mcwg 2012 annual report (jan 10 2013) - canadian chiropractic …€¦ · mcmaster chiropractic...

McMaster Chiropractic Working Group (MCWG)

Annual Report January 1, 2012 – December 31, 2012

Contributions from 2012 participants:

Dan Avrahami Craig Bauman Stephen Burnie Jason Busse

David Brunarski Ted Crowther

Kelly Donkers Ainsworth Charlie Goldsmith

Ryan Larson Frances LeBlanc (CCA)

Keshena Malik Jennifer Nash

John Riva

MCMASTER CHIROPRACTIC WORKING GROUP Annual Report 2012

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The McMaster Chiropractic Working Group (MCWG) was formed in January 2009. Its mission is provide chiropractors, with an affiliation to McMaster University, the opportunity to meet and collaboratively work on projects to achieve these directives:

1) Become a productive contributor to research, education and administration at McMaster University 2) Service the chiropractic profession in improving patient care http://www.ncbi.nlm.nih.gov/pubmed/20195420

In 2012, the MCWG had 13 contributors and 2 guests (Frouz Paiwand, Paul Nolet). Through the immense patience and leadership of the CCRF Research Chair at McMaster, Jason Busse, we have been given the opportunity to contribute back to the profession through high quality research. This year alone, Jason has contributed to 27 peer-‐reviewed publications and 20 conference abstracts. Notably, this year, Jason was awarded the 2012 Research in Chiropractic Award by the Ontario Chiropractic Association. As well, the Canadian Institutes for Health Research (CIHR) awarded him two prestigious grants that have offered our group opportunities to participate on larger interprofessional research teams. $94,452.00 Busse JW, You JJ, Faulhaber M, Rampersaud YR, Mills EJ, Thorlund K, Riva JJ, Guyatt GH, Feasby TE.

Appropriateness of imaging use in Canada: a systematic review. Granting Agency: CIHR, Evidence on Tap -‐ Expedited Knowledge Synthesis Grants, 2012. Competition Code: 201201ETR.

$99,253.00 Busse JW, Kunz R, Riva JJ, Calvo M, Buckley D, Vandrik P, Sessler D, Guyatt GH, Moore AE, Krawchenko IE, Schandelmaier S, Johnston B, Bellman M, Ebrahim S. The effect of opioids on chronic non-‐cancer pain: a systematic review and meta-‐analysis of randomized controlled trials. Granting Agency: CIHR, Knowledge Synthesis Grants, 2012.

Along with the research grants awarded to Jason this year, we are fortunate to have 8 peer-‐reviewed articles and 8 conference abstracts at various stages of publication from our shared work (involving 2 or more). Also, five of us provided university-‐based academic and clinical interprofessional teaching contributions this year, some in Family Health Teams, to further advance integration. Lastly, we have offered mentorship to graduate students. As we enter our 5th year of quarterly meetings of the MCWG, I reflect back to a time in 2008 when Steve Passmore (now CCRF Chair in University of Manitoba) and myself, newly entering the McMaster University, sat down to have lunch feeling somewhat isolated as chiropractors in the setting. This summary hopes to inform other isolated chiropractors, venturing forward with integration of the profession into the healthcare system, on the value of collaboration. Sharing academic turf and working together, with the common goal of improving patient care, is the best advice I can offer. John J. Riva, DC Assistant Clinical Professor, Department of Family Medicine MSc Candidate, Health Research Methodology Program McMaster University


