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PRISMA flow diagram for clinical practice guidelines literature search. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
Source publication
Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive...
Contexts in source publication
Context 1
... for which CPGs were identified were health promotion and disease prevention, diet, physical activity and obesity management, and tobacco cessation. Figure 1 shows the results of this search (2018)(2019)(2020). Of 89 citations, 27 remained after screening for duplicates and eligibility (see Table 5 for list of articles). ...
Context 2
... for which CPGs were identified were health promotion and disease prevention, diet, physical activity and obesity management, and tobacco cessation. Figure 1 shows the results of this search (2018)(2019)(2020). Of 89 citations, 27 remained after screening for duplicates and eligibility (see Table 5 for list of articles). ...
Similar publications
Objective:
To investigate the changes of regional homogeneity (Reho) values before and after spinal manipulative therapy (SMT) in patients with chronic low back pain (CLBP) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI).
Methods:
Patients with CLBP (Group 1, n = 20) and healthy control subjects (Group...
Objective: To characterize the effect of unilateral (single and two-level) lumbar facet/zygapophysial joint fixation on paraspinal muscle spindle activity immediately following L4 or L6 high velocity low amplitude spinal manipulation (HVLA-SM) delivered at various thrust durations. Methods: Secondary analysis of immediate (≤2 s) post-HVLA-SM trunk...
Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot...
Background
Lumbar spinal manipulative therapy (SMT) is a common intervention used to treat low back pain (LBP); however, the exact neurophysiological mechanisms of SMT reducing pain measured through pain pressure threshold (PPT) have not been fully explored beyond an immediate timeframe (e.g., immediately or five-minutes following) referencing a co...
The purpose of this preliminary study was to determine the influence of thoracic spinal manipulation therapy (SMT) of different force magnitudes on blood biomarkers of inflammation in healthy adults.
Methods
Nineteen healthy young adults (10 female, age: 25.6 ± 1.2 years) were randomized into the following 3 groups: (1) control (preload only), (2)...
Citations
... When explicitly described, all CPG recommendations focused on individuals with the absence of serious pathology (e.g., cancer, infection, fracture). Several CPGs also outlined red flag indicators of possible serious pathology (e.g., history of malignancy) that would prompt additional evaluation or preclude SMT altogether [38,39,41,44,[46][47][48][49][50]52,54,57,59,[66][67][68][69]. ...
... described, all CPG recommendations focused on individuals with the absence of serious pathology (e.g., cancer, infection, fracture). Several CPGs also outlined red flag indicators of possible serious pathology (e.g., history of malignancy) that would prompt additional evaluation or preclude SMT altogether [38,39,41,44,[46][47][48][49][50]52,54,57,59,[66][67][68][69]. . Please note that a large number of studies were excluded at the title/abstract phase due to our broad search strategy. ...
Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972. We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT. We searched Scopus for articles associated with chiropractic (spanning 1972–2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for CPGs addressing SMT use (spanning 2013–2024). We identified 6286 articles on chiropractic. The rate of publication trended upward. Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews. We identified 33 CPGs, providing a total of 59 SMT-related recommendations. The recommendations primarily targeted low back pain (n = 21) and neck pain (n = 14); of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain. Recent CPG recommendations favored SMT for tension-type and cervicogenic headaches. There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the utility of SMT for spine-related disorders.
... Clinical Compass assisted in public distribution of the competency statements through posting on their website 26 and circulated the statements via an email distribution list utilized in the development of prior clinical practice guidelines. 27,28 Results ...
Background
There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training.
Objective
The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education.
Methods
A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies.
Results
Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration.
Conclusion
We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment.
... Most of the 18 articles meeting final eligibility criteria were clinical guidelines (n = 10) [32][33][34][35][36][37][38][39][40][41]. The remaining articles consisted of best practice recommendations (n = 6) [42][43][44][45][46][47], a modified Delphi study (n = 1) [48], and a clinical appropriateness standards development study (n = 1) [49]. Figure 2 summarizes the search and eligibility determination process consistent with PRISMA recommendations. ...
Background
Quality indicators are standardized, evidence-based measures of health care quality. Currently, there is no basic set of quality indicators for chiropractic care published in peer-reviewed literature. The goal of this research is to develop a preliminary set of quality indicators, measurable with administrative data.
