The identity, role, setting, and future of chiropractic practice: a survey of Australian and New Zealand chiropractic students

Luca, Katie de; Gliedt, Jordan A.; Fernandez, Matthew; Kawchuk, Greg; Swain, M. V.

doi:10.7899/jce-17-24

Cited by 16 publications

(20 citation statements)

References 23 publications

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“…For example, our data was not able to elicit information on the Australian chiropractic curriculum with respect to physical activity education, however almost 50% of Australian and New Zealand chiropractic students recently surveyed only agree (vs. 25% who strongly agree) with physical inactivity screening in the chiropractic setting. 59 This seems to contrast practice reality, with 85% Australian chiropractors often discuss physical activity in clinical practice, suggesting there may be greater room for improvement within the student curriculum. For practitioners, greater impact may be achieved by developing an accessible physical activity framework, which includes contemporary knowledge on guideline recommendations, thus encouraging further active promotion within the chiropractic setting.…”

Section: Discussionmentioning

confidence: 99%

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

Fernandez

Moore

Eklund

et al. 2019

Complementary Therapies in Medicine

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Background: Approximately one in four adults do not meet the World Health Organisation physical activity recommendations. While health promotion (i.e., physical activity) is common within chiropractic settings, little is known about chiropractors discussing this public health issue with their patients. The aim of our study is to examine the prevalence and characteristics of Australian chiropractors who frequently discuss patient physical activity. Methods: A national cross-sectional survey of chiropractors focusing upon practitioner characteristics, practice settings and clinical management characteristics. Regression analyses were conducted on 1924 survey respondents to identify factors associated with practitioners who frequently discuss physical activity with patients. Results: Eighty-five percent of Australian chiropractors reported 'often' discussing physical activity as part of their patient management. The strongest factors associated with chiropractors who frequently discuss physical activity obtained from the multivariate analysis include: often discussing occupational health and safety (odds ratio [OR] = 6.10; 95%CI: 3.88, 9.59), often discussing diet/nutrition (OR = 4.56; 95%CI: 3.12, 6.66), often discussing smoking/drugs/alcohol (OR = 4.41; 95%CI: 2.06, 9.40), often use of specific exercise therapy/rehabilitation/injury taping (OR = 3.76; 95%CI: 2.62, 5.39) and often caring for athletes or sports people (OR = 2.18; 95%CI: 1.56, 3.06) within their practice setting. Conclusion: Discussing physical activity is a frequent feature of patient management among most chiropractors in Australia. The association between these practitioners and discussion of other costly public health burdens could suggest chiropractors have a valuable role to play in chronic disease prevention. Given the growing need for practitioner-led promotion of patient physical activity further research examination of the role and contribution of chiropractors in promoting this important public health topic among patients and communities is needed.

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Section: Discussionmentioning

confidence: 99%

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

Fernandez

Moore

Eklund

et al. 2019

Complementary Therapies in Medicine

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“…A limitation of this study is that just under two-thirds of all ChiroSuisse members participated, and only half of these respondents also completed the Q-sort table. Although the overall response rate (65.4%) was high compared with many previous chiropractic surveys on medication prescription rights [ 1 , 4 , 10 , 11 , 41 , 42 ], this was not the case for the Q-survey. Therefore, it is possible that the current results are not applicable to all Swiss chiropractors.…”

Section: Discussionmentioning

confidence: 70%

Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study

Emary

Oremus

Houweling³

et al. 2020

Chiropr Man Therap

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Background Swiss chiropractors have been licensed since 1995 to prescribe from a limited formulary of medications for treating musculoskeletal (MSK) conditions. In January 2018, this formulary was expanded to include additional muscle relaxant, analgesic, and anti-inflammatory medications. Internationally, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession. Objective The purpose of this study was to assess Swiss chiropractors’ attitudes, beliefs, and practices regarding their existing medication prescription privileges. This information will provide new insights on the topic and help inform research and policy discussions about expanding chiropractic prescription rights in other jurisdictions. Methods A 13-item questionnaire and Q-methodology approach were used to conduct the assessment. Recruitment was conducted by e-mail between December 2019 and February 2020, and all members of the Swiss Chiropractic Association were eligible to participate. Data were analyzed using by-person factor analysis and descriptive statistics. Results In total, 187 Swiss chiropractors participated in this study (65.4% response rate). Respondents reported prescribing analgesics, anti-inflammatories, and muscle relaxants to a median of 5, 5, and 0% of patients, respectively. Forty-two percent of respondents expressed interest in further expanding the range of current medications available to Swiss chiropractors for treating MSK conditions. Only 15% expressed interest in expanding this range to include medications for treating non-MSK conditions. In the Q-methodology analysis, four salient viewpoints/groups regarding medication prescribing emerged: prescribers, non-prescribers, collaborators, and integrators. All except non-prescribers thought medication prescription privileges were advantageous for the chiropractic profession in Switzerland. There was also strong consensus among all four groups that medication prescribing should not replace manual therapy in chiropractic practice. Conclusion This was the first national survey on attitudes toward prescribing medications among Swiss chiropractors since the year 2000, and the first using Q-methodology. With this approach, four unique groups of chiropractic prescribers were identified. Even with diversity among clinicians, the findings of this study showed general support for, along with conservative use of, prescribing privileges within the Swiss chiropractic profession. Studies in jurisdictions outside of Switzerland are needed to assess whether chiropractors are interested in expanding their scopes of practice to include similar prescribing privileges.

