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Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.

OBJECTIVE: To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN: Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING: Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS: 741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS: Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES: Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS: Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS: For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.

Adolescent↗

Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America.

BACKGROUND: Recent U.S. practice guidelines recommend spinal manipulation for some patients with low back pain. If followed, these guidelines are likely to increase the number of persons referred for chiropractic care. Concerns have been raised about the appropriate use of chiropractic care, but systematic data are lacking. OBJECTIVE: To determine the appropriateness of chiropractors' decisions to use spinal manipulation for patients with low back pain. DESIGN: Retrospective review of chiropractic office records against preset criteria for appropriateness that were developed from a systematic review of the literature and a nine-member panel of chiropractic and medical specialists. Appropriateness criteria reflect the expected balance between risk and benefit. SETTING: 131 of 185 (71%) chiropractic offices randomly sampled from sites in the United States and Canada. PATIENTS: 10 randomly selected records of patients presenting with low back pain from each office (1310 patients total). MEASUREMENTS: Sociodemographic data on patients and chiropractors; use of health care services by patients; assessment of the decision to initiate spinal manipulation as appropriate, uncertain, or inappropriate. RESULTS: Of the 1310 patients who sought chiropractic care for low back pain, 1088 (83%) had spinal manipulation. For 859 of these patients (79%), records contained data sufficient to determine whether care was congruent with appropriateness criteria. Care was classified as appropriate in 46% of cases, uncertain in 25% of cases, and inappropriate in 29% of cases. Patients who did not undergo spinal manipulation were less likely to have a presentation judged appropriate and were more likely to have a presentation judged inappropriate than were patients who did undergo spinal manipulation (P = 0.01). CONCLUSIONS: The proportion of chiropractic spinal manipulation judged to be congruent with appropriateness criteria is similar to proportions previously described for medical procedures; thus, the findings provide some reassurance about the appropriate application of chiropractic care. However, more than one quarter of patients were treated for indications that were judged inappropriate. The number of inappropriate decisions to use chiropractic spinal manipulation should be decreased.

Adult↗

Chiropractic in Australia: the first forty years (1905-1945).

The history of chiropractic in Australia is traced from the first grateful patient who also attended a course of instruction at the Palmer School and Infirmary of Chiropractic under D.D. Palmer and B.J. Palmer and brought chiropractic to Australia. The influence of Henry Otterholt--a U.S.-born Palmer graduate who was recruited by an untrained manipulator to take over his practice in order to study chiropractic at Palmer--on the early development of chiropractic in Australia and New Zealand is noted. He actively recruited students to the Palmer school, who upon graduation not only spread chiropractic in New Zealand, but also in the various states of Australia. The first twenty years saw the establishment of chiropractic practices in the capital cities of most states, but it would take more years before chiropractic was established in the capital cities. By this time country circuits had been established to serve patients in provincial centers. The advent of World War II brought further development to a standstill. This early period saw the emergence of the first group of what is considered today as the second stream in chiropractic in Australia, practitioners who would later be registered as chiropractors in the various Australian jurisdictions under grandfather clauses.

Australia↗

Mechanical force, manually assisted short lever chiropractic adjustment.

