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Spinal manipulative therapy versus Graston Technique in the treatment of non-specific thoracic spine pain: Design of a randomised controlled trial
Amy Crothers, Bruce Walker, Simon D French
Chiropractic & Manual Therapies , 2008, DOI: 10.1186/1746-1340-16-12
Abstract: Eighty four eligible people with non specific thoracic pain mid back pain of six weeks or more will be randomised to one of three groups, either SMT, GT, or a placebo (de-tuned ultrasound). Each group will receive up to 10 supervised treatment sessions at the Murdoch University Chiropractic student clinic over a 4-week period. Treatment outcomes will be measured at baseline, one week after their first treatment, upon completion of the 4-week intervention period and at three, six and twelve months post randomisation. Outcome measures will include the Oswestry Back Pain Disability Index and the Visual Analogue Scale (VAS). Intention to treat analysis will be utilised in the statistical analysis of any group treatment effects.This trial was registered with the Australia and New Zealand Clinical Trials Registry on the 7th February 2008. Trial number: ACTRN12608000070336Published studies of the epidemiology of non-specific thoracic pain are uncommon. Niemelainen found that the one year prevalence of mid back pain in Finnish men was 17%, compared to 64% with neck pain and 66.8% who reported low back pain [1]. When upper or mid back pain was present, disability tended to occur less than if the pain was reported in the neck or low back. However, when disability was reported, the number of days of disability was similar when the pain involved the upper or mid back compared to other regions.Commonly used treatment options for non specific thoracic spine pain include massage, mobilisation, manipulation, acupuncture, and other physical therapies such as heat, electro-therapies, ultrasound and also non steroidal anti-inflammatories. A search of the literature concerning thoracic spinal pain established that there are no high quality studies for any of these modalities. There are some individual studies, however none show unequivocal proof of efficacy or effectiveness.To date we are only aware of one published randomised controlled trial performed assessing the effectiveness of s
Chiropractic care for children: too much, too little or not enough?
Simon D French, Bruce F Walker, Stephen M Perle
Chiropractic & Manual Therapies , 2010, DOI: 10.1186/1746-1340-18-17
Abstract: Many chiropractors provide care to children and chiropractors treat a wide variety of paediatric health conditions [1]. This is considered a controversial area of chiropractic management, both within [2,3] and outside of the profession [4,5]. Within the profession, there has been a recent call for chiropractors to assume the responsibility of spinal and musculoskeletal health in children [6]. Evidence is mounting that childhood health and lifestyle may have an impact on health and quality of life in later years, that chiropractors provide care to children and cannot be ignored [6]. The evidence-base for chiropractic care for children is scarce, however some evidence is available to inform practice. In commissioning this thematic series for Chiropractic & Osteopathy, we have brought together key people in the field of chiropractic care for children to provide an up-to-date overview for clinicians and researchers interested in the role of chiropractic care for children.The management techniques that chiropractors employ for children vary across the profession [1], but typically they are techniques modified from those used for adult patients. Although spinal manipulative therapy in its many forms is a core part of a chiropractor's treatment approach, the term "chiropractic care" in relation to this thematic series refers to the entire chiropractic clinical encounter which may also include other treatments such as dietary advice, nutritional or herbal supplements, posture correction, exercise prescription, physiotherapeutic modalities and behavioural counselling [2]. The series of articles we have commissioned for this topic have focussed on the manual therapies that chiropractors deliver.The first article in this thematic series presents a chiropractic approach to the management of the paediatric patient and makes recommendations as to how the chiropractic profession can safely and effectively manage the paediatric patient [7]. It also provides an overview of current c
Chiropractic & Osteopathy. A new journal
Bruce F Walker, Simon D French, Melainie Cameron
Chiropractic & Manual Therapies , 2005, DOI: 10.1186/1746-1340-13-1
Abstract: In 1959 Frederick George Roberts founded the Chiropractic and Osteopathic College of Australasia (COCA). The Melbourne based College graduated about two hundred chiropractic and osteopathic practitioners from the period 1959 to 1979. The College closed its undergraduate program in 1979 and the students transferred to the Preston Institute of Technology chiropractic program. This is now the Royal Melbourne Institute of Technology (RMIT University) chiropractic course. An osteopathic course commenced alongside the chiropractic course at Phillip Institute of technology (now also RMIT University) in 1986.Even though it has now closed its undergraduate operations, the College has maintained its company structure and acted as a repository for the records of its alma mater [1].In 1990 another organisation the Chiropractors and Osteopaths Musculo-Skeletal Interest Group (COMSIG) commenced. Several years later and after steady growth, COMSIG underwent a name change and incorporated