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Background: An increasing number of mixed methods studies have been conducted across health care professions in recent years. However, little is known about the methodological reporting quality among mixed methods studies involving chiropractic research. Objective: To examine the methodological quality of published chiropractic mixed methods studies, provide recommendations for improving future chiropractic mixed methods research, and apply these recommendations in two mixed methods health services evaluations of chiropractic integration and prescription opioid use for spinal pain. Methods: We conducted a meta-epidemiological review of the chiropractic mixed methods literature and examined reporting quality using the Good Reporting of A Mixed Methods Study guideline and risk of bias using the Mixed Methods Appraisal Tool. We used generalized estimating equations to explore factors associated with higher methodological quality. We applied our findings in two sequential explanatory mixed methods investigations of the association between chiropractic care and opioid prescribing for non-cancer spinal pain. Results: Among eligible mixed methods studies, we found that many were both poorly reported and at risk of bias. Publication in journals with an impact factor and/or more recent publication were significantly associated with higher methodological quality. In our sequential explanatory analyses, we found that receipt of chiropractic care was associated with decreases in initial opioid prescribing and long-term opioid use, and our qualitative results suggested these relationships were multi-factorial. Conclusion: We identified areas for improvement in the methodological reporting quality of chiropractic mixed methods research. Our mixed methods studies suggest that integration of chiropractic services into primary care centres may reduce the use of opioids for spinal pain. / Thesis / Doctor of Philosophy (PhD) / We reviewed the literature to assess the methodological reporting quality of mixed methods studies involving chiropractic research and found that most studies had important omissions. We applied these results to optimize methodologic reporting of two mixed methods studies on the association between chiropractic care and opioid prescribing. We found that patients with non-cancer spinal pain were less likely to receive an initial prescription for opioids if they accessed chiropractic care. Further, among chronic pain patients receiving opioids, we found that providing access to chiropractic care reduced their chances of continuing to receive opioids. The qualitative aspect of our studies provided important context to inform how patients and their primary care providers felt access to chiropractic care had reduced reliance on prescription opioids. These findings will increase awareness among researchers for opportunities to improve reporting quality of mixed methods research and highlight the potential role of chiropractic care in helping to address the opioid crisis.

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L'arthrose (OA) est l’atteinte la plus répandue chez les animaux de compagnie et se manifeste par l'apparition de douleurs chroniques et d'incapacités fonctionnelles. En l’absence de remède, des composés comme les produits de santé naturels (PSN) ont gagné en popularité. Cette revue systématique, enregistrée sur PROSPERO (CRD42021279368), avait pour objectif d'examiner les preuves d’efficacité analgésique des PSN et de diffuser correctement les conclusions sur leur potentiel thérapeutique. Quatre bases de données bibliographiques ont été consultées pour identifier les études testant leur efficacité sur l'OA canine et féline, naturelle ou induite. Après sélection des résultats de recherche, les données de qualité et d’efficacité ont été extraites à l’aide d’une grille d’évaluation originale basée sur les directives ARRIVE, CONSORT et l’outil d’évaluation CAMARADES. Ces grilles ont été préalablement validées : validation apparente, de contenu (interne / externe) et de construit (reproductibilité, répétabilité, sensibilité). Un consensus de 3 évaluateurs, de niveau d’expertise différent, était obligatoire pour chaque score attribué aux données extraites. La méta-analyse montre des preuves solides d’efficacité des suppléments et des diètes thérapeutiques enrichies d’acides gras en oméga-3 dans le traitement de l’OA, et le cannabidiol présente des preuves prometteuses. Les formulations de sulfate de glucosamine/chondroïtine ne présentent toutefois aucun intérêt et ne doivent plus être recommandées dans la prise en charge thérapeutique de cette maladie articulaire dégénérative des animaux de compagnie. Les résultats obtenus soulignent un manque évident de preuves pour supporter la recommandation d’utilisation de nombreux nutraceutiques et dénotent la nécessité de mettre en place des procédures normalisées de bonne pratique clinique pour de futurs essais. / Osteoarthritis (OA) is the most common disease in pets and manifests itself as chronic pain and functional disability. In the absence of a cure, compounds such as natural health products (NHPs) have gained popularity. This systematic review, registered on PROSPERO (CRD42021279368), aimed to examine the evidence for analgesic efficacy of NHPs and to properly disseminate findings on their therapeutic potential. Four bibliographic databases were searched to identify studies testing their efficacy in natural and induced canine and feline osteoarthritis. After selection of the search results, quality and efficacy data were extracted using an original evaluation grid based on the ARRIVE and CONSORT guidelines and the CAMARADES evaluation tool. The grids were previously validated: face, content (internal/external) and construct (reproducibility, repeatability, sensitivity) validation. A consensus of three evaluators, with different levels of expertise, was required for each score assigned to the extracted data. The meta-analysis shows strong evidence of efficacy in OA for omega-3 enriched supplements and therapeutic diets, while cannabidiol shows promising evidence. Glucosamine/chondroitin sulphate formulations are of no value and should no longer be recommended for the therapeutic management of OA in pets. The results highlight a clear lack of evidence to support the recommendation for use of many nutraceuticals and indicate the need for standardised good clinical practice procedures for future trials.

