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.

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.

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.