Chiropractic Scope Of Practice Research Articles

Digging deeper: exploring chiropractors online claims about non-musculoskeletal disorders

BackgroundSome chiropractors suggest that chiropractic treatment is appropriate for health issues other than musculoskeletal problems. The prevalence of such claims on individual clinic websites has previously been reported as approximately one-in-four in Denmark. The underlying rationales for such claims may reflect convictions about traditional chiropractic subluxations paradigms, but are not self-evident and has not previously been studied.MethodsAn exploratory qualitative case interview study of Danish chiropractors with websites which contain claims about chiropractic efficacy in the treatment of non-musculoskeletal disorders. Websites were identified from a nation wide random sample (57%) of all chiropractic clinic websites.ResultsOf the original 139 websites, 36 were identified as mentioning non-MSK conditions. When revisited, 19 of those clinic websites still mentioned non-MSK disorders and were contacted. Eleven (11) declined our invitation to participate. Interviews were conducted with the responsible chiropractor from each of the remaining 8 clinics.Five distinct themes were identified in the rationales for treating non-musculoskeletal disorders: ‘Positive side-effects,’ ‘Experience,’ ‘Web page,’ ‘Communication’ and ‘Conviction.’ConclusionsA minority of Danish chiropractic websites suggest that non-musculoskeletal disorders are within the chiropractic scope of practice. Those that do, do so for varying reasons—poor communication and website maintenance were commonly cited problems. An explicitly stated adherence to traditional chiropractic subluxations concepts was uncommon. By contrast, a more tempered rationale that suggested a potential beneficial side-effect of chiropractic on non-musculoskeletal health issues were more common and was typically presented in softer-language and/or with some reservations.

The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline.

Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January-February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.

A cross-sectional study of website claims related to diagnoses and treatment of non-musculoskeletal conditions

BackgroundThe Danish Authorisation Act sets out the chiropractic scope of practice. Under this legislation the scope of practice is diagnostics, prevention and treatment of biomechanical disorders of the spine, pelvis and extremities. Despite this and an international movement toward a scientifically active, evidence-based profession with a focus on treatment of musculoskeletal disorders, a large proportion of chiropractors still offer treatment of non-musculoskeletal disorders.This study aimed to investigate the content and characteristics of website claims by chiropractors in Denmark on non-musculoskeletal conditions and to assess whether these were aligned with the Danish Authorisation Act of the chiropractic scope of practice.MethodsIn this cross-sectional study data on a representative sample were collected from chiropractic clinic websites in Denmark. Information on non-musculoskeletal conditions from the websites was categorised. For each non-musculoskeletal condition, it was noted whether a clarifying explanation justifying the presence of the diagnosis was available and what it said. These explanations were assessed and categorised according to agreement or disagreement with the chiropractic scope of practice as defined by the Danish Authorisation Act. In addition, data on geographic location, clinic size, reimbursement coverage, country of education and special clinical focus (children, athletes, etc) were collected. Differences in characteristics of the clinics and the frequency of reporting non-musculoskeletal conditions were tested using Pearson’s chi-squared or Fisher’s exact test.ResultsA geographically stratified, random sample of 139 (57%) websites was included from chiropractic clinics in Denmark. In total, 36 (26%) of the sampled websites mentioned conditions of non-musculoskeletal origin that was not accompanied by a clarifying explanation in agreement with the chiropractic scope of practice. A positive association between advertising infant or children’s care and advertising treatment for non-musculoskeletal disorders (without adequate explanation) was observed.ConclusionsA total of 36 (26%) of the sampled chiropractic websites in Denmark mentioned diagnoses or symptoms of non-musculoskeletal origin on their websites without presenting an adequate clarifying explanation in agreement with the chiropractic scope of practice as defined by the Danish Authorisation Act. This could be misleading for patients seeking care for non-musculoskeletal conditions and consequently lead to inappropriate treatment.

Change in young people's spine pain following chiropractic care at a publicly funded healthcare facility in Canada

BackgroundThe presence of spinal pain in young people has been established as a risk factor for spinal pain later in life. Recent clinical practice guidelines recommend spinal manipulation (SM), soft tissue therapy, acupuncture, and other modalities that are common treatments provided by chiropractors, as interventions for spine pain. Less is known specifically on the response to chiropractic management in young people with spinal pain. The purpose of this manuscript was to describe the impact, through pain measures, of a pragmatic course of chiropractic management in young people's spinal pain at a publicly funded healthcare facility for a low-income population. MethodsThe study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic (MCC) chiropractic program database. Formal permission to conduct the analysis of the database was acquired from the officer of records at the MCC. The University of Manitoba's Health Research Ethics Board approved all procedures. ResultsYoung people (defined as 10–24 years of age) demonstrated statistically and clinically significant improvement on the numeric rating scale (NRS) in all four spinal regions following chiropractic management. ConclusionThe findings of the present study provide evidence that a pragmatic course of chiropractic care, including SM, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.