Methods
We conducted a scoping review searching PubMed/MEDLINE, CINAHL, and Index to Chiropractic Literature databases. Eligible articles were published after 2011, in English, developing/reporting best practices and clinical guidelines specifically developed for, or directly applicable to, chiropractic care. Eligible non-peer-reviewed sources such as quality measures published by the Centers for Medicare and Medicaid Services and the Royal College of Chiropractors quality standards were also included. Following a stepwise eligibility determination process, data abstraction identified specific statements from included sources that can conceivably be measured with administrative data. Once identified, statements were transformed into potential indicators by: 1) Generating a brief title and description; 2) Documenting a source; 3) Developing a metric; and 4) Assigning a Donabedian category (structure, process, outcome). Draft indicators then traversed a 5-step assessment: 1) Describes a narrowly defined structure, process, or outcome; 2) Quantitative data can conceivably be available; 3) Performance is achievable; 4) Metric is relevant; 5) Data are obtainable within reasonable time limits. Indicators meeting all criteria were included in the final set.
Results
Literature searching revealed 2562 articles. After removing duplicates and conducting eligibility determination, 18 remained. Most were clinical guidelines (n = 10) and best practice recommendations (n = 6), with 1 consensus and 1 clinical standards development study. Data abstraction and transformation produced 204 draft quality indicators. Of those, 57 did not meet 1 or more assessment criteria. After removing duplicates, 70 distinct indicators remained. Most indicators matched the Donabedian category of process (n = 35), with 31 structure and 4 outcome indicators. No sources were identified to support indicator development from patient perspectives.
Conclusions
This article proposes a preliminary set of 70 quality indicators for chiropractic care, theoretically measurable with administrative data and largely obtained from electronic health records. Future research should assess feasibility, achieve stakeholder consensus, develop additional indicators including those considering patient perspectives, and study relationships with clinical outcomes.
Trial registration
Open Science Framework, https://osf.io/t7kgm
... By nature of training and scope, chiropractors also address public health issues and supportive measures for healthy human development during the clinical encounter. 20 These may include advice regarding injury prevention, healthy diet, physical activity needs, sleep advice, reduced screen time (including mobile/cell phone use), healthy social relationships, and vigilance around childhood trauma. [21][22][23] It has been found that, in general, children with a decreased health-related quality of life have higher utilization of complementary and integrative medicine. ...
... We added an expanded section on health promotion and disease prevention practices recommended for all health professionals to this set of recommendations; thus, we searched recognized organizations, including the U.S. Preventive Services Task Force (USPSTF) and the U.S. Centers for Disease Control and Prevention (CDC), as well as a recently published clinical practice guideline (CPG) developed specifically for the role of chiropractic in health promotion and disease prevention for adults with musculoskeletal pain. 20,28,29 Evaluation of the quality of the evidence ...
... Seven of the eight guidelines were rated as high quality [41][42][43][44][45][46][47] ; one was not rated because two of the investigators on this project were authors, and it was used as a seed document for information about health promotion and disease prevention. 20 Of the four systematic reviews, three were rated as high quality [48][49][50] and one as acceptable. 12 Of the four narrative reviews, three were rated as high quality 16,48,51 and one as acceptable. ...
Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
... 53 They suggested numerous topics within a range of interventions they provide as an entire part of the patient encounter, including health promotion and preventative advice. 54 Practitioners suggested both an interest in and desire for more research in aspects of clinical practice pertaining to lifestyle, 54 nutrition, 55 and physical activity. 54 A large number of practitioners specified pediatric populations as a high research priority, which were not identified as a high priority area in previous international research agendas. ...
... 54 Practitioners suggested both an interest in and desire for more research in aspects of clinical practice pertaining to lifestyle, 54 nutrition, 55 and physical activity. 54 A large number of practitioners specified pediatric populations as a high research priority, which were not identified as a high priority area in previous international research agendas. 56,57 It is apparent that being mindful of external factors that may result in restriction of scope of practice, practitioners are understandably concerned that research be conducted in those populations. ...
Objective:
The purpose of this study was to identify and compare the research priorities of Australian practicing chiropractors and academics across listed research domains and to seek their views on existing chiropractic research strategies. Concurrent objectives were to gain insight into the perspectives on characteristics of research and solicit ideas and suggestions for future research from both groups.
