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Johnson CD, Green BN, Agaoglu M, Amorin-Woods L, Brown R, Byfield D, Clum GW, Crespo W, Da Silva KL, Dane D, Daniels CJ, Edwards M, Foshee WK, Goertz C, Henderson C, Hynes R, Johnson V, Killinger L, Konarski-Hart K, Kopansky-Giles D, Kowalski M, Little C, McAllister S, Mrozek J, Nixdorf D, Peeace LD, Peterson C, Petrocco-Napuli KL, Phillips R, Snow G, Sorrentino A, Wong YK, Yelverton C, Young KJ. Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic. JOURNAL OF CHIROPRACTIC HUMANITIES 2023; 30:23-45. [PMID: 37841068 PMCID: PMC10569958 DOI: 10.1016/j.echu.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Objective This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels. Methods For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings. Results Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts. Conclusion A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.
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Affiliation(s)
| | - Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Mustafa Agaoglu
- AECC University College, Bournemouth, United Kingdom
- Turkish Chiropractic Association, Turkey
| | - Lyndon Amorin-Woods
- College of Health & Education, School of Allied Health, Murdoch University, Perth, Australia
| | | | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, United Kingdom
| | | | | | - Kendrah L. Da Silva
- Chiropractic Association of South Africa, Centurion, South Africa
- University of Johannesburg, Johannesburg, South Africa
| | - Dawn Dane
- Central Queensland University, Queensland, Australia
| | - Clinton J. Daniels
- Veterans Administration Puget Sound Health Care System, Tacoma, Washington
| | | | | | | | - Charles Henderson
- Henderson Technical Consulting and Life Chiropractic College West, Hayward, California
| | - Roger Hynes
- Palmer College of Chiropractic, Davenport, Iowa
| | - Valerie Johnson
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | - Matthew Kowalski
- Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig Little
- Council on Chiropractic Education, Scottsdale, Arizona
| | | | | | | | | | - Cynthia Peterson
- European Council on Chiropractic Education and Councils on Chiropractic Education International, British Columbia, Canada
- University of Johannesburg, Johannesburg, South Africa
| | | | | | - Gregory Snow
- Palmer College of Chiropractic West, San Jose, California
| | | | - Yi Kai Wong
- Association of Chiropractic Malaysia, Kuala Lumpur, Malaysia
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Cupler ZA, Gliedt JA, Perle SM, Puhl AA, Schneider MJ. Associations between demographics and clinical ideology, beliefs, and practice patterns: a secondary analysis of a survey of randomly sampled United States chiropractors. BMC Complement Med Ther 2023; 23:404. [PMID: 37946159 PMCID: PMC10634061 DOI: 10.1186/s12906-023-04225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The chiropractic profession in the United States (US) has a long history of intra-professional discourse surrounding ideology and beliefs. Large-scale efforts have evaluated 3 distinctive subgroups of US chiropractors focused on these areas of practice: spine/neuromusculoskeletal, primary care, and vertebral subluxation. To our knowledge, there have not been any prior studies exploring the factors associated with these ideology and belief characteristics of these subgroups. The purpose of this study was to explore, describe, and characterize the association of US chiropractors' ideology, beliefs, and practice patterns with: 1) chiropractic degree program of graduation, 2) years since completion of chiropractic degree, and 3) US geographic region of primary practice. METHODS This was a secondary analysis of a cross-sectional survey of a random sample of US licensed chiropractors (n = 8975). A 10% random sample was extracted from each of the 50 states and District of Columbia chiropractic regulatory board lists. The survey was conducted between March 2018-January 2020. The survey instrument consisted of 7 items that were developed to elicit these differentiating ideologies, beliefs, and practice patterns: 1) clinical examination/assessment, 2) health conditions treated, 3) role of chiropractors in the healthcare system, 4) the impact of chiropractic adjustments [spinal manipulation] in treating patients with cancer, 5) vaccination attitudes, 6) detection of subluxation on x-ray, and 7) x-ray utilization rates. Multinomial regression was used to analyze associations between these 7 ideology and practice characteristic items from the survey (dependent variables) and the 3 demographic items listed above (independent variables). RESULTS Data from 3538 respondents (74.6% male) were collected with an overall response rate of 39.4%. Patterns of responses to the 7 survey items for ideologies, beliefs, and practice characteristics were significantly different based on chiropractic degree program of graduation, years since completion of chiropractic degree, and geographic region of primary practice. CONCLUSIONS Among US chiropractors, chiropractic program of graduation, years since completion of chiropractic degree, and geographic region of primary practice are associated with variations in clinical ideology, beliefs, and practice patterns. The wide variation and inconsistent beliefs of US chiropractors could result in public confusion and impede interprofessional integration.
