Chiropractic Profession Research Articles

Posture Queen Contests in Alabama

This paper recounts the history of the Alabama State Chiropractic Association's posture queen program. Perfect posture contests were a successful, unifying, public relations program in the chiropractic profession in the 1950s and 1960s. The Alabama State Chiropractic Association was at the forefront in using these pageants to their fullest. While they had a short lived tenure, these contests increased the public's awareness of chiropractic during a time of struggle for licensure. For unknown reasons, this pageant disappeared in the late 1960s. Alabama's posture queen program ran from 1956-1968.

Chiropractors as Safety Net Providers: First Report of Findings and Methods from a US Survey of Chiropractors

Objective This study evaluates the actual or potential contribution of the chiropractic profession in meeting US healthcare workforce needs. Methods The authors performed a descriptive cross-sectional mail survey of US chiropractors in 2002 to 2003. Results The amount of charity care provided by chiropractors closely approximates that of medical physicians; on a weekly basis, approximately 2 weekly hours of chiropractic care are provided for free, and 4 weekly hours are provided at a reduced fee. Conclusion Chiropractors serve a vital, though often overlooked, role in the US health care safety net.

Developmental Issues in Chiropractic: A South African Practitioner and Patient Perspective

Objective This study explores pertinent aspects of chiropractic practice in contemporary South Africa in terms of the domains of beliefs, philosophy, professional matters, and education. Methods Ten practitioners were purposively sampled. From these, 3 were used as gatekeepers to access 6 patients. Semistructured interviews were conducted with the 16 respondents, and computer-assisted thematic analysis was used to interpret data. Results The practitioners in this study distinguish between 2 main views of the chiropractic identity—the “technician” and “physician.” The patients interviewed responded that the strengths of the chiropractic profession lie in its social desirability and its health care utility. Two factors seem important in endorsing chiropractic, namely, on the grounds of patient beliefs and philosophical views with respect to health care and the model of practice encountered in the chiropractor's office. However, some patients seem confused by the lack of health care system integration and consequently display uncertainty of the status the chiropractor can claim professionally and educationally. Practitioners portrayed a view, indicating that chiropractic cannot claim coherence in any of the 3 domains investigated. Issues such as the apparent lack of conceptual identity of chiropractic; the absence of a coherent, marketable model of chiropractic practice; and poor interprofessional relationships with mainstream health care stakeholders were observed. The issue of integrated public health care practices as part of the education process and the concomitant perceived lack of exposure especially to black South Africans emerged as interesting and pertinent developmental themes in the local context. Conclusions The international discourse related to issues in the domains of philosophy, professionalism, and education and their effect on the practice of chiropractic seem reflected locally. The notion that an increased presence in the public sector might simultaneously increase social awareness and facilitate health care system integration requires further investigation.

How Important is Research-Based Practice to Chiropractors and Massage Therapists?

Objective This study evaluated the perceptions of research, frequency of use of research findings in practice, and the level of research skills of chiropractors and massage therapists in Canada. Predictors of application of research findings in clinical practice were also explored. Methods A survey was mailed to members of the College of Chiropractors of Alberta (n = 833) and the Massage Therapist Association of Alberta (n = 650). Univariate and logistic regression analysis were conducted with SPSS and Stata. Results A total of 483 questionnaires were returned (response rate, 32.6%). Chiropractors and massage therapists reported an overall positive perception toward research, acknowledging the importance of research to validate their practice. Although both groups felt comfortable using the library, they had little confidence in their research skills and overall application of research in practice was limited. Significant differences were found between the 2 professional groups, with chiropractors reporting more research skills and evidence-based practice. Primary discipline, frequent referral to peer-reviewed journals, and strong agreement with the statement that “research adds credibility to my discipline” were predictors of research application in practice. Conclusion It appears that in Canada neither chiropractors nor massage therapists consistently apply research in practice, which may result from a lack of research education and research skills. The differences between the 2 professional groups may be attributed to the chiropractic profession's relatively more research-focused professional training. Strategies to encourage greater research uptake and evidence-based behavior by practitioners include professional association incentives, such as education credits or practitioner cooperatives that would provide time and support for research.

Chiropractic Research in the Postmodern World: A Discussion of the Need to Use a Greater Variety of Research Methods

This paper aims to provide a discussion of postmodern research ideas that could be implemented in the chiropractic profession. Many studies on chiropractic care are really more evaluations of one or two modalities alone (such as spinal manipulative therapy / chiropractic adjustments) and do not consider the entire chiropractic clinical encounter. The results of chiropractic care in randomized controlled trials for example have not necessarily shown the results that one might anticipate and the evidence is conflicting. Postmodern research encourages looking at problems from multiple perspectives and requires consideration of local context first and foremost. Qualitative and practice-based / action research methods are postmodern techniques that have been employed sparingly in chiropractic research. These methods could be of benefit as they could reduce the gap between practice and research and provide a more patient-centered means of studying the profession. Several chiropractic researchers have indicated the need to use such techniques to improve the profession and our understanding of it. Implementing research methods that have postmodern perspective could be beneficial for the profession. This is not to say that randomized controlled trials should be abandoned, they are still an extremely necessary part of the health care research landscape, but tempering them with some studies that employ unique postmodern methodologies could be useful in helping expand our understanding of the profession, particularly at a local and clinical level.

