Evidence-based maintenance care among chiropractors in Norway: a cross-sectional survey in the Nordic maintenance care program

Background Chiropractors use a treatment strategy called maintenance care with the intent of secondary and tertiary prevention. The Nordic Maintenance Care Program provides evidence of when and for whom maintenance care should be offered. Dissemination has occurred through articles, workshops, social media, conference in Europe and internationally. However, little is known about chiropractors’ awareness and use of this evidence. This study explores chiropractors’ attitudes, skills, and use of evidence on maintenance care, as well as study their association with general evidence-based practice and demographic characteristics. Moreover, barriers and facilitators of evidence access are also examined. Methods Questions pertaining our research aim were included in the anonymous and digital Evidence-Based practice Attitude and utilization SurvEy, which was distributed to all members (n = 770) of the Norwegian chiropractic association in the fall of 2021. Results The response rate was 41% (n = 312). Regarding attitudes towards evidence-based maintenance care, 26% agreed they needed tools to recommend this care to patients. Approximately half (57%) believed they had skills to identify suitable patients, and 45% had used published information in the past month. Strong alignment was observed between Norwegian chiropractors’ attitudes, skills, and utilization of evidence-based maintenance care and general evidence-based practice. Maintenance care skills were significantly associated with age (those between 40 and 59 years being less likely to report having high skills), clinical setting (those working with conventional health care providers being less likely to report having high skills) and country of education (those educated in the US and Australia being more likely to report having high skills). Moreover, maintenance care use was significantly associated with country of education (those educated in Australia were less likely to have used published information regarding patient selection for maintenance care). Access to resources was a barrier, whereas knowledge of patient suitability facilitated evidence-based maintenance care. Conclusions Norwegian chiropractors had neutral attitudes towards maintenance care, but generally reported moderate skills. Most had not used evidence about maintenance care in the previous month. Access to useful resources about the evidence regarding maintenance care was a barrier, and knowledge of who responds to maintenance care was a facilitator.publishedVersio

Subjective recovery from pregnancy-related pelvic girdle pain the first 6 weeks after delivery: a prospective longitudinal cohort study

Purpose The purpose of this study was to investigate the subjective recovery from pregnancy-related pelvic girdle pain (PGP) during the first 6 weeks after delivery and to detect possible risk factors for a poor recovery. Methods The participants were included in this study at the routine ultrasound examination at 18 weeks of pregnancy. The women received a weekly SMS with the question “How many days during the last week has your PGP been bothersome?” The SMS-track from the final 10 weeks of pregnancy and first 6 weeks after delivery were assessed and sorted, based on individual graphs. A total of 130 women who reported PGP during pregnancy and met for clinical examination 6 weeks after delivery were included in the study. Results In all, 83% of the women experienced substantial recovery from severe or moderate PGP within 6 weeks after delivery. Of these, 44% reported a substantial recovery already within 2 weeks after delivery. More multiparous women, women reporting PGP the year before pregnancy, and women with high pain intensity during pregnancy had a poor recovery. Conclusions The prognosis following PGP in pregnancy is good and the majority of women recovered substantially from severe and moderate pregnancy-related PGP within 6 weeks after delivery. For many women, a subjective substantial recovery occurred within 2 weeks after delivery. Predictors for a poor recovery were multiparity, PGP the year before pregnancy and a high pain intensity during pregnancy.publishedVersio

Pregnancy-related pelvic girdle pain: Prognosis, risk factors, consequences, and chiropractic management

