Chiropractic Guideline Initiative and Evidence-Informed Practice
Explore the Canadian Chiropractic Guideline Initiative (CCGI) and its impact on clinicians, patients, and the chiropractic profession. Learn about the mission to develop evidence-based clinical practice guidelines, funded projects, and the significance of evidence-informed practice in healthcare. Discover the top causes of disability and the scope of CCGI's work in addressing musculoskeletal disorders.
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Presentation Transcript
Canadian Chiropractic Guideline Initiative (CCGI) Introduction & implications for clinicians, patients & our profession
CCGI Introduction Our Vision: Enhance the health of Canadians by fostering excellence in chiropractic patient care Our Mission: Develop evidence-based CPGs and best practice recommendations Facilitate dissemination & implementation within the chiropractic profession
CCGI Introduction Funded by a majority of Professional Associations & Licencing Boards CPG Projects: Neck Pain due to Whiplash (2010) Headache (2011) Neck Pain not due to Whiplash (2014) Back Pain (2014-2015) Other MSK Conditions (2016-2017)
Top 10 (+1) Causes of Disability (Global Burden of Disease Vos et al. 2012) 1. Low back pain 2. Major depressive disorder 3. Iron-deficiency anaemia 4. Neck pain 5. Chronic obstructive pulmonary disease 6. Other MSK disorders 7. Anxiety disorders 8. Migraine 9. Diabetes 10.Falls 11.Osteoarthritis Musculoskeletal Disorders (MSDs) result in enormous social, psychological & economic burdens (IOM 2011)
Scope of the CCGI Reasons for consulting chiropractors in North America 2% 3% 4% 4% Back pain 6% Upper/Lower extremity problems 42% 14% (Coulter 2005) 25%
Location of Patient Treatment Areas 6% Other 30% Low back region 28% 7% 20% 9% (Waalen & Mior 2005)
Evidence-Informed Practice & Clinical Practice Guidelines Canadian Chiropractic Guideline Initiative
WHAT DO YOU THINK OF WHEN YOU HEAR: Evidence-informed practice? Evidence-based medicine? Evidence-informed healthcare?
Evidence-Informed Practice (EIP) CLINICAL DECISION Clinical expertise Patient values & preferences Best research evidence Clinical context
Evidence-Informed Practice (EIP) Definition: The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients TAKE HOME POINT: All three aspects of the model are equally important!
WHY WOULD YOU USE EVIDENCE- INFORMED PRACTICE?
Why use EIP? chance of positive patient outcomes patient satisfaction risk of harm to the patient Facilitate effective and honest communication with patients Improve cultural authority of chiropractic Enhance integration and communication in multidisciplinary environments Evidence is a common language!
Reality of EIP Integration LOTS of new, useful research is published every month, but is consistent uptake and integration happening? Will we like what we see?
EIP Misconceptions EIP/research = allopathic medicine EIP is a rulebook/cookbook There is no chiropractic research Researchers don t understand practice realities and want to tell us what we can t do vs. what we can/should do Volume of new research is too large, making it impossible to stay current
WHAT ARE SOME BARRIERS TO IMPLEMENTING EIP IN YOUR PRACTICE? WHAT ARE POTENTIAL SOLUTIONS?
Challenges in EIP Uptake Clinicians Patients Practice Health care policy
Clinician Challenges Lack of time and/or motivation Personal beliefs regarding research: Doesn t reflect my practice/patients Statistics too complex Too much information! Don t know where to look
What is a Clinical Practice Guideline? CPGs are a comprehensive collection of: Current best evidence regarding etiology, diagnosis & treatment of a condition Expert opinion & consensus Practice-based recommendations Who puts these together? Researchers, clinicians and patient reps people we should listen to! It s a massive undertaking!
Clear Question Update & Revise Literature Search Study Selection Dissemination CPG Development Recommendations Critical Appraisal Data Analysis Extraction
Evidence-Informed Practice (EIP) CLINICAL DECISION Clinical expertise Patient values & preferences Best research evidence Clinical context
CPGs Key Points for Clinicians Living EIP document = updated regularly A tool to support clinical reasoning NOT standards of care/practice NOT a substitute for a practitioner s experience Contain practice recommendations linked to best evidence
MSDs: Associated Co-Morbidities MSDs are known to be associated with other health issues (ex. cardio vascular disease, depression, etc...). Addressing them together: Can be more efficient (time and money) Adds a broader health-related meaning Can improve patient compliance!
Summary & Take Home Messages EIP = rational integration of best available research, your clinical experience/expertise and what the patient wants
Summary & Take Home Messages CPGs help guide decision-making regarding diagnosis, treatment and patient management Patients should always be treated as individuals who can have multiple health problems and risk factors humans are complex!
The Canadian Chiropractic Guideline Initiative Website is NOW ONLINE! Your essential guide to the latest news on guidelines and best practice www.chiroguidelines.org Visit us today!
Finding the Neck Pain CPG Visit:www.chiroguidelines.org
Additional resources www.chiroguidelines.org Evidence Informed Practice Program - EIP modules Centre for Evidence-Based Medicine Evidence UP DATES: Free Tools for Evidence-Based Clinical Practice JAMA Evidence Evidence-Based Medicine Tool Kit Grey Matters: A practical search tool for evidence-based medicine Centre for Evidence-Based Medicine (Toronto)
GIG Group Members Project lead: Andr Bussi res Helping practitioners and patients make the right choice for optimal care Clinician 1) Kent Stuber (lead) 2) Jeff Quon (lead) 3) Fadi Al Zoubi 4) Sandy Sajko 5) Simon French (KT Expert) 6) Alex Pessoa (collaborator) Decision Makers 1) Diane Grondin (lead) 2) Simon Brockhusen (collaborator) 3) Andr Bussi res (KT Expert) 4) Michele Maiers (collaborateur) 5) John Triano Chiropractic programs 1) Tony Tibbles (lead) 2) Danica Brousseau (lead) 3) Tue Jensen 4) Aliki Thomas (KT Expert) 5) Craig Jacobs (CMCC collaborator) 6) Joe Lemire (UQTR collaborator) 7) Caroline Poulin (UQTR collaborator) 8)I sabelle Pouliot (UQTR student) Patients 1) Sara Ahmed (lead) 2) Shawn Davies 3) Monika Kastner (KT Expert) 4) Nadia Richer (UQTR collaborator) Any questions? Physical activity: Bob Grisdale (lead) Website- Vic Weatherall (lead) Reviewer: Bryan Budgell
References Coulter ID & Shekelle PG. Chiropractic in North America: Descriptive analysis. J Manipulative Physiol Ther 2005; 28(2): 83-89. Fineout-Overholt E, Mazurek Melnyk B, Schultz A. Transforming Health Care from the Inside Out: Advancing Evidence-Based Practice in the 21st Century. J Professional Nursing. 2005;21(6):335-44. Kawchuk G, Newton G, Srbely J, Passmore S, Bussi res A, Busse JW, Bruno P. Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap. J Can Chiropr Assoc 2014; 58(3):206-14 (In Press). Lizarondo L, Grimmer-Somers K, Kumar S. A systematic review of the individual determinants of research evidence use in allied health. J Multidisciplinary Healthcare. 2011;4:261-72. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn t. BMJ. 1996; 312(7023):71 72. Vos T, Flaxman AD, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2163 96. Waalen JK, Mior SA. Practice patterns of 692 Ontario chiropractors (2000-2001). J Can Chiro Assoc 2005; 49(1): 21-31.
