Barrett Losco

Aim:
To report the rate and severity of adverse events (AEs) among patients receiving services at university-based chiropractic clinical placements over a 15-year period in Western Australia.

Methods:
Patients reporting AEs were identified from an incident register between 2008 and 2023. Details of all incidents were authenticated through extracted data from patient follow-up, clinical records, clinician reports, legal, and insurer advice and were graded (1-5) based on severity.

Results and Discussion:
Chiropractic services were delivered by 921 chiropractic students and supervised by 44 registered chiropractors during the 15-year time span in metropolitan, rural, and remote locations. Among 410,957 clinical encounters (CE) comprising 349,075 treatment sessions for 61,882 unique patients, 20 mild (grade 1) clinical AEs were identified, yielding a crude incidence rate of 4.87 per 100,000 (95% CI: 2.79-7.52), or 1:20,548 clinical encounters. Signs and symptoms of AEs were acute or exacerbated low back pain, neck pain, and mid-back pain/shoulder pain. The most common presenting complaints among the patients reporting an AE were pain in 3 spinal regions.

Conclusions:
The incidence of AEs associated with chiropractic care in this population corroborates previous studies that report the rate and severity of AEs to be rare and mild.

Objective

This study aimed to explore chiropractic students' perceptions and attitudes about the appropriateness of peer physical examination as a teaching tool and their willingness and comfort with it.

Methods

A modified version of a validated questionnaire was used. First- and 2nd-year chiropractic students at Murdoch University were approached during their practical sessions. The responses were analyzed using descriptive statistics reporting frequencies and percentages. Comparison between classes, age, and sex was evaluated by cross-tabulation.

Results

A total of 184 questionnaires were completed with a response rate of 76.6%. Our results demonstrated that most students were comfortable with and willing to participate in peer physical examination as well as trusted it as an appropriate part of their training and a valuable learning experience. Nevertheless, a small percentage were uncomfortable with peer physical examination and regarded it as an unprofessional activity. In addition, it was revealed that younger females (≤20 years) reported feeling unnecessarily exposed and therefore significantly less comfortable with peer physical examination. They were also less comfortable when examined in the inguinal area by a student of the opposite sex.

Conclusion

Although peer physical examination appears to be a very popular training tool, it still has a few areas of concern that need to be investigated and addressed to improve students' attitude, perception, and comfort with this teaching technique. Further studies could investigate how other factors such as religious beliefs contribute toward students' perception and attitudes regarding peer physical examination.

Objective

The purpose of this study was to identify and compare the research priorities of Australian practicing chiropractors and academics across listed research domains and to seek their views on existing chiropractic research strategies. Concurrent objectives were to gain insight into the perspectives on characteristics of research and solicit ideas and suggestions for future research from both groups.

Methods

This study used a mixed-method research design to collect data using an online survey portal. Australian chiropractic academics (n = 220) and practicing chiropractors who were also members of a nationally representative, practice-based research network database (n = 1680) were invited to participate. Data were collected (February 19, 2019, to May 24, 2019). The free-text data were analyzed primarily via semantic coding and verbatim referential units in cases where the category was an exact match for the textual data. Content analyses of the qualitative data were presented in a tabulated and narrative manner as identified domains. Selected representative examples were provided verbatim.

Results

The response rate for the survey was 44% for full-time equivalent academics, 8% for casuals and part-time chiropractic academics, and 21.5% for Australian Chiropractic Research Network database chiropractic practitioners. Open-text data comprised a narrower focus on musculoskeletal (MSK) conditions and opposition or reservations by academics and some practitioners toward the research agenda of those espousing traditional concepts and terminology. Comments from both groups illustrate the strongly held views that characterize divergent factions of the chiropractic profession. Some practitioners were highly critical of the narrow focus and epistemological paradigm of Australian university-based research, while others were strongly supportive of the traditional focus of the Australian Spinal Research Foundation. Australian academics at the 4 university-based programs held the view that MSK and spinal pain, for which some evidence already exists, should be the priority of future research, building on what is known. Practitioners believed that future research should be directed toward expanded areas such as basic science, younger populations, and non-MSK conditions. Respondents were sharply divided on attitudes toward traditional chiropractic terminology, concepts, and philosophy and the utility of future research on these topics.

Conclusion

Our qualitative findings suggest there is a division in the Australian chiropractic profession regarding research direction and priorities. This divide exists between academics and researchers and within field practitioners. This study highlights the attitudes, opinions, and perceptions of important stakeholder groups, which should be considered by decision-makers when formulating research policy, strategy, and prioritization of funding.

