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PubMed1996

Research attitudes among chiropractic college students.

OBJECTIVE: To explore the attitudes of chiropractic students toward research and factors influencing it. DESIGN: This study was conducted through the use of a survey questionnaire. Students were given a questionnaire with no prior knowledge of the survey to ensure that their responses were spontaneous and to increase the possibility that the responses reflected their true feelings. SETTING: This study was conducted at a small southern chiropractic college. PARTICIPANTS: Students were selected from all quarters (1st-13th) to determine the effect of educational level on research attitude. RESULTS: Seventy students (51 men and 19 women, representing 40% of college student population) completed the questionnaire. Of those students, 51.62% indicated they were interested in research in general; 70.96% thought chiropractic research was important; 35.65% were interested in conducting research before coming to chiropractic college; 90.32% had experienced something interesting in chiropractic and wanted to know more about it; 64.52% had at some time thought about a chiropractic research topic; 35.48% had thought about other research topics; 67.75% agreed that there are many things that need to be researched in chiropractic; 25.81% had research experience in some setting; 45.16% thought basic research technique and statistics should be taught in chiropractic college; 19.36% thought research training should be a requirement in chiropractic college; and 61.29% would participate in chiropractic research if given the opportunity while in chiropractic college. Age and gender had very little effect on the research attitude of students in this study. The level of education in chiropractic college affected the students' general interest in research. Middle quarter-level students who had not taken the required research and chiropractic courses showed greater willingness to participate in research than senior students did. Students with previous research training and experience showed significant positive attitudes toward research in almost all questions. However, providing research training in school did not change students' attitudes toward research significantly in a short period of time. Lack of research experience and family concerns were the major factors affecting the students' interest in participating in research while in school. CONCLUSIONS: Most students completing the survey indicated an interest in research but were reluctant to take extra courses in research. A majority indicated an interest in participating in research. Students interested in doing research were most likely to be students who had some previous research experience or a personal interest as a result of some personal experience. Reasons given for the students' lack of desire to participate in research included family responsibilities, heavy study workload and lack of personal interest and/or previous experience. The overwhelming concern to the students in terms of participating in research was the additional time requirement.

Adult↗
PubMed1986

Limits to medical dominance: the case of chiropractic.

This paper describes and analyzes the social history of chiropractic in Canada to partially test a thesis regarding changes in the dominance of the medical profession. We earlier sketched the rise of medicine to dominance by World War I, its consolidation until after World War II, and signs of the start of a decline in dominance signalled by the 1962 doctors' strike in Saskatchewan. One test of the historical sequence described, and particularly the recent signs of decline in medical power, is to examine one of orthodox medicine's major competitors, chiropractic. To what degree has medicine been successful in its opposition to chiropractic? The development of chiropractic in Canada shows its early survival and latterly, in the 1960s and 1970s its increasing popular use and official recognition. Particularly important in its recent success was the establishment of a college in Canada in 1945 and partial inclusion of chiropractic under government health insurance in the 1970s. While chiropractic has gained in acceptance and recognition it has sacrificed many of its earlier claims to be an alternative healing art and to some degree chiropractic has become 'medicalized'. But medicine has also been forced to make concessions. Despite total medical opposition, chiropractic survives. The recent successes of chiropractic tend to confirm our earlier thesis of the beginnings of the decline of medical dominance and to show that medicine, while dominant, was never hegemenous. However, chiropractic did not produce medicine's current difficulties. Rather medicine is being challenged directly by state power and pressures to rationalize health care and indirectly is affected by the class struggle. Chiropractic itself owes much of its own early success to support by the working class and working class organizations such as unions. In this sense both medicine and chiropractic can only be adequately viewed both in relationship to one another and as part of the changing Canadian social structure as a whole.

Canada↗
PubMed1999

Supervision of chiropractors: a summary of results from two surveys involving chiropractic supervisors and graduates in England and Sweden.

