Introduction Some chiropractors seem to have an inflated belief in the powers of spinal manipulation (SMT), for example aiming at preventing future spinal degeneration and health problems, activities ...that are without supporting evidence. Non-evidenced health beliefs have been shown to be associated with a tendency toward magical thinking. Holding such beliefs about SMT is associated with a limitless scope of practice (LLSoP). Recent studies have shown that "chiropractic conservatism" (ChiroCon) is also associated with such approaches. We wanted to understand ChiroCon and these attitudes toward SMT by exploring three different factors: intolerance to uncertainty, academic achievement, and tendency toward magical thinking and how they relate to ChiroCon and LLSoP. Method A cross-sectional survey of 243 chiropractic students from an Australian chiropractic program was conducted in May 2020. Students answered a questionnaire involving a patient case-scenario for LLSoP, levels of ChiroCon, validated questionnaires on (i) Intolerance of uncertainty, (ii) Academic achievement, and (iii) Magical thinking. LLSoP was defined as wanting to treat with SMT a 5-year-old asymptomatic child for future (i) Musculoskeletal (MSK) problems and/or (ii) Non-musculoskeletal diseases. Logistic regression models were used to confirm if there was an association between ChiroCon and LLSoP and to explore associations between LLSoP and (i) Intolerance of uncertainty, (ii) Academic achievement, and (iii) Magical thinking. We repeated the same analyses using ChiroCon as the outcome variable. Results We confirmed that chiropractic students in the more extreme ChiroCon group were more likely to want to prevent future spinal disorders in an asymptomatic 5-year-old child as compared to those with lower levels (OR = 3.9, (95%CI 1.97-7.72). This was also the case for the prevention of future diseases in the same child (OR = 6.9, (95%CI 3.11-15.06). Of the three predictor variables, magical belief was positively associated with both ChiroCon and LLSoP. Conclusion Not surprisingly, ChiroCon is closely related to LLSoP and both were linked to magical thinking. Therefore, the questionnaire 'Magical Health Beliefs' could be a useful instrument to screen future chiropractic students to prevent a mismatch between student and institution. Depending on the outlook of the school, some schools would welcome these students, whereas other institutions would want to avoid them in their education program. Keywords: Chiropractic, Chiropractic education, Spinal manipulation, Scope of practice, Magic psychology, Uncertainty, Academic success, Mass screening, Survey
Chiropractors frequently use spinal manipulation therapy as a treatment modality in the management of musculoskeletal (MSK) conditions such as spinal pain and sometimes in the treatment of non-MSK ...disorders. The latter is not supported by evidence. This study aimed to investigate the extent of non-MSK website claims from French chiropractors to assess if websites were aligned with current recommendations on evidence-based practice.
This was a cross-sectional study of a representative sample of French chiropractors. Information on non-MSK conditions was collected from chiropractic professional websites by two independent observers in June 2020. For each non-MSK condition, it was noted whether a clarifying explanation justifying the mentioning of the condition was available. In addition, data on professional association affiliation status, country of education, years since graduation, and special clinical focus (e.g., seniors, children) were collected.
A total of 287 randomly selected websites were included in the study corresponding to 22% of all chiropractors registered in France. One or more of 42 different non-MSK conditions were identified on 231 websites, of which 5 (2.2%) provided a clarifying explanation. 226 (79%) websites mentioned a non-MSK condition without a clarifying explanation. The non-MSK conditions most often mentioned were sleep problems, constipation/digestive problems, unease/discontent in children and menstrual cramps/pains. A larger proportion of the websites advertising treatment for non-MSK disorders was found among those claiming a special clinical focus on infants/children, seniors, pregnant women or athletes compared to those that did not. Also, a larger proportion of chiropractors who were affiliated with a professional association were advertising treatment for non-MSK disorders compared to those who were not affiliated.
Eight out of ten chiropractic websites mentioned one or more non-MSK diagnoses or symptoms. It is unclear if this reflects inaccurate communication or if treatments for non-MSK conditions are provided by the chiropractors.
