International web survey of chiropractic students about evidence-based practice: a pilot study

<p>Abstract</p> <p>Background</p> <p>Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles.</p> <p>Methods</p> <p>We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis.</p> <p>Results</p> <p>Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9).</p> <p>Conclusions</p> <p>Although it is feasible to conduct an international web survey of chiropractic students, significant stakeholder participation is important to improve response rates. Students had relatively positive attitudes toward EBP. However, participants felt they needed more training in EBP and based on the knowledge questions they may need further training about basic research concepts.</p

Relationship between Biomechanical Characteristics of Spinal Manipulation and Neural Responses in an Animal Model: Effect of Linear Control of Thrust Displacement versus Force, Thrust Amplitude, Thrust Duration, and Thrust Rate

High velocity low amplitude spinal manipulation (HVLA-SM) is used frequently to treat musculoskeletal complaints. Little is known about the intervention’s biomechanical characteristics that determine its clinical benefit. Using an animal preparation, we determined how neural activity from lumbar muscle spindles during a lumbar HVLA-SM is affected by the type of thrust control and by the thrust's amplitude, duration, and rate. A mechanical device was used to apply a linear increase in thrust displacement or force and to control thrust duration. Under displacement control, neural responses during the HVLA-SM increased in a fashion graded with thrust amplitude. Under force control neural responses were similar regardless of the thrust amplitude. Decreasing thrust durations at all thrust amplitudes except the smallest thrust displacement had an overall significant effect on increasing muscle spindle activity during the HVLA-SMs. Under force control, spindle responses specifically and significantly increased between thrust durations of 75 and 150 ms suggesting the presence of a threshold value. Thrust velocities greater than 20–30 mm/s and thrust rates greater than 300 N/s tended to maximize the spindle responses. This study provides a basis for considering biomechanical characteristics of an HVLA-SM that should be measured and reported in clinical efficacy studies to help define effective clinical dosages

A systematic review of thrust manipulation for non-surgical shoulder conditions

PURPOSE: Although many conservative management options are available for patients with non-surgical shoulder conditions, there is little evidence of their effectiveness. This review investigated one manual therapy approach, thrust manipulation, as a treatment option. METHODS: A systematic search was conducted of the electronic databases from inception to March 2016: PubMed, PEDro, ICL, CINAHL, and AMED. Two independent reviewers conducted the screening process to determine article eligibility. Inclusion criteria were manuscripts published in peer-reviewed journals with human participants of any age. The intervention included was thrust, or high-velocity low-amplitude, manipulative therapy directed to the shoulder and/or the regions of the cervical or thoracic spine. Studies investigating secondary shoulder pain or lacking diagnostic confirmation procedures were excluded. Methodological quality was assessed using the PEDro scale and the Cochrane risk-of-bias tool. RESULTS: The initial search rendered 5041 articles. After screening titles and abstracts, 36 articles remained for full-text review. Six articles studying subacromial impingement syndrome met inclusion criteria. Four studies were randomized controlled trials (RCTs) and 2 were uncontrolled clinical studies. Five studies included 1 application of a thoracic spine thrust manipulation and 1 applied 8 treatments incorporating a shoulder joint thrust manipulation. Statistically significant improvements in pain scores were reported in all studies. Three of 4 RCTs compared a thrust manipulation to a sham, and statistical significance in pain reduction was found within the groups but not between them. Clinically meaningful changes in pain were inconsistent; 3 studies reported that scores met minimum clinically important difference, 1 reported scores did not, and 2 were unclear. Four studies found statistically significant improvements in disability; however, 2 were RCTs and did not find statistical significance between the active and sham groups. CONCLUSIONS: No clinical trials of thrust manipulation for non-surgical shoulder conditions other than subacromial impingement syndrome were found. There is limited evidence to support or refute thrust manipulation as a solitary treatment for this condition. Studies consistently reported pain reduction, but active treatments were comparable to shams. High-quality studies of thrust manipulation with safety data, longer treatment periods and follow-up outcomes are needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12998-016-0133-8) contains supplementary material, which is available to authorized users

Observations of the SW Sextantis star DW Ursae Majoris with the Far Ultraviolet Spectroscopic Explorer

We present an analysis of the first far-ultraviolet observations of the SW Sextantis-type cataclysmic variable DW Ursae Majoris, obtained in November 2001 with the Far Ultraviolet Spectroscopic Explorer. The time-averaged spectrum of DW UMa shows a rich assortment of emission lines (plus some contamination from interstellar absorption lines including molecular hydrogen). Accretion disk model spectra do not provide an adequate fit to the far-ultraviolet spectrum of DW UMa. We constructed a light curve by summing far-ultraviolet spectra extracted in 60-sec bins; this shows a modulation on the orbital period, with a maximum near photometric phase 0.93 and a minimum half an orbit later. No other periodic variability was found in the light curve data. We also extracted spectra in bins spanning 0.1 in orbital phase; these show substantial variation in the profile shapes and velocity shifts of the emission lines during an orbital cycle of DW UMa. Finally, we discuss possible physical models that can qualitatively account for the observed far-ultraviolet behavior of DW UMa, in the context of recent observational evidence for the presence of a self-occulting disk in DW UMa and the possibility that the SW Sex stars may be the intermediate polars with the highest mass transfer rates and/or weakest magnetic fields.Comment: accepted by the Astronomical Journal; 36 pages, including 12 figures and 4 table

