The use of internet analytics by a Canadian provincial chiropractic regulator to monitor, evaluate and remediate misleading claims regarding specific health conditions, pregnancy, and COVID-19

Background Internet analytics are increasingly being integrated into public health regulation. One specific application is to monitor compliance of website and social media activity with respect to jurisdictional regulations. These data may then identify breaches of compliance and inform disciplinary actions. Our study aimed to evaluate the novel use of internet analytics by a Canadian chiropractic regulator to determine their registrants compliance with three regulations related to specific health conditions, pregnancy conditions and most recently, claims of improved immunity during the COVID-19 crisis. Methods A customized internet search tool (Market Review Tool, MRT) was used by the College of Chiropractors of British Columbia (CCBC), Canada to audit registrants websites and social media activity. The audits extracted words whose use within specific contexts is not permitted under CCBC guidelines. The MRT was first used in October of 2018 to identify words related to specific health conditions. The MRT was again used in December 2019 for words related to pregnancy and most recently in March 2020 for words related to COVID-19. In these three MRT applications, potential cases of word misuse were evaluated by the regulator who then notified the practitioner to comply with existing regulations by a specific date. The MRT was then used on that date to determine compliance. Those found to be non-compliant were referred to the regulator’s inquiry committee. We mapped this process and reported the outcomes with permission of the regulator. Results In September 2018, 250 inappropriate mentions of specific health conditions were detected from approximately 1250 registrants with 2 failing to comply. The second scan for pregnancy related terms of approximately1350 practitioners revealed 83 inappropriate mentions. Following notification, all 83 cases were compliant within the specified timeframe. Regarding COVID-19 related words, 97 inappropriate mentions of the word “immune” were detected from 1350 registrants with 7 cases of non-compliance. Conclusion Internet analytics are an effective way for regulators to monitor internet activity to protect the public from misleading statements. The processes described were effective at bringing about rapid practitioner compliance. Given the increasing volume of internet activity by healthcare professionals, internet analytics are an important addition for health care regulators to protect the public they serve

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

Correlations Between Individuals' Characteristics and Spinal Stiffness in Individuals With and Without Back Pain: A Combined Analysis of Multiple Data Sets.

OBJECTIVE: The purpose of this study was to describe the correlations between individual characteristics and spinal stiffness as measured with different spinal stiffness measurement devices in individuals with and without back pain. METHODS: A secondary analysis of 3 adult data sets obtained using 3 different devices, in 2 spinal regions, from a total of 5 separate cross-sectional studies was conducted. Differences in spinal stiffness between men and women and in the strength of correlations among spinal stiffness and age and anthropometric characteristics were evaluated using either the t test for independent samples, Pearson's correlation coefficient, or Kendall's τ rank correlation coefficient. RESULTS: As expected, results varied between data sets; however, few factors had consistent correlations. Specifically, spinal stiffness was significantly lower in women than men in all 3 data sets. Height was positively correlated with spinal stiffness across all data sets. Although weight was correlated with thoracic stiffness, its correlation with lumbar stiffness varied. In 2 data sets, body mass index was inversely associated with lumbar spinal stiffness, whereas results from the thoracic spine region revealed a positive correlation. The results for 1 data set suggest that physiological measurement evaluating body weight distribution may also affect spinal stiffness; however, the specific correlation remains unclear. CONCLUSION: Despite data set differences, significant correlations were observed, indicating that participants' characteristics appear to affect spinal stiffness measurement

Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review of Studies With Objectively Measured Sitting Time

have determined sitting time by self-report and/or LBP by recall following exposure. Given known problems with recall and the validity of estimated sitting time, we conducted a systematic review of studies using objectively measured sitting time to determine if sitting time is associated with immediate LBP in adults. Methods: Four databases (PubMed, EMBASE, SPORTDiscus and CINAHL) were searched from inception to September 1, 2018. Randomized controlled trials, cohort and cross-sectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full text review, data extraction and risk of bias assessment (QUIPS) of included papers were performed independently by two reviewers, with a third available to resolve disagreements. Results: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility and 10 met the inclusion criteria. All but one reported sitting time to be associated with immediate increase in LBP. Six of these reported clinically relevant pain levels (n=330). Half of the included studies were rated as having low risk of bias and the remaining as moderate risk of bias. Conclusion: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP

Force distribution within spinal tissues during posterior to anterior spinal manipulative therapy: a secondary analysis

Background: Previous studies observed that the intervertebral disc experiences the greatest forces during spinal manipulative therapy (SMT) and that the distribution of forces among spinal tissues changes as a function of the SMT parameters. However, contextualized SMT forces, relative to the ones applied to and experienced by the whole functional spinal unit, is needed to understand SMT's underlying mechanisms. Aim: To describe the percentage force distribution between spinal tissues relative to the applied SMT forces and total force experienced by the functional unit. Methods: This secondary analysis combined data from 35 fresh porcine cadavers exposed to a simulated 300N SMT to the skin overlying the L3/L4 facet joint via servo-controlled linear motor actuator. Vertebral kinematics were tracked optically using indwelling bone pins. The functional spinal unit was then removed and mounted on a parallel robotic platform equipped with a 6-axis load cell. The kinematics of the spine during SMT were replayed by the robotic platform. By using serial dissection, peak and mean forces induced by the simulated SMT experienced by spinal structures in all three axes of motion were recorded. Forces experienced by spinal structures were analyzed descriptively and the resultant force magnitude was calculated. Results: During SMT, the functional spinal unit experienced a median peak resultant force of 36.4N (IQR: 14.1N) and a mean resultant force of 25.4N (IQR: 11.9N). Peak resultant force experienced by the spinal segment corresponded to 12.1% of the total applied SMT force (300N). When the resultant force experienced by the functional spinal unit was considered to be 100%, the supra and interspinous ligaments experienced 0.3% of the peak forces and 0.5% of the mean forces. Facet joints and ligamentum flavum experienced 0.7% of the peak forces and 3% of the mean forces. Intervertebral disc and longitudinal ligaments experienced 99% of the peak and 96.5% of the mean forces. Conclusion: In this animal model, a small percentage of the forces applied during a posterior-to-anterior SMT reached spinal structures in the lumbar spine. Most SMT forces (over 96%) are experienced by the intervertebral disc. This study provides a novel perspective on SMT force distribution within spinal tissues

Center of rotation locations during lumbar spine movements: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify and map current literature describing the center of rotation locations and migration paths during lumbar spine movements. INTRODUCTION: The importance of lumbar spine kinematics has been described and altered kinematics has been associated with pain and injury. Intervertebral segments' center of rotations, the point around which spinal segments rotate, are important for determining the lumbar spine kinematics features and the potential for increased injury risk during movements. Although many studies have investigated the center of rotations of humans' lumbar spine, no review has summarized and organized the state of the science related to center of rotation locations and migration paths of the lumbar spine during lumbar spine movements. INCLUSION CRITERIA: This review will consider studies that include human lumbar spines of any age and status condition (e.g. heathy, pathological) during lumbar spine movements. Quantitative study designs, including clinical, observational, laboratory biomechanical experimental studies, mathematical and computer modelling studies will be considered. Only studies published in English will be included, and there will be no limit on dates of publication. METHODS: PubMed, MEDLINE, Embase, the Cochrane Library Controlled Register of Trials, CINAHL, ACM Digital Library, Compendex, Inspec, Web of Science, Scopus, Google Scholar, and dissertation and theses repositories will be searched. After titles and abstracts screening of identified references, two independent reviewers will screen the full-text of identified studies and extract data. Data will be summarized and categorized, and a comprehensive narrative summary will be presented with the respective results