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Considerable research that is relevant to chiropractic was published in 2012, and some initiatives are showing promise for greater inclusion of chiropractic services into Canadian healthcare services. A recent survey by members of our group of 101 Canadian spine surgeons (84% response rate) has found that most respondents (78%) were interested in working with a chiropractor or physical therapist to screen patients with low back pain (LBP) referred for elective surgical assessment. Our survey achieved majority consensus regarding the core components for a low back-‐related complaints history and exam, and findings that would indicate a surgical assessment

was appropriate. A majority of respondents (75%) also agreed that they would be comfortable not assessing patients with low back-‐related complaints referred to their practice if indications for surgery were ruled out by a chiropractor or physical therapist. Additionally, the Ontario Ministry of Health and Long Term Care (MOHLTC) has recently launched the Inter-‐professional Spine Assessment and Education Clinics (ISAEC) (www.isaec.org/). In brief, the ISAEC model is geared to transition healthcare providers and patients to a chronic condition shared care management model for LBP. Involved family physicians and spine surgeons work with chiropractors and physical therapists to optimize management of LBP patients that present to their practices. The ISAEC initiative began enrolling referred LBP patients at 3 locations (Toronto, Hamilton & Thunder Bay) in November 2012 and continue to receive referrals from involved providers for one year. While the results from ISAEC remain to be seen, the high profile of this initiative, involvement of the MOHLTC and opinion leaders in both family medicine and spine surgery, and the purposeful inclusion of chiropractors in a key inter-‐disciplinary role, suggest that there is substantial interest in supporting greater integration of the chiropractic profession into Canadian mainstream healthcare.

Jason W. Busse, DC, PhD Assistant Professor Departments of Anesthesia and Clinical Epidemiology & Biostatistics McMaster University


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2012 MCWG Teaching Contributions: Jennifer Nash successfully created, instructed and integrated a formal pain course into the curriculum for Health Sciences students. She also facilitated/co-‐facilitated/instructed BHSc courses: HTH SCI 1E06 (Inquiry) and HTH SCI 2J03 (Health, Attitude & Behaviour). As well, she is part of a team that is developing a Whiplash Associated Disorder (WAD) learning module, with the department of anatomy, to be used by undergraduate medical students during their anatomy training. Lastly, she became a member of the Advisory Group for Program for Interprofessional Practice, Education and Research (PIPER). Craig Bauman, Ted Crowther and John Riva currently have part-‐time faculty appointments, as Assistant Clinical Professors, in Family Medicine. Ted Crowther and John Riva have continued to teach McMaster undergraduate medical students academically in the areas of musculoskeletal exam and complementary & alternative medicine (CAM) across the Niagara, Hamilton and Kitchener-‐Waterloo campuses. As well, Craig Bauman and John Riva have continued to teach both undergraduate medical students and family medicine residents in their clinical practices co-‐located in the Hamilton and Kitchener-‐Waterloo Family Health Teams. Jason Busse has Assistant Professor dual appointments in Anesthesia and Clinical Epidemiology & Biostatistics. He has continued to contribute to graduate level courses in research methods for randomized controlled trials and systematic reviews as part of the Health Research Methodology Program. As well, he was a tutor for the “How to Teach Evidence Based Clinical Practice” workshop run by the CLARITY Research Group. 2012 MCWG Peer-‐Reviewed Publications: 1. Bauman CA, Milligan JD, Lee JF, Riva JJ. Autonomic dysreflexia in spinal cord injury patients:

an overview. J Can Chiropr Assoc 2012; 56: 247-‐50. http://www.ncbi.nlm.nih.gov/pubmed/23204565

2. Riva JJ, Malik KMP, Burnie SJ, Endicott AR, Busse JW. What is your research question? An

introduction to the PICOT format for clinicians. J Can Chiropr Assoc 2012; 56: 167-‐71. http://www.ncbi.nlm.nih.gov/pubmed/22997465

3. Avrahami D, Hammond A, Higgins C, Vernon H. A randomized, placebo-‐controlled double-‐

blinded comparative clinical study of five over-‐the-‐counter non-‐pharmacological topical analgesics for myofascial pain: single session findings. Chiropr Man Therap. 2012; 20: 7. http://www.ncbi.nlm.nih.gov/pubmed/22436614

4. Patient education for neck pain. Gross A, Forget M, St George K, Fraser MM, Graham N, Perry L, Burnie SJ, Goldsmith CH, Haines T, Brunarski D. Cochrane Database Syst Rev. 2012; 3: CD005106. http://www.ncbi.nlm.nih.gov/pubmed/22419306


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5. Busse JW, Riva JJ, Nash JV, Hsu S, Fisher CG, Wai EK, Brunarski D, Drew B, Quon JA, Walter SD, Bishop PB, Rampersaud R. Non-‐physician screening of low back or low back related leg pain patients referred for surgical assessment: a survey of Canadian spine surgeons. Spine [accepted] 2012.

