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Chiropractic at the crossroads or are we just going around in circles?
... Subsequently, two vocal groups focussing on either "straight/philosophy/wellness" or "mixer/evidence/science" have developed [10,32,33]. In response, some suggest that the profession is at a critical crossroad [34,35]. Others have gone further suggesting the consideration of a complete divorce of the wellness groups from the profession [1,36]. ...
... Despite wellness being a fundamental principle of chiropractic [45] and wellness-related goals being important to many patients and practitioners, they are not important to all [35,46] as wellness appear to be sought after by a small percentage of the total number of patients presenting to chiropractors [47]. Most patients present for mainly musculoskeletal care [8]. ...
... The adoption of this entrepreneurial delivery of education and care has resulted in the castigation of the wellness clinicians by the science clinicians/academics, for not providing appropriate modern, evidence-based practice [1,35]. However, it could also be argued that the development of this educational component of the entrepreneurial groups grew out of the void created by the absence of valid and representative tertiary educational programs developed to teach wellness from a sciencebased perspective. ...
The chiropractic profession is 125 years old and has evolved a culture beset with internal conflict. The internal ructions have been particularly noticeable during the last 20 years. The recent resignation of the entire World Federation of Chiropractic Research Committee has again focussed the conflicting views and goals of the “wellness” and “evidence” factions within the profession. These polarising viewpoints are worsening to the degree that there are calls for the profession to break into two separate entities. Key to the recognition of the differences within the profession is the recognition of title for particular sub populations of patients presenting to chiropractors. For many of the sub populations such as sport or paediatrics there has grown appropriate post professional specialist educational training sometimes leading to a protected title. However, this is not occurring in that group of practitioners that choose to focus on wellness care. A recommendation is made that wellness chiropractic be viewed as a post professional specialty program within chiropractic, as it is in medicine and elsewhere, and that recognition follow after appropriate post professional educational programs have been completed, as is customary in the other special interest groups. In order to do so, consensus will be required from all stakeholders within the profession on the level, scope and depth of such programs. Furthermore, it is possible that different jurisdictions around the world may require different post graduate educational levels based on local competitive, legal and professional circumstances. In such cases, transitioning to the higher level over a period of time may be undertaken. Recognition of the wellness specialty by the profession would allow for vertical integration with other healthcare providers as well as help bridge a gap between the entrepreneur and academic groups that would be responsible for creating these programs at tertiary education institutions. Finally, should these programs acquire evidence to underpin them, a process that would be taught within the programs, it is likely that recognition of an extended scope of practice would occur increasing the appeal of chiropractic to the public.
... The issues concerning chiropractic identity and philosophical divides have been examined in several publications, for instance, by Meeker and Haldeman in 2002 [8], Reggars in 2011 [9], Schneider et al. in 2016 [10], Brosnan in 2017 [11], Leboeuf-Yde et al. in 2019 [12], and many others. ...
... Of greater concern to us is a disconcerting professional image [17][18][19][20], persistent and common claims of providing care for non-MSK disorders [21][22][23], internal conflicts which run deep and remain unresolved [12,24], professional development and integration into mainstream healthcare, which in our perspective has not exactly progressed at speed. At the core of this is a potentially more damaging issue: Relevant science is raising serious questions about original chiropractic dogmas [25], and conversely, dogmatic chiropractors are seriously questioning science as relevant [9,26]. It really does seem to us that there is a critical schism within the profession, which goes beyond the continuous navigation between scientific evidence and clinical individualization, which is common to all healthcare. ...
Spinal manual therapy is central to chiropractic history, clinical practice, and professional identity. That chiropractors have developed an expertise in this domain has provided some considerable advantages. However, we contend it is also at the crux of the ideological schism that fractures the chiropractic profession. In this article, which is the first in a series of two, we discuss chiropractors’ understanding and use of spinal manual therapy and do so with particular emphasis on what we see as weaknesses it creates and threats it gives rise to. These are of particular importance, as we believe they have limited the chiropractic profession’s development. As we shall argue, we believe that these threats have become existential in nature, and we are convinced that they call for a resolute and unified response by the profession. Subsequently, in part II, we discuss various strengths that the chiropractic profession possesses and the opportunities that await, provided that the profession is ready to rise to the challenge.
