Visit characteristics of 217 children attending a chiropractic college teaching clinic

The visit characteristics of 217 children attending a chiropractic teaching clinic are described. Forty-two percent suffered from musculoskeletal complaints, 20% from nonmusculoskeletal complaints and 33% attended the clinic for general physical examination. Patients who were members of the immediate family of a student intern were more likely to attend the clinic for general physical examination or for nonmusculoskeletal complaints. Previous experience with chiropractic was unrelated to the type of complaint, and, among children who had sought previous care for their presenting complaint from some other source, they were as likely to have seen a chiropractor as a medical doctor, regardless of the nature of their complaint. The study concludes that the characteristics of this patient group may be unique to the teaching clinic, reflecting a system in which friends and family are often recruited as patients. These patients might be more likely to view chiropractic care as a primary health care service.     

Stress and burnout in chiropractic students of European chiropractic colleges:: A cross-sectional study

ObjectiveHigh levels of stress and burnout are known to negatively impact academic success, quality of life, and well-being of students. The purpose of this study was to investigate the degrees of stress and burnout levels of students from several European chiropractic colleges.MethodsStress and burnout were assessed using the Perceived Stress Scale (PSS-10) and the Maslach Burnout Inventory–Student Survey (MBI-SS). Surveys were delivered electronically in November 2017 to chiropractic students from 4 different chiropractic colleges. Data were analyzed using t test and 1-way ANOVA to determine differences between demographic data. Scores in perceived stress and burnout subscales were compared to the general, chiropractic, and medical student populations.ResultsBoth the MBI-SS and PSS had similar response rates (30%–34%) and demonstrated statistically significant differences between institutions, with C-3 demonstrating the highest levels of exhaustion (p < .001) and the highest levels of perceived stress (p = .012). MBI-SS results show that in the general chiropractic student population, 26.4% presented high emotional exhaustion, 18.2% high cynicism, and 43.8% low academic efficacy. Meanwhile, the PSS score indicated “moderate” levels of stress.ConclusionsEuropean chiropractic students experience higher levels of perceived stress than the general population and they may suffer levels of burnout similar to those of medical students. These results suggest that colleges should monitor stress and burnout levels in their students. This may help to establish student support systems in order to improve students'' quality of life and academic performance, as well as help new graduates transition to their professional lives.     

Danish chiropractic patients then and now--a comparison between 1962 and 1999

BACKGROUND: Little is known about changes in the chiropractic patient population over time. OBJECTIVE: To compare 2 surveys describing the Danish chiropractic patient population. DESIGN: Data concerning location of primary complaint and its duration for patients in Danish chiropractic offices between 1962 and 1999 were compared. SETTING: Private chiropractic practice and nonprofit research institution. OUTCOME MEASURES: Location of primary diagnosis/complaint, duration of complaint. RESULTS: In 1962, data for 1118 patients were collected, with a participation rate of 93%. In 1999, data for 1897 patients were collected. Of all Danish chiropractic clinics, 88% participated in the study, and 94% of all eligible patients filled out a questionnaire. In both 1962 and 1999, the most frequent complaints were pain in the lower back or neck either alone or with radiation to the extremities (roughly 70% of patients). In 1962, almost 4 times as many patients complained of headache as in 1999 (11% vs 4%). Although there were significant differences, less that 10% of patients presented with a nonmusculoskeletal disorder in both 1962 and 1999 (7% vs 3%). In 1962, almost half of the patients had had their complaint for more than 1 year; in 1999, approximately 80% of patients had had their complaint for less than 1 year. CONCLUSIONS: In both 1962 and 1999, Danish chiropractors primarily treated patients with pain syndromes related to the lower back and neck. Patients presenting with type O disorders comprised less than 10% of the total patient population in both surveys.     

A comparison of patients and patient complaints at six chiropractic college teaching clinics

A cooperative study was undertaken by six chiropractic colleges for the purpose of studying similarities and/or differences among the patients and patient complaints at the college outpatient (teaching) clinics. There were some notable differences among the clinics with respect to the standard demographic variables of age, education, employment and income. The sociodemographic characteristics of patients appeared to be different to the extent that the characteristics of the neighborhoods in which the clinics were located were different. Patients referred to the clinics by chiropractic student/interns were more likely to attend for routine physical exam than patients referred by other sources. Although marked differences were observed in patient attendance for routine physical examination, the health problems for which patients sought treatment were very similar among all the clinics. Low back complaints were the most frequently reported health complaint. The characteristics of the low back complaints were very similar at all six sites.     

