This synopsis provides an overview of the benign and serious risks associated with chiropractic care for subjects with neck or low-back pain. Most adverse events associated with spinal manipulation are benign and self-limiting. The incidence of severe complications following chiropractic care and manipulation is extremely low. The best evidence suggests that chiropractic care is a useful therapy for subjects with neck or low-back pain for which the risks of serious adverse events should be considered negligible.

J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):461-4. Rubinstein SM. Institute for Research in Extramural Medicine, EMGO-Institute, VU University Medical Center, 1081 BT Amsterdam, The Netherlands. sm.rubinstein@vumc.nl

Social communication skills are critical in the health professions. The aim of this study was to measure and identify professional practice predictors of social communication skills of practicing chiropractors. METHODS: The study population was derived from a group of doctors of chiropractic who participated in a practice-based research program. Participating chiropractors agreed to complete a survey detailing the chiropractor's sex, years in practice, practice type, size of the practice community, typical weekly practice volume, and an instrument to measure skills of social communication. Regression analysis was applied to identify associations between independent variables and responses to the social skills instrument.

RESULTS: Results suggested that selected characteristics of clinical practice may be associated with clinician's social skills of communication. The weekly volume of patients to the practice emerged as a salient explanatory factor of overall social communication skills and as a factor individually for dimensions of social expressivity and social control. The practice arrangement (solo vs group) proved important in terms of respondent emotional control scores. Similarly, the solo vs group practice variable was associated with higher levels of emotional sensitivity; however, this association was mediated by the sex of the doctor of chiropractic; men reported lower levels of emotional sensitivity than women.

CONCLUSIONS: The findings of this study suggest associations between dimensions of social communication skills, practice characteristics, practice arrangements, and sex that may inform the efforts of educators as they endeavor to better prepare health professionals for practice in a wide spectrum of settings.

J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):682-9. Marchiori DM, Henkin AB, Hawk C. Academic Affairs, Palmer College of Chiropractic, Davenport, Iowa 52803, USA. marchiori_d@palmer.edu

A prospective cohort study on chiropractic patients with neck pain. OBJECTIVE: To examine the association between self-reported benign adverse events after chiropractic care for neck pain and the outcome measures namely, perceived recovery, neck pain, and neck disability.

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Prolonged use of computers during daily work activities and recreation is often cited as a cause of neck pain. This review of the literature identifies public health aspects of neck pain as associated with computer use. While some retrospective studies support the hypothesis that frequent computer operation is associated with neck pain, few prospective studies reveal causal relationships. Many risk factors are identified in the literature. Primary prevention strategies have largely been confined to addressing environmental exposure to ergonomic risk factors, since to date, no clear cause for this work-related neck pain has been acknowledged. Future research should include identifying causes of work related neck pain so that appropriate primary prevention strategies may be developed and to make policy recommendations pertaining to prevention.

JCCA J Can Chiropr Assoc. 2008 Aug;52(3):161-7. Green BN. Chiropractic Division, Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA.

The mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication. Notable improvement in the patient's symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care.

JCCA J Can Chiropr Assoc. 2008 Dec;52(4):248-55. Alcantara J, Anderson R. Research Director, International Chiropractic Pediatric Association, Media, Pa and Private Practice of Chiropractic, San Jose, CA, USA.

This study explores the extent to which consumers seek wellness care when choosing chiropractors whose practice methods are known to include periodic evaluative and interventional methods to maintain wellness and prevent illness. METHODS: Using an international convenience sample of Sacro-Occipital Technique (SOT) practitioners, 1316 consecutive patients attending 27 different chiropractic clinics in the USA, Europe and Australia completed a one-page survey on intake to assess reason for seeking care. A forced choice response was obtained characterizing the patient's reason for seeking chiropractic care. RESULTS: More than 40% of chiropractic patient visits were initiated for the purposes of health enhancement and/or disease prevention. CONCLUSION: Although prudence dictates great caution when generalizing from this study, if confirmed by subsequent research among other similar cohorts, the present results may lend support to continued arguments of consumer demand for a more comprehensive paradigm of chiropractic care, beyond routine musculoskeletal complaints, that conceptualizes the systemic, nonspecific effects of the chiropractic encounter in much broader terms.

JCCA J Can Chiropr Assoc. 2008 Aug;52(3):175-84. Blum C, Globe G, Terre L, Mirtz TA, Greene L, Globe D. Sacro Occipital Technique Organization - USA.