... 22 Martin's approach may help to counter modern criticisms that there was no early research on CVS. 22,[111][112][113] He stated: ...
... 149 Apart from the use of straw man arguments, the main questions these statements bring up have to do with what should account for evidence and validity in chiropractic research, especially because EBM has become more prominent in the last few years in the chiropractic field and is used by some to dismiss CVS research as nonexistent. 111,112,[136][137][138][139][140][141][142] This argument has also been used in an attempt to dictate the future of the chiropractic profession's identity. 125,144 Evidence-based Medicine and Chiropractic. ...
Objective:
The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation theories between 1928 and 1949.
Discussion:
Theories during this period grew in complexity and developed in 4 primary ways: upper cervical models, reflex models, global models, and models based on the work of Speransky. Authors, theorists, and technique developers during this time included B. J. Palmer, R. J. Watkins, Galen Price, John Hurley, Hugh Logan, Major Bertrand DeJarnette, Richard Van Rumpt, Roy Ashton, Joseph Janse, Henri Gillet, James Firth, and J. R. Verner. At least 8 perspectives on chiropractic vertebral subluxation were advanced through research, modeling, and applied clinical methods. By understanding the complexity of this period and analyzing the research, the modern practitioner will be able to appreciate this era. The foundations of modern clinical practice and theoretical applications have roots in this period.
Conclusion:
Theories during this period developed in levels of complexity, expanding existing models and clinical practice methods. The theories and research from this period had an effect on the chiropractic profession for the subsequent decades.
... It has been said before that chiropractic is at crossroads [46,47]. The future, which ever direction it takes, may be forced upon us, but to avoid this, the chiropractic profession needs to set its own heading for the future and to move in that direction as a unified profession. ...
In a previous paper, we presented some important weaknesses of and threats to the chiropractic profession as we see them. We further argued that the chiropractic profession’s relationship with its principal clinical tool (spinal manual therapy) is at the core of the ideological divide that fractures the profession and prevents professional development towards greater integration in the healthcare landscape. In this manuscript, we shall argue that the historical predilection for spinal manipulation also gifts the profession with some obvious strengths and opportunities, and that these are inextricably linked to the management of musculoskeletal disorders. The onus is now on the chiropractic profession itself to redefine its raison d’être in a way that plays to those strengths and delivers in terms of the needs of patients and the wider healthcare system/market. We suggest chiropractors embrace and cultivate a role as coordinators of long-term and broad-focused management of musculoskeletal disorders. We make specific recommendations about how the profession, from individual clinicians to political organizations, can promote such a development.
... In other physical and manual therapies, such as physiotherapy and osteopathy, there have been calls for these professions to incorporate EBP into their practice models and philosophies [8][9][10][11]. In chiropractic, similar calls have been made to accept and incorporate EBP [12,13], with some claiming that chiropractic is at a crossroads, facing a choice between EBP and ideological dogma [14]. Congruent with this, the past decade has seen a gradual shift towards the EBP model within the chiropractic profession with the development of practice-based guidelines, EBP educational programmes and evidence-informed practice statements by regulatory/licencing authorities as well as national and international associations [12,15]. ...
Background
Evidence-based practice (EBP) is integral to the delivery of high-quality health care. Chiropractic has been a licensed health profession in Sweden since 1989, but little is known of the uptake of EBP in this professional group. This study explored the self-reported skills, attitudes and uptake of EBP, and the enablers and barriers of EBP uptake, among licensed chiropractors in Sweden.
Methods
Licensed chiropractors ( n = 172) of the Swedish Chiropractic Association (Legitimerade Kiropraktorers Riksorganisation) were invited to participate in an anonymous online questionnaire, using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) in February 2019.
Results
Fifty-six (33%) chiropractors completed the survey. Participants were predominantly male, aged 30–49 years, held a Master’s degree, and had received their highest qualification and practiced chiropractic for over a decade. Chiropractors rated their EBP skill-level mostly in the moderate to moderate-high range. The majority of chiropractors reported positive attitudes towards EBP, with most agreeing or strongly agreeing that EBP is necessary in the practice of chiropractic, and that EBP assists in making decisions about patient care. Chiropractors reported an average level of engagement in EBP activities. All participants indicated professional literature and research findings were useful in their day-to-day chiropractic practice. The main perceived enabler of EBP uptake was internet access in the workplace, whereas the main barrier to EBP uptake was lack of clinical evidence in chiropractic.