Purpose The purpose of this paper is to work with Aboriginal and Torres Strait Islander people (ATSI), it is expected that non-ATSI health-care professionals become culturally aware; however, participants’ perceptions of the relative merit of cultural awareness training (CAT) formats is uncertain. Design/methodology/approach The authors compared undergraduate students’ perceptions of an asynchronous online format with onsite delivery formats of CAT using a mixed-method design. Students from five successive cohorts (n = 64) in an undergraduate programme were invited to complete a post-training survey which gathered quantitative and qualitative data. Findings Whilst feedback was positive regarding both formats, the onsite format was preferred qualitatively with several valuable learning outcome themes emerging from the results. These themes included; “perceived benefits of self-evaluation of students’ own culture whilst learning about Aboriginal culture”; “encouraging to be provided with scenarios, examples and exercises to enhance cultural awareness” and “engagement with the interactive facilitator approach”. There were differing views about the benefits of learning the history of oppression which warrant further research. Research limitations/implications Results may be applicable to undergraduate allied health students who participate in clinical immersion placements (CIPs) who participate in Aboriginal CAT. Practical implications Given the changing dynamic in education forced by the COVID-19 pandemic, more resources may need to be directed to improving online training and possibly combining formats in course delivery. Social implications The strength of the study is that the authors achieved a response rate of 100%, thus the results are highly significant for the sample. This sample represents 41.3% of chiropractic students who attended CAT and CIPs at this university over the course of 9 years, thus the results could be generalized to chiropractic students who participated in these types of placements. Originality/value To the best of the authors’ knowledge, this is the first study to compare student perceptions of different formats of Aboriginal CAT for final year chiropractic undergraduate students in Australia.

Aim: The aim of this study was to explore how clinical immersion placements (CIPs) in regional, rural and remote Western Australia impact undergraduate chiropractic student experience, attributes and employment destination. Methods: Ten cohorts of students in their final year of five-year Australian chiropractic undergraduate programs had undertaken a placement in regional, rural or remote Western Australia. Students from five of those cohorts were invited to complete the Service Experience Questionnaire (SEQ) and open-ended reflective feedback (Part A). The Australian Health Practitioner Regulation Agency/Chiropractic Board of Australia public register of chiropractors and the internet were also interrogated for data on graduate employment location (Part B). Results: All (n=67) invited students participated in the Part A study. All students agreed that the placement experience was educational, and should be retained in the undergraduate curriculum. Students also agreed that the placement enhanced respect for the individual and awareness of others in need (94.1%), highlighted the importance of respect for all people (94%), improved empathy for the disadvantaged (88.1%), and provided them with an opportunity to improve their communication skills (98.5%). A majority (56.7%) indicated that as a result of their placement, they would be more likely to practice in a country setting. Further, those who participated in a placement were significantly more likely to practice in a regional, rural or remote location of Western Australia after graduation. Conclusions: This study is the first in Australia to describe the extent to which CIPs impact the development of communication and interaction skills, social responsibility and a philosophy of caring in chiropractic students, and the decision to work in regional, rural or remote Australia. These results support the utility of clinical immersion placements to help meet the educational objectives of undergraduate chiropractic programs, and to address the mal-distribution of the chiropractic workforce in regional, rural and remote Australia.

Background
Various models and decision-making aids exist for chiropractic clinical practice.

Results
“PICO-D Man” (Patient-Intervention-Comparator-Outcome-Duration Management) is a decision-aid developed in an educational setting which field practitioners may also find useful for applying defensible evidence-based practice. Clinical decision-making involves understanding and evaluating both the proposed clinicalintervention(s) and the relevant and available management options with respect to describing the patient and their problem, clinical and cost effectiveness, safety, feasibility and time-frame.

Conclusions
For people consulting chiropractors this decision-aid usually requires the practitioner to consider a comparison of usual chiropractic care, (clinical management including a combination of active care and passive manual interventions), to usual medical care usually including medications, or other allied healthmanagement options while being mindful of the natural history of the persons’ condition.

