PATIENT CARE Health group brings physical activity to primary care for disease management Exercise Is Medicine Canada (EIMC) National Task Force, a team of multidisciplinary health-care and exercise professionals, is aiming to get physical activity and exercise into mainstream patient care in an effort to prevent and manage chronic diseases, including diabetes. Dr. Jan Hux, chief scientific advisor for the Canadian Diabetes Association, said the Canadian Diabetes Association’s 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommends all individuals with diabetes participate in at least 150 minutes of moderate to vigorous intensity aerobic exercise each week and encourages resistance training three times a week. “Providing diabetes care providers with practical and effective strategies for incorporating physical activity into a management plan is extremely valuable for people living with diabetes,” Hux said. Dr. Jonathon Fowles, an exercise physiologist at the Centre of Lifestyle Studies at Acadia University in Nova Scotia and a member of the Canadian Society for Exercise Physiology (CSEP) working group with EIMC, has been working extensively at promoting practical strategies to assist health-care professionals with incorporating exercise into primary care. “There’s a range of ways to help in the process as opposed to simply telling people to be more active,” said Dr. Fowles. Susan Yungblut, national task force manager with EIMC, said her organization is part of a global initiative that is bridging the gap between the physical activity sector and our traditional health-care sector, which reinforces the importance of exercise when talking to patients. “We understand that primary care professionals have very limited time when seeing patients. Our goal is to provide the resources and tools to support the integration of physical activity and exercise into our health-care system to improve patient outcomes.” For more on clinical management, visit www.canadianchiropractor.ca GERIATRIC CMCC forum highlights need for more research on senior care Chiropractors can have a huge role to play in successful aging among older adults, according to Dr. Cheryl Hawk, professor and director of clinical research at Logan College of Chiropractic in Chesterfield, Mo. Dr. Hawk was a presenter at a recent symposium hosted by the Canadian Chiropractic Memorial College. “Mobility and ability to stay active are essential to successful aging,” said Dr. Hawk. “Chiropractic has demonstrated effects on functional ability.” According to Dr. Hawk, successful aging measures include both mortality – how long a person lived – and morbidity, which indicates years lived with disability. Successful aging is not only about staying alive; it’s about living a healthy life without disability, she added. A study of 34 countries in the Organization for Economic Cooperation and Development (OECD) showed Canada ranks 12th in life expectancy, at 81 years, and ranks 10th in health-adjusted life expectancy (HALE), at 70 years. HALE takes into account both mortality and disability. This means that older adults in Canada may live up to an average of 81 years, but the average age they are living without a disability is only 70 years old. This, in turn, means that older adults are typically spending the last 10 years of their lives coping with some form of disability. “What can we do as chiropractors to close that gap? My belief is we can do more than anybody,” Dr. Hawk said. Keeping people out of nursing homes by helping them maintain their mobility is one way chiropractors can help with successful aging, said Dr. Hawk. The third leading cause of death in the U. S. is health-care-acquired infection, she said. Keeping older people away from hospitals and nursing homes will help reduce these types of deaths. “Physical activity is important in compressing morbidity, but that is only one part of what we can do as chiropractors,” said Dr. Hawk. Dr. Hawk also encouraged increased research on geriatrics and successful aging. More research should be focused on mobility, or the ability to function, as well as fall prevention among older adults, she added. Echoing Dr. Hawk, one chiropractor and professor at New York Chiropractic College has been doing his own research on chiropractic care for older adults. “There is a need to change our focus in the management of chronic pain syndromes from a pain management perspective to a functional management perspective,” said Dr. Paul Dougherty, professor at New York Chiropractic College. Pain is among the most common complaints reported by older patients. The problem, according to the NYCC professor, is that while there are many treatment interventions for lower back pain, no one intervention has been identified as being superior to another. “It is hypothesized that one of the reasons for this fact is The fundamental lack of understanding of back pain itself,” Dr. Dougherty told attendees at the CMCC symposium. Identifying safe and effective interventions for chronic low back pain in the elderly population is critical in promoting quality of life and reducing risks associated with chronic medication use, said Dr. Dougherty. Dr. Dougherty and his team conducted a placebo controlled RCT (randomized controlled trial) to compare the efficacy of routine chiropractic management versus an active placebo control group using a sham chiropractic treatment in adults 65 years and older who suffer chronic back pain. “The results of the study found statistically and clinically significant improvements in both groups in VAS (visual analogue scale) and ODI (Oswestry disability index) scores,” Dr. Dougherty said. “However, the patients undergoing ‘chiropractic care’ were found to have greater improvements in disability as compared to sham intervention.” The fact everybody got statistically significant improvements – whether they underwent chiropractic care or sham intervention with ultrasound treatment – stressed the importance