 It's time for This Week in ChiroPractic. I'm Dr. Nathan Cashin and here are the headlines for the week of February 28, 2021. In news, a new mobile app promises to be the solution to chiropractic job searches. ChiroPair is the first and only chiro-specific app to find and post jobs. It will be free for candidates seeking jobs and will charge employers a monthly fee for posting jobs. It is set to launch in April of this year. In events, the World Federation of ChiroPractic has announced their biennial Congress will be held virtually in 2021. The event will be held in partnership with Parker seminars to provide virtual presentation facilities, which promise a unique user experience. The theme is chiropractic for a new normal, and will be held September 23 through 25. The first ever Carl Oquium is set to be held this week. This virtual conference for the chiropractic community will feature keynote speakers and live poster sessions held in a virtual world, much like Second Life. Abstract submissions are now closed, but there may still be time to register as an observer. In research, a study in JAMA reveals that acute low back pain patients exposed to guideline discordant care are more likely to become chronic. Of the 5,233 patients with acute low back pain, one-third became chronic at six months. These patients were more than two times more likely likely to transition to chronic pain if exposed to three non-concordant processes of care within the first 21 days. Other characteristics associated with transition to chronic low back pain included obesity, severe disability at baseline, and depression or anxiety. The Global Summit on the Efficacy and Effectiveness of Spinal Manipulative Therapy found no evidence of an effect of spinal manipulative therapy for the management of non-muscular skeletal disorders, including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. World Spine Care and the Global Spine Care Initiative released a paper describing the development of their guides for managing back and neck pain during the time of COVID-19. This paper written by a team of 29 participants from 10 countries on four continents describes an open, progressive, iterative approach to creating the free guides which promise to empower patients and clinicians to manage uncomplicated spinal pain and may reduce overutilization when direct access to a spine care clinician is unavailable. Those are the headlines for this week in chiropractic for February 28th, 2021. For links to these stories and more, visit exploringchiropractic.com slash twitch. So pretty light on the news, although quite a bit of research coming out this week. Let me just go ahead and share my screen with you. So did you guys see this ad for chiropractic? It's been popping up for me over and over on Facebook and Instagram. It promises to be the first and only chiro specific app to find and post jobs. There's quite a few websites that allow that are job classifies. None of them are very good. And having it as a mobile app may be interesting. But again, I'm not so sure that that's these types of specific apps are as necessary anymore, especially with responsive design on mobile web pages. But it'll be interesting to see how they approach this. I've noticed that they've had billboards in Georgia, presumably outside of Palmer, which is, you know, the largest chiropractic school in the States. Doesn't really mention whether it will be international, although I would assume that they'll do that. Again, it'll be interesting to see how this works. It's fairly expensive for employers. Most classifieds such as the universities, the chiropractic schools, and some of the private charge somewhere around $100 a month is most common for what I've seen and sometimes even $100 for a three month posting. So $199 a month for employers when those employers usually are not continuously looking for new employees. But it's like, you know, I need a new associate. I'm going to post this for a month. That looks like that can be pretty expensive. But for those who are doing it and want to post it for a year, it's a better value, although $18.95 for a year still seems to be quite a bit. So also curious to see which types of jobs, is it just private clinics, you know, probably high PI type jobs, or will they be posting for hospital positions, for locum positions, that type of thing. So interested to see, I'm always interested when chiropractors try to harness or leverage newer technology, even though an app is, you know, 10 years old now. The World Federations Virtual Congress will be in September and it will be virtual and they're partnering with Parker. Now, I've not been able to attend any of the Parker seminars recently that they've been doing virtually Parker XR and Nexus, I think have been some recent ones. By the looks of them, they look pretty good, you know, full studio setup, where the presenters are there with a professional team. So it sounds like that's what the WFC will be doing. Although the mention here of a virtual platform and the iPoster session reminds me of the Karloquium, which we'll come to in just a moment. And in this virtual presentation facilities kind of makes me worry they're going to be using Verbella as part of this as well. And it remains to be seen how that will go with Karloquium, but I'm not too optimistic on it. Chiropractic Career New Normal is the theme, which, you know, this whole new normal thing is kind of cliche. But I think it's important to, you know, talk about how to continue progressing the profession in the wake of COVID-19. And even, you know, by September, it may not be history still. It may be very much our current reality even then. So a statement here by Richard Brown that the opportunity to host a virtual congress means that we can reach our entire global community of chiropractors. See, this is why it always surprises me that organizations like WFC and even bigger ones have not embraced virtual yet. People cannot travel to, you know, five, six conventions or congresses or conferences a year. Why not do it for sure? We've been able to do this stuff for years. And so that COVID was the thing that had to kick this into gear kind of still surprises me. So registration's not open yet. Just to save the date, abstracts will be submissions for abstracts will be announced in March. So again, the Carl Aquian, we've talked about this before coming up in a couple of days. I'll be attending. I'm actually now presenting the World Spine Care and Global Spine Care Initiative article that I mentioned in the headlines. I was one of the authors on that paper and created a poster kind of last minute because that that paper was published only two weeks ago. And so I kind of decided, Hey, why don't we, you know, submit this as a poster? There are over a hundred posters that will be at this conference. And again, it's going to be this virtual like second life or fortnight type world where you walk through as an avatar. And man, the avatar design is not great. I created mine and it's just such low resolution and just it was hard to get it to look like me, you know, you can pick hats and stuff, but they don't sit on the head very nicely. They don't match with the hairstyle that you might have picked. But I just, I do appreciate that that groups or organizations like Carl are trying something new. I'm sure we're all, you know, zoomed out. We're fatigued by being on zoom meetings all day long for everything else we're doing that this is at least going to be something fun. I don't think it's going to work