Background The chiropractic profession is split between those practicing evidence-based and those whose practice is honed by vitalism. The latter has been coined 'chiropractic conservatism'. In ...Denmark, the chiropractic education program is university-based in close collaboration with a medical faculty. We wanted to investigate if such conservative attitudes were present in this environment. Our objectives were to i) determine the level of chiropractic conservatism, ii) investigate if this was linked to academic year of study, iii) determine the level of clinical appropriateness, and iv) to investigate if this was affected by the level of conservatism among students in a chiropractic program, where the students are taught alongside medical students at the University of Southern Denmark (SDU). Methods A cross-sectional survey of 146 (response-rate 76%) 3rd to 5th year pre-graduate students and 1st year postgraduate clinical interns from the chiropractic degree course at the University of Southern Denmark was conducted during autumn of 2019. The students' levels of conservatism were dichotomized into appropriate/inappropriate, summed up, and used in a linear regression model to determine the association with academic year of study. Thereafter, the conservatism score was categorized into four groups (from low -1- to high -4-). Conservatism groups were cross-tabulated with the ability to answer appropriately on nine cases concerning i) contra-indications, ii) non-indications, and iii) indications for spinal manipulation and analyzed using logistic regression. Results Generally, the Danish chiropractic students had low conservatism scores, decreasing with increasing academic year of study. Seventy percent of the students were placed in the two lowest conservative groups. The level of conservatism (categories 1-3) was moderately (but not statistically significantly) associated with an inability to recognize non-indications to treatment. Three outliers (category 4), however, revealed a highly inappropriate handling of the clinical cases. Conclusions Chiropractic students enrolled at a university-based course closely integrated with a medical teaching environment are not immune to chiropractic conservatism. However, the course appears to attenuate it and limit its effect on clinical decision-making compared to other educational institutions. Keywords: Chiropractic students, Chiropractic conservatism, Spinal subluxation, Spinal adjustments, Contra-indication, Non-indication, Indication, Education, Survey
In March 2020, the World Health Organization elevated the coronavirus disease (COVID-19) epidemic to a pandemic and called for urgent and aggressive action worldwide. Public health experts have ...communicated clear and emphatic strategies to prevent the spread of COVID-19. Hygiene rules and social distancing practices have been implemented by entire populations, including 'stay-at-home' orders in many countries. The long-term health and economic consequences of the COVID-19 pandemic are not yet known.
During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements. We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.
Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.
While there is a broad spectrum of practice within chiropractic two sub-types can be identified, those who focus on musculoskeletal problems and those who treat also non-musculoskeletal problems. The ...latter group may adhere to the old conservative 'subluxation' model. The main goal of this study is to determine if chiropractic students with such conservative opinions are likely to have a different approach to determine
,
and
to chiropractic treatment versus those without such opinions.
An anonymous and voluntary survey on 3rd to 6th year French chiropractic students was conducted between November 2017 and January 2018. Level of chiropractic conservatism (10 items) and the ability to determine
(2 cases),
(4 cases) and
(3 cases) were evaluated through a questionnaire. Answers to these cases were dichotomized into 'appropriate' and 'inappropriate' answers, as defined by previous research teams and the present team. The level of conservatism was classified into four groups, 'group 4' corresponding to the highest score. Descriptive data are provided, and bi- and multivariate analyses were performed through logistic regression to test the associations between the level of conservatism and the ability to determine the suitability of chiropractic treatment.
In all, 359 of 536 (67%) students responded to the questionnaire. They generally recognized a number of
and
to treatment. However, they found it more difficult to identify
. The more conservative students were more likely to intend to treat their patients, even if this was irrelevant (
). For example, those who were most conservative (group 4) were much more willing than those in group 1 to treat 'chiropractically' a 5-year-old child with no history of back pain or disease to prevent future back pain (OR = 14.7) and also to prevent non-musculoskeletal disease (OR = 22).
It is concerning that students who adhere to the subluxation model are prepared to 'operationalize' their conservative opinions in their future scope of practice; apparently willing to treat asymptomatic people with chiropractic adjustments. The determinants of this phenomenon need to be understood.
The chiropractic vitalistic approach to the concept of 'subluxation' as a cause of disease lacks both biological plausibility and possibly proof of validity. Nonetheless, some chiropractors purport ...to prevent disease in general through the use of chiropractic care. Evidence of its effect is needed to be allowed to continue this practice. The objective of this systematic review was therefore to investigate if there is any evidence that spinal manipulations/chiropractic care can be used in primary prevention (PP) and/or early secondary prevention in diseases other than musculoskeletal conditions.
