How commonly and how quickly does low back pain reoccur in a cohort of people who have recently recovered from an episode of low back pain? What are the prognostic factors for a recurrence of low back pain? Prospective inception cohort study with monthly follow-up for 12 months. A total of 250 patients who had recovered from an episode of low back pain within the last month. The primary outcome was days to recurrence of an episode of low back pain. Secondary outcomes were: days to recurrence of low back pain severe enough to limit activity moderately, and days to recurrence of low back pain for which healthcare was sought. Within 12 months after recovery, 69% (95% CI 62 to 74) of participants had a recurrence of an episode of low back pain, 40% (95% CI 33 to 46) had a recurrence of activity-limiting low back pain, and 41% (95% CI 34 to 46) had a recurrence of low back pain for which healthcare was sought. The median time to recurrence of an episode of low back pain was 139 days (95% CI 105 to 173). Frequent exposure to awkward postures, longer time sitting (> 5 hours per day), and more than two previous episodes were predictive of recurrence of an episode of low back pain within 12 months (p < 0.01). Recurrence of low back pain is very common, with more than two-thirds of individuals having a recurrence within 12 months after recovery. Prognostic factors for a recurrence include exposure to awkward posture, longer time sitting, and more than two previous episodes.

Introduction: Primary degenerative scoliosis represents a new scoliosis developing in patients with no prior history of spinal curvature. Researchers sought to determine the prevalence of this type of scoliosis. Methods: MEDLINE, Embase, CINAHL, Web of Science and PubMed were searched from inception to 28th March, 2018. Studies that assessed adults from the general population for scoliosis using imaging techniques were included. Studies were included only if the study authors had excluded participants with previously diagnosed scoliosis and/or spinal disorders. Mixed-effects logistic-regression was used to establish an overall prevalence estimate with 95% confidence intervals (primary outcome) and to examine the effect of age and sex (secondary outcomes). Results: Four cross-sectional studies and one cohort study, involving 4069 participants (66.6% Female), aged between 41 and 94 years, were eligible for inclusion. Reported prevalence figures ranged from 13 to 68%. The pooled prevalence estimate from the mixed-effects logistic regression analysis was 37.6% (95% CI 18.7–61.8). Females were more likely to suffer from scoliosis compared with males (p < 0.001), with prevalence figures of 41.2% (95% CI 20.7–65.8) versus 27.5% (95% CI 12.2–51.1), respectively. Individuals aged < 60 years had a prevalence of 13% (95% CI 5.2–30.2), whereas the prevalence estimates were substantially higher in the > 60 age group [36% (95% CI 17.4–60.6)]. Conclusion: Primary degenerative scoliosis is a highly prevalent condition, especially in females. Further research targeting this type of scoliosis is required to obtain more precise global prevalence estimates and to understand the influence of age and sex.

The purpose of this study was to describe patient characteristics and summarize their perceptions of chiropractic in Australia. This study is part of a broader study aiming to extend the knowledge of the role of chiropractic within the current health care environment. A 33-item, paper-based, cross-sectional survey of a sample of patients from 100 systematically sampled chiropractic clinics from all the states and territories of Australia was conducted. The survey focused on patient demographics, socioeconomic status, perceived health status, and perceptions of chiropractic and chiropractic services. A total of 486 responses were received (24.3% response rate). Respondents were predominantly female patients (67.1%) of the 45- to 64-year age group. Approximately half of the respondents reported a pretax annual income exceeding $40000. Most patients sought chiropractic services because of musculoskeletal disorders (68.7%) and for general health (21.2%), and personal beliefs motivated most respondents (70.2%) to visit a chiropractor. Most respondents would seek the chiropractic services again (97.5%) and were satisfied with the service received. The results of this study show that the typical chiropractic patient in Australia is a middle-aged woman with a moderate to high income. Although only a small proportion of the Australian population sees a chiropractor, this group seems to be satisfied with the service.

Background: There is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population. Methods: CINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence. Results: Ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with follow-up times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study noted discomfort associated with bracing. Each of the six cohort studies demonstrated a high risk of bias. Conclusion: There is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium term influence on pain and function in adults with either progressive primary (de novo) degenerative scoliosis or progressive idiopathic scoliosis. At this point in time the evidence is of low quality and has been focused primarily on female patients with thoracolumbar and lumbar curves. More granular statements regarding the efficacy of different brace types or manufacturers, or the effect of this therapy on different curve types cannot be determined based on the current literature. Properly constructed prospective trials are required to better understand the efficacy of bracing in adult scoliosis.

Background: Chiropractors, physiotherapists, and osteopaths receive training in the diagnosis and management of musculoskeletal conditions. As a result there is considerable overlap in the types of conditions that are encountered clinically by these practitioners. In Australia, the majority of benefits paid for these services come from the private sector. The purpose of this article is to quantify and describe the development in service utilization and the cost of benefits paid to users of these healthcare services by private health insurers. An exploration of the factors that may have influenced the observed trends is also presented. Methods: A review of data from the Australian Bureau of Statistics, Australian Health Practitioner Regulation Agency, and the Australian Government Private Health Insurance Administration Council was conducted. An analysis of chiropractic, physiotherapy and osteopathic service utilisation and cost of service utilisation trend was performed along with the level of benefits and services over time. Results: In 2012, the number of physiotherapists working in the private sector was 2.9 times larger than that of chiropractic, and 7.8 times that of the osteopathic profession. The total number of services provided by chiropractors, physiotherapists, and osteopaths increased steadily over the past 15 years. For the majority of this period, chiropractors provided more services than the other two professions. The average number of services provided by chiropractors was approximately two and a half times that of physiotherapists and four and a half times that of osteopaths. Conclusions: This study highlights a clear disparity in the average number of services provided by chiropractors, physiotherapists, and osteopaths in the private sector in Australia over the last 15 years. Further research is required to explain these observed differences and to determine whether a similar trend exists in patients who do not have private health insurance cover.

The COVID-19 pandemic has impacted a wide range of health services. This study aimed to quantify the impact of the COVID-19 pandemic on manual therapy service utilization within the Australian private healthcare setting during the first half of 2020. Quarterly data regarding the number and total cost of services provided were extracted for each manual therapy profession (i.e., chiropractic, osteopathy, and physiotherapy) for the period January 2015 to June 2020 from the Australian Prudential Regulation Authority. Time series forecasting methods were used to estimate absolute and relative differences between the forecasted and observed values of service utilization. An estimated 1.3 million (13.2%) fewer manual therapy services, with a total cost of AUD 84 million, were provided within the Australian private healthcare setting during the first half of 2020. Reduction in service utilization was considerably larger in the second quarter (21.7%) than in the first quarter (5.7%), and was larger in physiotherapy (20.6%) and osteopathy (12.7%) than in chiropractic (5.2%). The impact varied across states and territories, with the largest reductions in service utilization observed in New South Wales (17.5%), Australian Capital Territory (16.3%), and Victoria (16.2%). The COVID-19 pandemic has had a profound impact on manual therapy service utilization in Australia. The magnitude of the decline in service utilization varied considerably across professions and locations. The long-term consequences of this decline in manual therapy utilization remain to be determined.