Far Ultraviolet Observations of the Dwarf Nova VW Hyi in Quiescence

We present a 904-1183 A spectrum of the dwarf nova VW Hydri taken with the Far Ultraviolet Spectroscopic Explorer during quiescence, eleven days after a normal outburst, when the underlying white dwarf accreter is clearly exposed in the far ultraviolet. However, model fitting show that a uniform temperature white dwarf does not reproduce the overall spectrum, especially at the shortest wavelengths. A better approximation to the spectrum is obtained with a model consisting of a white dwarf and a rapidly rotating ``accretion belt''. The white dwarf component accounts for 83% of the total flux, has a temperature of 23,000K, a v sin i = 400 km/s, and a low carbon abundance. The best-fit accretion belt component accounts for 17% of the total flux, has a temperature of about 48,000-50,000K, and a rotation rate Vrot sin i around 3,000-4,000 km/s. The requirement of two components in the modeling of the spectrum of VW Hyi in quiescence helps to resolve some of the differences in interpretation of ultraviolet spectra of VW Hyi in quiescence. However, the physical existence of a second component (and its exact nature) in VW Hyi itself is still relatively uncertain, given the lack of better models for spectra of the inner disk in a quiescent dwarf nova.Comment: 6 figures, 10 printed page in the journal, to appear in APJ, 1 Sept. 2004 issue, vol. 61

Antinociceptive Effects of Spinal Manipulative Therapy on Nociceptive Behavior of Adult Rats during the Formalin Test

Optimizing pain relief resulting from spinal manipulative therapies, including low velocity variable amplitude spinal manipulation (LVVA-SM), requires determining their mechanisms. Pain models that incorporate simulated spinal manipulative therapy treatments are needed for these studies. The antinociceptive effects of a single LVVA-SM treatment on rat nociceptive behavior during the commonly used formalin test were investigated. Dilute formalin was injected subcutaneously into a plantar hindpaw. Licking behavior was video-recorded for 5 minutes. Ten minutes of LVVA-SM at 20° flexion was administered with a custom-made device at the lumbar (L5) vertebra of isoflurane-anesthetized experimental rats (n=12) beginning 10 minutes after formalin injection. Hindpaw licking was video-recorded for 60 minutes beginning 5 minutes after LVVA-SM. Control rats (n=12) underwent the same methods except for LVVA-SM. The mean times spent licking the formalin-injected hindpaw of both groups 1–5 minutes after injection were not different. The mean licking time during the first 20 minutes post-LVVA-SM of experimental rats was significantly less than that of control rats (P<0.001). The mean licking times of both groups during the second and third 20 minutes post-LVVA-SM were not different. Administration of LVVA-SM had a short-term, remote antinociceptive effect similar to clinical findings. Therefore, mechanistic investigations using this experimental approach are warranted

Accretion and Outflow in Interacting Binary Systems: FUSE Observations of the Novalike Cataclysmic Variable, UX Ursae Majoris

We present far-ultraviolet (905 -- 1182 A), time-series spectroscopy of the eclipsing, novalike cataclysmic variable, UX UMa, acquired with FUSE. The time-averaged spectrum is complex and is dominated by overlapping spectral features. The most prominent features are emission lines of CIII, NIII}, NIV, and OVI. They are broad (FWHM >= 1800 km/s) and double-peaked with a central absorption at zero velocity. During eclipse, the spectrum is simpler: the emission lines remain bright, but the absorption components of the lines and the weaker features between the emission lines disappear entirely, leaving a flat continuum. This behavior is also evident in GHRS (1149 -- 1660 A) spectra that we retrieved from the HST archive. The FUV spectra show flickering on time scales of several minutes. The flickering is seen primarily in the continuum and/or the weaker lines rather than in the prominent emission lines. The orbital light curve has a dip in the FUV flux between orbital phases 0.45 -- 0.65, similar to a pre-eclipse dip detected in HST observations. The EWs of the line absorption features decrease during the dip. We have detected a systematic wavelength shift of spectral features on the orbital period, but with a phase lag of ~ 20 degrees, a phenomenon that has been reported at optical wavelengths. We discuss the implications of our results in the context of models of an accretion disk with a chromosphere between the disk and the extended wind. Finally, we note that the observed FUV flux is too low to be consistent with the temperature and radius of the WD derived by Baptista et al. (1995), suggesting that their remaining binary parameters, including a mass ratio of 1, ought to be viewed with skepticism.Comment: 24 pages, 10 figures; prepared using emulateapj5.sty. To appear in the Astrophysical Journa