We searched
, and some specialized chiropractic journals, from inception to October 2017, using terms including: "chiropractic", "subluxation", "wellness", "prevention", "spinal manipulation", "mortality". Included were English language articles that indicated that they studied the clinical preventive
t
or
manipulative therapy/chiropractic treatment in relation to PP and/or early treatment of physical diseases/morbidity in general, other than musculoskeletal disorders. Also, population studies were eligible. Checklists were designed in relation to the description of the reviewed articles and some basic quality criteria. Outcomes of studies were related to their methodological quality, disregarding results from those unable to answer the research questions on effect of treatment.
Of the 13.099 titles scrutinized, 13 articles were included (eight clinical studies and five population studies). These studies dealt with various disorders of public health importance such as diastolic blood pressure, blood test immunological markers, and mortality. Only two clinical studies could be used for data synthesis. None showed any effect of spinal manipulation/chiropractic treatment.
We found no evidence in the literature of an effect of chiropractic treatment in the scope of PP or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.
La chiropraxie est une thérapie manuelle fondée à la fin de XIXème siècle aux Etats-Unis. Au cours du XXème siècle, cette profession a su, dans certains pays, s’insérer progressivement au sein du ...système de santé et académique. Aujourd’hui, en France, la chiropraxie est définie comme une profession de la santé visant à la prévention et au traitement des troubles neuro-musculo-squelettiques.En marge de cette évolution, certains chiropracteurs adoptent une approche thérapeutique conservatrice, en accord avec les principes fondateurs de la chiropraxie. C’est particulièrement le cas dans le domaine de la prévention, où les soins de wellness sont parfois utilisés en chiropraxie. Les soins de wellness peuvent notamment être composés d’ajustements chiropratiques, visant à prévenir primairement les troubles neuro-musculo-squelettiques, mais aussi les troubles non neuro-musculo-squelettiques.Les travaux constitutifs de cette thèse ont pour but d’étudier la prévention en chiropraxie, principalement chez des patients asymptomatiques. La première revue systématique de la littérature a mis en évidence le fait que les chiropracteurs souhaitent effectuer des actes de prévention primaire auprès de leurs patients, y compris des soins de wellness. Cependant, les patients chiropratiques ne souhaitent pas consulter pour ces motifs. La deuxième revue systématique a montré que la prévention primaire/secondaire précoce des troubles non neuro-musculo-squelettiques n’est pas soutenue par l’évidence scientifique. Enfin, l’enquête effectuée auprès des étudiants en chiropraxie a montré que ces derniers ont des difficultés à identifier les cas de non-indications au traitement chiropratique préventif chez les patients asymptomatiques. Il a également été montré que ces difficultés sont associées à leurs opinions conservatrices envers la chiropraxie.
Chiropractic is a manual therapy founded in United States at the end of the XIXth century. During the XXth century, progressively in some countries, this profession succeeded to be integrated in the health care and academic systems. Today, in France, the chiropractic profession is defined as a health profession allowed to prevent and treat neuro-musculoskeletal disorders. However, some chiropractors have a conservative therapeutic approach, following the original principles of chiropractic. This approach is used in a form of chiropractic prevention, called wellness care. This type of care can especially include chiropractic ‘adjustments’ of the spine to primary prevent both neuro-musculoskeletal and non neuro-musculoskeletal disorders.The main goal of this theses is to study chiropractic prevention, mainly on asymptomatic patients. The first systematic review showed that chiropractors are willing to offer primary prevention care to their patients, wellness care included. However, chiropractic patients are not willing to consult a chiropractor for this motive. The second systematic review showed that primary/early secondary prevention of non neuro-musculoskeletal disorders is not supported by the scientific literature. Finally, a survey carried out on chiropractic students, showed that they have some difficulties to correctly identify chiropractic non-indicated cases on asymptomatic patients. These difficulties were found to be associated with their conservative approach to chiropractic care.
Chiropractic technique systems ('prescriptive' techniques) might be interpreted as helpful guidelines. However, 'prescriptive' techniques, such as Functional Neurology (FN), Sacro-Occipital ...Technique, and Applied Kinesiology are more concerned with the 'technical' diagnosis than the condition and its symptoms and, thus, seem to provide easy solutions.
