Systematic reviews (SRs) provide a solution to handle information overload for busy clinicians by summarising and synthesizing studies on a specific issue. However, because SRs are complicated and ...often boring to read, the busy or reluctant reader may make do with the abstract. When, as it has been shown, many authors overstate efficacy or understate harm in their abstracts, not consulting the underlying article could be misleading. This means that the prudent reader must have the ability to identify the 'tender points' of SRs to avoid falling for 'spin'. To this end we briefly review the method of SRs and ways to relatively quickly determine trustworthiness. Keywords: Systematic review, Evaluation studies, Evidence-based medicine, Health personnel, Information literacy
Background Many chiropractors use spinal manipulative techniques (SMT) to treat spinal pain. A recent Delphi study posited 18 items across five domains as predictors of patients experiencing ...non-specific low back pain most likely to experience a strong and immediate positive response to SMT. We sought to create a 'pen and paper' questionnaire that would measure these items and then pilot its use in a clinical setting to determine its 'usability' for a larger study. Knowing this information would inform a more efficacious use of SMT. Method Of the 18 items identified in the Delphi study, 13 were deemed historical in nature and readily provided by the chiropractor and patient. A literature search revealed reliable and valid measures for two more items. The remaining three items were generated by creating descriptive questions matched to an appropriate Likert scale. A panel of six chiropractors who had used SMT for at least 7 years when treating non-specific low back pain was formed to evaluate the items for clarity and relevance. Ten Western Australian chiropractors were then recruited to pilot the questionnaire on ten consecutive patients with non-specific low back pain where SMT was used from March to June 2020. Ethics approval was obtained from Murdoch University. Results COVID-19 restrictions impacted on practitioner recruitment and delayed the data collection. Of the intended 100 participants, only 63 could be recruited over a 3-month period from seven chiropractors. Time constraints forced the closure of the data collection. The measures of all predictor items demonstrated ceiling effects. Feedback from open-ended practitioner questions was minimal, suggesting an ease of use. Conclusion The length of time and level of participation required to collect the calculated sample size was inadequate and suggested that incentivization may be required for a larger investigation. Significant ceiling effects were found and suggested that participants did so because of a positive bias toward chiropractic care and the use of SMT. The questionnaires in this pilot study require alternative measures and further validation before use in a larger study. Keywords: Chiropractic, Therapeutic alliance, Patient expectations, Spinal manipulation
The chiropractic profession has a long history of internal conflict. Today, the division is between the 'evidence-friendly' faction that focuses on musculoskeletal problems based on a contemporary ...and evidence-based paradigm, and the 'traditional' group that subscribes to concepts such as 'subluxation' and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care.Because this is an issue with many factors to consider, we decided to illustrate it with an analogy. We aimed to examine the chiropractic profession from the perspective of an unhappy marriage by defining key elements in happy and unhappy marriages and by identifying factors that may determine why couples stay together or spilt up.
We argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the 'evidence-friendly' and the 'traditional' groups inhabiting the end points, with the majority of chiropractors in the middle. This middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of 'you never know who and what will respond to spinal manipulation'. We believe that this 'silent majority' makes it possible for groups of chiropractors to practice outside the logical framework of today's scientific concepts.
There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions. This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.
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
Australia has an aging population with increasing numbers embarking on the major life transition to retirement when compared to previous decades. The Australian university sector has experienced ...considerable upheaval as it has undergone austerity measures to attempt to manage the impact of the pandemic. The objective of this study was to conduct interviews with Australian university academics who have recently transitioned into retirement, to explore their experience of transitioning to retirement in a COVID-19 environment. The study followed the COREQ guidelines for qualitative studies. Participants were selected based on having recently retired within the previous two years from an Australian university. We conducted semi-structured interviews to explore the participants' in-depth experience of the transition to, as well the actual experience of retirement. Thematic analysis was conducted. Six participants with a mean age of 64.7 years were interviewed for this study. Five super-ordinate themes emerged; 'dissatisfaction with the university,' 'desire to continue to be involved,' 'financial considerations,' 'loss of identity, meaning and belonging,' and 'the need to plan and maintain a structured life.' Retirement was seen as an important change in life. There appeared to be a weighing up of the value of quality of life, perhaps influenced by a growing awareness of its shortness. The respondents believed it is extremely important to plan retirement and to start this process early. Proffered recommendations included the making of plans to remain mentally and physically active, and to maintain purpose into retirement.
The Council on Chiropractic Education Australasia (CCE-A) is tasked with assessment and accreditation of chiropractic programs (CPs) in the Australasian community. To achieve this process the CCE-A ...has developed educational standards and graduate competencies which include minimum expectations of graduates prior to entry into the workforce. We sought to explore if these are changing overtime, and if so are these changes for the better.
