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
-
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.
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!
Troubles temporo-mandibulaires
Cet outil fournit des informations pour faciliter la prise en charge des troubles temporo-mandibulaires chez l'adulte.
Les troubles temporo-mandibulaires sont définis comme un groupe d'affections qui affectent les muscles masticateurs, l'articulation temporo-mandibulaire et ses structures environnantes. Les troubles temporo-mandibulaires comprennent les entorses et les entorses. Les troubles temporo-mandibulaires peuvent se manifester par des douleurs, des bruits articulaires anormaux, des mouvements limités de la mâchoire et une sensibilité musculaire articulaire.
Examen ciblé
1. Histoire du patient
-
Éliminer les facteurs de risque de pathologies structurelles majeures ou autres. Si nécessaire, référer à un professionnel de la santé approprié.
-
Identifiez et évaluez les autres conditions et comorbidités. Gérez en utilisant des parcours de soins appropriés.
-
Abordez tous les facteurs pronostiques susceptibles de retarder le rétablissement.
Des pathologies structurelles majeures ou autres peuvent être suspectées avec certains signes et symptômes (drapeaux rouges):
-
Fracture de la mandibule (gonflement, malocclusion, mouvements limités), luxation du condyle mandibulaire (spasme musculaire, incapacité à fermer la bouche, anxiété), fracture/luxation de la colonne cervicale (règle C-spine canadienne positive), cancer (antécédents cancer, perte de poids inattendue, douleur nocturne, âge > 50 ans), infection (fièvre, utilisation de drogues par voie intraveineuse, infection récente), fractures ostéoporotiques (antécédents d'ostéoporose, utilisation de corticostéroïdes, âge avancé)
Exemples d'autres conditions / comorbidités
-
Conditions physiques: maux de dos, maux de tête
-
Conditions psychologiques: dépression, anxiété
-
Comorbidités: diabète, maladies cardiaques
Exemples de facteurs pronostiques susceptibles de retarder le rétablissement:
-
Conditions médicales préexistantes / concomitantes ou symptômes post-lésionnels
-
Facteurs personnels, psychosociaux ou environnementaux
2. Examen physique
-
Évaluer le niveau de préoccupation en ce qui concerne les grandes pathologies structurelles ou autres.
-
Évaluez l'articulation temporo-mandibulaire et l'amplitude de mouvement cervicale.
-
Effectuez des tests orthopédiques et palpez la zone.
3. Gestion
-
Offrir des informations sur la nature, la gestion et l'évolution des troubles temporo-mandibulaires. Rassurer le patient sur le caractère bénin et spontanément résolutif des troubles temporo-mandibulaires et renforcer l'importance de maintenir les activités de la vie quotidienne.
-
Discutez de la gamme d'interventions efficaces avec le patient et, ensemble, sélectionnez une intervention thérapeutique.
Document à distribuer aux patients
Prise en charge des troubles temporo-mandibulaires d'apparition récente (symptômes 3 mois)
La plupart des personnes atteintes de troubles temporo-mandibulaires se rétablissent d'elles-mêmes quelques semaines après la blessure. Cependant, il est recommandé que les éléments suivants soient effectués dans le cadre des soins cliniques standard:
-
surveiller les symptômes
-
rassurer sur la nature de la douleur
-
encourager le maintien des activités de la vie quotidienne
Prise en charge des troubles temporo-mandibulaires persistants (symptômes > 3 mois)
Offrir une éducation structurée au patient (conseils pour rester actif, rassurer, promouvoir et faciliter le retour au travail et aux activités normales, conseils d'auto-prise en charge) et l'une des interventions thérapeutiques suivantes* :
-
Envisagez un programme de gestion des autosoins comprenant, mais sans s'y limiter, une assurance sur le pronostic favorable des troubles temporo-mandibulaires, des conseils sur le retour aux activités, le maintien des activités de la vie quotidienne, une discussion sur la douleur attendue et le mécanisme de la douleur, une discussion sur le pronostic, les capacités d'adaptation à la douleur , et les stratégies d'autosoins ou de santé générale
-
Envisager une thérapie myofasciale intra-orale
-
Envisagez une thérapie cognitivo-comportementale
-
Ne pas offrir dispositif occlusal pour la douleur et l'amplitude des mouvements
*The guidelines does not include interventions for which there is a lack of evidence of effectiveness. The ordering of interventions does not reflect superiority of effectiveness
¹Semi-rigid brace during the daytime (4 weeks), semi-rigid boot during the daytime (4 weeks) or below-knee immobilization walking cast (10 days)
²The program should include 5 repetitions (30 seconds; grades I-IV mobilization at the provider’s discretion), twice per week for 4 weeks
³The program should include therapeutic exercises with cryotherapy adapted from a standard protocol that includes: active circumduction mobility (20 repetitions), active plantar flexion/dorsiflexion mobility (20 repetitions); static muscle strengthening: eversion, inversion, plantar flexion, dorsiflexion (5 repetitions each); functional movement pattern (lower limb triple flexion/extension; 30 repetitions); and triceps surae stretch (3 repetitions) 4 times per week for 4 weeks
⁴The program should include standard application of 20 minutes of continuous ice treatment performed every two hours; or, ice applied for 10 minutes, the ankle is rested at room temperature for 7 minutes, ice is reapplied for 10 minutes and performed every two hours; over the first 72 hours.
⁵Based on evidence of no benefit to patients
Therapeutic Recommendations - Persistent (>3 months symptom 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*:
Consider mobilization of the distal and proximal tibiofibular joints, talocrural, and subtalar joints¹
* Des interventions sont recommandées si les lignes directrices utilisent des termes tels que « recommandé pour examen » (par exemple, « offrir », « envisager »), « fortement recommandé », « recommandé sans aucune condition requise » ou « devrait être utilisé ». Les recommandations issues de preuves de faible qualité ne sont pas répertoriées.
Parcours de soins pour la prise en charge des troubles temporo-mandibulaires