The manual muscle test (MMT) has been offered as a chiropractic assessment tool that may help diagnose neuromusculoskeletal dysfunction. We contend that due to the number of manipulative practitioners using this test as part of the assessment of patients, clinical guidelines for the MMT are required to heighten the accuracy in the use of this tool. OBJECTIVE: To present essential operational definitions of the MMT for chiropractors and other clinicians that should improve the reliability of the MMT as a diagnostic test. Controversy about the usefulness and reliability of the MMT for chiropractic diagnosis is ongoing, and clinical guidelines about the MMT are needed to resolve confusion regarding the MMT as used in clinical practice as well as the evaluation of experimental evidence concerning its use. DISCUSSION: We expect that the resistance to accept the MMT as a reliable and valid diagnostic tool will continue within some portions of the manipulative professions if clinical guidelines for the use of MMT methods are not established and accepted. Unreliable assessments of this method of diagnosis will continue when non-standard MMT research papers are considered representative of the methods used by properly trained clinicians. CONCLUSION: Practitioners who employ the MMT should use these clinical guidelines for improving their use of the MMT in their assessments of muscle dysfunction in patients with musculoskeletal pain.

Chiropr Osteopat. 2008 Dec 19;16(1):16. Schmitt WH Jr, Cuthbert SC.

We have investigated the attitudes towards vaccination of undergraduate chiropractic and naturopathic students in the two major complementary and alternative medicine colleges in Canada. While the majority of the students were not averse to vaccination, we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs. Reasons for this are discussed, and we provide suggestions for strategies to address the situation.

Vaccine. 2008 Nov 18;26(49):6237-43. Busse JW, Wilson K, Campbell JB. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.

The purpose of the present study was to examine chiropractic utilization following a sport-related injury among National Team members and other high level Taekwondo athletes. METHODS: Retrospective surveys were conducted among Canadian male and female Taekwondo athletes (Group A, n = 60) competing in a national tournament and National Taekwondo team athletes (Group B, n = 16) at a training camp. RESULTS: A response rate of 46.7% (Group A) and 100% (Group B) was achieved. Twenty five percent (n = 4) of Group A athletes reported never seen a doctor of chiropractic (DC) regarding their injuries. Over 12% (n = 2) reported visiting a DC often, while just over 6% (n = 1) reported that they usually visited the DC following an injury. When injured, over 36% (n = 7) of the National Team members visit their family physician, over 15% (n = 3) visit a chiropractor or physiotherapist and the remaining athletes (n = 6) equally visit osteopaths, massage therapists, or athletic therapist following an injury. CONCLUSION: There is a lack of information surrounding chiropractic utilization in the majority of sports and minimal research published regarding the health care utilization of Taekwondo athletes. Chiropractors, and particularly those with extensive athlete contact, should endeavour to further utilization studies.

Kazemi M, Shearer H. Associate Professor, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada. Email: mkazemi@cmcc.ca. JCCA J Can Chiropr Assoc. 2008 Jun;52(2):96-109.

INTRODUCTION: Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. METHODS: A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. RESULTS: Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. CONCLUSION: As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.

Terre L, Globe G, Pfefer MT. University of Missouri-Kansas City. J Chiropr Educ. 2006 Fall;20(2):128-37.

ABSTRACT: BACKGROUND: Chiropractic treatment for low back pain (LBP) can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. METHOD: The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. RESULTS: Replies were received from 59 (60%) of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. CONCLUSION: To a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of LBP.

Axén I, Rosenbaum A, Eklund A, Halasz L, Jørgensen K, Lövgren PW, Lange F, Leboeuf-Yde C. Private practice and the Karolinska Institute, Stockholm, Sweden. iben.axen@ki.se. Chiropr Osteopat. 2008 Jun 18;16:6.

