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Minder CR, Gorbach C, Peterson CK. Factors Associated With Pain Medication Use and the Relationship to Chiropractic Treatment Outcomes for Patients With Low Back and Neck Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:575-585. [PMID: 37318388 DOI: 10.1016/j.jmpt.2023.03.002] [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: 02/09/2021] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study objectives were to identify baseline factors associated with pain medication use and determine any differences in chiropractic treatment outcomes in patients with low back pain (LBP) and neck pain (NP) depending on their use of pain medication. METHODS This cross-sectional, prospective outcomes study included 1077 adults with acute or chronic LBP and 845 adults with acute or chronic NP recruited from Swiss chiropractors in their offices within 4 years. Demographic data and the responses to the Patient's Global Impression of Change scale collected at 1 week, 1 month, 3 months, 6 months, and 1 year were analyzed with the χ2 test. Baseline pain and disability levels were measured using the numeric rating scale (NRS), Oswestry questionnaire for LBP, and Bournemouth questionnaire for patients with NP and analyzed with the Mann-Whitney U test between the 2 groups. To detect significant predictors of medication use at baseline, logistic regression analysis was performed. RESULTS Patients with acute LBP and NP were more likely than those with chronic pain to take pain medication (P < .001 LBP; P = .003 NP). Medication use was more likely with patients with radiculopathy (P < .001 LBP; P = .05 NP) who were smokers (P = .008 LBP; P = .024 NP) and those reporting below-average general health (P < .001 LBP and NP). Pain medication users had higher baseline pain (P < .001 LBP and NP) and disability (P < .001 LBP and NP) scores. CONCLUSION Patients with LBP and NP had significantly higher pain and disability levels at baseline, tended to have radiculopathy and poor health, were smokers, and presented during the acute phase. However, for this sample of patients, there were no differences in subjective improvement between users and non-users of pain medication for any data collection time point, which has management implications.
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Affiliation(s)
- Corinne R Minder
- Chiropractic Medicine Department, Faculty of Medicine, University of Zürich, Zürich, Switzerland.
| | - Christoph Gorbach
- Departments of Chiropractic Medicine and Orthopedic Rheumatology, Balgrist University Hospital, Zürich, Switzerland
| | - Cynthia K Peterson
- Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, Zürich, Switzerland
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Huluman T, Yelverton C, Peterson C. Attitudes towards limited drug prescription rights: A survey of South African chiropractors. Health SA 2022; 27:1731. [PMID: 35281290 PMCID: PMC8905459 DOI: 10.4102/hsag.v27i0.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background Several surveys that have been published show opinions regarding a change in the scope of chiropractic practice to include prescription rights. Currently, research into the attitudes of South African chiropractors towards having this right is non-existent. Aim To ascertain the attitudes of South African chiropractors towards the inclusion of drug prescription rights in their scope of practice. Setting The study was conducted on chiropractors registered with the Allied Health Professions Council of South Africa and members of the Chiropractic Association of South Africa. Method A self-administrative online questionnaire was developed, and sent via email to all registered chiropractors in South Africa in February 2020. Descriptive statistics were used to analyse the data. Results The response rate for this study was 15.9% (n = 138). 84% (n =105) were in favour of limited prescription rights for over-the-counter medication. However, 79.6% (n = 98) did not agree to full prescriptions rights for non-musculoskeletal drugs. A total of 33.6% (n = 42) rarely recommended OTC and prescription-based analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to their acute patients and 37.9% (n = 52) rarely recommended these drugs to chronic patients. 68.8% (n = 86) were confident in their knowledge of musculoskeletal drugs and 91.2% (n = 112) agreed on further education and training in pharmacology for those practitioners seeking limited medication prescription rights. Conclusion The majority of South African chiropractor respondents indicated an interest in expanding their scope of practice to include limited prescription rights. Contribution These findings could indicate a shift in the attitudes of chiropractors towards drug prescription rights within the profession.
