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Grace S, Baltrotsky K. Australian National Complementary Medicine Workforce Survey: A Profile of Practitioners and Their Practices. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:682-690. [PMID: 38150321 DOI: 10.1089/jicm.2023.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Introduction: Recent years have seen rapid changes to traditional, complementary, and integrative medicine (TCIM) practices in Australia associated with increased interest in TCIM during the COVID-19 pandemic and reorganization of practice delivery methods. This study aimed to update the understanding of the current TCIM workforce in Australia. Methods: Representatives of six TCIM professional organizations developed a survey for e-mail distribution to members. The anonymous online Qualtrics survey was based on previous surveys to identify workforce trends over time. Survey data were analyzed descriptively using Qualtrics and STATA statistical software (version 16). Results: Responses were recorded from 1921 participants. Respondents were predominantly female (79.7%); 71.8% were aged over 45 years. Remedial massage therapists represented 32.1% and naturopaths represented 23.7% of respondents. Highest qualifications were diplomas (37.7%), bachelor's degrees (28.9%), and advanced diplomas (21.8%). Metropolitan locations accounted for 68.1% of practices. Solo private practice was the main practice setting (59.8%); 13.8% practiced in group private practice with TCIM practitioners; and 10.6% practiced with allied health practitioners. Approximately three quarters of respondents (73.9%) saw 0-5 new clients per week; 42.2% had 0-5 follow-up consultations per week. Collaboration rates with TCIM practitioners, other non-TCIM practitioners, and general medical practitioners (GPs) were 68.7%, 24.4%, and 9.2%, respectively. A total of 93% did not suspect an adverse event from their treatment in the past year. Businesses of 75.9% of respondents were reportedly affected by the pandemic. Discussion: Comparisons with previous surveys show ongoing predominance of female practitioners, an aging workforce, a high proportion of remedial massage and naturopathy practitioners, and an increasingly qualified TCIM workforce. There was little change in the very low number of adverse events suspected by practitioners, number of consultations per week, and low levels of income of most TCIM practitioners compared with the average income in Australia. Respondents collaborated at similar rates as in the past; however, more with TCIM practitioners than with GPs.
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Affiliation(s)
- Sandra Grace
- Faculty of Health, Southern Cross University, Lismore, Australia
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Fernandez M, de Luca K, Moore C, French SD, Ferreira P, Swain M. Insights into physical activity promotion among Australian chiropractors: a cross-sectional survey. Chiropr Man Therap 2024; 32:22. [PMID: 38877559 PMCID: PMC11179190 DOI: 10.1186/s12998-024-00543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/24/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Despite the well-known benefits of physical activity, physical inactivity is presently a global health pandemic. Allied healthcare providers, such as chiropractors, knowingly recognise the importance of physical activity and are prepared to routinely discuss and/or counsel patients on this topic; however, little is known about Australian chiropractors in the physical activity setting. Our aim was to explore and identify factors associated with physical activity promotion among Australian chiropractors, including their knowledge of the physical activity and sedentary behaviour guidelines and their own levels of physical activity. METHODS From February to May 2021, a convenience sample of Australian chiropractors completed an online survey. Items assessed by Likert scale included: physical activity promotion frequency, with the type, quantity, barriers, perceptions, and feasibility. We asked questions about their familiarity with, and knowledge of, Australian Physical Activity and Sedentary Behaviour Guidelines, chiropractors' own physical activity, and whether the chiropractors met activity guidelines. Survey responses were descriptively reported. Univariable logistic regression models explored factors explaining frequent physical activity promotion. RESULTS Of 217 respondents, 64% reported that they frequently (≥ 70%) recommended a more physically active lifestyle. Only 15% often performed pre-exercise screening, 73% frequently prescribed resistance exercise, 19% reported time as the most frequent barrier, while 37% reported being not at all familiar with the guidelines. Univariable logistic regression models found male chiropractors were more likely to promote physical activity, [odds ratio (OR) = 2.33; 95% confidence interval (CI): 1.32-4.12)], while chiropractors who frequently treat children 0-3 years (OR = 0.5; 95% CI: 0.28-0.87), children 4-18 years (OR = 0.42; 95% CI: 0.21-0.86), and pregnant women (OR = 0.5; 95% CI: 0.26-0.94) were less likely. Chiropractors were more likely to promote physical activity if they were familiar with the activity guidelines (OR = 2.9; 95% CI: 1.32-6.41), were confident promoting (OR = 11.6; 95% CI: 1.37-98.71) and prescribing physical activity programs (OR = 4.5; 95% CI: 2.03-9.99). CONCLUSION Most chiropractors confidently and regularly integrate physical activity into practice. Yet, despite acknowledging its importance, one third of chiropractors reported poor knowledge of the Physical Activity and Sedentary Behaviour Guidelines. Identifying barriers to the awareness, and implementation of physical activity guidelines should be further explored within chiropractic clinical settings.
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Affiliation(s)
- Matthew Fernandez
- Discipline of Chiropractic, Faculty, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Katie de Luca
- Discipline of Chiropractic, Faculty, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Craig Moore
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paulo Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Swain
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Bernard-Giglio M, French SD, Myburgh C, de Luca K. Drivers, barriers, and response to care of Australian pregnant women seeking chiropractic care for low back and pelvic girdle pain: a qualitative case study. Chiropr Man Therap 2023; 31:43. [PMID: 37789336 PMCID: PMC10546639 DOI: 10.1186/s12998-023-00516-x] [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: 09/03/2022] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Pregnancy-related low back and/or pelvic girdle pain is common, with a prevalence rate of up to 86% in pregnant women. Although 19.5% of Australian pregnant women visit a chiropractor for pelvic girdle pain, little is known about the experience of pregnant women who seek this care. The aim of this study was to describe and explore the experiences of Australian pregnant women who seek chiropractic care for their current pregnancy-related low back and/or pelvic girdle pain. METHODS A qualitative case study approach with purposive sampling from 27 chiropractic practices was used. A grounded theory approach was informed by a constructivist and interpretivist stance, which provided understanding and meaning to the pregnant women's experiences. Online unstructured interviews were recorded, transcribed, and anonymised. A thematic analysis was subsequently conducted on the primary data. Codes and major themes were developed with the use of critical self- reflection (memos), survey finding triangulation and respondent validation. RESULTS Sixteen potential respondents expressed interest in participating. After eligibility screening and data saturation, nine interviews were undertaken. Four key themes were identified: "Care drivers: what drives care seeking?", "Care barriers: what barriers are encountered?", "Chiropractic treatment: what does treatment consist of?" and "Response to care: what response was there to care?". CONCLUSION Four key themes: care drivers, care barriers, chiropractic treatment, and response to care support an emergent substantive-level theory in women's care seeking experiences for pregnancy-related back pain and chiropractic care. This theory is that chiropractic care for pregnant women experiencing low back pain and pelvic girdle pain may improve pain and function, while reducing pregnancy-related biopsychosocial concerns. The findings may inform antenatal health providers and the chiropractic profession about pregnant women's experience seeking chiropractic care as well as directing future research.
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Affiliation(s)
- Maria Bernard-Giglio
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
- Chiropractic Knowledge Hub, University of Southern Denmark, Campusvej 55, Odense M, 5230, Denmark
| | - Katie de Luca
- Discipline of Chiropractic, School of Health, Medical and Applied Sciences, CQ University, Brisbane, Australia
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Amorin-Woods LG, Woods BL, Mullings BL, Vindigni D, Losco BE. Future Research by the Australian Chiropractic Profession: Analysis of Comments and Suggestions From a Nationwide Survey of Academics and Practitioners. J Manipulative Physiol Ther 2023:S0161-4754(23)00028-3. [PMID: 37422749 DOI: 10.1016/j.jmpt.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/13/2023] [Accepted: 05/15/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The purpose of this study was to identify and compare the research priorities of Australian practicing chiropractors and academics across listed research domains and to seek their views on existing chiropractic research strategies. Concurrent objectives were to gain insight into the perspectives on characteristics of research and solicit ideas and suggestions for future research from both groups. METHODS This study used a mixed-method research design to collect data using an online survey portal. Australian chiropractic academics (n = 220) and practicing chiropractors who were also members of a nationally representative, practice-based research network database (n = 1680) were invited to participate. Data were collected (February 19, 2019, to May 24, 2019). The free-text data were analyzed primarily via semantic coding and verbatim referential units in cases where the category was an exact match for the textual data. Content analyses of the qualitative data were presented in a tabulated and narrative manner as identified domains. Selected representative examples were provided verbatim. RESULTS The response rate for the survey was 44% for full-time equivalent academics, 8% for casuals and part-time chiropractic academics, and 21.5% for Australian Chiropractic Research Network database chiropractic practitioners. Open-text data comprised a narrower focus on musculoskeletal (MSK) conditions and opposition or reservations by academics and some practitioners toward the research agenda of those espousing traditional concepts and terminology. Comments from both groups illustrate the strongly held views that characterize divergent factions of the chiropractic profession. Some practitioners were highly critical of the narrow focus and epistemological paradigm of Australian university-based research, while others were strongly supportive of the traditional focus of the Australian Spinal Research Foundation. Australian academics at the 4 university-based programs held the view that MSK and spinal pain, for which some evidence already exists, should be the priority of future research, building on what is known. Practitioners believed that future research should be directed toward expanded areas such as basic science, younger populations, and non-MSK conditions. Respondents were sharply divided on attitudes toward traditional chiropractic terminology, concepts, and philosophy and the utility of future research on these topics. CONCLUSION Our qualitative findings suggest there is a division in the Australian chiropractic profession regarding research direction and priorities. This divide exists between academics and researchers and within field practitioners. This study highlights the attitudes, opinions, and perceptions of important stakeholder groups, which should be considered by decision-makers when formulating research policy, strategy, and prioritization of funding.