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Affiliation(s)
- Zachary A Cupler
- Butler VA Health Care System, Butler, PA, USA.
- Institute for Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen M Perle
- Big Data Interrogation Group, AECC University College, Bournemouth, Dorset, UK
- Discipline of Chiropractic, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, WA, Australia
| | - Aaron A Puhl
- Private Practice, Able Body Health Clinic, Lethbridge, AB, Canada
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Glucina TT, Krägeloh CU, Spencer K, Holt K. Defining chiropractic professional identity: A concept analysis. J Bodyw Mov Ther 2023; 35:75-83. [PMID: 37330807 DOI: 10.1016/j.jbmt.2023.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The concept of professional identity within chiropractic is often discussed and debated, however in the field to date, there is no formal definition of chiropractic professional identity (CPI). This article aims to create a coherent definition of CPI and to formalise the conceptual domains that may encompass it. METHODS Using the Walker and Avant (2005) process, a concept analysis methodology was employed to clarify the diffuse concept of CPI. This method initially involved selecting the concept (CPI), determining the aims and purpose of the analysis, identifying concept uses, and defining attributes. This was achieved from a critical literature review of professional identity across health disciplines. Chiropractic-related model, borderline and contrary cases were used to exemplify characteristics of CPI. The antecedents required to inform CPI, consequences of having, and ways to measure the concept of CPI were evaluated. RESULTS From the concept analysis data, CPI was found to encompass six broad attributes or domains: knowledge and understanding of professional ethics and standards of practice, chiropractic history, practice philosophy and motivations, the roles and expertise of a chiropractor, professional pride and attitude, and professional engagement and interaction behaviours. These domains were not mutually exclusive and may overlap. CONCLUSION A conceptual definition of CPI may bring together members and groups within the profession and promote intra-professional understanding across other disciplines. The CPI definition derived from this concept analysis is: 'A chiropractor's self-perception and ownership of their practice philosophies, roles and functions, and their pride, engagement, and knowledge of their profession'.
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Affiliation(s)
- Tanja T Glucina
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand.
| | - Christian U Krägeloh
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Kirsten Spencer
- School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
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Corcoran KL, Peterson DR, Zhao X, Moran EA, Lisi AJ. Characteristics and productivity of the chiropractic workforce of the Veterans Health Administration. Chiropr Man Therap 2022; 30:18. [PMID: 35410303 PMCID: PMC8996387 DOI: 10.1186/s12998-022-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Increasingly, integrated healthcare systems such as the United States Veterans Health Administration (VHA) are employing chiropractors. However, little is known about chiropractor employee clinical productivity which may be important for resource planning and monitoring care delivery. With its history of delivering chiropractic care and its enterprise-level assessment metrics, the VHA is an ideal setting to study a chiropractic workforce. We aim to assess characteristics of chiropractors employed by the VHA and explore associations between these characteristics and clinical productivity. METHODS This was a cross-sectional and serial analyses of VHA administrative data. Characteristics of the chiropractor workforce were evaluated from fiscal year (FY) 2016 to FY2019. Productivity was calculated using the VHA productivity measure, the quotient of an individual's total work relative value units (wRVUs) per FY divided by the direct clinical full-time equivalent (FTE) worked. A multivariable regression model was used to analyze the association between productivity and characteristics of the chiropractor and VHA facility. RESULTS From FY2016 to FY2019, the number of chiropractor employees increased from 102 to 167. In FY2019, the typical chiropractor employee was male, white, and 45.9 years old with 5.2 years of VHA experience. In FY2019, the VHA chiropractor workforce was 25.1% female, 79% white, and 20.4% Veteran. The productivity measure of a chiropractor was 3040 in FY2019. A higher facility complexity measure, presence of 3 chiropractor employees at a facility, and older age of the providers were the only characteristics studied that had a significant impact on productivity after adjusting for other covariates. CONCLUSION Provider characteristics and productivity metrics of the VHA chiropractor employee workforce are presented. The productivity measure provides an initial benchmarking that may be relevant to future modeling of chiropractor personnel in VHA and other healthcare systems.