6. Riva JJ, Wong JJ, Brunarski D, Chan AHY, Lobo RA, Aptekman M, Alabousi M, Imam M,

Gupta A, Busse JW. Consideration of chronic pain in trials of physical activity for diabetes: a systematic review of randomized controlled trials. PLoS One [submitted] 2012.

7. Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening

asymptomatic women for ovarian cancer: a systematic review and meta-‐analysis. Ann Intern Med [submitted] 2012.

8. Busse JW, Bruno P, Malik KMP, Connell G, Torrance D, Ngo T, Kirmayr K, Avrahami D, Riva

JJ, Ebrahim S, Struijs P, Brunarski D, Burnie SJ, LeBlanc F, Coomes EA, Steenstra IA, Slack T, Rodine R, Jim J, Montori VM, Guyatt GH. An efficient strategy allowed English-‐speaking reviewers to identify foreign-‐language articles that met eligibility criteria for a systematic review of management for fibromyalgia. J Clin Epidemiol [submitted] 2012.

2012 MCWG Peer-‐Reviewed Conference Abstracts: 1. Riva JJ, Busse JW, Wong JJ, Brunarski D, Chan AHY, Lobo, RA, Aptekman M, Gupta A.

Consideration of chronic pain in trials of physical activity for diabetes: a systematic review of randomized controlled trials. Association of Chiropractic Colleges Educational Conference Research Agenda Conference (ACC-‐RAC): Las Vegas, NV (March 16, 2012). Abstract published: Abstracts of ACC Conference Proceedings: Platform presentations. J Chiropr Educ 2012; 26: 83-‐115.

2. Busse JW, Kamaleldin M, Riva JJ, Kunz R, Vandvik PO, Hsu S, Schandelmaier S, Soobiah C,

Tsoi L, Wong A, Lam T, Johnston B, Ebrahim S, Heels-‐Ansdell D, Buckley N, Sessler D, Guyatt GH. Opioids for chronic non-‐cancer pain: a systematic review protocol. Presented as a poster at the Canadian Anesthesiology Society Annual Meeting. Quebec City, Québec (June 16, 2012).

3. Busse JW, Ngo T, Torrance D, Kirmayr K, Avrahami D, Riva JJ, Ebrahim S, Struijs P, Malik

KMP, Bruno P, Brunarski D, Burnie SJ, LeBlanc F, Connell G, Coomes EA, Streenstra I, Montori V, Guyatt GH. Can English-‐speaking reviewers correctly identify foreign-‐language articles that meet eligibility criteria for a systematic review of management for fibromyalgia? Accepted for poster presentation at the Cochrane Colloquium, Auckland, New Zealand (September 30, 2012).


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4. Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening asymptomatic women for ovarian cancer: a systematic review and meta-‐analysis. Accepted for a short oral presentation at the 14th Biennial Meeting of the International Gynecologic Cancer Society, Vancouver, BC (October 14, 2012). The abstract will also be published in the International Journal of Gynecologic Cancer.

5. Riva JJ, Busse JW, Stanford EC, Chan A, Greenway M, Konigsberg E. Attitudes towards

Complementary and Alternative Medicine (CAM) among McMaster University medical students: a cross-‐sectional survey. Accepted for an oral presentation at the 7th IN-‐CAM Research Symposium, Toronto, ON (November 3, 2012).