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Affiliation(s)
- Lyndon G Amorin-Woods
- School of Allied Health, Murdoch University Chiropractic Clinic, Perth, Western Australia, Australia.
| | - Beau L Woods
- Australian Chiropractic College, Adelaide, South Australia, Australia; Private practice, Perth, Western Australia, Australia
| | - Benjamin L Mullings
- School of Allied Health, Murdoch University Chiropractic Clinic, Perth, Western Australia, Australia
| | - Dein Vindigni
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Barrett E Losco
- School of Allied Health, Murdoch University Chiropractic Clinic, Perth, Western Australia, Australia
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Moore KM, Amorin-Woods D, Amorin-Woods LG, Vindigni D, Haworth NG. A cross-sectional study of Australian chiropractors' and students' readiness to identify and support patients experiencing intimate partner violence. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:71-81. [PMID: 36763495 PMCID: PMC10013599 DOI: 10.7899/jce-21-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/19/2022] [Accepted: 08/16/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To explore Australian chiropractors' and final year students' readiness to identify and support patient's experiencing intimate partner violence (IPV). METHODS This cross-sectional study used the Chiro-PREMIS, an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to explore chiropractors' and final year students' readiness. Survey responses were analyzed through a lens of Miller's framework for developing clinical competence and chiropractic graduate competencies. RESULTS One hundred forty participants completed the online survey (n = 99 chiropractors and n = 41 students). Reports of practice over the 4 weeks prior to completing the survey showed 21% of chiropractors and 20% of students consulted with patients who had disclosed they were involved in IPV. Thirty-three percent of chiropractors and 27% of students suspected a patient was involved, but that patient did not disclose. Participants report meager training in IPV. Many are unclear about appropriate questioning techniques, documentation, referrals, identifying available resources, and legal literacy. Overall, participants do not "know" about IPV, they do not "know how" to and may not be able to "show how" or "do" when it comes to managing IPV-related clinical scenarios. Further studies are needed to confirm if chiropractors have the appropriate clinical capabilities. CONCLUSION With proper preparation, chiropractors have an opportunity to make a positive contribution to this social problem. We anticipate chiropractic-specific discourse surrounding these escalating growing social concerns will highlight the intent of the chiropractic profession to make a substantial contribution to the health care of the Australian public. More studies are needed.
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Affiliation(s)
- Keri M. Moore
- Keri Moore is the director of Moore Clinical Education Specialists and Researchers (PO Box 1460, Coolangatta, Queensland 4220, Australia; )
| | - Deisy Amorin-Woods
- Deisy Amorin-Woods is a psychotherapist and family therapist at Insight Counselling & Relationship Centre and is a seasonal academic in the School of Arts and Humanities at Edith Cowan University (6/401 Oxford St, Mount Hawthorn 6016, Australia; )
| | - Lyndon G. Amorin-Woods
- Lyndon Amorin-Woods is a senior supervising clinician at the Murdoch University Chiropractic Clinic, Discipline of Psychology, Counselling, Exercise Science and Chiropractic, College of Science, Health, Engineering and Education (90 South St, Murdoch, Western Australia 6150, Australia; )
| | - Dein Vindigni
- Dein Vindigni is a senior lecturer in the Chiropractic Program, School of Health and Biomedical Sciences at RMIT University (PO Box 71, Bundoora, Victoria 3083, Australia; )
| | - Navine G. Haworth
- Navine Haworth is an associate professor and the Academic Deac at the Australian Chiropractic College (83 Currie St, Adelaide, South Australia 5000, Australia; )
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Ardakani EM, Theroux J, Beynon AM, Losco B. Exploring 1st- and 2nd-year chiropractic students' willingness and attitudes toward peer physical examination. THE JOURNAL OF CHIROPRACTIC EDUCATION 2023; 37:13-19. [PMID: 36306243 PMCID: PMC10013596 DOI: 10.7899/jce-20-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2021] [Accepted: 06/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study aimed to explore chiropractic students' perceptions and attitudes about the appropriateness of peer physical examination as a teaching tool and their willingness and comfort with it. METHODS A modified version of a validated questionnaire was used. First- and 2nd-year chiropractic students at Murdoch University were approached during their practical sessions. The responses were analyzed using descriptive statistics reporting frequencies and percentages. Comparison between classes, age, and sex was evaluated by cross-tabulation. RESULTS A total of 184 questionnaires were completed with a response rate of 76.6%. Our results demonstrated that most students were comfortable with and willing to participate in peer physical examination as well as trusted it as an appropriate part of their training and a valuable learning experience. Nevertheless, a small percentage were uncomfortable with peer physical examination and regarded it as an unprofessional activity. In addition, it was revealed that younger females (≤20 years) reported feeling unnecessarily exposed and therefore significantly less comfortable with peer physical examination. They were also less comfortable when examined in the inguinal area by a student of the opposite sex. CONCLUSION Although peer physical examination appears to be a very popular training tool, it still has a few areas of concern that need to be investigated and addressed to improve students' attitude, perception, and comfort with this teaching technique. Further studies could investigate how other factors such as religious beliefs contribute toward students' perception and attitudes regarding peer physical examination.
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Affiliation(s)
- Emad M. Ardakani
- Emad Ardakani is a lecturer in the College of Science, Health, Engineering, and Education at Murdoch University (Bldg 460, 90 South St, Murdoch, Western Australia 6150; )
| | - Jean Theroux
- Jean Theroux is a lecturer in the College of Science, Health, Engineering, and Education at Murdoch University (Bldg 460, 90 South St, Murdoch, Western Australia 6150; )
| | - Amber M. Beynon
- Amber Beynon is a research assistant in the College of Science, Health, Engineering, and Education at Murdoch University (Bldg 460, 90 South St, Murdoch, Western Australia 6150; )
| | - Barrett Losco
- Barrett Losco is a senior lecturer in the College of Science, Health, Engineering, and Education at Murdoch University (Bldg 460, 90 South St, Murdoch, Western Australia 6150; )
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Fernandez M, Young A, Milton K, Pinhiero M, de Luca K, Ferreira P, Hebert J. Physical activity promotion in chiropractic: a systematic review of clinician-based surveys. Chiropr Man Therap 2022; 30:55. [PMID: 36514061 PMCID: PMC9749165 DOI: 10.1186/s12998-022-00467-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. METHODS Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the 'Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices' tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors' views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. RESULTS From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). CONCLUSION A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors' own PA participation.
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Affiliation(s)
- Matthew Fernandez
- School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia.
| | - Anika Young
- grid.1004.50000 0001 2158 5405Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Karen Milton
- grid.8273.e0000 0001 1092 7967Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marina Pinhiero
- grid.1013.30000 0004 1936 834XInstitute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia ,grid.1013.30000 0004 1936 834XSchool of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie de Luca
- grid.1023.00000 0001 2193 0854School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Paulo Ferreira
- grid.1013.30000 0004 1936 834XSydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Jeffrey Hebert
- grid.266820.80000 0004 0402 6152Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Muacevic A, Adler JR, Lee WT. Use of Thrust Cervical Spinal Manipulative Therapy for Complicated Neck Pain: A Cross-Sectional Survey of Asia-Pacific Chiropractors. Cureus 2022; 14:e32441. [PMID: 36644078 PMCID: PMC9833810 DOI: 10.7759/cureus.32441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Background Chiropractors often use manual thrust cervical spinal manipulative therapy (thrust-cSMT) to treat musculoskeletal neck conditions. We hypothesized <50% of surveyed Asia-Pacific chiropractors would report using thrust-cSMT given potential contraindications, and secondarily explored predictors of thrust-cSMT use. Materials and methods We designed, validated, achieved sufficient reliability, and disseminated a survey to explore thrust-cSMT use. The survey queried chiropractors' characteristics (e.g., years in practice, education level, time with patients, importance of subluxation), and use of thrust-cSMT for uncomplicated neck pain and vignettes describing vertebral artery disorders, Arnold-Chiari malformation, and anterior cervical discectomy and fusion (ACDF). We performed logistic regression for each vignette with thrust-cSMT as the dependent variable and chiropractor characteristics as covariates. Results There were 241 respondents, having 12.8±10.9 years in practice, representing >15 countries. Less than 50% of chiropractors reported the use of thrust-cSMT for each vignette, including vertebral artery insufficiency (14%) and stenosis (17%), Arnold-Chiari type I (18%) and type II (5%), C5/6 ACDF (39%) and C3-6 ACDF (27%). Regressions identified significant predictors of increased or decreased use of thrust-cSMT including time spent with new patients, focus on subluxation, degree, group practice environment, use of thrust-cSMT on a healthy patient, and hours reading scientific literature (P<.05 for each). Conclusions This study was the first to chiropractors' use of thrust-cSMT for complicated neck pain and found that most Asia-Pacific chiropractors reported avoiding this treatment in the presence of a potential treatment contraindication. The use of thrust-cSMT in complicated neck pain may be related to practice characteristics. However, further research is needed to identify specific reasons why chiropractors use or avoid thrust-cSMT.
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Giuriato R, Štrkalj G, Prvan T, Hulme A, Pather N. Musculoskeletal anatomy knowledge in Australian chiropractors. ANATOMICAL SCIENCES EDUCATION 2022; 15:663-670. [PMID: 34218520 DOI: 10.1002/ase.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Anatomy is a key knowledge area in chiropractic and is formally offered in the undergraduate component of chiropractic education. There is the potential for loss of anatomy knowledge before the opportunity to apply it in a clinical setting. This study aimed to determine whether chiropractic clinicians retain a level of anatomy knowledge comparable to that of chiropractic students and to compare chiropractors' self-rating of their anatomical knowledge against an objective knowledge assessment tool. A previously validated multiple-choice test was utilized to measure retention of limb musculoskeletal (MSK) knowledge in Australian chiropractors. One hundred and one registered chiropractors completed the questionnaire and responses were scored, analyzed, and compared to scores attained by undergraduate and postgraduate chiropractic students who had previously completed the same questionnaire. The results indicated that practitioners retained their anatomy knowledge, with a significantly higher total mean score than the undergraduate group [total mean score = 36.5% (±SD 13.6%); P < 0.01] but not significantly different to the postgraduate group [total mean score = 52.2% (±SD 14.1%); P = 0.74]. There was a weak positive correlation between chiropractors' self-rated knowledge and test performance scores indicating the effectiveness of this Australian chiropractic group in self-assessing their anatomy knowledge. This study found that Australian chiropractors' knowledge of MSK anatomy was retained during the transition from university to clinical practice and they accurately evaluated their own test performance.
