Experiences With Chiropractic Care for Patients With Low Back or Neck Pain.

BackgroundMusculoskeletal disorders are the second leading cause of disability worldwide.ObjectiveExamine experiences of chiropractic patients in the United States with chronic low back or neck pain.MethodObservational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care.ResultsWe found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points).ConclusionsThe positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care

Articles Storytelling as Pedagogy: An Unexpected Outcome of Narrative Inquiry

ABSTRACT This study examines how the use of narrative research methods can serve as pedagogical strategies in preservice teacher education. In this study, we see the intersection of narrative inquiry and storytelling-as-pedagogy. The two often intersect, but rarely has that intersection been examined in a systematic manner. This study examines data collected as one ESL preservice teacher and one Bilingual preservice teacher were followed from their language arts methods class into student teaching and then their first year of teaching to see how they reflected on, questioned, and learned from their experiences. Incidents where narrative inquiry served as pedagogical tools were examined. Although storytelling-as-pedagogy was not a goal in this study, we found that it was an outcome of utilizing narrative inquiry as a methodology. Narrative inquiry is widely recognized as a viable approach to conducting qualitative research. Narrative and storytelling have long been perceived as pedagogical tools. In this study, we see the intersection of narrative inquiry and storytelling-as-pedagogy. Although storytelling-as-pedagogy was not a goal, we found that it was an outcome of utilizing narrative inquiry as a methodology in this study. PURPOSE OF THE STUDY In education, stories or narratives have been used in two different ways: first, storytelling as a pedagogical strategy and second, narrative as a research method. As a pedagogical strategy, "teachers themselves [can] gain insights into their practices and set new directions for their ongoing professional development" (Wood, 2000, p. 426). While as a research method, it is important that "narrative inquiry must question the 'truth' status of teacher narratives and seek multiple critical (re)readings from a variety of analytic approaches" (Johnson, 2001, p. 199). The two often intersect, but rarely has that intersection been examined in a systematic manner. The purpose of this article is to conduct such an examinationspecifically, how the use of narrative research methods can also serve as pedagogical strategies in preservice teacher education to help teachers reflect on, question, and learn from their experiences. In the study, one ESL preservice teacher and one Bilingual preservice teacher were followed through their language arts and reading methods course, through student teaching and their first year of teaching. In this paper, we examine those segments of raw data that elicited storytelling from the participants. We address all three segments of data collection (i.e., the methods course, student teaching, and first year of teaching), but concentrate on those incidents in which participation in the narrative methods of this study also served as pedagogical practices. What follows is a brief review of the literature in two parts. First, we focus on narrative or storytelling as a pedagogical strategy, that is, who has used it as such a strategy and how, and why storytelling is an appropriate pedagogical practice in preservice teacher education. Second, we examine the field of narrative research addressing issues such as what is narrative inquiry, who conducts this research, how they conduct it, and why it is particularly suited to the study of preservice teacher education. Following the review of the literature, we provide background information about the study including who the participants were, how they were chosen, and how and when data were collected, interpreted, and presented. Then, we describe the process by which we analyzed the data looking for those incidents in which the narrative inquiry also served as a pedagogical tool. We turn now to the review of the literature. REVIEW OF THE LITERATURE Storytelling as a Pedagogical Strategy A story is a beautiful means of teaching religion, values, history, traditions, and customs; a creative method of introducing characters and places; an imaginative 104 CATHY COULTER ET AL. way to instill hope and resourceful thinking. Stories help us understand who we are and show us what legacies to transmit to future generations. (Schram, 1994, p. 176

Coping and Management Techniques Used by Chronic Low Back Pain Patients Receiving Treatment From Chiropractors.

OBJECTIVES:The purpose of this study was to describe coping strategies (eg, mechanisms, including self-treatment) that a person uses to reduce pain and its impact on functioning as reported by patients with chronic low back pain who were seen by doctors of chiropractic and how these coping strategies vary by patient characteristics. METHODS:Data were collected from a national sample of US chiropractic patients recruited from chiropractic practices in 6 states from major geographical regions of the United States using a multistage stratified sampling strategy. Reports of coping behaviors used to manage pain during the past 6 months were used to create counts across 6 domains: cognitive, self-care, environmental, medical care, social activities, and work. Exploratory analyses examined counts in domains and frequencies of individual items by levels of patient characteristics. RESULTS:A total of 1677 respondents with chronic low back pain reported using an average of 9 coping behaviors in the prior 6 months. Use of more types of behaviors were reported among those with more severe back pain, who rated their health as fair or poor and who had daily occurrences of pain. Exercise was more frequent among the healthy and those with less pain. Female respondents tended to report using more coping behaviors than men, and Hispanics more than non-Hispanics. CONCLUSION:Persons with chronic back pain were proactive in their coping strategies and frequently used self-care coping strategies like those provided by chiropractors in patient education. In alignment with patients' beliefs that their condition was chronic and lifelong, many patients attempted a wide range of coping strategies to relieve their pain

Coulter, Cathy A., and Mary Lee Smith, The Construction Zone: Literary Elements in Narrative Research, Educational Researcher, 38(November, 2009), 577-590.