Prevalence of nonmusculoskeletal complaints in chiropractic practice: report from a practice-based research program

OBJECTIVE: To identify patient and practice characteristics that might contribute to people's seeking chiropractic care for nonmusculoskeletal complaints. DESIGN: This was a cross-sectional study conducted through the methods of practice-based research. SETTING: Data were collected in 1998--1999 in chiropractic offices in the United States, Canada, and Australia; data were managed by a practice-based research office operating in a chiropractic research center. POPULATION: The subjects were new and established patients of all ages who visited the participating offices during a designated data collection week. DATA ANALYSIS: Multiple logistic regression was used to examine factors associated with patients' presenting for nonmusculoskeletal chief complaints. Pearson's chi(2) test was used to examine associations among practice variables and the proportion of patients with nonmusculoskeletal chief complaints. RESULTS: A total of 7651 patients of 161 chiropractors in 110 practices in 32 states and 2 Canadian provinces participated; data from 2 Australian practices were included in the totals but not in the analysis. Nonmusculoskeletal complaints accounted for 10.3% of the chief complaints. The following characteristics made patients more likely to present with nonmusculoskeletal chief complaints: being less than 14 years of age (adjusted odds ratio [AOR], 6.9; 95% CI, 5.2--9.1); being female (AOR, 1.5; CI, 1.3--1.8); presenting in a small town/rural location (AOR, 1.9; CI, 1.3--2.7); reporting more than 1 complaint, especially nonmusculoskeletal complaints (AOR, 4.9; CI, 3.9--6.0); having received medical care for the chief complaint (AOR, 3.4; CI, 2.9--4.1); and having first received chiropractic care before 1960 (AOR, 1.7; CI, 1.1--2.4). Practices with the highest proportion of patients with nonmusculoskeletal chief complaints (>17%) were less likely to accept insurance and more likely to be in locations with populations greater than 100,000. They used the most common chiropractic adjustive techniques less frequently and used more nonadjustive procedures, especially diet/nutrition counseling, nutritional supplementation, herbal preparations, naturopathy, and homeopathy. CONCLUSIONS: Drawing on practices with the patient and practice characteristics identified in this study to conduct outcomes studies on nonmusculoskeletal conditions is a possible direction for future research.     

Examining the validity of chiropractic grade point averages for predicting National Board of Chiropractic Examiners Part I exam scores

ObjectiveThe main objective of this study was to evaluate the validity of grade point average (GPA) for predicting the National Board of Chiropractic Examiners (NBCE) Part I exam scores using chiropractic GPA.MethodsData were collected during the January 2019 computer-based testing administration of the NBCE''s Part I exam. The sample size was n = 2278 of test takers from 18 domestic and 4 international chiropractic educational institutions. Six regression models were developed and tested to predict the Part I domain scores from chiropractic GPA while controlling for self-reported demographic variables. Residuals from the models were disaggregated by pre–chiropractic GPA.ResultsChiropractic GPA revealed a positive, statistically significant correlation with sex. The chiropractic GPA was found to be a significant predictor of the Part I domain scores. A different perspective was obtained when residuals (observed minus predicted) were collected and split by the pre–chiropractic GPA. Very good students tended to be underpredicted, while other students were overpredicted.ConclusionThis study builds on the cascading evidence from educational literature by providing additional results suggesting that undergraduate (prechiropractic) GPA as well as the GPA obtained in doctor of chiropractic programs are related to the future performance on the NBCE Part I exam. The results provide a first glance at the connection between the standardized test scores, which are often used for instructors'' and institutional evaluation and the GPA obtained in a doctor of chiropractic program.     