BACKGROUND: Supervision of newly graduated health care practitioners takes place in many clinical settings, such as in different types of hospital departments, in general practice, and now also within the chiropractic profession. The author conducted an initial study to determine the most important issues regarding the supervision of chiropractic graduates in Sweden. Because it is important to define and discuss the format and contents for that part of the 1-year postgraduate education program for the newly graduated chiropractor that takes place in private chiropractic offices, a new study was conducted involving chiropractic supervisors and new graduates in Sweden and England. OBJECTIVES: To establish what chiropractic supervisors and new graduates believe is important for the graduates to learn during the clinical part of their postgraduate education, to describe the characteristics required (according to supervisors and graduates in the study) to be a good supervisor for a chiropractic graduate, and to investigate whether there are differences in opinions between supervisors and graduates and between the 2 countries. METHODS: Questionnaires were sent out to 11 Swedish chiropractic graduates, 30 English chiropractic graduates, and 30 English chiropractic supervisors who had chiropractic graduates at the time of the survey. RESULTS: Participants agreed that the most important aspect of the clinical activities was to have regular meetings with the graduate, to be professional, and to explain the patient's problems. The most important characteristic to become a good supervisor was that the supervisor is willing to spend time and listen to the graduate throughout the postgraduate training period. The Swedish participants more often considered it important to give the graduates academic articles to read. CONCLUSION: The results of this study suggest that it is the human aspect and the personal relationship between the supervisor and the graduate that are important during the graduate's 1-year postgraduate education at the chiropractic clinic. Chiropractic supervisors and new graduates both believe that one of the most important aspects of supervision is the ongoing dialogue between the supervisor and the graduate.

Chiropractic↗
PubMed1996

Torque: an appraisal of misuse of terminology in chiropractic literature and technique.

OBJECTIVE: To assess the use of the term "torque" in the chiropractic literature and to analyze its usage in chiropractic technique procedures. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: Articles were retrieved through literature searches of several indexing services [(MEDLINE, Index to Chiropractic Literature, Chiropractic Research Archives Collection (CRAC) and Chiropractic Literature Analysis and Retrieval System (ChiroLARS)] and hand searches in the technique section of a chiropractic college library. From textbooks, key terms included: Torque, Torsion, Biomechanics, Physics, Chiropractic, Nomenclature and Manipulation. For MEDLINE: Torque, Chiropractic Methods, Manipulation-Spinal Methods, Biomechanics, Nomenclature and Chiropractic Terminology. Texts and papers that discussed the word "torque" were reviewed for their association with the thrust of a spinal adjustment. Inferences of "torque" and its application were included to represent the present-day usage of the term in chiropractic. CONCLUSIONS: We believe that the term torque is misused in chiropractic literature. This misuse has been perpetuated in chiropractic college courses, student clinic examinations and state and national board examinations. We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources.

Chiropractic↗
PubMed2004

Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs.

BACKGROUND: Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations. This study ascertains the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system. METHODS: A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit. RESULTS: Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year, P<.001). Having chiropractic coverage was associated with a 1.6% decrease (P = .001) in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs (17.5 vs 22.7, P<.001), low back surgery (3.3 vs 4.8, P<.001), hospitalizations (9.3 vs 15.6, P<.001), and magnetic resonance imaging (43.2 vs 68.9, P<.001). Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). CONCLUSIONS: Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.

Adolescent↗
PubMedDate not supplied

The selection effects of the inclusion of a chiropractic benefit on the patient population of a managed health care organization.

OBJECTIVE: The aim of this study is to measure the selection effects of the inclusion of a chiropractic benefit on a managed care health plan. DESIGN: An analysis of enrollment data from a managed care health plan over a 4-year period was conducted. Employers could select the managed care plan with or without a chiropractic care benefit. Comparisons of demographic and comorbid characteristics were made between employees who had the chiropractic benefit and those who did not, and between individuals who self-selected chiropractic care and those who self-selected medical care. RESULTS: The cohort with chiropractic coverage was younger with fewer subjects in the older age group (>65 years; 6.5% vs 9.6%) and more subjects in the younger age group (0-17 years; 31.9% vs 26.2%). The mean age of the group with coverage was 32.9 compared with 35.5 in the group without coverage. Comparing self-selected chiropractic patients to self-selected medical patients, there were fewer subjects older than 65 years in the chiropractic group (4.9% vs 9.2%) and fewer subjects aged 0 to 17 years (9.4% vs 19.4%). In 6 of the 8 comorbid conditions studied, the rates were lower in the cohort with chiropractic coverage compared with the group without coverage. The rates of comorbid conditions in self-selected chiropractic patients were lower in all 8 categories compared with self-selected medical patients. CONCLUSION: The inclusion of a chiropractic benefit in a health plan produces a modest favorable selection processes resulting in a slightly younger patient population with fewer comorbidities. At the level of patient self-selection, chiropractic patients are considerably younger and healthier than comparable medical patients.