The knowledge and perception of general practitioners about chiropractic as a factor that may influence inter-professional communication: A South African perspective

The historical view has been that communication between medical orthodoxy and the chiropractic profession is not ideal (Verhoef & Page, [1996], Langworthy & Smink, [2000], Brussee et al. [2001]). H...

The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate

Objective: To provide an overview of the four principles originally developed by Thomas Beauchamp and James Childress are now used in modern bioethical decision-making and debate and to describe several challenges to their premier status in bioethics. Discussion: The four principles that form the core of modern bioethics discussion include autonomy, beneficence, nonmaleficence and justice. The originators of these principles claim that none is more important than another, yet challenges have been laid against these principles on that basis as well as on other areas of disagreement. This paper looks at the nature of the most significant of those challenges. Conclusion: The four principles have withstood challenge now for nearly 30 years and still form the basis for most decision making in both the research setting and in clinical practice within the chiropractic profession. However, professional understanding of the principles is not known and may provide a fertile area for further investigation. Key Indexing Terms: Biomedical Ethics; Chiropractic. (J Chiropr Humanit 2007;14:34-40)

Philosophy of Chiropractic: Its Origin and Its Future

ABSTRACT This paper, addressed to the World Federation of Chiropractic 9th Biennial Congress 2007 meeting, held in Vilamoura, Portugal, briefly overviews the history of philosophical underpinnings of the chiropractic profession. This paper further identifies future areas of thought and inquiry for the profession.

Commentary: The National Workshop to Develop the Chiropractic Research Agenda: 10 Years on, a New Set of White Papers

This commentary reports on the advances that have occurred over the 10-year period since the first National Workshop to Develop the Chiropractic Research Agenda was held and introduces the second set of white papers that were produced as a result of the 10th annual Research Agenda Conference. Four working groups were convened to update the original 5 white papers that represented the most significant results from the first workshop in 1996. Each group was to review the first report, examine the action steps and recommendations that were published in each report to see how much had been completed in the past decade, and develop new action steps and recommendations for the future. Four new articles were developed, each updating and adding significant amounts of new research to the original versions. New action steps and recommendations will help move the profession forward into the future. Chiropractic scientists have worked diligently over the past decade to address the recommendations noted in the first set of white papers. Despite significant advances in knowledge and scientific capacity, the chiropractic profession is still confronted with a large number of research challenges.

The organisation of the stress response, and its relevance to chiropractors: a commentary

The stress response is a natural reaction by the body, against potentially harmful stimuli to enhance the chance for survival. Persistent activation of the stress response can cause changes to homeostatic mechanisms. The study of stress neurophysiology, in the evaluation of the manifestation of disease in the body, suggests that these chronic changes have detrimental effects on sub cortical structures. Furthermore, there is much scientific support for the notion that chronic activation of supraspinal systems will lead to maladaptation of homeostatic mechanisms, causing the impairment of processes within the body, and ultimately leading to visceral disorders. The chiropractic profession for many years has alluded to chronic change of neurophysiological pathways as a potential explanation of visceral disorders, but the profession has typically described these in terms of somatovisceral or viscerosomatic reflex activity. Change in supraspinal neurophysiological efferent activity is increasingly being used to explain "stress" related disease. The chiropractic profession should consider investigating such stress responses by conducting spinal manipulative therapy trials that evaluate supraspinal effects of manipulation. Such research may help elucidate key mechanisms associated with the change of visceral disorders noted by some chiropractors following manipulative therapy.

The Council on Chiropractic Education's New Wellness Standard: A call to action for the chiropractic profession

BackgroundThe chiropractic profession has long considered itself to be a preventive science. Recently the Council on Chiropractic Education (CCE) has defined a set of standards that must be implemented at all US chiropractic colleges as of January of 2007. These are specific to wellness measures and health promoting efforts that should be performed by chiropractors. This will mandate traditional health promotion and prevention methods be taught to students at accredited colleges and to practicing chiropractors.ObjectiveTo present the idea of performing traditional health promotion and wellness-concepts in chiropractic practice as a call to action for clinicians and generate discussion on the topic.DiscussionThis manuscript discusses relevant topics of health promotion and prevention for chiropractors and other practicing clinicians that should be made priorities with patients in order to enhance both patient health and community and population health.ConclusionAll practicing chiropractors, as well as other clinicians should take these new standards from the CCE as a call to action to begin helping patients address the removable causes of morbidity, disability and premature mortality where they exist, in addition to treating their painful spinal conditions.

