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Background: The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience., Objectives: (1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices., Methods: We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors' knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities., Results: The key moments where participants felt they needed the most support were "treatment", "report of findings", "informed consent", "physical examination", and "before the appointment". All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals., Conclusion: Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada., Competing Interests: Declarations. Ethics approval and consent to participate: This study received ethics approval from the Ontario Tech University Research Ethics Board (#17528). Written consent was obtained from participants prior to the interviews. Consent for publication: Not applicable. Competing interests: This project was funded by the Canadian Chiropractic Association. The funder played a role in the conceptualisation and design of the study; however, the funders had no role in the data collection, analysis, or decision to publish. DT, DS, MAG, GC, CD, and CC are members of the Canadian Chiropractic Association. CD is employed by the Canadian Chiropractic Association. CC, HY, DS, and GC are supported by the Canadian Chiropractic Guideline Initiative., (© 2024. The Author(s).)

Background: Clinical care pathways may be useful tools to improve the quality of healthcare by facilitating the translation of evidence into practice. Our study is situated within a larger project, whereby end-users co-developed a care pathway for the management of shoulder pain. In this study, we explored end-user perceptions of the usefulness and practicality of implementing a care pathway to manage shoulder pain. We also solicited feedback for the pathway's improvement., Methods: We conducted a qualitative study using a transcendental phenomenological approach seen through a constructivist lens. Clinicians recorded themselves interacting with the care pathway while working through a clinical case. Clinicians described their thoughts and movements aloud as they completed the activity. Second, we conducted individual semi-structured interviews to discuss the usefulness and practicality of pathway implementation. Interview transcripts were coded independently by reviewers. Transcript codes and associated quotes were grouped into themes. Themes were sequenced and linked creating a 'web' of thematic connections. Summary statements were developed to synthesize the overall essence of the phenomena., Results: Nine clinicians participated. Participants included eight chiropractors and one medical physician. We found that clinicians believed the care pathway could be useful at various levels, including education (students, interns), for early career clinicians, for engaging patients, facilitating interprofessional communication, and as a reminder of information for certain, less familiar conditions. When discussing the practicality of implementing the care pathway into practice settings, clinicians expressed that agreement with the care pathway and its recommendations may influence its acceptability among clinicians. Additionally, integrating recommendations into practice may be a skill requirement included into clinical training. Clinicians described the importance of opinion leaders in the acceptability of new evidence. Various difficulties with the replicability of interventions into clinical care was also discussed. In general, clinicians suggested the layout of the care pathway was manageable, and there was sufficient information for clinical decision-making. Clinicians also made several recommendations for improvement., Conclusions: End-user involvement and collaboration provides tangible instruction to improve care pathways themselves, their implementation strategies and helps to support and strengthen future research for overcoming individual, systemic and contextual barriers., (© 2022. The Author(s).)

Introduction: Brief action planning (BAP) is a collaborative tool to support patients' self-management goal setting and action planning. BAP facilitates patient self-reflection, and provides opportunity to establish goals of their own priority. Case presentation: A 55 year-old female with recentonset low back pain with L5 nerve root distribution, described severe pain in the low back and sharp pain and tingle-sensations down to her right foot. Pain worsened with sitting, coughing, and bending. She was diagnosed with lumbar and other intervertebral disc disorder with radiculopathy (ICD 10: M51.1). Treatment: Initial treatment included reassurance, education, promotion of movement, and manual therapies. Symptoms worsened at the eighth visit (five weeks) where she also demonstrated paincatastrophizing behaviours and an over-reliance on passive treatment strategies (i.e., psychosocial factors or yellow flags). BAP was introduced into her treatment plan to set achievable goals for her care. Outcome: Decreased pain and disability were reported after incorporating BAP into care. Reduced pain-catastrophizing and reduced over-dependence on passive strategies were also demonstrated. Clinical gains were sustained at the 10-week follow-up assessment. Key clinical message: We describe the utilization of brief action planning as a technique for improving adherence to evidence-based clinical practice guideline recommendations in a patient with acute low back pain and radiculopathy, and late-onset psychosocial factors. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this commentary was to critically appraise the patellofemoral pain clinical practice guideline published by the Academy of Orthopaedic Physical Therapy in 2019 and to summarize their recommendations for chiropractic practice. Methods: Quality and reporting of this guideline was assessed with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Three reviewers independently scored between 1-7 (strongly disagree-strongly agree) for 23 items organized into six quality domains. Results: AGREE II quality domain scores ranged between 57%-98%, with overall quality of the recommendation rated 89%. The guideline contained evidence summaries and/or recommendations for three topics: impairment/function-based diagnosis; examination; and interventions. Conclusion: Based on its methodological quality, we recommend the use of this guideline for the examination, diagnosis, and management of patellofemoral pain in chiropractic practice. A summary of recommendations from this guideline is presented for use within the scope of chiropractic practice in Canada. [ABSTRACT FROM AUTHOR]