6. Busse JW, Riva JJ, Nash JV, Hsu S, Fisher CG, Wai EK, Brunarski D, Drew B, Quon JA, Walter

SD, Bishop PB, Rampersaud RY. Non-‐physician screening of low back or low back related leg pain patients referred for surgical assessment: a survey of Canadian spine surgeons. Accepted for oral presentation at the Association of Chiropractic Colleges Educational Conference Research Agenda Conference (ACC-‐RAC). Washington, DC, USA. March 14-‐16, 2013. [accepted for presentation]

7. Busse JW, Riva JJ, Rampersaud RY, Guyatt GH, Goytan MJ, Feasby TE, Reed M, You J.

Imaging practices for spine-‐related complaints referred for surgical assessment: a survey of Canadian spine surgeons. 13th Annual Canadian Spine Society meeting, Quebec, PQ (Feb 2013). [submitted]

8. Busse JW, Alexander PE, Abdul-‐Razzak A, Riva JJ, Alabousi M, Dufton J, Li R, Kagoma Y,

Zhang M, Faulhaber M, Couban R, Guyatt GH, Rampersaud RY, Goytan MJ, Lloyd N, DeMone B, Feasby TE, Reed M, Mills EJ, Thorlund K, Schünemann H, You JJ. Appropriateness of spinal imaging use in Canada. 2013 Canadian Agency for Drugs and Technologies in Health (CADTH) Symposium: Evidence in Context (May 2013). [submitted]

Acknowledgements: We would like to thank the Canadian Chiropractic Association and Craig Bauman for their organizational support. Jason Busse is funded by a New Investigator Award from the Canadian Institutes of Health Research and Canadian Chiropractic Research Foundation. John Riva is funded by an award from the NCMIC Foundation. Lastly, we would like to thank Professor Gordon Guyatt and Kristine Lynn Bonnell for in-‐kind support for our meeting venue and annual report preparation.


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Association of Chiropractic Colleges Educational Conference Research Agenda Conference (ACC-‐RAC): Las Vegas, NV (March 16, 2012) – presented as an oral presentation. Abstract published: Abstracts of ACC Conference Proceedings: Platform presentations. J Chiropr Educ 2012; 26: 83-‐115. Riva JJ, Busse JW, Wong JJ, Brunarski D, Chan AHY, Lobo, RA, Aptekman M, Gupta A. Consideration of chronic pain in trials of physical activity for diabetes: a systematic review of randomized controlled trials. Introduction: Chronic pain has been estimated to affect 60% of patients with diabetes and is a strong independent predictor of reduced activity tolerance. All randomized controlled trials (RCTs) that explored interventions to improve physical activity among patients with diabetes were systematically reviewed. Methods: Electronic literature searches were performed for RCTs that enrolled patients with diabetes and randomly assigned them to an intervention designed to promote physical activity. Trials that used supervised physical activity as part of the intervention were excluded. Each eligible trial was assessed to establish whether co-‐morbid chronic pain was captured at baseline, explored as an effect modifier, and included a component designed to target chronic pain. Results: Only one of 80 RCTs captured chronic pain at baseline. No trial included specific interventions to address chronic pain as a competing demand. Conclusions: When exploring interventions to promote physical activity among patients with diabetes, trialists should capture baseline chronic pain, explore its impact as an effect modifier, and consider incorporating strategies to address it.


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Canadian Anesthesiology Society Annual Meeting. Quebec City, Québec (June 16, 2012) – presented as a poster. Busse JW, Kamaleldin M, Riva JJ, Kunz R, Vandvik PO, Hsu S, Schandelmaier S, Soobiah C, Tsoi L, Wong A, Lam T, Johnston B, Ebrahim S, Heels-‐Ansdell D, Buckley N, Sessler D, Guyatt GH. Opioids for chronic non-‐cancer pain: a systematic review protocol.

Contact John Riva ([email protected]) for full-‐size version.


