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Abstract Objective. To estimate the prevalence and examine the associations of neuropathic-like pain in a community-based sample of older Australian women with arthritis. Design. Population based cross-sectional survey. Setting. Participants were recruited from the 1946-1951 cohort of the Australian Longitudinal Study of Women’s Health. Subjects. Women with self-reported arthritis (n = 147). Methods. Primary outcome measure was self-reported neuropathic-like pain, defined as scores ≥12 via the painDETECT screening tool. Descriptive statistics summarized health and socio-demographic characteristics, and comparisons made using student’s t-test or Wilcoxon Rank Sum test, and Chi-square tests. Independent health and demographic variables were examined by univariable logistic regression, and significant variables included in multiple variable logistic regression modelling. Results. Thirty-nine women (26.5%) were screened as having neuropathic-like pain. Women with neuropathic-like pain were more likely to have poorer health, worse pain, higher pain catastrophizing, more fatigue, and more depression than women with nociceptive pain. Neuropathic-like pain was significantly associated with higher scores on the SF-MPQ sensory scale and pain catastrophizing scale, and with more medication use. Conclusions. Neuropathic-like pain in women with arthritis was common and is associated with greater disability and poorer quality of life.

Background Research on perception of chiropractic is abundant in Western contexts, yet sparse in Asia. This study aims to bridge this gap by examining the perceptions of chiropractic among Taiwanese adults, focusing on demographics, utilisation, beliefs, and understanding. Methods An adapted survey with 27 close-ended items was administered to assess Taiwanese adults’ perception of chiropractic. The electronic survey, using Qualtrics, was delivered worldwide via Taiwanese Facebook groups from January 31 to March 31, 2024. Descriptive statistics, including frequencies and cross tabulations, were performed. Results A total of 769 individuals were surveyed, with 475 participants providing complete data. Over half of the participants (62%) had never visited a chiropractor, but in those who had visited a chiropractor 78% reported satisfaction. Of 475 participants, 45% considered chiropractic care safe while 34% were unsure. Though almost half (42%) were unclear about what chiropractors do, most participants (67%) expressed interest in learning more. Among the 151 participants with prior experience of chiropractic care, the demographic profile was 54% women, and individuals aged 28 to 37 (44%), and those with an undergraduate degree (52%) were most common. Conclusion Overall, our study found a positive perception and high acceptance of chiropractic among the Taiwanese population; however, generalisability may be limited due to the risk of selection bias. An understanding of the chiropractic profession was notably limited. Hence, efforts are needed to enhance awareness of chiropractic accreditation, clinical competencies, and its potential role in public healthcare in Taiwan.

Background Spinal pain and disorders are a major burden on our population and health systems. Previous research showed people with diabetes were 1.35 times and 1.24 times more likely to report low back pain and neck pain than people without diabetes respectively, but diabetes was not a predictor of future spinal pain. Here we update a previous systematic review to determine whether in an adult population, diabetes is associated with low back, neck, or spinal pain. Methods The search was performed in PUBMED, Medline, CINAHL and EMBASE. Studies between 2017–2025, of cross-sectional, case–control, twin-control, and cohort designs, assessing diabetes and low back, neck, or spinal pain in adult populations, were included. Excluded were single-case studies, spinal pathologies, multiple chronic diseases, additional pain sites, and gestational or pre-diabetes. Two independent reviewers extracted data on the incidence of pain and reported associations. Odds ratios (ORs) of the association between the exposure (diabetes) and outcome (back, neck, or spinal pain) were calculated using a random effects model. Systematic review registration: PROSPERO registration CRD42022333064. Results A total of 15 studies were included with 11 studies included in the meta-analysis. When compared to people without diabetes, people with diabetes had 1.44 times higher odds of reporting low back pain (n = 592,901; OR 1.44; 95% Confidence Interval (CI) 1.20- 1.74; p  = 0.001), a 1.11 times higher odds of reporting neck pain (n = 465,130; OR 1.11; 95%CI 1.13–1.20; p  =  < 0.001) and a 1.42 times higher odds of reporting spinal pain (n = 1,335,999; OR 1.42; 95%CI 1.26–1.63; p  =  < 0.001). Diabetes was significantly associated with 1.27 times higher odds of developing spinal pain (n = 35,435; OR 1.27; 95%CI 1.08–1.50; p  = 0.004) and 1.44 higher odds of developing neck pain (n = 15,075; OR 1.44; 95%CI 1.09 -1.90; p  = 0.010). There was no significant association between diabetes and developing low back pain (n = 21,215; OR 1.11; 95%CI 0.88–1.41, p  = 0.388). Conclusions With the inclusion of fifteen additional studies providing an overall sample size five and a half times larger than the previous review, diabetes was associated with prevalent neck, low back and spinal pain, as well as incident neck and neck and spinal pain. Clinicians must be adept at identifying co-morbid conditions and risk factors, understanding the interplay between them and creating well managed networks to address these complex presentations.