Conclusions
Participating chiropractors of the Swedish Chiropractic Association were generally favourable of EBP, though only reported modest levels of EBP-related skills and engagement in EBP activities. Our findings suggest future studies investigating interventions focussed on improving chiropractors’ skills and uptake of EBP are warranted.
... It is generally thought that the MSK and non-MSK factions exist as polar extremes with the majority falling somewhere in the middle [45]. The two factions strongly defend their own position and question the other's paradigm [46][47][48], to the extent that a recent discussion paper proposed that these differences were irreconcilable and the profession should consider divorcing along these lines [46]. ...
Background
Professional associations (PAs) are perceived to promote their professions and support their members. Despite these advantages, about 1 in 3 Australian chiropractors choose not to belong to either of the two PAs. Our study had two objectives: 1) to explore the views of non-member chiropractors about PAs in general; 2) seek to understand the motivations of non-member Australian chiropractors about not joining a PA.
Methods
This qualitative descriptive study utilised in-depth semi-structured interviews with open-ended questions for thematic analysis and was conducted from January to April 2020. Nine participants were interviewed before no new themes were articulated. Participants had to be registered chiropractors who had not been members of a PA for at least three years. Recruitment was through a Facebook advertisement and snowball sampling. Interviews were transcribed and imported into NVivo qualitative analysis software, allowing identification of key concepts surrounding non-membership of chiropractic PAs.
Results
Five themes were identified. 1) A tarnished image, suggested the profession has a poor standing in the eyes of the public and other health professionals. 2) Not worth the money, expressed the annual membership dues were not viewed as good value for money. 3) Going it alone / what’s in it for me? indicated there was no direct benefit or anything deemed essential for practice. 4) Two warring factions, reflected not wanting to be seen to be part of the internal conflict between conservative and evidence-based practitioners. 5) Lack of visibility, described no visible presence or strong communication that clearly displayed the advantages of membership.
Conclusions
Non-members are looking for PAs to enhance the respectability of the profession in a manner that ultimately results in increased patient volume and the provision of readily accessible day-to-day resources and information. These results can inform the construction of a survey for the broader chiropractic non-membership community to confirm and expand upon these findings and potentially improve PAs.
... It is generally thought that the MSK and non-MSK factions exist as polar extremes with the majority falling somewhere in the middle [45]. The two factions strongly defend their own position and question the other's paradigm [46][47][48], to the extent that a recent discussion paper proposed that these differences were irreconcilable and the profession should consider divorcing along these lines [46]. Several of the respondents in this study thought that PAs had a role to play by regulating substandard behaviour of its members. ...
Background: Professional associations (PAs) are perceived to promote their professions and support their members. Despite these advantages, about 1 in 3 Australian chiropractors choose not to belong to either of the two PAs. Our study had three objectives: 1) to explore the views of non-member chiropractors about PAs in general; and 2) seek to understand the motivations of non-member Australian chiropractors about not joining a PA; and 3) to discover their reasons that might lead them to join a PA.
Methods: This qualitative descriptive study utilised in-depth semi-structured interviews with open-ended questions for thematic analysis and was conducted from January to March 2020. Nine participants were interviewed before no new themes were being articulated. Participants had to be registered chiropractors who had not been members of a PA for at least three years or more. Recruitment was through a Facebook ad and snowball sampling. Interviews were transcribed and imported into NVivo qualitative analysis software, allowing identification of key concepts surrounding non-membership of chiropractic PAs.
Results: Five themes were identified: A tarnished image; the profession has a poor standing in the eyes of the public and other health professionals, Not worth the money; the annual membership dues were not viewed as good value for money, Going it alone / what’s in it for me?; there was no direct benefit or anything deemed essential for practice, Two warring factions; not wanting to be seen to be part of the internal conflict between conservative and evidence-based practitioners, Lack of visibility; no visible presence or strong communication that clearly displayed the advantages of membership.