OBJECTIVES: Chiropractic mechanical force, manually assisted short lever adjusting is a spinoff of the specific toggle recoil adjusting techniques, which were based on the original chiropractic subluxation theory propounded by Daniel David Palmer in 1895. This article reviews: a) the principles of the chiropractic subluxation complex from the standpoint of its historical origin and present-day scientific status; b) the purpose and objectives of specific spinal manipulative techniques; c) the use of mechanical adjusting instruments to effect a velocity/direction controlled adjustive thrust; and d) an assessment of scientific and clinical data relating to the biomechanical and neurological aspects of mechanical force, manually assisted short lever adjusting. DATA SOURCES: Prime sources were from the National Library of Medicine's on-line Index Medicus database, the Chirolars Research Resource Retrieval database, the Chiropractic Research Abstract Collection and the Chiropractic Library Consortium's reference works. Direct search of other nonindexed chiropractic sources was limited to those available in the collection of the National Institute of Chiropractic Research. Early information never documented by publication was obtained by written personal communication. STUDY SELECTION: The principal author selected articles reporting data (as opposed to anecdotal reports) from conference proceedings and peer-reviewed journals. DATA EXTRACTION: Data quality was assessed based on experimental conditions such as sample size, study design and statistical analysis. DATA SYNTHESIS: While mechanical force, manually assisted short lever adjusting seemingly is capable of beneficially altering the cause/effect relationship of spinal subluxations, more research in the nature of controlled clinical trials is needed to ascertain its benefits in the chiropractic treatment of specific conditions. CONCLUSIONS: Basic research is needed in order to establish the scientific basis for the chiropractic subluxation syndrome regardless of the technique employed.

Biomechanical Phenomena↗

Addressing the issue of cataloging and making accessible chiropractic literature: Part II. Pilot software development program.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty, and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A solution to those problems of accessing, obtaining, and storing article citations from the chiropractic literature come from a pilot computerized program developed for use on the Los Angeles College of Chiropractic (LACC) campus. The Chiropractic Literature Archive and Search Program (CLASP) is dedicated to chiropractic literature. It provides rapid access to the literature and directs the user to one of the participating chiropractic campuses where the article can be found. Because of its ease of operation, the program is a useful tool for nearly all areas of chiropractic, ranging from education and research to clinical patient management. The program would be inexpensive to fully implement, and the hardware needed is minimal. Important protocols have been developed for database input, use and maintenance. Testing of this program on the LACC campus reveals that such a program is capable of making citations of the chiropractic literature available within days of their publication.

Abstracting and Indexing↗

Further analysis of health care costs for chiropractic and medical patients.

OBJECTIVE: To compare the health care costs of patients who have received chiropractic treatment in insurance plans that do not restrict chiropractic or medical benefits with those treated solely by medical and osteopathic physicians. DESIGN: Retrospective statistical analysis of 2 yr of claims data on total insurance payments and total outpatient payments. OUTCOME MEASURES: Total insurance payments and total outpatient payments, each adjusted for sociodemographic characteristics. RESULTS: Patients receiving chiropractic care experienced significantly lower total health care costs as represented by adjusted third-party payments in the fee-for-service sector. Total adjusted cost differences ranged from $291 to $1722 over the 2-yr period. Total adjusted outpatient costs tended to be slightly lower for medical patients but lower hospital utilization for chiropractic patients more than offsets the additional outpatient costs associated with chiropractic care. CONCLUSIONS: The analysis of well-insured patients in plans that do not restrict the chiropractic benefit strengthens results previously reported. In this study, therefore, the favorable cost patterns for chiropractic patients cannot be attributed to insurance restrictions limiting reimbursement for chiropractic services relative to other services. Because adjustments for patient characteristics systematically reduce the cost advantages of chiropractic patients as compared to mean differences derived from unadjusted data, the results also demonstrate that adjusted values should be used for meaningful comparisons between the two groups of patients.

Chiropractic↗

Costs and recurrences of chiropractic and medical episodes of low-back care.