Impostor phenomenon among US chiropractic students

ObjectiveImpostor phenomenon is expressed by feelings of self-doubt and the belief that one is unintelligent. The purpose of this research was to describe the prevalence of impostor phenomenon among students enrolled in a doctor of chiropractic program and to evaluate for any differences in the rates of impostor phenomenon between males and females.MethodsWe performed an anonymous cross-sectional, online survey of all students enrolled in the doctor of chiropractic program at 2 campuses of 1 chiropractic college. We reported the point prevalence of impostor phenomenon and used χ² to evaluate the differences in impostor phenomenon among males and females. We also evaluated for between-group differences for 4 other demographic factors believed to influence impostor phenomenon.ResultsWe received 406 survey responses (34% response rate). Impostor phenomenon was reported in 39% of students responding to our survey. Approximately 46% of all females and 32% of all males met the criteria for impostor phenomenon, and females had significantly higher rates of impostor phenomenon (p = .005). The following variables were not associated with impostor phenomenon: year in which students were enrolled; marital status; whether chiropractic was their first career; and type of clinical experience the student encountered.ConclusionOur findings demonstrate that over a third of students enrolled in a doctor of chiropractic program met the criteria for impostor phenomenon, and females were significantly more likely to experience impostor phenomenon. The results from this survey are similar to those reported in other healthcare educational settings.     

Effects of chiropractic care on spinal symptomatology among professional drivers: a pilot study

Rationale:Increased spinal morbidity among drivers is well-documented and its pathomechanism has been objectively verified elsewhere by the authors. This study aims to explore the effects of chiropractic intervention in symptomatic drivers, assess the benefits to the driver and the transport company.Study design:A group of 22 symptomatic bus drivers were treated for various spinal complaints, following which their improvement, recovery and satisfaction were measured through a telephone survey. Analysis of the changes in the number of spine-related sick days, together with its financial benefits to their employer, was performed.Statistical design:The design was a retrospective two-tailed hypothesis testing of variances, using a single cohort of 22 symptomatic bus drivers. The independent variable was the driver’s spinal complaint and the dependent variables an independent questionnaire and company’s sick days record.Results:Twenty-two symptomatic drivers approached the clinic, most of them with multiple spinal complaints of insidious onset and well-established chronicity. At the end of the treatment programme, drivers reported 84.3% improvement and 91.6% overall satisfaction. Average spinal absenteeism within the same group compared to previous year had dropped from 1.55 sick days per employee for 6 months down to 0.16. This trend achieved 95% significance in a paired t-test of variances.Conclusion:Chiropractic intervention within the work place for this population shows positive effects in terms of employee satisfaction, resolution of symptoms and cost effectiveness for the company involved.     

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.     

Attitudes and behaviors of chiropractic interns toward occupational history taking

ObjectiveThis study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking.MethodsAll chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study.ResultsThe supervising clinician assessed 20 interns'' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was “very important.” Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%).ConclusionChiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.     

Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache

BACKGROUND: The clinical significance of the ponticulus posticus is far from clear. It has been associated with headaches, Barré-Lieou syndrome, photophobia, and migraine. However, little epidemiologic evidence for this exists. OBJECTIVE: This study investigated the relationship of ponticulus posticus on x-ray studies and headache symptoms in a series of chiropractic patients. METHODS: Eight hundred ninety-five patients who visited a chiropractic clinic for the first time and whose conditions required cervical spine x-ray examinations were studied. Complaints were categorized as migraine with aura, migraine without aura, cervicogenic headache, neck pain only, and other conditions. The presence or absence of the ponticulus posticus (whether partial or complete) was determined by means of a lateral cervical film and noted as a positive or negative finding. The data were analyzed by frequency analysis and Pearson's chi 2 test. RESULTS: Forty-six percent of the sample were men and the predominant complaint was neck pain (33%). Most patients were in the fourth decade of life. The frequencies of the other complaints were migraine with aura (7%), migraine without aura (4%), cervicogenic headache (22%), other conditions (33%). An 18% prevalence of ponticulus posticus was found. This finding was significantly associated with migraine without aura (chi 2 = 4.97; P = .03) and not with any other conditions. CONCLUSION: In a chiropractic patient population that required cervical x-ray examinations, a significant association was found between ponticulus posticus and migraine without aura, with an odds ratio of 2.19:1 in favor of this complaint being present with the osseous anomaly. The mechanism for this remains obscure but may be related to ischemic compression of the vertebral artery or by dural tension at the craniocervical junction.     

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.