BackgroundIn 2009, the heads of the Executive Council of the European Chiropractors' Union (ECU) and the European Academy of Chiropractic (EAC) involved in the European Committee for Standardization (CEN) process for the chiropractic profession, set out to establish European guidelines for the reporting of adverse reactions to chiropractic treatment. There were a number of reasons for this: first, to improve the overall quality of patient care by aiming to reduce the application of potentially harmful interventions and to facilitate the treatment of patients within the context of achieving maximum benefit with a minimum risk of harm; second, to inform the training objectives for the Graduate Education and Continuing Professional Development programmes of all 19 ECU member nations, regarding knowledge and skills to be acquired for maximising patient safety; and third, to develop a guideline on patient safety incident reporting as it is likely to be part of future CEN standards for ECU member nations.ObjectiveTo introduce patient safety incident reporting within the context of chiropractic practice in Europe and to help individual countries and their national professional associations to develop or improve reporting and learning systems.DiscussionProviding health care of any kind, including the provision of chiropractic treatment, can be a complex and, at times, a risky activity. Safety in healthcare cannot be guaranteed, it can only be improved. One of the most important aspects of any learning and reporting system lies in the appropriate use of the data and information it gathers. Reporting should not just be seen as a vehicle for obtaining information on patient safety issues, but also be utilised as a tool to facilitate learning, advance quality improvement and to ultimately minimise the rate of the occurrence of errors linked to patient care.ConclusionsBefore a reporting and learning system can be established it has to be clear what the objectives of the system are, what resources will be required and whether the implementing organisation has the capacity to operate the system to its full advantage. Responding to adverse event reports requires the availability of experts to analyse the incidents and to provide feedback in a timely fashion. A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.
Evidence suggests that chiropractic manipulation might exert positive effects in osteoporotic patients. The aim of this study was to evaluate the effects of chiropractic manipulation on bone structure and skeletal muscle in rats with bone loss caused by ovariectomy (OVX). The 6-month old Sprague-Dawley rats at 10 weeks following OVX or sham operation (Sh) did not suffer chiropractic manipulation (NM group) or were submitted to true chiropractic manipulation using the chiropractic adjusting instrument Activator V three times/week for 6 weeks as follows: Force 1 setting was applied onto the tibial tubercle of the rat right hind limb (TM group), whereas the corresponding left hind limb received a false manipulation (FM group) consisting of ActivatorV firing in the air and slightly touching the tibial tubercle. Bone mineral density (BMD) and bone mineral content (BMC) were determined in long bones and L3-L4 vertebrae in all rats. Femora and tibia were analyzed by μCT. Mechano growth factor (MGF) was detected in long bones and soleus, quadriceps and tibial muscles by immunohistochemistry and Western blot. The decrease of BMD and BMC as well as trabecular bone impairment in the long bones of OVX rats vs Sh controls was partially reversed in the TM group versus FM or NM rats. This bone improvement by chiropractic manipulation was associated with an increased MGF expression in the quadriceps and the anterior tibial muscle in OVX rats. These findings support the notion that chiropractic manipulation can ameliorate osteoporotic bone at least partly by targeting skeletal muscle.
Objective: Many countries require examinations as a gateway to chiropractic licensure; however, the relevance of these exams to the profession has not been explored. The purposes of this study were to analyze perceptions of international stakeholders about chiropractic qualifying examinations (CQEs), observe if their beliefs were in alignment with those that society expects of professions, and suggest how this information may be used when making future decisions about CQEs. Methods: We designed an electronic survey that included open-ended questions related to CQEs. In August 2019, the survey was distributed to 234 international stakeholders representing academic institutions, qualifying boards, students, practitioners, association officers, and others. Written comments were extracted, and concepts were categorized and collapsed into 4 categories (benefits, myths, concerns, solutions). Qualitative analysis was used to identify themes. Results: The response rate was 56.4% representing 43 countries and yielding 775 comments. Perceived benefits included that CQEs certify a minimum standard of knowledge and competency and are part of the professionalization of chiropractic. Myths included that CQEs are able to screen for future quality of care or ethical practices. Concerns included a lack of standardization between jurisdictions and uncertainty about the cost/value of CQEs and what they measure. Solutions included suggestions to standardize exams across jurisdictions and focus on competencies. Conclusion: International stakeholders identified concepts about CQEs that may facilitate or hinder collaboration and efforts toward portability. Stakeholder beliefs were aligned with those expected of learned professions. This qualitative analysis identified 9 major themes that may be used when making future decisions about CQEs.