How much health promotion and disease prevention is enough?: should chiropractic colleges focus on efficacy training in screening for family violence?

Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.

The reporting of patient safety incidents—first experiences with the chiropractic reporting and learning system (CRLS): A pilot study

Summary Objective To design and test a reporting format for patient safety incidents (PSIs) related to chiropractic practice. Design A pilot study of adverse event monitoring. Setting Field chiropractic practice and the teaching clinic of the Anglo-European College of Chiropractic. Subjects Members of the British Chiropractic Association and final year clinical students. Methods Following design of a reporting format, chiropractors and/or final year clinical students responded by completing a form and submitting this to a central collection point for analysis. Results Forms were received from seven field practitioners and from 63 students providing information on a number of PSIs. The low number of field practitioners responding prevented any summative analysis and the results are therefore presented individually. With reference to the final year clinical students, the majority of PSIs were associated with misuse of therapeutic equipment (32%) and the treatment intervention itself (31%). Conclusions Gathering information on PSIs using this format was shown to be both feasible and fit for purpose. Further work is planned to widen access and to facilitate and promote the attributes for an informed safety culture for the chiropractic profession.

Where’s the patient’s voice in health professional education?

The first international conference to address the question Where's the patients' voice in health professional education? was held in Vancouver, Canada, from 3 to 5 November 2005. The 240 participants came from a variety of patient groups, including marginalized populations, lobby groups and patient-as-teachers programs. In addition there were health professional educators, researchers and students from schools of medicine, nursing, pharmacy, occupational therapy, physiotherapy, chiropractic, social work, psychology, law, and other related professions.

Applying the Item Response Theory to Classroom Examinations

Objective The purpose of this research project was to determine if the item response theory (IRT) can successfully be applied to smaller-sized class examinations. Methods The Rasch mathematical model (RMM) was selected from the family of IRT models because of its ability to work with smaller sample sizes. Two simulated examinations were created for 100 students by 100-item dichotomous examinations. Examination 2 contained 20 items common with those in examination 1. Examination 1 was systematically exposed to randomly missing student responses and to entire items being removed to determine the robustness of the RMM to missing data. The two examinations were then analyzed with the RMM individually and then in combination. Student scores and IRT measures were compared to determine if the IRT could successfully place the students from the two examinations on the same metric of measure. Results The student measures were not affected when up to 20% of the student responses were randomly missing. Student measures continued to have high reliability and correlated with full matrix measures for up to 40% of items being dropped from the examination. Student scores and IRT measures correlated highly when the two examinations were combined. Conclusions The RMM can be successfully applied to small-sized class examinations, such as those at chiropractic, medical, and other health profession institutions. It is possible to place candidates from different administrations on the same metric of measure if there is as little as a 20% overlap of items between examinations. The RMM could assist faculty in determining if differences in candidate scores are caused by ability or item difficulty.

Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor

Use of manual therapy in the form of manipulation and massage is evident in the earliest recordings of history. Today, manual therapy is an evidence-based practice that can be used with predictable results in the treatment of a variety of neuromusculoskeletal problems. However, for some manual therapists, treatment is still based on a belief system that incorporates vitalism, energy healing, and other metaphysical concepts. Cooperation of practitioners in researching the effects of manual therapy would require uniformity based upon the guidelines of science, following rules for selection of an evidence-based therapy that produces predictable and replicable results. Such an approach would not allow contamination by dogma or by an agenda that is designed more to support a belief system than to find the truth. The chiropractic profession, which began with a founding father in 1895, is identified primarily by its use of manipulation. But chiropractic is based upon a vertebral subluxation theory that is generally categorized as supporting a belief system. The words "manipulation" and "subluxation" in a chiropractic context have meanings that are different from the meanings in evidence-based literature. An orthopedic subluxation, a partial dislocation or displacement of a joint, can sometimes benefit from manipulation or mobilization when there are joint-related symptoms. A chiropractic subluxation, however, is often an undetectable or asymptomatic "spinal lesion" that is alleged to be a cause of disease. Such a subluxation, which has never been proven to exist, is "adjusted" by chiropractors, who manipulate the spine to restore and maintain health. The reasons for use of manipulation/ mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors. Only evidence-based chiropractors, who have renounced subluxation dogma, can be part of a team that would research the effects of manipulation without bias.