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Affiliation(s)
- Kelsey L. Corcoran
- grid.281208.10000 0004 0419 3073Pain Research, Informatics, Multimorbidity and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT USA ,grid.47100.320000000419368710Yale Center for Medical Informatics, Yale School of Medicine, 300 George Street, New Haven, CT USA
| | - Douglas R. Peterson
- grid.413721.20000 0004 0419 317XOffice of Productivity, Efficiency and Staffing, VA Central Office, 810 Vermont Ave NW, Washington, DC USA
| | - Xiwen Zhao
- grid.281208.10000 0004 0419 3073Pain Research, Informatics, Multimorbidity and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT USA ,grid.47100.320000000419368710Yale Center for Analytical Sciences, Yale School of Public Health, 300 George Street, New Haven, CT USA
| | - Eileen A. Moran
- grid.413721.20000 0004 0419 317XOffice of Productivity, Efficiency and Staffing, VA Central Office, 810 Vermont Ave NW, Washington, DC USA
| | - Anthony J. Lisi
- grid.281208.10000 0004 0419 3073Pain Research, Informatics, Multimorbidity and Education (PRIME) Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT USA ,grid.47100.320000000419368710Yale Center for Medical Informatics, Yale School of Medicine, 300 George Street, New Haven, CT USA
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Long CR, Salsbury SA, Vining RD, Lisi AJ, Corber L, Twist E, Abrams T, Wallace RB, Goertz CM. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a single-arm, pragmatic, pilot trial of multimodal chiropractic care for U.S. veterans with chronic low back pain. Pilot Feasibility Stud 2022; 8:54. [PMID: 35256010 PMCID: PMC8900358 DOI: 10.1186/s40814-022-01008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial. Methods This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10-week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables. Results We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial. Conclusions We demonstrated the feasibility of participant recruitment, retention, and electronic data collection for conducting a pragmatic clinical trial of chiropractic care in a Veterans Health Administration facility. Using the pilot data and lessons learned, we modified and refined a protocol for a full-scale, multisite, pragmatic, National Institutes of Health-funded randomized trial of multimodal chiropractic care for veterans with chronic LBP that began recruitment in February 2021. Trial registration ClinicalTrials.gov NCT03254719 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01008-0.
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Salsbury SA, Twist E, Wallace RB, Vining RD, Goertz CM, Long CR. Care Outcomes for Chiropractic Outpatient Veterans (COCOV): a qualitative study with veteran stakeholders from a pilot trial of multimodal chiropractic care. Pilot Feasibility Stud 2022; 8:6. [PMID: 35031072 PMCID: PMC8759237 DOI: 10.1186/s40814-021-00962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is common among military veterans seeking treatment in Department of Veterans Affairs (VA) healthcare facilities. As chiropractic services within VA expand, well-designed pragmatic trials and implementation studies are needed to assess clinical effectiveness and program uptake. This study evaluated veteran stakeholder perceptions of the feasibility and acceptability of care delivery and research processes in a pilot trial of multimodal chiropractic care for chronic LBP. METHODS The qualitative study was completed within a mixed-method, single-arm, pragmatic, pilot clinical trial of chiropractic care for LBP conducted in VA chiropractic clinics. Study coordinators completed semi-structured, in person or telephone interviews with veterans near the end of the 10-week trial. Interviews were audiorecorded and transcribed verbatim. Qualitative content analysis using a directed approach explored salient themes related to trial implementation and delivery of chiropractic services. RESULTS Of 40 participants, 24 completed interviews (60% response; 67% male gender; mean age 51.7 years). Overall, participants considered the trial protocol and procedures feasible and reported that the chiropractic care and recruitment methods were acceptable. Findings were organized into 4 domains, 10 themes, and 21 subthemes. Chiropractic service delivery domain encompassed 3 themes/8 subthemes: scheduling process (limited clinic hours, scheduling future appointments, attendance barriers); treatment frequency (treatment sufficient for LBP complaint, more/less frequent treatments); and chiropractic clinic considerations (hire more chiropractors, including female chiropractors; chiropractic clinic environment; patient-centered treatment visits). Outcome measures domain comprised 3 themes/4 subthemes: questionnaire burden (low burden vs. time-consuming or repetitive); relevance (items relevant for LBP study); and timing and individualization of measures (questionnaire timing relative to symptoms, personalized approach to outcomes measures). The online data collection domain included 2 themes/4 subthemes: user concerns (little difficulty vs. form challenges, required computer skills); and technology issues (computer/internet access, junk mail). Clinical trial planning domain included 2 themes/5 subthemes: participant recruitment (altruistic service by veterans, awareness of chiropractic availability, financial compensation); and communication methods (preferences, potential barriers). CONCLUSIONS This qualitative study highlighted veteran stakeholders' perceptions of VA-based chiropractic services and offered important suggestions for conducting a full-scale, veteran-focused, randomized trial of multimodal chiropractic care for chronic LBP in this clinical setting. TRIAL REGISTRATION ClinicalTrials.gov NCT03254719.