Describes and illustrates ten literary elements used in constructing stories in narrative research; three articles providing comments and criticism of his article immediately follow as well as a response to these articles by the original authors

Group and Individual-level Change on Health-related Quality of Life in Chiropractic Patients With Chronic Low Back or Neck Pain.

Study designA prospective observational study.ObjectiveThe aim of this study was to evaluate group-level and individual-level change in health-related quality of life among persons with chronic low back pain or neck pain receiving chiropractic care in the United States.Summary of background dataChiropractors treat chronic low back and neck pain, but there is limited evidence of the effectiveness of their treatment METHODS.: A 3-month longitudinal study of 2024 patients with chronic low back pain or neck pain receiving care from 125 chiropractic clinics at six locations throughout the United States was conducted. Ninety-one percent of the sample completed the baseline and 3-month follow-up survey (n = 1835). Average age was 49, 74% females, and most of the sample had a college degree, were non-Hispanic White, worked full-time, and had an annual income of $60,000 or more. Group-level (within-group t tests) and individual-level (coefficient of repeatability) changes on the Patient-Reported Outcomes Measurement Information System (PROMIS-29) v2.0 profile measure was evaluated: six multi-item scales (physical functioning, pain, fatigue, sleep disturbance, social health, emotional distress) and physical and mental health summary scores.ResultsWithin-group t tests indicated significant group-level change (P < 0.05) for all scores except for emotional distress, and these changes represented small improvements in health (absolute value of effect sizes ranged from 0.08 for physical functioning to 0.20 for pain). From 13% (physical functioning) to 30% (PROMIS-29 v2.0 Mental Health Summary Score) got better from baseline to 3 months later according to the coefficient of repeatability.ConclusionChiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better ("responders"). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.Level of evidence3

Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 3: Designing Instruments With Patient Input.

ObjectivesThe purpose of this article is to describe how we designed patient survey instruments to ensure that patient data about preferences and experience could be included in appropriateness decisions. These actions were part of a project that examined the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain.MethodsWe conducted focus groups, cognitive interviews, a literature review of measures in prior chiropractic and complementary and integrative health research, and a pilot study to develop questionnaires of patient preferences, experiences, values, and beliefs.ResultsQuestionnaires were administered online to 2024 individuals from 125 chiropractic clinics. The survey included 3 long questionnaires and 5 shorter ones. All were administered online. The baseline items had 2 questionnaires that respondents could complete in different sittings. Respondents completed shorter biweekly follow-ups every 2 weeks and a final questionnaire at 3 months. The 2 initial questionnaires had 81 and 140 items, the 5 biweekly follow-up questionnaires had 37 items each, and the endline questionnaire contained 121 items. Participants generally responded positively to the survey items, and 91% of the patients who completed a baseline questionnaire completed the endpoint survey 3 months later. We used "legacy" measures, and we also adapted measures and developed new measures for this study. Preliminary assessment of reliability and validity for a newly developed scale about coping behaviors indicates that the items work well together in a scale.ConclusionsThis article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions

Experiences With Chiropractic Care for Patients With Low Back or Neck Pain.

BackgroundMusculoskeletal disorders are the second leading cause of disability worldwide.ObjectiveExamine experiences of chiropractic patients in the United States with chronic low back or neck pain.MethodObservational study of 1853 chronic low back pain and neck pain patients (74% female) who completed an online questionnaire at the 3-month follow-up that included Consumer Assessment of Healthcare Providers and Systems (CAHPS) items assessing their experiences with care.ResultsWe found similar reports of communication for the chiropractic sample and patients in the 2016 CAHPS National Database, but 85% in the database versus 79% in the chiropractic sample gave the most positive response to the time spent with provider item. More patients in the CAHPS database rated their provider at the top of the scale (8 percentage points). More chiropractic patients reported always getting answers to questions the same day (16 percentage points) and always being seen within 15 minutes of their appointment time (29 percentage points).ConclusionsThe positive experiences of patients with chronic back and neck pain are supportive of their use of chiropractic care

Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group

Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training