of doctor-patient interaction, according to Dr. Dougherty. Geriatrics was not the only topic of discussion at the twoday CMCC symposium held on Oct. 26 and 27. Women’s health and pediatrics were also addressed. By Mari-Len De Guzman ASSOCIATION OCA names new president The Ontario Chiropractic Association (OCA) has elected Dr. Kristina Peterson as the association’s new president. Dr. Peterson took over from previous president, Dr. Natalia Lishchnya, on Oct. 5, 2013. Dr. Peterson currently owns and operates a multidisciplinary chiropractic practice in Thunder Bay, Ont., and has been practicing there since 1997. She has been an essential contributor to the OCA as a director of the board since 2000, as chair and participant in multiple board committees and as a media spokesperson for the Thunder Bay area, the OCA said. Dr. Peterson is also peer assessor for the College of Chiropractors of Ontario and a member of the Falls Prevention Working group in her Local Heath Integration Network. “This presidency begins at a very exciting juncture for the profession in Ontario,” said Dr. Peterson.“Given recent news from the Ministry of Health and Long-Term Care around the implementation of lower back pain programs and the addition of chiropractors to the list of health professionals that are eligible to work in primary care settings, we have a number of unique opportunities for chiropractors and their patients. I look forward to working with the board, staff and all of our members across the province to continue implementing our vision to provide Ontarians with access to chiropractic services.” Dr. Peterson is the third woman to serve as OCA president, following Dr. Roberta Koch, who served from 1989-1991, and her immediate predecessor, Dr. Lishchyna, who served from 2011-2013. By Canadian Chiropractor staff RESEARCH Expert cites potential of medical images for research A Canadian expert is suggesting scientists are missing a chance to see the big picture when it comes to medical images. Dr. Alan Moody says X-rays, MRIs and CT-scans could provide a treasure trove of information if they were systematically studied. But currently, medical images are used simply to diagnose or rule out a problem for an individual, then gather dust in the patient’s file. Moody says if databases of images were amassed, they could be studied in the way researchers currently mine anonymized patient records for clues to drug efficacy or side-effects and other medical questions. He says part of the beauty of such a system would be that the images have already been paid for, so this would be low-cost research. Moody, who is chairman of the department of medical imaging at the University of Toronto, is making the argument in a commentary published in the journal Nature. Medicine has long stored preserved tissue samples taken from biopsies for study. Medical images could be used in the same manner, Moody said in an interview. “Akin to pathology specimens which are sitting there, this is even richer data in a sense. We have whole body scans, we have brain Scans, we have fundamental whole organ information,” Moody says. “The power of that comes when you put a lot of that data all in one space and then analyze that data, which is this ‘Big data, big picture’ idea.” One example of how images could be used in this way relates to the study of dementia. If researchers could look at brain scans of individuals who have experienced early symptoms of what might be Alzheimer’s disease and are being followed, the scientists might be able to identify what an early Alzheimer’s brain looks like. “Often we see snapshots of individuals coming with a plethora of different signs which in that small snapshot cannot be put together to give you any larger information. But if you imagine instead of that one patient... in Toronto alone we’d probably have a thousand of these patients a year,” Moody says. “You would then have this large data bank of brain scans that would then start giving you the bigger picture.” Moody says a system would need to be developed whereby images could be shared in a way that didn’t jeopardize individual patient privacy. But these kinds of systems are already in place for the study of other types of data. By Helen Branswell, The Canadian Press DEPARTURE CMCC president to step down in 2014 The Canadian Memorial Chiropractic College(CMCC) board of governors has announced that Dr. Jean Moss will step down from her position as president, effective June 30, 2014. She will continue to lead CMCC for the remainder of the academic year. “It is a bittersweet milestone. Jean leaves an extraordinary legacy of innovation and success and very large shoes to fill,” said Dr. Mark Symchych, chair of the CMCC board of governors and CMCC graduate from the class of 1993. Dr. Moss attended CMCC and graduated in 1970 as a Doctor of Chiropractic. She began a private practice and joined the CMCC faculty on a parttime basis in 1971. Since then, she has held a number of increasingly responsible roles at CMCC that culminated in her appointment as president in 1990. During her tenure, CMCC has grown and prospered and has achieved national and international recognition for the quality of its programs, the competence of its graduates and the breadth of its innovations and contributions in education and research, according to the CMCC. “The board of governors owes a debt of gratitude to Dr. Moss for her tireless efforts, and her dedication to the profession. Her vision is the driving force behind innumerable advances over the years, including the building of a landmark campus in 2004;The establishment of the McMorland Family Research Chair in Mechanobiology (the only one established in an independent chiropractic institution); obtaining degree granting status for the Doctor of Chiropractic program and then renewed consent for an unprecedented 10-year period,” the CMCC said in a statement. CMCC students and faculty have benefited from her leadership in