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Affiliation(s)
- Rosemary Giuriato
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Goran Štrkalj
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Tania Prvan
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Anneliese Hulme
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nalini Pather
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Amorin-Woods LG, Woods BL, Moore CS, Leach MJ, Kawchuk GN, Adams J. Research Priorities of the Australian Chiropractic Profession: A Cross-Sectional Survey of Academics and Practitioners. J Manipulative Physiol Ther 2022; 45:73-89. [PMID: 35760594 DOI: 10.1016/j.jmpt.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 10/08/2021] [Accepted: 03/17/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the research priorities of Australian practicing chiropractors and academics across a set of research domains to determine the agreement or disagreement based on these domains. METHODS We conducted a pilot-tested online survey focusing on the following 5 principal research domains: basic science, conditions (disorders chiropractors may encounter), patient subgroups, clinical interventions, and practice and public health/health services. Responses were sought regarding support for funding research scholarships, practice-based research networks, scientific conferences/symposia, journals, and existing research agendas. Data were collected (February 19 to May 24, 2019) from a sample of chiropractic academics (n1 = 33) representing 4 Australian programs and practicing chiropractors (n2 = 340). Collected data were ranked and analyzed to determine agreement across domains and items. RESULTS There was agreement between the 2 groups across the majority (>90%) of domain items. The closest agreement and highest rankings were achieved for the "clinical interventions and practice" and "conditions" domains. Disagreement was observed within specific domain items, such as patient subgroups (infants), and for 1 intervention (chiropractic-specific techniques). Disagreement also occurred outside of the main domains, including research agenda support and funding. CONCLUSIONS There was overall agreement between practicing chiropractors and academics across most research area domain items, which should help facilitate consensus-led development of any potential Australian Chiropractic research agenda. Disagreements across specific domain items, such as population subgroups, interventions, and funding require further investigation.
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Affiliation(s)
- Lyndon G Amorin-Woods
- Murdoch University Chiropractic Clinic/College of Science, Health, Engineering and Education (SHEE), Perth, Western Australia.
| | - Beau L Woods
- Private Practice, Perth, Western Australia, Australia
| | - Craig S Moore
- Department of Chiropractic, Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
| | - Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | | | - Jon Adams
- School of Public Health, University of Technology, Sydney, New South Wales, Australia
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Management of people with low back pain: a survey of opinions and beliefs of Dutch and Belgian chiropractors. Chiropr Man Therap 2022; 30:29. [PMID: 35725617 PMCID: PMC9208165 DOI: 10.1186/s12998-022-00437-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Chiropractors commonly provide care to people with low-back pain (LBP). The aim of this survey was to determine the opinions and beliefs of chiropractors regarding the support and management of LBP. We also investigated whether their management is in accordance with the three most commonly recommended approaches to LBP based upon international guidelines (i.e. advice regarding return-to-work, limit bedrest, and stay active). Methods A web-based survey was sent out in 2013 to collect data from registered Dutch and Belgian chiropractors. In addition to providing a description of their sociodemographic and practice characteristics, chiropractors were asked to complete six patient vignettes representing people with LBP who typically present to a chiropractor. The respondents indicated which intervention(s) they would recommend or undertake. Based upon these vignettes, we were able to determine whether their management approach adhered to clinical guidelines. Generalized mixed models were used to explore guidelines adherence and their relationship to chiropractors’ characteristics. Results In total, 60% (n = 203/340) of the chiropractors who were invited, chose to participate. Chiropractors reported applying a chiropractic adjustment in 90% of all vignettes, while the advice to exercise varied from one-third in the chronic cases to approximately half of those with acute LBP. More than 75% of the chiropractors would initially treat LBP 1–2 times a week. More than 90% of the chiropractors advised against bedrest. Overall, self-reported adherence to clinical guidelines for all six vignettes was [64.5% (CI 58.7–70.0)]. Adherence in the chronic vignettes [73.4% (CI 66.7–79.2)] was better than in the acute vignettes [55.9% (CI 50.5–61.1)]. Importantly, regarding recommended approaches to LBP, chiropractors more consistently followed guidelines regarding advice to limit bedrest [98.5% (CI 97.3–99.1)] than advice to stay active [77.5% (CI 72.3–81.9)] or return-to-work [59.4% (CI 55.2–63.4)]. Finally, Dutch chiropractors were more likely to adhere to the guidelines than Belgian chiropractors. Conclusions Chiropractic adjustments were the most common self-reported treatment modalities supplemented by exercise in the management of LBP patients. Two-thirds of the chiropractors reported adhering to the guidelines regarding management and advice for LBP patients. Practitioners should improve guideline adherence, particularly for acute LBP cases, and when advising on return-to-work. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00437-1.
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Readford TR, Hayes M, Reed WM. Factors affecting chiropractor requests for full-length spinal radiography: A scoping review. J Med Radiat Sci 2022; 69:236-249. [PMID: 34995416 PMCID: PMC9163483 DOI: 10.1002/jmrs.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022] Open
Abstract
Chiropractors often refer their patients for full-length (three- to four-region) radiographs of the spine as part of their clinical assessment, which are frequently completed by radiographers in medical imaging practices. Overuse of spinal radiography by chiropractors has previously been reported and remains a contentious issue. The purpose of this scoping review was to explore the issues surrounding the utilisation of full-length spinal radiography by chiropractors and examine the alignment of this practice with current evidence. A search of four databases (AMED, EMBASE, MedLine and Scopus) and a hand search of Google was conducted using keywords. Articles were screened against an inclusion/exclusion criterion for relevance. Themes and findings were extracted from eligible articles, and evidence was synthesised using a narrative approach. In total, 25 articles were identified, five major themes were extracted, and subsequent conclusions drawn by authors were charted to identify confluent findings. This review identified a paucity of literature addressing this issue and an underrepresentation of relevant perspectives from radiographers. Several issues surrounding the use of full-length spinal radiography by chiropractors were identified and examined, including barriers to the adherence of published guidelines for spinal imaging, an absence of a reporting mechanism for the utilisation of spinal radiography in chiropractic and the existence of a spectrum of beliefs amongst chiropractors about the clinical utility and limitations of full-length spinal radiography. Further investigation is required to further understand the scope of this issue and its impacts for radiation protection and patient safety.
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Affiliation(s)
- Thomas R. Readford
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Melanie Hayes
- Discipline of Work Integrated Learning, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| | - Warren Michael Reed
- Medical Imaging Optimisation and Perception Group (MIOPeG), Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
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Moore C, Wong AYL, de Luca K, De Carvalho D, Johansson MS, Pohlman KA, Miller A, Funabashi M, Dougherty P, French S, Adams J, Kawchuk G. The impact and public health response of chiropractors to the COVID-19 pandemic: a survey across four continents. Chiropr Man Therap 2022; 30:24. [PMID: 35534844 PMCID: PMC9081962 DOI: 10.1186/s12998-022-00432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/15/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of COVID-19 on chiropractors internationally, and examines the public health response of chiropractors to the COVID-19 pandemic practising under a musculoskeletal spine-care versus subluxation-based care paradigm. METHODS A survey was distributed to chiropractors in Australia, Canada, Denmark, Hong Kong, United Kingdom and United States (Oct. 2nd-Dec. 22nd, 2020) via professional bodies/publications, and social media. Questions were categorised into three domains: socio-demographic, public health response and business/financial impact. Multivariable logistic regression explored survey items associated with chiropractors practising under different self-reported paradigms. RESULTS A total of 2061 chiropractors representing four global regions completed the survey. Our recruitment method did not allow the calculation of an accurate response rate. The vast majority initiated COVID-19 infection control changes within their practice setting, including increased disinfecting of treatment equipment (95%), frequent contact areas (94%) and increased hand hygiene (94%). While findings varied by region, most chiropractors (85%) indicated that they had implemented regulator advice on the use of personal protective equipment (PPE). Suspension of face-to-face patient care during the peak of the pandemic was reported by 49% of the participants with 26% implementing telehealth since the pandemic began. Chiropractors practising under a musculoskeletal spine-care paradigm were more likely to implement some/all regulator advice on patient PPE use (odds ratio [OR] = 3.25; 95% confidence interval [CI]: 1.57, 6.74) and practitioner PPE use (OR = 2.59; 95% CI 1.32, 5.08); trust COVID-19 public health information provided by government/World Health Organisation/chiropractic bodies (OR = 2.47; 95% CI 1.49, 4.10), and initiate patient telehealth in response to COVID-19 (OR = 1.46; 95% CI 1.02, 2.08) compared to those practising under a subluxation-based paradigm. CONCLUSIONS Chiropractors who responded to our survey made substantial infectious control changes in response to COVID-19. However, there was regional variation in the implementation of the advised practitioner and patient use of PPE and limited overall use of telehealth consultations by chiropractors during COVID-19. Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.