Adolescent↗
PubMedDate not supplied

Chiropractic consultation requests in the Veterans Affairs Health Care System: demographic characteristics of the initial 100 patients at the Western New York medical center.

OBJECTIVES: The objectives of this study were to review the demographic characteristics of Veterans Affairs (VA) chiropractic patients and to determine the level of appropriateness of chiropractic consultation requests within a VA chiropractic clinic. Information regarding the volume of requests and wait times for appointments were obtained to provide insight on the demand for and access to VA chiropractic services. METHODS: A purposive sample of the first 100 chiropractic consultation requests received through the Computerized Patient Record System at the VA of Western New York Health Care System was selected for data collection and analysis. RESULTS: The VA chiropractic patients in this study were primarily older men with chronic low-back pain that had not responded to medical management and other treatment modalities. More than half of the patients had service-connected disabilities. Consultation requests came largely from primary care, and most requests were for patients for whom chiropractic was clinically indicated and requested preconsultation diagnostic studies had been performed. CONCLUSIONS: The VA chiropractic patients in this study differed from traditional non-VA chiropractic patients with regard to age and sex. A review of the chiropractic consultation requests that were considered inappropriate resulted in a revision of the instructions for requesting providers within the Computerized Patient Record System. Additional health systems research is indicated to evaluate chiropractic implementation on a larger scale within the VA Health Care System.

Adult↗
PubMedDate not supplied

Chiropractic patients in Denmark: a short description of basic characteristics.

BACKGROUND: The vast majority of information on chiropractic and chiropractic patients originates from English-speaking countries. Lately, however, reports describing chiropractic patients and practice in other European countries have emerged. OBJECTIVE: To describe basic characteristics of Danish chiropractic patients. DESIGN: Survey questionnaire. All chiropractic clinics in Denmark were asked to collect information on new patients during 1 randomly assigned week in 1999. SETTING: Private chiropractic practice and a nonprofit research institution. OUTCOME MEASURES: Age and sex, location and duration of chief complaint, pain intensity, limitation of activities of daily living from chief complaint, and mode of referral. RESULTS: Eighty-eight percent of all chiropractic clinics in Denmark participated in the study. Out of 2020 patients from the participating clinics, 1897 (94%) filled out a self-administered questionnaire. The mean age of participants was 42 years, and slightly more women than men returned the questionnaire. By far the most frequent area of complaint was pain related to the lower back (50%) followed by pain related to the neck (15%). The majority of patients had complaints in the subacute or chronic category (duration 1-6 months). Patients with sciatica had significantly higher pain scores and limitation in activities of daily living (ADL) than any other group, whereas patients with neck pain tended to score lower. Patients in the subacute category had the highest pain scores and limitation in ADL. For complaints lasting more than 6 months, limitation in ADL remained constant at a low level. Twenty-three percent of all patients were referred to the chiropractor, most frequently by a general medical practitioner. More than half of all patients had previously been treated for the same or similar problems, most frequently by a chiropractor. Fifty-one percent had also received chiropractic care for other types of problems. CONCLUSIONS: Most Danish chiropractic patients complain of pain related to the low back or neck of between 1 and 6 months' duration. This study confirms that chiropractic is fairly well integrated in the Danish primary health care system. There are differences between the chiropractic patient population in Denmark compared with that of Sweden and Holland.

Adolescent↗
PubMed2006

Chiropractic services in the Canadian Armed Forces: a pilot project.

This article reports on satisfaction associated with the introduction of chiropractic services within a military hospital, through a Canadian Armed Forces Pilot Project. We distributed a 27-item survey that inquired about demographic information and satisfaction with chiropractic services to 102 military personnel presenting for on-site chiropractic services at the Archie McCallum Hospital in Halifax, Nova Scotia. We provided a second 3-item survey, designed to explore referral patterns and satisfaction with chiropractic services, to all referring military physicians. A multivariable linear regression model was constructed to explore which factors were associated with patients' satisfaction with chiropractic services. The response rate to the patient and physician satisfaction surveys was 67.6% (69 of 102) and 83.3% (10 of 12), respectively. Chronic low back pain accounted for most presentations to the hospital chiropractic clinic. The majority of military personnel (94.2%) and referring physicians (80.0%) expressed satisfaction with chiropractic services. Our adjusted analysis found that older age (beta = -0.37; 95% confidence interval = -0.73 to -0.02) and a presenting complaint of knee pain (beta = -15.56; 95% confidence interval = -29.61 to -1.51) was associated with decreased satisfaction with chiropractic care. Although our finding of high satisfaction with chiropractic services is encouraging, formal studies on functional outcomes and cost effectiveness of chiropractic care are required to better inform the role of chiropractic services in the Canadian Armed Forces.