Methods:
This study used a mixed-method research design to collect data using an online survey portal. Australian chiropractic academics (n = 220) and practicing chiropractors who were also members of a nationally representative, practice-based research network database (n = 1680) were invited to participate. Data were collected (February 19, 2019, to May 24, 2019). The free-text data were analyzed primarily via semantic coding and verbatim referential units in cases where the category was an exact match for the textual data. Content analyses of the qualitative data were presented in a tabulated and narrative manner as identified domains. Selected representative examples were provided verbatim.
Results:
The response rate for the survey was 44% for full-time equivalent academics, 8% for casuals and part-time chiropractic academics, and 21.5% for Australian Chiropractic Research Network database chiropractic practitioners. Open-text data comprised a narrower focus on musculoskeletal (MSK) conditions and opposition or reservations by academics and some practitioners toward the research agenda of those espousing traditional concepts and terminology. Comments from both groups illustrate the strongly held views that characterize divergent factions of the chiropractic profession. Some practitioners were highly critical of the narrow focus and epistemological paradigm of Australian university-based research, while others were strongly supportive of the traditional focus of the Australian Spinal Research Foundation. Australian academics at the 4 university-based programs held the view that MSK and spinal pain, for which some evidence already exists, should be the priority of future research, building on what is known. Practitioners believed that future research should be directed toward expanded areas such as basic science, younger populations, and non-MSK conditions. Respondents were sharply divided on attitudes toward traditional chiropractic terminology, concepts, and philosophy and the utility of future research on these topics.
Conclusion:
Our qualitative findings suggest there is a division in the Australian chiropractic profession regarding research direction and priorities. This divide exists between academics and researchers and within field practitioners. This study highlights the attitudes, opinions, and perceptions of important stakeholder groups, which should be considered by decision-makers when formulating research policy, strategy, and prioritization of funding.
... The consensus panel included stakeholders, and we invited public comments using methods we developed for previous projects. 5,13 Consensus Rounds Two modified Delphi consensus rounds were conducted; all 69 panelists completed both. For Round 1, all of the 38 statements but 1 had a mean rating of >80% (median rating = 9 on a 0-9 scale). ...
... because they were used as background/seed documents and were developed by the group involved in the current study. 5,13 Table 2 lists the 10 systematic reviews included; all were rated high-quality [27][28][29][30][31][32][33] or acceptable-quality. [34][35][36] Table 3 lists the 5 randomized controlled trials included; all were rated high-quality. ...
... Figure 2 lists important terms and definitions related to LBP management, including specific classifications of LBP-related terms. 13 including examination, diagnosis, and treatment/no treatment options, clearly and in terms the patient understands. Explain both benefits and risks. ...
Objective:
The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States.
Methods:
Two experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations.
Results:
The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP.
Conclusion:
This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.
... First Published Online February 13 2023 Chiropractors may have a role in preventing IPV if they have appropriate screening tools. 6 A chiropractors' knowledge and skills in recognizing IPV is likely to affect their clinical reasoning, decisionmaking, and clinical outcomes. Furthermore, they are obliged to comply with clinical and legal responsibilities. ...
Objective
To explore Australian chiropractors' and final year students' readiness to identify and support patient's experiencing intimate partner violence (IPV).
Methods
This cross-sectional study used the Chiro-PREMIS, an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to explore chiropractors' and final year students' readiness. Survey responses were analyzed through a lens of Miller's framework for developing clinical competence and chiropractic graduate competencies.
Results
One hundred forty participants completed the online survey (n = 99 chiropractors and n = 41 students). Reports of practice over the 4 weeks prior to completing the survey showed 21% of chiropractors and 20% of students consulted with patients who had disclosed they were involved in IPV. Thirty-three percent of chiropractors and 27% of students suspected a patient was involved, but that patient did not disclose. Participants report meager training in IPV. Many are unclear about appropriate questioning techniques, documentation, referrals, identifying available resources, and legal literacy. Overall, participants do not “know” about IPV, they do not “know how” to and may not be able to “show how” or “do” when it comes to managing IPV-related clinical scenarios. Further studies are needed to confirm if chiropractors have the appropriate clinical capabilities.