Conclusions: Non-members are looking for PAs to enhance the respectability of the profession in a manner that ultimately results in increased patient volume and the provision of readily accessible day-to-day resources and information. These results can inform the construction of a survey for the broader chiropractic non-membership community to confirm and expand upon these findings and potentially improve PAs.
... Also it was demonstrated by the CCE (USA) and CCE (Canada) expectations that chiropractic students should be able to understand and select methods for evaluating spinal articular subluxation or dysfunction [11] [13]). This is remarkable, as the term 'subluxation' does not represent a reproducible clinically diagnosable entity [54]. Currently 'subluxation' remains a theoretical concept without evidence for its existence or ability to impact on the wellbeing of patients [55][56][57] and the intra and inter-reliability of students' or practitioners' ability to detect 'subluxations' is little better than chance [58][59][60]. ...
Background:
Chiropractors see themselves as well positioned to provide safe, effective and economical care for the on-going financial burden that spinal pain imposes. However, in many places of the world, the chiropractic profession continues to find itself struggling to gain acceptance as a mainstream allied health care provider. There is evidence of the existence of undesirable chiropractic practice patterns and it is in part due to some of the world's accredited chiropractic programs. This indicated a need for scrutiny of international chiropractic educational accreditation standards, which are the responsibility of Councils on Chiropractic Education (CCEs). To this end we reviewed an emerging body of evidence about the chiropractic educational system in order to identify issues and make recommendations that may enhance professional acceptance through improved graduate outcomes and hopefully the quality of patient care. This commentary summarises the findings of that research.
Main text:
We reviewed recent relevant studies, including our own, into the role and function of CCEs and found that there is sufficient evidence to identify areas of concern that could be addressed, at least in part, by improvements to CCEs' educational standards and processes. Areas included a lack of definitions for key terms such as, 'chiropractic', 'diagnosis', and 'competency', without which there can be no common understanding at a detailed level to inform graduate competencies and standards for a matching scope of practice. Further, there is some evidence to suggest that in some cases this level of detail is avoided in order to enable a "big tent" approach that allows for a diversity of approaches to clinical care to co-exist. This combined with the held view that chiropractic is "unique", highly valued, and best understood by other chiropractors, explains how students and practitioners can cling to 'traditional' thinking. This has implications for public safety and patient quality of care.
Conclusion:
If chiropractic care is to gain mainstream acceptance worldwide then it needs to adopt, through revitalised CCE accreditation standards and processes, those of other allied healthcare professions and wholeheartedly embrace science, evidence-based practice and patient centred care.
... It is generally thought that the MSK and non-MSK factions exist as polar extremes with the majority falling somewhere in the middle [40]. The two factions strongly defend their own position and question the other's paradigm [41][42][43], to the extent that a recent discussion paper proposed that these differences as irreconcilable and the profession should consider divorcing along these lines [41]. The most recent example of this conflict being the claim from non-MSK practitioners that spinal manipulation can boost the human body's immune response and has a role to play in the management of the COVID-19 pandemic (Axen et al, in review). ...
Background Professional associations are perceived to promote their professions and support their members. They can provide assistance with complaints, negotiate favourable professional indemnity insurance rates, provide access to research libraries and databases, and organise continuing professional development events. Despite these apparent advantages, about 1 in 3 Australian chiropractors choose not to belong to either of the two professional associations. Our study had three objectives: 1) to explore the views of non-member chiropractors about professional associations in general; and 2) seek to understand the motivations of non-member Australian chiropractors about not joining a professional association; and 3) to discover their reasons that might lead them to join a professional association.
Methods This was a qualitative descriptive study utilising in-depth semi-structured interviews with open-ended questions for thematic analysis conducted from January to March 2020. It was estimated that between 6 -15 participants in total would be required to achieve saturation of data, that is, the point where no new themes were being articulated. Participants had to be registered chiropractors who had not been members of a professional association (PA) for the last five years. Recruitment was through a Facebook ad and snowball sampling. Interviews were transcribed and imported into NVivo qualitative analysis software, allowing identification of key concepts surrounding non-membership of chiropractic professional associations.