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Affiliation(s)
- Thriya Huluman
- Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Christopher Yelverton
- Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Cynthia Peterson
- Department of Chiropractic, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Emary PC, Oremus M, Houweling TAW, Wangler M, Akhtar-Danesh N. Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study. Chiropr Man Therap 2020; 28:54. [PMID: 33076943 PMCID: PMC7574492 DOI: 10.1186/s12998-020-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022] Open
Abstract
Background Swiss chiropractors have been licensed since 1995 to prescribe from a limited formulary of medications for treating musculoskeletal (MSK) conditions. In January 2018, this formulary was expanded to include additional muscle relaxant, analgesic, and anti-inflammatory medications. Internationally, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession. Objective The purpose of this study was to assess Swiss chiropractors’ attitudes, beliefs, and practices regarding their existing medication prescription privileges. This information will provide new insights on the topic and help inform research and policy discussions about expanding chiropractic prescription rights in other jurisdictions. Methods A 13-item questionnaire and Q-methodology approach were used to conduct the assessment. Recruitment was conducted by e-mail between December 2019 and February 2020, and all members of the Swiss Chiropractic Association were eligible to participate. Data were analyzed using by-person factor analysis and descriptive statistics. Results In total, 187 Swiss chiropractors participated in this study (65.4% response rate). Respondents reported prescribing analgesics, anti-inflammatories, and muscle relaxants to a median of 5, 5, and 0% of patients, respectively. Forty-two percent of respondents expressed interest in further expanding the range of current medications available to Swiss chiropractors for treating MSK conditions. Only 15% expressed interest in expanding this range to include medications for treating non-MSK conditions. In the Q-methodology analysis, four salient viewpoints/groups regarding medication prescribing emerged: prescribers, non-prescribers, collaborators, and integrators. All except non-prescribers thought medication prescription privileges were advantageous for the chiropractic profession in Switzerland. There was also strong consensus among all four groups that medication prescribing should not replace manual therapy in chiropractic practice. Conclusion This was the first national survey on attitudes toward prescribing medications among Swiss chiropractors since the year 2000, and the first using Q-methodology. With this approach, four unique groups of chiropractic prescribers were identified. Even with diversity among clinicians, the findings of this study showed general support for, along with conservative use of, prescribing privileges within the Swiss chiropractic profession. Studies in jurisdictions outside of Switzerland are needed to assess whether chiropractors are interested in expanding their scopes of practice to include similar prescribing privileges.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. .,Chiropractic Department, D'Youville College, Buffalo, NY, USA. .,Private Practice, 1145 Concession Road, Cambridge, Ontario, N3H 4L5, Canada.
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Noori Akhtar-Danesh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
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Emary PC, Oremus M, Houweling TAW, Wangler M, Akhtar-Danesh N. Attitudes, beliefs, and practices regarding medication prescribing for musculoskeletal conditions: a protocol for a national Q-methodology study of Swiss chiropractors. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2020; 64:119-130. [PMID: 33012811 PMCID: PMC7500235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Since 1995, chiropractors in Switzerland have been licensed to prescribe medications for treating musculoskeletal conditions. However, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession internationally. OBJECTIVE To assess Swiss chiropractors' attitudes, beliefs, and practices regarding their existing medication prescription privileges. METHODS A Q-methodology approach will be used to collect data for the assessment. In addition, scope expansion and frequency of prescribing by Swiss chiropractors will be queried using a 13-item questionnaire. Recruitment will be conducted by e-mail and all members of the Swiss Chiropractic Association will be eligible to participate. Data will be analyzed using by-person factor analysis and descriptive statistics. DISCUSSION This will be the first national update on attitudes toward prescribing medications among Swiss chiropractors since 2003, and the first using Q-methodology. The results of this study are important as they will inform future directions and research regarding chiropractic prescription rights.