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Affiliation(s)
- Craig Moore
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Arnold Y. L. Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Katie de Luca
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | | | - Melker S. Johansson
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Amy Miller
- AECC University College, Bournemouth, UK
| | - Martha Funabashi
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | | | - Simon French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
| | - Greg Kawchuk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Wiggins D, Downie A, Engel R, Brown BT. Factors that influence scope of practice of the chiropractic profession in Australia: a scoping review. Chiropr Man Therap 2022; 30:19. [PMID: 35421996 PMCID: PMC9011944 DOI: 10.1186/s12998-022-00428-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The World Health Organization describes chiropractic as a health profession that treats the musculoskeletal system and the effects of that system on the function of the nervous system and general health. Notwithstanding such descriptions, scope of practice remains a contentious issue in Australia chiropractic with various authors defining it differently. To date, the peak governing body, the Chiropractic Board of Australia, has focused on title protection rather than defining a scope of practice for the profession. A well-defined scope of practice is important, as it helps to identify what is acceptable in the profession and the role chiropractic has in the broader healthcare system. OBJECTIVE The objective of this scoping review was to explore the literature on the factors that influence scope of practice of chiropractic in Australia. METHODS This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the chiropractic profession in Australia. RESULTS A total of 1270 articles were identified from the literature search. Six studies fulfilled the inclusion criteria and were included in the final analysis. Four factors that influence scope of practice were identified: education, professional identity, patient safety, and organisational structure. CONCLUSION The results of this study will inform future discussions around establishing a framework for a more comprehensive scope of practice for the chiropractic profession in Australia. Such a framework has the potential to benefit patient safety, professional identity, public perception, education, and regulation of the profession.
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Affiliation(s)
- Desmond Wiggins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Fleischmann M, Vaughan B, Bird A, Grace S, Fitzgerald K, McLeod G. Demographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths. BMC Health Serv Res 2022; 22:224. [PMID: 35180867 PMCID: PMC8855537 DOI: 10.1186/s12913-022-07520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. Methods The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. Results Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59–0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98–13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82–20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03–2.26), compared to osteopaths who do not refer to podiatrists. Conclusion This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.
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Affiliation(s)
- Michael Fleischmann
- College of Health and Biomedicine, Victoria University, Melbourne, Australia. .,School of Public Health, University of Technology Sydney, Sydney, Australia.
| | - Brett Vaughan
- School of Public Health, University of Technology Sydney, Sydney, Australia.,Department of Medical Education, University of Melbourne, Melbourne, Australia.,School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Adam Bird
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sandra Grace
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Kylie Fitzgerald
- Department of Medical Education, University of Melbourne, Melbourne, Australia
| | - Gopi McLeod
- School of Public Health, University of Technology Sydney, Sydney, Australia.,School of Health and Human Sciences, Southern Cross University, Lismore, Australia
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16
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Nelson L, Pollard H, Ames R, Jarosz B, Garbutt P, Da Costa C. A descriptive study of sports chiropractors with an International Chiropractic Sport Science Practitioner qualification: a cross-sectional survey. Chiropr Man Therap 2021; 29:51. [PMID: 34903268 PMCID: PMC8667448 DOI: 10.1186/s12998-021-00405-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background This paper describes the education and case management profile of sports chiropractors with the Federation of International Sports Chiropractors (FICS) postgraduate qualification: International Chiropractic Sport Science Practitioner (ICSSP). The ICSSP is the predominant international sports chiropractic qualification.
Methods A cross-sectional survey, carried out between 22/10/2014 and 22/12/2014,was utilized with a 39-item web-based survey examining practitioner, practice and clinical management characteristics, and was distributed via email to all sports chiropractors who held an ICSSP qualification (n = 240) in 2014.
Results The survey response rate was 64% (n = 154). 36% of chiropractors were aged between 31 and 40 years, just over three quarters were male, and 27% had been in practice for 5–10 years. The majority of respondents were based in North America. All sports chiropractors surveyed reported treating neuromusculoskeletal conditions outside of the spine. 91% utilized a multimodal approach in most of their treatments, prescribing rehabilitative exercises in 76% of consultations. Almost 64% of respondents reported current treatment of professional athletes, and 78% reported current treatment of semi-professional athletes, whilst the vast majority of those surveyed endorsed past treatment of professional (91%) and semi-professional (95%) athletes. All respondents reported referring to a range of conventional and allied health providers. Conclusions This study of ICSSP-qualified sports chiropractors describes a small but well-educated workforce treating high-level athletes, managing a wide range of spine and non-spinal neuromusculoskeletal conditions, utilising multimodal approaches (including active and passive strategies), and referring to and co-managing with other health practitioners. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00405-1.
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Affiliation(s)
- Luke Nelson
- Health and High Performance, 437 Belmore Rd, Mont Albert North, VIC, 3129, Australia.
| | | | - Rick Ames
- RMIT University, Melbourne, Australia
| | - Brett Jarosz
- Optimize Sports Chiropractic, South Yarra, Australia
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Jenkins HJ, Downie AS, Fernandez M, Hancock MJ. Decreasing thoracic hyperkyphosis - Which treatments are most effective? A systematic literature review and meta-analysis. Musculoskelet Sci Pract 2021; 56:102438. [PMID: 34375856 DOI: 10.1016/j.msksp.2021.102438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND A variety of treatments aim to reduce thoracic hyperkyphosis in adults, thereby improving posture and reducing possible complications. OBJECTIVE To investigate the effectiveness of treatments to reduce thoracic hyperkyphosis. DESIGN Systematic review and meta-analysis. METHODS MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to March 2021. Two authors independently selected randomised controlled trials assessing the effectiveness of treatments to reduce thoracic hyperkyphosis in adults. Raw data on mean change in thoracic kyphosis were extracted and standardised mean differences (SMD) calculated. Meta-analysis was performed on studies homogenous for study population and intervention. Strength of evidence was assessed using GRADE. RESULTS Twenty-eight studies were included, with five meta-analyses performed. Low to moderate-quality evidence found structured exercise programs of three-months duration or less effective in reducing thoracic hyperkyphosis in younger (SMD -2.8; 95%CI -4.3 to -1.3) and older populations (SMD -0.3; 95%CI -0.6 to 0.0). Low-quality evidence found bracing for three months or more effective in older participants (SMD -1.0, 95%CI -1.3 to -0.7). A single study demonstrated the effectiveness of multimodal care in younger participants. The available evidence suggests multimodal care, structured exercise programs over three months duration, and taping in older adults, and biofeedback and muscle stimulation in younger adults, are ineffective in reducing thoracic hyperkyphosis. CONCLUSION Low to moderate-quality evidence indicates that structured exercise programs are effective to reduce thoracic hyperkyphosis. Low-quality evidence indicates that bracing is effective to reduce thoracic hyperkphosis in older adults.
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Affiliation(s)
- Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron S Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Matthew Fernandez
- School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, Australia
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18
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. FRONTIERS IN PAIN RESEARCH 2021; 2:765921. [PMID: 35295422 PMCID: PMC8915715 DOI: 10.3389/fpain.2021.765921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
Spine pain is a highly prevalent condition affecting over 11% of the world's population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists. The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be provided. In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Arantxa Ortega de Mues
- Madrid College of Chiropractic—Real Centro Universitario (RCU) María Cristina, San Lorenzo de El Escorial, Spain
| | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Cognition, Neurosciences, Affect et Comportement (CogNAC) Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- *Correspondence: Mathieu Piché
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Jessup B, Barnett T, Obamiro K, Cross M, Mseke E. Review of the Health, Welfare and Care Workforce in Tasmania, Australia: 2011-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137014. [PMID: 34209098 PMCID: PMC8297215 DOI: 10.3390/ijerph18137014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
Background: On a per capita basis, rural communities are underserviced by health professionals when compared to metropolitan areas of Australia. However, most studies evaluating health workforce focus on discrete professional groups rather than the collective contribution of the range of health, care and welfare workers within communities. The objective of this study was therefore to illustrate a novel approach for evaluating the broader composition of the health, welfare and care (HWC) workforce in Tasmania, Australia, and its potential to inform the delivery of healthcare services within rural communities. Methods: Census data (2011 and 2016) were obtained for all workers involved in health, welfare and care service provision in Tasmania and in each statistical level 4 area (SA4) of the state. Workers were grouped into seven categories: medicine, nursing, allied health, dentistry and oral health, health-other, welfare and carers. Data were aggregated for each category to obtain total headcount, total full time equivalent (FTE) positions and total annual hours of service per capita, with changes observed over the five-year period. Results: All categories of the Tasmanian HWC workforce except welfare grew between 2011 and 2016. While this growth occurred in all SA4 regions across the state, the HWC workforce remained maldistributed, with more annual hours of service per capita provided in the Hobart area. Although the HWC workforce remained highly feminised, a move toward gender balance was observed in some categories, including medicine, dentistry and oral health, and carers. The HWC workforce also saw an increase in part-time workers across all categories. Conclusions: Adopting a broad approach to health workforce planning can better reflect the reality of healthcare service delivery. For underserviced rural communities, recognising the diverse range of workers who can contribute to the provision of health, welfare and care services offers the opportunity to realise existing workforce capacity and explore how ‘total care’ may be delivered by different combinations of health, welfare and care workers.
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Simpson JK, Innes S. It's not my fault although it might be: chiropractic practice and vicarious liability. Chiropr Man Therap 2021; 29:21. [PMID: 34127012 PMCID: PMC8201713 DOI: 10.1186/s12998-021-00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background While chiropractic care is most commonly provided within a private practice context, the ‘traditional’ solo practice is now uncommon. Chiropractors, manual therapists and related health professionals commonly work within the same practice bringing obvious advantages to both the practitioners and their patients. However, multi-practitioner, multi-disciplinary clinics also carry often unrecognized liabilities. We refer here to vicarious liability and non-delegable duties. Vicarious liability refers to the strict liability imposed on one person for the negligent acts of another person. The typical example is an employer being held vicariously liable to the negligent acts of an employee. However, vicarious liability can arise outside of the employer-employee relationship. For example, under non-delegable duty provisions, an entity owing a non-delegable duty can be liable for an independent contractor’s wrongdoing. After a plain English explanation of this complex area of law, we provide seven scenarios to demonstrate how vicarious liability can envelop practice principals when things go wrong. We also make suggestions for risk mitigation. Conclusion Practice owners may unexpectedly find themselves legally liable for another’s actions with dire consequences. A knowledge of vicarious liability along with implementing risk mitigation strategies has the potential to minimize the likelihood of this unwanted event. Recommendations are made to this end.