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Affiliation(s)
- Stacie A. Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
| | - Elissa Twist
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
| | - Robert B. Wallace
- Department of Epidemiology, College of Public Health, The University of Iowa, S422 CPHB, 145 N. Riverside Drive, Iowa City, Iowa 52242 USA
| | - Robert D. Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
| | - Christine M. Goertz
- Department of Orthopaedic Surgery, Duke University School of Medicine, 200 Morris Street, Durham, North Carolina 27701 USA
| | - Cynthia R. Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, Iowa 52803 USA
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Green BN, Dunn AS. An Essential Guide to Chiropractic in the United States Military Health System and Veterans Health Administration. JOURNAL OF CHIROPRACTIC HUMANITIES 2021; 28:35-48. [PMID: 35002576 PMCID: PMC8720651 DOI: 10.1016/j.echu.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this article is to provide an essential overview of chiropractic services in United States military and veterans' health care systems. METHODS We reviewed literature, legislation, and policies from 1936 through September 2021 pertaining to chiropractic services in the United States military and veterans' health systems. Using these sources and our combined experience in these systems, we identified fundamental themes in the delivery of chiropractic care in the health care systems of the Department of Defense (providing health care for active duty service members) and the Department of Veterans Affairs (providing health care for veterans) in main topic areas. RESULTS We identified 7 main topic areas relevant to the 2 systems: populations served by chiropractors; health care systems; integration; utilization and supply of chiropractic care; vetting of chiropractors; roles and evaluation of chiropractors; and oversight and leadership. Key information about chiropractic care in these systems was synthesized into the main topic areas. Benefits of high-quality within-system chiropractic care to active-duty service members and veterans are presented. The assets that within-system chiropractors bring to the Department of Defense and Department of Veterans Affairs health care systems are discussed for each main topic area. CONCLUSION This article contains an essential overview of chiropractic services in the Department of Defense and the Department of Veterans Affairs. It offers clarity regarding the integration of chiropractic services into these health care systems and includes a 1-page brief of talking points that may help better inform ongoing discussions of chiropractic services in these 2 different but intertwined environments.
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Affiliation(s)
- Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Andrew S. Dunn
- Chiropractic Department, VA Western New York Healthcare System, Buffalo, New York
- Department of Chiropractic Clinical Sciences, New York Chiropractic College, Seneca Falls, New York
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Gliedt JA, Perle SM, Puhl AA, Daehler S, Schneider MJ, Stevans J. Evaluation of United States chiropractic professional subgroups: a survey of randomly sampled chiropractors. BMC Health Serv Res 2021; 21:1049. [PMID: 34610831 PMCID: PMC8491397 DOI: 10.1186/s12913-021-07081-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Professional subgroups are common and may play a role in aiding professional maturity or impeding professional legitimization. The chiropractic profession in the United States has a long history of diverse intra-professional subgroups with varying ideologies and practice styles. To our knowledge, large-scale quantification of chiropractic professional subgroups in the United States has not been conducted. The purpose of this study was to quantify and describe the clinical practice beliefs and behaviors associated with United States chiropractic subgroups. Methods A 10% random sample of United States licensed chiropractors (n = 8975) was selected from all 50 state regulatory board lists and invited to participate in a survey. The survey consisted of a 7-item questionnaire; 6 items were associated with chiropractic ideological and practice characteristics and 1 item was related to the self-identified role of chiropractic in the healthcare system which was utilized as the dependent variable to identify chiropractic subgroups. Multinomial logistic regression with predictive margins was used to analyze which responses to the 6 ideology and practice characteristic items were predictive of chiropractic subgroups. Results A total of 3538 responses were collected (39.4% response rate). Respondents self-identified into three distinct subgroups based on the perceived role of the chiropractic profession in the greater healthcare system: 56.8% were spine/neuromusculoskeletal focused; 22.0% were primary care focused; and 21.2% were vertebral subluxation focused. Patterns of responses to the 6 ideologies and practice characteristic items were substantially different across the three professional subgroups. Conclusions Respondents self-identified into one of three distinct intra-professional subgroups. These subgroups can be differentiated along themes related to clinical practice beliefs and behaviors. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07081-0.
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Affiliation(s)
- Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen M Perle
- University of Bridgeport, College of Health Sciences, School of Chiropractic, Bridgeport, CT, USA.,Murdoch University, Discipline of Chiropractic, College of Science, Health, Engineering and Education, Murdoch, Western Australia, Australia
| | - Aaron A Puhl
- Private Practice, Able Body Health Clinic, Lethbridge, AB, Canada
| | - Sarah Daehler
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Schneider
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA. .,University of Pittsburgh, Clinical Translation and Science Institute, Pittsburgh, PA, USA.
| | - Joel Stevans
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Clinical Translation and Science Institute, Pittsburgh, PA, USA
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Halloran SM, Coleman BC, Kawecki T, Long CR, Goertz C, Lisi AJ. Characteristics and Practice Patterns of U.S. Veterans Health Administration Doctors of Chiropractic: A Cross-sectional Survey. J Manipulative Physiol Ther 2021; 44:535-545. [DOI: 10.1016/j.jmpt.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
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Lisi AJ, Salsbury SA, Hawk C, Vining RD, Wallace RB, Branson R, Long CR, Burgo-Black AL, Goertz CM. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process. J Manipulative Physiol Ther 2019; 41:137-148. [PMID: 29482827 PMCID: PMC6103526 DOI: 10.1016/j.jmpt.2017.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. METHODS The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. RESULTS The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. CONCLUSION This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain.