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“…The strongest predictors of dissonance among chiropractic students in our analyses are geographical region, and pre-chiropractic education. Our previous study [ 11 ] and additional contemporary research on student [ 15 ] and practitioner [ 20 ] professional identity shows that chiropractic (institution) programs explain much of the variance around professional identity and practice characteristics. This implies that educational stakeholders (institutions, faculty and accreditation bodies) may be responsible for much of the dissonance that hypothetically hinders learning and distorts clinical judgement.…”

Section: Discussionmentioning

confidence: 99%

“…Chiropractic students may be subject to these differing viewpoints and may not fully comprehend the concepts and implications of a vitalistic and/or evidence-based paradigm. Recent regional studies have investigated chiropractic students’ ideology encompassing the profession’s identity and role [ 11 , 12 ]. Results suggest the potential for cognitive dissonance in students, where internal conflicts in ideology are explained by a desire or an obligation to attempt to validate historical theories of the chiropractic profession [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent regional studies have investigated chiropractic students’ ideology encompassing the profession’s identity and role [ 11 , 12 ]. Results suggest the potential for cognitive dissonance in students, where internal conflicts in ideology are explained by a desire or an obligation to attempt to validate historical theories of the chiropractic profession [ 11 , 12 ]. de Luca, et al uncovered apparent internal conflicts among students from different chiropractic institutions in Australia and New Zealand, whereby the institution contributed most towards the explanation of a chiropractic student’s ideology [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Chiropractic students’ cognitive dissonance to statements about professional identity, role, setting and future: international perspectives from a secondary analysis of pooled data

et al. 2021

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Background Chiropractic students demonstrate philosophically opposing views about the chiropractic profession. The primary aim was to describe chiropractic students’ responses to statements about chiropractic identity, role, setting, and future direction. A secondary aim was to describe the frequency of internally conflicting responses. Methods Three datasets from Europe, North America, and Australia/New Zealand were pooled in a secondary data analysis. Chiropractic students from 25 chiropractic training institutions completed interrelating surveys (combined response rate 21.9%) between 2013 and 2018. The survey instrument investigated student viewpoints about chiropractic professional identity, role, practice setting and future direction of chiropractic practice. Student attitudes about chiropractic were described using weighted proportions to adjust for unequal population sampling across the three geographical regions. The frequency of concordant and discordant student responses was described by combining identity items with items that explored responses about practice role, setting and future direction. The relationship between student characteristics (age, sex, education, association membership and geographical region) and ideologically conflicting responses were assessed using the Chi-squared test and Cramér’s V. Results Data from 2396 student chiropractors (50.8% female; from Europe 36.2%, North America 49.6% and Australia/New Zealand 14.5%) were analysed. For identity, nearly half of the chiropractic students (weighted 45.1%) agreed that it is important for chiropractors to hold strongly to the traditional chiropractic theory that adjusting the spine corrects “dis-ease” and agreed (weighted 55.5%) that contemporary and evolving scientific evidence is more important than traditional chiropractic principles. The frequency of discordant (ideologically conflicting) student responses ranged from 32.5% for statements about identity versus role, to 51.4% for statements about identity versus future. There was no association between student age, sex and internally conflicting responses. Chiropractic students’ professional association membership status, pre-chiropractic education and geographical region were associated with ideologically conflicting responses. Conclusions Chiropractic students in this analysis show traditional and progressive attitudes towards the chiropractic profession. Individual student responses frequently contradict in terms of professional ideology, but most (approximately half) students demonstrate concordant progressive and mainstream attitudes. Ideological conflict may raise concerns about some students’ ability to learn and make clinical judgements, and potential for disharmony in the chiropractic fraternity.

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The identity, role, setting, and future of chiropractic practice: a survey of Australian and New Zealand chiropractic students

Cited by 16 publications

References 23 publications

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

The prevalence and determinants of physical activity promotion by Australian chiropractors: A cross sectional study

Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study

Chiropractic students’ cognitive dissonance to statements about professional identity, role, setting and future: international perspectives from a secondary analysis of pooled data

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