Adult↗
PubMed2002

Chiropractic: a profession at the crossroads of mainstream and alternative medicine.

Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine. Chiropractic has taken on many of the attributes of an established profession, improving its educational and licensing systems and substantially increasing its market share in the past two decades. The public increasingly uses chiropractic largely for spinal pain syndromes and appears to be highly satisfied with the results. Of all the so-called alternative professions, chiropractic has made the largest inroads into private and public health care financing systems and is increasingly viewed as an effective specialty by many in the medical profession. Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation. This effort has helped bring spinal manipulation out of the investigational category to become one of the most studied forms of conservative treatment for spinal pain. Chiropractic theory is still controversial, but recent expansion in federal support of chiropractic research bodes well for further scientific development. The medical establishment has not yet fully accepted chiropractic as a mainstream form of care. The next decade should determine whether chiropractic maintains the trappings of an alternative health care profession or becomes fully integrated into all health care systems.

Chiropractic↗
PubMedDate not supplied

Chiropractic education: a student survey.

This study surveyed 1296 chiropractic students, 724 (55.9%) of who were in their first term, and 569 (43.9%) who were beginning their second academic year (third term/fourth quarter). From the available students in 12 of the colleges participating in this study, 73.2% responded to the three-page questionnaire. Questions included the extent and specialization of previous education, population demographics, the application process, justification for separate health care professions, attitudes concerning the integration of chiropractic principles into the curriculum, the efficacy of chiropractic adjustments, and exposure to chiropractic prior to entering chiropractic college. Results showed that chiropractic students represent individuals from all walks of life, most of whom selected chiropractic as a first choice. They clearly distinguish between chiropractic physicians and medical doctors and are overwhelmingly convinced that the chiropractic adjustment is effective, especially if they had themselves received chiropractic care. Most entered chiropractic college with a nonchiropractic family background.

Adolescent↗
PubMedDate not supplied

An interactive model of chiropractic practice: reconstructing clinical reality.

OBJECTIVE: This study proposes an interactionist model of chiropractic care, uses practice observation to ascertain whether this framework is compatible with clinical reality and explores a novel explanation of how chiropractic clinical communication may contribute to healing. DESIGN: A constructivist inquiry paradigm based upon purposive sampling, grounded theory, inductive analysis and contextual interpretation was used. The compatibility of chiropractic clinical reality with an evolving interactionist model was ascertained through reflection on contemporary literature and practice observation of 208 consultations undertaken by 34 chiropractors working in geographically dispersed areas of Australia. Sample selection used a maximum variation strategy. Triangulation of data collected was undertaken by mailing the clinical communication scenario constructed by the investigator to participating chiropractors for comment and by having 144 patients complete a questionnaire. RESULTS: Interaction observed in chiropractic practice is bidirectional, is both task- and relationship-oriented, and seems to be verbal and nonverbal in nature. Touch, whether diagnostic or therapeutic, emerged as an fundamental feature of chiropractic care. CONCLUSION: Verbal and nonverbal communication in chiropractic practice, when analyzed within a interactionist framework, can be construed to create an environment conducive to healing by establishing a shared clinical reality. The ability of the consultation to change perceptions and reduce anxiety is presented as a substantial factor contributing to the potency of the chiropractic care. The interactionist model proposed for chiropractic care was found to provide a useful framework for reconceptualizing chiropractic clinical practice. By providing an additional perspective of chiropractic practice, this model enhances discourse on the variables contributing to the success of chiropractic care.

Australia↗
PubMed1997

Legislative approaches to the regulation of the chiropractic profession.