establishing interprofessional collaborations in diverse clinical environments – most recently, the Academic Family Health Team at St. Michael’s Hospital. An academic articulation agreement with the University of Ontario Institute of Technology (UOIT) led to the establishment of the UOITCMCC Centre for the Study of Disability Prevention and Rehabilitation situated at the CMCC campus. For her accomplishments, Dr. Moss has received numerous awards and accolades. She was recently the recipient of the World Federation of Chiropractic Honour Award, a citation reserved for those who have contributed a lifetime of distinguished and exceptional service to advance the growth of chiropractic. The CMCC board of governors has appointed a presidential search committee to direct the recruitment process to find a successor for Dr. Moss and will undertake the search immediately. Pain Management Ontario recognizes chiropractic role in primary health care The Ontario Ministry of Health and Long-Term Care will soon be releasing a call for proposals for a primary care low back pain (PCLBP) pilot program that will support interprofessional health-care teams in providing more effective management of low back pain. Minister Deb Matthews made the announcement in a video message to the Ontario Chiropractic Association (OCA) during its annual general meeting on Oct. 5. “You’re an important part of our efforts to deliver the right care in the right place at the right time,” said Matthews. “This pilot program is aimed at improving lower back pain management in primary care settings. Interdisciplinary teams will be funded to design, plan and implement a lower back pain program,” the minister explained. The model for primary care low back pain management will be geared towards family health teams, nurse-practitioner- led clinics, community health centres and aboriginal access health centres, according to Matthews. In addition, Matthews announced that within the year, chiropractic will be added to the list of professions eligible to work in family health teams and nurse-practitioner-led clinics. “Combined with the lower back pain program, these are important first steps in exploring the ways in which chiropractors can be integrated into interdisciplinary primary health-care teams,” Matthews said. In a statement posted on its website, the OCA welcomed Matthews’ announcements, saying this development is “unique” in the history of chiropractic in Ontario and presents a significant shift in government policy. “The announcements together signify that chiropractors are viewed by the ministry as an important component of the health-care system, and further paths for our inclusion are being explored,” the OCA statement said. Taking its cue from these announcements, the OCA said it will now focus on how family health teams, nurse-practitioner-led clinics, community health centres and aboriginal access health centres will take advantage of the opportunity. “Our member-driven Local Health Integration Network liaison program, which exists for promoting opportunities like these throughout all regions of the province, will be an integral part of this effort,” the OCA said. According to David Jensen, spokesperson for the Ministry of Health and Long-Term Care, the PCLBP pilot is in line with the ministry’s low back pain (LBP) strategy, by promoting better patient outcomes and satisfaction, improving quality and efficiency in LBP management and supporting the adoption of clinical best practices in the treatment of LBP. To date, the ministry’s LBP strategy has seen reductions of almost 20 per cent in diagnostic imaging, resulting in cost savings of $13 million, Jensen told Canadian Chiropractor. “The PCLBP pilot will see the integration of interprofessional allied health provider Services into primary care teams to provide treatment, assessment, patient education and referral for LBP patients,” Jensen explained. “Through the pilot, the above-noted primary care settings will recruit allied health providers with the appropriate skills and fit to deliver services, with any combination of chiropractor, physiotherapist, occupational therapist and kinesiologist eligible for inclusion.” The addition of chiropractic in the list of eligible professions in primary health-care setting means chiropractors are now eligible to work in Ontario’s family health teams (FHTs) and nurse-practitioner- led clinics (NPLCs). He added the need for chiropractors in these primary care settings would be determined by each organization based on the health needs of their patient population and their ability to integrate new professionals into their team. The OCA said the announcements will not likely generate a huge number of new positions for chiropractors in primary care team settings in the immediate future. “The full impact of this on the profession and our patients will be seen over the next decade. However there will be new opportunities for chiropractors to be funded through both the ministry’s new low back pain project and through the FHT/Nurse Led Practitioner Clinic budget lines. On a broader basis, the inclusion of our profession in a funded primary care system will enhance the reputation and brand of the profession across the province.,” the OCA said. By Mari-Len De Guzman BOOK Bike ride through life, faith Nova Scotia-based chiropractor and former Canadian Chiropractor editorial advisory board member Dr. Patrick Milroy has launched his new book, The Forest Tabernacle, a memoir about faith and overcoming adversities. On a spiritual quest, free from the Catholic paradigm of his upbringing, young Dr. Milroy set out on a bicycle excursion from St. Thomas, Ont., to Fort Lauderdale in Florida. From bike trails to roadways, campgrounds to cafés, he encountered a variety of eccentric characters. In his book, Dr. Milroy takes readers through adversity and affliction, establishing his self-identity and redefining his relationship with God, even against the hostility