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Affiliation(s)
- Peter C Emary
- PhD Student, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Adjunct Assistant Professor, Chiropractic Department, D'Youville College, Buffalo, NY, USA
- Private Practice, Cambridge, ON, Canada
| | - Mark Oremus
- School of Public Health and Health Systems, University of Waterloo
- Department of Health Research Methods, Evidence and Impact, McMaster University
| | | | | | - Noori Akhtar-Danesh
- School of Nursing, McMaster University
- Department of Health Research Methods, Evidence and Impact, McMaster University
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Emary PC, Lamont H, Taylor JA. Attitudes Toward Medication Prescription Rights: A Survey of Chiropractic Students and Faculty at D'Youville College. J Chiropr Med 2019; 18:286-298. [PMID: 32952474 PMCID: PMC7486473 DOI: 10.1016/j.jcm.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/22/2018] [Accepted: 01/16/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of this study was to ascertain the general attitudes of students and faculty in the chiropractic department of D'Youville College, Buffalo, New York, toward the inclusion of medication prescription rights in the chiropractic scope of practice. METHODS A 15-item questionnaire was adapted from a previous instrument used in assessing chiropractors' opinions toward medication prescription rights. Invitations were sent by e-mail to all 123 chiropractic students and faculty at D'Youville College in September 2018. Data were collected and analyzed using descriptive and inferential statistics. RESULTS A total of 113 questionnaires were completed for a 92% response rate. Ninety percent of respondents agreed that chiropractors should be authorized to prescribe medications such as over-the-counter and prescription-based analgesics, anti-inflammatories, and muscle relaxants. Respondents were less in favor of chiropractors prescribing opioids or having full prescribing rights. Over half indicated that their knowledge of musculoskeletal medications was high, whereas a similar number indicated that their knowledge of nonmusculoskeletal medications was low. Most respondents indicated that further education in pharmacology should be necessary for those in the profession wishing to prescribe medications. CONCLUSION Chiropractic students and faculty at D'Youville College endorsed expanding the chiropractic scope of practice to include limited medication prescription. Surveys and qualitative studies of students and faculty from other chiropractic educational institutions are warranted.
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Affiliation(s)
- Peter C. Emary
- Private Practice, Cambridge, Ontario, Canada
- Chiropractic Department, D'Youville College, Buffalo, New York
| | | | - John A. Taylor
- Chiropractic Department, D'Youville College, Buffalo, New York
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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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Papuga MO, Barnes AL. Correlation of PROMIS CAT instruments with Oswestry Disability Index in chiropractic patients. Complement Ther Clin Pract 2018; 31:85-90. [PMID: 29705486 DOI: 10.1016/j.ctcp.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/17/2018] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The inefficiency associated with collecting standard validated instruments has been a barrier to routine use. We utilized computer adaptive testing (CAT) instruments available through Patient-Reported Outcomes Measurement Information System (PROMIS) and correlated these with the Oswestry Disability Index (ODI). METHODS All measurements were collected at a routine chiropractic visit. The ODI assessment was used for comparison as a widely used patient reported outcomes instrument. RESULTS The average time to complete all questions during an office visit was 170 ± 67 s (average ± Stdev) to answer 25 ± 6 questions. Regression analysis revealed a good linear fit between ODI and both PROMIS pain behavior and physical function with R2 values of 0.5219 and 0.6754 respectively, and a good linear fit between anxiety and depression with R2 values of 0.5236. CONCLUSIONS PROMIS CAT instruments can be efficiently administered during routine clinical visits and correlations values found validate the utility when compared to ODI.
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Affiliation(s)
- M Owen Papuga
- New York Chiropractic College, 2360 State Route 89, Seneca Falls, NY 13148, United States.
| | - Alicia L Barnes
- New York Chiropractic College, 2360 State Route 89, Seneca Falls, NY 13148, United States
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Strahinjevich B, Simpson JK. The schism in chiropractic through the eyes of a 1st year chiropractic student. Chiropr Man Therap 2018; 26:2. [PMID: 29372046 PMCID: PMC5769380 DOI: 10.1186/s12998-017-0171-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022] Open
Abstract
Since its inception, the chiropractic profession has been divided along ideological fault lines. These divisions have led to a profession wide schism, which has limited mainstream acceptance, utilisation, social authority and integration. The authors explore the historical origins of this schism, taking time to consider historical context, religiosity, perpetuating factors, logical fallacies and siege mentality. Evidence is then provided for a way forward, based on the positioning of chiropractors as mainstream partners in health care.
