Chiropractic students' cognitive dissonance to statements about professional identity, role, setting and future: international perspectives from a secondary analysis of pooled data

Exploration of chiropractic students' motivation toward the incorporation of new evidence on chiropractic maintenance care: a mixed methods study

Objectives

This sequential explanatory mixed-method study aimed to explore chiropractic students' attitudes toward incorporating maintenance care (MC) focused evidence.

Methods

Attitudes towards using an evidence-based clinical protocol for maintenance care (MC), the MAINTAIN instrument, were assessed via surveys, monologue responses, dialogues, and qualitative feedback. Participants from a single chiropractic educational institution completed questionnaires evaluating their perspectives on patient-centeredness, chronic pain, and evidence incorporation. Descriptive statistics summarized quantitative data, while content analysis was used for qualitative data.

Results

74.4% (n=419) of students participated, mostly male (57.5%), with an average GPA of 3.15 (out of a maximum of 4.0). Qualitative analysis identified the need to clarify MC terminology and factors motivating students to adopt new evidence, such as quality and alignment with healthcare beliefs.

Conclusions

This study's findings emphasize the importance of refining healthcare training strategies, including defining terminology and addressing motivators for evidence incorporation, as evidence for MC for low back pain evolves.

Development and validation of the Chiropractic Professional Identity Embodiment Scale (CPIES)

BACKGROUND AND PURPOSE

Chiropractic professional identity (CPI) encompasses diverse values, beliefs, experiences, and philosophies about one's work, specific to the chiropractic profession. Yet currently, there is no instrument available to measure CPI. This study aimed to develop and validate the Chiropractic Professional Identity Embodiment Scale (CPIES).

MATERIALS AND METHODS

A mixed-methods sequential exploratory design was employed where qualitative inquiry preceded quantitative analysis of survey items conducted in New Zealand in 2022. Expert key informants provided feedback on candidate items via one-to-one cognitive interviews. Candidate items were administered to Board-registered chiropractors or chiropractic students through an online survey. The suitability of candidate items was evaluated using a variety of psychometric analyses including conceptually guided exploratory factor analysis (EFA) and reliability testing.

RESULTS

Based on relevant professional identity literature and feedback from 15 expert key informants, a draft survey instrument with 92 candidate items (across six domains) was rated by 231 participants. Using EFA, the number of items was reduced to 15. The CPIES sum score exhibited significant correlations with individuals' philosophical self-categorisation and five of the six optional subscales.

CONCLUSION

The 15-item CPIES, either as a unidimensional score or with six separate subscale scores, has been demonstrated to provide valid and reliable measurement of CPI. Future research could utilise the CPIES to investigate how CPI influences clinical practice, patient outcomes, career satisfaction, and public perception of the chiropractic profession, further advancing professionalisation and recognition within healthcare.

Associations between demographics and clinical ideology, beliefs, and practice patterns: a secondary analysis of a survey of randomly sampled United States chiropractors

BACKGROUND

The chiropractic profession in the United States (US) has a long history of intra-professional discourse surrounding ideology and beliefs. Large-scale efforts have evaluated 3 distinctive subgroups of US chiropractors focused on these areas of practice: spine/neuromusculoskeletal, primary care, and vertebral subluxation. To our knowledge, there have not been any prior studies exploring the factors associated with these ideology and belief characteristics of these subgroups. The purpose of this study was to explore, describe, and characterize the association of US chiropractors' ideology, beliefs, and practice patterns with: 1) chiropractic degree program of graduation, 2) years since completion of chiropractic degree, and 3) US geographic region of primary practice.

METHODS

This was a secondary analysis of a cross-sectional survey of a random sample of US licensed chiropractors (n = 8975). A 10% random sample was extracted from each of the 50 states and District of Columbia chiropractic regulatory board lists. The survey was conducted between March 2018-January 2020. The survey instrument consisted of 7 items that were developed to elicit these differentiating ideologies, beliefs, and practice patterns: 1) clinical examination/assessment, 2) health conditions treated, 3) role of chiropractors in the healthcare system, 4) the impact of chiropractic adjustments [spinal manipulation] in treating patients with cancer, 5) vaccination attitudes, 6) detection of subluxation on x-ray, and 7) x-ray utilization rates. Multinomial regression was used to analyze associations between these 7 ideology and practice characteristic items from the survey (dependent variables) and the 3 demographic items listed above (independent variables).

RESULTS

Data from 3538 respondents (74.6% male) were collected with an overall response rate of 39.4%. Patterns of responses to the 7 survey items for ideologies, beliefs, and practice characteristics were significantly different based on chiropractic degree program of graduation, years since completion of chiropractic degree, and geographic region of primary practice.

