Abstract Background Low back pain (LBP) is the leading cause of years lived with disability globally and a major contributor to disease burden in Australia. Superficial heat is recognised as a non-pharmacological intervention for LBP. However, its clinical use among chiropractors and osteopaths remains unclear. Objective To examine how chiropractors and osteopaths in Australia use superficial heat in the management of LBP, explore their perceptions of its role and effectiveness, and assess their awareness and application of clinical practice guidelines for LBP. Methods A cross-sectional survey was conducted between June and October 2022 among registered chiropractors and osteopaths in Australia. The online 43-item questionnaire captured demographic, practice, and clinical data. This included frequency and method of superficial heat use, perceived effectiveness, and awareness of clinical practice guidelines for LBP. Descriptive statistics were used to summarise findings. Results A total of 341 practitioners completed the survey (78.3% chiropractors, 21.7% osteopaths). This represents approximately 3.5% of the total registered chiropractic and osteopathic workforce in Australia. Approximately half of all respondents (44.6%) reported using superficial heat for LBP in the preceding 12 months. Among those, chiropractors were more likely to use superficial heat for chronic LBP (44.6%) than for acute LBP (13.8%), whereas osteopaths were more likely to use it for acute LBP (20.3%). Superficial heat was acknowledged by 71.3% of respondents to have a role in LBP management, while 66.0% regarded it as an adjunct to spinal manipulation. In contrast, superficial heat was recommended for self-management by 34.1% of chiropractors and 28.4% of osteopaths. Awareness of LBP clinical guidelines was moderate, with 58.4% of practitioners reporting they knew how and where to access them. Chiropractors most commonly referred to the American College of Physicians (ACP) guidelines, whereas osteopaths more frequently used the UK NICE guidelines. Conclusion Despite its recognised clinical value, the use of superficial heat for LBP was limited, with 44.6% of practitioners reporting its use in practice, and fewer chiropractors (34.1%) and osteopaths (28.4%) recommending it for patient self-management. These findings indicate a gap between awareness and guideline-concordant care, highlighting the need for targeted education and clearer clinical guidance to support its consistent integration within multimodal LBP management.

Abstract Background Spinal pain and disorders are a major burden on our population and health systems. Previous research showed people with diabetes were 1.35 times and 1.24 times more likely to report low back pain and neck pain than people without diabetes respectively, but diabetes was not a predictor of future spinal pain. Here we update a previous systematic review to determine whether in an adult population, diabetes is associated with low back, neck, or spinal pain. Methods The search was performed in PUBMED, Medline, CINAHL and EMBASE. Studies between 2017–2025, of cross-sectional, case–control, twin-control, and cohort designs, assessing diabetes and low back, neck, or spinal pain in adult populations, were included. Excluded were single-case studies, spinal pathologies, multiple chronic diseases, additional pain sites, and gestational or pre-diabetes. Two independent reviewers extracted data on the incidence of pain and reported associations. Odds ratios (ORs) of the association between the exposure (diabetes) and outcome (back, neck, or spinal pain) were calculated using a random effects model. Systematic review registration: PROSPERO registration CRD42022333064. Results A total of 15 studies were included with 11 studies included in the meta-analysis. When compared to people without diabetes, people with diabetes had 1.44 times higher odds of reporting low back pain (n = 592,901; OR 1.44; 95% Confidence Interval (CI) 1.20- 1.74; p = 0.001), a 1.11 times higher odds of reporting neck pain (n = 465,130; OR 1.11; 95%CI 1.13–1.20; p = < 0.001) and a 1.42 times higher odds of reporting spinal pain (n = 1,335,999; OR 1.42; 95%CI 1.26–1.63; p = < 0.001). Diabetes was significantly associated with 1.27 times higher odds of developing spinal pain (n = 35,435; OR 1.27; 95%CI 1.08–1.50; p = 0.004) and 1.44 higher odds of developing neck pain (n = 15,075; OR 1.44; 95%CI 1.09 -1.90; p = 0.010). There was no significant association between diabetes and developing low back pain (n = 21,215; OR 1.11; 95%CI 0.88–1.41, p = 0.388). Conclusions With the inclusion of fifteen additional studies providing an overall sample size five and a half times larger than the previous review, diabetes was associated with prevalent neck, low back and spinal pain, as well as incident neck and neck and spinal pain. Clinicians must be adept at identifying co-morbid conditions and risk factors, understanding the interplay between them and creating well managed networks to address these complex presentations.

BackgroundGlobally, almost one-third of adults are considered physically inactive. Chiropractors knownly promote physical activity (PA) within their musculoskeletal management plans, despite their limited PA and sedentary behavior (SB) guideline knowledge.ObjectiveTo deepen our understanding of chiropractors' perspectives, including factors that may influence PA promotion. Specifically our objectives are to (1) explore chiropractors' knowledge of PA guidelines, (2) examine chiropractors' practices in PA assessment and advice, and (3) identify barriers, enablers, and factors influencing PA promotion in chiropractic.MethodsTwenty registered Australian chiropractors were interviewed to understand their perspectives on promoting PA in practice. We used a qualitative descriptive approach with inductive content analysis to identify patterns and themes.ResultsFour themes captured chiropractors' perspectives regarding PA: (1) chiropractors striving to take a person-centered approach to PA promotion, (2) chiropractors had limited knowledge of the PA/SB guidelines, (3) chiropractors relied on their personal intuitions and experience to try and be PA role models for their patients, and (4) chiropractors identified important enablers including longer appointment time and patient motivation as well as barriers such as limited knowledge, skill and time. Chiropractors identified interest and motivation as patient barriers.ConclusionChiropractors have limited PA/SB guideline knowledge but nevertheless report being confident, safe and person-centered with respect to PA promotion, often relying on their own experiences to be PA role models for their patients. Supporting behavior change among chiropractors, while addressing time constraints and patient motivation are important considerations.

BACKGROUND:Research on perception of chiropractic is abundant in Western contexts, yet sparse in Asia. This study aims to bridge this gap by examining the perceptions of chiropractic among Taiwanese adults, focusing on demographics, utilisation, beliefs, and understanding. METHODS:An adapted survey with 27 close-ended items was administered to assess Taiwanese adults' perception of chiropractic. The electronic survey, using Qualtrics, was delivered worldwide via Taiwanese Facebook groups from January 31 to March 31, 2024. Descriptive statistics, including frequencies and cross tabulations, were performed. RESULTS:A total of 769 individuals were surveyed, with 475 participants providing complete data. Over half of the participants (62%) had never visited a chiropractor, but in those who had visited a chiropractor 78% reported satisfaction. Of 475 participants, 45% considered chiropractic care safe while 34% were unsure. Though almost half (42%) were unclear about what chiropractors do, most participants (67%) expressed interest in learning more. Among the 151 participants with prior experience of chiropractic care, the demographic profile was 54% women, and individuals aged 28 to 37 (44%), and those with an undergraduate degree (52%) were most common. CONCLUSION:Overall, our study found a positive perception and high acceptance of chiropractic among the Taiwanese population; however, generalisability may be limited due to the risk of selection bias. An understanding of the chiropractic profession was notably limited. Hence, efforts are needed to enhance awareness of chiropractic accreditation, clinical competencies, and its potential role in public healthcare in Taiwan.

INTRODUCTION:Low back pain (LBP) is a highly prevalent and disabling condition. People with LBP may be referred to elective surgical clinics for further evaluation and consideration of surgery. Despite long waits for an initial appointment, many of these patients are not surgical candidates and may be discharged, receiving minimal-to-no care, advice or alternative treatment options, leaving a critical gap in care. METHODS:Approximately 25 participants with dominant, chronic non-specific axial LBP who are (1) referred to and (2) discharged without spinal surgery following consultation in two elective spinal surgery clinics in Western Australia will participate in a one-on-one pre-consultation semi-structured interview and a similar post-consultation qualitative interview. Purposive sampling will be used to recruit participants. Interviews will be audio-recorded and transcribed, underpinned by a qualitative descriptive approach to explore participants' care journey, including pre-consultation expectations and overall experiences post-consultation. We will use inductive content analysis to analyse our data, allowing for the identification of themes that are generated from the participants' responses. DISCUSSION/CONCLUSION:This protocol outlines the methodological process for a qualitative study exploring the experiences and expectations of LBP patients before and after consulting in elective spinal surgery clinics in Western Australia. The findings may give rise to consumer-focused solutions to improve the care journey and highlight gaps in patient expectations and understanding of non-surgical management, informing the development of tailored educational resources, communication strategies and new care pathways. PATIENT OR PUBLIC CONTRIBUTION:This study will incorporate patient and/or public involvement by engaging representatives from Musculoskeletal Australia (https://muscha.org/) to contribute to the study design and interpretation of findings. Specifically, a consumer with lived experience of low back pain will be invited to review and provide feedback on the semi-structured interview questions, to ensure they are appropriate, accessible and reflective of patient experiences. CLINICAL TRIAL REGISTRATION:This study is not a clinical trial and is therefore not registered.