Osteoarthritis (OA) is a degenerative disease characterized by injury of all joint tissues. Our previous study showed that in experimental osteoporosis, chiropractic manipulation (CM) exerts protective effects on bone. We here assessed whether CM might ameliorate OA by improving subchondral bone sclerosis, cartilage integrity and synovitis. Male New-Zealand rabbits underwent knee surgery to induce OA by anterior cruciate ligament injury. CM was performed using the chiropractic instrument ActivatorV 3 times/week for 8 weeks as follows: force 2 setting was applied to the tibial tubercle of the rabbit right hind limb (TM-OA), whereas the corresponding left hind limb received a false manipulation (FM-OA) consisting of ActivatorV firing in the air and slightly touching the tibial tubercle. After sacrifice, subchondral bone integrity was assessed in the tibiae by microCT and histology. Cartilage damage and synovitis were estimated by Mankin's and Krenn's scores, respectively, and histological techniques. Bone mineral density and content in both cortical and trabecular compartments of subchondral bone decreased in OA rabbits compared to controls, but partially reversed in the TM-OA group. Trabecular bone parameters in the latter group also showed a significant improvement compared to FM-OA group. Moreover RANKL, OPG, ALP and TRAP protein expression in subchondral bone significantly decreased in TM-OA rabbits with respect to FM-OA group. CM was associated with lower Mankin's and Krenn's scores and macrophage infiltrate together with a decreased protein expression of pro-inflammatory, fibrotic and angiogenic factors, in TM-OA rabbits with respect to FM-OA. Our results suggest that CM may mitigate OA progression by improving subchondral bone as well as cartilage and synovial membrane status. Osteoarthritis (OA) is one of the most common chronic diseases affecting all anatomical structures of the joint, namely cartilage, subchondral bone and synovial membrane 1. This disease affects about 15% of the population aged 25-75 years, and its prevalence significantly increases with age, affecting 70% of the population over 65 years 2. Although OA has been described as a cartilage disorder, changes in the underlying (subchondral) bone also occur in this disease 3. In this sense, different molecular alterations associated with the latter bone remodeling, e.g., in expression of nuclear factor ligand receptor kappa B (RANKL) and osteoprotegerin (OPG), have been described in OA 4-7. Preclinical and clinical studies point to the observed alterations in subchondral bone as an important OA pathogenic factor 8. In fact, studies in animal models of combined osteoporosis (OP) and OA (OPOA) demonstrate that OP induces cartilage damage 9. In this setting, the observed significant correlation between deterioration of subchondral bone and cartilage injury indicates that alterations in subchondral microstructure aggravate cartilage damage 10 .
BackgroundLearning to cycle is an important milestone for children, but the popularity of cycling and the environmental factors that promote the development and practice of this foundational movement skill vary among cultures and across time. This present study aimed to investigate if country of residence and the generation in which a person was born influence the age at which people learn to cycle.MethodsData were collected through an online survey between November 2019 and December 2020. For this study, a total of 9,589 responses were obtained for adults (self-report) and children (parental report) living in 10 countries (Portugal, Italy, Brazil, Finland, Spain, Belgium, United Kingdom, Mexico, Croatia, and the Netherlands). Participants were grouped according to their year of birth with 20-year periods approximately corresponding to 3 generations: 1960–79 (generation X; n = 2,214); 1980–99 (generation Y; n = 3,994); 2000–2019 (generation Z; n = 3,381).ResultsA two-way ANOVA showed a significant effect of country, F(9,8628) = 90.17, p < 0.001, ηp2 = 0.086, and generation, F(2,8628) = 47.21, p < 0.001, ηp2 = 0.122, on the age at which individuals learn to cycle. Countries with the lowest learning age were the Netherlands, Finland and Belgium and countries with the highest learning age were Brazil and Mexico. Furthermore, the age at which one learns to cycle has decreased across generations. There was also a significant country x generation interaction effect on learning age, F(18,8628) = 2.90, p < 0.001; however, this effect was negligible (ηp2 = 0.006).ConclusionsThese findings support the socio-ecological perspective that learning to cycle is a process affected by both proximal and distal influences, including individual, environment and time.
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