CONCLUSIONS

Among US chiropractors, chiropractic program of graduation, years since completion of chiropractic degree, and geographic region of primary practice are associated with variations in clinical ideology, beliefs, and practice patterns. The wide variation and inconsistent beliefs of US chiropractors could result in public confusion and impede interprofessional integration.

Chiropractic care and research priorities for the pediatric population: a cross-sectional survey of Quebec chiropractors

BACKGROUND

Chiropractors commonly treat pediatric patients within their private practices. The objectives of this study were (1) to identify the treatment techniques and health advice used by Quebec chiropractors with pediatric patients; (2) to explore the research priorities of Quebec chiropractors for the pediatric population; and (3) to identify Quebec chiropractors' training in the field of pediatric chiropractics.

METHODS

A web-based cross-sectional survey was conducted among all licensed Quebec chiropractors (Qc, Canada). Descriptive statistics were used to analyze all quantitative variables.

RESULTS

The results showed that among the 245 respondents (22.8% response rate), practitioners adapted their treatment techniques based on their patients' age group, thus using softer techniques with younger pediatric patients and slowly gravitating toward techniques used with adults when patients reached the age of six. In terms of continuing education, chiropractors reported an average of 7.87 h of training on the subject per year, which mostly came from either Quebec's College of Chiropractors (OCQ) (54.7%), written articles (46.9%) or seminars and conferences (43.7%). Both musculoskeletal (MSK) and viscerosomatic conditions were identified as high research priorities by the clinicians.

CONCLUSIONS

Quebec chiropractors adapt their treatment techniques to pediatric patients. In light of limited sources of continuing education in the field of pediatric chiropractics, practitioners mostly rely on the training provided by their provincial college and scientific publications. According to practitioners, future research priorities for pediatric care should focus on both MSK conditions and non-MSK conditions.

Defining chiropractic professional identity: A concept analysis

BACKGROUND

The concept of professional identity within chiropractic is often discussed and debated, however in the field to date, there is no formal definition of chiropractic professional identity (CPI). This article aims to create a coherent definition of CPI and to formalise the conceptual domains that may encompass it.

METHODS

Using the Walker and Avant (2005) process, a concept analysis methodology was employed to clarify the diffuse concept of CPI. This method initially involved selecting the concept (CPI), determining the aims and purpose of the analysis, identifying concept uses, and defining attributes. This was achieved from a critical literature review of professional identity across health disciplines. Chiropractic-related model, borderline and contrary cases were used to exemplify characteristics of CPI. The antecedents required to inform CPI, consequences of having, and ways to measure the concept of CPI were evaluated.

RESULTS

From the concept analysis data, CPI was found to encompass six broad attributes or domains: knowledge and understanding of professional ethics and standards of practice, chiropractic history, practice philosophy and motivations, the roles and expertise of a chiropractor, professional pride and attitude, and professional engagement and interaction behaviours. These domains were not mutually exclusive and may overlap.

CONCLUSION

A conceptual definition of CPI may bring together members and groups within the profession and promote intra-professional understanding across other disciplines. The CPI definition derived from this concept analysis is: 'A chiropractor's self-perception and ownership of their practice philosophies, roles and functions, and their pride, engagement, and knowledge of their profession'.

Use of Thrust Cervical Spinal Manipulative Therapy for Complicated Neck Pain: A Cross-Sectional Survey of Asia-Pacific Chiropractors

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.

Factors that influence scope of practice of the chiropractic profession in Australia: a scoping review

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.

Student attitudes toward the International Clinical and Professional Chiropractic Education Position Statement and Evidence-based practice: a survey of UQTR chiropractic students

OBJECTIVE

The aim of this study is to describe the attitude of Université du Québec à Trois-Rivières (UQTR) chiropractic students toward the International Clinical and Professional Chiropractic Education Position Statement and evidence-based practice (EBP) beliefs.

METHODS

A cross-sectional survey was administered to all the UQTR chiropractic students. Using a five-point Likert scale, students were asked to rate their level of agreement with the position statement (10 items), EBP (2 items), interprofessional collaboration (2 items) and vitalistic philosophy (2 items).

RESULTS

Survey response rate was 71%. Students most frequently reported strong agreement with the position statement, EBP and interprofessional collaboration. They also most frequently disagreed with vitalistic philosophy. The attitude toward the position statement was positively correlated with the year of study in the program (r=0.10, p=0.019), EBP (r=0.56, p<0.001) and interprofessional collaboration (r=0.45, p <0.001).

CONCLUSIONS

UQTR chiropractic students demonstrate high levels of agreement with EBP and the Education Position Statement.

Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering

Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.