News / Publications

June 5, 2018

TORONTO, June 5, 2018: The World Federation of Chiropractic (WFC) is amongst 14 international organizations that have come together to found the new Global Rehabilitation Alliance (GRA), with chiropractor and epidemiologist Professor Pierre Côté being elected to the Board. .

The GRA is an initiative of the World Health Organization (WHO) and arose out of a high-level meeting, Rehabilitation 2030: A Call To Action that took place in February 2017. WFC Disability and Rehabilitation Committee Chair, Professor Pierre Côté and Secretary-General Dr Richard Brown were in attendance at this meeting and contributed in drafting a formal statement of support for the WHO on behalf of the global health professions.

Following a number of meetings and the drafting of a White Paper setting out the aims and objectives of the new alliance, the formal launch of the GRA took place at the International Committee of the Red Cross Headquarters in Geneva during the week of the World Health Assembly.

At its inaugural meeting, Professor Côté was elected to the Board. As well as holding the federally-funded Canada Research Chair in Disability Prevention and Rehabilitation, Professor Côté holds positions at the University of Ontario Institute of Technology (UOIT) and at the Canadian Memorial Chiropractic College (CMCC), where he heads the UOIT-CMCC Centre for Disability Prevention and Rehabilitation.

The aims of the GRA are to advocate for rehabilitation services around the world and to strengthen the role of rehabilitation in health and social systems around the world. The GRA will aim to further the efforts of existing rehabilitation organizations by building and strengthening networks and partnerships. It will work with WHO as a strategic partner to advocate for quality, co-ordinated and accessible rehabilitation services.

According to WHO, only 10 people per million population in the world currently has access to skilled rehabilitation services. It is also known that 74% of the total years lived with disability in the world are living with conditions for which rehabilitation is beneficial. With a 23% increase in prevalence of health conditions with severe disability, there is a large unmet need in low- and middle-income countries, the need for a dedicated focus on rehabilitation workers is critical.

Speaking on his appointment to the GRA, Professor Côté commented: “The founding of this important alliance comes at an important time. I am honoured and privileged to have been elected by the founder members of the GRA to sit on its Board and look forward to contributing to coordination of advocacy work in this area of global health. As an epidemiologist, I am all too aware of the catastrophic global impact of disability and the GRA’s advocacy efforts will make a key contribution towards supporting WHO’s commitment to the UN Sustainable Development Goals ”

WFC Secretary-General Dr Richard Brown said: “As primary contact health professionals, chiropractors can take a leading role in rehabilitation and disability prevention. With low back pain the leading global cause of years lived with disability, chiropractors have an opportunity to actively engage in rehabilitation. In addition, collaborating with other organizations and forming strategic partnerships will greatly increase the role our Constituent Member nationals associations can play.”

Inaugural Board of the Global Rehabilitation Alliance

Board members, Global Rehabilitation Alliance
Left to right: Pierre Côté, Jan Monsbakken, Karsten Dreinhofer, Emma Stokes, Thierry Regenass, Christoph Gutenbrunner, Isabelle Urseau, Stephanie Clarke.

Founder Members of the Global Rehabilitation Alliance

• American Speech-Language-Hearing Association (ASHA)
• Dementia Alliance International
• Global Alliance for Musculoskeletal Health (GMusc)
• Humanity & Inclusion (HI)
• International Council of Nurses (ICN)
• International Committee of the Red Cross (ICRC)
• ICRC MoveAbility Foundation
• International Society for Prosthetics and Orthotics (ISPO)
• International Society of Physical and Rehabilitation Medicine (ISPRM)
• International Spinal Cord Society (ISCoS)
• World Confederation for Physical Therapy (WCPT)
• World Federation for NeuroRehabilitation (WFNR)
• World Federation for Occupational Therapy (WFOT)
• World Federation of Chiropractic (WFC)

About the WFC

The World Federation of Chiropractic (WFC) is a worldwide, not-for-profit organization which serves as the global voice of the chiropractic profession. Its members are the national associations of chiropractors in over 90 countries worldwide. In addition, its non-voting association members include chiropractic educational institutions, corporate partners and individual supporters. Since 1997, the WFC has been an non-governmental organization in official relations with the World Health Organization (WHO). Its headquarters are in Toronto, Canada.   

