265 Chiropractic and osteopathic knowledge and experience in treating patients with axial spondyloarthritis
Bibliographic record
Abstract
Background: Chiropractors and osteopaths are important gatekeepers in the initial diagnosis and subsequent management of axial spondyloarthritis (axSpA). In view of recent significant advances in diagnosis and treatment, we sought to understand current knowledge and working practices among these important groups of healthcare professionals. Methods: In June 2018, a web-based questionnaire, comprising 30 open and closed questions relating to recognition of axSpA which included items on recognition of symptomology and onward referral processes was advertised via the Royal College of Chiropractors, Institute of Osteopathy and the National Ankylosing Spondylitis Society via online mechanisms including e-news and social media. Results: Three hundred and eighty-two completed responses were received; 237 chiropractors (62%) and 145 osteopaths (38%), 81% aged 30-59, 59% female; 63% practicing for >10 yrs. The majority (59%) were seeing between 1-5 back patients per day and 30% saw more than 5. All were familiar with the term ankylosing spondylitis (AS) and 99% were confident with their understanding of this. However only 63% were familiar with the term axSpA and 57% felt confident with this. For non-radiographic axSpA, 25% were aware of the term with 22% feeling confident with their understanding. Seventy-seven percent were confident with the concept of inflammatory back pain with the majority familiar with the characteristic features; including back pain onset <45 yrs (69%), insidious onset (78%), symptoms lasted >3 months (80%), pain improved by activity (55%), pain relieved by NSAIDs (77%); morning stiffness lasting >30 minutes (83%), alternating buttock pain (35%) Fifty-two percent considered localised spinal tenderness to be important. Regarding extra articular manifestations and peripheral musculoskeletal features, respondents routinely asked about a history of psoriasis (81%), inflammatory bowel disease (91%), acute anterior uveitis (AAU-49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%), and dactylitis (20%). Eighty-seven percent were aware of the association between axSpA and HLA-B27, 77% routinely asked about family history, and 56% routinely enquired about inflammatory markers. Only 29% recognised that axSpA was common in women. Forty percent recommend an X-ray (pelvic in 80%), and if normal 27% would recommend MRI sacroiliac joints and whole spine. Forty-four percent were aware of biologic therapies. On a weighted average, respondents indicated that their confidence in securing onward referral to rheumatology via the general practitioner (GP) was 3.2 out of 5 ; 43% were confident with the process. The principal perceived barrier to onward referral was reluctance by the GP to accept their findings. Conclusion: Overall knowledge of AS is good, however the term axSpA is poorly understood. Specific learning needs include sex preponderance, awareness of AAU and the availability of biological therapies. There is a lack of confidence in the onwards referral process to rheumatology via the GP. Disclosures: C. Yong: None. J. Hamilton: None. J. Benepal: None. K. Griffiths: None. Z. Clark: None. M. Rush: None. R. Sengupta: None. J. Martindale: None. K. Gaffney: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".