AECC University College

OBJECTIVE: To assess whether spinal manipulative therapy (SMT) application procedures (ie, target, thrust, and region) impacted changes in pain and disability for adults with spine pain. DESIGN: Systematic review with network meta-analysis. LITERATURE SEARCH: We searched PubMed and Epistemonikos for systematic reviews indexed up to February 2022 and conducted a systematic search of 5 databases (MEDLINE, EMBASE, CENTRAL [Cochrane Central Register of Controlled Trials], PEDro [Physiotherapy Evidence Database], and Index to Chiropractic Literature) from January 1, 2018, to September 12, 2023. We included randomized controlled trials (RCTs) from recent systematic reviews and newly identified RCTs published during the review process and employed artificial intelligence to identify potentially relevant articles not retrieved through our electronic database searches. STUDY SELECTION CRITERIA: We included RCTs of the effects of high-velocity, low-amplitude SMT, compared to other SMT approaches, interventions, or controls, in adults with spine pain. DATA SYNTHESIS: The outcomes were spinal pain intensity and disability measured at short-term (end of treatment) and long-term (closest to 12 months) follow-ups. Risk of bias (RoB) was assessed using version 2 of the Cochrane RoB tool. Results were presented as network plots, evidence rankings, and league tables. RESULTS: We included 161 RCTs (11 849 participants). Most SMT procedures were equal to clinical guideline interventions and were slightly more effective than other treatments. When comparing inter-SMT procedures, effects were small and not clinically relevant. A general and nonspecific rather than a specific and targeted SMT approach had the highest probability of achieving the largest effects. Results were based on very low- to low-certainty evidence, mainly downgraded owing to large within-study heterogeneity, high RoB, and an absence of direct comparisons. CONCLUSION: There was low-certainty evidence that clinicians could apply SMT according to their preferences and the patients' preferences and comfort. Differences between SMT approaches appear small and likely not clinically relevant. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 7 January 2025. https://doi.org/10.2519/jospt.2025.12707.

Tendons play a crucial role in the musculoskeletal system, connecting muscles to bones and enabling efficient force transfer. However, they are prone to acute and chronic injuries, which, if not properly repaired, can significantly impair function. Tendinopathy, a prevalent condition affecting approximately 20% of musculoskeletal complaints, arises from an imbalance between micro-injury accumulation and repair processes. The extracellular matrix (ECM) of tendons is a hierarchical structure comprising collagen fibrils, proteoglycans, and glycoproteins that regulate organization, hydration, and mechanical properties. Mechanotransduction pathways, mediated by integrins and focal adhesion complexes, activate signaling cascades such as MAPK/ERK and PI3K/Akt, driving tenocyte gene expression and ECM remodeling. Adaptations to load involve region-specific remodeling, with tensile regions favoring aligned Type I collagen and compressive regions promoting proteoglycans like aggrecan. Stress shielding or reduced loading disrupts these pathways, leading to matrix disorganization and inflammation, predisposing tendons to degenerative changes. Insights into these molecular mechanisms inform rehabilitation strategies to enhance tendon repair and mitigate tendinopathy progression in both athletic and general populations.

Abstract Use of simulation-based education (SBE) in social work is growing. However, there is a lack of substance use training, for both post-qualified social workers and undergraduate social work students. This study addressed a gap in undergraduate substance use education around prenatal alcohol exposure (PAE) and its impact on foetal development. A mixed methods approach was used with undergraduate social work students across two universities in the Southwest of the UK. Both groups received a taught session on foetal alcohol syndrome (FAS), completed pre- and post-taught session questionnaires assessing FAS knowledge, and had the opportunity to interact with the FAS neonate simulator. Creative activities around interaction with the FAS simulator enabled feedback on thoughts, feelings and practice implications. Findings revealed increased pre- to post-FAS knowledge and enhanced understanding of the long-term impacts of gestational alcohol use for the developing child. Social work students felt more aware of the impact of alcohol use during pregnancy and were more confident to address these issues through future practice. The use of FAS neonate simulators as a pedagogic tool is beneficial to help elucidate student knowledge on alcohol use during pregnancy and to increase confidence working with people who are pregnant who may be using alcohol or substances.