Chiropractic

Chiropractic is one of the most controversial and poorly defined healthcare professions with recognition and licensure in the United States. Chiropractic was started by D. D. Palmer, a magnetic healer who formulated the vertebral subluxation theory. The profession was developed by his son, B. J. Palmer. Although the definition of chiropractic as a method of correcting vertebral subluxations to restore and maintain health is questionable, spinal manipulation is of value in the treatment of some types of back pain. The chiropractic profession is still based on the vertebral subluxation theory, and has the confusing image of a back specialty capable of treating a broad scope of health problems. Despite opposition to use of spinal manipulation as a method of treating a broad scope of health problems (as opposed to the generally accepted use of manipulation in the treatment of back pain), chiropractors seek support as primary care providers in alternative medicine. It is essential to understand the theories, philosophies, and methods of chiropractic for an objective evaluation.

Editorial from the Editor-in-Chief: Maturation of Chiropractic Education

I recently completed a 30-year project of writing the biography of the former president of the chiropractic college I attended. Joseph Janse: The Apostle of Chiropractic Education is the life history of a man who served as president of the National College of Chiropractic from 1945 to 1983—38 years of service. Any aficionado of chiropractic history will recognize the significance of individuals who led the profession in years past. College presidents were often better known than the schools they led. Personalities dominated; often individual faculty members were subservient to their leaders or they would find themselves unemployed. Names like Palmer, Napolitano, Janse, Wolf, Logan, Haynes, Cleveland, and Budden are powerhouse personalities remembered more for themselves than the colleges each of them led for so many years. By way of contrast, who knows the name of the current president of Yale or Harvard or Stanford or even Whittier College? We recognize the name of the university or college and have a fair glimpse of the type of institution it is and the quality it represents, but are usually clueless as to who presides. I consider this awareness of an institutional image absent the dependence of an awareness of the institutional leader as a measure of institutional maturity. In other words, the institution stands on its own reputation and not on the reputation of an individual officer within the institution. One may argue that the reputation of Cal Tech rests on the fact that many faculty members are recipients of the Nobel Prize in one category or another. This is true; but the reputation of the institution rests on the collective reputations of its outstanding faculty members—and most certainly not the reputation of its president. This I deem a second measure of educational maturity in an academic institution. Although we may not know individual faculty members at Cal Tech or USC, we presume by a variety of inputs that the faculty is exceptional. In other words, their teaching skills, their research, scholarly productivity, student support and interactions, and their love for what they do all contribute to the perceived image of their institution. What then is the level of educational maturity within chiropractic education? (Although I presume these same measures could be applied to educational institutions within acupuncture and oriental medicine, I am not familiar with their internal workings or the personalities of their leadership to comment.) When I mention the name, “Life University,” does the image of Sid Williams come to mind? Likewise, one cannot help but think of the four generations of Cleveland chiropractors when one mentions “Cleveland College” simply by name association. Other schools may not have such a close association between the personality of the president and the image of the institution. Chiropractic education is maturing. As a profession, our educational institutions are becoming less personality dependent. Presidents have an important role to play in an academic institution. Institutions cannot function adequately without a president, but as an institution matures, its dependence upon a personality in the chief executive role for success is less critical. Rather, institutional image and institutional personality and institutional success are more the product of the faculty and the work they produce. As the chiropractic profession continues to mature and as individual institutions within the profession continue to mature, the comings and goings of presidents and other senior leadership, although important in the context of local circumstance, will have little consequence on institutional success. Hopefully, chiropractic educational institutions are approaching a level of academic maturity that allows them to be more reliant on faculty productivity than they are on presidential personalities.

A Chiropracticness Test

BackgroundThere is little homogeneity of opinion in the chiropractic profession about its essence and identity. Matters compromising the establishment of a coherent identity include the issue of vertebral subluxation, philosophy, mercantilism, poverty of qualifications in some chiropractic college faculty, and lack of intellectual productivity in some chiropractic college faculty.DiscussionThe Chiropractic profession has mislabeled rhetoric, supposition and cant as philosophy, whilst showing sparse evidence for the existence of more than a few chiropractors writing in philosophy as a discipline. There is no evidence for "Chiropractic Philosophy".I propose, however, that a better use of the discipline of philosophy can be of great use to the Chiropractic profession. Various thinkers throughout the ages have written about deduction, induction and falsificationism as methods to discover more reliably the nature of things in the world about us. Each method has strengths and frailties, but some of the latter are insurmountable for our purposes.SummaryUsing a contrivance of that method which seems most suited, sui generis, for the purpose, I propose a Chiropracticness Test as a tool to assist the search for essence and identity in Chiropractic.

Subluxation: dogma or science?

Subluxation syndrome is a legitimate, potentially testable, theoretical construct for which there is little experimental evidence. Acceptable as hypothesis, the widespread assertion of the clinical meaningfulness of this notion brings ridicule from the scientific and health care communities and confusion within the chiropractic profession. We believe that an evidence-orientation among chiropractors requires that we distinguish between subluxation dogma vs. subluxation as the potential focus of clinical research. We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma, and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory.