Australian chiropractic students’ perceptions of education: validation of a questionnaire

BackgroundThis study aimed to validate a questionnaire to address an absence of a measure to evaluate Australian chiropractic students’ perceptions of the quality of chiropractic programs.MethodPotential relevant questionnaire items were selected from the Australian chiropractic accreditation standards. Chiropractic students rated these items for clarity and relevance, which resulted in a pilot questionnaire of 47 items. Principal components analysis was used to establish the structure of the scales. Finally, intra-class correlation coefficients were used to establish the scales’ test-retest reliability.ResultsThirty-four items were omitted resulting in the retention of 13 items that strongly loaded onto five factors. Internal consistency was adequate. The test-retest reliability ranged from adequate to good for four of the derived factors. The fifth was poor and omitted.ConclusionA valid questionnaire for assessing Australian chiropractic programs has been developed comprising four scales that enquire about: 1) quality of the educational program; 2) provision of student support services; 3) enablement of independent learning; and 4) adequacy of teaching resources.     

捏脊疗法对6个月婴儿生长及智能发育的影响

目的 探讨捏脊疗法对6个月婴儿生长和智能发育的影响.方法 将160例1月龄足月正常婴儿分为捏脊组与对照组,每组各80例.对捏脊组婴儿每天进行捏脊疗法,观察2组婴儿6个月时体质量、身长、头围的增长情况,并对其智能发育进行测评.结果 捏脊组婴儿6个月时体质量、身长的增长均高于对照组,差异有统计学意义,同时捏脊组的智能发育水平也显著高于对照组.结论 捏脊疗法对6个月婴儿的体格发育及智能发育具有明显的促进作用,值得推广.     

Prevalence and Associated Risk Factors of Burnout Among US Doctors of Chiropractic

Objective

The purpose of this study was to establish the frequency of burnout among doctors of chiropractic in the United States.

Methods

Using a nonprobability convenience sampling methodology, we e-mailed the Maslach Burnout Inventory–Human Services Survey and a sociodemographic questionnaire to a randomized sample of licensed doctors of chiropractic (n = 8000).

Results

The survey return rate was 16.06%. Twenty-one percent of the participants had high emotional exhaustion (EE), 8% had low personal accomplishment, and 8% had high depersonalization.

Discussion

Significant differences (P < .001) were found in the level of EE, depersonalization, and personal accomplishment as a function of sex, time dedicated to clinical care and administrative duties, source of reimbursement, the type of practice setting, the nature of practitioners' therapeutic focus, the location of chiropractic college, self-perception of burnout, the effect of suffering from a work-related injury, the varying chiropractic philosophical perspectives, and the public's opinion of chiropractic.

Conclusion

Although doctors of chiropractic in the United States who responded to the survey had a relatively low frequency of burnout, higher levels of EE remain workplace issues for this professional group.     

Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging–Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity,Low-Amplitude,Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up

Objective

The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with high-velocity, low-amplitude spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year and to determine if outcomes differ between acute and chronic patients using a prospective, cohort design.

Methods

This prospective cohort outcomes study includes 148 patients (between ages of 18 and 65 years) with LBP, leg pain, and physical examination abnormalities with concordant lumbar disc herniations. Baseline numerical rating scale (NRS) data for LBP, leg pain, and the Oswestry questionnaire were obtained. The specific lumbar spinal manipulation was dependent upon whether the disc herniation was intraforaminal or paramedian as seen on the magnetic resonance images and was performed by a doctor of chiropractic. Outcomes included the patient’s global impression of change scale for overall improvement, the NRS for LBP, leg pain, and the Oswestry questionnaire at 2 weeks, 1, 3, and 6 months, and 1 year after the first treatment. The proportion of patients reporting “improvement” on the patient’s global impression of change scale was calculated for all patients and acute vs chronic patients. Pretreatment and posttreatment NRS scores were compared using the paired t test. Baseline and follow-up Oswestry scores were compared using the Wilcoxon test. Numerical rating scale and Oswestry scores for acute vs chronic patients were compared using the unpaired t test for NRS scores and the Mann-Whitney U test for Oswestry scores. Logistic regression analysis compared baseline variables with “improvement.”

Results

Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.

Conclusions

A large percentage of acute and importantly chronic lumbar disc herniation patients treated with chiropractic spinal manipulation reported clinically relevant improvement.     

