Silvano Mior

• DC, PhD
• Professor (Full) at Canadian Memorial Chiropractic College

Background Since the 1990s, spine disorders have remained the leading cause of global disability, disproportionately affecting economically marginalized individuals, rural populations, women, and older people. Back pain related disability is projected to increase the most in remote regions where lifestyle and work are increasingly sedentary, yet re...

Objectives To describe the structure and development of a new international, chiropractic, practice-based research network (PBRN), the Chiropractic International Research Collaborative (CIRCuit), as well as the demographic, practice, and clinical management characteristics of its clinician participants. An electronic survey was used to collect info...

Background Chiropractors and chiropractic students commonly report low back pain (LBP). However, the burden of LBP in this occupational group has not been synthesized in the literature. This systematic review aims to describe the epidemiology of LBP in chiropractors and chiropractic students. Methods We searched MEDLINE, Embase, CINAHL, and PsycIN...

Background Research enables a profession to establish its cultural authority, validate its professional roles and ensure ongoing improvement in the quality of its academic programming. Despite the clear importance of research, a mature research culture has eluded the chiropractic profession. A fostering institutional culture that enables, values, a...

Background Despite increases in musculoskeletal disorders (MSD) in Canada, evidence suggests utilization of chiropractic services has remained relatively stable over time. Understanding the extent to which chiropractors are consulted and factors associated with their utilization may suggest factors related to accessing care. We assessed the change...

Introduction Individuals with participation and activity limitations face important healthcare challenges. Objectives We investigated healthcare utilization and characteristics of Canadians living with participation and activity limitations between 2001 and 2010. Methods We pooled data from 5 cycles of the Canadian Community Health Survey (2001-2...

Background Since the 1990s, spine disorders have remained the leading cause of global disability, disproportionately affecting economically marginalized individuals, rural populations, women, and older people. Back pain related disability is projected to increase the most in remote regions where lifestyle and work are increasingly sedentary, yet re...

Interprofessional healthcare teams have become the benchmark for optimising athlete health and performance in high-stakes sports. Despite a history of utility as provider partners, chiropractors are currently a relatively underutilised human resource in this rapidly developing and challenging field. Consequently, our study explored the global exper...

Background Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access...

Musculoskeletal (MSK) conditions are the leading cause of disability, resulting in up to 40% of visits to family physicians. Current primary care workforce shortages in Canada require other providers to maximize scopes of practice. Few MSK providers have been trained in team-based primary care settings. Study objectives included: (1) educating part...

This prospective, community-based, active surveillance study aimed to report the incidence of moderate, severe, and serious adverse events (AEs) after chiropractic (n = 100) / physiotherapist (n = 50) visit in offices throughout North America between October-2015 and December-2017. Three content-validated questionnaires were used to collect AE info...

Background. Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited acces...

Background A significant proportion of children and adolescents experience back pain. However, a comprehensive systematic review on the effectiveness of rehabilitation interventions is lacking. Objectives To evaluate benefits and harms of rehabilitation interventions for non-specific low back pain (LBP) or thoracic spine pain in the pediatric popu...

Introduction The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods This systematic review search...

Introduction Understanding healthcare utilization by Canadians with back problems informs healthcare planning nationally. Research question What is the prevalence of utilization of healthcare providers (medical doctors, chiropractors, physiotherapists, nurses), and associated characteristics among Canadians with chronic back problems (2001–2016)?...

Background Little is known about lived experience of synchronous telehealth in patients with musculoskeletal (MSK) disorders. Objective We conducted a rapid systematic review to answer: (1) what are the lived experiences and/or perspectives of people with MSK disorders receiving non-pharmacological interventions delivered through synchronous teleh...

LAY SUMMARY Spinal pain is responsible for a large proportion of pain and disability in the Canadian Armed Forces (CAF). The authors developed and implemented a program of care (PoC) that included communication strategies and care pathways supporting chiropractic care for CAF personnel with spine-related problems. The authors tested the feasibility...

Purpose The aims of this study were to describe cultural diversity among physiotherapists, to understand the challenges to the delivery of physiotherapy to equity-seeking communities, and to measure and assess factors associated with cultural competency. Methods We conducted a cross-sectional survey (57-items) of Canadian physiotherapists that ass...

Objective To describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. Design Data from the Impacts of COVID-19 on Canadians – Living with Long-Term Conditions and Disabilities , a national cross-sectional survey...

Objectives Developing a research agenda is one method to facilitate broad research planning and prioritise research within a discipline. Despite profession-specific agendas, none have specifically addressed the research needs of the specialty of sports chiropractic. This study determined consensus on research priorities to inform a global sports ch...

Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommend...

Purpose Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention...

Purpose To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. E...

Purpose Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise p...

As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this seri...

Purpose Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (compa...

Driving posture can lead to musculoskeletal pain. Most work focuses on the lower back; therefore, we know little about automobile seat design and neck posture. This study evaluated an automobile driver seat that individualized upper back support to improve head and neck posture. Specifically, we examined the system’s impact on anterior head transla...