OBJECTIVE: To compare health insurance payments and patient outcomes for recurrent episodes of care for nine common lumbar and low-back conditions initiated with chiropractic treatment vs. episodes initiated with medical treatment. DATA AND METHODS: Retrospective analysis of episodes constructed using 208 ICD-9-CM codes from 2 yr of insurance claims data for a large population of beneficiaries in the private fee-for-service sector. A total of 7077 patients were represented within 9314 episodes of care, of which 8018 episodes were initiated by clearly identified chiropractic or medical physicians. There were 1215 patients with initial physician or chiropractic-initiated episodes who had recurrent episodes. Outcome measures included total insurance payments, total outpatient payments, lengths of initial and recurrent episodes, consistent use of initiating providers for recurrent episodes and time lapsed between episodes. RESULTS: Total insurance payments within and across episodes were substantially greater for medically initiated episodes. Analysis of recurrent episodes as measures of patient outcomes indicated that chiropractic providers retain more patients for subsequent episodes, but that there is no significant difference in lapse time between episodes for chiropractic vs. medical providers. Chiropractic and medical patients were comparable on measures of severity; however, the chiropractic cohort included a greater proportion of chronic cases. CONCLUSION: Patients who "cross over" between providers for multiple episodes are more likely to return to chiropractic providers, which suggests that chronic, recurrent low-back cases may gravitate to chiropractic care over time. The findings from this and related studies point out the importance of appropriately operationalizing cost and outcome variables in analyses of care for conditions such as chronic and/or recurrent low-back pain.

Chiropractic↗

The state of the art of research on chiropractic education.

OBJECTIVE: To review the current status of research on chiropractic education, including barriers to chiropractic educational research, and provide recommendations for future research activities. DESIGN: Narrative literature review with annotated bibliography and formal consensus statements using a modified nominal group process. METHODS: A literature search from January 1985 to May 1996. The following databases were searched: Medline, Chirolars, CINAHL and ERIC. Keywords included student selection, curriculum, student learning, faculty development, performance assessment, instruction, accreditation, program evaluation, interdisciplinary education, institutional culture, governance and leadership. Conference proceedings and the personal files of the authors were searched for relevant citations. A modified nominal group process was used to generate recommendations by the education study group. RESULTS: The vast majority of current chiropractic educational research studies are descriptive in nature and receive no external funding. These studies are usually presented at chiropractic conferences and published in chiropractic journals. The annotated bibliography identifies key studies and potential models for future research. The education study group recommended that the chiropractic profession should embrace a patient-centered approach to health care and engage in research concerning all components of the educational process including assessment of students, faculty and educational programs. CONCLUSION: The field of chiropractic educational research should develop its theory and science by defining research issues and questions for investigation and then underpin them with appropriate research methodology. Studies of the chiropractic educational process is critical to the future of chiropractic education and practice.

Chiropractic↗

Chiropractic radiologists: a survey of chiropractors' attitudes and patterns of use.

OBJECTIVE: To assess the chiropractic use of radiography, referral patterns to both medical and chiropractic radiologists and attitudes toward radiologists. DESIGN: Random sample mail survey. PARTICIPANTS: Practicing U.S. chiropractors. RESULTS: The response rate was 46% (197 of 425). Seventy-four percent of the respondents have radiographic facilities in their offices. Contraindication screen (71%), pathological diagnosis (63%), biomechanics and posture (51%) and medicolegal protection (27%) were considered important reasons for taking radiographs. When chiropractors refer for radiographic services, 67% refer to medical radiologists and 17% to chiropractic radiologists. Eighty-five percent agreed that chiropractic radiologists are as well qualified as medical radiologists, but 36% thought that medical interpretation carried more legal authority than chiropractic interpretation. Seventy-six percent of respondents thought that the chiropractic radiologist should be consulted only for second opinions. CONCLUSIONS: Most chiropractors obtain radiographs for clinical reasons, such as confirming a diagnosis of pathology, but many continue to use radiography as a screening tool and for medicolegal protection. Prevailing attitudes seem to indicate a need for this specialty in chiropractic, but the chiropractic radiological consultant is not widely used. The disparity between the perceived need for chiropractic radiologists and the current utilization patterns requires further research.

Attitude of Health Personnel↗

Reliability and validity of lumbosacral spine radiograph reading by chiropractors, chiropractic radiologists, and medical radiologists.