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Affiliation(s)
- J Keith Simpson
- Discipline of Psychology, Exercise Science, Counselling and Chiropractic (PESCC), College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch University, Murdoch, Australia.
| | - Stanley Innes
- Discipline of Psychology, Exercise Science, Counselling and Chiropractic (PESCC), College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch University, Murdoch, Australia
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Trager RJ, Dusek JA. Chiropractic case reports: a review and bibliometric analysis. Chiropr Man Therap 2021; 29:17. [PMID: 33910610 PMCID: PMC8080364 DOI: 10.1186/s12998-021-00374-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
Objective To determine publication trends, gaps, and predictors of citation of chiropractic case reports (CRs). Methods A bibliometric review was conducted by searching PubMed, Index to Chiropractic Literature (ICL), and Google Scholar to identify PubMed-indexed CRs, which were screened according to selection criteria. Case reports were categorized by International Classification of Disease (ICD-10) code, patient age, topic describing case management or adverse effects of care, focus being spinal or non-spinal, journal type, integrative authorship, title metrics, and citation metrics. Binary logistic regression was used to identify independent predictors of citations per year and total citations greater than the median values. Results The search identified 1176 chiropractic CRs meeting selection criteria. There was an increasing trend of CRs having a case management topic, non-spinal focus, non-chiropractic journal, neuromusculoskeletal-focus, diagnosis of vascular pathology, and a decreasing trend of adverse effect vascular pathology CRs. Independent predictors of greater total citations (or citation rate) included ICD-10 categories of perinatal conditions, infections, “case” in title, case management topic, and physical therapy, integrative, and dental journal type. Predictors of fewer citations included diseases of the blood, neoplasms, other findings not elsewhere classified, a title > 11 words, and multidisciplinary authorship. ICD-10 categories describing non-musculoskeletal diseases and special populations such as pediatrics, pregnancy, and perinatal conditions had few CRs. Conclusion Chiropractic CRs are diversifying from spine-related topics. Chiropractors are encouraged to publish objective, structured CRs within defined research gaps. Published CRs can inform the design of future research studies with a higher level of clinical relevance and evidence. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-021-00374-5.
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Affiliation(s)
- Robert J Trager
- Connor Integrative Health Network, Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Jeffery A Dusek
- Connor Integrative Health Network, Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
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Cupler ZA, Daniels CJ, Anderson DR, Anderson MT, Napuli JG, Tritt ME. Suicide prevention, public health, and the chiropractic profession: a call to action. Chiropr Man Therap 2021; 29:14. [PMID: 33853629 PMCID: PMC8048297 DOI: 10.1186/s12998-021-00372-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Suicide is a major public health concern that has wide-reaching implications on individuals, families, and society. Efforts to respond to a public health concern as a portal-of-entry provider can reduce morbidity and mortality of patients. The objective of this commentary is a call to action to initiate dialogue regarding suicide prevention and the role the chiropractic profession may play. DISCUSSION This public health burden requires doctors of chiropractic to realize current strengths and recognize contemporaneous deficiencies in clinical, research, and policy environments. With this better understanding, only then can the chiropractic profession strive to enhance knowledge and promote clinical acumen to target and mitigate suicide risk to better serve the public. CONCLUSION We implore the profession to transition from bystander to actively engaged in the culture of suicide prevention beholden to all aspects of the biopsychosocial healthcare model. The chiropractic profession's participation in suicide prevention improves the health and wellness of one's community while also impacting the broader public health arena.
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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 School of Medicine, Pittsburgh, PA, USA.
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Verville L, Dc PC, Grondin D, Dc SM, Kay R. The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:95-105. [PMID: 33175979 PMCID: PMC7958658 DOI: 10.7899/jce-19-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/13/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. METHODS Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. RESULTS Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. CONCLUSION Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.
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Fitzgerald K, Devonshire E, Vaughan B. Pain Knowledge, Attitudes and Beliefs of Allied Health Learners Across Three Curricular Models. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Innes SI, Cope V, Young KJ. Factors influencing Australian chiropractors who choose not to join national professional associations: a qualitative study. Chiropr Man Therap 2020; 28:58. [PMID: 33256780 PMCID: PMC7704117 DOI: 10.1186/s12998-020-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-020-00351-4.
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Affiliation(s)
- Stanley I Innes
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia.
| | - Vicki Cope
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Australia
| | - Kenneth J Young
- School of Sport and Health Sciences, University of Central Lancashire, Lancashire, England
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Zabel S, Munk N. Practice-Based Research Networks and Massage Therapy: a Scoping Review. Int J Ther Massage Bodywork 2020; 13:25-34. [PMID: 33282033 PMCID: PMC7704044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Practice-based research networks (PBRNs) are means to connect practitioners with researchers and increase the body of rigorous research. PBRNs have been used in medicine for decades, but efforts to create PBRNs in massage therapy (MT) are limited. PURPOSE Examine and describe the amount of and nature of MT-related publications derived from PBRN-supported endeavors. PUBLICATION SELECTION Databases: Scopus, CINAHL, PubMed, ClinicalKey, EMBASE, Google Scholar. Keywords: massage, massage therapy, practice-based research network, PBRN. Key items: publication year, operating PBRN, article type, study design, general theme, massage therapist involvement/MT application. Inclusion Criteria: studies conducted through a PBRN using MT/massage therapists as an investigated factor; articles/editorials focused on PBRN-related MT research. RESULTS Initial database search resulted in 444 records; 40 articles included in analysis from database search, PBRN website access, and PBRN staff contacts. Publication dates ranged from 2005 to 2019, with nearly all published since 2013. Nine PBRNs published 29 articles based on 20 studies and sub-studies as research papers (n=21) or poster/oral presentation abstracts (n=8), and articles discussing the need for PBRNs in MT (n=8). Most research studies were conducted as surveys (n=21), examining practice characteristics (n=9) and patient perspectives/utilization (n=7). Three articles discussing PBRNs in MT were not connected to any specific PBRN. CONCLUSION The PBRN model holds promise to further the field of MT, but implementation needs significant development. Promoting the creation and growth of massage-specific PBRNs should be a focus of professional associations and research institutions to expand the body of scientific evidence supporting MT. While the United States has had the most PBRN-related research efforts, a sustainable implementation model is not evident as highlighted by inactivity from US-based PBRNs after initial productivity. An Australian PBRN may serve as a needed sustainability model for massage-related PBRNs in the US if their productivity trajectory continues.
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Affiliation(s)
- Samantha Zabel
- Department of Health Sciences, Indiana University School of Health and Human Sciences—IUPUI, Indianapolis, IN, USA,Corresponding author: Samantha Zabel, MA, Department of Health Sciences, Indiana University School of Health and Human Sciences—IUPUI, 901 W. New York St., PE 250, Indianapolis, IN, USA 46202,
| | - Niki Munk
- Department of Health Sciences, Indiana University School of Health and Human Sciences—IUPUI, Indianapolis, IN, USA,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo NSW, Australia
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"Paper, face-to-face and on my mobile please": A survey of women's preferred methods of receiving antenatal education. Women Birth 2020; 34:e547-e556. [PMID: 33172801 DOI: 10.1016/j.wombi.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antenatal education prepares women for childbirth and can be delivered face-to-face, in hard-copy and electronically. Smartphones allow access to online learning and internet searching is common among pregnant women. It is unclear which mode of health information delivery women prefer. AIM This study aimed to investigate how women at one Local Health District (LHD) preferred to receive health information during pregnancy and the early postnatal period. METHODS We developed a survey to gather data on women's preferences for educational information. Women who were discharged from one LHD, in NSW Australia, were invited, in 2019, to participate in a simple 14 question survey, either online or in hard copy format. FINDINGS In total, 685 women completed the survey which represented a 40% response rate over a period of two months. The survey revealed women commonly used smart phones, or other devices, to source information. Despite this, most women preferred to receive antenatal education via non-electronic methods. Of note many participants felt underprepared for the post-birth period. The method of survey completion, whether hardcopy or online, aligned with individuals' preferences for information delivery. CONCLUSION Non-electronic methods of education delivery were the preferred method for most women, and this was consistent across all educational, cultural and socioeconomic levels. Women sought information online, or through apps, but these options did not always meet their knowledge needs, especially regarding the postnatal period. We recommend that hospitals continue to provide information in a variety of modes, as exclusively electronic methods may marginalise groups of women.
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Fitzgerald K, Vaughan B, Fleischmann M, Pritchard S, Mulcahy J, Austin P. Utilisation of pain counselling in osteopathic practice: secondary analysis of a nationally representative sample of Australian osteopaths. Scand J Pain 2020; 21:330-338. [PMID: 34387951 DOI: 10.1515/sjpain-2020-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Advice, reassurance and education are recommended as first line treatments for musculoskeletal pain conditions such as low back pain. Osteopaths are registered primary contact allied health professionals in the Australian healthcare system who primarily manage acute and chronic musculoskeletal pain conditions. This study aimed to investigate the proportion of Australian osteopaths who do and do not utilise advice, reassurance and education (pain counselling) in their clinical practice, and determine the characteristics associated with the frequency of using pain counselling in clinical practice. METHODS A secondary analysis of practice characteristics from a nationally representative sample of Australian osteopaths was undertaken. Participants completed a 27-item practice characteristics questionnaire between July-December 2016. Bivariate analyses were used to identify significant variables for inclusion in a backward multiple logistic regression model. Adjusted odds ratios (OR) were calculated for significant variables. RESULTS Responses were received from 991 Australian osteopaths, representing 49% of the profession. Of these 264 (26.64%) indicated often utilising pain counselling, and 727 (73.36%) reported not often utilising pain counselling. Those who utilised pain counselling were more than twice as likely to report research evidence had a high impact on their clinical practice (OR 2.11), and nearly twice as likely to discuss physical activity with their patients (OR 1.84). CONCLUSIONS Pain counselling is under-utilised by nearly three quarters of the Australian osteopathic profession as a management strategy. Future studies are required to explore the reasons why most in the profession comprised in this sample are infrequently utilising this guideline recommendation. Given the frequency of chronic musculoskeletal pain conditions presenting to Australian osteopaths, strategies appear to be needed to advance the profession via professional development in accessing and using evidence-based care for pain conditions.