Background Chiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chir...

Purpose: The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). Material and methods: We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iter...

Purpose This study is the second part of a cross-sectional questionnaire aiming to identify Canadian physiotherapists needs and strategies for physiotherapy associations to improve cultural competence in physiotherapy. Methods We conducted a descriptive qualitative analysis of one open-ended question of a cross-sectional questionnaire. We used ind...

Project supported by Canadian Chiropractic Research Foundation SUMMARY OF RESEARCH PROPOSAL (ABSTRACT) SCOPE: Neck pain is a common musculoskeletal problem in the general population, second only to low back pain in frequency among spine-specific conditions (1). Causes of chronic neck pain are multifactorial (2). Nociplastic pain is thought to be t...

Degenerative cervical radiculopathy (DCR) can lead to severe pain, paraesthesia, and/or motor weakness, resulting in significant morbidity, disability, and reduced quality of life. Typically, individuals suffer from prolonged symptoms, with time to complete recovery spanning months to years. Little is known about the impact DCR has on peoples' live...

Objective: We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic. Design: Cross-sectional survey. Setting: Individuals residing in Canada during the first wave of the COVID-19 pandemic. Participants: Eligibl...

Background: There is a paucity of research assessing cultural competency among Canadian chiropractors. Therefore, the aims of this study were to (1) measure cultural competency among Canadian chiropractors, (2) understand chiropractors' perspectives of challenges and attitudes regarding the delivery of chiropractic services to equity-seeking commu...

Background Little is known about the diversity of the chiropractic profession with respect to gender, sexual orientation, race, ethnicity and community of practice. This knowledge is important as profession representation of key equity seeking groups may impact quality of care and access for vulnerable communities. The aim of this cross-sectional s...

Background Knowledge about patient satisfaction and experience with care they receive can guide practitioners in establishing doctor-patient relationships and improve health outcomes. Although evidence suggests high patient satisfaction with chiropractic care in general, there is limited understanding of the expectations and experiences of athletes...

Knowledge of the pre-rehabilitation generic status of functioning in individuals with low back pain is necessary to understand the clinical utility of rehabilitation care. We conducted a scoping review to describe the pre-rehabilitation functioning status of persons with nonspecific low back pain using the World Health Organization Disability Asses...

Background Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of...

Background The purpose of this study is to develop a list of performance indicators to assess the status of the chiropractic profession in Canada. Method We conducted a 4-round modified Delphi technique (March 2018–January 2020) to reach consensus among experts and stakeholders on key status indicators for the chiropractic profession using online...

Objective We conducted a systematic review to determine measurement properties and minimal important change (MIC) of World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short (12 questions) and full (36 questions) versions in persons with non-specific LBP. Data Sources MEDLINE, Embase, CINAHL, APA-PsycInfo, CENTRAL (inception...

Background Little is known about the diversity of the chiropractic profession with respect to gender, sexual orientation, race, ethnicity and community of practice. Diversity provides a foundation for culturally competent care delivery at the provider level and is paramount in the pursuit of a culturally congruent model of chiropractic care. The ob...

Objectives In November 2020, a series of reports, In Plain Sight , described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peop...

Background Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and...

Background In October 2017, a partnership was established between the University Hospital of Toulouse and the French Chiropractic College, “Institut Franco-Européen de Chiropraxie” (IFEC). Before 2017, chiropractors did not practice in hospitals in France. Chiropractic students and chiropractors are now integrated in an interdisciplinary medical te...

Objective The purposes of this study were to quantify the number of patients referred weekly from primary health care general practitioners (GPs) to chiropractors and to identify chiropractor characteristics associated with the number of referrals. Methods An online, cross-sectional survey was sent to the 600 active members of the Danish Chiroprac...

Prevost et al. published a systematic review evaluating the use of manual therapy for clinical conditions in the pediatric population in 2019. However, several methodological flaws in the conduct of the review limit the internal validity of its conclusions. We caution readers about the validity of the recommendations and suggest that the review not...

An amendment to this paper has been published and can be accessed via the original article.

Background Chiropractors have diverse views of practice, but the impact on their patient profiles and treatment approaches remains unclear. We assessed the association between chiropractors’ view of practice (unorthodox versus orthodox) and patient encounter-level characteristics among chiropractors who practice in Ontario, Canada. Methods We cond...

Objective To determine whether non-pharmacological interventions delivered through synchronous telehealth are as effective and safe compared to in-person interventions for the management of patients with musculoskeletal conditions in improving pain, functioning, self-reported recovery, psychological outcomes or health-related quality of life using...

Background Patient safety research is expanding from hospitals to community-based healthcare settings. Knowledge gaps persist among manual therapy professions that may impede patient safety initiatives within musculoskeletal care settings. Objectives To describe perceptions of patient safety among chiropractors and physiotherapists who provide spi...

Soccer referees represent a specialized population who are required to perform decisional or perceptual tasks during physical exertion. Recent studies have demonstrated that submaximal acute exercise has a positive impact on cognitive performance. However, less is known about the impact of more strenuous exertion on cognitive performance. This stud...

