Updates on chiropractic research groups, studies and achievements.

Improving mobility in ankylosing spondylitis patients

Most patients who are given the diagnosis of ankylosing spondylitis have no idea what the disease is all about. Essentially, ankylosing spondylitis is a form of inflammatory arthritis that localizes in the spine. Because it is an auto-immune disease, the body attacks the facet joints between the vertebra, resulting in fusion and the hallmark forward stooping posture. It is difficult to diagnose and patients can live with it for years undetected. Arthritis is generally thought to be an old person’s disease, however, ankylosing spondylitis is most commonly seen in individuals between 17 and 35 years of age.A new class of drugs called biologics have revolutionized the treatment of auto-immune diseases and many patients are able to improve their quality of life as a result. Dr. Carlo Ammendolia at the University of Toronto says that the use of these drugs actually control the inflammatory process and are life changing for those struggling with the pain ankylosing spondylitis, however, they do not address the fusion of the joints that can impair mobility. Since most people are young when they receive their diagnosis, the thought of not being able to enjoy all of life’s activities because of spinal fusion can be devastating. Through his research, Dr. Ammendolia is working with patients to develop management approaches to help minimize or slow the fusion process.Dr. Ammendolia has identified several tailored exercises that when combined with the drugs can help improve or slow the fusion process. “The exercise program is really geared towards lifestyle and self management where patients are doing things sitting, standing, walking and sleeping in a posture that mitigates that risk to fuse in that posture.” The goal is to improve the muscles around the joints so that optimal posture is maintained. Chiropractic care also plays a role, with carefully considered treatments known as “adjustments” adding to the overall treatment plan to help maintain mobility. Push/relax techniques are used to help regain neck flexibility. In cases where joints are already fused together, adjustment or manual manipulation is not performed.As much as we hate to admit it, most health care, especially disease management, requires commitment from the patient to improve or maintain their wellness. That is of course what Empowered Health is all about, right? With these protocols, Dr. Ammendolia hopes that individuals suffering from ankylosing spondylitis will be “kick started” into self management of the condition. Next steps include developing tools and resources that will help patients track and monitor their progress. For more information, be sure to consult your family chiropractic doctor.

Narrowing the evidence-practice gap

Healthcare research is conducted daily around the world and we often see headlines published on a single topic in newspapers or broadcast on the news. Some of these findings are nothing short of amazing, disc regeneration for example, but most studies provide small steps forward to improve prevention opportunities and recovery time. While most research papers do not garner airtime due to the volume of research, this should not dismiss their significance. But how do we get the attention of the public, or more importantly, the health professional when it comes to these types of studies?Dr. André Bussières DC, PhD holds the CCRF Professorship in Rehabilitation Epidemiology at McGill University. His goal is to develop methods and resources to narrow what some call the evidence-practice gap. This “gap” refers to published comprehensive research and what is practiced by the healthcare provider in the clinic setting. Dr. Bussières says that 30-40% of patients do not receive the best care as a result of this “gap”, so patients aren’t receiving care that is reflective of the latest research. Knowledge transfer is an extremely tricky process and it usually takes a long time to convey the latest best practices to clinicians.One of the reasons why communication is so difficult is because the research is scattered throughout many different journals and publications. To help centralize the information, Dr. Bussières and his team at McGill plan to look at all of the evidence and research available for a given condition or therapy. Once the review is complete and the research is scrutinized, qualifying studies are synthesized into one comprehensive document (also known as a Clinical Practice Guideline or CPG) that explains the research resources and demonstrates best practices supported by the research at that time. This creates somewhat of a road map that the health professional can use to assist with diagnosis and treatment. In addition, CPGs can reinforce a doctor’s experience with patients in practice (practice based evidence) through evidence-based research (what is learnt in the lab).Comprehensive CPGs can be very useful in the transfer of knowledge and support best practices in the clinic setting. These resources are also valuable when discussing expected outcomes and recovery times with insurance providers or patients themselves. The public is more informed about their health now than ever before so it is plausible that patients will have questions and ask for reassurance when receiving a diagnosis and recommended care.

Research finds back pain assessments show room for improvement

Most people who experience back pain will consult their medical doctor first for treatment and advice. In fact, one third of all office visits to a medical doctor are for spine and spine related problems. Not only is back pain a huge burden on our health care system, it has many causes and is therefore difficult to diagnose. Dr. Jason Busse, Chiropractic Research Chair at McMaster University is conducting research into ways to improve medical assessments for low back pain and create greater efficiency when determining the most appropriate course of care.8629595Dr. Busse’s research reinforces the notion that most medical doctors are not confident in their diagnosis of spine conditions. Back pain can result from physical, chemical or emotional stress. It can be difficult to pin down the individual factors that are causing each patient’s case of back pain. As a result, many doctors consult advanced medical imaging such as CT Scans or MRIs as part of the assessment process when in reality, these types of imaging are best used to reinforce or rule out a diagnosis. Imaging used for assessment purposes is generally not helpful.In order to gain confidence in the patient’s diagnosis, Dr. Busse is investigating better assessment techniques that include the involvement of a chiropractic doctor in conjunction with a medical doctor. Through this collaborative approach, Dr. Busse’s research suggests that patients who require conservative care, advanced imaging or surgical assessment would be easier to identify and triage appropriately.With our current system, back pain patients who do not recover or “fail” are usually referred by their medical doctor for surgical consult to a spine surgeon. The wait time for this consult in Canada is approximately six months. When Dr. Busse polled Canadian spine surgeons he found that 20% of referred patients are rejected without a consult. These patients are left to find another way to manage their condition. Of the patients that do receive a surgical consult, only one in every ten is an eligible candidate for surgery. These patients must then wait another six months for their surgery.A recent study into the early predictors of lumbar spine surgery after occupational back injury also highlighted another interesting point about the incidence of spine surgery amongst injured workers. Of these patients, 42.7% of those who first saw a spine surgeon had surgery while 1.5% of those who saw a chiropractic doctor first were referred for surgery.These findings suggest that conservative care can play a key role in the appropriate treatment and management of back problems. Dr. Busse’s research continues to build on this idea with the goal of better patient outcomes and a more streamlined assessment process. Through this shift in cultural behaviour for the treatment of chronic spinal conditions, health care dollars can go farther with less need for surgery and imaging and focus can be given to what is truly best for the patient and their recovery.

New CCGI Evidence Informed Practice Definition adopted by BCCA

The BCCA recently adopted the Canadian Chiropractic Guideline Initiative (CCGI) Definition of “Evidence Informed Practice”:“Canadian chiropractors adopt evidence-informed practice principles to guide clinical decision making by integrating their clinical expertise, patients’ preferences and values, and the best available scientific evidence.”BC’s Chiropractic Doctors are proud to support the CCGI and their mission to develop evidence-based clinical practice guidelines (CPGs) and best practice recommendations, and facilitate their dissemination and implementation within the chiropractic profession.For more information, visit the CCGI website.