Attitudes of chiropractic patients: a preliminary survey of patients receiving care in a chiropractic teaching clinic

A survey of 390 patients receiving care in the teaching clinics of the Northwestern College of Chiropractic (NWCC) was conducted to obtain information about patient satisfaction with their chiropractic care and about their prior or subsequent utilization of other types of health care services. Patients were contacted by telephone after a period of at least one month had passed since discharge or discontinuance of care. Of patients surveyed, 92.1% responded that there was improvement in their condition ranging from "slight" to "complete" while 7.9% stated that there was no improvement in their complaint after receiving care. When asked about receiving treatment for their complaint prior to admittance, 58.0% stated that they had not sought previous care while 42.0% received treatment from another doctor first. These data are discussed and compared to other recently published investigations regarding utilization of chiropractic health care services and patient attitudes concerning chiropractic.     

Review of the literature supporting a scientific basis for the chiropractic subluxation complex

A review of the literature reveals strong evidence for both the mechanical model of disease production (structural) and the neurobiological model (functional). Outdated models which attempt to describe a scientific basis for chiropractic theory are inadequate and indeed harmful to the progress and acceptance of chiropractic. Pragmatic or empirical arguments that "Chiropractic works and that's what counts" have served a useful purpose, but now must be augmented by extant research findings. The "paradigm shift" is on. Research investigators around the world are focusing on the multiple components of the chiropractic subluxation complex (CSC), a definitive, provable clinical entity. No longer can "informed" critics support the accusation that "chiropractic practice is based upon irrational, untenable premises." Only a few more pieces of the puzzle need to be fitted into place to produce the "big picture," i.e., the vertebral column is one of the most neglected vital organs in the human body--the sine qua non of the neurobiomechanical system--which influences every structure and function. Historically, its role in maintaining health has been almost totally ignored and for nearly a century chiropractors have battled against the consequences of this neglect. The scientific community is about to see that chiropractic is leading the way in discovering the "new world" in health care. Past, present and future research is discussed.     

The evolution and importance of spinal and chiropractic research.

From its discovery in 1895 to its current status, in which the World Federation of Chiropractic Meeting may be considered a prestigious international scientific conference, the evaluation of chiropractic can be viewed as a compression of the phases which medical and scientific evolution have followed over a much longer period. Chiropractic theory started primarily as a vitalistic philosophy justifying its treatment while the medical scientific community was rejecting vitalism. Both chiropractic and medical spine specialists went through a period of speculative theory in the first half of this century based upon either perceived neurological or pathological observations. There was a period of single-theory preoccupation by chiropractors (the subluxation) and medical specialists (disc herniation) which brought these professions into conflict. The past decade has led to greater scientific exploration by both professions, with more national scientific discussion of the causes and treatment of spinal problems. The next decade, however, appears likely to require greater emphasis on social research into clinical effectiveness of treatments, prevention of back pain, patient satisfaction and quality assurance. This evolution should be considered the normal maturation of a health care profession.     

A look in the mirror: a critical and exploratory study of public perceptions of the chiropractic profession in New Jersey

This paper reports the results of a telephone survey of 693 respondents which was commissioned by the New Jersey Chiropractic Society. This exploratory study provides a broad-ranging and critical examination of key aspects relating to the chiropractic profession as it is practiced in New Jersey. The study concludes that chiropractic in New Jersey is a viable means of treating various disorders, but there remains much confusion and distrust among prospective and current patients as well as the threat of heightened competition from other health professionals. Chiropractic must develop clear boundaries around the number and extent of the conditions it claims to treat, and must substantiate its claims with valid clinical trials. A research-based education campaign is necessary if the discipline is to encourage nonusers to become users. The most powerful vehicle for influencing public opinion and the number of referrals is family and friends. The findings also indicate that comparisons with medical doctors can backfire, making the "chiropractic physician" (the professional label preferred by most respondents) less qualified by comparison. Rather than reject the paradoxical nature of their role as primary care physicians and specialists in spine-related disorders, chiropractors should embrace this uniqueness and establish themselves as a integral component of the health care network. Clearer boundaries, a grounding in scientific clinical research and better interprofessional relations can ensure continued growth and success in New Jersey.     

An exploration of community leader perspectives about minority involvement in chiropractic clinical research

OBJECTIVE: The aim of this study was to examine the perspectives of individuals in leadership or advocacy positions from two different minority groups about involvement with chiropractic clinical research. DESIGN: The narratives from two focus groups provided the primary source data. Purposive sampling was used for participant selection. Within- and across-group analyses of focus group data were conducted using a matrix consisting of the core constructs awareness, acceptance, and access. SETTING: The Palmer Center for Chiropractic Research in Davenport, Iowa, was the setting. SUBJECTS: Participants were in leadership or advocacy positions from two minority communities in the greater Quad Cities area of Iowa. Eight (8) participants were in the Hispanic/Latino focus group, and 6 were in the Black/African-American focus group. RESULTS: The findings suggest that there is limited awareness about chiropractic and chiropractic research in the Hispanic/Latino and Black/African-American communities. Cultural and ethnic representation will facilitate efforts toward increasing awareness, acceptance, and access to the community. Generational differences exist in acceptance of chiropractic and chiropractic research by both communities. Gaining the trust of the Black/African-American community is essential before they will become involved in research. Participants from both groups reported that negative beliefs by health professionals impede access to chiropractic services. The participants identified a myriad of venues and methods for collaborating with their constituents. CONCLUSIONS: Honoring the perspectives and needs of the Hispanic/Latino and the Black/African-American community is essential to facilitate participation in chiropractic clinical research. The study calls on research institutions to reconceptualize how they interact with the community to foster a more relational approach.     

Depressive symptoms in chiropractic students: a 3-year study

Background:

The intensive training associated with health care education has been suggested to have unintended negative consequences on students’ mental or emotional health that may interfere with the development of qualities deemed essential for proficient health care professionals. This longitudinal study examined the prevalence and severity of depressive symptoms among students at a chiropractic educational institution.

Methods:

Chiropractic students at all levels of training were surveyed at Canadian Memorial Chiropractic College during the academic years of 2000/2001, 2001/2002, and 2002/2003. The measurement tool employed was the Beck Depression Inventory, 2nd edition (BDI-II). Previously established BDI-II cutoff scores were used to assess the severity of reported depression symptoms, and these were compared by sex and year of training.

Results:

The survey was completed by 1303 students (70%) over the 3 years of the study. The prevalence of depressive symptoms was nearly 25%, with 13.7% of respondents indicating a rating of mild depression, 7.1% indicating moderate depressive symptoms, and 2.8% indicating severe symptoms. Significant differences were found between years of training, with 2nd-year students having the highest prevalence of depressive symptoms, and sex, with females having a higher rate of symptoms.

Conclusions:

Chiropractic students surveyed at Canadian Memorial Chiropractic College had high rates of depression similar to those measured in other health care profession students. Chiropractic educational institutions should be aware of this situation and are encouraged to emphasize students’ awareness of their own personal health and well-being and their access to appropriate care, in addition to the same concerns for their future patients.     

Epilepsy and seizure disorders: a review of literature relative to chiropractic care of children

OBJECTIVE: To review the currently available literature regarding chiropractic care relative to patients with epilepsy, particular emphasis being placed on those who have epilepsy as children. DATA SOURCES: The Index to Chiropractic Literature was searched for the years 1980 through 1998 through use of the keywords epilepsy and seizure. The MANTIS database was searched for the years 1970 through 2000 through use of the Medical Subject Heading (MeSH) keywords chiropractic, epilepsy, seizure, and child/children. In addition, a MEDLINE search of the literature was performed for the years 1966 through 2000 through use of the same subject headings. RESULTS: The present study reviews 17 reports of pediatric epileptic patients receiving chiropractic care. Fourteen of the 17 patients were receiving anticonvulsive medications, which had proven unsuccessful in the management of the condition. Upper cervical care to correct vertebral subluxation was administered to 15 patients, and all reported positive outcomes as a result of chiropractic care. CONCLUSIONS: Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.     

