Chiropractic + Naturopathic Doctor • April 2017 • Roundup

For those who have created a LinkedIn profile just because it seemed like the right thing to do, consider this your secret strategy session to finding new opportunities, new clients, or just keeping on top of industry news.

Polish that profile. Regardless of your reasons to having a LinkedIn profile, you never know who might see it. So make sure your profile is accurate, detailed and complete. As your profile photo will have the greatest impact on first impressions, make sure it’s professionally taken, you’re smiling, and dressed appropriately for your profession.

Join groups. There are LinkedIn groups for virtually every industry or profession. So be sure to join ones for both your own and those of your customers. This will allow you to keep current with industry trends and the interests and current issues of the markets you serve.

Be active, be responsive. If you have an idea, a different point of view, or something worth mentioning pertaining to your industry, I encourage you to share your thoughts on LinkedIn. Participating in groups will expose you to potential customers or opportunities while positioning you as a thought leader. If you read someone else’s post, don’t hesitate to respond to it, either with words of support or a counter point. Remember to keep it professional.

Personalize your message. If you want to connect with someone on LinkedIn, don’t use the generic default note. Instead, mention people you may both know, an industry event you both attended, or just that you think there may be some opportunities to work together. Never start off with a sales pitch. On the flip side, when accepting someone else’s invitation to connect, be sure to drop them a personal message thanking them and letting them know you’re always ready to be a resource.

Write articles. This is especially important if you’re in an industry where knowledge and information is what you provide. Sharing applicable advice, ideas or tips is a great way to demonstrate your expertise while attracting new people to your profile. Good thing you now have such a great photo.

THE CANADIAN CHIROPRACTIC Guideline Initiative (CCGI) has launched a series of video resources for clinicians and patients in an effort to promote the effective application of recently released clinical practice guidelines.

The series consists of tailored exercise videos based on the findings under the recently published guideline recommendations on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). The findings, published by CCGI’s André Bussières and his team, provide evidence supporting chiropractic practices, and involving “a multimodal approach including manual therapy, self-management advice, and exercise as an effective treatment strategy for both recent-onset and persistent neck pain.”

The innovative video series, which includes 33 specific exercise videos in four clearly-marked playlists, has been created in collaboration with chiropractic experts at the Université du Québec à Trois-Rivières. This new video series is available on the CCGI YouTube channel in English and French.

To assist clinicians in recommending exercises for their patients, and to help patients with self-management at home, CCGI has also created matching exercise forms with links to each of the exercises. Clinicians can now quickly check off the exercises they suggest with the patient, and add their own notes if required. These forms can be downloaded by clinicians from the CCGI website and handed to the patient, or completed as fillable PDFs and sent electronically to their patient’s device.

“We are excited to see this new tool now available in English and French. A whiteboard video explaining how to use the patient exercise videos and forms is available on the website,” the CCGI said in a statement.

Downloadable accompanying documents for clinicians also include a one-page Summary of Recommendations, the Practitioner Guide and one-page algorithms for NAD and WAD. A 60-minute recorded webinar and 30-minute interactive learning module are available through Canadian Memorial Chiropractic College Continuing Education courses. Free continuing education hours may apply in some jurisdictions and clinicians should contact their regulatory board for more information.

These tools have been specially developed by CCGI for clinicians to ease the application of guideline recommendations.

The full guideline, along with all accompanying resources for clinicians and patients can be found on the CCGI website. For more information, go to the CCGI website www.chiroguidelines. org and for free access to the JMPT article.

CHICAGO – Older adults who suffer from arthritis need to keep moving to be functionally independent. But in an examination of a goal that is daunting for most of this aging population, a new Northwestern Medicine study found that performing even a third of the recommended activity is beneficial.

Federal guidelines suggest achieving 150 minutes of moderate activity per week to prevent premature death and serious illness. However, only one in 10 older American adults with arthritis in their knees meet these guidelines. Northwes tern Medicine researchers wanted to determine a less overwhelming activity goal to get this population up and moving, and 45 minutes per week was that magic number.