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Affiliation(s)
- Anthony J Lisi
- Physical Medicine and Rehabilitation, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | - Robert D Vining
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Richard Branson
- Department of Physical Medicine and Rehabilitation, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa
| | | | - Christine M Goertz
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, Iowa..
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Mior S, Sutton D, Cancelliere C, French S, Taylor-Vaisey A, Côté P. Chiropractic services in the active duty military setting: a scoping review. Chiropr Man Therap 2019; 27:45. [PMID: 31338157 PMCID: PMC6628474 DOI: 10.1186/s12998-019-0259-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background Musculoskeletal injuries are one of the most prevalent battle and non-battle related injuries in the active duty military. In some countries, chiropractic services are accessed to manage such injuries within and outside military healthcare systems; however, there is no recent description of such access nor outcomes. This scoping review aimed to synthesize published literature exploring the nature, models, and outcomes of chiropractic services provided to active duty military globally. Method We employed scoping review methodology. Systematic searches of relevant databases, including military collections and hand searches were conducted from inception to October 22, 2018. We included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. Paired reviewers independently reviewed all citations and articles using a two-phase screening process. Data from relevant articles were extracted into evidence tables and sorted by study type. Results were descriptively analyzed. Results We screened 497 articles and 20 met inclusion criteria. Chiropractic services were commonly provided on-base only in the US. Services were accessed by physician referral and commonly after initiation or non-response to other care. Use of scope of practice was determined by the system/facility, varying from intervention specific to comprehensive services. Back pain with and without radiculopathy accounted for most complaints. Treatment outcomes were reported primarily by case reports. However, two recent randomized trials reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain. Specific reaction time measures in special operation forces military did not improve after chiropractic care compared to wait-list control. Conclusions Our scoping review found the majority of published articles described chiropractic services in the active duty military in the US setting. Recent RCTs suggest a benefit of including chiropractic care to usual medical care in managing back pain in active duty military. Yet despite reported benefits in Australia, Canada, and the US, there is a need for further qualitative, descriptive, and clinical trial data worldwide to inform the role of chiropractic services in active duty military.
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Affiliation(s)
- Silvano Mior
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Daphne To
- Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Carolina Cancelliere
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
| | - Simon French
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, 17 Wally’s Walk, North Ryde, NSW 2109 Australia
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
| | - Pierre Côté
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), 6100 Leslie Street, Toronto, Ontario M2H 3J1 Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), 2000 Simcoe Street North, Oshawa, Ontario L1G 0C5 Canada
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Rosenthal B, Gravrand H, Lisi AJ. Interprofessional collaboration among complementary and integrative health providers in private practice and community health centers. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.xjep.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mior SA, Vogel E, Sutton D, French S, Côté P, Nordin M, Loisel P, Laporte A. Exploring Chiropractic Services in the Canadian Forces Health Services - Perceptions of Facilitators and Barriers Among Key Informants. Mil Med 2019; 184:e344-e351. [PMID: 30462275 DOI: 10.1093/milmed/usy319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/16/2018] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Musculoskeletal (MSK) conditions have a significant impact on the health and operational readiness of military members. The Canadian Forces Health Services (CFHS) provides a spectrum of health services in managing Canadian Armed Forces (CAF) personnel health care needs with on-base and off-base services provided by civilian and uniformed health care professionals, including chiropractors. Although chiropractic services are available in US DoD and VA systems, little is known about the facilitators and barriers to integrating on-base chiropractic services within the CFHS. This study explored key informants' perceptions of facilitators and barriers to the integration of on-base chiropractic services within the CFHS. METHODS We conducted a qualitative study to describe and understand how an integrated chiropractic service could be designed, implemented, and evaluated within the current interdisciplinary CFHS. Telephone interviews were conducted, using a semi-structured interview guide, to explore key informants' perceptions and experiences of chiropractic care within the CFHS. In total, we invited 27 individuals across Canada to participate; 15 were identified through purposeful sampling, 12 through a snowball sampling technique, and 2 declined. The 25 participants included military personnel (52%), public servants and contractors employed by the Department of Defense (24%), as well as civilian health care providers (24%). All participants were health care providers [physicians (MD) (7), physiotherapists (PT) (13), chiropractors (DC) (5)]. Interviews were audio-recorded and transcribed verbatim. Transcripts were