In comparison to normally developing children, many children with Autism Spectrum Disorders (ASD) do not possess the same opportunities to be physically active due to the impairments exhibited by their disorder. A systematic review using the Downs and Black checklist and the PEDro scale was conducted to assess the methodological quality of the literature on promoting physical activity in children with ASD. The following inclusion criteria had to be met: (1) subjects must include children with a clinical ASD diagnosis (2) the children have to be under the age of thirteen years old (3) the interventions must target physical activity; lastly, (4) they must be a relevant peer-reviewed English language study. The search was conducted using four electronic databases: MEDLINE, ERIC, PsycInfo, and CINHL with no restriction on the publication year. The following keywords were utilized: "Autism", "ASD/ Autism Spectrum Disorder", "Asperger", "Pervasive Developmental Disorder" Those terms were paired with "physical activity", "physical exercise", "exercise", "fitness", "aerobic", "swim", "aquatic", "jog", "walk", "recreational activity" Which were also paired with the terms "school age", "child", "toddler", "preadolescent". This multi-step search procedure occurred during February 2013. The methodological quality of six studies was evaluated in February 2013. Overall, the conclusive scores determined by the Downs and and Black checklist and the PEDro scale varied greatly. The scores reported by the Downs and Black checklist ranged from 19 to 21 on a 27-point scale. PEDro scale yielded scores ranging between two and six on a 10-point scale. A vote count revealed that the exercise interventions increased the physical fitness, aquatic skills, social behaviors, and sensory integration children with ASD. In summary, the variation within the scores and the quality of the studies leads to a demand for future research.; In order to adequately determine what exercise interventions effectively increase physical activity in children with ASD, future researchers should conduct randomized controlled trials in order to produce the highest quality of evidence.

Les objectifs de cette thèse étaient de produire des connaissances nouvelles sur les méthodologies d’évaluation de l’optimalité des soins avec l’exemple des délais diagnostiques et des infections bactériennes sévères de l’enfant (IBS). Nous avons mis en évidence, dans deux revues systématiques de la littérature, que les points méthodologiques potentiellement associés à des risques de biais et d’obstacles à la transportabilité des résultats étaient rarement rapportés dans les études primaires sur les délais diagnostiques ou rarement évalués par les auteurs de méta-analyses. Nous avons donc construit et validé internationalement une reporting guideline pour aider les scientifiques à prendre en compte ces points méthodologiques critiques. Nous avons montré par une enquête confidentielle avec comité d’experts en population que : (i) les prises en charge étaient suboptimales pour 76% des enfants décédés d’IBS, (ii) un retard au recours médical, une sous-évaluation de la gravité ou un retard à l’antibiothérapie étaient retrouvés dans la prise en charge de respectivement 20%, 20% et 24% des enfants atteints d’IBS, (iii) les soins suboptimaux étaient indépendamment et fortement associés au risque de décès et (iv) les soins suboptimaux étaient plus fréquents chez les enfants de moins d’un an ou lorsque qu’ils n’étaient pas administrés par un médecin spécifiquement formé. La minimisation des biais dans la sélection des participants et la mesure de l’optimalité et la prise en compte de facteurs de confusion comme la sévérité intrinsèque de la maladie sont des éléments clefs de l’évaluation de l’optimalité des soins afin de produire des messages cliniques correctifs valides. / The aim of this thesis was to product new knowledge about the methodology on how to assess the optimality of care with the examples of time to diagnosis and serious bacterial infection (SBI). In two systematic reviews, we found that the key methodological points potentially related to risks of bias or threats to transportability were rarely reported in the primary studies and rarely evaluated by authors of systematic reviews. Then, we developed and internationally validated a reporting guideline to help scientists to better take into consideration these critical methodological points. In a population-based confidential inquiry, we found that: (i) care was suboptimal in 76% of the initial management of children who died from SBI, (ii) delayed first medical contact, undervaluation of severity or delayed antibiotic administration were detected in the management of 20%, 20% and 24% of children admitted to intensive care for a SBI, respectively, (iii) the total number of suboptimal cares delivered during the management was independently associated with death, and (iv) suboptimal cares were more frequent in children younger than one year old and if the care was delivered by a non specialist physician. Minimizing the risks of bias both in the selection process of the study population and in the assessment of the optimality of care, and taking into account confounding factors such as the intrinsic severity of the disease are keys elements to ensure a reliable evaluation of optimality of care in order to produce effective corrective clinical messages.