University College of Osteopathy Repository
Not a member yet
570 research outputs found
Sort by
Cauda Equina Syndrome: Are final-year clinical student chiropractors and their supervisors recognising and implementing the correct referral pathways in the UK? Two case reports
No full textBackground: Low back pain is a condition that is treated by chiropractors, osteopaths, and physiotherapists who use manipulation as one of their therapies. One presentation of low back pain is a disc extrusion or sequestration. Here the disc material has ruptured through the annular fibres and because of its acidic nature starts to damage the nerve root and can lead to cauda equina syndrome (CES). This paper explores this documented cause of CES with final year chiropractic students who are in a primary contact position. It describes whether they screen for signs and symptoms of CES and ask the appropriate questions leading to correct referral pathway. We review iatrogenic causes of CES by professionals who use manipulation, and ask does the literature support this effect? If signs and symptoms are not diagnosed, it can lead to a life-changing future for the patient and result in a legal process and an insurance claim. Professions treating low back pain must be vigilant and constantly screen for CES.
Intervention: Two cases presented to the AECC University college Chiropractic (AECC UC) Teaching Clinic are reviewed. Final-year students see patients in their placement year as part of their training. They take a detailed history and physically examine the presenting complaint. Low back pain is a common complaint presented by patients at the AECC UC Chiropractic teaching Clinic. Are Cauda Equina Syndrome (CES) questions asked during the initial consultation and treatment? The required routinely asked questions are as follows: Has the patient experienced any of or a combination of the following signs and symptoms: saddle anaesthesia, nerve root pain, sexual dysfunction, bowel disturbance, bladder disturbance and relevant medical history relating to a previously diagnosed CES?
Outcomes: The findings from the case reports suggest that chiropractic students supervised by registered chiropractors are good at recognising CES signs and symptoms either initially or ongoing, through a course of treatment and are following the modified NHS guidelines for referral with the AECC UC CES pathway. The literature refers to a mechanical cause of CES due to lumbar spinal manipulation. According to the current literature lumbar spinal manipulation delivered by a registered professional for low back pain is not a risk factor for CES.
Conclusion: Patients with low back pain may have an elevated risk of cauda equina syndrome independent of manipulative treatment which is not considered a risk factor. Therefore, students and clinicians treating lower back pain patients are ideally placed in clinical settings to identify cauda equina syndrome signs and symptoms and should always be aware of any deterioration in presentation and review CES signs and symptoms and use the appropriate clinical pathway
Effect of perioperative immunonutrition intervention among gynecological cancer patients: A systematic review
No full textBackground: Gynecologic cancer (GC) patients often experience systemic inflammation, malnutrition, and compromised postoperative outcomes. This systematic review aims to comprehensively synthesize existing data regarding the impact of perioperative immunonutrition (IMN) intervention on GC patients.
Methods: The databases of CENTRAL, EMBASE, Web of Science, and the Cochrane Library were used to conduct a literature search, supplemented by internet search engines and manual searches. Publications released between January 2009 and October 2023 was identified, reviewed, and data extracted.
Results: The review encompasses six studies involving 712 patients, comprising two randomized controlled trials (RCTs), two prospective studies, and two retrospective cohort studies. Three studies prescribed IMN perioperatively; two pre-operatively and one post-operatively. Four out of six studies reported less post-operative infection and complications. Two studies reported shorter hospitalization using the IMN formula. One study reported a longer hospitalization with IMN supplementation. Overall survival showed no significant difference in the two studies. Four studies reported positive modulation of inflammatory markers and lymphocytes as outcomes, with IMN formulas.
Discussion and conclusion: Perioperative IMN emerge as a promising intervention, demonstrating notable benefits included shortened hospitalization as well and positive modulation of inflammatory markers
Validation of the CRAVE-C scale in Chinese adults: a four-study examination of competing motivations for physical activity versus rest
No full textBackground: The study aimed to validate the Cravings for Rest and Volitional Energy Expenditure (CRAVE) scale among Chinese adults with different health conditions (healthy control, chronic illnesses, and psychiatric disorders) and skill levels (athletes vs. non-athletes).
Methods: In Study 1, a confirmatory factor analysis (CFA) using the Maximum Likelihood Method (MLM) was performed on a Chinese sample of emerging adults (N = 481) to evaluate the structural validity of the Cravings for Rest and Volitional Energy Expenditure-Chinese version (CRAVE-C). In Study 2, differences in "Move" and "Rest" desires were examined among patients with psychiatric disorders, patients with chronic illnesses, and healthy controls. In study 3, investigated the relationship between cardiorespiratory fitness and exercise motivation using the CRAVE-C (N = 83). In Study 4, the changes in "Move" desire from baseline to post-training were compared between athletes and non-athletes.
Results: Results from Study 1 indicated that the 10-item CRAVE-C showed good fit indices ( Chi2 (34) = 118.769, CFI = 0.95, TLI = 0.934, SRMR = 0.053, RMSEA = 0.072). "Move" positively correlated with various factors of the Affective Exercise Experiences Questionnaire-Chinese and the Physical Effort Scale-Chinese, while "Rest" correlated negatively. In Study 2, Patients with psychiatric disorders had a significantly higher "Move" desire than healthy controls. Patients with chronic illnesses had a significantly higher "Rest" desire than healthy controls. In Study 3, higher cardiorespiratory fitness was associated with a slight increase in "Move" desire (3.26% ± 37.35%) and a decrease in "Rest" desire (18.94% ± 66.99%). Lower fitness was linked to a significant decline in "Move" desire (-54.61% ± 111.33%) and an increase in "Rest" desire (43.62% ± 63.64%). In Study 4, the athlete group demonstrated a significant increase in "Move" desire from baseline to post-training, whereas the non-athlete group reported a significant decrease in "Move" desire from baseline to post-training.