Mechanical force, manually assisted short lever chiropractic adjustment.

OBJECTIVES: Chiropractic mechanical force, manually assisted short lever adjusting is a spinoff of the specific toggle recoil adjusting techniques, which were based on the original chiropractic subluxation theory propounded by Daniel David Palmer in 1895. This article reviews: a) the principles of the chiropractic subluxation complex from the standpoint of its historical origin and present-day scientific status; b) the purpose and objectives of specific spinal manipulative techniques; c) the use of mechanical adjusting instruments to effect a velocity/direction controlled adjustive thrust; and d) an assessment of scientific and clinical data relating to the biomechanical and neurological aspects of mechanical force, manually assisted short lever adjusting. DATA SOURCES: Prime sources were from the National Library of Medicine's on-line Index Medicus database, the Chirolars Research Resource Retrieval database, the Chiropractic Research Abstract Collection and the Chiropractic Library Consortium's reference works. Direct search of other nonindexed chiropractic sources was limited to those available in the collection of the National Institute of Chiropractic Research. Early information never documented by publication was obtained by written personal communication. STUDY SELECTION: The principal author selected articles reporting data (as opposed to anecdotal reports) from conference proceedings and peer-reviewed journals. DATA EXTRACTION: Data quality was assessed based on experimental conditions such as sample size, study design and statistical analysis. DATA SYNTHESIS: While mechanical force, manually assisted short lever adjusting seemingly is capable of beneficially altering the cause/effect relationship of spinal subluxations, more research in the nature of controlled clinical trials is needed to ascertain its benefits in the chiropractic treatment of specific conditions. CONCLUSIONS: Basic research is needed in order to establish the scientific basis for the chiropractic subluxation syndrome regardless of the technique employed.     

An investigation into the demographics and motivations of students studying for a chiropractic degree

Objective

This research aimed to investigate motivations for studying chiropractic, and to determine what students look for in a course/college and potential barriers to studying chiropractic.

Methods

The study design was a cross-sectional survey. Following IRB/Ethical approval, a paper-based questionnaire was distributed to students at McTimoney College of Chiropractic. Demographic data were compared to another chiropractic college in the United Kingdom.

Results

The questionnaire response rate was 70.8% (n = 121). Motivating factors for studying chiropractic included a desire to help others (54.5%, n = 66), with 44.6% (n = 54) attracted by chiropractic''s holistic, drugless approach to health. Previous help from chiropractic influenced 55.4% (n = 67) and 22.3% (n = 27) felt chiropractic had “changed their life.” Just over half of the respondents (55.4%, n = 67) viewed the ability to work while studying as extremely important and 73.6% (n = 89) said they could not have studied chiropractic without this.

Conclusion

Previous help from chiropractic care was a common motivation for studying chiropractic. The ability to work while studying was seen as vital by many students and, without it, the vast majority felt they could not have studied chiropractic.Key Indexing Terms: Chiropractic, Education, Motivation, Students     

Health information and promotion in chiropractic clinics

OBJECTIVE: To explore the current health education behaviors of chiropractors, ascertain their willingness to provide patient counseling, and compare this with topics of interest to chiropractic patients. METHODS: This study involved a postal survey of 400 randomly selected members of the Chiropractic Association of Australia (35% response rate) and a semistructured interview of 316 patients attending one of 20 purposively selected chiropractic practices. Data were collated, and the current health information practices of chiropractic respondents and their willingness to undertake counseling on various topics was identified and compared with the information interests of participating patients. Particular emphasis was placed on injury prevention both with respect to patient counseling and chiropractic practice risk. RESULTS: Respondents expressed varying degrees of willingness to provide health information on diverse topics, but no clear health education chiropractic practice pattern emerged. Although expressing willingness to undertake counseling, respondents were more likely to provide health information brochures than develop a tailored health promotion contract. Health education topics ranged from exercise (91%) to osteoporosis prevention (23%). Seventy-eight percent of chiropractors were prepared to offer counseling on injury prevention, yet 45% of respondents themselves reported having some work-related injury. Maintenance care failed to emerge as a global term for describing a common core of topics or chiropractic health education practices. CONCLUSION: This study demonstrated an interest by chiropractors in providing and by chiropractic patients in obtaining health information that extends beyond spinal health. The range of relevant topics covered and modes used for health information transmission in chiropractic practice requires clarification. The prevalence of work-related injury among chiropractors suggests a need to develop safe chiropractic clinical practice protocols.     