Traditional and complementary health care services have a growing and significant role in both developed and developing countries. In the United Kingdom the British Medical Association (BMA) has identified five complementary approaches to health care that should now be regarded as "discrete clinical disciplines" because they have "established foundations of training and have the potential for greatest use alongside orthodox medical care". These are acupuncture, chiropractic, herbalism, homeopathy and osteopathy. The BMA recommended that there should be legislation to regulate these disciplines and the Chiropractors' Act enacted in the U.K in 1994. The chiropractic profession was founded in the United States in 1895, and the practice of chiropractic has been regulated in the United States and Canada since the 1920s, in Australia since the late 1940s, in New Zealand and South Africa since the 1960s, and more recently in Asia, Europe, Latin America and elsewhere. Figure 1 lists the countries which currently recognize and regulate the chiropractic profession. Many countries, such as Japan with approximately 10,000 chiropractors with different levels of education, and Trinidad & Tobago with 5 chiropractors who are graduates of accredited chiropractic colleges in North America, are considering legislation. Croatia, with 3 chiropractors, is preparing legislation. Cyprus, with 6 chiropractors, has legislation. Even in countries such as these, where the profession is small, there are compelling public interest arguments for regulation. This is especially true in the 1990s. One reason is the growing incentive for lay healers and others without formal training to use the title "chiropractor" as chiropractic practice gains increasing acceptance. The majority of chiropractic practice involves patients with non- specific or mechanical back and neck pain. The chiropractic approach to management, which includes spinal adjustment or manipulation, other physical treatments, postural advice, rehabilitative exercises and early return to activities, formally only had empirical evidence of success. Now there is firm scientific support. Recent national, evidence- based, multi-disciplinary guidelines in Canada (neck pain), the United Kingdom (back pain), and the United States (back pain) support these methods as a first line of management for most patients. Another reason for regulation is that international standards of chiropractic education and scope of practice have been established by appropriate chiropractic organizations, including the World Federation of Chiropractic which represents national associations of chiropractors in 63 countries. This paper now reviews current legislation worldwide.

Back Pain↗
PubMed2005

Chiropractic as spine care: a model for the profession.

BACKGROUND: More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. OBJECTIVE: To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. DISCUSSION: The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. CONCLUSION: This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

Journal Article↗
PubMed2006

Inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' in the peer-reviewed biomedical literature.

BACKGROUND: The misuse of the title 'chiropractor' and term 'chiropractic manipulation', in relation to injury associated with cervical spine manipulation, have previously been reported in the peer-reviewed literature. The objectives of this study were to--1) Prospectively monitor the peer-reviewed literature for papers reporting an association between chiropractic, or chiropractic manipulation, and injury; 2) Contact lead authors of papers that report such an association in order to determine the basis upon which the title 'chiropractor' and/or term 'chiropractic manipulation' was used; 3) Document the outcome of submission of letters to the editors of journals wherein the title 'chiropractor', and/or term 'chiropractic manipulation', had been misused and resulted in the over-reporting of chiropractic induced injury. METHODS: One electronic database (PubMed) was monitored prospectively, via monthly PubMed searches, during a 12 month period (June 2003 to May 2004). Once relevant papers were located, they were reviewed. If the qualifications and/or profession of the care provider/s were not apparent, an attempt was made to confirm them via direct e-mail communication with the principal researcher of each respective paper. A letter was then sent to the editor of each involved journal. RESULTS: A total of twenty four different cases, spread across six separate publications, were located via the monthly PubMed searches. All twenty four cases took place in one of two European countries. The six publications consisted of four case reports, each containing one patient, one case series, involving twenty relevant cases, and a secondary report that pertained to one of the four case reports. In each of the six publications the authors suggest the care provider was a chiropractor and that each patient received chiropractic manipulation of the cervical spine prior to developing symptoms suggestive of traumatic injury. In two of the four case reports contact with the principal researcher revealed that the care provider was not a chiropractor, as defined by the World Federation of Chiropractic. The authors of the other two case reports did not respond to my communications. In the case series, which involved twenty relevant cases, the principal researcher conceded that the term chiropractor had been inappropriately used and that his case series did not relate to chiropractors who had undergone appropriate formal training. The author of the secondary report, a British Medical Journal editor, conceded that he had misused the title chiropractor. Letters to editors were accepted and published by all four journals to which they were sent. To date one of the four journals has published a correction. CONCLUSION: The results of this year-long prospective review suggests that the words 'chiropractor' and 'chiropractic manipulation' are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' may be a significant source of over-reporting of the link between the care provided by chiropractors and injury. Finally, editors of peer-reviewed journals were amenable to publishing 'letters to editors', and to a lesser extent 'corrections', when authors had inappropriately used the title 'chiropractor' and/or term 'chiropractic manipulation'.

Journal Article↗
PubMed2001

Chiropractic hospitals in America: A case study of the Bakkum Hospital (1936-1950).