July 5, 2017

Professor Martin Descarreaux has been announced as the newest member of the WFC Research Council.

Dr. Descarreaux graduated from the UQTR’s first cohort of the chiropractic program in 1998, and completed a PhD in kinesiology at the Université Laval 6 years later.

He is now a full professor at UQTR in the Department of Human Kinetics and is a visiting professor at the Institut Franco-Européen de Chiropraxie (Paris and Toulouse) and at the Paris-Sud University’s Faculty of sports sciences.

His current research projects involve the characterization of the neurophysiological and biomechanical effects of spinal manipulation, the various effects of pain and pain-related psychological components on trunk neuromuscular strategies, as well as motor learning of spinal manipulation. In the past five years alone, Dr Descarreaux has been a primary or named author in over 60 published papers.

Over the years, he has developed several strategies to better integrate motor learning principles, which have been shared with students, professors and those responsible for clinical training within chiropractic teaching institutions not only in Canada, but also in Europe.

He is currently the Director of the Groupe de recherche sur les affections neuromusculosquelettiques (Research Group on neuromusculoskeletal disorders) at UQTR.

Chair of the WFC Research Council, Professor Greg Kawchuk commented: "On behalf of the Research
Council, I would like to welcome Dr. Descarreaux as our newest member. Martin's prior experience as a judge at many WFC events combined with his research record as a full professor at UQTR will assist the RC greatly in building toward the next WFC Congress in 2019 and beyond".

May 8, 2017

A new Canadian guideline published today (May 8, 2017) in the Canadia Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.

The guideline (http://www.cmaj.ca/content/189/18/E...) is the product of an extensive review of evidence involving stakeholders from medical, non-medical, regulatory, and patient stakeholders.

The lead author, Dr Jason Busse DC, PhD is a graduate of Canadian Memorial Chiropractic College and is an Associate Professor in the Department of Anaesthesia at McMaster University. Other authors of the guideline include those from the fields of physiotherapy, dentistry, public health and medicine.

Chronic non-cancer pain (CNCP) is defined as pain lasting more than 3 months that is not associated with malignancy. It is estimated that up to 20% of adult Canadians suffer with CNCP and, the guideline says, is the leading cause of health resource utilization and disability among working age adults.

Behind the USA, Canada has the second-highest level of opioid prescribing in the world. It is an enormous issue, with a doubling of admissions to publicly-funded opioid-related treatment programs between 2004 and 2012. In 2015, over 2000 Canadians died of opioid overdose, with final figures expected to be higher in 2016. Many of these deaths were associated with Fentanyl, the same opioid cited as being the cause of death of the musician Prince in 2016. Other commonly used opioid drugs are Percocet, OxyContin, Dilaudid and morphine.

The new guidelines significantly revise those published in 2010 with a clear message that opioids should not be the first-line therapy in CNCP and should only be used as a last, carefully dose-controlled resort after all other options have been exhausted.

Another key recommendation is that MDs do not simply keep raising the dose level of opioids if recommended levels are not providing effective relief, and to avoid opioids altogether where there is a history of substance abuse or mental health issues.

None of this is relevant to those already addicted to opioids. The guideline addresses this issue by advocating a tapering down of doses over time, utilizing multidisciplinary care options, such as chiropractic.

A keynote speaker at the joint WFC/ACC/ACA Conference, DC2017, Dr Brian Goldman, has spoken out strongly against MDs prescribing opioids, but says that the guideline must be supported by national programs to encourage compliance with the guideline’s recommendations (http://www.cbc.ca/radio/whitecoat/b...).

With many users of opioids doing so due to chronic back pain or other musculoskeletal disorders, the recommendation to primary care physicians to optimize their use of non-opioid medications and non-pharmacological therapy has the potential to increase utilization of chiropractic.

Secretary-General of the World Federation of Chiropractic, Richard Brown, commented: “The dangers of opioid therapy for chronic non-cancer pain are well documented, not just in Canada, but throughout the world. This new guideline sets out very clearly the recommendation to avoid prescribing opioids and to consider safer alternatives. The evidence for manual therapy in the treatment of back pain is strong and we are now seeing growing calls for its use as a first-line option.”