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Cochrane Colloquium, Auckland, New Zealand (September 30, 2012) – presented as a poster. Busse JW, Ngo T, Torrance D, Kirmayr K, Avrahami D, Riva JJ, Ebrahim S, Struijs P, Malik KMP, Bruno P, Brunarski D, Burnie SJ, LeBlanc F, Connell G, Coomes EA, Streenstra I, Montori V, Guyatt GH. Can English-‐speaking Reviewers Correctly Identify Foreign-‐language Articles that meet Eligibility Criteria for a Systematic Review of Management for Fibromyalgia? Background: Systematic reviews endeavor to capture all publications that meet pre-‐defined eligibility criteria. Non-‐English studies may present resource challenges in meeting this goal. If English-‐speaking reviewers could differentiate eligible from ineligible foreign language publications it would limit demands for participation in the review from those speaking other languages. Objective: We are exploring whether English-‐speaking reviewers can differentiate eligible from ineligible foreign-‐language studies in a systematic review of all treatments for fibromyalgia. Methods: We searched AMED, CIHAHL, MEDLINE, EMBASE, HealthSTAR, PsycINFO, Papers First, Proceedings First and CENTRAL from inception of each database to April 2011. Eligible studies randomly assigned patients with fibromyalgia to any form of therapy or a control group. Results: We retrieved 20,747 unique citations of which 765 were potentially eligible and were retrieved in full text; the 135 non-‐English full text articles represented 19 different languages. Pairs of reviewers fluent in the language of publication evaluated all foreign-‐language full text articles for final eligibility, independently and in duplicate. Fifty-‐three foreign language articles -‐ (39%) proved eligible, representing 12% of all eligible trials (53 of 431). Using explicit criteria to guide decision-‐making, including authors’ report of study design in the title or abstract, and the presence of a table presenting a comparison of baseline characteristics between groups, pairs of English-‐speaking reviewers, blinded to eligibility status, are in the process of evaluating the 135 foreign-‐language articles regarding their eligibility for the review. Results will be available at the time of the Colloquium. Conclusions: Our findings should prove helpful for informing whether English-‐speaking reviewers are able to identify foreign-‐language studies that are eligible for data abstraction. If successful, our findings may provide a strategy to increase the feasibility of, and minimize resources associated with, including foreign-‐language studies in systematic reviews.


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14th Biennial Meeting of the International Gynecologic Cancer Society, Vancouver, BC (October 14, 2012) – presented as a short oral presentation. The abstract will also be published in the International Journal of Gynecologic Cancer. Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening asymptomatic women for ovarian cancer: a systematic review and meta-‐analysis. Background: Screening asymptomatic women could potentially reduce mortality from ovarian cancer but may also cause harm. We performed a systematic review and meta-‐analysis to quantify risks and benefits of ovarian cancer screening. Methods: We searched MEDLINE, EMBASE, CINAHL, and CENTRAL, without language restrictions, from 1979 to February 5, 2012. Eligible studies enrolled asymptomatic women and randomly assigned them to screening for ovarian cancer or usual care. Two reviewers independently screened studies for eligibility, assessed risk of bias, abstracted data, and applied the GRADE framework to evaluate the strength of inferences for each outcome. Findings: Ten randomized trials proved eligible. High quality evidence from one trial found that screening did not reduce all-‐cause mortality (relative risk (RR)= 1·∙0, 95% confidence interval (CI) 0·∙96-‐1·∙06), moderate quality evidence from two trials suggested no benefit for ovarian cancer specific mortality (RR= 1·∙08, 95% CI 0·∙84-‐1·∙38), and low quality evidence from three trials showed no reduction in the risk of diagnosis at an advanced stage (RR= 0·∙86, 95% CI 0·∙68-‐1·∙11). The number of surgeries required to detect one case of ovarian cancer differed according to the type of screening test (interaction p<0·∙001). Transvaginal ultrasound resulted in a mean of 38 surgeries per ovarian cancer detected (95% CI 15·∙7-‐178·∙1) while screening with CA-‐125 led to 4 surgeries per ovarian cancer detected (95% CI 2·∙7-‐ 4·∙5). Surgery was associated with severe complications in 6% of women (95% CI 1% -‐ 11%). High quality evidence found that quality of life was not affected by screening; however, women with false-‐positive results had increased cancer-‐specific distress compared to those with normal results (odds ratio= 2·∙22, 95% CI 1·∙23-‐3·∙99). Interpretation: Screening asymptomatic women for ovarian cancer does not reduce mortality or diagnosis at an advanced stage and is associated with unnecessary surgery. Screening for ovarian cancer is not recommended.