Objective: The aim of this study was to (1) generate a valid questionnaire to determine immunology knowledge, (2) compare immunology knowledge across 3 different cohorts of chiropractic students that had already studied immunology, (3) examine the attitudes of chiropractic students to the study of immunology, and (4) examine whether students' attitudes affected their knowledge levels. Methods: Factor analysis was used to refine an immunology knowledge and perceptions questionnaire that was generated by a group of experts that was then completed by 90 students. Immunology knowledge level of each of the cohorts was compared using a 1-way analysis of variance. Kappa statistics were used to measure agreement between 2 statements, and logistic regression was used to determine whether students' attitudes were associated with their knowledge levels. Results: There was a significant difference in the immunology knowledge levels across the 3 year groups (F[2, 87] = 4.78, p = .011). Fifth-year students (n = 26) demonstrated 25% less immunology knowledge than third-year students (n = 35; p = .005). Of 90 students, 64 agreed that immunology knowledge was important to chiropractors, and 53 agreed that immunology knowledge was important for the average person. No relationship existed between their value of immunology knowledge and their score on the multiple-choice questions. Conclusion: Third-year students' immunology knowledge was significantly higher than that of the fifth-year students. Students value immunology knowledge, but this does not translate to retention of this knowledge. The validated questionnaire is a useful tool for assessing immunology knowledge retention for undergraduate students.

Manual therapy is suggested as a potentially therapeutic intervention that may improve pulmonary function. However, this form of therapy is largely based on clinical observations and hypothetical models rather than mechanistic knowledge. This study examined the influence of a single session of manual therapy applied to the thoracic spine and thorax on dynamic pulmonary function over an extended time frame in healthy adults. 21 healthy individuals (14 males) aged 19-35 (mean [SD] age = 23 [3.9], BMI [SD] = 22.97 [2.41]) completed one experimental testing session consisting of five pulmonary function tests and the delivery of a manual therapy intervention. Pulmonary function was measured at baseline and 1 minute, 10 minutes, 20 minutes and 30 minutes following the intervention. Baseline mean (SD) forced vital capacity (FVC), forced expired volume in 1 second (FEV 1) and maximal voluntary ventilation (MVV) were 5.55(1.23 L), 4.64(0.92 L) and 165.7(40.0L min â '1) respectively. The mean (SD) FEV 1 /FVC ratio was 0.84(0.07). There were no statistically significant changes in any of the pulmonary function measures following the manual therapy intervention. Our findings do not support the use of manual therapy to provide a short-term benefit in respiratory function to healthy adults.

This commissioned review paper offers a summary of our current understanding of nonmalignant spinal pain, particularly persistent pain. Spinal pain can be a complex problem, requiring management that addresses both the physical and psychosocial components of the pain experience. We propose a model of care that includes the necessary components of care services that would address the multidimensional nature of spinal pain. Emerging care services that tailor care to the individual person with pain seems to achieve better outcomes and greater consumer satisfaction with care, while most likely containing costs. However, we recommend that any model of care and care framework should be developed on the basis of a multidisciplinary approach to care, with the scaffold being the principles of evidence-based practice. Importantly, we propose that any care services recommended in new models or frameworks be matched with available resources and services – this matching we promote as the fourth principle of evidence-based practice. Ongoing research will be necessary to offer insight into clinical outcomes of complex interventions, while practice-based research would uncover consumer needs and workforce capacity. This kind of research data is essential to inform health care policy and practice.

It has been demonstrated that a positive correlation exists between clinical knowledge and retained concepts in basic sciences. Studies have demonstrated a modest attrition of anatomy knowledge over time, which may be influenced by students' perceived importance of the basic sciences and the learning styles adopted. The aims of this study were to: (1) conduct a cross-sectional evaluation of the retention of anatomical knowledge in preclinical (second-year) and clinical (fifth-year) chiropractic students at Murdoch University; and (2) examine students' perceptions of factors that may influence their anatomy knowledge retention. Second- and fifth-year chiropractic students at Murdoch University were invited to participate in the study. Ninety-one students voluntarily participated. The Carpal Bone Test, previously utilized to determine the retention of anatomical knowledge, was utilized to determine the extent to which participants retained gross anatomy knowledge. Participants also completed a questionnaire specifically designed to identify the factors that may have influenced their retention of gross anatomy knowledge. A two-sided Pearson chi-square test of association was used to ascertain statistically significant differences in carpal bone retention and students' responses between the two cohorts. Seventy percent of the fifth-year (clinical) chiropractic students correctly identified all eight carpal bones compared to only six percent of second-year chiropractic students. The majority of participants in both cohorts believed that gross anatomy knowledge is of clinical importance. The use of mnemonics and the clinical application of anatomy knowledge were identified as factors that significantly influenced participants' gross anatomy knowledge retention within this study.