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Purpose: To update findings of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches).Methods: We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles.Results: We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful.Conclusions: The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy. [ABSTRACT FROM AUTHOR]

Abstract: Low back pain (LBP) is the most common and expensive musculoskeletal (MSK) disorder in industrialized countries. There is evidence that personal and occupational psychosocial variables play a more important role than spinal pathology or the physical demands of the job. However, it is unclear which psychosocial variables are most important. The objective of this study is to understand which psychosocial variables are deemed most important to various workplace stakeholders involved in the process of returning a worker with LBP to work. Nine focus groups were convened with injured workers, small and large employers, unions, health and safety associations, physicians and non-physician clinicians, return to work coordinators and compensation board representatives in Ontario, Canada. A qualitative grounded theory approach was applied to explore, from their perspectives, important psychosocial factors that prevent the promotion of early and safe return to work (RTW) for individuals with LBP. While the study began by asking questions related to the various psychosocial factors and their association to LBP and RTW, it took an interesting turn. The majority of study participants described how psychosocial factors were the product of larger systemic/organizational issues. Rather than focusing solely on individual psychosocial factors, respondents described how the context of a much larger system, and the complex interplay between the many different components of that system, contributes directly or indirectly to the treatment of LBP and RTW. It is the interrelationships between these systems that determine the process of returning an injured worker with LBP back to work. Although it is important to understand how psychosocial factors affect RTW, organizational structures within our social context seem to play a role in shaping how all stakeholders see and emotionally respond to LBP and RTW, as well as the degree to which they can envision taking action on them. We need to consider moving beyond a psychosocial conceptualization of LBP and RTW into a sociopolitical and economic conceptualization. This reconceptualization provides insight into the “upstream factors” associated with LBP and RTW. [Copyright &y& Elsevier]

Abstract: Background context: In Ontario, chiropractors see one-third of patients who seek care for low back pain. Previous studies suggest that chiropractors have high utilization rates of lumbar and full spine radiography. There has been a proliferation of evidence-based guidelines recommending that plain film radiography be used only to assess high-risk patients with low back pain. Evidence for the use of full spine radiography, except for the evaluation of scoliosis is lacking. It is uncertain what impact the growing evidence against their use has had on radiography utilization by Ontario chiropractors. Purpose: To describe the annual costs and use of lumbar and full spine plain film radiography among Ontario chiropractors between 1994 and 2001. Study design/setting: Time-trend analysis of radiography utilization by Ontario chiropractors. Patient sample: Chiropractic claims data submitted to the Ontario Health Insurance Plan or the Workplace Safety & Insurance Board from 1994/1995 to 2000/2001. Outcome measures: Change in the annual cost and proportion of claimants receiving lumbar and full spine radiography. Methods: Time-trend analysis of chiropractic claims submitted to the Ontario Health Insurance Plan (OHIP) or Workplace Safety & Insurance Board (WSIB) from 1994/1995 to 2000/2001 fiscal years. Results: During the 7-year period, the proportion of OHIP claimants receiving lumbar spine radiography decreased from 4.54% to 3.25% and for full spine radiography from 3.87% to 3.04%. For WSIB claimants, lumbar spine radiography deceased from 6.49% to 3.30% of claimants and full spine radiography from 1.51% to 0.94%. OHIP payments for lumbar spine radiography decreased 12.7% to $562,944, whereas full spine radiography payments decreased 5.3% to $1,071,408. WSIB lumbar and full spine radiography payments decreased 44.2% and 34.3% to $31,202 and $11,713 respectively. Conclusions: Claims data from the two largest third-party payers of chiropractic services in Ontario, suggest that lumbar and full spine radiography, and their associated costs decreased steadily between 1994 and 2001. [Copyright &y& Elsevier]

Objective: To evaluate the ability of a systematic educational intervention strategy to change the plain radiography ordering behavior of chiropractors toward evidence-based practice For patients with acute low back pain (LBP). Design: A quasi-experimental method was used comparing outcomes before and after the intervention with those of a control community. Setting: Two communities in southern Ontario. Data Source: Mailed survey data on the management of acute LBP. Outcome Measures: Plain radiography use rates for acute LBP based on responses to mailed surveys. Results: Following the intervention, there was a 42% reduction in the self-report need for plain radiography for uncomplicated acute LBP (P < .025) and a 50% reduction for patients with acute LBP <1 month (P<.025) in the intervention community. There was no significant change in the self-report need for plain radiography in the control community ( P > .05). Conclusions: The educational intervention strategy used in this study appeared to have an effect in reducing the perceived need for plain radiography in acute LBP. [ABSTRACT FROM AUTHOR]

Investigates the use of radiography for patients with acute low back pain (LBP) among chiropractors in Ontario. Diagnostic evaluation of patient with LBP; Symptoms of LBP; Factors associated with higher radiography use by chiropractors.