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Challenges of the Past, Challenges of the Present

By |May 3, 2018|Chiropractic Education|

Challenges of the Past,
Challenges of the Present

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SOURCE:   J Chiropractic Humanities 2015 (Nov 18); 22 (1): 30–46

Scott Haldeman, DC, MD, PhD

Adjunct Professor,
Department of Epidemiology,
School of Public Health,
University of California,
Los Angeles, CA.


The McAndrews Leadership Lecture was developed by the American Chiropractic Association to honor the legacy of Jerome F. McAndrews, DC, and George P. McAndrews, JD, and their contributions to the chiropractic profession. This article is a transcription of the presentation made by Dr Scott Haldeman on February 28, 2015, in Washington, DC, at the National Chiropractic Leadership Conference.

KEYWORDS:   Chiropractic; History; Humanities; Philosophy


The Full-Text Lecture:

The McAndrews Leadership Lecture by Scott Haldeman, DC, MD, PhD

Thank you, Christine (Goertz, DC, PhD), for your kind words. I also want to thank George (P. McAndrews, JD) for his wonderful presentation and for the discussion. We all appreciate what George has done. In addition, I want to thank Lou (Sportelli, DC), one of my oldest and best friends. The profession would not be where it is if it were not for you.

This was a difficult talk to prepare. I received a request from Tony (W. Hamm, DC) to do the inaugural McAndrews Leadership Lecture. I told him that normally when I lecture, I present statistics and graphs and lots of different numbers and figures. For this lecture, I thought something different would be in order. So I am going to try something new, although I am not sure it is going to work. I am going to make it very personal, primarily because Jerry and George played a very important part in my professional life and growth. In this presentation, I want to explain how the world has evolved over the last 50 years and include how the McAndrews brothers played a part in this evolution.

I want start by having you imagine an 18-year-old kid from South Africa who arrives in Davenport, IA, on New Year’s Eve in a snowstorm. His father was a chiropractor, and his grandmother was the very first chiropractor ever to practice in Canada. And, unlike George, this young man received his first adjustment at the age of 2 days old. (I cannot beat them all.) Growing up in a chiropractic household, adjustments were the first treatment consideration for any illness. However, we primarily grew up with an understanding that the body has an innate ability to heal itself provided it is taken care of. Adjustments were not the cure for everything, but adjustments were given when needed.

I was an 18-year-old kid who arrives in a snowstorm in Davenport, but my ride does not show up. I ended up sitting at the edge of the airport, in the snowstorm, waiting until they closed and switched the lights off. Luckily, a Palmer student who was a taxi driver came by on his last rounds, picked me up, and dropped me off at a frat house for a New Year’s Eve party.

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The Swiss Master in Chiropractic Medicine Curriculum: Preparing Graduates to Work Together With Medicine to Improve Patient Care

By |December 19, 2016|Chiropractic Education|

The Swiss Master in Chiropractic Medicine Curriculum: Preparing Graduates to Work Together With Medicine to Improve Patient Care

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SOURCE:   J Chiro Humanities 2016 (Dec);   23 (1):   53–60

B. Kim Humphreys, DC, PhD,
Cynthia K. Peterson, DC, MMedEd

Chiropractic Medicine Department,
University Hospital Balgrist,
University of Zürich,
Zürich, Switzerland


OBJECTIVE:   In 2007, chiropractic became 1 of the 5 medical professions in Switzerland. This required a new chiropractic program that was fully integrated within a Swiss medical school. The purpose of this article was to discuss the Master in Chiropractic Medicine (MChiroMed) program at the University of Zürich, including advantages, opportunities, and challenges.

DISCUSSION:   In 2008, the MChiroMed program began with its first student cohort. The MChiroMed program is a 6-year Bologna model 2-cycle (bachelor and master) “spiral curriculum,” with the first 4 years being fully integrated within the medical curriculum. A review of the main features of the curriculum revealed the advantages, opportunities, and challenges of this program in comparison with other contemporary chiropractic educational programs. Advantages and opportunities include an integrated curriculum within a university, medical school, and musculoskeletal hospital, with their associated human and physical resources. Many opportunities exist for high-level research collaborations. The rigorous entrance qualifications and small student cohorts result in bright, motivated, and enthusiastic students; appropriate assessments; and timely feedback on academic and clinical subjects. Early patient contact in hospitals and clinical facilities encourages the integration of academic theory and clinical practice. The main challenges faced by this program include difficulty recruiting a sufficient number of students because of the rigorous entrance requirements and curriculum overload resulting from undertaking a full medical curriculum and chiropractic modules.

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Chiropractic Identity:
A Neurological, Professional, and Political Assessment

By |July 31, 2016|Chiropractic Education|

Chiropractic Identity:
A Neurological, Professional, and Political Assessment

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SOURCE:   J Chiropractic Humanities 2016 (Jul 20); 20: 1–11

Anthony L. Rosner, PhD, LLD (Hon)

Private Practice
Watertown, MA


Objective   The purpose of this article is to propose a focused assessment of the identity of chiropractic and its profession, triangulating multiple viewpoints converging upon various aspects and definitions of neurology, manual medicine, and alternative or mainstream medicine.

Discussion   Over 120 years since its inception, chiropractic has struggled to achieve an identity for which its foundations could provide optimal health care. Despite recognition of the benefits of spinal manipulation in various government guidelines, advances in US military and Veterans Administration, and persistently high levels of patient satisfaction, the chiropractic profession remains underrepresented in most discussions of health care delivery. Distinguishing characteristics of doctors of chiropractic include the following:

(1)   they embrace a model of holistic, preventive medicine (wellness);

(2)   they embrace a concept of neurological imbalance in which form follows function, disease follows disturbed biochemistry, and phenomenology follows physiology;

(3)   they diagnose, and their institutions of training are accredited by a body recognized by the US Department of Education;

(4)   they manage patients on a first-contact basis, often as primary care providers in geographical areas that are underserved;

(5)   the spine is their primary — but not exclusive — area of interaction;

(6)   they deliver high-velocity, low-amplitude adjustments with a superior safety record compared with other professions; and

(7)   they use a network of institutions worldwide that have shown increasing commitments to research.

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A Diagnosis-based Clinical Decision Rule For Spinal Pain Part 2: Review Of The Literature

By |January 13, 2014|Chiropractic Education, Clinical Decision-making, Diagnosis, Spinal Manipulation|

A Diagnosis-based Clinical Decision Rule For Spinal Pain Part 2: Review Of The Literature

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SOURCE:   Chiropractic & Osteopathy 2008 (Aug 11); 16: 7

Donald R Murphy, Eric L Hurwitz, and Craig F Nelson

Rhode Island Spine Center,
Pawtucket, RI 02860, USA


BACKGROUND:   Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented.

METHODS:   The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors’ libraries were searched.

RESULTS:   A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity.

CONCLUSION:   Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.


From the FULL TEXT Article:

Introduction

Accurate diagnosis or classification of patients with spinal pain has been identified as a research priority [1]. We presented in Part 1 the theoretical model of an approach to diagnosis in patients with spinal pain [2]. This approach incorporated the various factors that have been found, or in some cases theorized, to be of importance in the generation and perpetuation of neck or back pain into an organized scheme upon which a management strategy can be based. The authors termed this approach a diagnosis-based clinical decision rule (DBCDR). The DBCDR is not a clinical prediction rule. It is an attempt to identify aspects of the clinical picture in each patient that are relevant to the perpetuation of pain and disability so that these factors can be addressed with interventions designed to improve them. The purpose of this paper is to review the literature on the methods involved in the DBCDR regarding reliability and validity and to identify those areas in which the literature is currently lacking.

The Three Essential Questions of Diagnosis

The DBCDR is based on what the authors refer to as the 3 essential questions of diagnosis [2]. The answers to these questions supply the clinician with the most important information that is required to develop an individualized diagnosis from which a management strategy can be derived.

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Evidence-Based Practice and Chiropractic Care

By |August 5, 2013|Chiropractic Education, Evidence-based Medicine|

Evidence-Based Practice and Chiropractic Care

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SOURCE:   J Evid Based Comp Altern Med. 2012 (Dec 28); 18 (1): 75-79

Ron LeFebvre, MA, DC, David Peterson, DC, and Mitchell Haas, MA, DC

University of Western States,
Portland, OR, USA.


Evidence-based practice has had a growing impact on chiropractic education and the delivery of chiropractic care. For evidence-based practice to penetrate and transform a profession, the penetration must occur at 2 levels. One level is the degree to which individual practitioners possess the willingness and basic skills to search and assess the literature. Chiropractic education received a significant boost in this realm in 2005 when the National Center for Complementary and Alternative Medicine awarded 4 chiropractic institutions R25 education grants to strengthen their research/evidence-based practice curricula. The second level relates to whether the therapeutic interventions commonly employed by a particular health care discipline are supported by clinical research. A growing body of randomized controlled trials provides evidence of the effectiveness and safety of manual therapies.


Introduction

The use of complementary and alternative medicine has increased dramatically during the past several decades. [1, 2] Estimates based on the 2002 National Health Interview Survey reveal that 62.1% of US adults used complementary and alternative medicine therapies during the previous year. [3] Chiropractic is the largest complementary and alternative medicine profession in the United States, with approximately 70 000 members, [4] and chiropractic services account for the greatest number of complementary and alternative medicine visits. [1] In 2002, approximately 7.4% of Americans consulted a chiropractor for treatment. [2] Chiropractic is a well-established part of the health care delivery system, included under Medicare and Medicaid laws, with worker’s compensation coverage in all 50 states. Insurance coverage for chiropractic is also quite extensive. Approximately 50% of health maintenance organizations and 75% of private health insurance plans cover chiropractic care.

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