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Affiliation(s)
- Kylie Fitzgerald
- School of Health and Biomedical Sciences, RMIT University, Bundoora Campus, 264 Plenty Rd, Mill Park 3082, Melbourne, VIC, Australia
| | - Brett Vaughan
- Department of Medical Education, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Fleischmann
- School of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Shane Pritchard
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Jane Mulcahy
- School of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Phil Austin
- Department of Palliative Care, HammondCare, Sydney, NSW, Australia
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Lystad RP, Brown BT, Swain MS, Engel RM. Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. Chiropr Man Therap 2020; 28:49. [PMID: 32951611 PMCID: PMC7504850 DOI: 10.1186/s12998-020-00338-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Better understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. METHODS Data regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008-2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008-2012 and 2013-2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period. RESULTS A cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013-2017 than 2008-2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013-2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017. CONCLUSION Service provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Michael S Swain
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Vaughan B, Fleischmann M, Fitzgerald K, Grace S, McLaughlin P, Jolly B, Trumble S. Profile of an Allied Health Clinical Supervision Workforce: Results From a Nationally Representative Australian Practice-Based Research Network. HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bill AS, Dubois J, Pasquier J, Burnand B, Rodondi PY. Osteopathy in the French-speaking part of Switzerland: Practitioners' profile and scope of back pain management. PLoS One 2020; 15:e0232607. [PMID: 32357175 PMCID: PMC7194435 DOI: 10.1371/journal.pone.0232607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/18/2020] [Indexed: 12/29/2022] Open
Abstract
Background Osteopathy is commonly used for spinal pain, but knowledge about back pain management by osteopaths is scarce. Objective The aim of this study was to survey osteopaths across the French-speaking part of Switzerland about the scope of their practice and their management of patients with back pain. Design This cross-sectional observational study was based on an online survey conducted from March to June 2017. Setting and participants: All registered osteopaths of the French-speaking part of Switzerland were asked to complete the survey. Outcome measures: In addition to descriptive statistics (practice characteristics, patients’ profiles, scope of treatment modalities, health promotion, research, and osteopathic practice), we explored variables associated with osteopaths’ practice, such as age and gender. Results A total of 241 osteopaths completed the questionnaire (response rate: 28.8%). Almost two thirds of osteopaths were female. Ages ranged from 25 to 72 years with an overall mean of 42.0 (SD 10.7) years. Male osteopaths reported more weekly working hours than female osteopaths did (38.2 [SD 11.0] vs 31.6 [SD 8.9], respectively, p<0.001). Almost a third (27.8%,) of osteopaths could arrange an appointment for acute conditions on the same day and 62.0% within a week. Acute or subacute spinal conditions, mainly low back and neck pain, were the most frequent conditions seen by our respondents. For 94.4% of osteopaths, one to three consultations were required for the management of such conditions. Conclusion Osteopaths play a role in the management of spinal conditions, especially for acute problems. These findings, combined with short waiting times for consultations for acute conditions, as well as prompt management capabilities for acute low back and acute neck pain, support the view that the osteopathic profession constitutes an added value to primary care.
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Affiliation(s)
- Anne-Sylvie Bill
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
- * E-mail:
| | - Julie Dubois
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Bernard Burnand
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Rodondi
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
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The Chiropractic Research Priorities in Australia (ChiRPA) project: A study protocol. ADVANCES IN INTEGRATIVE MEDICINE 2020. [DOI: 10.1016/j.aimed.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Demortier M, Leboeuf-Yde C. Unravelling Functional Neurology: an overview of all published documents by FR Carrick, including a critical review of research articles on its effect or benefit. Chiropr Man Therap 2020; 28:9. [PMID: 32002178 PMCID: PMC6986008 DOI: 10.1186/s12998-019-0287-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Functional Neurology (FN), founded by FR Carrick, is an approach used by some chiropractors to treat a multitude of conditions via the nervous system including the brain. However, it seems to lack easily obtainable scientific evidence for its clinical validity. Objectives 1) To define the topics of FR Carrick’s publications, 2) to define the proportion of articles that are research studies, case studies, abstracts and conference papers, 3) to define how many of these are clinical research studies that purported or appeared to deal with the effect or benefit of FN, 4) in these studies, to establish whether the design and overall study method were suitable for research into the effect or benefit of FN, and 5) to describe the evidence available in relation to the clinical effect or benefit of FN, taking into account seven minimal methodological criteria. Method A literature search was done on Pubmed from its inception till October 2018, supplemented by a search on Scopus and ResearchGate to find all published documents by FR Carrick. We identified their types and topics, retaining for a critical review full text scientific articles appearing to test effect/benefit of FN procedures, subjecting them to a basic quality assessment (scoring 0–7). Results from studies of methodologically acceptable standard would be taken into account. Results We found 121 published texts, 39 of which were full scientific research articles. Of these, 23 dealt with topics relating to FN. Fourteen articles reported on clinical validity but only seven included a control group. The methodological quality of these seven articles was low, ranging between 1.5–4 out of 7. We therefore did not further report the outcomes of these studies. Conclusion We found no acceptable evidence in favour of effect/benefit of the FN approach. We therefore do not recommend its promotion as an evidence-based method. Further research on this topic should be conducted in collaboration with independent scientific institutions using commonly accepted research methods. Trial registration PROSPERO This review was registered in PROSPERO (application date 23.02.2019; no CRD42019126345).
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Affiliation(s)
- Marine Demortier
- 1CIAMS, University of Paris-Sud, University of Paris-Saclay, F-91405 Orsay Cedex, France.,2CIAMS, University of Orléans, F- 45067 Orléans, France.,Institut Franco Européen de Chiropraxie, 24 boulevard Paul Vaillant Couturier, F- 94200 Ivry sur Seine, France
| | - Charlotte Leboeuf-Yde
- 1CIAMS, University of Paris-Sud, University of Paris-Saclay, F-91405 Orsay Cedex, France.,2CIAMS, University of Orléans, F- 45067 Orléans, France.,Institut Franco Européen de Chiropraxie, 24 boulevard Paul Vaillant Couturier, F- 94200 Ivry sur Seine, France.,4Institute for Regional Health Research, University of Southern Denmark, DK-5000 Odense, Denmark
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Giuriato R, Štrkalj G, Meyer AJ, Pather N. Anatomical Sciences in Chiropractic Education: A Survey of Chiropractic Programs in Australia. ANATOMICAL SCIENCES EDUCATION 2020; 13:37-47. [PMID: 30793519 DOI: 10.1002/ase.1871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
Human anatomy knowledge is a core requirement for all health care clinicians. There is a paucity of information relating to anatomy content and delivery in Australian chiropractic programs. The aim of this study was to describe anatomy teaching in Australian chiropractic programs, utilizing a survey which was distributed to all four programs, requesting information on: anatomy program structure, delivery methods, assessment, teaching resources, and academic staff profile at their institution. The survey was undertaken in 2016 and documented practices in that academic year. All four institutions responded. There was a reported difference in the teaching hours, content, delivery and assessment of anatomy utilized in Australian chiropractic programs. Anatomy was compulsory at all four institutions with the mean total of 214 (SD ± 100.2) teaching hours. Teaching was undertaken by permanent ongoing (30%) and sessional academic staff, and student to teacher ratio varied from 15:1 to 12:1. A variety of teaching resources were utilized, including human tissue access, either as prosected cadavers or plastinated body parts. The results of this survey confirm that anatomy has an established place in chiropractic education programs in Australia and while curricular variations exist, all programs had similar course design, delivery, and assessment methods. This study confirmed the provision of a strong foundation in topographical anatomy and neuroanatomy, while other anatomical sciences, such as histology and embryology were not consistently delivered. Formalization of a core anatomy curriculum together with competency standards is needed to assist program evaluation and development, and for accreditation purposes.
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Affiliation(s)
- Rosemary Giuriato
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Goran Štrkalj
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Amanda J Meyer
- School of Human Sciences, Faculty of Science, University of Western Australia, Perth, Western Australia, Australia
| | - Nalini Pather
- Department of Anatomy, School of Medical Sciences, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
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Vindigni D, Zark L, Sundberg T, Leach M, Adams J, Azari MF. Chiropractic treatment of older adults with neck pain with or without headache or dizziness: analysis of 288 Australian chiropractors' self-reported views. Chiropr Man Therap 2019; 27:65. [PMID: 31867101 PMCID: PMC6918629 DOI: 10.1186/s12998-019-0288-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors’ caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes? Methods An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data. Results Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors’ patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly: manipulation of the thoracic spine (82.0%); activator adjustment of the neck (77.3%); and massage of the neck (76.5%). The average number of visits required to resolve headache symptoms was reported to be highest among those with migraine (M 11.2, SD 8.8). The majority of chiropractors (57.3%) reported a moderate response to treatment in reported dizziness amongst older adults with neck pain. Approximately 82% of older adult patients were estimated to use at least one other health service concurrently to chiropractic care to manage their neck pain. Conclusion This is the first known study to investigate chiropractic care of older adults living with neck pain. Chiropractors report using well-established conservative techniques to manage neck pain in older adults. Our findings also indicate that this target group of patients may frequently integrate chiropractic care with other health services in order to manage their neck pain. Further research should provide in-depth investigation of older patients’ experience and other patient-reported outcomes of chiropractic treatment.