Feasibility Using Amazon Mechanical Turk for Online Surveys of Attitudes and Perceptions of Chiropractic Health Care in the United States

ObjectiveThe purpose of this study was to determine the feasibility and utility of using Amazon Mechanical Turk (MTurk) for online surveys of US adults about their perceptions of chiropractors and to report differences between people who have positive versus negative attitudes toward chiropractic care. MethodsA 74-item, unvalidated survey was developed through iterative review to assess attitudes of respondents to chiropractic, including a query stratifying respondents based on previous and future use of chiropractic (have used, would consider; have used, would not consider; have not used, would consider; have not used, would not consider). The electronic survey was delivered using Qualtrics; respondents were recruited using MTurk, a crowdsourcing website. Descriptive statistics, including frequencies and cross tabulations, were performed. ResultsA total of 1300 responses were obtained. Consistent with previous reports, 32.2% of the respondents reported having seen a chiropractor in the past. Chiropractic care was perceived as being effective for musculoskeletal complaints. Respondents who would not consider future chiropractic care shared a common set of beliefs related to training of chiropractors, scope of chiropractic practice, and safety and reputation of chiropractic. These respondents reported increased likelihood of chiropractor use with the recommendation of a primary care physician. ConclusionRecruiting survey participants using MTurk is feasible, affordable, and quick and offers high utility to academic researchers. Using this resource, we ascertained preliminary data about attitudes and perceptions from individuals who would or would not consider chiropractic, stratified by their previous use.

More Battles Among Licensed Occupations: Estimating the Effects of Scope of Practice and Direct Access on the Chiropractic, Physical Therapist, and Physician Labor Market

Primary-care physicians, chiropractors, and physical therapists (PTs) may all potentially treat patients experiencing back and neck pain — a $300 billion market. In this paper, we examine how state-level changes in chiropractic scope of practice and PT direct access to patients influence the wages, hours worked, and employment of each practitioner. Our results suggest that expansions in chiropractic scope of practice are associated with an increase in average chiropractor wages and a slight reduction in the average hours chiropractors work per week. We find little evidence that PT direct access has affected the labor market for any of the three studied practitioners.

A Qualitative Study of Doctors of Chiropractic in a Nova Scotian Practice-based Research Network: Barriers and Facilitators to the Screening and Management of Psychosocial Factors for Patients With Low Back Pain

ObjectivesThis study aimed to assess chiropractors’ awareness of clinical practice guidelines for low back pain and to identify barriers and facilitators to the screening and management of psychosocial factors in patients with low back pain. MethodsThis qualitative study used semi-structured interviews informed by the Theoretical Domains Framework with 10 Nova Scotian chiropractors who were members of a practice-based research network. ResultsThe participants correctly identified what the guidelines generally recommend and described the value of psychosocial factors; however, none of the participants could name specific clinical practice guidelines for low back pain. We identified 6 themes related to barriers and facilitators for chiropractors screening and managing psychosocial factors. The themes revolved around the participants’ desire to fulfill patients’ anatomy-focused treatment expectations and a perceived lack of training for managing psychosocial factors. Participants had concerns about going beyond the chiropractic scope of practice, and they perceived a lack of practical psychosocial screening and management resources. Social factors, such as the influence of other health care practitioners, were reported as both barriers and facilitators to screening and managing psychosocial factors. ConclusionsThe participants in this study reported that they mostly treated with an anatomical and biomechanical focus and that they did not always address psychosocial factors identified in their patients with low back pain. Although these findings are limited to Nova Scotian chiropractors, the barriers identified appeared to be potentially modifiable and could be considered in other groups. Low-cost interventions, such as continuing education using evidence-informed behavior change techniques, could be considered to address these barriers.