Abstract Background Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. Methods From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors’ own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. Results Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32–4.12)], while chiropractors who frequently treat children 0–3 years (OR = 0.5; 95% CI: 0.28–0.87), children 4–18 years (OR = 0.42; 95% CI: 0.21–0.86), and pregnant women (OR = 0.5; 95% CI: 0.26–0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32–6.41), were confident promoting (OR = 11.6; 95% CI: 1.37–98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03–9.99). Conclusion Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings.

Abstract Background Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection. Methods Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests. Results Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement. Conclusion GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.

Background Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. Methods Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the ‘Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices’ tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors’ views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. Results From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). Conclusion A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors’ own PA participation.

The Chiropractic Academy for Research Leadership (CARL) was formed in 2016 in response to a need for a global network of early career researchers and leaders in the chiropractic profession. Thirteen fellows were accepted competitively and have since worked together at residentials and virtually on many research and leadership projects. In 2020, the CARL program ended for this first cohort, and it is now timely to take stock and reflect on the achievements and benefits of the program. In this paper we present the structure of CARL, the scientific and leadership outputs as well as the personal value of CARL for the participating fellows. As a result of the success of the first CARL cohort, organizations from Europe, North America, and Australia have supported a second cohort of 14 CARL fellows, who were competitively accepted into the program in early 2020.

Background: A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications. Objective: To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis. Design: Systematic review and meta-analysis. Methods: MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE. Results: Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD-2.8; 95%CI-4.3 to-1.3) and older populations (SMD-0.3; 95%CI-0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD-1.0, 95%CI-1.3 to-0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis. Conclusion: Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.

Objective: To explore the self-perceived preparedness and clinical proficiency in headache diagnosis and management of Australian chiropractic students in senior years of study. Methods: Australian chiropractic students in the 4th (n = 134) and 5th year (n = 122) of 2 chiropractic university programs were invited to participate in an online cross-sectional survey. Descriptive analyses were conducted for all variables. Post hoc analyses were performed using simple linear regression to evaluate the relationship between self-perceived preparedness and correctness of headache diagnosis and management scores. Results: Australian chiropractic students in senior years demonstrated moderate overall levels of self-perceived preparedness and proficiency in their ability to diagnose and manage headache disorders. Final-year students had a slightly higher self-perceived preparedness and proficiency in headache diagnosis and management compared to those students in the 4th year of study. There was no relationship between self-perceived preparedness and correctness of headache diagnosis and management for either 4th- or 5th-year chiropractic students. Conclusion: Our findings suggest that there may be gaps in graduate chiropractic student confidence and proficiency in headache diagnosis and management. These findings call for further research to explore graduate chiropractic student preparedness and proficiency in the diagnosis and management of headache disorders.

BACKGROUND:Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta-analysis has investigated the effectiveness of SMT exclusively for CGHA. OBJECTIVE:To evaluate the effectiveness of SMT for CGHA. DATABASES AND DATA TREATMENT:Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk-of-bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow-up periods. GRADE described the quality of evidence. RESULTS:Seven trials were eligible. At short-term follow-up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] -10.88 [95% CI, -17.94, -3.82]) and small effects for pain frequency (standardized mean difference [SMD] -0.35 [95% CI, -0.66, -0.04]). There was no effect for pain duration (SMD - 0.08 [95% CI, -0.47, 0.32]). There was a significant, small effect favouring SMT for disability (MD - 13.31 [95% CI, -18.07, -8.56]). At intermediate follow-up, there was no significant effects for pain intensity (MD - 9.77 [-24.21 to 4.68]) and a significant, small effect favouring SMT for pain frequency (SMD - 0.32 [-0.63 to - 0.00]). At long-term follow-up, there was no significant effects for pain intensity (MD - 0.76 [-5.89 to 4.37]) and for pain frequency (SMD - 0.37 [-0.84 to 0.10]). CONCLUSION:For CGHA, SMT provides small, superior short-term benefits for pain intensity, frequency and disability, but not pain duration, however, high-quality evidence in this field is lacking. The long-term impact is not significant. SIGNIFICANCE:CGHA are a common headache disorder. SMT can be considered an effective treatment modality, with this review suggesting it providing superior, small, short-term effects for pain intensity, frequency and disability when compared with other manual therapies. These findings may help clinicians in practice better understand the treatment effects of SMT alone for CGHA.

Background: Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods: This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who 'often' treated patients with LBRLP compared to those who treated LBRLP 'never/rarely/sometimes'. Multiple logistic regression models identified independent factors associated with chiropractors who 'often' treated patients with LBRLP. Results: A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them 'often' treating LBRLP. Chiropractors who 'often' treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR=21.1), referred/radicular neck pain (OR=10.8) and referred/radicular thoracic pain (OR=3.1). While no specific management strategies were identified, chiropractors who 'often' treated LBRLP were more likely to discuss medication (OR=1.8), manage migraine (OR=1.7) and degenerative spine conditions (OR=1.5), and treat women during pregnancy (OR=1.6) and people with work-related injuries (OR=1.5), compared to those not treating LBRLP frequently. Conclusions: Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.

ObjectiveTo examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older.MethodsA national cross‐sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older.ResultsIn total, 73.5% of participants report “often” treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72‐2.94), working in a non‐urban area (OR 1.85; 95% CI 1.35‐2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26‐2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15‐1.96).ConclusionsThe majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group.

Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and females are known to be more susceptible to multiple joint pain sites, however the association of multisite joint pain with physical and psychosocial functions in this population are unknown.

Background: Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity. Methods: A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients. Results: Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting. Conclusion: Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.

Objective: To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice. Methods: An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests. Results: A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student's chiropractic institution (Pillai's trace =.638, F[16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice. Conclusions: Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.

In an evidence-based health care environment, healthcare professions require a sustainable research culture to remain relevant. At present however, there is not a mature research culture across the chiropractic profession largely due to deficiencies in research capacity and leadership, which may be caused by a lack of chiropractic teaching programs in major universities. As a response to this challenge the Chiropractic Academy for Research Leadership, CARL, was created with the aim of develop a global network of successful early-career chiropractic researchers under the mentorship of three successful senior academics from Australia, Canada, and Denmark. The program centres upon an annual week-long program residential that rotates continental locations over the first three-year cycle and between residentials the CARL fellows work on self-initiated research and leadership initiatives. Through a competivite application process, the first cohort was selected and consists of 13 early career researchers from five professions in seven countries who represent diverse areas of interests of high relevance for chiropractic. The first residential was held in Odense, Denmark, with the second being planned in April 2018 in Edmonton, Canada, and the final residential to be held in Sydney, Australia in 2019.

Purpose: Musculoskeletal pain is the most common cause of disability globally and is associated with tremendous health costs. Research suggests that localised musculoskeletal pain frequently coexists in more than one body region and that multisite joint pain is common. A higher number of painful sites is known to be associated with greater physical and psychological dysfunctions, impaired sleep quality and poor prognosis. Older people and females are consistently found to be more susceptible to widespread pain; women are reported to have a higher prevalence of pain at each anatomic site and a greater total number of pain sites in comparison to men. No study has looked at multi-site joint pain in a population of older women. Therefore, the purposes of this study were to report the prevalence of multisite joint pain in a community-dwelling sample of older Australian women and investigate the association between multisite joint pain and health and sociodemographic variables. Methods: The Australian Longitudinal Study on Women's Health (ALSWH), is a longitudinal population-based survey that has been studying the health of a national sample of over 40,000 Australian women since 1996. A sub study survey of 700 women selected from the 1946–1951 cohort was performed, and women were asked “Which of your joints have been troublesome (painful, aching, swollen or stiff) on most days of the past month?”. Pain was measured by the self-reported duration of pain (in months), the present pain intensity (PPI Scale) of the McGill Pain Questionnaire (Short Form) (SF-MPQ) and the PainDETECT (a self-report screening tool for neuropathic pain). Health was assessed using the SF-36 and sociodemographic variables included residence, marital status, alcohol status, employment, body mass index and medication use. Statistical analysis included comparison of three joint pain groups: no joint pain (reference group), 1-4 sites of joint pain (some joint pain) and 5+ sites of joint pain (Many joint pain sites) using chi-squared tests and one way ANOVA (for categorical and continuous variable respectively), univariate ordinal logistic regression to assess association and generalized ordinal logistic regression to describe the association between multi-site joint pain and pain, health, and sociodemographic variables. Results: Of the 700 women invited to participate in the sub study, 579 women consented to participate and returned surveys (82.7% response rate). Of the 579 women, 177 women (30.57%) reported that they had never had troublesome joints or had no joint pain in the last month. Overall, 48 women (8.29%) reported having one location of joint pain in the last month, which left 354 women (61.14%) having multi-site joint pain. 205 women (35.4%) had between 1 and 4 sites of joint pain, with 197 women (34.0%) having between 5 and 22 sites of joint pain. The most common sites of joint pain were low back (34.5%), right knee (27.5%), right hand (26.6%) and neck (25.0%). Older women with multisite joint pain had consistently, significantly poorer physical and emotional health related quality of life, as well as more severe pain, a higher proportion of neuropathic pain and a longer duration of pain. The results of the generalised ordinal logistic regression revealed that the proportional odds assumption was maintained for duration of joint pain and the number of medications, whilst the proportional odds assumption was relaxed for present pain intensity and SF-36 physical component scale (Table 1). Conclusions: Multi-site joint pain is a considerable problem in older Australia women, resulting in a significant reduction in health related quality of life. Astonishingly, more than one third of women had more than 5 sites of joint pain. Logistic regression models suggest that with an increasingly number of joint pain sites, the duration of joint pain is longer, the intensity of join pain in more distressing, physical quality of life is poorer and women are prescribed more medications. Future research will explore patterns of multi-site joint pain and the impact on physical function.

Purpose: To investigate the potential risk factors associated with the development of osteoarthritis/low back pain, after considering genetics as a potential confounder. Methods: An extensive body of research, including systematic reviews of non-twin studies and randomised control trials involving twins, was conducted by our group. Our study findings were compared to systematic reviews conducted under the Cochrane framework. Results: Our systematic review of non-twin studies has shown that depression is a risk factor for back pain (pooled OR = 1.59; 95%CI: 1.26 to 2.01), however the risk is significantly attenuated and disappears when the effects of genetics on the depression-low back pain relationship is considered in twin studies (OR = 0.92; 95%CI: 0.42 to 2.05). Not surprisingly, the results of systematic reviews conducted under the Cochrane framework investigating the effects of anti-depressants for back pain have shown no effects (pooled effect = -0.04; 95%CI:−0.25 to 0.17). Our research using twins has shown that the risk of developing back pain in people with poor sleep quality is more pronounced when the effects of genetics on the sleep-low back pain relationship is considered (OR = 2.2; 95%CI:1.2 to 3.7) as opposed to when it is not (OR = 2.0; 95%CI:1.6 to 2.5). Conclusions: Our research has shown that when a more robust and precise analysis is undertaken to consider the confounding effects of genetics, other potential modifiable risk factors associated with osteoarthritis and back pain may emerge and be more pronounced. Therefore, further research should take into consideration people's genetic predisposition to the development of osteoarthritis/back pain or the related risk factors. Ultimately, a more precise identification of the factors that prevent or cause recurrent osteoarthritis and low back pain will be a significant breakthrough, and will inform the design of effective prevention and treatment strategies. This will have significant impact to the individual and society.