STUDY DESIGN: A cross-sectional diagnostic study was conducted in two sessions. OBJECTIVE: To determine and compare the reliability and validity of contraindications to chiropractic treatment (infections, malignancies, inflammatory spondylitis, and spondylolysis-listhesis) detected by chiropractors, chiropractic radiologists, and medical radiologists on plain lumbosacral radiographs. SUMMARY OF BACKGROUND DATA: Plain radiography of the spine is an established part of chiropractic practice. Few studies have assessed the ability of chiropractors to read plain radiographs. METHODS: Five chiropractors, three chiropractic radiologists and five medical radiologists read a set of 300 blinded lumbosacral radiographs, 50 of which showed an abnormality (prevalence, 16.7%), in two sessions. The results were expressed in terms of reliability (percentage and kappa) and validity (sensitivity and specificity). RESULTS: The interobserver agreement in the first session showed generalized kappas of 0.44 for the chiropractors, 0.55 for the chiropractic radiologists, and 0.60 for the medical radiologists. The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. The mean sensitivity and specificity of the first round, respectively was 0.86 and 0.88 for the chiropractors, 0.90 and 0.84 for the chiropractic radiologists, and 0.84 and 0.92 for the medical radiologists. No differences in the sensitivities were found between the professional groups. The medical radiologists were more specific than the others. CONCLUSIONS: Small differences with little clinical relevance were found. All the professional groups could adequately detect contraindications to chiropractic treatment on radiographs. For this indication, there is no reason to restrict interpretation of radiographs to medical radiologists. Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors.

Chiropractic↗

Insomnia: does chiropractic help?

OBJECTIVE: To evaluate the effect of chiropractic care on insomnia. DESIGN: Tripartite pilot study. METHODS: The expectations of the chiropractic community were canvassed, a retrospective study to recall changes in sleep patterns was undertaken, and a prospective pilot study to monitor sleep patterns after chiropractic care was carried out. Convenience sampling was used. RESULTS: The 221 patients and 15 chiropractors who completed the expectation study tended to believe that patients with sleeping difficulties benefited from chiropractic care. The chiropractors were more guarded in their expectations than participating patients. One third of the 154 patients who completed the semistructured interview reported their sleep pattern was changed immediately after their chiropractic adjustment. All but 1 of these 52 patients reported improvement. Twenty patients with insomnia participated in the prospective study. Although compared with the report in their screening questionnaire, improvement was noted in certain sleep parameters in the 6 days after their adjustment, no temporal trends emerged in the days and/or weeks after the chiropractic consultation. Most patients reported experiencing less or no discomfort during the duration of the study. CONCLUSION: Although a number of patients do perceive chiropractic care offers temporary respite from their insomnia problem, when changes were more objectively monitored, improvements were erratic and no consistent temporal trends were detectable. Convincing evidence has yet to be produced before routine chiropractic care can be considered adequate intervention for patients with sleeping difficulties. More definitive answers may result from future research being undertaken in sleep laboratories.

Adult↗

Effect of chiropractic care on heart rate variability and pain in a multisite clinical study.

OBJECTIVE: The purpose of this study is to investigate the effect of chiropractic care in a multiclinic setting on sympathetic and parasympathetic nervous system activities using heart rate variability (HRV) analysis. METHODS: Physicians of chiropractic in private practice were provided with an HRV device to perform analysis before and after chiropractic adjustments on 10 subjects. At each site, 8 subjects were monitored before and after a single chiropractic adjustment, and 2 additional patients were followed for a 4-week period with 2 HRV recordings per week. Patient information forms and a visual analog scale (VAS) questionnaire were completed both before and after each chiropractic adjustment. RESULTS: Data from 96 physicians were divided into single-visit and 4-week groups. After 1 chiropractic adjustment, pain as analyzed by VAS was reduced significantly from 3.7 +/- 2.2 to 2.1 +/- 2.0 (P < .001). The mean heart rate reduced from 76.7 +/- 12.7 to 74.3 +/- 12.4 (P < .01), the SD of normal-to-normal QRS increased from a range of 55.8 to 44.6 to a range of 60.6 to 47.2 (P < .001), the high-frequency component increased from 359 +/- 968 to 444 +/- 1069 (P < .01), the low-frequency component increased from 403 +/- 753 to 465 +/- 755 (P < .05), and the total power increased from 1063 +/- 1886 to 1265 +/- 2048 (P < .01). After 4 weeks of chiropractic adjustments, pain measured by the VAS was reduced significantly before and after each visit as analyzed by t tests, but the significant changes were not found using analysis of variance analysis. The reduction of pain from each treatment was not maintained over the 4 weeks of study period. The analysis of variance on the HRV 4-week data found that changes in the SD of normal-to-normal QRS, total power, and low-frequency components reached statistically significant levels (P < .05). The heart rate and the high-frequency component did not change significantly (P > .05). CONCLUSION: In this study, HRV and VAS changed in patients as a result of chiropractic care.