Background End-user involvement in developing evidence-based tools for clinical practice may result in increased uptake and improved patient outcomes. Understanding end-user experiences and perceptions about the co-production of knowledge is useful to further the science of integrated knowledge translation (iKT) – a strategy for accelerating the up...

Objectives To develop an evidence‐based guideline for the non‐invasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. Methods This guideline is based on high‐quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost‐effectiveness...

Background Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage condi...

Importance Claims that spinal manipulative therapy (SMT) can improve immune function have increased substantially during the COVID-19 pandemic and may have contributed to the rapid spread of both accurate and inaccurate information (referred to as an infodemic by the World Health Organization). Objective To identify, appraise, and synthesize the s...

Introduction: Musculoskeletal (MSK) conditions are primary reasons prohibiting Canadian Armed Forces (CAF) personnel from being deployed, with back pain the second most common activity-limiting condition. CAF provides a spectrum of services, including chiropractic care. There is a paucity of data related to chiropractic interprofessional care (IPC...

Objective: To explore perspectives, including social and psychological aspects, of patients seeking manual care for low back pain, in order to understand constructs of functioning that are important across different cultural contexts. The International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of these as...

Background A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. Objectives We convened a Global Summit...

Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made i...

Introduction: When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial. Objectives: To determine the...

Background Chiropractors are a particular subset of health care professionals that reportedly suffer occupational musculoskeletal disorders (MSDs), yet they have received minimal attention to date regarding mitigating risks of occupational injury. Our study determined the prevalence of occupationally-related MSDs in the preceding year, their bodily...

Background Understanding the mechanisms underlying chronic, nonspecific low back pain (CNSLBP) is essential to advance personalized care and identify the most appropriate intervention. Recently, two intervertebral motion biomarkers termed “Motion Sharing Inequality” (MSI) and “Motion Sharing Variability” (MSV) have been identified for CNSLBP using...

Objective To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. Methods Using an integrated knowledge translation m...

Introduction Little is known about effective, efficient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice. Objective To inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost–effecti...

Background: Patient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee's attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study ev...

Objective: To describe the best evidence on the effectiveness of technology-based learning tools designed to improve knowledge of health care providers about clinical practice guidelines (CPGs). Methods: We conducted a systematic review, searching MEDLINE, Embase, and CINAHL from inception to July 2018. Included studies investigated the effectiv...

Background: Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions...

Corso, M, Liang, L, Tran, S, Howitt, S, Srbely, J, and Mior, SA. The immediate effect of spinal manipulation on ball velocity and neuromuscular function during an instep kick in former Varsity soccer players: a feasibility study. J Strength Cond Res XX(X): 000-000, 2020-Spinal manipulation (SM) has been shown to increase ball velocity (BV) in socce...

Background Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions an...

Background: Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions a...

Aim: To explore the lived experiences of persons with low back pain (LBP) and disability within the context of the International Classification of Function, Disability and Health (ICF) framework. Methods: Qualitative study using focus group methodology. We stratified LBP patients into two low (n=9) and one high disability (n=3) groups. Transcrip...

Background: Health locus of control (LOC) represents an individual's beliefs regarding one's ability to influence health outcomes. In patients with chronic and neurodegenerative diseases, greater internal LOC has been associated with lower levels of disability. Objective: To examine LOC in patients with Huntington disease (HD). Methods: A cros...

Background: Staying Well, Independent and Fit Together (SWIFT), a seniors' exercise program, aims to promote health, strength, mobility and community engagement. We compared quality of life and balance confidence in SWIFT participants and non-participants, aged 60 years and older. Methods: Cross-sectional study comparing participants and non-par...

Background: Benign Joint Hypermobility Syndrome (BJHS) is a relatively prevalent condition of the spectrum of heritable connective tissue disorders, with musculoskeletal, visceral and psychological manifestations. The conservative management of the musculoskeletal symptomatology must be modified for optimal effectiveness and minimal sequelae. Pur...

Purpose: To update the findings of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) on prognostic factors for whiplash-associated disorder (WAD) outcomes. Materials and methods: We conducted a systematic review and best-evidence synthesis. We systematically searched MEDLINE, EMBASE, CIN...

Introduction Surgical rates for low back pain (LBP) have been increasing in Europe, North America and Asia. Many patients treated surgically will require postsurgical rehabilitation. Little is known about the effectiveness of postsurgical rehabilitation interventions on health outcomes or about patients’ experiences with these interventions. Objec...

Introduction: The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue. Objectives: We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incide...

The World Health Organization (WHO), in its "Rehabilitation 2030 A Call for Action", identified the need to strengthen rehabilitation in health systems to meet the growing demands of current and future populations. Greater access to rehabilitation services is required to secure the achievement of the United Nation's third Sustainable Development Go...

Background: Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review...

Background: Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students' attitudes towards patient-centred care compare to those of other health professions or wheth...