prepared and analyzed using an interpretivist approach that explored key informants' perceptions and experiences. RESULTS Qualitative analysis revealed numerous facilitators and barriers to chiropractic services in the CFHS. These were categorized under three broad themes: base-to-base variations, variable gatekeeper roles, and referral processes. Barriers to integrating chiropractic services included: lack of clarity about a chiropractor's clinical knowledge and skills; CFHS team members' negative prior experiences with chiropractors (e.g., inappropriate patient-focused communication, clinical management that was not evidence-based, ignorance of military culture); suboptimal bi-directional communication between CAF personnel and DCs across bases; and wide-ranging perspectives pertaining to duplication of services offered by PTs and DCs in managing MSK conditions. Facilitators associated with the integration of chiropractic services within a collaborative and interdisciplinary CAF environment included: patient benefits associated with multiple approaches utilized by different providers; adoption of up-to-date, high-quality evidence and guidelines to standardize care and curtail "dependency" between patient and providers; and co-location of providers to strengthen existing interprofessional communication and relationships. Key informants called for patient care that is collaborative, integrated and patient-centered, rather than "patient-driven" care; civilian providers understanding and respecting military culture rather than assuming transferability of patient management processes from the public civilian sector; standardization of communication protocols and measures to evaluate outcomes of care; and the need to move slowly and respectfully within the current CAF health care system if planning the on-base implementation of chiropractic services. CONCLUSION This study illuminated many opportunities and barriers, in complex and diverse domains, related to introducing collaborative chiropractic services in the CFHS. The findings are relevant to increasing understanding and strengthening interprofessional collaborative care within the unique CAF health care delivery system.
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Affiliation(s)
- Silvano A Mior
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada
| | - Ellen Vogel
- University of Ontario Institute of Technology, Faculty of Health Sciences, 2000 Simcoe Street North, Oshawa, Ontario, Canada
| | - Deborah Sutton
- Queen's University, Rehabilitation Science, Faculty of Health Sciences, Louise D Acton Building, Kingston, Ontario, Canada
| | - Simon French
- Queen's University, Rehabilitation Science, Faculty of Health Sciences, Louise D Acton Building, Kingston, Ontario, Canada.,Department of Chiropractic, Macquarie University, NSW, Australia
| | - Pierre Côté
- Department of Research and Innovation, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada.,University of Ontario Institute of Technology, Faculty of Health Sciences, 2000 Simcoe Street North, Oshawa, Ontario, Canada
| | | | - Patrick Loisel
- University of Toronto, Institute of Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, Ontario, Canada
| | - Audrey Laporte
- University of Toronto, Institute of Health Policy, Management and Evaluation, 155 College Street, 4th Floor, Toronto, Ontario, Canada.,Canadian Centre for Health Economics, 155 College Street, 4th Floor, Toronto, Ontario, Canada
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Shannon ZK, Salsbury SA, Gosselin D, Vining RD. Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. Altern Ther Health Med 2018; 18:316. [PMID: 30514271 PMCID: PMC6278071 DOI: 10.1186/s12906-018-2386-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
Abstract
Background Few studies have investigated patient and provider expectations of chiropractic care, particularly in multidisciplinary settings. This qualitative study explored stakeholder expectations of adding a chiropractor to the healthcare team at a rehabilitation specialty hospital. Methods The research methodology was an organizational case study with an inpatient facility for persons recovering from complex neurological conditions serving as the setting. Sixty stakeholders, including patients, families, hospital staff, and administrators, were interviewed or participated in focus groups in June 2015. Semi-structured questions guided the interview sessions which were digitally audiorecorded and transcribed. Data were entered into a qualitative software program to conduct content analysis using an iterative approach to identify key themes. Results Expectations for the chiropractic program were mostly positive with themes consistently reported across stakeholder groups. The central domain, making progress, encompassed the organizational mission to empower patients to reach hospital discharge and return to life in the community. Higher order goals, characterized as achieving whole person healing, encompassed patients’ quality of life, self-efficacy, and activities of daily living. Stakeholders expected the addition of chiropractic to help patients progress toward these goals by improving pain management and physical functioning. Pain management themes included pain intensity, medication use, and pain-related behaviors, while functional improvement themes included muscle tone, extremity function, and balance and mobility. In addition to these direct effects on clinical outcomes, stakeholders also expected indirect effects of chiropractic care on healthcare integration. This indirect effect was expected to increase patient participation in other providers’ treatments leading to improved care for the patient across the team and facility-level outcomes such as decreased length of stay. Conclusions Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge. Understanding stakeholder expectations may allow providers to align current expectations with what may be reasonable, in an effort to achieve appropriate clinical outcomes and patient and staff satisfaction.
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Lisi AJ, Salsbury SA, Twist EJ, Goertz CM. Chiropractic Integration into Private Sector Medical Facilities: A Multisite Qualitative Case Study. J Altern Complement Med 2018; 24:792-800. [PMID: 30016118 DOI: 10.1089/acm.2018.0218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Chiropractic care may have value in improving patient outcomes and decreasing opioid use, but little is known about the impetus for or process of incorporating these services into conventional medical settings. The purpose of this qualitative study was to describe organizational structures, care processes, and perceived value of chiropractic integration within U.S. private sector medical facilities. DESIGN Multisite, comparative organizational case study. SETTINGS Nine U.S. private sector medical facilities with on-site chiropractic care, including five hospitals and four clinics. PARTICIPANTS One hundred and thirty-five key facility stakeholders including doctors of chiropractic (DCs), non-DC clinicians, support staff, administrators, and patients. METHODS Researchers conducted 2-day site visits to all settings. Qualitative data were collected from audio-recorded, semi-structured, role-specified, individual interviews; standardized organizational data tables; and archival document review. A three-member, interdisciplinary team conducted thematic content analysis of verbatim transcripts using an existing conceptual framework and emergent codes. RESULTS These nine medical facilities had unique organizational structures and reasons for initiating chiropractic care in their settings. Across sites, DCs were sought to take an evidence-based approach to patient care, work collaboratively within a multidisciplinary team, engage in interprofessional case management, and adopt organizational mission and values. Chiropractic clinics were implemented within existing human resources, physical plant, information technology, and administrative support systems, and often expanded over time to address patient demand. DCs usually were co-located with medical providers and integrated into the collaborative management of patients with musculoskeletal and co-morbid conditions. Delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success. CONCLUSION A diverse group of U.S. private sector medical facilities have implemented chiropractic clinics, and a wide variety of facility stakeholders report high satisfaction with the care provided.
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Affiliation(s)
- Anthony J Lisi
- 1 Pain Research, Informatics, Multi-Comorbidities and Education Center, VA Connecticut Healthcare System , West Haven, CT.,2 Yale Center for Medical Informatics, Yale School of Medicine , Yale University, New Haven, CT
| | - Stacie A Salsbury
- 3 Palmer Center for Chiropractic Research, Palmer College of Chiropractic , Davenport, IA
| | - Elissa J Twist
- 3 Palmer Center for Chiropractic Research, Palmer College of Chiropractic , Davenport, IA
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Salsbury SA, Vining RD, Gosselin D, Goertz CM. Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team. Chiropr Man Therap 2018; 26:29. [PMID: 29977521 PMCID: PMC6014012 DOI: 10.1186/s12998-018-0200-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022] Open
Abstract
Background While chiropractors are integrating into multidisciplinary settings with increasing frequency, the perceptions of medical providers and patients toward adding chiropractors to existing healthcare teams is not well-understood. This study explored the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting. Methods This qualitative analysis was part of a multi-phase, organizational case study designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team. The setting was a 62-bed rehabilitation specialty hospital located in the northeastern United States. Participants included patients, families, community members, and professional staff of the administrative, medical, nursing, and therapy departments. Data collection consisted of audiotaped, individual interviews and profession-specific focus groups guided by a semi-structured interview schedule. Transcripts were imported into a qualitative data analysis program for data analysis. An iterative coding process using thematic content analysis categorized key themes and domains. Results Sixty participants were interviewed in June 2015, including 48 staff members, 6 patients, 4 family members, and 2 community members. Our analysis generated a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings composed of 5 domains and 13 themes. The central domain, Patient-Centeredness, or the provision of healthcare that is respectful, responsive, and inclusive of the patient’s values, preferences, and needs, was mentioned in all interviews and linked to all other themes. The Professional Qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence. Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting. Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization. Conclusions Our findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations. Electronic supplementary material The online version of this article (10.1186/s12998-018-0200-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stacie A Salsbury
- 1Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA USA
| | - Robert D Vining
- 1Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA USA
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Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey. J Manipulative Physiol Ther 2018; 41:149-155. [DOI: 10.1016/j.jmpt.2017.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/01/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022]
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Lisi AJ, Brandt CA. Trends in the Use and Characteristics of Chiropractic Services in the Department of Veterans Affairs. J Manipulative Physiol Ther 2018; 39:381-386. [PMID: 27288324 DOI: 10.1016/j.jmpt.2016.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze national trends and key features of the Department of Veterans Affairs' (VA's) chiropractic service delivery and chiropractic provider workforce since their initial inception. METHODS This was a serial cross-sectional analysis of the VA administrative data sampled from the first record of chiropractic services in VA through September 30, 2015. Data were obtained from VA's Corporate Data Warehouse and analyzed with descriptive statistics. RESULTS From October 1, 2004, through September 30, 2015, the annual number of patients seen in VA chiropractic clinics increased from 4052 to 37349 (821.7%), and the annual number of chiropractic visits increased from 20072 to 159366 (693.9%). The typical VA chiropractic patient is male, is between the ages of 45 and 64, is seen for low back and/or neck conditions, and receives chiropractic spinal manipulation and evaluation and management services. The total number of VA chiropractic clinics grew from 27 to 65 (9.4% annually), and the number of chiropractor employees grew from 13 to 86 (21.3% annually). The typical VA chiropractor employee is a 45.9-year-old man, has worked in VA for 4.5 years, and receives annual compensation of $97860. VA also purchased care from private sector chiropractors starting in 2000, growing to 159533 chiropractic visits for 19435 patients at a cost of $11155654 annually. CONCLUSIONS Use of chiropractic services and the chiropractic workforce in VA have grown substantially over more than a decade since their introduction.