Autonomic Nervous System↗

Stress management: an exploratory study of chiropractic patients.

BACKGROUND: Stress is a recognized variable in the diagnosis, management, and prognosis of musculoskeletal conditions; chiropractic care is reputed to be successful in the management of stress-related visceral conditions. It may be useful for chiropractors to include stress management as a clinical care option. OBJECTIVE: To explore screening tools to aid stress self-assessment, investigate patients' perceptions of stress management as a chiropractic care option, and examine which stress-management strategies chiropractic patients perceive as most useful. DESIGN: A multiphase qualitative study with purposive sampling of chiropractic clinics to maximize the diversity of the patient population. Convenience sampling of patients was undertaken in a Western Australian case study, an inner city, and a national exploratory study. Data for the case study were collected by semistructured interview. Questionnaires and a self-assessed stress-management task were used to collect data from the inner city and national studies. Data was thematically analyzed, and results were triangulated. RESULTS: The sample size of chiropractic patients in the West Australian case study was 48, 15 in the Western Australia exploratory study and 36 in the national study. A number of chiropractic patients participating in this study perceive themselves to be stressed and were interested in having stress-management strategies included in their chiropractic care. Individual patients preferred different stress-management options. This qualitative study found little justification for routinely using a stress-assessment technique more complex than asking the patient to rate his or her stress level as absent, minimal, moderate, or severe. Exercise, particularly walking, was found to be a prevalent pasttime among participants in the case study. CONCLUSION: This study was too small to warrant statistical analysis; nonetheless, the results of this study are relevant because some patients believe they would benefit from chiropractic care that includes information about stress-management strategies.

Adolescent↗

Chiropractic management of Ehlers-Danlos syndrome: a report of two cases.

OBJECTIVE: To discuss 2 patients with Ehlers-Danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders. CLINICAL FEATURES: Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation. INTERVENTION AND OUTCOME: Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator Methods Chiropractic Technique. Patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in Chiropractic BioPhysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and Neck Pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients. CONCLUSION: Chiropractic care may be of benefit to some patients with connective tissue disorders, including Ehlers-Danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.

Adult↗

Chiropractic treatment of postsurgical neck syndrome with mechanical force, manually assisted short-lever spinal adjustments.

