Rapid Reviews to Advise the CCBC on Claims of Effectiveness of Interventions Used by Chiropractors

Dr. Pierre Côté and Dr. Carol Cancelliere were invited to submit a proposal to the College of Chiropractors of British Columbia (CCBC) to provide guidance on the evidentiary basis regarding interventions used by chiropractors for the management of non-musculoskeletal disorders.

What is a rapid review?

Rapid reviews are a form of knowledge synthesis that provide a high-quality synthesis of available evidence. They are created by streamlining traditional systematic review methodology in a timely and cost-effective manner.

Methods:

The research team begins by translating the CCBC's question into a research question. A rapid review protocol is then developed, following the evidence-based PRISMA statement, and submitted to the Open Science Framework Registry (OSF), a free, open platform to support your research and enable collaboration.

The rapid reviews are performed and deliverables (within eight to twelve weeks) include evidence briefs that include the search strategies, evidence tables, evidence summaries and relevant appendixes. Evidence related to claims in question is synthesized, not critically appraised.

Team Members:

Pierre Côté - Project Lead

Carol Cancelliere - Project Lead

Silvano Mior - Scientist

Melissa Corso- Research Associate

Ngai Chow - Research Associate

Anne Taylor-Vaisey - Research Associate/Librarian

Poonam Cardoso - Research Administration Officer

Publications:

View the published and in process CCBC rapid reviews.

The scientific literature on COVID-19 and SARS-COV-2 is increasing in volume and complexity with every day that the outbreak continues. World Health Organization (WHO) staff in WHE and in other technical units and offices at headquarters and in regional are grappling with how to keep up with the emerging literature. One approach to this “infodemic” is to provide a daily service that screens new scientific publications for relevance and quality, identifies key studies, summarizes them at the study level, and disseminates them to relevant audiences. We term this product a “Daily Digest”.

The WHO selected CDPR to lead a collaborative effort to inform key individuals within the WHO about COVID-19 trends and issues. The CDPR research team is responsible for reviewing and producing the WHO daily COVID-19 Research Digest. The Digest compiles the latest trends on a wide range of issues, including:

Breakthroughs in research into interventions/therapeutics.

Major advances in knowledge about the virus or disease and challenges to previously held understandings.

Clinical updates, such as new symptoms, risk factors, and associated COVID-19 conditions.

Epidemiology and public health trends.

The Daily Digest that is compiled provides end-users at WHO with rapid access to the exploding range of new literature from key publications of primary research related to COVID-19, including epidemiology, lab studies, vaccine development, travel restriction measures, and more. The report ensures public health experts are apprised of the latest findings around the globe.

Team Members:

Pierre Côté - Project Lead

Heather Shearer - Senior Research Associate

Deborah Sutton - Research Associate

Dan Wang - Post-doctoral Fellow

Jessica Wong - Research Associate

Poonam Cardoso - Research Administration Officer

Dan (Demi) Wang, PhD

Understanding health care utilization for musculoskeletal disorders and disability in Canada: A population-based perspective

Project Objectives:

Using data from two national surveys conducted by Statistics Canada: the Canadian Community Health Survey and Canadian Survey on Disability, this project aims to understand the utilization of chiropractors and other health providers for musculoskeletal pain and disability by:

1. Estimating the annual national, age-, sex-, province/territory-specific prevalence of utilization of chiropractic, medical, nursing, physiotherapy, and psychology services by Canadians for the management of musculoskeletal disorders and disability;

2. Describing the sociodemographic, health, work and environmental characteristics of Canadians who consult chiropractors, medical doctors, nurses, physiotherapists, psychologists or other providers; and

3. Determining the association between sociodemographic, health, work, and environmental characteristics and type of health care providers consulted.

External funding: Ontario Tech and CMCC

Collaborators:

Pierre Côté, DC, PhD

Silvano Mior, DC, PhD, FCCS(C)

Sheilah Hogg-Johnson, MMATH, PhD

Jessica Wong, BSc, DC, MPH, FCCS(C)

Reporting of Outcomes in Randomized Controlled Trials of Rehabilitation Interventions: A RCTRaCk Initiative

Project Objectives:

Participating as one of the Working Groups of the RCTRaCk project which has been developed by the Cochrane Rehabilitation team, this project aims to systematically identify, synthesize, and make recommendations for potential criteria attributes of outcome reporting in RCTs of rehabilitation interventions by:

1. Reviewing the preliminary RCTRaCk papers to identify reporting and methodological issues related to outcomes in rehabilitation randomized controlled trials (RCTs);

