Abstract Background Chronic non-specific back pain (CBP) is a leading cause of disability worldwide and is commonly associated with limitations in movements such as lifting. Although spinal manipulation (SMT) and exercise therapy (ET) are recommended treatments for CBP, their effects on objectively measured movement performance remain insufficiently explored. Open-label placebo (OLP) has gained attention for engaging placebo-related mechanisms ethically. This study aimed to investigate the immediate effects of SMT, ET, and OLP on lifting performance and pain in individuals with CBP, and to evaluate the add-on effects of OLP. Methods A motion laboratory–based crossover randomized controlled trial included 50 individuals with CBP. Participants were recruited between April and July 2025 and attended a single laboratory session between September and October 2025. Participants performed lifting tasks using light and heavy loads before and after SMT, ET, and OLP interventions in randomized order. Three-dimensional motion capture was used to assess temporal, spatial, and spatiotemporal aspects of lifting performance. Subjective outcomes included pain intensity, perceived effectiveness, willingness to undergo each treatment, and treatment preference. Data were analyzed using linear mixed-effects models and functional data analysis. Results Overall lifting performance changed to a small degree following the interventions. No significant between-group differences were observed at the primary endpoint. Significant within-group changes were observed following SMT, including altered intersegmental coordination during the light lift, characterized by a greater relative contribution of back movement early in the lifting phase, reduced thorax–pelvis tilt during the heavy lift, and reduced pain. OLP was associated with reduced thorax–pelvis tilt and increased hip and knee flexion during the light lift. Subjective evaluations did not consistently correspond to objective biomechanical changes. Conclusion SMT, ET, and OLP demonstrated limited immediate effects on overall lifting performance in individuals with CBP. However, some within-group changes in thorax–pelvis movement and intersegmental coordination suggest that certain aspects of movement quality may respond to short-term interventions even when conventional biomechanical outcomes remain largely unchanged. The findings suggest the value of integrating subjective and objective outcomes, while advanced biomechanical analyses may provide insight into subtle movement changes in CBP. Trial registration The trial is registered at ClinicalTrials.gov (ID NCT06891625).
Abstract Background Cervical artery dissection (CeAD) is a rare but life-threatening condition that commonly presents with non-specific symptoms such as neck and head pain, complicating early recognition in ambulatory care settings. The CeAD diagnostic decision support tool (DDST) is a 4-item assessment designed to identify patients that should be referred for advanced diagnostic work-up to rule out CeAD; however, its utility in ambulatory settings has not been established. Methods This quality improvement project aimed to evaluate the accuracy, inter-rater reliability, and intra-rater reliability of chiropractors applying the CeAD DDST using clinical vignettes simulating a typical ambulatory encounter before deploying the DDST broadly as part of the clinical workflow. Five experienced chiropractors assessed 40 standardized clinical vignettes. CeAD-positive cases (n = 10) were derived from published imaging-confirmed ambulatory care case reports. CeAD-negative cases (n = 30) were developed using generative artificial intelligence and refined by senior authors to reflect common conditions encountered in chiropractic practice. Raters independently assessed cases with the DDST (score 0–4), with a cutoff score of ≥ 3 recommending referral for advanced diagnostic work-up in two rounds, beginning November 11, 2025 and January 07, 2026, with a two-week capture period. Accuracy, inter-rater reliability, and intra-rater reliability were assessed. Results Accuracy in identification ranged from 72.5% to 95.0% across raters and rounds. False positives and negatives were present across raters in both rounds, with false positives being more prevalent. Inter-rater reliability was moderate to substantial in both rounds (Round 1: κ = 0.609, 95% CI 0.432–0.806, Round 2: κ = 0.540, 95% CI 0.365–0.735). Intra-rater reliability ranged from moderate to almost perfect agreement (range 0.457–0.931). Conclusions The CeAD DDST demonstrated moderate to good accuracy and reliability among chiropractors in a simulated ambulatory setting. The presence of false negatives and inter-rater reliability falling below recommended benchmarks preclude recommendation for implementation at this time. Iterative refinement informed by end-user input and prospective ambulatory testing is warranted prior to clinical adoption of the CeAD DDST. Future evaluations should include prospective studies using real clinical data to better represent real-world settings.
