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Objective This systematic review aimed to describe the prevalence, incidence, and associated factors of unmet health care needs among adults with osteoarthritis. Methods We searched Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), and PsycINFO (Ovid) from inception through May 15, 2024. Eligible studies were cross‐sectional, cohort, and case‐control studies investigating the prevalence, incidence, associated factors, or risk factors of unmet health care needs in adults with osteoarthritis. We restricted to articles published in English, French, Italian, and Chinese for feasibility. Reviewers independently screened articles, assessed risk of bias using the Joanna Briggs Institute Checklists, and extracted data. We descriptively synthesized results from low/moderate risk‐of‐bias studies, stratifying results by age (<60 vs ≥60 years). Results Of 3,589 citations screened, 7 cross‐sectional studies with low/moderate risk‐of‐bias were included in the synthesis (3 from South Korea, 4 from the United States). In South Korea, the 12‐month prevalence of unmet health care needs was 31.6% (95% confidence interval [CI] 29.9%–33.3%) among adults aged ≥50 years with osteoarthritis and 31% (95% CI 30.9%–31.1%) among those aged ≥65 years with arthritis. In the United States, the 12‐month prevalence of unmet needs in the general population due to unaffordability ranged from 15% to 30% in adults with osteoarthritis or arthritis. Prevalence was higher among those who exclusively used complementary and alternative medicine and varied during the COVID‐19 pandemic, peaking in the summer of 2020. Evidence suggests that unmet needs are associated with lower income, no insurance, and activity limitations. Conclusion Unmet health care needs are common in adults with osteoarthritis, particularly those facing socioeconomic disadvantages or functional limitations. Given the paucity of high‐quality studies, additional research is needed.

ObjectiveTo determine the association between early vs. late presentation to a concussion management clinic following sport-related concussion (SRC) and time-to-recovery among adolescent Canadian athletes.DesignHistorical cohort study.SettingCanadian community concussion management clinics.ParticipantsCanadian male and female athletes aged 12–18 presenting for care after SRC (n=4606).Interventions (or Assessment of Risk Factors)The exposure was time of clinic presentation after SRC, defined as early (0–7 days) or late (8–28 days).Outcome MeasuresThe outcome was time-to-recovery related to SRC (defined as clinician clearance to return to sport). Propensity scores were first derived from logistic regression with early versus late clinic presentation as the outcome. Cox proportional hazards regression analysis was then used to model the relationship between early versus late clinic presentation and time-to-recovery, while including the propensity score to adjust for confounding. The association was expressed using hazard rate ratios (HRR) with 95% confidence intervals (CI).Main ResultsEarly (vs. late) presentation to a concussion management clinic following SRC was associated with time-to-recovery (adjusted HRR 1.23; 95% CI 1.14 to 1.32). This association was consistent within each quintile of propensity score. Median time to recovery was 18 versus 22-days in the early and late groups, respectively.ConclusionsAthletes with SRC have favourable recovery trajectories regardless of presentation time. Recovery may be quicker with earlier presentation which can lead to faster return to school and sport.

Purpose To identify and synthesize evidence for the measurement properties of the QuickDASH, a shortened version of the 30-item DASH (Disabilities of the Arm, Shoulder and Hand) instrument. Methods This systematic review used a best evidence synthesis approach to critically appraise the measurement properties [using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)] of the QuickDASH and cross-cultural adaptations. A standard search strategy was conducted between 2005 (year of first publication of QuickDASH) and March 2011 in MEDLINE, EMBASE and CINAHL. Results The search identified 14 studies to include in the best evidence synthesis of the QuickDASH. A further 11 studies were identified on eight cross-cultural adaptation versions. Conclusions Many measurement properties of the QuickDASH have been evaluated in multiple studies and across most of the measurement properties. The best evidence synthesis of the QuickDASH English version suggests that this tool is performing well with strong positive evidence for reliability and validity (hypothesis testing), and moderate positive evidence for structural validity testing. Strong negative evidence was found for responsiveness due to lower correlations with global estimates of change. Information about the measurement properties of the cross-cultural adaptation versions is still lacking, or the available information is of poor overall methodological quality.