2. Surveying the Instructions to Authors of all major peer-reviewed rehabilitation journals to determine how journals require authors to report outcomes in rehabilitation RCTs;

3. Reviewing all official and unofficial CONSORT extensions to determine how other specialty groups have addressed the reporting of outcomes specific to their fields;

4. Conducting a focused scoping review of systematic reviews, clinical practice guidelines and methodological studies on RCTs of rehabilitation interventions to examine the nature and variations of criteria used to evaluate the quality of outcome reporting; and

5. Producing a list of criteria items to be considered for reporting outcomes in RCTs of rehabilitation interventions.

Collaborators:

Pierre Côté, DC, PhD

Stefano Negrini, MD

Anne Taylor-Vaisey, MLS

Publication:

Wang D, Taylor-Vaisey A, Negrini S, Côté P. Criteria to evaluate the quality of outcome reporting in RCTs of rehabilitation interventions. Am J Phys Med Rehabil. 2021;100(1):17-28.

View more CDPR contributions to Cochrane Rehabilitation.

Today’s university students will be tomorrow’s workforce. However, an epidemic of back pain and mental health problems is disabling undergraduate students, and little is known about the causes of this problem. In partnership with the Canadian Mental Health Association-Durham, Professor Côté secured funding from the Ontario Trillium Foundation and the Canadian Association of College and University Student Services to develop a program of epidemiologic research aimed at understanding the burden and risk factors for disabling pain and psychological distress in university students. To date, Côté and his team have completed two systematic reviews on the association between physical activity, sleep quality and mental health in undergraduate students; conducted a pilot study; and conducted a cross-sectional study of students enrolled in Ontario Tech University’s faculties of Health Sciences and Education, and CMCC.

Professor Côté has supervised four Master of Health Sciences (MHSc) students at Ontario Tech University (Nayantara Hatagandi, Nancy Fynn, Andrew Reynolds and Michael Short) and served on the thesis committee of two post-graduate residents at the CMCC (Lydia Brodie and Christine Meckamalil). The project involved collaborators from:

Ontario Tech University:

- Faculty of Health Sciences: Dr. Lori Livingston, Dr. Efrosini Papaconstantinou and Dr. Shilpa Dogra

- Faculty of Education: Dr. Jennifer Laffier

- Faculty of Social Science and Humanities: Dr. Tyler Fredrick

Ontario Shores Centre for Mental Health Sciences: Dr. Krystle Martin

CMCC: Dr. Sheilah Hogg-Johnson

University of Alberta: Dr. Linda Carroll

To date, this project has led to two peer-reviewed publications and the funding of the Sustainable University Life (SUN), a large cohort study of university students from Stockholm Sweden, at the Karolinska Institutet where Professor Côté is a co-principal investigator.

Professor Côté was the Principal Investigator (PI) of the Ontario Protocol for Traffic Injury Management Collaboration (OPTIMa), a project that developed evidence-based clinical practice guidelines for the management of common traffic injuries. Côté received a $2.8 million peer-reviewed grant from the Ontario Government for this work. To meet the project’s goal, Côté convened a panel of local, national and international experts; led more than 40 systematic reviews; and guided the development of evidence-based recommendations. Côté’s report, entitled Enabling Recovery from Common Traffic Injures: A Focus on the Injured Person, was submitted to the Ontario Minister of Finance to guide reforms of the Ontario automobile insurance system. Côté’s report was influential in informing the study led by David Marshall who was appointed as a Special Adviser to the Minister of Finance to review and make recommendations to improve the system of auto insurance in Ontario. This research involved two trainees supervised by Côté: Maja Stupar (postdoctoral fellow, Ontario Tech University) who developed a clinical prediction rule for the recovery of whiplash; and Rachel Goldgrub (MHSc, Ontario Tech University) who conducted her thesis on the rehabilitation of shoulder injuries. More than 30 papers resulted from this research and were published in leading journals (Spine Journal, Physical Therapy, JOSPT, Clinical Journal of Pain, Manual Therapy, European Journal of Pain and European Spine Journal) and presented at international meetings in Australia, France, Germany, Sweden and the USA.

Background: Whiplash-associated disorders (WAD) is the most common traffic injury and leads to a significant burden of disability and health care utilization. The clinical management of acute WAD is complex. The type, intensity, and timing of health care delivery varies greatly with some approaches potentially delaying recovery. Rising health care costs and increasing disability rates have led various governments and insurers to develop and implement guidelines for the treatment of WAD. Most guidelines emphasize education, reassurance, mobility, return-to-activity, and exercise despite their being little evidence to support their effectiveness. In Ontario, the provincial government introduced guidelines (in the form of regulations) in an attempt to ensure timely access to rehabilitation services, improve the utilization of health care resources, and establish consistent fee schedules for insurers and health care providers.