Approximately one third of participants improved or had high function after two years. But those participants who achieved this minimum of 45 minutes of moderate activity, such as brisk walking, per week were 80 per cent more likely to improve or sustain high future function over two years compared with those doing less. This finding was true for both men and women.

“Even a little activity is better than none,” said first author Dorothy Dunlop, professor of rheumatology and preventive medicine at Northwestern University Feinberg School of Medicine. “For those older people suffering from arthritis who are minimally active, a 45-minute minimum might feel more realistic.”

A rare examination of the type and intensity of physical activity older adults need to remain functional, the study was published online in the journal Arthritis Care & Research.

Only one in 10 older adults with arthritis in their knees meet the federal guidelines of 150 minutes of moderate activity per week

“The federal guidelines are very important because the more you do, the better you’ll feel and the greater the health benefits you’ll receive,” Dunlop said. “But even achieving this less rigorous goal will promote the ability to function and may be a feasible starting point for older adults dealing with discomfort in their joints.”

Using sophisticated movement- monitoring accelerometers, the researchers measured the physical activity of 1,600 adults from the nationwide research study, Osteoarthritis Initiative, who had pain, aching or stiffness in their hips, knees or feet.

“We found the most effective type of activity to maintain or improve your function two years later was moderate activity, and it did not need to be done in sessions lasting 10 minutes or more, as recommended by federal guidelines,” Dunlop said.

The research was supported in part by the U.S. NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The American College of Physicians (ACP) has issued a clinical practice guideline for the management of low back pain, recommending non-pharmacological approaches as first line of treatment.

The guidelines were based on the ACP clinical guide- lines committee’s systematic review of randomized, con- trolled trials and systematic reviews on noninvasive pharmacologic and nonpharmacologic treatments for low back pain published until April 2015.

The new guideline is de- signed for all clinicians and adult patients with acute, sub-acute and chronic low back pain.

In the guideline, the ACP recommends that patients with acute, sub-acute and chronic low back pain should first seek non-drug treatments to relieve their pain. For acute and subacute low back pain, the guideline recommends superficial heat, massage therapy, acupuncture or spinal manipulation.

For chronic low back pain patients, non-drug treatment options should include exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, mo- tor control exercise, progressive relaxation, electromyography biofeedback , low-level laser therapy, operant therapy, cognitive behavioural therapy, or spinal manipulation.

Clinicians should only consider pharmacologic Treatment for chronic low back pain if patients have responded inadequately to non-drug therapies.

“Clinicians and patients should consider pharmacologic treatment with non-steroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy,” the guideline recommends. Opioids should only be considered an option for patients who have failed “the above treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients,” it added.

The American Chiropractic Association welcomed the new guidelines from the ACP citing a “growing body of research” that points to the effectiveness of non-drug treatments for low back pain.

“The chiropractic profession has long advocated for doctors and patients to use a more conservative approach to treating low back pain,” said ACA president Dr. David Herd. “These new guidelines by the American College of Physicians support a growing body of research as well as increasing recognition in the health- care community regarding the value and effectiveness of non-drug approaches, such as spinal manipulation, for acute and chronic low back pain.”

The Canadian Chiroprac- tic Association did not respond to requests for comment.

In a number of jurisdictions, chiropractors have developed advanced standards of practice, including the ability to order advanced diagnostic imaging as well as prescription rights for a limited formulary of medications. Recent reports indicate that a growing number of chiropractors in various other jurisdictions are also interested in expanding their scopes of practice to include such limited formulary access.

Chiropractors in Switzerland have had limited prescriptive authority since 1995, and surveys indicate that these privileges are regarded by Swiss chiropractors as a distinct advantage for both the profession and patients in that country. Despite the advances in some jurisdictions, the right to prescribe medications continues to be a contentious issue for many in the chiropractic profession.

The objective of this commentary was to examine the arguments for and against limited medication prescription rights for chiropractors, and to discuss the implications of implementing such privileges for the profession.

