chiropractic utilization at the 2009 world...
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Chiropractic utilization at the 2009 World Master
Henry POLLARD* Peter GARBUTT#
Natalie FROSTICK^ Drew SAUVE ^ Terri SOPER ^ Nancy SONG ^
#^ Department of Chiropractic, Faculty of Science, Macquarie University, Australia * The University of Notre Dame Australia, Sydney Australia
Background • Chiropractors frequently participate
in multidisciplinary healthcare teams providing management for injuries sustained during sporting events
• (Hoskins & Pollard 2010, Stude et al 2008).
• Little is known about the scope of the chiropractic involvement in these events
• (Hoskins et al 2008). • Knowledge of this involvement will
facilitate the integration of chiropractic within the healthcare team
• (Pollard et al 2007).
Aims • To analyze the injury
frequencies, characteristics and management strategies used by chiropractors / senior (final year) intern chiropractors during the World Masters Games in Sydney 2009.
• To beta test a new software program for field based electronic record keeping
Methods • Data collected from standardized paper based instrument
used by Macquarie University • Data later transferred to a new injury management and record
keeping program called RecordPro • The data obtained included:
– personal details, details about presenting complaint and relevant medical history, practitioners examination findings, diagnosis and treatment.
• The form also contained consent to treat as well as consent to collect and publish de-identified medical details.
• Electronic data analyzed to obtain descriptive statistics about the number of injuries per body region and how these injuries were managed.
Results • Retrospective analysis of paper based
records • Managed by chiropractors / intern
chiropractors during 2009 Masters Games. – 188 Chiropractors (n=75) / senior chiro
interns (n=113) – Onsite at 14 of 28 sports – 28,676 athletes – 4,600 support registrants (umpires /
team personnel) – 12000 staff and volunteers – 13,577 treatments rendered – 4,692 athletes (16.4%) received
treatment – Average age: 50.1 years.
Athlete Consulta-ons by Gender (N=4820) Male 53.8% Female 46.2%
Total Treatments (N=11,146) % Chiro 2.8 Intern 97.2
Region Injuries 1 Pelvis/Buttock 804 2 Lumbar Spine 726 3 Thoracic Spine 719 4 Thigh 649 5 Neck 427 6 Shoulder 423 7 Lower Leg 384 8 Knee 376 9 Ankle 195 10 Hip/Groin 153 11 Foot 102 12 Elbow 84 13 Chest 70 14 Wrist/Hand 50 15 Upper Arm 27 16 Forearm 22 17 Trunk/Abdominal 10 18 Unknown 9 19 Head 9
ConsultaDon by body region (n=5,239) %
15.3 13.9 13.7 12.4 8.1 8.1 7.3 7.2 3.7 2.9 1.9 1.6 1.3 1.0 0.5 0.4 0.2 0.2 0.2
Spine 51% Extremity 47%
Name Count Volleyball 616 Netball 492 Hockey 491 Softball 458 Tennis 415 Basketball 394 Football (Soccer) 296 Athletics 269 Cycling 265 Rugby Union 214 Rowing 185 Touch Football 175 Canoe / Kayak 82 Surf Lifesaving 53 Swimming 42 Badminton 39
Name Count Archery 23 Baseball 22 Weightlifting 17 Golf 15 Orienteering 8 Diving 5 Lawn Bowls 4 Squash 4 Voucher 3 Biathlon 2 Sailing 2 Shooting - Clay Target 2 Shooting - Pistol 2 Table Tennis 2 Shooting - Smallbore 1
Consulta-ons by sport (n=4598)
% 13.4 10.7 10.7 9.9 9.0 8.6 6.4 5.8 5.7 4.6 4.0 3.8 1.8 1.1 0.9 0.8
Ball sports: 8 of top 10
Treatment Type (N=13,577) Treatment Count
1 Soft tissue therapy 5586 2 Joint manipulation 3237 3 Joint mobilisation 2623 4 Stretching (static) 468
5 Exercises (strength / ROM) 452
6 Stretching (PNF) 355 7 R.I.C.E 316 8 Taping 271 9 Other 118 10 Rest 45 11 Thermal treatment 35 12 Medical Referral 11 13 Self Massage 10 14 Instrument 9 15 Imaging 9
16 Anti-inflammatories/analgesics 8