Current and Prospective Use of Musculoskeletal Diagnostic Ultrasound Imaging at Chiropractic Teaching Institutions: A Worldwide Survey of Diagnostic Imaging Staff

ObjectiveThe purpose of this study was to survey the use of musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) at chiropractic educational programs worldwide and to elicit opinions of academic diagnostic imaging staff of its prospective use at their teaching institutions. MethodsAn electronic questionnaire was delivered in 2014 using SurveyMonkey and notifications were disseminated by e-mail to 127 diagnostic imaging staff at chiropractic programs worldwide. The questionnaire consisted of 27 items using multiple-choice, Likert-type, and open-ended questions. Descriptive statistics were used for basic demographic data and the results of the numerical scales used in each item. ResultsFifty-nine respondents (46.5%) from 24 (24/41) chiropractic programs returned questionnaires. The reported use of MSK-DUSI at chiropractic programs is low (n = 5/24); however, respondents from 9 institutions stated that it is planned to be implemented. Few respondents stated they had formal MSK-DUSI qualifications (4/59); however, 7 respondents stated they were in the process of becoming certified. Most respondents expressed an interest in the prospect of incorporating MSK-DUSI at their chiropractic program. Sixty-five percent stated that chiropractic programs should provide MSK-DUSI training to chiropractic students, and 75% of respondents stated that chiropractic programs should be providing accredited postgraduate MSK-DUSI courses. ConclusionsThe current use of MSK-DUSI among chiropractic programs that responded to this survey is low. The opinions of diagnostic imaging staff who responded suggest a positive attitude to its use and possible growth in its use if foundational work, including gaining funding, accreditation, and acceptance of within the scope of chiropractic practice, is undertaken.

The Chiropractic Scope of Practice in the United States: A Cross-Sectional Survey

ObjectiveThe purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998. MethodsA cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability. ResultsPartial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30). ConclusionThe scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.

The scope of chiropractic practice: A survey of chiropractors in the UK

In the UK, chiropractic has undergone significant change in recent years, particularly with the advent of statutory regulation and an increasing emphasis on evidence-based and multidisciplinary health care. Little is known about what effect, if any, such changes have had on the profession's view of its scope of practice. To ascertain the opinion of UK chiropractors regarding chiropractic beliefs and philosophy, the benefit of chiropractic intervention in paediatric, adolescent and adult conditions and its relationship with the National Health Service (NHS). Differences in opinion between chiropractors from different UK chiropractic associations – the British Chiropractic Association (BCA), McTimoney Chiropractic Association (MCA), the Scottish Chiropractic Association (SCA) and the United Chiropractic Association (UCA) – were also investigated. A one-shot postal questionnaire was sent to 490 randomly selected chiropractors in the UK registered with the General Chiropractic Council (GCC) (Sample 1). Subjects were selected by a simple random probability sample design. Sample 2 comprised a further 45 randomly chosen subjects from the same sampling frame and was used to test whether Sample 1 was representative of the population. Data were subjected to descriptive analysis using SPSS v10. Differences between groups were investigated by Chi-square analysis and the Kruskal–Wallis H -test. The response rate for Samples 1 and 2 was 54% and 53%, respectively. There was no difference between the two samples in terms of gender, age, college of graduation and chiropractic association membership. Internal consistency of the questionnaire was proven to be weak-moderate ( r = −.265 [interclass correlation (IC): −256; 95% confidence interval (CI): −368 to −.136] to .591 [IC: 583; 95% CI: .494–.659]). Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents. Statistically significant differences between chiropractors of different associations in the UK were present, particularly regarding the benefits of chiropractic treatment for non-musculoskeletal conditions. The chiropractors in this study may not view themselves as neuromusculoskeletal (NMS) specialists only. Respondents reported treating visceral/organic conditions and expressed a belief that patients with these complaints can benefit from chiropractic. Differences in opinion appear to remain between the professional associations, particularly in relation to treatment benefits for viscero-somatic conditions and philosophical relevance. However, these findings need to be explored in a more representative sample.

A conservative management protocol for calcific tendinitis of the shoulder

Objective: This paper presents a management protocol for calcific tendinitis and describes its effective application in 2 cases of calcific tendinitis of the supraspinatus tendon in middle-aged women. Clinical Features: Two patients presented to a chiropractic clinic with previously diagnosed calcific tendinitis of the supraspinatus tendon. Both patients complained of chronic pain and tenderness in the shoulder region and had a limited range of shoulder motion as a result of the pain. Radiographs demonstrated calcific deposits in the region of the supra-spinatus tendon. Intervention and Outcomes: Both patients were admitted to a treatment protocol involving approximately 20 sessions of phonophoresis (driving of medication into tissue by ultrasound) with Movelat cream followed by cross-friction massage to the supraspinatus tendon and range of motion exercises. A second set of radiographs was requested. The calcific deposits, clearly seen on the previous radiographs, were no longer visible, and symptoms were resolved. At 4-month follow up, both patients continued to be symptom-free. Conclusion: The result of these studies indicates that the management of calcific tendinitis falls within the scope of chiropractic practice and supports the use of a trial period of conservative management in cases of calcific tendinitis before consideration of surgical treatment. (J Manipulative Physiol Ther 1999;22:622–7)