Results Five themes were identified from the data. They were: “Not worth the money”, “Tarnished image of the profession”, “Going it alone / what’s in it for me”, “Lack of visibility”, and “Two warring factions”. The most commonly voiced suggestions for improvement included providing continuing professional development/lectures, frequent email updates about events affecting practice/business, improve the image of the profession through the media, and act as a regulator to the profession.
Conclusions Non-members are looking for PAs to enhance the respectability of the profession in a manner that ultimately results in increased patient volume and the provision of readily accessible day-to-day resources and information. These results can inform the construction of a survey for the broader chiropractic non-membership community to confirm and expand upon these findings and improve PAs.
... [134][135][136]155,249 This neuropathic perspective on the CVS is lacking in much of the recent critical literature. 47,[250][251][252][253] This may be in part due to the 1970s research emphasizing pain disorders related to CVS rather than the pathophysiology associated with neurodystrophic and neuropathic processes. 42,[254][255] Nevertheless, this element of theory should not be ignored and should be included in critical appraisals. ...
Objective:
The purpose of this paper is to review and discuss the history of chiropractic vertebral subluxation (CVS) during 1996 and 1997. The literature during this period offered critical and integrative models emphasized by a need for research into operational and functional definitions.
Discussion:
Several integrative approaches emerged, from Rome's 296 synonyms to Bergman's Pain/Tenderness, Asymmetry/Alignment, Range of Motion Abnormality, Tissue Tone, Texture, Temperature Abnormality, and Special Tests (PARTS) analysis adopted by the profession in the United States. Other noteworthy contributions included Ruch's Atlas of Common Subluxations, Epstein's introduction of network spinal analysis, and Kent's review of CVS models. Boone's introduction of the Journal of Vertebral Subluxation Research was accompanied by his 3-part model with Dobson. These years also included the paradigm statement of the Association of Chiropractic Colleges, which was adopted by the American Chiropractic Association, International Chiropractors Association, and World Federation of Chiropractic. Two other papers included Nelson's critique of the CVS paradigm and Keating's 1996 "Hunt for the Subluxation."
Conclusion:
The CVS reached a new stage of complexity and critique and offered new directions for research, integration, and development.
... Although research indicates that adoption of electronic patient records in health care more generally faces well-established hurdles, including time and cost, technological design, implementation, and patient privacy challenges, 9 it is arguably particularly challenging when faced with a professional group such as chiropractors in Australia where the current use of patient record management systems is potentially diverse and ad hoc. 10 Australian chiropractors practice exclusively in the private sector of the health care system and operate as either independent businesses or member practices of relatively small networks of comanaged businesses. 11 With this type of organizational profile, it is not feasible to expect or demand chiropractors in Australia who may join a voluntary PBRN, especially on a national scale, to be required also to sign up to a specific preallocated patient record management system that will attract a more significant financial and professional burden. ...
Objectives:
The purpose of this paper is to report on the recruitment and promotion strategies employed by the Australian Chiropractic Research Network (ACORN) project aimed at helping recruit a substantial national sample of participants and to describe the features of our practice-based research network (PBRN) design that may provide key insights to others looking to establish a similar network or draw on the ACORN project to conduct sub-studies.
Methods:
The ACORN project followed a multifaceted recruitment and promotion strategy drawing on distinct branding, a practitioner-focused promotion campaign, and a strategically designed questionnaire and distribution/recruitment approach to attract sufficient participation from the ranks of registered chiropractors across Australia.
Results:
From the 4684 chiropractors registered at the time of recruitment, the project achieved a database response rate of 36% (n = 1680), resulting in a large, nationally representative sample across age, gender, and location. This sample constitutes the largest proportional coverage of participants from any voluntary national PBRN across any single health care profession.
Conclusions:
It does appear that a number of key promotional and recruitment features of the ACORN project may have helped establish the high response rate for the PBRN, which constitutes an important sustainable resource for future national and international efforts to grow the chiropractic evidence base and research capacity. Further rigorous enquiry is needed to help evaluate the direct contribution of specific promotional and recruitment strategies in attaining high response rates from practitioner populations who may be invited to participate in future PBRNs.
... The chiropractic profession has maintained its position as the largest alternative or non-traditional approach to healthcare [4][5][6]. At the same time, the profession seeks wider mainstream acceptance by both the public and its healthcare peers [7][8][9][10][11][12][13][14][15][16]. In response, many chiropractic colleges now teach EBCP approaches to chiropractic care [17][18][19][20]. ...