Introduction: Trust is a key component of any therapeutic relationship and correlates with treatment satisfaction. Patients with high levels of trust in their healthcare providers report more beneficial heath behaviours, fewer symptoms, and a higher quality of life. The purpose of this study was to explore how chiropractors in British Columbia (BC) understand the process of building trust with patients. Design: This was a sequential exploratory mixed-methods design. Semi-structured one-on-one interviews informed an online survey that was sent to all BC Chiropractic Association members. Participants: Interviews were completed by six chiropractors from the Vancouver Practice Based Research Network; an online survey was completed by 97 chiropractors. Results: Themes of honesty, communication, perceived competence, and caring emerged during interviews. Survey findings confirmed the importance of honesty, communication, and perceived competence in building trust. Conclusion: Chiropractors can employ a variety of interpersonal strategies to foster trust with patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence and presenting complaints of HIV/AIDS patients attending a chiropractic outpatient teaching clinic in downtown Toronto, and explore their self-reported comorbidities, medications used, and consumption of other complementary health care. Methods: A random sample was drawn from the entire clinic file collection spanning the years 2007 to 2013. Files were anonymized and coded to ensure confidentiality. Results: A total of 264 files were randomly pulled from approximately 3750 clinic files. The prevalence of HIV positive patients was 5.7% (15/264), predominantly males, with 3 patients having developed AIDS. Coinfection with Hepatitis B and/or C was identified in 5/15 patients. The most common presenting complaint was neck pain (80%), followed by low back pain (47%) compared to 20% and 43% respectively for the general cohort. Eleven of 15 patients were on antiretroviral treatment (ART); The frequency of comorbidities was 8/15 (53%) however, none were identified as being dominant. In addition to chiropractic, 7/15 patients reported receiving other complementary therapies. Conclusions: A relatively small proportion of HIV/ AIDS patients were found to be receiving treatments in this downtown chiropractic clinic situated within a community health clinic setting. The principal presenting complaint was neck pain. [ABSTRACT FROM AUTHOR]

Concussions are increasingly recognized as a public health concern. This paper evaluates Canadian concussion care guidelines, advocating for the inclusion of a broader range of healthcare professionals (HCPs) in concussion assessment, diagnosis, and management. It emphasizes the role of chiropractors, in addition to medical doctors (MDs) and nurse practitioners (NPs), highlighting their extensive training in musculoskeletal and neurological disorders. Chiropractors are adept at managing symptoms like headache, neck pain, and dizziness, and employing evidence-based, comprehensive interventions including patient education, exercise therapy, manual therapy, cervicovestibular rehabilitation, and return-to-sport (RTS) protocols. The paper also addresses regional variations in chiropractors' roles, focusing on Ontario's "Rowan's Law," and argues that limiting aspects of concussion care (assessment, diagnosis, RTS clearance) to MDs and NPs may result in healthcare inefficiencies and inequities. The findings are significant for policymakers and healthcare leaders, indicating a need for updated concussion care guidelines that integrate and utilize diverse HCPs. This could lead to improved patient outcomes, healthcare efficiency, and equity in concussion management across Canada. [ABSTRACT FROM AUTHOR]