Conclusion
With proper preparation, chiropractors have an opportunity to make a positive contribution to this social problem. We anticipate chiropractic-specific discourse surrounding these escalating growing social concerns will highlight the intent of the chiropractic profession to make a substantial contribution to the health care of the Australian public. More studies are needed.
... Worldwide, the median 12-month utilisation of chiropractic services has been estimated to be approximately 9%, primarily for musculoskeletal conditions [11]. Yet, the role that chiropractors play in influencing lifestyle-related risk factors, like PA, remains under researched and underutilised [12,13]. A systematic review on primary prevention in chiropractic practice showed that approximately 90% of chiropractors had a positive opinion towards healthy lifestyle promotion and were interested in their patients engaging in healthier lifestyles [14]. ...
Background
Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients.
Methods
Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the ‘Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices’ tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors’ views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported.
Results
From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.).
Conclusion
A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors’ own PA participation.
... 94 Alternatively, a Delphi process could be used, developing seed statements and recommendations that would be rated by SMEs worldwide. A similar process was recently used by Hawk et al. 95 that developed clinical practice guidelines for the role of chiropractic care for health promotion and clinical preventive services for adult patients with MSK pain. That said, one obstacle to developing a standardized or model JEB curriculum is the significant differences between jurisdictions worldwide with respect to legislation, especially scope of practice. ...
Introduction:
The objectives of this study was to conduct an updated comparative audit involving a larger and more representative group of accredited chiropractic programs in order to determine if (i) if there has been any changes in the delivery of JEB curricula since the first audit was conducted in 2010, and (ii) provide recommendations that could lead toward a standardized or model JEB curriculum worldwide.
Methods:
This study was approved by the ERB of the University of South Wales. Twenty-one chiropractic programs agreed to provide JEB course outlines for review.
Results:
A total of 88 different course outlines, which listed 83 different topics pertaining to JEB course content, were submitted for review.
Conclusion:
The results of this comparative audit revealed there has been an increase in the variability of JEB course content taught to students over time. Recommendations are provided for the next steps that could lead toward a standardized or model JEB curriculum curricula.
... Claims for the use of wellness-based chiropractic for health require evidence. At present there is little evidence for primary prevention in MSK conditions [52] and particularly in MSK low back pain [53], so it may be challenging for wellnessbased chiropractors to create evidence for primary prevention. ...
... Clearly, claims currently outstrip evidence in this area and it remains a key goal for this group to validate their claims. A recent best practice guideline in chiropractic health promotion is recommended as a possible way forward [52]. The challenge to the wellness group will be to find evidence to support the teaching of any prevention strategies in evidence-based wellness practitioner training programs. ...
The chiropractic profession is 125 years old and has evolved a culture beset with internal conflict. The internal ructions have been particularly noticeable during the last 20 years. The recent resignation of the entire World Federation of Chiropractic Research Committee has again focussed the conflicting views and goals of the “wellness” and “evidence” factions within the profession. These polarising viewpoints are worsening to the degree that there are calls for the profession to break into two separate entities. Key to the recognition of the differences within the profession is the recognition of title for particular sub populations of patients presenting to chiropractors. For many of the sub populations such as sport or paediatrics there has grown appropriate post professional specialist educational training sometimes leading to a protected title. However, this is not occurring in that group of practitioners that choose to focus on wellness care. A recommendation is made that wellness chiropractic be viewed as a post professional specialty program within chiropractic, as it is in medicine and elsewhere, and that recognition follow after appropriate post professional educational programs have been completed, as is customary in the other special interest groups. In order to do so, consensus will be required from all stakeholders within the profession on the level, scope and depth of such programs. Furthermore, it is possible that different jurisdictions around the world may require different post graduate educational levels based on local competitive, legal and professional circumstances. In such cases, transitioning to the higher level over a period of time may be undertaken. Recognition of the wellness specialty by the profession would allow for vertical integration with other healthcare providers as well as help bridge a gap between the entrepreneur and academic groups that would be responsible for creating these programs at tertiary education institutions. Finally, should these programs acquire evidence to underpin them, a process that would be taught within the programs, it is likely that recognition of an extended scope of practice would occur increasing the appeal of chiropractic to the public.
