Background
Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing self-neck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis.
Case presentation
A 63-year-old man presented to the emergency department with worsening interscapular pain radiating to his neck 1 day after performing self-manipulation of his cervical spine. He was found to be coagulopathic upon admission, secondary to chronic warfarin therapy for the management of atrial fibrillation. Approximately 48 h after the manipulation, the patient became acutely quadriparetic and hypotensive. Urgent magnetic resonance imaging revealed a multilevel spinal epidural hematoma from the lower cervical to thoracic spine.
Conclusions
Partial C7, complete T1 and T2, and partial T3 bilateral laminectomy was performed for evacuation of the spinal epidural hematoma. Following a 2-week course of acute inpatient rehabilitation, the patient returned to his baseline functional status. This case highlights the risks of self-manipulation of the neck and potentially other activities that significantly stretch or apply torque to the cervical spine. It also presents a clinical scenario in which practitioners of spinal manipulation therapy should be aware of patients undergoing anticoagulation therapy.
Objective
To describe the clinical use of patient-reported outcome measures (PROMs) and screening tools (STs) for low back pain (LBP) in clinics of chiropractic teaching institutions in the United States.
Methods
A descriptive analysis was completed with data collection achieved between June 2018 and March 2019. PROMs/STs were classified as disability/functional measures, pain measures, psychosocial measures, and other measures. Frequencies of use of PROM/ST instruments were calculated.
Results
Representatives from 18 of 19 chiropractic institutions (94.75%) provided a description of PROM/ST use for LBP in their teaching clinics. Seventeen institutions (94.4%) reported the routine clinical use of PROMs/STs for LBP. Disability/functional measures were the most common type of instruments used, followed by pain measures, psychosocial measures, and others. The 4 most common individual PROMs/STs reported were (1) Oswestry Disability Index, (2) a variation of a pain rating scale, (3) Keele STarT Back Tool, and (4) Patient Specific Functional Scale. Six out of 18 (33%) institutions reported the use of a PROM/ST specifically designed to focus on psychosocial influences.
Conclusion
Most chiropractic institution teaching clinics in the United States reported the clinical use of PROMs/STs for patients presenting with LBP. This mirrors trends in chiropractic literature of increasing use of PROMs/STs. A minority of institutions described the clinical use of a PROM/ST specifically designed to detect psychosocial influences.
Background Healthcare providers’ attitudes and beliefs about pain conditions influence those of patients and may impact outcomes. While the use of chiropractic care for persistent low back pain (PLBP) is prevalent, chiropractors’ attitudes and beliefs related to PLBP patients are not fully understood. The purpose of this study was to assess the attitudes and beliefs and activity/work recommendations of students and faculty at a chiropractic teaching institution regarding PLBP patients.Methods The Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) and clinical vignettes were requested to be completed by all chiropractic students and faculty at Parker University in April 2018 and July-December 2020. HC-PAIRS scores range from 1–7, with higher scores indicating stronger beliefs that PLBP justifies disability and limitation of activities. Activity and work recommendations from clinical vignettes were rated as “adequate”, “neutral”, or “inadequate”. Descriptive statistics and independent t-tests were used to analyze results.Results Student and faculty response rates in 2018 and 2020 were 63.6% (n = 497) and 25.9% (n = 305), and 76.7% (n = 23) and 41.5% (n = 22), respectively. Faculty mean HC-PAIRS scores (SD) (2018: 3.66 (0.88); 2020: 3.49 (0.91)) were significantly lower than students’ (2018: 4.41 (0.71); 2020: 4.22 (0.69)) in both years (p < 0.05). The decrease in student mean scores between years was statistically significant (mean change: 0.19, p < 0.05), while the decrease in faculty mean scores was insignificant (mean change: 0.17, p = 0.55). In 2018 and 2020, the percentage of faculty that provided “adequate” activity (2018: 62.1; 2020: 66.7) and work (2018: 41.0; 2020: 45.5) recommendations was significantly greater than students’ activity (2018: 33.9; 2020: 30.3) and work (2018: 21.2; 2020: 23.8) recommendations. Within-group changes in percentage of “adequate” recommendations given by students and faculty between years were not significant.Conclusions As the first study to consecutively assess the PLBP attitudes and beliefs of students and faculty of a chiropractic college, we found that there is room for improvement in these areas. Changes in attitudes and activity/work recommendations between the 2 years were minimal and found faculty scores to be more appropriate than those of students. Strategies to improve scores should be considered at chiropractic training institutions.
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