under the company structure and banner of the Chiropractic & Osteopathic College of Australasia. From this beginning COCA has grown into the leading provider of post-graduate vocational training for both professions in Australia [1].In 1992 COMSIG started its own journal and this was known as COMSIG Review. In 1995 after incorporation under the COCA banner the journal changed its name to Australasian Chiropractic & Osteopathy. It is this journal that has changed from a print journal to the Open Access, online journal Chiropractic & Osteopathy.Both chiropractic and osteopathy are over a century old. They are now regarded as complementary health professions having started their evolution as alternative health groups; this evolution is still underway. There is an imperative for both professions to research the principles and claims that underpin them, and Chiropractic & Osteopathy provides a scientific forum for the publication of such research.For many years both professions were driven by ideology
Extending ICPC-2 PLUS terminology to develop a classification system specific for the study of chiropractic encounters
Melanie J Charity, Simon D French, Kirsty Forsdike, Helena Britt, Barbara Polus, Jane Gunn
Chiropractic & Manual Therapies , 2013, DOI: 10.1186/2045-709x-21-4
Abstract: The coder referred to the ICPC-2 PLUS system when coding chiropractor recorded encounter details (reasons for encounter, diagnoses/problems and processes of care). The coder used rules and conventions supplied by the Family Medicine Research Unit at the University of Sydney, the developers of the PLUS system. New chiropractic specific terms and codes were created when a relevant term was not available in ICPC-2 PLUS.Information was collected from 52 chiropractors who documented 4,464 chiropractor-patient encounters. During the study, 6,225 reasons for encounter and 6,491 diagnoses/problems were documented, coded and analysed; 169 new chiropractic specific terms were added to the ICPC-2 PLUS terminology list. Most new terms were allocated to diagnoses/problems, with reasons for encounter generally well covered in the original ICPC 2 PLUS terminology: 3,074 of the 6,491 (47%) diagnoses/problems and 274 of the 6,225 (4%) reasons for encounter recorded during encounters were coded to a new term. Twenty nine new terms (17%) represented chiropractic processes of care.While existing ICPC-2 PLUS terminology could not fully represent chiropractic practice, adding terms specific to chiropractic enabled coding of a large number of chiropractic encounters at the desired level. Further, the new system attempted to record the diversity among chiropractic encounters while enabling generalisation for reporting where required. COAST is ongoing, and as such, any further encounters received from chiropractors will enable addition and refinement of ICPC-2 PLUS (Chiro). More research is needed into the diagnosis/problem descriptions used by chiropractors.The chiropractic profession in Australia is an important component of the healthcare system. There are approximately 4,300 registered chiropractors in Australia [1] and each year it is estimated that over three million people, or 16% of the Australian population, consult a chiropractor at least once [2,3]. However, very little is known
Recruitment difficulties in a primary care cluster randomised trial: investigating factors contributing to general practitioners' recruitment of patients
Matthew J Page, Simon D French, Joanne E McKenzie, Denise A O'Connor, Sally E Green
BMC Medical Research Methodology , 2011, DOI: 10.1186/1471-2288-11-35
Abstract: General practitioners enrolled in the study were posted a questionnaire, consisting of quantitative items and an open-ended question, to assess possible reasons for poor patient recruitment. Descriptive statistics were used to summarise quantitative items and responses to the open-ended question were coded into categories.Seventy-nine general practitioners completed at least one item (79/94 = 84%), representing 68 practices (85% practice response rate), and 44 provided a response to the open-ended question. General practitioners recalled inviting a median of two patients with acute low-back pain to participate in the trial over a seven-month period; they reported that they intended to recruit patients, but forgot to approach patients to participate; and they did not perceive that patients had a strong interest or disinterest in participating. Additional open-ended comments were generally consistent with the quantitative data.A number of barriers to the recruitment of patients with acute low-back pain by general practitioners in a professional-cluster trial were identified. These barriers were similar to those that have been identified in the literature surrounding the recruitment of patients in individual patient randomised trials. To advance the evidence base for patient recruitment strategies in primary care settings, trialists undertaking professional-cluster trials need to develop and evaluate patient recruitment strategies that minimise the efforts required by practice staff to recruit patients, while also meeting privacy and ethical responsibilities and minimising the risk of selection bias.Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).Patient recruitment is often reported as the most challenging step in conducting randomised trials (RTs) and data on effective recruitment strategies is lacking [1-3]. This is particularly the case for cluster randomised trials (CRTs), where intact social groups (for example, p
Investing in updating: how do conclusions change when Cochrane systematic reviews are updated?
