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

Acknowledgement

hpollard@optushome.com.au

Thank you

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

RecordPro

•  What do we do best? – Strong statistical analysis program – Flexibility for sport specific requirements – High level professional reporting – Real time athlete profile updating – Remote access database – Flexible data collection fields – Easy to use