very well, but I think it's it'll be fun to try something new. So a few key notes will be happening. And then the poster sessions and they have time time zones for all around the world, but it's just two hours each day. There will be a 20 minute keynote followed by two 40 minute poster sessions, followed by another 20 minute keynote or or some type of address. So looking forward to it. I think this is going to be interesting. Even if I don't think the technology is the right choice, but but I might be wrong. And I'm going to be curious to hear what you think as well. If you participate, if you join, do you like flying around in a virtual world and talking to people who might, you know, be either lagging from latency or just not even there, right? I'm going to have to sign in, but keep watching my kids. So I don't know if I'm going to be able to talk to people. Here's an interesting paper from JAMA looking at the risk factors associated with transitioning from acute chronic low back pain specifically for us patients seeking primary care. So they go to the doctor, the medical doctor, presumably, how likely are they to transition to chronic low back pain instead of acute and surprisingly a third of these patients became chronic and the factors that led to that were obesity, depression, anxiety, and high disability at baseline. But the paper really emphasizes the guideline discordant care, meaning these MDs, these GPs, are not following guidelines for low back pain. They may be getting too much imaging. They may be providing opioids. And when they do this, that leads to a higher risk of developing chronic low back pain. And so the odds were 1.39 to 2.16 times more likely to develop chronic low back pain if the patient was exposed to one, two or three non-concordant processes of care within the first 21 days. We know that medical doctors don't follow guidelines, but this is surprising to see how much of an effect it has on the chronicity, on increasing the chronicity of the low back pain. So just another reminder of how important it is to follow the guidelines, not to over image, not to provide opioids and to take a conservative approach. So a global summit on the efficacy and effectiveness of spinal manipulative therapy for prevention and treatment of non-musculoskeletal disorders. This is obviously going to be controversial, but led by Pierre Cotet on hardfixin and others. And they basically came together for a few days, a couple of days in Canada, 50 researchers from eight countries and 28 observers from 18 chiropractic organizations and reviewed the literature and said, look, do these claims of curing infantile colic of non-musculoskeletal conditions, do they hold up in the literature? And the answer is no. There's no evidence of an effective SMT for the management of non-musculoskeletal disorders, including infantile colic childhood asthma, hypertension, primary dysmenorrhea and migraine. Migraine is surprising. There have been some papers that discuss that and show benefit. But again, from the perspective of a systematic review, the evidence is lacking. So certainly challenges, you know, there's more vitalistic chiropractors who claim these things. But the challenge here and what a lot of people are worried about is that insurance companies, governments, third party payers will begin to cut back on reimbursement even for things that it may be helpful. And again, what do you think? I mean, when evidence is lacking, what should that mean for policy, for insurance reimbursement? When clinicians say, you know, I see people get better all the time. I find this challenging. I don't really know what to do about this. So let me know your thoughts in the comments on the webpage or on social media. I'd like to hear what you think. As I mentioned, I was an author of this paper. So this is a bit self-serving, I admit. But this paper on distance management of spinal disorders during the COVID-19 pandemic and beyond evidence-based patient and clinician guides from the Global Spine Care Initiative and from World Spine Care. So if you don't know World Spine Care, say multinational non-profit, they have clinics in four countries providing primary spine care. But those clinics closed in March of 2020 when the pandemic hit. And members of World Spine Care kind of quickly realized we need to figure out something to do with our volunteers and with our time when we can't be seeing patients in the clinic and realize that many chiropractic clinics at the time were closing. And when clinics close, it doesn't mean people stop having back pain. So how do you address that? How can patients connect with doctors if they have a concern for low back pain or neck pain when they can't actually be seen in person? And so the attempt here, and this is led by Scott Haldeman and Margarita Nordin and 28 researchers and laypeople as well involved with World Spine Care or the GSCI to come up with kind of a step-by-step approach. And there is a guide for clinicians, a five-step guide, where they get the basic information screened for red flags, determined based on the Global Spine Care Initiative papers that were published in 2018, following those guidelines, determining what type of care does this need? Can it be managed at home by the patient with some guidance via telehealth or phone calls? Or is this urgent and should the patient go to the emergency department? There's also a patient guide, which is two steps. And again, basically rules out red flags with a couple of questions and then gives options for home care, rehabilitation, movement, and provides other resources. And so this paper came out in JMIR, the Journal of Medical and Internet Research, Public Health and Surveillance Journal. It's a subsidiary of the JMIR main journal, but a high impact factor. And pretty proud of this. It was, you know, experience as my first, being my first experience being an author on a paper. You know, I basically kind of stood back and gave feedback where I felt I could offer something, but you know, got to see what basically was a long email chain back and forth, creating these guides, outlining them and then tweaking them here and there. Great experience working with, of course, some really well known researchers who all provided input. And then I was able to privilege to design these guides and publish them as a PDF. And so they're available on the World Spine Care webpage as a free download. And we'll be potentially following up with these with some other tools. What we realized is that this does not only benefit patients and clinicians during the COVID pandemic, because in many countries and many parts of the world, even in developed countries, there is oftentimes limited access to spine care providers by people with spine pain. And so this can serve them as well despite the pandemic, whether the pandemic ends or continues. This can be used in a number of situations, which is why it was termed distance management of spinal disorders. So great experience for me. Hope you check it out and check out the guides and the poster session at Carl Oakwium. A little bit short on news this week, the past two weeks really having to catch up here. But quite a few research papers. We'll talk about a few more in the next episode. In the meantime, you can follow me on social media at exploring Cairo on Facebook, Twitter, Instagram, TikTok, and visit the website exploring chiropractic.com slash TWI CH for this week in chiropractic. I'm Nathan Cashion. And thanks again for joining me. We'll see you again in the next one.