Background Spinal pain is a highly prevalent condition affecting a large part of the population. Chiropractic maintenance care (MC) is a management strategy intended to prevent spinal pain recurrent episodes and deterioration by treating patients at pre-planned intervals. A previous study showed that patients identified as a dysfunctional subgroup by the West Haven-Yale Multidimensional Pain Inventory (MPI) and receiving MC had fewer days with bothersome LBP. This suggests MC may have superior effectiveness in this subgroup of patients. The MPI, however, is not practical for daily clinical practice, prompting the development of the MAINTAIN instrument. This study aims to (1) assess the effectiveness and cost-effectiveness of stratified MC using the MAINTAIN instrument, and (2) assess the fidelity and procedure compliance of implementing the MAINTAIN instrument. Methods This pragmatic randomized clinical trial will recruit 225 consecutive patients (18–65 years old) with significant (> 30 days in the past 12 months) recurrent spinal pain presenting to chiropractic clinics. After the initial 3 weeks (6 visits) of chiropractic care, patients will be randomized to receive either Stratified MC or Standard Chiropractic Care. Stratified MC: patients will complete the MAINTAIN instrument and be stratified to MC or symptom-guided care (clinicians’ judgment). Patients in the Standard Chiropractic Care arm will receive standard treatment based on the chiropractor’s judgment. The primary outcome is the total number of days with activity-limiting pain measured at 12 months. Secondary outcomes include the number of missed working days and loss of work productivity due to pain, pain intensity, disability, health-related quality of life, perceived improvement, and implementation of MAINTAIN instrument outcomes. An intention-to-treat protocol and generalized estimating equations (GEE) linear regression models will be used for analysis. Discussion This study investigates the impact of using a clinical instrument to identify patients with recurrent spinal pain to target those who benefit most from a chiropractic MC approach. Strict inclusion criteria should ensure a suitable target group, and frequently collected repeated measures should provide accurate outcome assessment. The study is pragmatic and includes standard clinical procedures facilitating the generalizability and transferability of the results into clinical practice. Trial registration ClinicalTrials.gov NCT05350254. Prospectively registered on April 22, 2022, last modified on December 08, 2023. The first patient was randomized into the study on December 21, 2023.

Background Literature on low back pain (LBP) treatment suggests not all LBP is the same and patients with extension- or flexion-related LBP may benefit from different strategies. This study’s objective was to evaluate the effect of participant positioning when delivering spinal manipulation on reported immediate comfort, in individuals with LBP. Methods This a randomized crossover trial. Volunteer adult participants with LBP were recruited from a chiropractic college campus clinic to receive two procedures in random order: 1. Standard side posture lumbopelvic manipulation (SPLM) and 2. Modified flexed lumbopelvic manipulation. The modified position was similar to the standard, but with increased hip and lumbopelvic flexion. Participants were not blinded. The primary outcome of self-reported comfort was recorded using a 0–10 scale. Paired t-tests were used to compare mean comfort scores, and a minimal clinically important difference of 2.0 was used. Secondary analysis examined correlations between comfort during active range of motion (AROM) and the two SPLM procedures. An exploratory analysis comparing within-participant differences was examined. All reported harms were mild in nature (e.g. discomfort). Results Forty participants were recruited (mean 25.5 years of age, 75% female). 20 participants started with the Standard SPLM and 20 started with the Modified Flexed SPLM. No differences in comfort were found between the Standard SPLM (N = 40) versus Modified flexed SPLM (N = 40), (mean (SD) = − 0.01 (2.3), Effect Size Cohen’s d  = − 0.004 95% CI (− 0.32, 0.32)). No correlations were found between the comfort during AROM and the two SPLM procedures. Observing within-participant differences for individual comfort, 14 participants had a clinically significant difference ≥ 2. Specifically, 6 participants had lower scores with Standard SPLM and 8 participants had lower scores with Modified flexed SPLM. Conclusion Comparing comfort during a Modified flexed SPLM to the Standard one revealed no difference for a population with LBP. However, some individuals did demonstrate a comfort preference for a Standard versus a Modified flexed position. Future studies should examine other variations of manipulation and particular subgroups of individuals with LBP (e.g. direction related) that experience discomfort during manipulation.

This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test–retest reliability and lumbar FRR has moderate to high test–retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference − 1.16 [95% CI − 2.00, − 0.32] and − 1.21 [− 1.84, − 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.

Background Arthritis covers a range of chronic diseases presenting as joint pain and inflammation with prevalence of 20% in Canadians. Treatment guidelines for arthritis depend upon the type of arthritis but most include recommendations for rehabilitation interventions designed to optimize functioning and reduce disability. We set out to estimate the prevalence of healthcare utilization with different providers and to explore factors associated with utilization of different providers among Canadians with arthritis. Methods This population-based study used Canadian Community Health Survey data (2001–2018) restricted to respondents with arthritis (≥12 years). We used self-reported consultation with healthcare providers (medical doctor, chiropractor, physiotherapist, nurse, psychologist) (2001–2010), and self-reported regular healthcare provider (2015–2018). We calculated the 12-month prevalence of utilization with providers, and used modified Poisson regression to assess predisposing (e.g. age, sex, education), enabling (e.g. income, province) and need (e.g. self-percieved health) factors associated with utilization of providers. Results From 2001–2010 and 2015–2018, respectively, prevalence of utilization of medical doctors was 92.0% (95%CI: 91.7–92.2%) and 91.0% (95%CI: 90.5–91.5%); chiropractors 13.1% (12.8–13.4%) and 9.6% (9.1–10.1%); physiotherapists 14.5% (14.1–14.8%) and 9.4% (8.9–9.9%); nurses 14.2% (13.9–14.5%) and 7.5% (7.2–7.9%); psychologists 3.0% (2.8–3.1%) and 3.9% (3.5–4.2%). Females were more likely to see any provider. Users of chiropractic care were less likely to be smokers and more physically active with greater utilization in the western provinces than in the east. Those with poorer self-perceived health were more likely to see physiotherapists, nurses and psychologists. Consultation with a nurse (2001–2010) was more likely in the northern territories, while regular care from a nurse (2015–2018) was more likely in older age groups. Conclusions Canadians with arthritis were most likely to see medical doctors. Characteristics of healthcare utilizers varied by provider type. Geographical variation in utilization of chiropractors and physiotherapists likely related to differences by province and over time in what provincial health insurance covered while geographical variation in utilization of nurses was likely related to the lack of availability of medical doctors. Findings inform the need to strengthen healthcare delivery for Canadians, perhaps providing better access to providers of rehabilitation interventions.

