An online survey of chiropractors' opinions of continuing education

BACKGROUND: Continuing Education (CE) for chiropractors is mandatory for licensure in most North American jurisdictions. Numerous chiropractic colleges have begun collaborating with universities to offer master's degree programs. Distance education master's degree programs may be desirable to allow full-time practicing doctors to further their post-graduate education. The present survey sought to answer three questions. First, what is the level of satisfaction of chiropractors with their continuing education? Second, what is the level of interest of chiropractors in online master's degree programs? Lastly, what is the response rate of chiropractors to an online survey? METHODS: An online survey consisting of 22 multiple choice questions was e-mailed to 1000 chiropractors randomly selected from the mailing list of an online chiropractic newsletter. Upon completion of the questionnaire, participants' answers were saved on a secure site. Data analysis included evaluation of the demographic characteristics of the respondents, their opinions of and patterns of taking CE including online education, preferred learning formats, and their interest in proposed online master's degree programs. A survey response rate was determined. RESULTS: Nearly 86% of respondents felt their previously completed CE courses were either somewhat or extremely satisfactory. Over ninety percent of respondents who had completed online or distance CE coursesfound them to be somewhat or extremelysatisfactory. Almost half the respondents indicated that they most preferred online distance learning, while 34.08% most preferred face-to-face interaction. Fifty-three percent of respondents indicated an interest in starting a master's degree program; however 70.46% of respondents were interested in an online master's degree program that would offer CE credit. A response rate of 35.8% was obtained. CONCLUSION: Satisfaction among chiropractors with CE programs is high. The notion of completing a part-time online master's degree (or online combined with face-to-face interaction) appears to be popular among respondents, with a M.Sc. in Chiropractic Sciences being the most popular of those mentioned. Online surveys are a viable method of obtaining opinion in a cost and time efficient manner; there are some sources of bias involved in this type of research, and numerous steps need to be taken to obtain a suitable response rate

Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey

Objectives: To identify Canadian chiropractors' attitudes, skills and use of evidence based practice (EBP), as well as their level of awareness of previously published chiropractic clinical practice guidelines (CPGs). Methods: 7,200 members of the Canadian Chiropractic Association were invited by e-mail to complete an online version of the Evidence Based practice Attitude & utilisation SurvEy (EBASE) a valid and reliable measure of participant attitudes, skills and use of EBP. Results: Questionnaires were completed by 554 respondents. Most respondents (>75%) held positive attitudes toward EBP. Over half indicated a high level of self-reported skills in EBP, and over 90% expressed an interest in improving these skills. A majority of respondents (65%) reported over half of their practice was based on evidence from clinical research, and only half (52%) agreed that chiropractic CPGs significantly impacted on their practice. Conclusions: While most Canadian chiropractors held positive attitudes towards EBP, believed EBP was useful, and were interested in improving their skills in EBP, many did not use research evidence or CPGs to guide clinical decision making. Our findings should be interpreted cautiously due to the low response rate. (JCCA. 2015 59(4): 332-348) KEY WORDS: chiropractic complementary and alternative medicine evidence-based practice survey Objectifs: Cerner les comportements, les competences et la mise en oeuvre de la pratique factuelle (pratique fondee sur des donnees probantes) des chiropraticiens canadiens, ainsi que leur niveau de connaissance des guides de pratique clinique chiropratiques precedemment publies. Methodes: 7 200 membres de l'Association chiropratique canadienne ont ete invites par courriel pour remplir une version en ligne du sondage sur l'utilisation et le comportement associes a la pratique factuelle une evaluation valable et fiable des comportements, des competences et de la mise en oeuvre de la pratique factuelle par les participants. Resultats: Les questionnaires ont ete remplis par 554 repondants. La plupart des repondants (> 75 %) ont revele des comportements positifs vis-a-vis de la pratique factuelle. Plus de la moitie d'entre eux ont rapporte un niveau eleve d'aptitudes autodeclarees en matiere de pratique factuelle, et plus de 90 % d'entre eux ont fait part de leur interet a ameliorer ces competences. La majorite des repondants (65 %) a indique que plus de la moitie de leur pratique etait fondee sur des donnees probantes issues de la recherche clinique, et seulement la moitie de ces derniers (52 %) a reconnu que les guides de pratique clinique chiropratiques avaient des repercussions importantes sur leur pratique. Conclusions: Si la plupart des chiropraticiens canadiens ont revele des comportements positifs vis-a-vis de la pratique factuelle, pensaient que celle-ci etait utile et etaient interesses a l'idee d'ameliorer leurs competences en la matiere, un grand nombre d'entre eux n'utilisaient pas les donnees probantes issues de la recherche ou les guides de pratique clinique pour orienter leurs prises de decisions cliniques. Nos conclusions doivent etre interpretees avec precaution en raison du faible taux de reponse. (JCCA. 2015 59(4): 332-348) MOTS-CLES: chiropratique, medecine parallele et medecine douce, pratique factuelle, sondag

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults

PURPOSE Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence. RESULTS We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved health-related quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95%CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = - 1.21, 95%CI - 1.50; - 0.92) and 3 months (9 RCTs; MD = - 1.56, 95%CI - 2.80; - 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = - 1.39, 95%CI - 2.00; - 0.77) and 3 months (8 RCTs; SMD = - 0.57, 95%CI - 0.92; - 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = - 1.10, 95%CI - 1.71; - 0.48) and 3 months (SMD = - 1.04, 95%CI - 1.66; - 0.43). Compared with usual care, NT reduced pain (MD = - 1.35, 95%CI - 1.86; - 0.84) and functional limitations (MD = - 2.55, 95%CI - 3.70; - 1.40) at 3 months. CONCLUSION Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults

PURPOSE: To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS: We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE. RESULTS: Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95% confidence interval  -1.54 to -0.26), and a reduction in pain catastrophizing in the short term (3 months) with TENS versus no intervention or interventions with TENS specific effects (1 RCT) (MD = -11.20, 95% CI -17.88 to -3.52). For other outcomes, little or no difference was found between TENS and the comparison interventions. The certainty of the evidence for all outcomes was very low. CONCLUSIONS: Based on very low certainty evidence, TENS resulted in brief and marginal reductions in pain (not deemed clinically important) and a short-term reduction in pain catastrophizing in adults with CPLBP, while little to no differences were found for other outcomes

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

PURPOSE: Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS: Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence. RESULTS: We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low. CONCLUSION: Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity.

BACKGROUND: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. MAIN BODY: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. CONCLUSION: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system

Risk of bias in chiropractic mixed methods research:a secondary analysis of a meta-epidemiological review

OBJECTIVE: To examine the risk of bias in chiropractic mixed methods research. METHODS: We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias. RESULTS: Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias. CONCLUSION: Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research