Dear All: As we head
in to the holiday break, I thought I would leave for now with some of the
recent work your colleagues have accomplished. Please have a wonderful break,
and I will see you in January.
Roecker C, Long CR, Vining
R, Lawrence DJ. Attitudes toward evidence-based clinical practice among doctors
of chiropractic with diplomate-level training in orthopaedics. Chiropr Man
Ther 2013, 21:43 doi:10.1186/2045-709X-21-43
Background: Evidence-based clinical practice (EBCP) is a practice model gaining prominence within healthcare, including the chiropractic profession. The status of EBCP has been evaluated in a variety of healthcare disciplines, but little is known regarding the attitudes doctors of chiropractic (DCs) hold toward this model of healthcare. This project examines the attitudes toward EBCP within a specialty discipline of DCs.
Methods: We
identified a survey questionnaire previously used to evaluate EBCP among
non-chiropractic complementary and alternative practitioners. We adapted this
questionnaire for use among DCs and pretested it in 5 chiropractic college
faculty. The final version was administered to DCs with diplomate-level
training in orthopedics. The survey was emailed to 299 potential participants;
descriptive results were calculated.
Results: 144 surveys
were returned, resulting in a 48% response rate. The majority of respondents
perceived EBCP as an important aspect of chiropractic practice. Respondents
also believed themselves to have an above average skill level in EBCP, reported
that training originated from their diplomate education, and based the majority
of their practice on clinical research.
Conclusion:
Doctors of
chiropractic with an orthopedic diplomate appear to have favorable attitudes
toward EBCP. Further study will help understand EBCP perceptions among general
field DCs. A logical next step includes validation of this questionnaire.
Background: Evidence-based clinical practice (EBCP) is an accepted practice for informed clinical decision making in mainstream health care professions. EBCP augments clinical experience and can have far reaching effects in education, policy, reimbursement and clinical management. The proliferation of published research can be overwhelming—finding a mechanism to identify literature that is essential for practitioners and students is desirable. The purpose of this study was to survey leaders in the chiropractic profession on their opinions of essential literature for doctors of chiropractic, faculty, and students to read or reference.
Methods: Deployment
of an IRB exempted survey occurred with 68 academic and research leaders using
SurveyMonkey®. Individuals were solicited via e-mail in August of 2011; the
study closed in October of 2011.Collected data were checked for citation
accuracy and compiled to determine multiple responses. A secondary analysis
assessed the scholarly impact and Internet accessibility of the recommended
literature.
Results: Forty-three
(43) individuals consented to participate; seventeen (17) contributed at least
one article of importance. A total of 41 unique articles were reported. Of the
six articles contributed more than once, one article was reported 6 times, and
5 were reported twice.
Conclusions:
A manageable
list of relevant literature was created. Shortcomings of methods were
identified, and improvements for continued implementation are suggested. A wide
variety of articles were reported as “essential” knowledge; annual or bi-annual
surveys would be helpful for the profession
Triano JJ, Budgell B,
Bagnulo A, Roffey B, Bergmann T, Cooperstein R, Gleberzon B, Good C, Perron J,
Tepe R. Review of methods used by chiropractors to determine the site for
applying manipulation. Chiropr Man Ther 2013, 21:36
doi:10.1186/2045-709X-21-36
ABSTRACT
Background:
With the
development of increasing evidence for the use of manipulation in the
management of musculoskeletal conditions, there is growing interest in
identifying the appropriate indications for care. Recently, attempts have been
made to develop clinical prediction rules, however the validity of these
clinical prediction rules remains unclear and their impact on care delivery has
yet to be established. The current study was designed to evaluate the
literature on the validity and reliability of the more common methods used by
doctors of chiropractic to inform the choice of the site at which to apply
spinal manipulation.
Methods: Structured
searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand
searches of archives, to identify studies of the diagnostic reliability and
validity of common methods used to identify the site of treatment application.
To be included, studies were to present original data from studies of human
subjects and be designed to address the region or location of care delivery.
Only English language manuscripts from peer-reviewed journals were included.
The quality of evidence was ranked using QUADAS for validity and QAREL for
reliability, as appropriate. Data were extracted and synthesized, and were
evaluated in terms of strength of evidence and the degree to which the evidence
was favourable for clinical use of the method under investigation.
Results: A total of 2594
titles were screened from which 201 articles met all inclusion criteria. The
spectrum of manuscript quality was quite broad, as was the degree to which the
evidence favoured clinical application of the diagnostic methods reviewed. The
most convincing favourable evidence was for methods which confirmed or provoked
pain at a specific spinal segmental level or region. There was also high
quality evidence supporting the use, with limitations, of static and motion
palpation, and measures of leg length inequality. Evidence of mixed quality
supported the use, with limitations, of postural evaluation. The evidence was
unclear on the applicability of measures of stiffness and the use of spinal
x-rays. The evidence was of mixed quality, but unfavourable for the use of
manual muscle testing, skin conductance, surface electromyography and skin
temperature measurement.
Conclusions:
A
considerable range of methods is in use for determining where in the spine to
administer spinal manipulation. The currently published evidence falls across a
spectrum ranging from strongly favourable to strongly unfavourable in regard to
using these methods. In general, the stronger and more favourable evidence is
for those procedures which take a direct measure of the presumptive site of
care– methods involving pain provocation upon palpation or localized tissue
examination. Procedures which involve some indirect assessment for identifying
the manipulable lesion of the spine–such as skin conductance or
thermography–tend not to be supported by the available evidence.
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