17 Brace/Orthotic device 7 18 Dietary Supplements 6 19 Wound Management 3 20 Allied Health referral 5 21 Fluid Replacement 2
% 41.1 23.8 19.3 3.6 3.3 2.6 2.3 2.0 0.8 0.3 0.2 0.1 0.1
SoP Dssue therapy: 41.1% Joint therapy: 43.1%
Exercise therapy: 9.5%
MulDmodal Management Approach
Consulta-ons by Country Country Percent
1 Australia 51.9 2 Unknown 22.0 3 Canada 8.4 4 New Zealand 4.1 5 United States of America 2.5 6 Papua New Guinea 1 7 United Kingdom 1 8 South Africa 0.5 9 Brazil 0.4 10 Russian Federation 0.4 11 Other 3.4
Discussion • Problems with paper based record keeping:
– Deforestation – Coordinating 188 practitioners – Incredibly time consuming – Data
• Missing data • Transcription errors • Inconsistent
– terminology / definitions • Jargon • No rating scales
Record Pro Software – Uses consistent definitions for accurate comparative data analysis
• user defined fields including: – Event, sport, location, age, practitioner, treatment and other user defined variables
– Intuitive flow of data entry – Accurate – Reliable – Detailed – Fast data entry – Real time record keeping – Easy to use – Research ready
• OSICS 10, VAS, other – Customisable reporting & data transfer – IOC compatible – Sport specific and sport agnostic – Highly customisable data collection fields
Conclusion • Significant chiropractic participation in the 2009
Sydney World Masters Games. – Chiropractors attended half of the sports – Worked well within multidisciplinary team
• Chiropractors managed spinal and extremity complaints to athletes of English speaking countries using a multimodal approach of joint & muscle techniques as well as exercise therapy. – A significant number of treatments were rendered to
extremity joints using a multimodal approach. – Consistent with recent reporting on chiropractic
extremity management • (Nook & Nook 2011, Hoskins et al 2006, McHardy et al 2008)
Conclusion • Significant problems with record keeping
– Needs: • Easy, fast, accurate, portable system • Reporting function • Real time updating • Alert system • Outcome measures
– developed to perform all these functions
www.recordpro.com.au
What does RecordPro offer? • Athlete injury management system. • Event reporting service
– Injuries – Support staff utilisation statistics
• Statistical analysis of all facets of injury and athlete treatment • Web based format for mobile devices • Full medical team integration • Specific injury reporting feature • Able send reports externally • Ability to manage teams within larger squads • Training vs competition injury • Universal report coding formats (OSICS, IOC, ICD-10) • Field tested
Who is RecordPro for?
• Clinicians • Team practitioners • Event managers • NSO’s • Team administrators
Reporting functions • Identifies the team, time period, year, level
of sport, total athletes, total physicians • Injury rate by sport • Injuries by region • Injury by severity • Treatments per practitioner • Missed matches/time loss • Others • Injury incidence • Risk by sport • Training or competition • Illness vs injury • New vs existing/aggravations • Mechanism • Symptoms by sport • Symptoms by age • Symptoms by level of sport • Symptoms by training vs competition • Symptoms by severity
• Symptoms by body region • Injuries by sport • Injuries by age • Injuries by level of sport • Injuries by training vs competition • Injuries by severity • Injuries by body region • Amount of treatment by sport • Amount of treatment by age • Amount of treatment by level of sport • Amount of treatment by training vs
competition • Amount of treatment by severity • Amount of treatment by body region • Training Density • Injuries by training type • Injuries by training density • Training volume measures • User definable others