Abstract Background Compensation claims represent a selective subset of adverse events in healthcare and provide insight into patient safety. Compensation claims vary between countries and jurisdictions due to administrative, legal, and clinical differences. This study aimed to describe compensation claims related to chiropractic consultations in Norway from 2013 to 2024. Methods We conducted a retrospective registry study using data from the Norwegian System of Patient Injury Compensation and national chiropractic consultation data. All completed claims associated with chiropractic care between 2013 and 2024 were included regardless of whether they were approved or rejected. Claim frequencies were calculated per 100,000 consultations and per first-assessment consultations. Descriptive analyses were used to summarise results. Results A total of 147 claims were filed during the study period, of which 17 (12%) were approved. Over 24 million chiropractic consultations were recorded for the period, corresponding to an average annual claim approval rate of 0.1 per 100,000 consultations and 0.5 per 100,000 first-assessment consultations. Most claims involved musculoskeletal conditions (89%). High approval proportions were observed for claims related to central nervous system and circulatory disturbances (60%). The most common reasons for rejection were lack of causation and absence of healthcare failure. Total compensation amounted to 21.7 million Norwegian Kroner (~ 2.2 million Euros). Conclusions Compensation claims related to chiropractic care in Norway are rare relative to consultation volume, and only a small proportion were approved. Most claimants presented with common musculoskeletal conditions, while approved cases often involve serious events temporally associated with chiropractic consultations. These findings contribute updated national evidence on compensation claims in chiropractic practice and may inform quality improvement and policy.
Abstract Background Asymmetrical load carriage is a common component of daily activities. Carrying a backpack, handbag, or groceries on one side for example alters the center of mass of the system and may challenge postural stability. Such asymmetrical demands on postural control may be a meaningful stressor to evaluate and address during clinical management. Objective To determine the influence of lateral asymmetrical load on postural metrics, whether greater loads produce larger responses, and whether location of the load affects the response. Methods Twenty-four healthy young adults (21.13 ± 1.48 years) participated in this repeated-measures study during November 2025. Participants completed five standing conditions including no load, handheld as well as shoulder loads at 15% and 20% body mass using the same backpack. Postural metrics were assessed using a force plate. Outcome measures included average mediolateral center of pressure location (COP X), average anteroposterior center of pressure location (COP Y), 95% ellipse area of postural sway, and total path length. Repeated measures analyses of variance with planned contrasts were performed to evaluate differences among conditions. Results Loaded conditions demonstrated greater mediolateral shift in COP X (toward the side of load), greater 95% ellipse sway area, and greater path length compared with the no load condition. Greater magnitude loading (e.g. 20% vs. 15%) amplified both COP X and path length. Hand loading increased mediolateral shift in COP X more than shoulder loading whereas shoulder loading increased 95% sway area more than the hand. Load location did not affect path length. Lateral loading had no statistically significant effect on COP Y. Conclusions Both load magnitude and load location influence postural control metrics during asymmetrical load carriage. Clinicians may use this information to guide patients toward safer load carrying strategies when attempting to reduce postural instability and musculoskeletal strain.
Abstract Background Spinal manipulation (SM) and spinal mobilization (Smob) are conservative therapies recommended by several clinical guidelines for the treatment of chronic neck pain (CNP). The purpose of this study was to investigate differences between clinical and neuromechanical effects of SM and Smob in patients with CNP. Methods This study was a randomized mechanistic cross-over trial. Eighty-nine individuals with mechanical neck pain participated in two sessions, 72 h apart, where they randomly received either SM or Smob during the first session and the other intervention during the second session. Recruitment took place in Zurich from August 2023 to January 2024, and in Trois-Rivières from March 2024 to June 2024. Cervical range of motion (ROM), pain intensity, grip-strength and pressure pain threshold (PPT) outcomes were assessed before and after each treatment, while muscular activity was recorded during the treatment using surface electromyographic electrodes (EMG). PPT and EMG activity were assessed for three muscles bilaterally: sternocleidomastoid (SCM), upper trapezius (UT) and tibialis anterior. Outcomes following SM and Smob were compared using linear mixed-effects model, Wilcoxon signed-rank test and McNemar test. Results All ROM increased significantly over time after SM and Smob with no difference between interventions. However, pain intensity analyses showed a significant time x intervention interaction indicating a greater improvement following SM (mean decrease: 0.786 NPRS points) compared with Smob (mean decrease: 0.373 NPRS points) ( β = 0.413, 95% CI [0.160; 0.665], p = 0.002). Muscular response was significantly higher after SM compared to Smob for both SCM (0.144 ± 0.121 vs. 0.023 ± 0.013) and UT (0.083 ± 0.100 vs. 0.024 ± 0.025) muscles, on both sides. A higher PPT was observed for SCM and UT after both interventions. No consistent change was observed for grip-strength. Overall, results showing statistical significance did not reach clinical significance. Conclusion Although SM and Smob both led to higher ROM, SM resulted in immediate lower subjective pain intensity and yielded higher muscular responses for participants with CNP. However, given the mechanistic nature of this study and the absence of clinically significant findings, caution is warranted when considering implications for clinical practice. Trial registration This trial was registered with Open Science Framework (OCF) on May 23, 2023. https://doi.org/ https://doi.org/10.17605/OSF.IO/UNBJ5 .