Low- and lower-middle-income countries bear the greatest burden of anemia, particularly those living in rural settings such as an indigenous community. The objective of this systematic review was to determine the prevalence of anemia and its determinants among the Orang Asli children in Peninsular Malaysia. A web-based search of PubMed, Web of Science, Scopus, Medline, and ProQuest from January 2000 to June 2022, using specified search/MeSH (Medical Subject Headings) terms and keywords, was conducted. The search identified studies reported the prevalence of anemia among the children of Orang Asli and its causes. Eight studies were included in the final analysis. The prevalence of anemia among the Orang Asli children was high (61.6%). Most research has focused primarily on iron-deficiency anemia and soil-transmitted helminth infections. Other causes include female gender, mothers with low education levels, and low household incomes. Despite being a public health concern, this study found no studies associating Orang Asli children with hereditary anemia and malaria, which is a limitation. In conclusion, the Orang Asli children are more likely to have anemia compared with the general Malaysian population. To overcome this, a comprehensive examination of the determinants of anemia in this community is required. Thus, interventions can be personalized.

In a previous paper, we presented some important weaknesses of and threats to the chiropractic profession as we see them. We further argued that the chiropractic profession’s relationship with its principal clinical tool (spinal manual therapy) is at the core of the ideological divide that fractures the profession and prevents professional development towards greater integration in the healthcare landscape. In this manuscript, we shall argue that the historical predilection for spinal manipulation also gifts the profession with some obvious strengths and opportunities, and that these are inextricably linked to the management of musculoskeletal disorders. The onus is now on the chiropractic profession itself to redefine its raison d’être in a way that plays to those strengths and delivers in terms of the needs of patients and the wider healthcare system/market. We suggest chiropractors embrace and cultivate a role as coordinators of long-term and broad-focused management of musculoskeletal disorders. We make specific recommendations about how the profession, from individual clinicians to political organizations, can promote such a development.

In the domain of frequency sweeping interferometry, the accurate extraction of distance information from nonlinear frequency scanning signals holds paramount significance in ensuring meticulous measurements of high precision. This paper presents a novel, to the best of our knowledge, high-speed distance extraction algorithm based on the table lookup method and validates its feasibility through theoretical models, simulations, and practical experiments. The proposed algorithm achieves comparable accuracy to traditional methods involving resampling and Hilbert transform. However, it outperforms them in robustness against noise and variations in sampling points. This method can accurately process signals sampled even below the Nyquist sampling rate. The simplicity and computational efficiency of the proposed approach make it suitable for various nonlinear sampling applications, promising broad applicability in scientific and engineering contexts.

BackgroundTrunk muscle activity and thoraco-lumbar kinematics can discriminate between non-specific chronic low back pain (NSCLBP) subgroups and healthy controls. However, research commonly focuses on lumbar kinematics, with limited understanding of relationships between kinematics and muscle activity across clinical subgroups. Similarly, the thoracic spine, whilst intuitively associated with NSCLBP, has received less attention and potential relationships between spinal regions and muscle activity requires exploration. Research questionIs there a relationship between trunk muscle activation and regional thoracic and lumbar kinematics in NSCLBP subgroups during a forward bending task? MethodsObservational, case-control study. Fifty subgrouped NSCLBP motor control impairment participants (27 Flexion Pattern (FP-MCI), 23 Active Extension Pattern (AEP-MCI)) and 28 pain-free controls were evaluated using 3D motion analysis (Vicon™) and surface electromyography during a forward bending and return to upright task. Mean sagittal angles for the upper-thoracic (UTx), lower-thoracic (LTx), upper-lumbar (ULx) and lower-lumbar (LLx) regions were compared with normalised (% sub-maximal voluntary contraction) mean amplitude electromyography of bilateral transversus abdominis/internal oblique, external oblique, superficial lumbar multifidus and erector spinae (longissimus thoracis) muscles between groups. Pearson correlations were computed to assess relationships (significance p < 0.01). ResultsAEP-MCI individuals demonstrated statistically significant relationships between superficial lumbar multifidus and ULx and LLx kinematics (−.812 to.659). FP-MCI individuals exhibited statistically significant relationships between erector spinae and superficial lumbar multifidus and LLx and LTx kinematics (−.686 to.664) in both task phases, and between external oblique and LTx during forward bending) (−.459 to.572). Correlations were moderate to strong for all significant relationships (−.812 to .664). SignificanceRelationships between muscle activity and regional spinal kinematics varied between NSCLBP subgroups, suggesting that those with flexion- or extension-related LBP adopt different motor control strategies when performing a bending task. As effectively mechanical biomarkers, these findings may inform treatment by improving understanding of varied motor strategies in subgroups.