OBJECTIVE: The purpose of this article is to relate the story of the Bakkum Chiropractic Clinic and Hospital and offer evidence regarding the lost days of chiropractic hospitalization and inpatient care. DISCUSSION: The number of chiropractic facilities offering inpatient care peaked in the period between World Wars I and II. Little information is available about the vast majority of these facilities. One of them was the Bakkum Chiropractic Clinic and Hospital in Waukon, Iowa. The proprietor was Roy C. Bakkum, DC; he and his wife, Jessie H. Bakkum, DC, opened their 30-bed facility in 1936. Patients received hole-in-one chiropractic adjustments, rest, and nursing care at this facility. Dr Roy Bakkum not only envisioned chiropractors as true primary caregivers but also implemented that vision to the best of his ability. He saw chiropractic as the principal type of health care that the vast majority of people should receive, even as inpatients; instead of being the usual and customary type of hospital care, pharmaceutical and surgical intervention would be called on only as needed. Mainly because of economic pressures, the Bakkums' facility closed in 1950. CONCLUSION: The Bakkum Chiropractic Clinic and Hospital may have been fairly typical of small chiropractic facilities offering inpatient care. Like many private hospitals of various kinds, the Bakkums' facility closed in the post-World War II period, primarily because of economic and political losses. This article traces the history of one chiropractic facility to add historical context to chiropractors' long struggle to own and operate chiropractic hospitals.

Chiropractic↗
PubMed2002

Health information and promotion in chiropractic clinics.

OBJECTIVE: To explore the current health education behaviors of chiropractors, ascertain their willingness to provide patient counseling, and compare this with topics of interest to chiropractic patients. METHODS: This study involved a postal survey of 400 randomly selected members of the Chiropractic Association of Australia (35% response rate) and a semistructured interview of 316 patients attending one of 20 purposively selected chiropractic practices. Data were collated, and the current health information practices of chiropractic respondents and their willingness to undertake counseling on various topics was identified and compared with the information interests of participating patients. Particular emphasis was placed on injury prevention both with respect to patient counseling and chiropractic practice risk. RESULTS: Respondents expressed varying degrees of willingness to provide health information on diverse topics, but no clear health education chiropractic practice pattern emerged. Although expressing willingness to undertake counseling, respondents were more likely to provide health information brochures than develop a tailored health promotion contract. Health education topics ranged from exercise (91%) to osteoporosis prevention (23%). Seventy-eight percent of chiropractors were prepared to offer counseling on injury prevention, yet 45% of respondents themselves reported having some work-related injury. Maintenance care failed to emerge as a global term for describing a common core of topics or chiropractic health education practices. CONCLUSION: This study demonstrated an interest by chiropractors in providing and by chiropractic patients in obtaining health information that extends beyond spinal health. The range of relevant topics covered and modes used for health information transmission in chiropractic practice requires clarification. The prevalence of work-related injury among chiropractors suggests a need to develop safe chiropractic clinical practice protocols.

Adult↗
PubMed2006

A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study.

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To compare the long-term effectiveness of medical and chiropractic care for low back pain in managed care and to assess the effectiveness of physical therapy and modalities among patients receiving medical or chiropractic care. SUMMARY OF BACKGROUND DATA: Evidence comparing the long-term relative effectiveness of common treatment strategies offered to low back pain patients in managed care is lacking. METHODS: A total of 681 low back pain patients presenting to a managed-care facility were randomized to chiropractic with or without physical modalities, or medical care with or without physical therapy, and followed for 18 months. The primary outcome variables are low back pain intensity, disability, and complete remission. The secondary outcome is participants' perception of improvement in low back symptoms. RESULTS: Of the 681 patients, 610 (89.6%) were followed through 18 months. Among participants not assigned to receive physical therapy or modalities, the estimated improvements in pain and disability and 18-month risk of complete remission were a little greater in the chiropractic group than in the medical group (adjusted RR of remission = 1.29; 95% CI = 0.80-2.07). Among participants assigned to medical care, mean changes in pain and disability and risk of remission were larger in patients assigned to receive physical therapy (adjusted RR = 1.69; 95% CI = 1.08-2.66). Among those assigned to chiropractic care, however, assignment to methods was not associated with improvement or remission (adjusted RR = 0.98; 95% CI = 0.62-1.55). Compared with medical care only patients, chiropractic and physical therapy patients were much more likely to perceive improvement in their low back symptoms. However, less than 20% of all patients were pain-free at 18 months. CONCLUSIONS: Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care.

Academic Medical Centers↗