13 research outputs found
An Assessment of Patient-Centred Care in Patients with Chronic Musculoskeletal Conditions Attending Chiropractic Practice
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The treatment experience of patients with low back pain during pregnancy and their chiropractors: a qualitative study
No full textAssessing patient-centered care in patients with chronic health conditions attending chiropractic practice:protocol for a mixed-methods study
No full textBACKGROUND: The management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perceive their care is patient-centred. We will assess concordance with the CCM using the Patient Assessment of Chronic Illness Care (PACIC) survey in study patients. We will also explore perception of how patient-centered the care provided by chiropractors is for those with chronic health conditions according to patients and chiropractors.METHODS/DESIGN: We will use a sequential mixed methods design with quantitative priority. In the quantitative component patients will complete a written questionnaire providing sociodemographic, health status, and health care interaction information, all of which will serve as the independent variables. Patients will also complete a modified version of the PACIC; the average overall score will be the dependent variable. In the qualitative component semi-structured interviews and focus groups with patients and chiropractors will be conducted. A pilot study will be conducted to determine if the modified PACIC will perform adequately in measuring concordance with the CCM for chiropractic care. Pilot testing will also allow for assessment of the interview and focus groups guides. Variables found to be significantly associated will be included in a multivariate linear regression analysis to identify significant predictors of the dependent variable. Qualitative data will be analyzed using an inductive thematic analysis to provide meaning to the quantitative results.DISCUSSION: There is a paucity of research describing the extent to which chiropractic care for patients with chronic health conditions is concordant with the CCM. This study will examine this relationship and the perceptions and experiences of patients and chiropractors regarding how patient-centered chiropractic care is for these patients.</p
An explanatory mixed methods study assessing Canadian chiropractors’ attitudes and orientation toward patient-centred care
No full textBackground: Patient-centred care (PCC) is considered an essential concept in twentyfirst-century healthcare; however, health care providers’ attitudes can be an important barrier or facilitator to its actual implementation. Chiropractic is frequently referred to as providing PCC. However, the attitudes of practising chiropractors towards patient-centred care have not previously been evaluated. Objectives: To explore attitudes and orientation of chiropractors towards patient-centered care. Methods: We used a sequential explanatory mixed methods with quantitative priority study design. Data were collected from May 2018 to April 2019 from a convenience sample of Canadian chiropractors located across Canada. Quantitative data were collected by a survey consisting of demographic and clinical practice questions, and the Patient-Practitioner Orientation Scale (PPOS) to measure practitioner attitudes towards care delivered (range 1–6, scores < 4.57 = doctor-centred attitudes). Qualitative data were collected using semi-structured interviews. Quantitative data were analyzed with descriptive statistics and bivariate analysis; whilst qualitative data were analyzed using thematic analysis. Results: We included 31 chiropractors in the study, with seven completing interviews. The mean for PPOS Overall score was 4.35 (95% CI [4.18, 4.52]) and was found to be significantly associated with years in practice and number of patients seen per week. The average PPOS Sharing and PPOS Caring scores were 4.20 (95% CI 3.95–4.45) and 4.50 (95% CI 4.35–4.66), respectively. Number of patients seen per week and per hour were significant predictors of the PPOS Sharing score; whilst years in practice was a significant predictor of PPOS Caring and Overall scores. Interview data supported the association between greater exposure to patients and more patient-centred attitudes among chiropractors. Conclusions: In our sample of Canadian chiropractors, doctor-centred attitudes towards care prevailed, comparable to that reported for other health professions. The significant association between patient-centred attitudes and patient load and clinical experience suggests that chiropractors may learn such attitudes through experience. Future research to further explore chiropractors’ attitudes and orientation towards care using the PPOS or a similar instrument are required
Risk of bias in chiropractic mixed methods research: a secondary analysis of a meta-epidemiological review
No full textOBJECTIVE: To examine the risk of bias in chiropractic mixed methods research. METHODS: We performed a secondary analysis of a meta-epidemiological review of chiropractic mixed methods studies. We assessed risk of bias with the Mixed Methods Appraisal Tool (MMAT) and used generalized estimating equations to explore factors associated with risk of bias. RESULTS: Among 55 eligible studies, a mean of 62% (6.8 [2.3]/11) of MMAT items were fulfilled. In our adjusted analysis, studies published since 2010 versus pre-2010 (adjusted odds ratio [aOR] = 2.26; 95% confidence interval [CI], 1.39 to 3.68) and those published in journals with an impact factor versus no impact factor (aOR = 2.21; 95% CI, 1.33 to 3.68) were associated with lower risk of bias. CONCLUSION: Our findings suggest opportunities for improvement in the quality of conduct among published chiropractic mixed methods studies. Author compliance with the MMAT criteria may reduce methodological bias in future mixed methods research
Quality of Reporting in Chiropractic Mixed Methods Research: A Methodological Review
No full textThe purpose of this methodological review is to examine the reporting quality of chiropractic mixed methods research articles published in the biomedical and allied health literature
Consensus on the clinical diagnosis of lumbar spinal stenosis: Results of an International Delphi Study
No full textSTUDY DESIGN
Delphi.
OBJECTIVE
The aim of this study was to obtain an expert consensus on which history factors are most important in the clinical diagnosis of lumbar spinal stenosis (LSS).
SUMMARY OF BACKGROUND DATA
LSS is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians.
METHODS
Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An online survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting.
RESULTS
A total of 279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were "leg or buttock pain while walking," "flex forward to relieve symptoms," "feel relief when using a shopping cart or bicycle," "motor or sensory disturbance while walking," "normal and symmetric foot pulses," "lower extremity weakness," and "low back pain." Significant change in certainty ceased after six questions at 80% (P < .05).
CONCLUSION
This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of "seven history items" that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long term may lead to more cost-effective treatment, improved health care utilization, and enhanced patient outcomes.
LEVEL OF EVIDENCE
2
Quality of Reporting Using Good Reporting of A Mixed Methods Study Criteria in Chiropractic Mixed Methods Research:A Methodological Review
No full textOBJECTIVE: The purpose of this review was to examine the reporting in chiropractic mixed methods research using Good Reporting of A Mixed Methods Study (GRAMMS) criteria. METHODS: In this methodological review, we searched MEDLINE, Embase, CINAHL, and the Index to Chiropractic Literature from the inception of each database to December 31, 2020, for chiropractic studies reporting the use of both qualitative and quantitative methods or mixed qualitative methods. Pairs of reviewers independently screened titles, abstracts, and full-text studies, extracted data, and appraised reporting using the GRAMMS criteria and risk of bias with the Mixed Methods Appraisal Tool (MMAT). Generalized estimating equations were used to explore factors associated with reporting using GRAMMS criteria. RESULTS: Of 1040 citations, 55 studies were eligible for review. Thirty-seven of these 55 articles employed either a multistage or convergent mixed methods design, and, on average, 3 of 6 GRAMMS items were reported among included studies. We found a strong positive correlation in scores between the GRAMMS and MMAT instruments (r = 0.78; 95% CI, 0.66-0.87). In our adjusted analysis, publications in journals indexed in Web of Science (adjusted odds ratio = 2.71; 95% CI, 1.48-4.95) were associated with higher reporting using GRAMMS criteria. Three of the 55 studies fully adhered to all 6 GRAMMS criteria, 4 studies adhered to 5 criteria, 10 studies adhered to 4 criteria, and the remaining 38 adhered to 3 criteria or fewer. CONCLUSION: Our findings suggest that reporting in chiropractic mixed methods research using GRAMMS criteria was poor, particularly among studies with a higher risk of bias