Background Evidence-based clinical practice (EBCP) is an accepted practice for informed clinical decision making in mainstream health care professions. EBCP augments clinical experience and can have far reaching effects in education, policy, reimbursement and clinical management. The proliferation of published research can be overwhelming—finding a mechanism to identify literature that is essential for practitioners and students is desirable. The purpose of this study was to survey leaders in the chiropractic profession on their opinions of essential literature for doctors of chiropractic, faculty, and students to read or reference. Methods Deployment of an IRB exempted survey occurred with 68 academic and research leaders using SurveyMonkey®. Individuals were solicited via e-mail in August of 2011; the study closed in October of 2011. Collected data were checked for citation accuracy and compiled to determine multiple responses. A secondary analysis assessed the scholarly impact and Internet accessibility of the recommended literature. Results Forty-three (43) individuals consented to participate; seventeen (17) contributed at least one article of importance. A total of 41 unique articles were reported. Of the six articles contributed more than once, one article was reported 6 times, and 5 were reported twice. Conclusions A manageable list of relevant literature was created. Shortcomings of methods were identified, and improvements for continued implementation are suggested. A wide variety of articles were reported as “essential” knowledge; annual or bi-annual surveys would be helpful for the profession.
... Further there is a need for a clear understanding of how the physical examination relates to chiropractic practice. The terms currently used, such as "subluxation" are not reproducible clinically diagnosable entities [34]. This is further complicated by the general difficulty in arriving at a diagnosis for commonly encountered chiropractic conditions, such as low back pain [35]. ...
Background:
Councils of Chiropractic Education (CCE) indirectly influence patient care and safety through their role of ensuring the standards of training delivered by chiropractic educational institutions. This is achieved by CCEs defining competence and creating lists of descriptive statements to establish the necessary standards for students to attain before graduating. A preliminary review suggested that these definitions and descriptive lists lacked consensus. This creates the potential for variations in standards between the CCE jurisdictions and may compromise patient care and safety and also inter-jurisdictional mutual recognition. The purposes of this study were 1) to investigate similarities and differences between the CCEs in their definitions of competence, domains of educational competencies, components of the domains of competencies, as represented by assessment and diagnosis, ethics, intellectual development, and 2) to make recommendations, if significant deficiencies were found.
Method:
We undertook a systematic review of the similarities and differences between various CCEs definitions of competence and the descriptive lists of educational competencies they have adopted. CCEs were selected on the basis of WHO recommendations. Blinded investigators selected the data from CCE websites and direct contact with CCEs. This information was tabulated for a comparative analysis.
Results:
All CCEs' definitions of competence included the elements of "knowledge", "skills" and "attitudes" whereas only one CCE included the expected "abilities" element. The educational application of the definition of competency among CCEs varied. A high level of similarity when comparing the domains of competence adopted by CCEs was found despite variations in the structure. Differences between CCEs became increasingly apparent when the three selected representative domains were compared. CCEs were found to stipulate varying levels of prescriptiveness for graduate entry level standards.
Conclusions:
A series of recommendations are proposed to create uniform and high quality international standards of care. Future research should compare the levels of CCEs enforcement of standards to see if similarities and differences exist.
... The chiropractic profession has maintained its position as the largest alternative or non-traditional approach to healthcare [4][5][6]. At the same time, the profession seeks wider mainstream acceptance by both the public and its healthcare peers [7][8][9][10][11][12][13][14][15][16]. In response, many chiropractic colleges now teach EBCP approaches to chiropractic care [17][18][19][20]. ...
Evidence-based clinical practice (EBCP) is an accepted practice for informed clinical decision making in mainstream health care professions. EBCP augments clinical experience and can have far reaching effects in education, policy, reimbursement and clinical management. The proliferation of published research can be overwhelming-finding a mechanism to identify literature that is essential for practitioners and students is desirable. The purpose of this study was to survey leaders in the chiropractic profession on their opinions of essential literature for doctors of chiropractic, faculty, and students to read or reference.