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Affiliation(s)
- Dein Vindigni
- 1Chiropractic Discipline, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Laura Zark
- 1Chiropractic Discipline, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,2School of Psychology, Faculty of Health, Deakin University, Burwood, Melbourne, Australia
| | - Tobias Sundberg
- 3Musculoskeletal & Sports Injury Epidemiology Center (MUSIC), Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,4Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Matthew Leach
- 4Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia.,5Department of Rural Health, University of South Australia, Adelaide, Australia
| | - Jon Adams
- 4Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Michael F Azari
- 1Chiropractic Discipline, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Private practice, Azari Chiropractics, Mount Waverley, Melbourne, Australia
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Innes SI, Stomski N, Theroux J. Chiropractic students' perceptions of barriers and facilitators to joining a professional association". Chiropr Man Therap 2019; 27:67. [PMID: 31788182 PMCID: PMC6880539 DOI: 10.1186/s12998-019-0285-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background In Australia, about 1 in 3 chiropractors choose not to belong to either of the two professional associations and this is considerably lower compared to other health professional organisations in this country. The reasons for this remain unknown. We sought to explore possible reasons by asking chiropractic students their perceptions of barriers and facilitators to joining a professional association. However, we were unable to identify validated survey instruments that could be used to obtain information about reasons for joining health professional associations. Aim Therefore, the objectives of this study were to: 1) develop a survey instrument that captures information about what influences chiropractic students in joining professional association; and 2) identify factors that promote association membership among chiropractic students. Methods A literature review was undertaken to identify known determinants of professional association membership and were used to construct a preliminary survey instrument, which comprised 47 items. Six fourth-year chiropractic students assessed the preliminary survey instrument’s content validity. Principal components analysis was used to establish the structure of the scales. Cronbach’s alpha was derived to determine whether all items in each scale tapped a discrete construct. Logistic regression was used to examine the association between the scale scores and having joined a chiropractic professional association. Results In March 2019, 348 chiropractic students from Murdoch University (71.0%) responded to a voluntary, anonymous questionnaire. Principal components analysis resulted in the retention of 21 items that strongly loaded onto 6 factors. Internal consistency was found to be adequate. The results of the logistic regression analysis demonstrated that only “development of the profession” was significantly associated with have joined a professional chiropractic association (p = 0.049, OR = 2.22; 95% CI = 1.26–3.40). Conclusion Chiropractic organisations can probably most effectively increase membership numbers through raising awareness of their contribution to the development of the profession.
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Affiliation(s)
- Stanley I Innes
- College of Science, Health, Engineering and Education, Murdoch University, 90, South Street, Murdoch, Western Australia 6150 Australia
| | - Norman Stomski
- College of Science, Health, Engineering and Education, Murdoch University, 90, South Street, Murdoch, Western Australia 6150 Australia
| | - Jean Theroux
- College of Science, Health, Engineering and Education, Murdoch University, 90, South Street, Murdoch, Western Australia 6150 Australia
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Meyer AL, Amorim MA, Schubert M, Schweinhardt P, Leboeuf-Yde C. Unravelling functional neurology: does spinal manipulation have an effect on the brain? - a systematic literature review. Chiropr Man Therap 2019; 27:60. [PMID: 31632640 PMCID: PMC6788096 DOI: 10.1186/s12998-019-0265-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background A recent hypothesis purports that spinal manipulation may cause changes at a brain level. Functional Neurology, a mainly chiropractic approach, promotes the use of spinal manipulation to improve ‘brain function’ as if it were a proven construct. No systematic review has been performed to investigate how well founded this hypothesis is. Objective To investigate whether spinal manipulation has an effect on ‘brain function’ that is associated with any clinical benefits. Method In this systematic review, the literature was searched in PubMed, Embase, and PEDro (final search February 2018). We included randomized or non-randomized controlled studies, in which spinal manipulation was performed to any region of the spine, applied on either symptomatic or asymptomatic humans, and compared to a sham or to another type of control. The outcome measures had to be stated as direct or proxy markers of ‘brain function’. Articles were reviewed blindly by at least two reviewers, using a quality checklist designed for the specific needs of the review. Studies were classified as of ‘acceptable’, ‘medium’, or ‘low’ methodological quality. Results were reported in relation to (i) control intervention (sham, ‘inactive control’, or ‘another physical stimulus’) and (ii) study subjects (healthy, symptomatic, or with spinal pain” subjects/spinal pain”), taking into account the quality. Only results obtained from between-group or between-intervention comparisons were considered in the final analysis. Results Eighteen of 1514 articles were included. Studies were generally of ‘low’ or ‘medium’ methodological quality, most comparing spinal manipulation to a control other than a sham. Thirteen out of the 18 studies could be included in the final analysis. Transitory effects of different types of ‘brain function’ were reported in the three studies comparing spinal manipulation to sham (but of uncertain credibility), in “subclinical neck/spinal pain” subjects or in symptomatic subjects. None of these three studies, of ‘medium’ or ‘acceptable’ quality, investigated whether the neurophysiological effects reported were associated with clinical benefits. The remaining 10 studies, generally of ‘low’ or ‘medium’ quality, compared spinal manipulation to ‘inactive control’ or ‘another physical stimulus’ and similarly reported significant between-group differences but inconsistently. Conclusion The available evidence suggests that changes occur in ‘brain function’ in response to spinal manipulation but are inconsistent across and - sometimes - within studies. The clinical relevance of these changes is unknown. It is therefore premature to promote the use of spinal manipulation as a treatment to improve ‘brain function’. Electronic supplementary material The online version of this article (10.1186/s12998-019-0265-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne-Laure Meyer
- 1CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France.,2CIAMS, Université d'Orléans, 45067 Orléans, France.,Institut Franco Européen de Chiropraxie, 24 Bd Paul Vaillant Couturier, 94200 Ivry sur Seine, France
| | - Michel-Ange Amorim
- 1CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France.,2CIAMS, Université d'Orléans, 45067 Orléans, France
| | - Martin Schubert
- 4Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland
| | - Petra Schweinhardt
- 5Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zürich, Zürich, Switzerland
| | - Charlotte Leboeuf-Yde
- 1CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France.,2CIAMS, Université d'Orléans, 45067 Orléans, France.,Institut Franco Européen de Chiropraxie, 24 Bd Paul Vaillant Couturier, 94200 Ivry sur Seine, France.,6Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Fernandez M, Moore C, Eklund A, Swain M, de Luca K, Sibbritt D, Adams J, Peng W. The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study. Complement Ther Med 2019; 45:172-178. [PMID: 31331556 DOI: 10.1016/j.ctim.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/15/2019] [Accepted: 06/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity. METHODS A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients. RESULTS Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting. CONCLUSION Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.
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Affiliation(s)
- Matthew Fernandez
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia; Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.
| | - Craig Moore
- Chiropractic Academy for Research Leadership (CARL), Sydney, Australia; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Australia.
| | - Andreas Eklund
- Chiropractic Academy for Research Leadership (CARL), Sydney, Australia; Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Michael Swain
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia; Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.
| | - Katie de Luca
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia; Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.
| | - David Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Australia.
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Australia.
| | - Wenbo Peng
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Australia.
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Fernandez M, Moore C, Peng W, de Luca K, Pohlman KA, Swain M, Adams J. The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network. Chiropr Man Therap 2019; 27:19. [PMID: 31015956 PMCID: PMC6469207 DOI: 10.1186/s12998-019-0239-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who ‘often’ treated patients with LBRLP compared to those who treated LBRLP ‘never/rarely/sometimes’. Multiple logistic regression models identified independent factors associated with chiropractors who ‘often’ treated patients with LBRLP. Results A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them ‘often’ treating LBRLP. Chiropractors who ‘often’ treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who ‘often’ treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.
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Affiliation(s)
- Matthew Fernandez
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, Room 369, 17 Wally's Walk, Sydney, NSW Australia.,Chiropractic Academy for Research Leadership (CARL), Sydney, Australia
| | - Craig Moore
- Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.,3Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Wenbo Peng
- 3Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Katie de Luca
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, Room 369, 17 Wally's Walk, Sydney, NSW Australia.,Chiropractic Academy for Research Leadership (CARL), Sydney, Australia
| | - Katherine A Pohlman
- Chiropractic Academy for Research Leadership (CARL), Sydney, Australia.,4Research Institute, Parker University, Dallas, Texas USA
| | - Michael Swain
- 1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Level 3, Room 369, 17 Wally's Walk, Sydney, NSW Australia.,Chiropractic Academy for Research Leadership (CARL), Sydney, Australia
| | - Jon Adams
- 3Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
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Moore C, de Luca K, Wong AYL, Fernandez M, Swain M, Hartvigsen J, Adams J, Peng W. Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors. Australas J Ageing 2019; 38:249-257. [PMID: 30977304 DOI: 10.1111/ajag.12652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 02/25/2019] [Accepted: 03/09/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the prevalence and profile of chiropractors who frequently manage people aged 65 years and older. METHODS A national cross-sectional survey collected practitioner characteristics, practice settings and clinical management characteristics. Multiple logistic regression was conducted on 1903 chiropractors to determine the factors associated with the frequent treatment of people 65 years and older. RESULTS In total, 73.5% of participants report "often" treating those aged 65 years and older. These chiropractors were associated with treating degenerative spine conditions (OR [odds ratio] 2.25; 95% [confidence interval] CI 1.72-2.94), working in a non-urban area (OR 1.85; 95% CI 1.35-2.54), treating low back pain (referred/radicular) (OR 1.74; 95% CI 1.26-2.40) and lower limb musculoskeletal disorders (OR 1.50; 95% CI 1.15-1.96). CONCLUSIONS The majority of chiropractors report often providing treatment to older people. Our findings call for more research to better understand older patient complaints that are common to chiropractic practice and the care provided by chiropractors for this patient group.