Simon D French, Steve McDonald, Joanne E McKenzie, Sally E Green
BMC Medical Research Methodology , 2005, DOI: 10.1186/1471-2288-5-33
Abstract: This descriptive study examined all completed systematic reviews in the Cochrane Database of Systematic Reviews (CDSR) Issue 2, 1998. The latest version of each of these reviews was then identified in CDSR Issue 2, 2002 and changes in the review were described. For reviews that were updated within this time period and had additional studies, we determined whether their conclusion had changed and if there were factors that were predictive of this change.A total of 377 complete reviews were published in CDSR Issue 2, 1998. In Issue 2, 2002, 14 of these reviews were withdrawn and one was split, leaving 362 reviews to examine for the purpose of this study. Of these reviews, 254 (70%) were updated. Of these updated reviews, 23 (9%) had a change in conclusion. Both an increase in precision and a change in statistical significance of the primary outcome were predictive of a change in conclusion of the review.The concerns around a lack of updating for some reviews may not be justified considering the small proportion of updated reviews that resulted in a changed conclusion. A priority-setting approach to the updating of Cochrane systematic reviews may be more appropriate than a time-based approach. Updating all reviews as frequently as every two years may not be necessary, however some reviews may need to be updated more often than every two years.When people make decisions about health care they should have access to the most up-to-date and reliable evidence. Cochrane systematic reviews aim to provide healthcare professionals, consumers and policy makers with the 'best available' and most up-to-date evidence on the effects of healthcare interventions. One of the advantages of an electronic publication such as The Cochrane Library is that reviews are replaced with an updated version as this new evidence becomes available or mistakes are identified [1]. This differs from print journals where readers do not necessarily know if they are accessing the most up-to-date systematic
Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting
Duncan Mortimer, Simon D. French, Joanne E. McKenzie, Denise A. O′Connor, Sally E. Green
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0075647
Abstract: Introduction The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. Methods Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone. Results The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that – irrespective of willingness to pay (WTP) – we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. Conclusions Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.
The journal 'chiropractic & osteopathy' changes its title to 'chiropractic & manual therapies'. a new name, a new era
Bruce F Walker, Simon D French, Melainie Cameron, Stephen M Perle, Charlotte Lebouef-Yde, Sidney M Rubinstein
Chiropractic & Manual Therapies , 2011, DOI: 10.1186/2045-709x-19-1
Abstract: This first paper in 2011 marks some significant changes for the journal. The first and most noticeable change is the title from Chiropractic & Osteopathy (C&O) to Chiropractic & Manual Therapies (CMT). This change reflects the expanding base of submissions from clinical scientists interested in the discipline of manual therapy. It is also in accord with the findings and changes suggested by Coulter and Khorsan in their invited review of our journal. They noted that the articles in C&O are overwhelmingly from chiropractors and proposed several recommendations including a change in the journal title [1]. This title change does not exclude osteopathic submissions. To the contrary, the title change should encourage submissions from all professionals interested in manual therapy.The decision to change the title was also influenced by successful negotiations with the European Academy of Chiropractic (EAC) to enter into a joint venture agreement on the journal. The EAC also encouraged a name change. This agreement with the EAC and its parent body the European Chiropractors' Union (ECU) was signed in June 2010 making the journal Chiropractic & Osteopathy (C&O) the official journal of the Chiropractic and Osteopathic College of Australasia (COCA) and the EAC.COCA is a non-profit, member-based organisation that provides continuing education to its members predominantly in Australia (COCA website [2]). COCA aims to assist all members of the chiropractic, osteopathic and related health professions to engage with best practice healthcare methods and to develop the skills required to practice competently. COCA encourages a scientific and ethical approach to patient management, fosters related research, and seeks to participate in activities related to public health with an emphasis on promoting the integration of chiropractors and osteopaths into the broader community healthcare community. Given the broad goals of COCA the name change of its journal seems to fulfil those aims.The