Aim: To evaluate the effectiveness of an Ontario government-regulated rehabilitation guideline for the treatment of acute whiplash injuries.

Objectives:

1. Evaluate the effectiveness of a government-regulated rehabilitation guideline compared to education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation program on self-reported global recovery from acute whiplash-associated disorders (WAD) grades I-II.

2. Determine which of the three interventions was more effective in reducing time on insurance benefits, neck pain intensity, whiplash-related disability, depressive symptoms, and in improving health-related quality of life.

Implications: This work provides evidence of the effectiveness of a government-regulated guideline for the rehabilitation of whiplash-associated disorders. The implementation of such a guideline could promote faster recovery compared to education and activation by general practitioners, or a preferred-provider insurance-based rehabilitation.

Funding: The trial was funded by grants from Aviva Canada

Team Members:

Pierre Côté DC, PhD (Principal Investigator)

Eleanor Boyle PhD (Co-Principal Investigator

David Cassidy DC, PhD (Co-Prinicipal investigator)

Gabrielle van der Velde DC, PhD (Co-investigator)

Simon Carette, MD (Co-investigator)

Carlo Ammendolia DC, PhD (Co-investigator)

Jill Hayden DC, PhD (Co-investigator)

Maurits van Tulder PhD (Co-Investigator)

John Frank MD, MSc (Co-Investigator)

Heather Shearer DC, MSc, PhD (candidate) (Research Coordinator)

Maja Stupar DC, PhD (Research Coordinator)

Craig Jacobs DC, MSc (Research Coordinator)

Poonam Cardoso BHS, PMP (Research Administration Officer)

Background: At least 1 in 3 people globally will require rehabilitation at some point in their life and most of these needs are unmet. Globally and including in Canada, at least 2.4 billion people are in need of rehabilitation services and low back pain (LBP) is the most common reason for unmet rehabilitation needs. The World Health Organization (WHO) recognized this important problem and issued a call to strengthen access to rehabilitation. It is therefore critically important that people with LBP receive effective rehabilitation services from health care providers. However, no global indicator is currently available to measure effective coverage for LBP rehabilitation. To fill this critical gap, we are collaborating with the WHO Rehabilitation Programme to inform the development of this global indicator. Global indicators measure whether rehabilitation aligns with countries’ health profiles, and are of sufficient quality to produce health benefits for populations. One promising indicator is the WHO Disability Assessment Schedule (WHODAS), a questionnaire developed by the WHO to measure functioning across cultures and settings. However, the utility of WHODAS as an instrument to capture effective coverage for rehabilitation is not established.

Objectives: We aim to inform the development of a global indicator to measure effective coverage of LBP rehabilitation. The specific objectives are to: 1) conduct a systematic review to determine the psychometric properties (e.g., validity, reliability, responsiveness) and minimal clinically important difference (MCID) of the WHODAS-36 and WHODAS-12 in persons with non-specific LBP; and 2) conduct a scoping review to describe the pre-rehabilitation scores of functioning measured using the WHODAS-36 or WHODAS-12 in persons with non-specific LBP.

Implications: Our findings will determine the utility of WHODAS for measuring effective coverage of rehabilitation and monitoring the needs of persons with LBP worldwide. This will have global impact by informing the development of a WHO global tracer indicator of effective coverage for rehabilitation of LBP from health care providers. Importantly, this work will provide a much-needed metric that can be used in global impactful studies, such as the Global Burden of Disease Study. In collaboration with the WHO, our research aligns with the goal for all people to receive high-quality services and rehabilitation that they need to achieve optimal health and functioning.

Funding: This research is funded by the Canadian Chiropractic Research Foundation.

For more information, please visit: https://www.canadianchiropracticresearchfoundation.ca/grants/current-and-past-projects/

Team Members:

Jessica Wong (Principal Investigator)

Pierre Côté (Co-principal Investigator)

Sheilah Hogg-Johnson (Co-investigator)

Wouter De Groote (WHO; Co-author)

Alarcos Cieza (WHO; Co-author)

Astrid DeSouza (Co-author)

Danielle Southerst (Co-author)

Melissa Belchos (Co-author)

Nadège Lemeunier (Co-author)

Stephanie Alexopulos (Co-author)

Hamid Varmazyar (Co-author)

Silvano Mior (Co-author)

Paula Stern (Co-author)

Margareta C. Nordin (Co-author)

Anne Taylor-Vaisey (Co-author)

Kent Murnaghan (Co-author)

Poonam Cardoso (Research Administration Officer)