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7th IN-‐CAM Research Symposium, Toronto, ON (November 3, 2012) – presented as an oral presentation. Riva JJ, Busse JW, Stanford EC, Chan A, Greenway M, Konigsberg E. Attitudes towards Complementary and Alternative Medicine (CAM) among McMaster University medical students: a cross-‐sectional survey. Background: Canadian medical schools are increasingly incorporating material on CAM into their curriculum, but little is known regarding students’ attitudes. Medical students at McMaster University are provided CAM education in a sub-‐unit of their family medicine clerkship rotation. This includes a lecture, readings, and a half-‐day observership with 1 of 5 CAM provider types (chiropractic, osteopathy, naturopathy and traditional Chinese medicine and energy medicine) followed by a small group tutorial. Objective: To assess student attitudes towards CAM and the family medicine CAM sub-‐unit. Methods: In February 2012, we administered a 21-‐item cross-‐sectional survey to 613 McMaster medical students that enquired about demographic and CAM sub-‐unit preference variables as well as general knowledge and attitudes towards CAM exposures during their training. The primary outcome was an aggregate score from 12 items that represented respondents' attitude towards CAM. Results: 233 medical students provided completed surveys, for a response rate of 38%. Most students (62%) reported that they would prefer to receive CAM education earlier in their training (pre-‐clerkship). Few (8%) reported that CAM education should not be provided at all. Among the 64 respondents who provided written comments, many noted that CAM is challenging to consider as a whole since multiple professions are considered in this category. We anticipate that further results will be available at the time of the symposium. Conclusion: The majority of McMaster medical students consider CAM education an important aspect of their training.


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Association of Chiropractic Colleges Educational Conference Research Agenda Conference (ACC-‐RAC). Washington, DC, USA. March 14-‐16, 2013. [accepted for an oral presentation] 13th Annual Canadian Spine Society meeting, Quebec, PQ (Feb 2013). [submitted] Busse JW, Riva JJ, Nash JV, Hsu S, Fisher CG, Wai EK, Brunarski D, Drew B, Quon J, Walter SD, Bishop PB, Rampersaud R. Attitudes towards non-‐physician clinician screening of low back and leg pain patients referred for surgical assessment: a survey of Canadian spine surgeons. The primary objective of our study was to explore Canadian spine surgeons’ attitudes towards the involvement of non-‐physician clinicians (NPC) to screen low back or low back related leg pain patients referred for surgical assessment. Methods: We administered a 28-‐item survey to all 101 surgeon members of the Canadian Spine Society that inquired about demographic variables, patient screening efficiency, typical wait times for both assessment and surgery, important components of low back related complaints history and examination, indicators for assessment by a surgeon, and attitudes towards the use of NPCs to screen low back and leg patients referred for elective surgical assessment. Results: 85 spine surgeons completed our survey, for a response rate of 84.1%. Most respondents (77.6%) were interested in working with a NPC to screen patients with low back-‐related complaints referred for elective surgical assessment. Perception of suboptimal wait-‐time for consultation and poor screening efficiency for surgical candidates were independently associated with greater surgeon interest in a NPC model of care, whereas surgeon age and the proportion of patient typically seen were not associated. We achieved majority consensus regarding the core components for a low back-‐related complaints history and exam, and 4 findings that would indicate a surgical assessment was appropriate. A majority of respondents (75.3%) agreed that they would be comfortable not assessing patients with low back related complaints referred to their practice if clear indications for surgical assessment were ruled out by a NPC Conclusion: The majority of Canadian spine surgeons were open to working with NPCs to assess and triage patients referred to their practices with non-‐urgent low back related complaints. Furthermore, there was majority agreement upon a minimum set of history, examination, and surgical candidacy criteria for patients with a low back related complaints.