Protocol for economic evaluation alongside the IMPLEMENT cluster randomised controlled trial
Duncan Mortimer, Simon D French, Joanne E McKenzie, Denise A O'Connor, Sally E Green, the IMPLEMENT study group
Implementation Science , 2008, DOI: 10.1186/1748-5908-3-12
Abstract: Cost-effectiveness and cost-utility analyses alongside the IMPLEMENT cluster randomised controlled trial (CRCT) from a societal perspective to quantify the additional costs (savings) and health gains associated with a targeted implementation strategy as compared with access to the CPG via dissemination only.The protocol provided here registers our intent to conduct an economic evaluation alongside the IMPLEMENT study, facilitates peer-review of proposed methods and provides a transparent statement of planned analyses.Australian New Zealand Clinical Trials Registry ACTRN012606000098538The recent development and publication of evidence-based clinical practice guidelines (CPGs) for acute low back pain (LBP) has resulted in evidence-based recommendations that, if implemented, have the potential to improve the quality and safety of care for acute LBP [1]. While a strategy has been specified for dissemination of the CPG for acute LBP in Australia, there is as yet no accompanying plan for active implementation. The IMPLEMENT study will consider the incremental benefits and costs of progressing beyond development and dissemination to implementation, and has the following objectives: to develop a targeted strategy for implementing CPG for acute LBP into Australian general practice; to test the effectiveness of the strategy for implementing the CPG for acute LBP, with respect to both general practitioners' (GPs) practice and patient outcomes, by conducting a cluster randomised controlled trial (CRCT); and, to determine the cost-effectiveness of the developed strategy as compared to current practice.The purpose of the present paper is to describe methods for the cost-effectiveness analysis alongside the CRCT. Detailed descriptions of methods for development of the targeted implementation strategy and design of the CRCT in the IMPLEMENT study are given elsewhere [2].It is now well established that development and dissemination of CPGs will not necessarily produce improvements i
Genetic Characterisation of Malawian Pneumococci Prior to the Roll-Out of the PCV13 Vaccine Using a High-Throughput Whole Genome Sequencing Approach
Dean B. Everett, Jennifer Cornick, Brigitte Denis, Claire Chewapreecha, Nicholas Croucher, Simon Harris, Julian Parkhill, Stephen Gordon, Enitan D. Carrol, Neil French, Robert S. Heyderman, Stephen D. Bentley
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044250
Abstract: Background Malawi commenced the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant immunisation schedule in November 2011. Here we have tested the utility of high throughput whole genome sequencing to provide a high-resolution view of pre-vaccine pneumococcal epidemiology and population evolutionary trends to predict potential future change in population structure post introduction. Methods One hundred and twenty seven (127) archived pneumococcal isolates from randomly selected adults and children presenting to the Queen Elizabeth Central Hospital, Blantyre, Malawi underwent whole genome sequencing. Results The pneumococcal population was dominated by serotype 1 (20.5% of invasive isolates) prior to vaccine introduction. PCV13 is likely to protect against 62.9% of all circulating invasive pneumococci (78.3% in under-5-year-olds). Several Pneumococcal Molecular Epidemiology Network (PMEN) clones are now in circulation in Malawi which were previously undetected but the pandemic multidrug resistant PMEN1 lineage was not identified. Genome analysis identified a number of novel sequence types and serotype switching. Conclusions High throughput genome sequencing is now feasible and has the capacity to simultaneously elucidate serotype, sequence type and as well as detailed genetic information. It enables population level characterization, providing a detailed picture of population structure and genome evolution relevant to disease control. Post-vaccine introduction surveillance supported by genome sequencing is essential to providing a comprehensive picture of the impact of PCV13 on pneumococcal population structure and informing future public health interventions.
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