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Affiliation(s)
- Anthony J Lisi
- Chiropractic Section Chief, VA Connecticut Healthcare System, West Haven, CT; Assistant Clinical Professor, Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT.
| | - Cynthia A Brandt
- Staff Physician, VA Connecticut Healthcare System, West Haven, CT; Professor, Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
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Green BN, Johnson CD, Daniels CJ, Napuli JG, Gliedt JA, Paris DJ. Integration of Chiropractic Services in Military and Veteran Health Care Facilities: A Systematic Review of the Literature. J Evid Based Complementary Altern Med 2016; 21:115-30. [PMID: 26677851 DOI: 10.1177/2156587215621461] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/16/2015] [Indexed: 02/06/2023] Open
Abstract
This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria. Studies reporting utilization and policy show that chiropractic services are successfully implemented in various military and veteran health care settings and that integration varies by facility. Doctors of chiropractic that are integrated within military and veteran health care facilities manage common neurological, musculoskeletal, and other conditions; severe injuries obtained in combat; complex cases; and cases that include psychosocial factors. Chiropractors collaboratively manage patients with other providers and focus on reducing morbidity for veterans and rehabilitating military service members to full duty status. Patient satisfaction with chiropractic services is high. Preliminary findings show that chiropractic management of common conditions shows significant improvement.
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Affiliation(s)
- Bart N Green
- Naval Medical Center San Diego, San Diego, CA, USA National University of Health Sciences, Lombard, IL, USA
| | | | | | - Jason G Napuli
- National University of Health Sciences, Lombard, IL, USA Bay Pines VA Healthcare System, Bay Pines, FL, USA New York Chiropractic College, Seneca Falls, NY, USA
| | | | - David J Paris
- VA Northern California Health Care System, Redding, CA, USA Palmer College of Chiropractic, Davenport, IA, USA
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Bronston LJ, Austin-McClellan LE, Lisi AJ, Donovan KC, Engle WW. A Survey of American Chiropractic Association Members' Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings. J Chiropr Med 2015; 14:227-39. [PMID: 26793034 DOI: 10.1016/j.jcm.2015.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to examine the self-report of experiences, attitudes, and perceived educational needs of American Chiropractic Association members regarding practice in integrated health care settings. METHODS This was a descriptive observational study of the American Chiropractic Association members. Participants completed an electronic survey reporting their current participation and interest in chiropractic integrated practice. RESULTS The survey was completed in 2011 by 1142 respondents, for a response rate of 11.8%. The majority of respondents (82.9%) did not currently practice in an integrated setting, whereas 17.1% did. Those practicing in various integrated medical settings reported delivering a range of diagnostic, therapeutic, and case management services. Participation in administrative and scholarly activities was less common. Respondents not practicing in integrated settings reported being interested in delivering a very similar array of clinical services. Doctors of chiropractic practicing in hospital or outpatient medical facilities reported frequent engagement in interprofessional collaboration. Both nonintegrated and integrated respondents reported very similar educational interests on a range of clinical topics. CONCLUSION The findings of this survey provide insight into the experiences, participation, and interests in integrated clinical practice for members of the American Chiropractic Association.
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Affiliation(s)
| | - Lauren E Austin-McClellan
- Adjunct Assistant Professor of Clinical Services, University of Bridgeport College of Chiropractic, Bridgeport, CT; Staff Chiropractor, VA Connecticut Healthcare System, West Haven, CT
| | - Anthony J Lisi
- Chiropractor, Aquidneck Chiropractic, Middletown, RI; Chiropractor, Engle Chiropractic Center, Denver, PA
| | - Kevin C Donovan
- Associate Professor of Clinical Sciences, University of Bridgeport College of Chiropractic, Bridgeport, CT
| | - Walter W Engle
- Chiropractic Section Chief, VA Connecticut Healthcare System, West Haven, CT
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