OBJECTIVE: To describe a case of postsurgical neck pain, after multiple spinal surgeries, that was successfully treated by chiropractic intervention with instrumental adjustment of the cervical spine. CLINICAL FEATURES: A 35-year-old woman had chronic neck pain for over 5 years after two separate surgeries of the cervical spine: a diskectomy at C3/4 and a fusion at C5/6. Surgeries were performed 6 months apart in an attempt to resolve persistent neck pain and spasm of the cervical musculature. Neither surgery was effective in relieving the patient's pain. Five years after the second surgery, a third surgery was recommended by the patient's physicians to alleviate the chronic pain. The patient sought chiropractic evaluation of her condition to avoid further surgical intervention. INTERVENTION AND OUTCOME: The patient was treated with conservative instrumental chiropractic manipulation, consisting of mechanical force, manually assisted short-lever spinal adjustments rendered with an Activator Adjusting Instrument (AAI) II. She comfortably tolerated the treatment and responded favorably to this therapy. All chronic symptoms had resolved within 30 days of instituting the chiropractic instrumental adjustments with an AAI. More interestingly, longitudinal examination over the next 2 years showed that the patient experienced no residual effects or further recurrences of her previous chronic problem after her initial course of chiropractic care. CONCLUSION: Chiropractic treatment of postsurgical neck syndrome may be effectively treated, in certain cases, by mechanical force, manually assisted adjusting procedures with an AAI. The use of instrumental adjustment methodology may provide chiropractic physicians with an effective alternative to manual manipulation in those cases in which the patient's surgical history or presenting symptoms make forceful manipulation of the spine, particularly performed at end range, inappropriate. This approach may be contemplated by physicians faced with managing this type of condition. Further study should be made in this regard, in an academic research setting, to determine the safest and most effective approaches to managing postsurgical patients in a chiropractic setting.

Adult↗

An exploration of community leader perspectives about minority involvement in chiropractic clinical research.

OBJECTIVE: The aim of this study was to examine the perspectives of individuals in leadership or advocacy positions from two different minority groups about involvement with chiropractic clinical research. DESIGN: The narratives from two focus groups provided the primary source data. Purposive sampling was used for participant selection. Within- and across-group analyses of focus group data were conducted using a matrix consisting of the core constructs awareness, acceptance, and access. SETTING: The Palmer Center for Chiropractic Research in Davenport, Iowa, was the setting. SUBJECTS: Participants were in leadership or advocacy positions from two minority communities in the greater Quad Cities area of Iowa. Eight (8) participants were in the Hispanic/Latino focus group, and 6 were in the Black/African-American focus group. RESULTS: The findings suggest that there is limited awareness about chiropractic and chiropractic research in the Hispanic/Latino and Black/African-American communities. Cultural and ethnic representation will facilitate efforts toward increasing awareness, acceptance, and access to the community. Generational differences exist in acceptance of chiropractic and chiropractic research by both communities. Gaining the trust of the Black/African-American community is essential before they will become involved in research. Participants from both groups reported that negative beliefs by health professionals impede access to chiropractic services. The participants identified a myriad of venues and methods for collaborating with their constituents. CONCLUSIONS: Honoring the perspectives and needs of the Hispanic/Latino and the Black/African-American community is essential to facilitate participation in chiropractic clinical research. The study calls on research institutions to reconceptualize how they interact with the community to foster a more relational approach.

Adult↗

Patients using chiropractors in North America: who are they, and why are they in chiropractic care?

SUMMARY OF BACKGROUND DATA AND OBJECTIVES: Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. METHODS: The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. RESULTS: More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. CONCLUSION: These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.

Adult↗

The evolution of chiropractic orthopedists: a bootstrapping of clinical skills.

Spanning half of the chiropractic century, the development of the American Board of Chiropractic Orthopedists (ABCO) is a story of an educational bootstrapping that originated from the concerns of practicing field chirporactors. In the post World War II era, a need was determined to develop various principles and procedures of orthopedics in relation to chiropractic practice. Innovative chiropractors sought to promote greater levels of diagnostic precision within the profession by creating a post graduate program to teach advanced methods of physical and neuromusculoskeletal examination and treatment. Various specialty societies emerging after the 1947 creation of the professionally owned, non-profit Los Angeles College of Chiropractic provided a humble beginning for the task. Eventually, with its roots in the National Chiropractic Association, the ABCO and its predecessors were successful in enhancing the education of practicing doctors, instituting similar programs in chiropractic college curricula, contributing papers to chiropractic literature and providing groundwork for early chiropractic research pertaining to musculoskeletal disorders.

Chiropractic↗