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Affiliation(s)
| | - J. Keith Simpson
- Discipline of Chiropractic, Murdoch University, Perth, WA Australia
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Young KJ. Historical influence on the practice of chiropractic radiology: part II - thematic analysis on the opinions of diplomates of the American Chiropractic College of Radiology about the future. Chiropr Man Therap 2017; 25:15. [PMID: 28503293 PMCID: PMC5421334 DOI: 10.1186/s12998-017-0145-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past 20 years, various authors have addressed the question of the future of chiropractic. Most were positive about the future, with some advocating evidence-based practice and integration with mainstream healthcare, some advocating continued separation with an emphasis on subluxation-based care or the traditional/historical paradigm of chiropractic, and some calling for tolerance and unity. No papers were found specifically inquiring about the future of chiropractic radiology. METHODS The study population consisted of all current members of the American Chiropractic College of Radiology (ACCR), estimated at 190 people, known as chiropractic radiologists or Diplomates of the American Chiropractic Board of Radiology (DACBRs). An internet-based, anonymous survey using SurveyMonkey was implemented, supplemented by hard copies distributed at a conference. The main point of interest for this paper is the final item of the overall questionnaire. This item inquired about the future of chiropractic radiology. Thematic analysis was used on the responses, coded in both constructionist and inductive ways to extract both a general outlook and more specific themes. The inductive themes were also assigned secondarily to a SWOT (strengths, weaknesses, opportunities, and threats) analysis. RESULTS The overall response rate to the survey was 38% (73/190); within the group of respondents, 71 of 73 (98%) answered the item that is the subject of this paper. Opinions on the outlook for chiropractic radiology in the future were more negative than positive, with 14 respondents giving a positive outlook, 26 negative, and 14 non-committal. 28 respondents advocated integration with the wider healthcare community, 11 recommended emphasising separateness or a focus on working within chiropractic, and 15 did not express an opinion on this issue. Ten strengths were noted, 11 weaknesses, 57 opportunities, and 30 threats. CONCLUSIONS The increasing necessity of demonstrating evidence for diagnostic and therapeutic procedures in healthcare makes it likely that chiropractic radiologists and the wider chiropractic profession will need to take a more active position on evidence-based practice. Re-evaluation of guidelines and legislation as well as enforcement policies and practices will be necessary. The consequences of failing to do so may include increased marginalisation and reduced viability as a profession.
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Affiliation(s)
- Kenneth J. Young
- School of Arts, School of Health Professions, Murdoch University, Perth, WA 6150 Australia
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Mirtz TA. A treatise for a new philosophy of chiropractic medicine. Chiropr Man Therap 2017; 25:7. [PMID: 28286645 PMCID: PMC5338096 DOI: 10.1186/s12998-017-0138-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 02/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The philosophy of chiropractic has been a much debated entity throughout the existence of the chiropractic profession. Much criticism has been passed upon the historical philosophy of chiropractic and propagated by contemporary adherents. To date, a new philosophy has not been detailed nor presented that demonstrates principles by which to follow. AIM The purpose of this paper is to expand upon the work of Russell Kirk (b.1918, d. 1994), an American political theorist, as a basis for principles to guide the formation of a philosophy of chiropractic medicine (PCM). Each of Kirk's principles will be explained and expounded upon as applicable to a PCM. The addition of the term "medicine" to chiropractic is indicative of a new direction for the profession. DISCUSSION The ten principles that provide a foundation for a PCM include: (a) moral order, (b) custom, convention and continuity, (c) prescription, (d) prudence, (e) variety, (f) imperfectability, (g) freedom and property linkage, (h) voluntary community and involuntary collectivism, (i) prudent restraints upon power and human passions, and (j) permanence and change. Each of these principles offers not a dogmatic approach but provides insight into the application of chiropractic medicine to the entire station of the patient and society at large especially that of the economic, social and political. These principles provide direction in not only the approach to the doctor-patient encounter but can be used to visualize the wider world and its potential impact. Instead, these principles examine many tangential issues worthy of discussion that may impact health, social, political, and economic policy and how the chiropractic profession can approach these issues. CONCLUSION This paper provides the initial steps in formulating a PCM using principles from a sociological, political and economic standpoint which may impact on how chiropractic medicine approaches the patient and society in totality. In addition, these principles provide the necessary first steps in the arena of the social, political and economic aspects and how chiropractic medicine can advance.
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Affiliation(s)
- Timothy A Mirtz
- Department of Secondary and Physical Education, Bethune-Cookman University, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, FL 32114 USA
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