The chiropractic doctor

Chiropractors as autonomous consulting professionals, acting as a portal of entry into the health care system, have a scope of practice which is diagnostically unlimited but therapeutically restricted. Chiropractic therapy is confined to natural means of intervention. Included in the health care responsibilities of primary contact practitioners is the requirement that they serve as a health relevant information source for their patients and clients. Chiropractors are achieving disease intervention by participating in the health education of their patients. Modern chiropractic doctors are teaching clinicians. In line with chiropractic philosophy, their perspective is holistic. In order to minimise intrusion upon the practice of their clinical expertise, health education tools are recommended and used by busy practitioners with a health promotion conscience.     

Osteopathic vs. chiropractic education: a student perspective

This study compares nationwide survey results from 506 second year students of 11 osteopathic schools and 881 students from the first and second academic year (third term/fourth quarter) of eight chiropractic colleges. Each student was given a questionnaire regarding his/her perspective on the education he/she was receiving. Both populations were questioned about whether or not they came from an osteopathic/chiropractic family, their application process, the efficacy of osteopathic manipulative therapy (OMT)/chiropractic adjustments, their first year attitude concerning the efficacy of OMT/chiropractic adjustments, the integration of osteopathic/chiropractic principles into the curriculum and the justification for separate health care professions. Osteopathic and chiropractic students entered their respective professions from nonosteopathic/non-chiropractic families. Although both populations selected their profession as a first and primary choice, chiropractic students were more substantially represented. Upon entering their program, osteopathic students were not convinced, but had an open mind concerning the effectiveness of osteopathic manipulative therapy (OMT), and were divided as to whether there is enough of a distinction between DOs and MDs to justify separate professions. Chiropractic students, on the other hand, entered their program convinced that chiropractic adjustments are effective, and saw a clear distinction between the roles of chiropractic physicians and medical doctors.     

Public demand and the integration of complementary and alternative medicine in the US health care system

Public use of complementary and alternative medicine (CAM) grew 25% between 1990 and 1997 and had a number of implications for chiropractic and the US health care system. Recent surveys describe the issues surrounding definitions of CAM; patterns of CAM use and its costs; attitudes of the public, health care providers and business entities; increasing scientific research; and changes in the health care system. Almost one third (192 million) of the 629 million visits to CAM providers in 1997 were to chiropractors. The new US National Center for Complementary and Alternative Medicine have funded chiropractic and other CAM research as a regular part of its scientific portfolio. Health maintenance organizations and other health care business entities have created new markets for CAM services, including chiropractic. profession, chiropractic appears to be positioned somewhere between mainstream practice and CAM, with conflicting opinions held by the public, the health care industry, and chiropractors themselves. The benefits and risks of chiropractic being identified with the CAM movement must be weighed carefully.     

Founding integrative medicine centers of excellence: one strategy for chiropractic medicine to build higher cultural authority

Chiropractic physicians are seeking a higher level of cultural authority within their communities and the United States health care system. This commentary suggests an innovative strategy that might expedite the attainment of professional authority while improving the training of chiropractic students and faculty. The authors propose the founding of integrative medicine centers of excellence by colleges of chiropractic that will employ clinical faculties comprised of allopathic, chiropractic, osteopathic, and naturopathic physicians. Initially, the health care facilities should offer primary care through an integrative medicine model. It is anticipated that these centers of excellence will require both government and private funding in order to develop research programs, provide high-quality patient care, and improve the medical training for students with residents programs     

