Clinical practice guidelines (CPGs) are designed to ensure that evidence-based treatment is easily put into action. Whether patients and clinicians follow these guidelines is equivocal.
The objectives of this study were to examine how many patients complaining of low back pain (LBP) underwent evidence-based medical interventional treatment in line with CPG recommendations before consultation with a spine surgeon, and to evaluate any associations between adherence to CPG recommendations and baseline factors.
This is a cross-sectional cohort analysis at a tertiary care center.
A total of 229 patients were referred for surgical consultation for an elective lumbar spinal condition.
The outcome measures include the number of CPG-recommended treatments undertaken by patients at or before the time of referral, the validated pain score, the EuroQol-5D (EQ-5D) health status, and the Oswestry Disability Index (ODI) score.
Questionnaires assessing demographic and functional characteristics as well as overall health care use were sent to patients immediately after their referral was received by the surgeon\'s office.
Medications were the most common modality before consultation (74.2% of patients), of which 46.3% received opioids. The number of medications taken was significantly related to a higher ODI score (R=0.23, p=.0004), a higher pain score (R=0.15, p=.026), and a lower EQ-5D health status (R=-0.15, p=.024). In contrast, a lower pain score (7.2 vs. 7.7, p=.037) and a lower ODI score (26.6 vs. 29.9, p=.0023) were associated with performing adequate amounts of exercise. There was a significant association between lower numbers of treatments received and higher numerical pain rating scores (R=-0.14, p=.035). The majority (61.1%) of patients received two or less forms of treatment.
Evidence-based medical interventional treatments for patients with LBP are not being taken advantage of before spine surgery consultation. If more patients were to undertake CPG-endorsed conservative modalities, it may result in fewer unnecessary referrals from primary care physicians, and patients might not deteriorate as much while lingering on long wait lists. Further studies incorporating knowledge translation or health system pathway changes are necessary.

BACKGROUND: Case reports are a fundamental tool through which therapeutic massage and bodywork (TMB) practitioners can inform research and impact their field by detailing the presentation, treatment, and follow-up of a single individual encountered in practice. Inconsistencies in case reporting limit their impact as fundamental sources of clinical evidence. Using the TMB-adapted CAse REport (CARE) guidelines, the current study sought to provide a rich description regarding the reporting quality of TMB practitioner authored TMB case reports in the literature.
METHODS: 1) Systematic identification of published, peer-reviewed TMB case reports authored by TMB practitioners following PRISMA recommendations; 2) audit development based on TMB-adapted CARE guidelines; 3) audit implementation; and 4) descriptive analysis of audit scores.
RESULTS: Our search identified 977 articles and 35 met study inclusion criteria. On average, TMB case reports included approximately 58% of the total items identified as necessary by the TMB-adapted CARE guidelines. Introduction sections of case reports had the best item reporting (80% on average), while Case Presentation (54%) and Results (52%) sections scored moderately overall, with only 20% of necessary Practitioner Description items included on average. Audit scores revealed inconsistent abstract reporting and few audited case reports including client race (20%), perspective (26%), and occupation/activities (40%); practitioner practice setting (12%), training (12%), scope-of-practice (29%), and credentialing (20%); adverse events or lack thereof (17%); and some aspect of informed consent (34%). Treatment descriptor item reporting varied from high to low. Various implications of concern are discussed.
CONCLUSIONS: The current audit and descriptive analysis highlight several reporting inconsistencies in TMB case reports prior to 2015. Reporting guidelines for case reports are important if standards for, and impact of, TMB case reports are desired. Adherence to reporting specifications outlined by the TMB-adapted CARE guidelines could improve the impact and usability of TMB case reports in research, education, and practice.

Case reports provide the foundation of practice-based evidence for therapeutic massage and bodywork (TMB), as well as many other health-related fields. To improve the consistency of information contained in case reports, the CARE (CAse REport) Group developed and published a set of guidelines for the medical community to facilitate systematic data collection (http://www.care-statement.org/#). Because of the differences between the practice of medicine and TMB, modifying some sections of the CARE guidelines is necessary to make them compatible with TMB case reports. Accordingly, the objectives of this article are to present the CARE guidelines, apply each section of the guidelines to TMB practice and reporting with suggested adaptations, and highlight concerns, new ideas, and other resources for potential authors of TMB case reports. The primary sections of the CARE guidelines adapted for TMB case reports are diagnostic assessment, follow-up and outcomes, and therapeutic intervention. Specifically, because diagnosis falls outside of the scope of most TMB practitioners, suggestions are made as to how diagnoses made by other health care providers should be included in the context of a TMB case report. Additionally, two new aspects of the case presentation section are recommended: a) assessment measures, which outline and describe the outcome measures on which the case report will focus, and b) a description of the TMB provider (i.e., scope of practice, practice environment, experience level, training, credentialing, and/or expertise) as part of the intervention description. This article culminates with practical resources for TMB practitioners writing case reports, including a TMB Case Report Template-a single document that TMB practitioners can use to guide his or her process of writing a case report. Once the template is adopted by authors of TMB case reports, future efforts can explore the impact on the quality and quantity of case reports and how they impact TMB practice, research, education and, ultimately, the clients.

BACKGROUND: The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is committed to advancing human health through the advancement and integration of the complementary and alternative medicine (CAM) professions within the American healthcare system. This will involve the maturation and integration of the licensed CAM professions into conventional healthcare delivery, and in turn, it will involve the development of competency in integrative healthcare and interprofessional education within the CAM professions.
RESULTS: In 2010, ACCAHC resolved to identify the competencies necessary for this transformation, and in the process, discovered a parallel process of competency development within conventional healthcare, the Interprofessional Education Collaborative (IPEC), representing the six major conventional healthcare professions.
CONCLUSIONS: The ACCAHC competency document, its development, and its similarity to the IPEC document are discussed. The ACCAHC competency document identified two domains of competence that were not present in the IPEC document: evidence-informed practice and institutional healthcare practices. These two domains of competency are discussed with respect to their significance in both CAM and conventional healthcare practices.
CONCLUSIONS: ACCAHC\'s goal is to foster collaboration among its member professions and with conventional healthcare professions, and to use these competency documents to improve and optimize healthcare delivery, practices, and outcomes in America. It is hoped that ACCAHC\'s competency document will catalyze interaction with IPEC leading to the adoption of a single shared competency document that will meet the needs of all healthcare providers and educators.