“Chiropractors as spine care experts are well-placed to deliver an effective and evidence-informed alternative as part of the solution to the opioid crisis. Chiropractors working in collaborative teams with other health professionals, such as in the US Veterans Administration, is resulting in very positive outcomes and we anticipate significant growth in the involvement of chiropractors in helping to tackle the opioid crisis. The WFC welcomes these recommendations and congratulates Dr Busse and his team on the publication of this important guideline.”

The WFC Public Health Committee has identified opioid overuse as one of its key priority areas. Its Chair, Dr Chris Cassirer D.Sc, MPH is clear on how chiropractors can make a difference. He remarked: “As nations continue to struggle with the growing epidemic of opioid addiction, it is imperative that we underscore the importance of this new Canadian guideline. Recommending chiropractic care as a primary intervention for patients suffering from neck and spine related conditions recognizes the growing body of scientific evidence that chiropractic is no longer an ‘alternative’, and instead it is a clinically effective first line of intervention for all doctors to recommend.”

Later this month, the WFC will be in Geneva at the World Health Assembly and will meet with representatives of the World Health Organization to discuss how chiropractic is contributing to global public health initiatives. As the only chiropractic non-governmental organization in official relations with WHO, the WFC is committed to supporting key strategies in a range of health areas, including the provision of non-pharmacologic health care around the world.

May 5, 2017

By World Federation of Chiropractic

Richard Deyo is a bit of a big cheese in the back pain world. A medical practitioner, he’s a Professor of Evidence-Based Medicine in the Department of Family Medicine at Oregon Health and Sciences University. He’s the Deputy Editor of Spine. He’s also on the editorial board of the Back Review Group of the Cochrane Collaboration. So it’s fair to say that so far as back pain goes, when he speaks, we should listen.

In the April 11 issue of the Journal of the American Medical Association (JAMA), Deyo’s editorial (1) focuses on the role of spinal manipulation in the treatment of back pain. Like this week’s article by Dr Aaron Carroll published in the New York Times (For Back Backs It May Be Time To Rethink Prejudices About Chiropractors, May 1, 2017), Deyo stresses the need to balance popular criticism often leveled at those using spinal manipulation with a few home truths when it comes to so-called conventional approaches to acute and chronic back pain.

Deyo hints that although spinal manipulation’s profile is rising as an evidence-based treatment intervention, its link to chiropractic has stunted its growth. Why? Because, he says, outdated views about health promoted by some chiropractors, rejecting immunization and other scientific advances, have led to suspicion and a reluctance of medical doctors to refer to them.

Despite this, Deyo reflects on the popularity of chiropractic in the US, citing one study involving 4000 respondents that showed chiropractic had more ‘highly satisfied’ consumers than physical therapy and primary care physicians. While reflecting on a recent systematic review that showed spinal manipulation to lead to modest improvements in pain and dysfunction, Deyo highlights the challenges of finding studies comparable in subjects, study design and interventions; thus, he say, it’s difficult to really be certain about the real magnitude of benefit.

Deyo concedes that there remains much we don’t know about the precise mechanisms of back pain, or how spinal manipulation actually works. Importantly, however, he says that this is no reason not to use it as a first-line intervention. Addressing the “but it’ll get better on its own” brigade, Deyo is quick to point out, as do many chiropractors, that the body has a tremendous ability to heal itself, but stresses that this is no reason not to manage pain associated with back pain using spinal manipulation.

Deyo refers widely in his editorial to a new systematic review and meta-analysis published by Neil Paige and his colleagues in the same April 11 issue of JAMA (2). The multidisciplinary authorship of this paper, including chiropractors Paul Dougherty and Richard Branson, sets out the benefits of spinal manipulation as well as transient harms. As Deyo points out, not a single study examined in the systematic review suggested that spinal manipulation was less effective than conventional care.

Key to Deyo’s editorial is the admission that we don’t have all of the answers when it comes to back pain. What’s the precise cause? Why some people do better than others? How do we best predict responses? How exactly does manipulation work?

When it comes to the popularity of chiropractic, contextual factors are often cited in explaining successful outcomes, and Deyo touches on these in his editorial. The hands-on nature of care. The ongoing doctor-patient relationship, with continuity of care over successive visits. The expectation of positive change, often with practitioner encouragement, reassurance, and positivity. Patients who feel empowered by their experience. As Deyo suggests, is it really so important that we don’t quite know the precise mechanisms of action when care is considered in the round and patients are so satisfied with their treatment?