Background In Australian emergency departments, 30% of all back pain presentations are for older adults. Relatively little is known about the care that this population receives during an emergency department stay, including admission to hospital. The aim of this study is to describe emergency department management of older adults diagnosed with a lumbar spine condition and to determine predictors of healthcare use in this population. Methods A retrospective analysis of electronic medical record data of adults aged ≥ 65 years with a lumbar spine discharge diagnosis. Demographic, clinical care (date and time of presentation and discharge, length of stay in the emergency department, mode of arrival, triage category, re-presentations to the emergency department (within 48 h), discharge mode, the administration of pain-relieving medicines, lumbar imaging, and laboratory tests) and costs data were extracted from the electronic medical record system. Descriptive analyses and multilevel mixed-effects logistic regression models were performed. Results Over the period January 2016 to December 2019 there were 4,093 presentations to emergency departments by older adults with a lumbar spine discharge diagnosis (82.0% were non-specific low back pain). Most were female (58.3%), 39.9% had some form of lumbar imaging, and 34.1% were admitted to hospital. The most administered pain medicines were opioid analgesics (67.1%), followed by paracetamol (63.9%) and NSAIDs (33.0%). Predictors of healthcare use and hospital inpatient admission were receiving a laboratory test and receiving any opioid. For the financial period 2019-20, the mean (SD) total cost of care per presentation was $5,629 ($11,982). Conclusion In the emergency department, more than two thirds of older adults with a lumbar spine condition received opioid analgesics. They often received imaging and laboratory tests, had high costs and were admitted to hospital. Alternative pathways of care are needed to support older adults with low back pain, to receive guideline-concordant emergency department care and have good health outcomes.

Background Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care. Methods A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ 2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors. Results A total of 6781 chiropractor–adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment. Conclusions From 6781 chiropractor–adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.

Background Pregnancy-related low back and/or pelvic girdle pain is common, with a prevalence rate of up to 86% in pregnant women. Although 19.5% of Australian pregnant women visit a chiropractor for pelvic girdle pain, little is known about the experience of pregnant women who seek this care. The aim of this study was to describe and explore the experiences of Australian pregnant women who seek chiropractic care for their current pregnancy-related low back and/or pelvic girdle pain. Methods A qualitative case study approach with purposive sampling from 27 chiropractic practices was used. A grounded theory approach was informed by a constructivist and interpretivist stance, which provided understanding and meaning to the pregnant women’s experiences. Online unstructured interviews were recorded, transcribed, and anonymised. A thematic analysis was subsequently conducted on the primary data. Codes and major themes were developed with the use of critical self- reflection (memos), survey finding triangulation and respondent validation. Results Sixteen potential respondents expressed interest in participating. After eligibility screening and data saturation, nine interviews were undertaken. Four key themes were identified: “Care drivers: what drives care seeking?”, “Care barriers: what barriers are encountered?”, “Chiropractic treatment: what does treatment consist of?” and “Response to care: what response was there to care?”. Conclusion Four key themes: care drivers, care barriers, chiropractic treatment, and response to care support an emergent substantive-level theory in women’s care seeking experiences for pregnancy-related back pain and chiropractic care. This theory is that chiropractic care for pregnant women experiencing low back pain and pelvic girdle pain may improve pain and function, while reducing pregnancy-related biopsychosocial concerns. The findings may inform antenatal health providers and the chiropractic profession about pregnant women’s experience seeking chiropractic care as well as directing future research.