If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the health-care system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine/musculoskeletal disorders. This is in keeping with a current move within the profession toward “rebranding” itself to align with a musculoskeletal scope of practice and a more comprehensive approach to patient care. Limited prescribing rights for chiropractors could also benefit patients and the health-care system by providing more streamlined, cost-effective care plus reduced waiting times for patients. Moreover, with such privileges chiropractors could have a positive influence on public health.

However, if the chiropractic profession wishes to expand its scope of practice to include limited prescriptive authority, necessary changes to chiropractic education and legislation must be addressed. For this, the profession could look to Switzerland where an excellent educational and legislative model for chiropractic has been developed.

Chiropractors who wish to pursue limited prescriptive authority should lobby their professional associations and regulatory bodies to engage in dialogue with like-minded politicians and third-party payers to highlight and promote the benefits of making such changes to the existing health-care system. Prior to this, discussions should take place within the chiropractic profession in order to present a uniform position on the part of the various memberships with respect to changing the profession’s scope of practice.

If such a move is to occur, it would be important that professional governing bodies, associations and respective memberships provide a united approach, perhaps initially validated after member consultation in the form of national surveys.

– Peter Emary, Taco Houweling, Martin Wangler, Stephen Burnie, Katherine Hood and Mark Erwin

This article was selected by the editorial team of the Chiropractic & Manual Therapies journal as the best paper for the third quarter of 2016. The full commentary of this paper has been published and can be freely accessed online at the following URL: http://chiromt.Biomedcentral.com/articles/10.1186/s12998-016-0114-y

World Spine Care will be the beneficiary of a seminar series designed to educate chiropractic practitioners on the latest research and promote evidence-based practice.

Dr. Shawn Thistle, founder and CEO of RRS Education, will donate $10 per registration to his upcoming RRS Education Seminars across Canada this spring. These informative, evidence-based and clinically-applicable seminars will feature interesting and important topics like neck pain, osteoarthritis, spinal health and visceral conditions, pain neuroscience and others.

“RRS Education Seminar attendees will enjoy an entertaining, contextual review of current research and gain practical, patient-centred understanding of how these topics pertain to patient care,” Thistle said. Events are now available for registration in Ottawa (April 1 - 2), Calgary (April 22 - 23), Edmonton (May 6 - 7), Owen Sound (June 3) and Vancouver (June 10 - 11).

“I am proud to support World Spine Care by donating $10 per attendee at the 2017 Seminars to this worthy cause,” Thistle said.

A safety review has found a risk of serious burns with the use of some over-the-counter topical pain relievers that contain menthol, according to Health Canada.

These pain relievers are applied to the skin and are intended to help relieve muscle and joint pain. They come in a variety of formulations, including creams, gels, liquids and patches.

Health Canada has received 21 reports of serious side-effects involving topical pain relievers containing menthol in various concentrations, either as a single ingredient or in combination with other compounds.

In many cases, the products were used as directed, with burns, severe swelling and blistering appearing within 24 to 48 hours after the first application.

Health Canada says available data did not allow it to determine whether the risk of serious burns is linked to any specific brand, formulation or menthol concentration, or to any ingredient other than menthol.

Consumers who experience serious skin reactions such as pain, swelling or blistering are advised to stop using the product and seek immediate medical attention.

The safety review also looked at the ingredients methyl salicylate and capsaicin. While serious skin burns have been reported with the use of topical pain relievers containing these compounds, the review did not find sufficient evidence to confirm they carry the same risk as menthol.

All topical pain relievers containing menthol, methyl salicylate or capsaicin produce a warming or cooling sensation where they are applied, but they should not cause severe pain or skin damage, Health Canada said in an advisory released in February

Even so, some menthol-containing topical pain relievers warn about the risk of serious skin burns on their labels or packaging.

Health Canada said it will publish an updated labeling standard for all menthol-containing topical pain relievers in the coming weeks to better inform consumers about the risk.