The CCE-A 2009 and 2017 Competency Standards were located and downloaded. The competencies were placed into tables for a comparative analyses in a systematic manner to enable the identification of similarities and differences. In addition, word counts were conducted for the most commonly occurring words and this took place in December 2019.
The 2017 competency standards were over three times smaller than the previous standards 2009 standards. More similarities than differences between the old and the new standards were found. There were 18 additions to the 2017 graduate competencies with many that were in unison with contemporary aspects of healthcare such as patient centred-care, respect for practitioner-patient boundaries and patient sexual orientation, transitioning patients to self-management, and consideration of improving lifestyle options. Some competencies were not bought forward to the new standards and included, among others, students being competent in screening for mental health conditions, an expectation to discuss cost of care, re-evaluating and monitoring patients at each visit, and knowing when to discharge patients. The competencies continued to be silent on known issues within the chiropractic profession of a lack of a definition for chiropractic that would inform scope of practice and the presence of vitalism within CPs.
There have been positive changes which reflect contemporary mainstream health care standards between CCE-A graduate competency revisions. The absence of a clear definition of chiropractic and its attendant scope of practice as well as continued silence on vitalism reflect known issues within the chiropractic profession. Recommendations are made for future accreditation standards to inform the required competencies and aid the integration of chiropractic into the broader health care community.
In Australia, about 1 in 3 chiropractors choose not to belong to either of the two professional associations and this is considerably lower compared to other health professional organisations in this ...country. The reasons for this remain unknown. We sought to explore possible reasons by asking chiropractic students their perceptions of barriers and facilitators to joining a professional association. However, we were unable to identify validated survey instruments that could be used to obtain information about reasons for joining health professional associations.
Therefore, the objectives of this study were to: 1) develop a survey instrument that captures information about what influences chiropractic students in joining professional association; and 2) identify factors that promote association membership among chiropractic students.
A literature review was undertaken to identify known determinants of professional association membership and were used to construct a preliminary survey instrument, which comprised 47 items. Six fourth-year chiropractic students assessed the preliminary survey instrument's content validity. Principal components analysis was used to establish the structure of the scales. Cronbach's alpha was derived to determine whether all items in each scale tapped a discrete construct. Logistic regression was used to examine the association between the scale scores and having joined a chiropractic professional association.
In March 2019, 348 chiropractic students from Murdoch University (71.0%) responded to a voluntary, anonymous questionnaire. Principal components analysis resulted in the retention of 21 items that strongly loaded onto 6 factors. Internal consistency was found to be adequate. The results of the logistic regression analysis demonstrated that only "development of the profession" was significantly associated with have joined a professional chiropractic association (
= 0.049, OR = 2.22; 95% CI = 1.26-3.40).
Chiropractic organisations can probably most effectively increase membership numbers through raising awareness of their contribution to the development of the profession.
The COVID-19 pandemic has seen the emergence of unsubstantiated claims by vertebral subluxation-based chiropractors that spinal manipulative therapy has a role to play in prevention by enhancing the ...body's immune function. We contend that these claims are unprofessional and demonstrate a disturbing lack of insight into the doctrine of informed consent. As such it is timely to review how informed consent has evolved and continues to do so and also to discuss the attendant implications for contemporary health practitioner practice. We review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. We argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered. The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. We discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending "inhouse" products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings.
Ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.
Background While chiropractic care is most commonly provided within a private practice context, the 'traditional' solo practice is now uncommon. Chiropractors, manual therapists and related health ...professionals commonly work within the same practice bringing obvious advantages to both the practitioners and their patients. However, multi-practitioner, multi-disciplinary clinics also carry often unrecognized liabilities. We refer here to vicarious liability and non-delegable duties. Vicarious liability refers to the strict liability imposed on one person for the negligent acts of another person. The typical example is an employer being held vicariously liable to the negligent acts of an employee. However, vicarious liability can arise outside of the employer-employee relationship. For example, under non-delegable duty provisions, an entity owing a non-delegable duty can be liable for an independent contractor's wrongdoing. After a plain English explanation of this complex area of law, we provide seven scenarios to demonstrate how vicarious liability can envelop practice principals when things go wrong. We also make suggestions for risk mitigation. Conclusion Practice owners may unexpectedly find themselves legally liable for another's actions with dire consequences. A knowledge of vicarious liability along with implementing risk mitigation strategies has the potential to minimize the likelihood of this unwanted event. Recommendations are made to this end. Keywords: Duty of care, Negligence, Vicarious liability, Non-delegable duty of care, Chiropractic
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