Deployment of an IRB exempted survey occurred with 68 academic and research leaders using SurveyMonkey®. Individuals were solicited via e-mail in August of 2011; the study closed in October of 2011.
Forty-three (43) individuals consented to participate; seventeen (17) contributed at least one article of importance. A total of 41 unique articles were reported. Of the six articles contributed more than once, one article was reported 6 times, and 5 were reported twice.
A manageable list of relevant literature was created. Shortcomings of methods were identified, and improvements for continued implementation are suggested. A wide variety of articles were reported as "essential" knowledge; annual or bi-annual surveys would be helpful for the profession.
... 71 The subluxation concept is one of the most controversial ideas in chiropractic. 72 The subluxation complex, a theoretical model of motion segment dysfunction of the spine that incorporates interaction of pathologic changes in nerve, muscle, ligaments, vascular, and connective tissues, 73 lacks sufficient evidence base to support it as a clinical entity. 74 This concept is at the center of a paradigm difference (experiential vs evidence-based practice) between many chiropractors and researchers, academic chiropractors, and elected leaders. ...
Objective:
Nonspecific back pain is associated with high use of diagnostic imaging in primary care, yet current evidence suggests that routine imaging of the spine is unnecessary. The objective of this study is to describe current practice patterns in spine radiograph utilization among doctors of chiropractic enrolled in an American provider network.
Methods:
A cross-sectional analysis of administrative claims data from one of the largest providers of complementary health care networks for health plans in the United States was performed. Survey data containing provider demographics were linked with routinely collected data on spine radiograph utilization and patient characteristics aggregated at the provider level. We calculated rates and variations of spine radiographs over 12 months. Negative binomial regression was performed to identify significant predictors of high radiograph utilization and to estimate the associated incidence risk ratio.
Results:
Complete data for 6946 doctors of chiropractic and 249193 adult patients were available for analyses. In 2010, claims were paid for a total of 91542 new patient examinations and 23369 spine radiographs (including 17511 ordered within 5 days of initial patient examination). The rate of spine radiographs within 5 days of an initial patient visit was 204 per 1000 new patient examinations. Significant predictors of higher radiograph utilization rates included the following: practicing in the Midwest or South US census regions, practicing in an urban or suburban setting, chiropractic school attended, and being a male provider in full-time practice with more than 20 years of experience.
Conclusion:
Chiropractic school attended and practice location were the most influential predictors of spine radiograph utilization among network chiropractors. This information may help to inform the development and evaluation of a tailored intervention to address overuse of radiograph utilization.
Background Chiropractic care often exists outside of national healthcare systems, with exceptions in some national settings. This situation has led to suboptimal interprofessional communication and referral, with implications for the provision of appropriate and efficient care. To find solutions, the attitudes and perceptions of other professions must be better understood. We conducted a systematic review to assess other healthcare professionals’ perceptions and attitudes towards chiropractors and chiropractic care. Methods The review was registered with PROSPERO (CRD42023403381). Reporting was guided by the PRISMA statement. A search was carried out on PubMed, CINAHL, AMED, Index of Chiropractic Literature (ICL) and MEDLINE in Jan 2021 and updated on Jan 2022, February 2023 and June 2024. We included qualitative and quantitative study designs, focusing on healthcare professionals' attitudes toward and perceptions of chiropractic. Methodological quality was assessed using the Centre for Evidence Based Medicine tools for qualitative and cross-sectional survey studies Results The search retrieved 245 articles, of which 43 were included for review. Studies had been conducted across multiple national jurisdictions A total of 10,108 participants were included across the studies, including primary and secondary healthcare professionals as well as healthcare students. Issues identified with influencing opinions of chiropractic practice included participants’ knowledge of chiropractic methods, scope of practice, interprofessional communication, research base, and education. While some participants reported a perception of positive clinical outcomes associated with chiropractic care, communication between healthcare professionals and chiropractors was often lacking. Attitudes towards chiropractic varied, with factors like knowledge, patient interest, and referrals influencing perceptions. Conclusions To improve interprofessional attitudes and perceptions, the chiropractic profession might prioritise increased communication and information access concerning contemporary chiropractic care with other health care professions including educational interventions. Mitigation of a persistent lack of reliable information may improve how the profession is perceived in general, reduce misinformation and increase the likelihood that patients will receive the joined-up care they need.
