Background Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes. Methods A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores. Results Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (− 1.55 points for each 10-year increment from age 28; 95%CI − 2.67 to − 0.44), belief that adverse events are common with chiropractic care (− 1.41 points; 95% CI − 2.59 to − 0.23) and reported use of the research literature (− 6.04 points; 95% CI − 8.47 to − 3.61) or medical school (− 5.03 points; 95% CI  − 7.89 to − 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic. Conclusions Although generally positive, Canadian family physicians’ attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.

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Background: Knee arthritis is a leading cause of limited function and long-term disability in older adults. Despite a technically successful total knee arthroplasty (TKA), around 20% of patients continue to have persisting pain with reduced function, and low quality of life. Many of them continue using opioids for pain control, which puts them at risk for potential long-term adverse effects such as dependence, overdose, and risk of falls. Although persisting pain and opioid use after TKA have been recognised to be important issues, individual strategies to decrease their burden have limitations and multi-component interventions, despite their potential, have not been well studied. In this study, we propose a multi-component pathway including personalized pain management, facilitated by a pain management coordinator. The objectives of this pilot trial are to evaluate feasibility (recruitment, retention, and adherence), along with opioid-free pain control at 8 weeks after TKA. Methods: This is a protocol for a multicentre pilot randomized controlled trial using a 2-arm parallel group design. Participants in the intervention group will receive support from a pain management coordinator who will facilitate a multicomponent pain management pathway including: 1) preoperative education on pain and opioid use; 2) preoperative risk identification and mitigation; 3) personalized post-discharge analgesic prescriptions; 4) continued support for pain control and recovery up to 8 weeks post-op. Participants in the control group will undergo usual care. The primary outcomes of this pilot trial are to assess the feasibility of participant recruitment, retention, and adherence to the interventions, and key secondary outcomes are persisting pain and opioid use. Discussion: The results of this trial will inform implementation of a coordinated approach, integrating a multicomponent pain pathway to improve pain control and reduce harms, while keeping an emphasis on patient centered care and shared decision making. Trial Registration: Prospectively registered in clinicaltrials.gov (NCT04968132) on 21 July 2021. https://clinicaltrials.gov/ct2/show/NCT04968132

Background: Osteoarthritis (OA) is one of the most common degenerative joint diseases that occurs in the elderly population. Total knee arthroplasty is a recognized treatment for end-stage knee OA and is effective in managing pain and improving function. However, postoperative pain and opioid use continue to be major challenges. Clinical trials aiming to study interventions to decrease these twin challenges have used different priorities and varied approaches to measure and report pain and opioid use as clinical outcomes. The purpose of this study is to methodologically review randomized controlled trials on total knee arthroplasties to describe and report the approach to measuring pain and opioid use. Because pain and opioid use are interrelated concepts that, we argue, should not be conceptually separated, we will particularly focus on whether and how pain and opioid use are reported as either a combined outcome or as co-primary outcomes.Methods: This is a protocol for a methodological review of pain and opioid use outcomes used in knee arthroplasty RCTs published in the past 10 years (Jan 1, 2012 – Oct 1, 2022). Eligible studies will be identified by searching MEDLINE, EMBASE, and CENTRAL databases. A systematic review management software, Covidence, will be used to conduct the screening and data extraction stages of the study. Screening and data extraction will be done individually and in duplicate for study inclusion and final analysis. Discussion: Previous studies have outlined potential analytical approaches to combine and report pain scores and opioid use as either co-primary outcomes or one outcome, but no consensus has been reached in the reporting of these two outcomes. This study will add to the literature by methodologically evaluating the literature on pain and opioid use outcomes following a total knee arthroplasty and describe how these two outcomes are reported, with a particular focus on whether and how they are reported as one combined outcome or co-primary outcomes.

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Background: Attitudes of Canadian family physicians towards chiropractic are uncertain. Methods: A 50-item survey administered to a ranmdom sample of Canadian family physcians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was an 80-point chiropractic attitude questionnaire (CAQ); higher scores indicated more positive attitudes toward chiropractic. Results: Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2,429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, with 27% expressing uncertainty and 25% holding negative views. Most respondents (72%) referred patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity within the chiropractic profession presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (-1.55 points for each 10-year increment from age 28; 95%CI -2.67 to -0.44), belief that adverse events are common with chiropractic care (-1.41 points; 95% CI -2.59 to -0.23) and reported use of the research literature (-6.04 points; 95% CI -8.47 to -3.61) or medical school (-5.03 points; 95% CI = -7.89 to -2.18) as a source of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic.Conclusions: Although generally positive, Canadian family physicians’ attitudes towards chiropractic are diverse, and most physicians acknowledge that practice diversity within the chiropractic profession presents a barrier to interprofessional collaboration.

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