ObjectivesThere is no current detailed profile of people seeking chiropractic care in Canada. We describe the profiles of chiropractors’ practice and the reasons, nature of the care provided to their patients and extent of interprofessional collaborations in Ontario, Canada.DesignCross-sectional observational study.SettingPrimary care setting in Ontario, Canada.ParticipantsWe randomly recruited chiropractors from a list of registered chiropractors (n=3978) in active practice in 2015. Of the 135 randomly selected chiropractors, 120 were eligible, 43 participated and 42 completed the study.Outcome measuresEach chiropractor recorded information for up to 100 consecutive patient encounters, documenting patient health profiles, reasons for encounter, diagnoses and care provided. Descriptive statistics summarised chiropractor, patient and encounter characteristics, with analyses accounting for clustering and design effects.ResultsChiropractors provided data on 3523 chiropractor-patient encounters. More than 65% of participating chiropractors were male, mean age 44 years and had practised on average 15 years. The typical patient was female (59% of encounters), between 45 and 64 years (43%) and retired (21%) or employed in business and administration (13%). Most (39.4%) referrals were from other patients, with 6.8% from physicians. Approximately 68% of patients paid out of pocket or claimed extended health insurance for care. Most common diagnoses were back (49%, 95% CI 44 to 56) and neck (15%, 95% CI 13 to 18) problems, with few encounters related to maintenance/preventive care (0.86%, 95% CI 0.2 to 3.9) and non-musculoskeletal problems (1.3%, 95% CI 0.7 to 2.3). The most common treatments included spinal manipulation (72%), soft tissue therapy (70%) and mobilisation (35%).ConclusionsThis is the most comprehensive profile to date of chiropractic practice in Canada. People who present to Ontario chiropractors are mostly adults with a musculoskeletal condition. Our results can be used by stakeholders to make informed decisions about workforce development, education and healthcare policy related to chiropractic care.

Objectives. We used individual participant data from multiple studies to conduct a comprehensive meta-analysis of mechanical exposures in the workplace and low back pain. Methods. We conducted a systematic literature search and contacted an author of each study to request their individual participant data. Because outcome definitions and exposure measures were not uniform across studies, we conducted 2 substudies: (1) to identify sets of outcome definitions that could be combined in a meta-analysis and (2) to develop methods to translate mechanical exposure onto a common metric. We used generalized estimating equation regression to analyze the data. Results. The odds ratios (ORs) for posture exposures ranged from 1.1 to 2.0. Force exposure ORs ranged from 1.4 to 2.1. The magnitudes of the ORs differed according to the definition of low back pain, and heterogeneity was associated with both study-level and individual-level characteristics. Conclusions. We found small to moderate ORs for the association of mechanical exposures and low back pain, although the relationships were complex. The presence of individual-level OR modifiers in such an area can be best understood by conducting a meta-analysis of individual participant data.

Background Involvement in a compensation process following a motor vehicle collision is consistently associated with worse health status but the reasons underlying this are unclear. Some compensation systems are hypothesised to be more stressful than others. In particular, fault-based compensation systems are considered to be more adversarial than no-fault systems and associated with poorer recovery. This study compares the perceived fairness and recovery of claimants in the fault-based compensation system in New South Wales (NSW) to the no-fault system in Victoria, Australia. Methods One hundred eighty two participants were recruited via claims databases of the compensation system regulators in Victoria and NSW. Participants were > 18 years old and involved in a transport injury compensation process. The crash occurred 12 months ( n  = 95) or 24 months ago ( n  = 87). Perceived fairness about the compensation process was measured by items derived from a validated organisational justice questionnaire. Health outcome was measured by the initial question of the Short Form Health Survey. Results In Victoria, 84 % of the participants considered the claims process fair, compared to 46 % of NSW participants (χ 2  = 28.54; p  < .001). Lawyer involvement and medical assessments were significantly associated with poorer perceived fairness. Overall perceived fairness was positively associated with health outcome after adjusting for demographic and injury variables (Adjusted Odds Ratio = 2.8, 95 % CI = 1.4 – 5.7, p  = .004). Conclusion The study shows large differences in perceived fairness between two different compensation systems and an association between fairness and health. These findings are politically important because compensation processes are designed to improve recovery. Lower perceived fairness in NSW may have been caused by potential adversarial aspects of the scheme, such as liability assessment, medical assessments, dealing with a third party for-profit insurance agency, or financial insecurity due to lump sum payments at settlement. This study should encourage an evidence informed discussion about how to reduce anti-therapeutic aspects in the compensation process in order to improve the injured person’s health.