Lyndon Amorin-Woods

Evidence Supports Model of Chiropractic Professional Competence

Introduction & Aim: A scoping review of chiropractic education publications is needed to guide future policy development, research agendas, and educational initiatives within the chiropractic profession. This review mapped the number of studies, topics, and designs of chiropractic education publications worldwide.

Methods: The study was conducted by authors from 9 countries with 704 years of combined academic experience. JBI methodology was followed and the PRISMA extension for scoping reviews guided reporting. Several health and education databases were searched from their inception to November 2023 without language limits. Data were extracted for primary topics, study designs, and regions and entered in Covidence by paired independent reviewers.

Results: The search resulted in 7494 documents of which 598 (years 1970-2023) were selected for data extraction. Education topics included knowledge and cognitive competence (49), functional and clinical competence (93), personal/behavioral competence (34), values/ethical competence (3), and program-relevant research (419). Most designs were quantitative (391), followed by descriptive reports (91), qualitative (43), mixed methods (40), commentary (22), and literature reviews (11). Chiropractic education was studied in 15 countries; most were in the United States (359), Australia (116), and Canada (106). The number of publications and proportion of research designs increased over time.

Conclusion: This scoping review quantifies the body of chiropractic education research. Program-relevant research comprises the majority, and all domains of learner competence are represented. The data show that chiropractic scholars and programs are engaged in collecting, analyzing, and distributing data relevant to education and training and that education research is becoming more complex.

In 2019, Safer Care Victoria (SCV) conducted a government-funded inquiry into the practice of spinal manipulation (SMT) of children under 12 years of age by chiropractors. SCV assembled an advisory panel, commissioned a Cochrane Collaboration Review, and invited submissions from consumers, health practitioners, insurers, education institutions, professional organizations, and interested stakeholders.

The report's principal findings were that while spinal manipulation of children results in very rare instances of harm, since evidence of the effectiveness of SMT is lacking, SMT cannot be recommended for children under 12 for a list of conditions or for general wellness.

Critique and Discussion: Five reviewers evaluated the Cochrane Review that formed a part of the inquiry using the Scottish Intercollegiate Guideline Network (SIGN) instrument. Two reviewers also evaluated the SCV report in its entirety. A strength of the report is the safety review and the information in the detailed responses from consumers. There were 29,599 on li ne submissions received from across Australia, making it the largest survey of this kind. There were no reports of physical, mental, or financial harm to a child derived from this robust process.

However, the report and the Cochrane Review contain weaknesses.

1) An internal contradiction erroneously reported a cerebrovascular incident (CVI ) rate of 1:20,000 with SMT among children in the main text.

2) There was a departure from the inclusion/exclusion criteria for effectiveness studies. 3) The final recommendations disregard the submissions from consumers, the public, and practitioners.

Conclusion: While it has strengths, the SCV report is also flawed, and its final recommendations should be viewed with caution. The Cochrane Review within the report adds little to the body of knowledge or clinical practice for chiropractors managing children under 12.

Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice.

Results: Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain.

Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.

Study objective: To describe the imaging utilisation and spinal therapy intervention patterns for patients aged 50 years and over presenting to a chiropractic teaching clinic. Methodology: An audit of all consultations for patients 50 years and over spanning 2005-2010 was undertaken, and patient data were categorised according to management; treatment type; spinal region imaged; whether imaging was utilised or undertaken prior to care; and imaging acquisition location. Results: 2054 patient records were included. Of these, 47.5% patients received imaging of at least one spinal region from any imaging acquisition location. When imaging was utilised, the majority was of one spinal region (58.5%). 57.5% of images were acquired at the clinic. Regarding clinical management and imaging, 76.6% received passive care with SMT (51.7% with imaging). Regionally, 1126 patients received cervical spine SMT, 36.0% undergoing cervical imaging; 1382 patients received thoracic spine SMT, 14.7% undergoing thoracic imaging; and 1295 patients received lumbo-pelvic SMT, 42.9% undergoing lumbo-pelvic imaging. Discussion/Conclusions: Imaging rates within the training institution studied appear to follow spinal imaging guidelines. So far as the authors are aware, this study is the first to quantify imaging utilisation patterns over an extended period of time in a university-based chiropractic clinic.

Chiropractic is an emerging profession with an evolving role in musculoskeletal health, particularly regarding patient assessment and musculoskeletal care. Concurrently, the WA Department of Health is actively planning future services by exploring innovative ways to provide for the health care needs of the population, using the Health Networks as a vehicle. Of relevance is the Musculoskeletal Health Network that focuses on various musculoskeletal issues, like spinal pain and chronic disease, with a view to inform future healthcare planning and services. In line with the Musculoskeletal Health Network’s models of care, the chiropractic profession in WA is actively exploring pioneering roles with a view to contribute to the mainstream health care system and service provision. An example of this is the chiropractic care provided to residents at Palmerston Farm in Perth, a novel service to people affected by substance use, by supervised chiropractic Interns from Murdoch University. Although this type of community outreach is not original, this project represents a fresh, contemporary role for chiropractic to participate in mainstream healthcare services. The drug free approach to health care intrinsic to chiropractic constitutes an intuitive adjunct to the Palmerston ethos of recovery with empowerment.

This collaborative project examines the effect of experience on chiropractic Interns with respect to perceptions, learning outcomes and attitudes toward those in substance recovery, alongside the measurement of patient outcomes and satisfaction with care. The process of care provision is to be evaluated and implications for health service provision and impact on the wider community explored.