at the respective follow-ups. Prevalence rates were provided as percentages with 95% confidence intervals. Univariate analysis for group comparisons included chi squared for categorical comparisons. The association of predictor variables and shoulder pain was assessed using logistical regression.</p><p><strong>Results: </strong>In Gen1 31.4% of adults aged 40-80 reported the presence of shoulder pain in the last month, with no significant difference between females and males. Gen1 participants younger than 65 reported more shoulder pain (OR[95%CI] = 1.80 [1.04-3.09]). Gen2 females (14.7%) reported shoulder pain in either shoulder more frequently than males (7.7%) and bilateral shoulder pain (8.0%) more frequently than males (1.9%). Gen1 had increased odds of reporting shoulder pain if their work was \"physical or heavy manual\" compared to \"sedentary\" (OR [95% CI] = 1.659 [1.185-2.323]) and when categorised with depression (OR [95% CI] = 1.940 [1.386-2.715]) or anxiety (OR [95% CI] = 1.977 [1.368-2.857]). Gen2 participants with depression (OR [95% CI] = 2.356 [1.620-3.427]) or anxiety (OR [95% CI] = 2.003 [1.359-2.952]) reported more shoulder pain.</p><p><strong>Conclusion: </strong>Overall, shoulder pain was more prevalent in young females than males and was more prevalent in those under the age of 65. Cross-sectional associations were established between some occupational factors in older adults and depression in all adults, and shoulder pain.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"31 1","pages":"48"},"PeriodicalIF":1.9,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446617","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 effect of clinical guidelines on the utilisation of radiographs in chiropractic clinics in Denmark - an interrupted time series analysis.","authors":"Pernille Schaldemose Reibke, Henriette Godskesen, Rikke Krüger Jensen, Simon D French, André Bussières, Henrik Wulff Christensen, Tue Secher Jensen","doi":"10.1186/s12998-023-00518-9","DOIUrl":"10.1186/s12998-023-00518-9","url":null,"abstract":"<p><strong>Background: </strong>In Denmark, chiropractors have a statutory right to use radiography and the government-funded national Health Insurance provides partial reimbursement. Danish National Clinical Guidelines recommends against routine use of imaging for uncomplicated spinal pain; however, it is not clear if clinical imaging guidelines recommendations have had an effect on the utilisation of spinal radiography. This study aimed to describe the utilisation rate of radiographs in Danish chiropractic clinics in the period from 2010 to 2020 and to assess the impact of clinical guidelines and policy changes on the utilisation of radiographs in Danish chiropractic clinics.</p><p><strong>Methods: </strong>Anonymised data from January 1st, 2010, to December 31st, 2020, were extracted from the Danish Regions register on health contacts in primary care. Data consisted of the total number of patients consulting one of 254 chiropractic clinics and the total number of patients having or being referred for radiography. Data were used to investigate the radiography utilisation per month from 2010 to 2020. An 'interrupted time series' analysis was conducted to determine if two interventions, the dissemination of 1) Danish clinical imaging guidelines recommendations and policy changes related to referral for advanced imaging for chiropractors in 2013 and 2) four Danish clinical guidelines recommendations in 2016, were associated with an immediate change in the level and/or slope of radiography utilisation.</p><p><strong>Results: </strong>In total, 336,128 unique patients consulted a chiropractor in 2010 of which 55,449 (15.4%) had radiography. In 2020, the number of patients consulting a chiropractor had increased to 366,732 of which 29,244 (8.0%) had radiography. The pre-intervention utilisation decreased by two radiographs per 10,000 patients per month. Little absolute change, but still statistically significant for Intervention 1, in the utilisation was found after the dissemination of the clinical guidelines and policy changes in 2013 or 2016.</p><p><strong>Conclusions: </strong>The proportion of Danish chiropractic patients undergoing radiography was halved in the period from 2010 to 2020. However, the dissemination of clinical imaging guidelines recommendations and policy changes related to referrals for advanced imaging showed little meaningful change in the monthly utilisation of radiographs in the same period.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"31 1","pages":"47"},"PeriodicalIF":1.9,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10666323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296211","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}