BackgroundDatabases have become an important tool in understanding trends and correlations in health care by collecting demographic and clinical information. Analysis of data collected from large cohorts of patients can have the potential to generate insights into factors identifying treatments and the characteristics of subgroups of patients who respond to certain types of care. The Care Response (CR) database was designed to capture patient-reported outcome measures (PROMs) for chiropractic patients internationally. Although several papers have been published analysing some of the data, its contents have not yet been comprehensively documented. The primary aim of this study was to describe the information in the CR database. The secondary aim was to determine whether there was suitable information available to better understand subgroups of chiropractic patients and responsiveness to care. This would be achieved by enabling correlations among patient demographics, diagnoses, and therapeutic interventions with machine learning approaches.MethodsData in all available fields were requested with no date restriction. Data were collected on 12 April 2022. The output was manually scanned for scope and completeness. Tables were created with categories of information. Descriptive statistics were applied.ResultsThe CR database collects information from patients at the first clinical visit, 14, 30, and 90 days subsequently. There were 32,468 patient responses; 3210 patients completed all fields through the 90 day follow up period. 45% of respondents were male; 54% were female; the average age was 49. There was little demographic information, and no information on diagnoses or therapeutic interventions. We received StartBack, numerical pain scale, patient global impression of change, and Bournemouth questionnaire data, but no other PROMs.ConclusionsThe CR database is a large set of PROMs for chiropractic patients internationally. We found it unsuitable for machine learning analysis for our purposes; its utility is limited by a lack of demographic information, diagnoses, and therapeutic interventions. However, it can offer information about chiropractic care in general and patient satisfaction. It could form the basis for a useful clinical tool in the future, if reformed to be more accessible to researchers and expanded with more information collected.

Background/objective: Exercise-related cognitive errors (ECEs) is a significant factor that can influence regular physical activity among emerging adults. Findings of previous studies suggested that mindfulness interventions can improve the level of regular physical activity (PA) levels. However, the potential mechanisms of how mindfulness is related to PA levels are still relatively unknown. Thus, this study investigated the potential association between trait mindfulness and PA and determined whether trait self-control and exercise-related cognitive errors serve as mediators. Method: In total, 328 Chinese participants (61.3% female, Mean age=20.65, SD=2.21) completed a series of questionnaires, including demographics, the Five Dimension Mindfulness Questionnaire short form (FFMQ-SF), the Exercise Cognitive Bias Questionnaire (E-CEQ), the Brief Self Control Scale (BSCS), and the International Physical Activity Questionnaire short form (IPAQ-SF). A structural equation model was used to investigate the potential relationships between trait mindfulness and PA levels, with trait self-control and exercise-related cognitive errors as mediating variables. Results: Trait mindfulness, trait self-control, and ECEs were significantly correlated with PA. Further, trait self-control and exercise-related cognitive errors mediated the relationship between trait mindfulness and PA. Conclusions: This study provides evidence that trait self-control and ECEs are likely to mediate the relationship between trait mindfulness and PA levels, providing a new direction for further research aiming to reduce ECEs and improve PA among emerging adults.

BackgroundPresenting at professional and scientific conferences can be an important part of an individual’s career advancement, especially for researchers communicating scientific findings, and can signal expertise and leadership. Generally, women presenting at conferences are underrepresented in various science disciplines. We aimed to evaluate the gender of presenters at research-oriented chiropractic conferences from 2010 to 2019.MethodsWe investigated the gender of presenters at conferences hosted by chiropractic organisations from 2010 to 2019 that utilised an abstract submission process. Gender classification was performed by two independent reviewers. The gender distribution of presenters over the ten-year period was analysed with linear regression. The association of conference factors with the gender distribution of presenters was also assessed with linear regression, including the gender of organising committees and abstract peer reviewers, and the geographic region where the conference was hosted.ResultsFrom 39 conferences, we identified 4,340 unique presentations. Women gave 1,528 (35%) of the presentations. No presenters were classified as gender diverse. Overall, the proportion of women presenters was 30% in 2010 and 42% in 2019, with linear regression demonstrating a 1% increase in women presenting per year (95% CI = 0.4–1.6%). Invited/keynote speakers had the lowest proportion of women (21%) and the most stagnant trajectory over time. The gender of conference organisers and abstract peer reviewers were not significantly associated with the gender of presenters. Oceanic conferences had a lower proportion of women presenting compared to North America (27% vs. 36%).ConclusionsOverall, women gave approximately one-third of presentations at the included conferences, which gradually increased from 2010 to 2019. However, the disparity widens for the most prestigious class of keynote/invited presenters. We make several recommendations to support the goal of gender equity, including monitoring and reporting on gender diversity at future conferences.