Objective: To discuss the professional identify of chiropractic as evident in the profession's literature. Methods: Structured literature review followed by a pragmatic historical narrative of found artefacts. Results: The literature appears vague regarding chiropractic's identity. Discussion: The literature does allow a broad determination that the identity of chiropractic is uni-modal gathered around the founding premise of DD Palmer with an informed prediction of a left-skewed, negative distribution of concessional chiropractors representing no more than 30% of all. It appears this minority becomes more dogmatic as it concedes elements of conventional identity and adopts extreme evidence-based musculoskeletal medicine to become a sect of about 0.2% of all. About 70% of chiropractors identify with subluxation in an evidence-informed context and I call this representation the conventional chiropractic identity. Conclusion: The identity of chiropractic may now be described as conventional when its practitioners adhere to the profession's founding precepts, or concessional when it modifies or ignores these. The majority of the profession can be considered conventional. (J Contemporary Chiropr 2020;3:111-126)
Background: Evidence-based practice (EBP) is a clinical decision-making framework that supports quality
improvement in healthcare. While osteopaths are key providers of musculoskeletal healthcare, the extent to which
osteopaths engage in EBP is unclear. Thus, the aim of this cross-sectional study was to investigate UK osteopaths’
attitudes, skills and use of EBP, and perceived barriers and facilitators of EBP uptake.
Methods: UK-registered osteopaths were invited to complete the Evidence-Based Practice Attitude and Utilisation
Survey (EBASE) online.
Results: Of the 5200 registered osteopaths in the UK, 9.9% (517/5200) responded to the invitation, and 7.2% (375/
5200) completed the EBASE (< 20% incomplete answers). The demographic characteristics of the survey sample
were largely similar to those of the UK osteopathy workforce. The osteopaths reported overall positive attitudes
towards EBP, with most agreeing that EBP improves the quality of patient care (69.3%) and is necessary for
osteopathy practice (76.5%). The majority reported moderate-level skills in EBP, and most (80.8%) were interested in
improving these skills. Participating osteopaths typically engaged in EBP activities 1–5 times over the last month.
Barriers to EBP uptake included a lack of time and clinical evidence in osteopathy. Main facilitators of EBP included
having access to online databases, internet at work, full-text articles, and EBP education materials.
Conclusions: UK osteopaths were generally supportive of evidence-based practice, had moderate-level skills in EBP
and engaged in EBP activities infrequently. The development of effective interventions that improve osteopaths’
skills and the incorporation of EBP into clinical practice should be the focus of future research.
Background:
Physical manipulation and manual therapies are thousands of years old. The most popular western world iteration of these therapies is delivered by chiropractors. It can be argued that the collective public health benefit from chiropractic for spinal pain has been very substantial, however as chiropractic has transitioned from craft to profession it has encountered many internally and externally driven machinations that have retarded its progress to a fully accepted allied health profession. This article sets out a ten point plan for a new chiropractic that will achieve full acceptance for this troubled profession.
Discussion:
This article is based on a keynote speech known as the FG Roberts Memorial Address delivered on October 10, 2015, in Melbourne, Australia at the Chiropractic & Osteopathic College of Australasia and Chiropractic Australia national conference. The ten point plan consists of the following: improving the pre-professional education of chiropractors, establishing a progressive identity, developing a special interest for the profession, marginalising the nonsensical elements of the profession, being pro-public health, supporting the legitimate organised elements of the profession, improving clinical practice, embracing evidence based practice, supporting research and showing personal leadership.
Conclusion:
Adherence to this fresh ten point plan will, over time, see the chiropractic profession gain full legitimacy in the allied health field and acceptance by other health providers, policy makers and the public at large.
Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions.
A retrospective claims analysis and clinical evaluation were performed to assess the influence of on-site chiropractic services on health care utilization and outcomes.
Patients treated off-site were significantly more likely to have physical therapy (P < 0.0001) and outpatient visits (P < 0.0001). In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group (all P < 0.0001). Last, headache, neck pain, and low back pain-functional status improved significantly (all P < 0.0001).
These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.
ResearchGate has not been able to resolve any references for this publication.