In a voluntary anonymous questionnaire survey carried out late 2017, we explored interest in 'prescriptive' techniques, particularly FN, among French chiropractic students in grades 3-6, and the possible link with chiropractic conservatism. We investigated their: i) attitudes to the use of 'prescriptive' techniques, ii) awareness of FN, and iii) attitudes to FN. Further, if their attitudes to some conservative chiropractic concepts influenced their clinical approach on iv) some 'prescriptive' chiropractic techniques and v) attitudes to FN.
Data reported in tables illustrated the prevalence of the use of 'prescriptive' techniques, awareness of FN, and positive attitude to FN (i.e. interest in and acceptance of). Students were given a FN score based on five questions on their interest in and acceptance of FN (0 to 5), dichotomized into two groups: 'not positive attitude' (0 to 1) and 'positive attitude' (2 to 5). Chiropractic conservatism was graded from 1 to 4. Associations were tested between conservatism groups and i) interest in 'prescriptive' techniques and ii) FN attitudes groups.
The response rate was 67% (N = 359), of which 90% were positive toward 'prescriptive' techniques. Only 10% had never heard about FN and in the 6th year all had heard about it. Only a minority, unrelated to the year of study, approved of the two examples given of FN concepts. Nevertheless, a majority were positive towards FN, more so in the higher grades. Students with the most conservative beliefs were 17 times more likely to want to use 'prescriptive' techniques and 11 times more likely to have a higher FN score.
Although not taught in the curriculum, these students were attracted to 'prescriptive' techniques including FN, particularly in the higher grades. Curiously, despite this interest they do not generally agree with some key concepts within FN.
Abstract Introduction S’il existe de nombreuses approches chiropratiques, deux types de chiropracteurs peuvent-être identifiés; ceux s’intéressant aux troubles musculo-squelettiques et ceux ...souhaitant prendre en charge aussi des troubles non musculo-squelettiques. Il est possible que ces derniers adhèrent au modèle conservateur de la subluxation. Le principal objectif de cette étude est de déterminer si les étudiants en chiropraxie ayant ce type d’opinions conservatrices ont une approche différente pour déterminer les contre-indications, non-indications, et indications au traitement chiropratique, comparés à ceux n’ayant pas ce type d’opinions. Méthode Une enquête anonyme et volontaire sur les étudiants en chiropraxie de 3ème, 4ème, 5ème, et 6ème années à l’Institut Franco Européen de Chiropraxie a été effectuée entre les mois de novembre 2017 et janvier 2018. Le niveau de conservatisme (10 items) et la capacité à déterminer les contre-indications (2 cas cliniques), les non-indications (4 cas cliniques) et les indications (3 cas cliniques) ont été évalués. Les réponses à ces cas cliniques ont été dichotomisées en réponses « appropriées » et « non appropriées », comme il avait été défini par les précédentes et l’actuelle équipe de recherche. Le niveau de conservatisme a été classé en quatre groupes, le score le plus élevé étant celui du groupe « 4 ». Les données descriptives ont été rapportées, des analyses bi- et multivariées ont été effectuées à travers des régressions logistiques. Le but étant d’évaluer s’il existe des associations entre le niveau de conservatisme et la capacité d’avoir une décision de prise en charge adaptée. Résultats 359 sur 536 étudiants (67%) ont répondu au questionnaire. Ils reconnaissent correctement quelques cas de contre-indications et d’indications au traitement chiropratique. Cependant, il leur est plus difficile de détecter les non-indications. Les plus conservateurs d’entre eux sont plus sujets à prendre en charge les patients, même si cela n’est pas nécessaire (non-indications). Par exemple, les plus conservateurs (groupe 4) sont plus enclins, comparés à ceux étant dans le groupe 1, à prendre en charge en chiropraxie un enfant de 5 ans n’ayant jamais eu de douleur ou maladies pour prévenir l’apparition de douleurs rachidiennes (OR = 14,7) et de maladies non musculo-squelettiques (OR = 22). Conclusion Il est préoccupant de constater que les étudiants qui adhèrent au modèle de la subluxation soient prêts à intégrer ces opinions dans leurs futures prises en charge; souhaitant proposer des ajustements chiropratiques aux patients asymptomatiques. Les déterminants de ce phénomène se doivent d’être compris.
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