OBJECTIVE: Outcome assessment normally used in research can support the therapeutic process by tracking patient symptoms and function and offering a common language to clinicians and researchers. This study's objectives were to (1) identify patient-based outcomes assessments used in published chiropractic studies, (2) describe a framework for identifying appropriate sets of measures, and (3) address the challenges associated with these measures relevant to chiropractic. METHODS: This literature review identified and evaluated the most commonly used to outcome measures in chiropractic research. Instruments were evaluated in terms of feasibility, practicality, economy, reliability, validity, and responsiveness to clinical change. A search of PubMed and Index to Chiropractic Literature (from inception to June 2006) was performed. RESULTS: A total of 1166 citations were identified. Of these, 629 were selected as relevant. The most common patient-based outcomes assessments instruments identified were the Oswestry Pain/Disability Index, Visual Analog Scale, and Short Form 36. CONCLUSIONS: The integration of outcome measures is consistent with current national initiatives to enhance health care quality through performance measurement and can also be used to further the field of chiropractic health care research. Outcome measures are both a research tool and a means by which providers can consistently measure health care quality. Based upon this review, there is a wide range of outcome measures available for use in chiropractic care. Those most commonly cited in the literature are the numeric rating scale, Visual Analog Scale, Oswestry Pain/Disability Index, Roland-Morris Low Back Pain and Disability Questionnaire, and Short Form 36.

J Manipulative Physiol Ther. 2008 Jun;31(5) Khorsan R, Coulter ID, Hawk C, Choate CG. Integrative Medicine and Military Medical Research, Samueli Institute, Corona del Mar, CA 92625, USA. rkhorsan@siib.org

Content on integrative healthcare and complementary and alternative medicine is being taught in hundreds of educational programs across the country. Nursing, medical, osteopathic, chiropractic, acupuncture, naturopathic, and other programs are finding creative and innovative ways to include these approaches in new models of education and practice. This column spotlights such innovations in integrative healthcare and CAM education and presents readers with specific educational interventions they can adapt into new or ongoing educational efforts at their institution or programs. We invite readers to submit brief descriptions of efforts in their institutions that reflect the creativity, diversity and interdisciplinary nature of the field.

Sierpina VS, Kreitzer MJ, Weeks J. University of Texas Medical Branch, Galveston, Texas, USA. Explore (NY). 2008 May-Jun;4(3):221-4.

Chiropractic physicians are seeking a higher level of cultural authority within their communities and the United States health care system. This commentary suggests an innovative strategy that might expedite the attainment of professional authority while improving the training of chiropractic students and faculty. The authors propose the founding of integrative medicine centers of excellence by colleges of chiropractic that will employ clinical faculties comprised of allopathic, chiropractic, osteopathic, and naturopathic physicians. Initially, the health care facilities should offer primary care through an integrative medicine model. It is anticipated that these centers of excellence will require both government and private funding in order to develop research programs, provide high-quality patient care, and improve the medical training for students with residents programs.

Lehman JJ, Suozzi PJ. College of Chiropractic, University of Bridgeport. J Chiropr Educ. 2008 Spring;22(1):29-33.

This report is an examination of the perceived need for business skills among chiropractors. METHODS: An online survey was completed by 64 chiropractors. They assessed the need for business skills and current levels of business skills. Using this information, gaps in business skills are identified.

RESULTS: The need for business skills is broad, encompassing all major business functions. Existing business skills are well below needed levels.

CONCLUSION: The chiropractic profession needs significantly greater business and practice management skills. The existing gap between needed business skills and existing skills suggests that current training and education programs are not providing adequate business skills training.

J Chiropr Educ. 2008 Fall;22(2):145-51. Henson SW, Pressley M, Korfmann S. Western Carolina University.

To describe a formal process designed to determine the nature and extent of change that may enhance the depth of student learning in the pre-professional, clinical chiropractic environment. METHODS: Project teams in the Royal Melbourne Institute of Technology (RMIT) School of Health Sciences and the Division of Chiropractic explored questions of clinical assessment in several health care disciplines of the School and the issue of implementing change in a manner that would be embraced by the clinicians who supervise student-learning in the clinical environment. The teams applied to RMIT for grant funding within the Learning and Teaching Investment Fund to support two proposed studies. RESULTS: Both research proposals were fully funded and are in process. DISCUSSION: The genesis of this work is the discovery that the predominant management plan in the chiropractic teaching clinics is based on diagnostic reductionism. It is felt this is counter-productive to the holistic dimensions of chiropractic practice taught in the classroom and non-supportive of chiropractic's paradigm shift towards wellness. A need is seen to improve processes around student assessment in the contemporary work-integrated learning that is a prime element of learning within the clinical disciplines of the School of Health Sciences, including chiropractic. CONCLUSION: Any improvements in the manner of clinical assessment within the chiropractic discipline will need to be accompanied by improvement in the training and development of the clinicians responsible for managing the provision of quality patient care by Registered Chiropractic Students.

J Chiropr Educ. 2008 Fall;22(2):152-60. Ebrall P, Draper B, Repka A. Division of Chiropractic RMIT University.