Deyo goes on to address those who claim that spinal manipulation is dangerous. Besides pointing out that none of the RCTs or large observational studies reviewed by Paige et al identified any serious complications, he highlights the prevalence of renal and gastrointestinal adverse events from non-steroidal anti-inflammatory drugs and the risk of addition to opioids, both of which, he says, should be factored into cost comparisons when studying the relative effectiveness of spinal manipulation and conventional pharmacological approaches.

In conclusion, Deyo cautions against chiropractors who make exaggerated claims over the likely benefits of their care, especially in relation to non-musculoskeletal diseases, but stresses that spinal manipulation is a legitimate treatment option for low back pain, which the evidence shows is at least as effective as conventional drug approaches. In an era of evidence-based care, he observes that this is one area where the informed views and preferences of patients should count as much as the preferences of clinicians.

What Richard Deyo’s excellent editorial makes clear is that with a growing body of evidence suggesting comparative effectiveness, cost-effectiveness and safety of spinal manipulation, chiropractors are faced with opportunities like never before to position themselves as spinal health care experts in the healthcare system. At the same time, issues that perpetuate suspicion and mistrust must be tackled forcefully. Our future is, quite literally, in our hands.

References:
Deyo R. The role of spinal manipulation in the treatment of low back pain. JAMA (2017) April 11; 317(14):1418-1419.
Paige NM, Miake-Lye IM, Booth MS, et. al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. JAMA (2017) April 11; 317(14):1451-1460

April 7, 2017

TORONTO, CANADA, April 7, 2017. The World Federation of Chiropractic (WFC) has named world renowned epidemiologist Professor Pierre Côté DC, PhD as the first Chair of its new Disability and Rehabilitation Committee.

Dr Côté is the Canada Research Chair in Disability Prevention and Rehabilitation. He graduated as a chiropractor from the Canadian Memorial Chiropractic College in 1989. In 1996 he obtained a Master of Surgery degree from the University of Saskatchewan where he studied the Epidemiology of Neck and Back Pain in the General Population. He completed his PhD in Epidemiology and a minor in Research Bioethics at the University of Toronto in 2002. In 2003, he was awarded a five-year New Investigator Award from the Canadian Institutes of Health Research.

Prior to joining UOIT, where he is an Associate Professor, Dr Côté was a scientist in the Division of Health Care and Outcomes Research at the Toronto Western Research Institute and an Associate Professor of Epidemiology at the Dalla Lana School of Public Health at the University of Toronto, where he continues to hold an appointment. He was a member of the Scientific Secretariat of the 2000-2010 Bone and Joint Task Force on Neck Pain and its Associated Disorders and also held a 2010 appointment as Chair of the Catastrophic Impairment Expert Panel.

Dr Côté is currently the Chair of the Minor Injury Guideline Project funded by the Ontario Ministry of Finance. He is the Director of the UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation. He is a member of EuroSpine, the European spine society, and is a past member of the WFC Research Council.

The Disability and Rehabilitation Committee (DRC) has been established by the WFC in response to the growing global need for experts in disability prevention and rehabilitation. Priority areas of work are the positioning chiropractic as a global partner for the promotion of evidence-based disability prevention, publication of evidence-informed position papers and advancing and facilitating the involvement of chiropractors as members of rehabilitation teams and as agents for the implementation of local, national and international public health policies on disability and rehabilitation.

WFC President Dr Espen Johannessen said: “We are delighted that Dr Côté has accepted this important new position within the WFC. As a non-governmental organization in official relations with WHO, it is important that we strongly encourage doctors of chiropractic to be agents of change in their practices and communities. Disability prevention and rehabilitation are critical components in supporting population health.”

The WFC was a signatory to WHO’s Rehabilitation 2030 Call to Action at a high level international meeting in Geneva in February. Attended by ministers of health, numerous government representatives and other health leaders, the meeting highlighted the global need for rehabilitation services.

The WFC will shortly issue a call for applications for membership of the committee, which will seek to attract members from both within and outside the chiropractic profession.