Background To report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019. Methods Global Burden of Disease (GBD) 2019 study meta-data on all musculoskeletal conditions and LBP specifically were accessed and aggregated. Counts and age-standardised rates, for both sexes and across all ages, for prevalence, YLDs and attributable risk factors are reported. Results In 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113–7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722–921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327–3,061,066) prevalent cases of LBP and 298,624 (95% UI: 209,364–402,395) YLDs due to LBP. LBP was attributed to 44% of YLDs due to musculoskeletal conditions. In 2019, 22.3% and 39.8% of YLDs due to musculoskeletal conditions and LBP, respectively, were attributed to modifiable GBD risk factors. Conclusions The ongoing high burden due to musculoskeletal conditions impacts Australians across the life course, and in particular females and older Australians. Strategies for integrative and organisational interventions in the Australian healthcare system should support high-value care and address key modifiable risk factors for disability such as smoking, occupational ergonomic factors and obesity.

Background Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. Methods From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors’ own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. Results Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32–4.12)], while chiropractors who frequently treat children 0–3 years (OR = 0.5; 95% CI: 0.28–0.87), children 4–18 years (OR = 0.42; 95% CI: 0.21–0.86), and pregnant women (OR = 0.5; 95% CI: 0.26–0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32–6.41), were confident promoting (OR = 11.6; 95% CI: 1.37–98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03–9.99). Conclusion Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings.

Background Low back pain (LBP) is common among older adults, and it is a frequent reason for seeking chiropractic care. The STarT Back Screening Tool (SBT) was developed to stratify patients with LBP into low, medium, and high-risk treatment pathways, so that the treatment can be matched to each participant’s risk profile. But its prognostic performance varies across settings and populations. No studies have focused on the SBT’s utility as a stratified-care tool in older adults with LBP in a chiropractic setting. Therefore, our aim was to evaluate the ability of the SBT to predict three-, six-, and 12-month disability and pain outcomes in older adults (≥55 years) with a new episode of LBP consulting chiropractors in the Netherlands, Sweden, and Australia. Methods This was a secondary analysis of the Back Complaints in Older Adults – Chiropractic (BACE-C) cohort. Participants visiting chiropractors with LBP completed baseline questionnaires for demographic and clinical characteristics, including the SBT. Follow-up questionnaires assessed disability (Roland Morris Disability Questionnaire (RMDQ)) and pain intensity (11-point Numerical Rating Scale (NRS)). “No improvement” on disability and pain intensity was defined as less than 30% reduction in baseline scores. We used logistic regression models to estimate discrimination metrics including the area under the receiver operating characteristic curve (AUC). Subgroup analyses were conducted by country, sex, and LBP duration; sensitivity analyses employed alternative “no improvement” definitions and linear regression on continuous outcome scores. Results A total of 738 participants were included. The mean age of the study sample was 66.2 ± 7.5 years and 50.9% of the participants were female. The SBT showed poor discrimination for predicting no improvement in disability and pain intensity. All AUC values were below 0.60 regardless of whether SBT risk subgroups (i.e. low/medium/high) or the SBT sum score were used. Subgroup and sensitivity analyses did not meaningfully improve discrimination. Conclusion The SBT presented limited prognostic ability to predict outcomes of disability and pain intensity in older adults with LBP in a chiropractic setting. These findings suggest insufficient evidence for the prognostic ability of the SBT risk stratification tool. Future research should explore reasons behind the limited prognostic accuracy and consider potential modifications or alternative tools.