CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
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discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Headaches
This tool provides information to facilitate the management of persistent headaches associated with neck pain for adults.
Focused examination
1. Patient History
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Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.
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Address prognostic factors that may delay recovery.
Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):
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Worsening headache with fever; sudden-onset headache (thunderclap) reaching maximum intensity within 5 minutes; new-onset neurological deficit; new-onset cognitive dysfunction; change in personality; impaired level of consciousness; recent (typically within the past 3 months) head trauma; headache triggered by exertion (e.g., cough, valsalva maneuver (trying to breathe out with nose and mouth blocked), sneeze or exercise); headache that changes with posture; symptoms suggestive of giant cell arteritis; symptoms and signs of acute narrow-angle glaucoma; a substantial change in the characteristics of the patient’s headache; new onset or change in headache in patients who are aged over 40; headache wakening the patient up (migraine is the most frequent cause of morning headache); patients with risk factors for cerebral venous sinus thrombosis; jaw claudication or visual disturbance; neck pain or stiffness; limited neck flexion upon examination; new onset headache in patients with a history of human immunodeficiency virus (HIV) infection; new –onset headache in patients with a history of cancer
Examples of other conditions/co-morbidities:
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Physical conditions: back pain, neck pain
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Psychological conditions: depression, anxiety
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Co-morbidities: diabetes, heart disease
Examples of prognostic factors that may delay recovery:
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Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization
2. Physical Examination
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Assess levels of concern regarding major structural or other pathologies.
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Assess for neurological signs.
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Identify type of headache.
Tension-type headache feels like there is a tight band around the head
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Episodic: at least 10 episodes occurring on ≥1 but <15 days per month for at least 3 months (≥12 and <180 days per year)
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Chronic: occurring on ≥15 days per month on average for >3 months (≥180 days per year)
Cervicogenic headache is head pain coming from the neck
3. Management
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Offer information on nature, management, and the course of headaches associated with neck pain. See patient handouts for more information to provide to patients.
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Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.
Patient Handouts
Management of persistent (>3 months duration) cervicogenic headaches
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider low-load endurance craniocervical and cervicoscapular exercises with resistance
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Consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine
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Do not offer multimodal care that includes a combination of exercise, spinal manipulation and spinal mobilization
Management of episodic tension-type headache (>3 months duration)
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and the following therapeutic intervention*:
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Consider low-load endurance craniocervical and cervicoscapular exercises with resistance in addition to structured patient education
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Do not offer manipulation of the cervical spine
Management of chronic tension-type headache (>3 months duration)
Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
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Consider general exercise (including warm-up, neck and shoulder stretching and strengthening, and aerobic exercise)
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Consider low-load craniocervical and cervicoscapular exercises
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Consider multimodal careᶧ combining spinal mobilization, craniocervical exercise and postural correction
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Consider clinical massage
Do not offer manipulation of the cervical spine as the sole form of treatment
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
ᶧMultimodal care: treatment involving at least two distinct therapeutic modalities, provided by one or more health care disciplines.
Care Pathway for the management of cervicogenic headaches
Care Pathway for the management of tension-type headaches
Exercise Videos
The shoulder pain videos are based on the recommendations from the Clinical Practice Guideline for the Management of Shoulder Pain. Select a link below to view the patient exercise videos.
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors that may delay recovery.
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.