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13th Annual Canadian Spine Society meeting, Quebec, PQ (Feb 2013). [submitted] Busse JW, Riva JJ, Rampersaud R, Guyatt GH, Goytan MJ, Feasby TE, Reed M, You J. Imaging practices for spine-‐related complaints referred for surgical assessment: a survey of Canadian spine surgeons. The primary objective of our study was to explore Canadian spine surgeons’ requirements with respect to imaging studies accompanying spine-‐related referrals. Methods: We administered an 8-‐item survey to all 100 surgeon members of the Canadian Spine Society (CSS), with active surgical practices, that inquired about demographic variables and imaging practices related to patients referred for spine-‐related complaints. Results: Fifty-‐five spine surgeons completed our survey, for a response rate of 55%. All but 1 respondent was male, the average age was 50, and 60% of respondents had been in practice for more than 11 years. Practices of 82% of respondents were restricted to adults. Sixty-‐five percent of respondents dedicated more than 50% of their practice to elective lumbar spine surgery (31% dedicated >75% of their practice).

The majority of respondents (84%; 46 of 55) required imaging studies to accompany any spine-‐related referral; the types of imaging studies required was highly variable, with respondents endorsing 7 different types of imaging or imaging combinations. Most surgeons (60%; 33 of 55) required an MRI, alone or in combination with other forms of imaging studies, in order to consider a spine-‐related referral. Fifty-‐one percent required plain films alone or in combination with other forms of imaging studies. Half of our respondents refused at least 20% of all spine-‐related referrals without a consultation. None of our respondents endorsed that they acquired post-‐operative MRIs as part of routine practice after performing spine surgery. Conclusion: Most Canadian spine surgeons require imaging studies to accompany all spine-‐related referrals; however, the type and combination of studies is highly variable and many referrals are not seen for a consultation. Standardization and optimization of imaging practices for spine-‐related complaints referred for surgical assessment may be an important area for cost-‐savings.


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2013 Canadian Agency for Drugs and Technologies in Health (CADTH) Symposium: Evidence in Context (May 2013). [submitted] Busse JW, Alexander PE, Abdul-‐Razzak A, Riva JJ, Alabousi M, Dufton J, Li R, Kagoma Y, Zhang M, Faulhaber M, Couban R, Guyatt GH, Rampersaud RY, Goytan MJ, Lloyd N, DeMone B, Feasby TE, Reed M, Mills EJ, Thorlund K, Schünemann H, You JJ. Appropriateness of spinal imaging use in Canada. Costs of diagnostic imaging in Canada have increased rapidly in the last 2 decades and there is a pressing need to find efficiencies in the use of diagnostic imaging technology. To inform the appropriateness of spine-‐related imaging, we conducted a systematic review of the literature, surveyed Canadian spine surgeons, and analyzed the last decade of utilization data in both Ontario and Manitoba. We identified 22 studies that have explored appropriateness of spine-‐related imaging, and all have found some inappropriate use; however, there appears to be little consensus on a common definition of appropriateness. 16 studies have explored interventions to improve appropriateness of spine-‐related imaging, and active decision aids appear more promising than passive dissemination of educational material. Our survey of Canadian spine surgeons found that the large majority (84%) require imaging studies to accompany all spine-‐related referrals. MRI is the most common form of imaging required, but there is tremendous variability in this area. Furthermore, even with imaging studies, 53% of surgeons refuse more than 20% of all referrals without a consultation, and less than 20% of patients who are assessed are surgical candidates. Our analysis of provincial healthcare utilization data from 2001-‐2011, found that MRI spine utilization has increased markedly, but this has not reduced the use of spine x-‐ray or CT spine. Improved health system coordination for patients with spinal complaints may help to improve efficiency of spine imaging use (e.g., diagnostic imaging pathways to reduce need for “lead up” testing with x-‐ray or CT spine before MRI).

mcwg 2012 annual report (jan 10 2013) - canadian chiropractic …€¦ · mcmaster chiropractic...

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