A survey of chiropractic students' perceived business preparedness at graduation

ObjectiveThe objective of this study was to assess chiropractic college graduates'' business experience, education, and need for further education at the time of graduation.MethodsWe conducted an anonymous survey of graduating chiropractic students in 2015 and 2016 regarding their prior business experience, business courses taken before and during chiropractic education, business abilities and needs, and practice plans.ResultsEighty-one responded out of 114 surveyed (71% response rate). Less than half had taken college-level business courses or had business experience prior to entering chiropractic college. Almost 90% of respondents took 1 or more of 3 elective courses in business skills during their chiropractic education. Sixty-eight percent planned to work as an associate doctor and to be in private practice after 5 years. The respondents indicated that they were more prepared in the business abilities of ethics/risk management/jurisprudence, employee management, strategic planning, and marketing/advertising, and least prepared in business operations, accounting, and billing/reimbursement. In the areas of economics, finance, business taxes, and starting a practice, the respondents indicated a need for further education or experience. It was statistically significant (p < .001) that students who had prior business experience and/or college business education were more confident in operating a health care practice.ConclusionChiropractic business education provides students with some of the practice management skills essential for operating a health care practice. Students with prior business experience and/or education reported more confidence in their ability to run a chiropractic practice immediately after graduation.     

Evaluating the quality of clinical practice guidelines

OBJECTIVE: To review and identify established methods for evaluating the quality of practice guidelines and to use a selected assessment tool to assess 2 chiropractic practice guideline documents. METHODS: A search of the medical literature was performed to identify current methods and procedures for practice guideline evaluation. Two chiropractic practice guideline documents, Vertebral Subluxation in Chiropractic Practice (CCP) and Guidelines for Chiropractic Quality Assurance and Practice Parameters (Mercy) were then independently evaluated for validity by 10 appraisers using the identified appraisal tool. The appraisal scores were tabulated, and consensus appraisals were generated for the CCP and Mercy guideline documents. RESULTS: The "Appraisal Instrument for Clinical Guidelines" (Cluzeau instrument) was identified as a reliable and valid method of guideline evaluation. The result of the application of this appraisal tool in the assessment of the CCP and Mercy guideline documents was that the former scored notably lower than the latter. On the basis of the results of the guideline appraisals, the CCP document is not recommended, and its guidelines are not considered suitable for application in chiropractic practice. The Mercy guidelines are recommended for application in chiropractic practice, with the proviso that new scientific data should be considered. CONCLUSIONS: The literature reviewed suggests that professional organizations or groups should undertake a critical review of guidelines using available critical guideline appraisal tools. Guideline validity appraisal should be done before acceptance by the chiropractic profession. To avoid unwarranted utilization of poorly constructed guidelines, it is strongly recommended that all future guidelines be reviewed for validity and scientific accuracy with the findings published in a medically indexed journal before they are adopted by the chiropractic community.     

Prevalence of nonmusculoskeletal versus musculoskeletal cases in a chiropractic student clinic

Objective

We sought to identify the percentage of nonmusculoskeletal and musculoskeletal conditions treated by interns in the National University of Health Sciences (NUHS) Student Clinic compared to chiropractic and allopathic health care professionals.

Methods

The information gathered was taken from the charts of patients treated in the fall trimester, dated September 12, 2011 through December 9, 2011. The data collected included ICD-9 codes for the conditions treated, the number of patient visits, age, and gender, and was evaluated using Microsoft Excel.

Results

Over half of the 113 eligible patients were women with a mean patient age of 28 years, an average of three treated diagnoses, and a mean of seven treatments. Those treated only for musculoskeletal conditions totaled 52% of the patients; 48% of the patients were treated for nonmusculoskeletal conditions, or musculoskeletal plus nonmusculoskeletal conditions.

Conclusion

The NUHS Student Clinic interns are treating a greater percentage of nonmusculoskeletal conditions and a lesser percentage of musculoskeletal conditions than practicing chiropractic physicians. The student interns also treat a lesser percentage of nonmusculoskeletal and a greater percentage of musculoskeletal conditions than allopathic practitioners. This comparison would suggest that NUHS is nearing its institutional goal of training its student interns as primary care practitioners.Key Indexing Terms: Chiropractic, Manipulation, Chiropractic, Physicians, Primary Care, Primary Health Care