Evaluation of Peak Force of a Manually Operated Chiropractic Adjusting Instrument With an Adapter for Use in Animals

Objective

This study was designed to assess the peak force of a manually operated chiropractic adjusting instrument, the Activator Adjusting Instrument 4 (AAI 4), with an adapter for use in animals, which has a 3- to 4-fold smaller contact surface area than the original rubber tip.

Methods

Peak force was determined by thrusting the AAI 4 with the adapter or the original rubber tip onto a load cell. First, the AAI 4 was applied perpendicularly by a doctor of chiropractic onto the load cell. Then, the AAI 4 was fixed in a rigid framework and applied to the load cell. This procedure was done to prevent any load on the load cell before the thrust impulse. In 2 situations, trials were performed with the AAI 4 at all force settings (settings I, II, III, and IV, minimum to maximum, respectively). A total of 50 000 samples per second over a period of 3 seconds were collected.

Results

In 2 experimental protocols, the use of the adapter in the AAI 4 increased the peak force only with setting I. The new value was around 80% of the maximum value found for the AAI 4. Nevertheless, the peak force values of the AAI 4 with the adapter and with the original rubber tip in setting IV were similar.

Conclusion

The adapter effectively determines the maximum peak force value at force setting I of AAI 4.     

Cost-Effectiveness of Manual Therapy for the Management of Musculoskeletal Conditions: A Systematic Review and Narrative Synthesis of Evidence From Randomized Controlled Trials

Objectives

The purpose of this study was to systematically review trial-based economic evaluations of manual therapy relative to other alternative interventions used for the management of musculoskeletal conditions.

Methods

A comprehensive literature search was undertaken in major medical, health-related, science and health economic electronic databases.

Results

Twenty-five publications were included (11 trial-based economic evaluations). The studies compared cost-effectiveness and/or cost-utility of manual therapy interventions to other treatment alternatives in reducing pain (spinal, shoulder, ankle). Manual therapy techniques (eg, osteopathic spinal manipulation, physiotherapy manipulation and mobilization techniques, and chiropractic manipulation with or without other treatments) were more cost-effective than usual general practitioner (GP) care alone or with exercise, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. Chiropractic manipulation was found to be less costly and more effective than alternative treatment compared with either physiotherapy or GP care in improving neck pain.

Conclusions

Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability. However, at present, there is a paucity of evidence on the cost-effectiveness and/or cost-utility evaluations for manual therapy interventions. Further improvements in the methodological conduct and reporting quality of economic evaluations of manual therapy are warranted in order to facilitate adequate evidence-based decisions among policy makers, health care practitioners, and patients.     

A Pilot Randomized Controlled Trial of Flexion-Distraction Dosage for Chiropractic Treatment of Lumbar Spinal Stenosis

Objective

The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis (LSS) into a clinical trial that used different dosages of flexion-distraction manipulation.

Methods

This randomized controlled trial used a 4-group design. Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages (8, 12, or 18 treatments). The fourth group was given 8 treatments of placebo care. Feasibility measures included recruitment goals, adherence to various treatment schedules, credibility of the placebo treatment, and rates of adverse events. The primary outcome measure was the Swiss Spinal Stenosis Questionnaire, a validated self-report of LSS symptom severity and physical function.

Results

The recruitment and adherence goals of the study were met with a total of 60 subjects randomized (n = 15 per group) and most subjects attending at least 75% of their scheduled visits. No adverse events were reported by any of the subjects in the trial. Our placebo treatment did not appear to be credible; most subjects correctly guessed that they were receiving a placebo treatment. Between-group effect size estimates were small, indicating larger samples are needed for future studies.

Conclusion

This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a 6-week treatment schedule. The information gained from this trial will be useful to inform the design of larger trials.     

Exploring Patient Satisfaction: A Secondary Analysis of a Randomized Clinical Trial of Spinal Manipulation,Home Exercise,and Medication for Acute and Subacute Neck Pain

Objective

The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction.

Methods

This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson's correlation and multiple linear regression.

Results

Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = − 0.75 to − 0.77; R² = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = − 0.65 to 0.67; R² = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R² = 0.08-0.21).

Conclusions

Individuals with acute/subacute neck pain were more satisfied with specific aspects of care received during spinal manipulation therapy or home exercise interventions compared to receiving medication. The relationship between neck pain and satisfaction with care was weak.