Background Pelvic girdle pain (PGP) is a common musculoskeletal disorder during pregnancy; affected women experience various degrees of pain, disability, and reduced quality of life. In addition, PGP is a frequent cause of sick leave during pregnancy. Although most women recover from PGP after delivery, some women struggle with persistent PGP for months and years. There is still limited knowledge about etiology, occurrence, risk factors, consequences, and treatment options for PGP during pregnancy and after delivery. Objectives The overall aim of this thesis was to provide more knowledge about the recovery and persistence of PGP, including risk factors and consequences of persistent PGP. Furthermore, to investigate the effect of chiropractic management for women with PGP during pregnancy and after delivery. Methods The four papers in this thesis are based on two separate data collections at Stavanger University Hospital. Paper I and II originate from a retrospective cohort study conducted in 2009. In Paper I, women with persistent PGP 3–6 months after delivery (n=330), underwent a clinical examination and filled in questionnaires to examine the frequency of persistent PGP, its influence on the women´s daily life, and potential risk factors for persistent PGP. The pilot study, Paper II, aimed to investigate the feasibility of conducting a randomized clinical trial for women with persistent dominating one-sided PGP. The study included 11 women. Six women received individualized rehabilitation and chiropractic treatment, and five women were offered individualized rehabilitation alone. Papers III and IV originate from a prospective longitudinal cohort study carried out in 2010. Inclusions took place at the second-trimester routine ultrasound examination. All eligible women (n=503) filled in questionnaires and answered a weekly SMS question during pregnancy and up to six weeks after delivery. Women with pain in the pelvic area underwent a clinical examination. Those who were diagnosed with dominating one-sided PGP during pregnancy were included in a randomized clinical trial to investigate the effect of chiropractic treatment compared to conventional health care, presented in Paper III. In Paper IV, we included women that reported PGP during pregnancy and met for a clinical examination six weeks after delivery. We investigated the subjective recovery from pregnancy-related PGP and detected possible risk factors for a poor recovery. The SMS replies from the final 10 weeks of pregnancy and first six weeks after delivery were used to analyze the proportions of women with substantial recovery and women with either no, transitory or incomplete recovery, based on individual graphs of weekly number of bothersome days due to PGP. Results In Paper I, we found that 16% of women reporting pelvic pain (PP) during pregnancy were diagnosed with persistent PGP 3‒6 months after delivery. Women with persistent PGP reported mild and moderate pain, and minor disability, but a reduced quality of life. Risk factors for persistent PGP were age ≥ 30 years, moderate or high disability during pregnancy, and combined PP and low back pain (LBP) during pregnancy. In Paper II, the small number of women with persistent dominating onesided PGP, and the additional drop-outs, resulted in a low number of women in the clinical trial. Both groups reported improvement in disability and pain after 20 weeks of intervention. The randomized controlled trial (RCT) study (Paper III) showed no statistically significant differences in sick leave, pain intensity of PGP, disability, and health related quality of life between the treatment group and the control group during pregnancy or after delivery. In Paper IV, four out of five women experienced a substantial recovery from PGP within six weeks after delivery. Evident risk factors for a poor recovery were multiparity, PGP the year before pregnancy, and a high pain intensity of PGP during pregnancy. Conclusions Most women recovered from pregnancy-related PGP after delivery. However, six weeks after delivery, one out of five women reported persisting PGP, and 3–6 months after delivery, one of out of six women were diagnosed with persistent PGP after a clinical examination. Several risk factors for a poor recovery were found. Women with persistent PGP after delivery reported mild and moderate pain and a reduced quality of life, but seemed to cope fairly well with their daily activities. The results from the clinical trials were inconclusive

Investigating attitudes, skills, and use of evidence-based practice among Norwegian chiropractors; a national cross-sectional study

Abstract Background Evidence-based practice (EBP) is essential in improving the quality of healthcare and of importance for all health care personnel. No study in Norway has investigated attitudes, skills and use related to EBP among chiropractors. The aim of this study was to describe Norwegian chiropractors’ attitudes, skills, and use of EBP, as well as the barriers and facilitators to their use of EBP. Methods A national cross-sectional survey, the online version of the Evidence Based practice Attitudes & Utilisation SurvEy (EBASE), was sent by email to 770 Norwegian practicing chiropractors, all members of the Norwegian Chiropractic Association. Three EBASE sub-scores were generated (Attitudes, Skills and Use), and the demographic characteristics of the sample were reported. Linear regression analyses were conducted to examine the association between responses of the three sub-scores and demographic characteristics. Information on main barriers and facilitators of EBP was collected and described. Results A total of 312 (41%) chiropractors responded to the survey, and 95% agreed that EBP is necessary for chiropractic practice. While overall use of EBP activities was low participants were interested in learning and improving their skills to incorporate EBP into practice. Chiropractors’ attitudes, skills, and use of EBP were positively associated with being female and having spent more than one hour per week on research, but negatively associated with having practiced more than 10 years. Main barriers of EBP were lack of skills to critically evaluate, interpret, and apply research findings to practice. Main facilitators of EBP included access to the internet and free online databases in the workplace. Conclusion Although chiropractors in Norway reported positive attitudes and moderate skills in EBP, their use of EBP activities was limited. The main barriers and facilitators to EBP were primarily related to perceived skills deficits, whilst enablers of EBP were mostly related to infrastructure requirements

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial

Abstract Background The aim of this study was to investigate the outcome of chiropractic management for a subgroup of pregnant women with dominating one-sided pelvic girdle pain (PGP). Methods The study population was recruited from a prospective longitudinal cohort study of pregnant women. Women reporting pelvic pain (PP), and who were diagnosed with dominating one-sided PGP after a clinical examination, were invited to participate in the intervention study. Recruitment took place either at 18 weeks, or after an SMS-tracking up to week 29. The women were randomized into a treatment group or a control group. The treatment group received chiropractic treatment individualized to each woman with regards to treatment modality and number of treatments. The control group was asked to return to conventional primary health care. The primary outcome measure was new occurrence of full time and/or graded sick leave due to PP and/or low back pain. Secondary outcome measures were self-reported PP, physical disability and general health status. Proportion of women reporting new occurrence of sick leave were compared using Chi squared tests. Differences in secondary outcome measures were estimated using linear regression analyses. Results Fifty-Six women were recruited, and 28 of them were randomized into the treatment group, and 28 into the control group. There was no statistically significant difference in sick leave, PP, disability or general health status between the two groups during pregnancy or after delivery. Conclusion The study did not demonstrate superiority of chiropractic management over conventional care for dominating one-sided PGP during pregnancy. However, the analyses revealed wide confidence intervals containing both positive and negative clinically relevant effects. Trial registration The study was registered in ClinicalTrials.gov ( NCT01098136 ; 22/03/2010)