Conclusion: The 10-item CRAVE-C has good reliability and validity in the Chinese cultural context and can be used among Chinese adults with different health conditions and skill levels
Contested role boundaries and professional title: Implications of the independent review of podiatric surgery in Australia
No full textIntroduction
In October 2023, the Podiatry Board of Australia commissioned an independent review of the regulation of podiatric surgery in Australia, with a remit to re-evaluate the regulatory framework, identify any risks to patient safety and recommend improvements to public protection. It reported in March 2024 and set out 14 key recommendations. The review was prompted by a number of complaints about podiatric surgeons but also reflected calls for reform by the medical profession and several critical media reports. This paper sets out to examine the review report, alongside the concerns of the medical profession and the media articles expressed within it, through the lens of an established sociological framework focused on interprofessional conflict and the contested use of professional titles.
Methods
As a review rather than the research paper, the Independent Review of Podiatric Surgery (the ‘Paterson Report’) served as data for the sociological analysis, adopting a Neo-Weberian and Bordieuan framework to examine the strategies adopted by the medical profession and media reports cited in the report, consistent with the exercise of professional power.
Results
The sociological analysis provides insights into the ways in which professions seek to maintain symbolic, social, cultural and economic privileges and rewards through the exclusion of competitors, using strategies such as social closure, symbolic violence, symbolic devaluation, gatekeeper roles, and jurisdictional disputes.
Conclusions
The review report acknowledges the influence of the medical profession and its opposition to the practice of podiatric surgery and use of the title ‘podiatric surgeon’. The arguments made and strategies deployed are consistent with those found in the wider literature. In light of these findings, the implications for the future of podiatric surgery are considered in terms of professional practice, use of professional title, and access to public funding
The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic
No full textBackground: The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice.
Methods: Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance.
Results: The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance.
Conclusions: Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations.
Keywords: Chiropractor-patient relationship; Confidence; Context; Expectations; Expertise; Explanations; Pain; Therapeutic Alliance; Trust; Working Alliance
Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review
No full textIntroduction: Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients.
Methods: A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis.
Results: The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI.
Discussion: Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate.
Implications for practice: MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI
Linking 24-h movement behavior guidelines to cognitive difficulties, internalizing and externalizing problems in preterm youth
No full textBackground: Given the heightened risk of developmental challenges associated with preterm birth, it is crucial to explore interventions that may ameliorate potential adverse outcomes. This study aimed to examine whether meeting the 24-h movement behavior (24-HMB) guidelines, which include recommendations on physical activity (PA), screen time (ST), and sleep (SL), is related to indicators of cognitive difficulties, internalizing problems (e.g., depression and anxiety), and externalizing problems (e.g., difficulties in making friends and arguing) in a sample of preterm youth (children and adolescents born preterm). Method: In this cross-sectional study, data from 3410 preterm youth (aged 6 to 17 years) were included for data analyses. Multivariable logistic regression was used to investigate associations between meeting the 24-HMB guidelines and the above-mentioned health outcomes, while controlling for sociodemographic and health-related factors. Results: The prevalence of meeting 24-HMB guidelines varied across independent and integrated components of the 24-HMB guidelines. Meeting the ST guideline alone (p < 0.05) and integrated guidelines (i.e., ST + SL and ST + SL + PA) were associated with fewer cognitive difficulties and reduced internalizing and externalizing problems (p < 0.05). Specifically, meeting the SL guideline alone and integrated guidelines (i.e., SL + ST) were associated with lower odds of depression and anxiety (p < 0.01). Additionally, meeting independent, and integrated (PA and/or ST) guidelines were associated with less pronounced difficulties in making friends and arguing (p < 0.05). Meeting 24-HMB guidelines in an isolated and integrated manner are linked to better cognitive performance and fewer internalizing and externalizing problems in preterm youth. Conclusion: Results suggest that advocating for the implementation of the 24-HMB guidelines may reduce cognitive challenges and behavioral issues, which is of high relevance for improving public health. Future longitudinal studies in preterm youth should investigate how modifying specific 24-HMB behaviors, especially ST, influence cognitive difficulties, internalizing and externalizing problems in this vulnerable population
The development of the National Council for Osteopathic Research - Research Network (NCOR-RN): A qualitative focus group study of osteopath's views
No full textBackground: Practice Based Research Networks (PBRNs) are groups of clinicians working with academic organisations to conduct research that answers questions relevant to clinical practice. A PBRN for osteopathy in the
UK would be a suitable approach for the National Council for Osteopathic Research to achieve its mission
statement of ‘developing a culture of research’.
Objective: We aimed to explore osteopaths’ views on the utility of creating a PBRN and to identify barriers and
facilitators to their involvement in a PBRN.
Methods: Focus groups were conducted as part of a free CPD day advertised nationally to all osteopaths to collect
qualitative data. A reflexive thematic analysis framework was used to develop themes from the data.
Results: Forty osteopaths took part in 5 focus groups conducted at three locations around the UK. Six themes were
developed describing the utility, barriers, and facilitators to developing a PRBN for osteopathy: research experience, finance and time, developing osteopathy, insecurity and identity, integration into practice, and PBRN
organisation.
Conclusions: Osteopaths perceived a PBRN had the potential for increasing the evidence base for osteopathy,
enhancing the status of the profession, and im