of a predator. Early in his chiropractic clinical practice, Dr. Milroy has expressed empathy for victims of assault. His affinity to help others relates to his own experience of sexual assault during a cross-country bicycle tour in 1986. Born in St. Paul, Minn., in 1962, Dr.Milroy holds a bachelor and masters degrees in Physical Education from the University of Western Ontario. Upon graduation from the Canadian Memorial Chiropractic College in 1994, he started his practice and built a life in Halifax. Throughout his personal and professional life, Dr. Milroy has been devoted in his passion for educating others on the importance of caring for the body – which he calls the “temple of the soul.” He continues to reach out to people, groups and organizations to promote physical, mental and spiritual healing and wellness. The Forest Tabernacle is available through online bookstore Amazon.com or through his website, theforesttabernacle.com. CLINICAL Rise in U.S. spinal surgeries sparks call for non-invasive approach The American Chiropractic Association (ACA), in response to a recent government report and articles questioning the rise in spinal fusion surgeries in the United States, has urged patients and health-care providers to consider the benefits of a more conservative approach to back pain. “Research supports the use of more conservative treatments as a first-line defence against pain. This sensible approach not only reduces health-care costs but also may help some patients avoid riskier treatments altogether,” said ACA president Dr. Keith Overland. Dr. Overland’s comments follow the release in October of a report from the U.S. Department of Health and Human Services Office of the Inspector General (OIG) showing that hospitals that purchased spinal devices from phy s ician- owned distributors (POD) had higher rates of spinal surgeries than the rate of hospitals overall. The report noted that many Hospitals rely on the surgeon’s preference when making purchasing decisions, and in some cases those surgeons have a financial stake in the companies selected. OIG findings show that using a POD did not reduce costs and those hospitals that did generally saw an increase in the number of surgeries performed – indicating clinical decision may have been affected by the business relationship. A related article published on Oct. 27 in the Washington Post reports the number of spinal fusion surgery in the United States has risen six-fold in the past 20 years, from 56,000 in 1994 to 465,000 in 2011. The Post analyzed 125,000 patient records in Florida and found that half the rise in spinal surgery cases in that state involved patients whose diagnoses would not normally make them candidates for the procedure. The article added that Medicare estimates more than $200 million was spent improperly on spinal fusions in 2011 because a conservative course of treatment had not been tried first. Medical guidelines for back pain recommend the use of conservative treatments. An article published in the Journal of the American Medical Association (JAMA) in April 2013 encourages patients with back pain to first try conservative treatments – exercises, physical therapy, chiropractic or acupuncture – and resort to surgery only when less invasive options fail. A study published earlier this year in the journal JAMA Internal Medicine confirms that many physicians don’t follow guidelines and instead refer back pain patients to surgery or write prescriptions for powerful painkillers. The latter is part of an epidemic problem of prescription drug abuse in the United States, according to the ACA. The number of prescriptions filled for opioid painkillers – some of the most powerful medications available – has increased by nearly 50 per cent in the past 10 years to 257 million. Unintentional overdose deaths involving opioids now outnumber cocaine and heroin deaths combined. “It’s important today for patients facing spine surgery to do their due diligence and ensure no stone is left unturned. There are effective, more conservative treatments that help many patients each year avoid surgery, lessen reliance on addictive painkillers, and get back to their normal lives and activities,” said Dr. Overland. LEGISLATION Spousal exemption bill approved Chiropractors may soon be allowed to legally treat their spouses without fear of losing their licence to practice following the unanimous passage of a Private Member’s Bill from Leeds- Grenville MPP Steve Clark. MPP Clark’s Bill 70, An Act to Amend the Regulated Health Professions Act, 1991, passed third reading in the Ontario Legislative Assembly on Wednesday, Oct. 23, and is awaiting Royal Assent. The bill applies to health-care professionals regulated under the Act, including chiropractors and dentists. Under the Regulated Health Professions Act (RHPA), there is zero tolerance for sexual contact between health professionals and their patient. For chiropractors, this prohibition is covered under the College of Chiropractors of Ontario (CCO) Standard of Practice S-014 (S-014). Health professionals have raised concerns there was no spousal exception to the policy, meaning any treatment automatically results in a professional being charged with sexual misconduct and in jeopardy of losing their licence to practice. In its regular e-mail communication, the Chiropractic Awareness Council of Ontario (CAC) welcomed the development saying it has been working on getting the CCO S-014 amended since 2007. “While we are 100 per cent in favour of a standard which clearly outlines a zero tolerance for sexual abuse of a patient, we are just as fervent in our belief that adjusting one’s spouse is not in any way a form of sexual abuse,” wrote Dr. Steven Silk, chair of the board of directors of the CAC. Silk said once Bill 70 receives Royal Assent, it will then be possible for the CCO to amend S-014 to include spousal exemption on the prohibition of sexual relationship with a patient. By Mari-Len De Guzman