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Affiliation(s)
- Craig Moore
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Chiropractic Academy for Research Leadership
| | - Katie de Luca
- Chiropractic Academy for Research Leadership.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Arnold Y L Wong
- Chiropractic Academy for Research Leadership.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Matthew Fernandez
- Chiropractic Academy for Research Leadership.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Swain
- Chiropractic Academy for Research Leadership.,Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Wenbo Peng
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Prevalence and profile of Australian osteopaths treating older people. Complement Ther Med 2019; 43:125-130. [DOI: 10.1016/j.ctim.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/26/2023] Open
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43
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Complementary and alternative medicine research in practice-based research networks: A critical review. Complement Ther Med 2019; 43:7-19. [DOI: 10.1016/j.ctim.2018.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/15/2018] [Accepted: 12/31/2018] [Indexed: 11/17/2022] Open
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Bernstein C, Wayne PM, Rist PM, Osypiuk K, Hernandez A, Kowalski M. Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series. Glob Adv Health Med 2019; 8:2164956119835778. [PMID: 30944771 PMCID: PMC6440032 DOI: 10.1177/2164956119835778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/31/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
This case series illustrates an integrated model of care for migraine that combines standard neurological care with chiropractic treatment. For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face "hallway" interaction, medical notes, team meetings, and clinical outcomes. Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. Suggestions for future areas of research evaluating integrative approaches are discussed.
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Affiliation(s)
- Carolyn Bernstein
- Osher Clinical Center, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Peter M Wayne
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kamila Osypiuk
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Audrey Hernandez
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Matthew Kowalski
- Osher Clinical Center, Brigham and Women’s Hospital, Boston, Massachusetts
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Rist PM, Hernandez A, Bernstein C, Kowalski M, Osypiuk K, Vining R, Long CR, Goertz C, Song R, Wayne PM. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache 2019; 59:532-542. [PMID: 30973196 DOI: 10.1111/head.13501] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several small studies have suggested that spinal manipulation may be an effective treatment for reducing migraine pain and disability. We performed a systematic review and meta-analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability. METHODS PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine-related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta-analytic methods were employed to estimate the effect sizes (Hedges' g) and heterogeneity (I2 ) for migraine days, pain, and disability. The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool. RESULTS Our search identified 6 RCTs (pooled n = 677; range of n = 42-218) eligible for meta-analysis. Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability. Methodological quality varied across the studies. For example, some studies received high or unclear bias scores for methodological features such as compliance, blinding, and completeness of outcome data. Due to high levels of heterogeneity when all 6 studies were included in the meta-analysis, the 1 RCT performed only among chronic migraineurs was excluded. Heterogeneity across the remaining studies was low. We observed that spinal manipulation reduced migraine days with an overall small effect size (Hedges' g = -0.35, 95% CI: -0.53, -0.16, P < .001) as well as migraine pain/intensity. CONCLUSIONS Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta-analysis, we consider these results to be preliminary. Methodologically rigorous, large-scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.
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Affiliation(s)
- Pamela M Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Audrey Hernandez
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Carolyn Bernstein
- Osher Clinic Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew Kowalski
- Osher Clinic Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Kamila Osypiuk
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Peter M Wayne
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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46
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Adams J, de Luca K, Swain M, Funabashi M, Wong A, Pagé I, Sibbritt D, Peng W. Prevalence and practice characteristics of urban and rural or remote Australian chiropractors: Analysis of a nationally representative sample of 1830 chiropractors. Aust J Rural Health 2019; 27:34-41. [PMID: 30719793 DOI: 10.1111/ajr.12447] [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] [Accepted: 05/20/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the prevalence and clinical management characteristics of chiropractors practising in urban and rural or remote Australia. DESIGN A cross-sectional analysis of the Australian Chiropractic Research Network project data. SETTING Nationally representative sample of registered chiropractors practising in Australia. PARTICIPANTS Chiropractors who participated in the Australian Chiropractic Research Network project and answered a question about practising in urban or rural or remote areas in the practitioner questionnaire. MAIN OUTCOME MEASURE The demographics, practice characteristics and clinical management of chiropractors. RESULTS The majority of chiropractors indicated that they practise in urban areas only, while 22.8% (n = 435) practice in rural or remote areas only and 4.0% (n = 77) practice in both urban and rural or remote areas. Statistically significant predictors of chiropractors who practice in rural or remote areas, as compared to urban areas, included more patient visits per week, practising in more than one location, no imaging facilities on site, often treating degenerative spinal conditions or migraine, often treating people aged over 65 years, frequently treating Aboriginal and Torres Strait Islander people and frequently using biomechanical pelvic blocking or the sacro-occipital technique. CONCLUSION A substantial number of chiropractors practice in rural or remote Australia and these rural or remote-based chiropractors are more likely to treat a wide range of musculoskeletal cases and include an Indigenously diverse group of patients than their urban-located colleagues. Unique practice challenges for rural or remote chiropractors include a higher workload and a lack of diagnostic tools. Chiropractors should be acknowledged and considered within rural or remote health care policy and service provision.
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Affiliation(s)
- Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Katie de Luca
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia.,Chiropractic Academy for Research Leadership, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael Swain
- Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, New South Wales, Australia.,Chiropractic Academy for Research Leadership, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Martha Funabashi
- Chiropractic Academy for Research Leadership, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, New South Wales, Australia.,Collaborative Orthopedic Research, Alberta Health Services, Edmonton, Alberta, Canada
| | - Arnold Wong
- Chiropractic Academy for Research Leadership, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, New South Wales, Australia.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Isabelle Pagé
- Chiropractic Academy for Research Leadership, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, New South Wales, Australia.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Wenbo Peng
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Doyle MF, Miller JE. Demographic Profile of Chiropractors Who Treat Children: A Multinational Survey. J Manipulative Physiol Ther 2019; 42:1-11. [DOI: 10.1016/j.jmpt.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 10/27/2022]
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Moore C, Leaver A, Sibbritt D, Adams J. The management of common recurrent headaches by chiropractors: a descriptive analysis of a nationally representative survey. BMC Neurol 2018; 18:171. [PMID: 30332996 PMCID: PMC6192187 DOI: 10.1186/s12883-018-1173-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 10/04/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Headache management is common within chiropractic clinical settings; however, little is yet known about how this provider group manage headache sufferers. The aim of this study is to report on the prevalence of headache patients found within routine chiropractic practice and to assess how chiropractors approach key aspects of headache management applicable to primary care settings. METHODS A 31-item cross-sectional survey was distributed to a national sample of chiropractors (n = 1050) to report on practitioner approach to headache diagnosis, interdisciplinary collaboration, treatment and outcome assessment of headache patients who present with recurrent headache disorders. RESULTS The survey attracted a response rate of 36% (n = 381). One in five new patients present to chiropractors with a chief complaint of headache. The majority of chiropractors provide headache diagnosis for common primary (84.6%) and secondary (90.4%) headaches using formal headache classification criteria. Interdisciplinary referral for headache management was most often with CAM providers followed by GPs. Advice on headache triggers, stress management, spinal manipulation, soft tissue therapies and prescriptive neck exercises were the most common therapeutic approaches to headache management. CONCLUSION Headache patients make up a substantial proportion of chiropractic caseload. The majority of chiropractors managing headache engage in headache diagnosis and interdisciplinary patient management. More research information is needed to understand the headache types and level of headache chronicity and disability common to chiropractic patient populations to further assess the healthcare needs of this patient population.
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Affiliation(s)
- Craig Moore
- Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street Ultimo, Sydney, NSW 2007 Australia
| | - Andrew Leaver
- Faculty of Health Science, University of Sydney, Sydney, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street Ultimo, Sydney, NSW 2007 Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street Ultimo, Sydney, NSW 2007 Australia
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Clohesy N, Schneiders A. A preliminary investigation examining patient reported outcome measures for low back pain and utilisation amongst chiropractors in Australia: facilitators and barriers to clinical implementation. Chiropr Man Therap 2018; 26:38. [PMID: 30338054 PMCID: PMC6176508 DOI: 10.1186/s12998-018-0208-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background The current utilisation of patient reported outcome measures (PROMs) for low back pain (LBP) within the Australian Chiropractic profession is unknown. The aims of this study were to determine the current utilisation of LBP PROMs amongst Chiropractors in Australia and to identify the potential barriers and facilitators of using PROMs for LBP in Chiropractic practice. Methods A cross sectional online survey was distributed to Chiropractors in Australia who were members of the Chiropractic Association of Australia (CAA) and Chiropractic Australia (CA) between June-August 2016. Three thousand fourteen CAA members and 930 CA members were invited to participate totaling 3944 potential participants. Results The findings from this survey provides baseline data for the prevalence of LBP PROMs within the Australian Chiropractic profession. A total of 558 participants completed the survey reflecting a response rate of 14.1%. 72.5% of respondents used LBP PROMs in clinical practice. PROMs were categorised into pain, function and health. At initial patient consultations the most commonly used pain PROMs were the pain diagram, Visual Analogue Scale and Numeric Rating Scale. Most commonly used functional LBP PROMs were the Oswestry Disability Index, Functional Rating Index and Roland Morris Questionnaire. The Health Status Questionnaire (HSQ) was the most commonly used health LBP PROM followed by RAND Health Questionnaires. Conclusion Most of the survey respondents use PROMs in clinical practice. The most common barrier chiropractors identified that prevent LBP PROM utilisation was the lack of operational definition surrounding PROMs, as well as how to use them and the perception that they are time consuming. Facilitatory factors to implement PROMs included using simple administration systems, utilising electronic forms and consistent implementation. This research indicates that there is a potential need to further educate the Chiropractic profession regarding PROMs.
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Affiliation(s)
- Natalie Clohesy
- Department of Exercise & Health Sciences. School of Health, Medical and Applied Sciences, Central Queensland University, University Dr, Branyan, QLD 4670 Australia
| | - Anthony Schneiders
- Department of Exercise & Health Sciences. School of Health, Medical and Applied Sciences, Central Queensland University, University Dr, Branyan, QLD 4670 Australia
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de Luca KE, Gliedt JA, Fernandez M, Kawchuk G, Swain MS. The identity, role, setting, and future of chiropractic practice: a survey of Australian and New Zealand chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2018; 32:115-125. [PMID: 29509506 PMCID: PMC6192485 DOI: 10.7899/jce-17-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE: To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice. METHODS: An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests. RESULTS: A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student's chiropractic institution (Pillai's trace =.638, F[16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice. CONCLUSIONS: Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.
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