Chiropractic Research Assignment

CHIROPRACTIC IDENTITY

Chiropractic Identity

The European- South African- Australian Education Collaboration, in 2014, gave a press release detailing a position statement on chiropractic training and education. It stresses the basic principles of chiropractic, being that the patients’ welfare is paramount. As a chiropractor, my practice will be founded on the principles of evidence-based healthcare1, as stipulated in the consensus statement.

In clause 2a of the consensus statement, chiropractic education institutions should take an evidence-based approach to all aspects of care for improved quality of life for patients with musculoskeletal disorders. These aspects include the case history, the physical examination, diagnosis and diagnostic imaging, report of findings and management plan2. According to Sackett3, evidence-based medicine refers to the integration of “individual clinical expertise with the best available external clinical evidence from systematic research… especially from patient-centred clinical research”. As a healthcare professional, it is very important to have facts supporting every procedure and decision made regarding a patient’s health and quality of life. The clause means I should work with other chiropractors whilst accompanying my practice with tonnes of research into new methods of alternative treatment through chiropractic.

In 1895, the first chiropractic adjustment was made, curing deafness. Wagner and Fend reported a case of a 36-year-old athlete losing hearing in his right ear suddenly, after hitting the ball with his head. He was declared completely deaf by his physician after an audiogram. However, the thoracic spine was adjusted through manipulation, and this greatly improved his hearing after a short while4. This treatment opened the way to more research on the treatment of deafness using chiropractic, including a study of various auditory function disorders caused by pathology of the cervical spine, by Svatko, Ivanichev and Sobol’ in 1987. Continued research on this connection has allowed a greater understanding of the mechanisms behind treatment of deafness using chiropractic, such as the cortical, thalamic and brainstem changes that are effected by chiropractic. Extensive research presents me and other chiropractors with undisputable evidence on methods that would otherwise be deemed unconventional, such as the one in the above-mentioned case. Collaborating with fellow chiropractors on my cases enables me a greater pool of information and skills regarding different evidence-based treatment options.

Chiropractors are not usually primary healthcare givers. Therefore, more often than not, I will be required to collaborate with other healthcare professionals in the overall goal of improving the patient’s quality of life. A patient may sometimes present with a complex condition, maybe one with many facets that cannot be handled by chiropractic alone. Seidman, Vining and Salsbury present a case report of a 65-year-old female who presented with lower back pain5. In her case, she had undergone treatment a number of times for the same problem, with no permanent solution. She had been subjected to fragmented healthcare, and potential complications to her LBP were overlooked constantly. Upon collaborative care, however, a number of underlying risk factors were discovered, among them a long-term smoking history, physical inactivity and obesity. Her lower back pain was handled through chiropractic. The professionals then explained to her that her smoking addiction impeded her recovery from her LBP, at which point the doctor of osteopathy prescribed a nicotine patch to help her get over the addiction6.

This is an example of interprofessional practice for the best result for the patients, as recommended in clause 2b of the consensus statement. As a doctor of chiropractic, I recognise overall medical language, which can be understood by all medical practitioners. I also understand that there are those terms that would only be understood by doctors of chiropractic. I will, therefore, bring on board other professionals where need be, to avoid the potential effects of fragmented healthcare, as in the case mentioned above.

Clause 2c, along with 2a and 2b, create the overall effect of an improved quality of life for the patient. In my practice, by staying up-to-date with new evidence-based methods of chiropractic, I will have sufficient knowledge of preventative measures related to musculoskeletal care. This also encompasses my role as a chiropractor in public health. For example, as a healthcare professional, it is my duty to advise the public on the health problems associated with smoking. In the case presented by Seidman et al above, the patient’s LBP was aggravated by her smoking addiction7. Other contributing factors to her LBP were obesity and physical inactivity. These are issues that need to be addressed by through public health initiatives. By regular physical activity, for instance, a whole wide range of musculoskeletal conditions can be prevented, as well as other health problems such as heart diseases. Therefore, I intend to keep advising my patients on how to prevent many conditions just by living a healthy lifestyle. I will also push chiropractic as a prevention method for other diseases such as osteoporosis.

Vertebral subluxation as the primary cause of disease is a theory that has been contested several times over the years. Inasmuch as this theory formed the backbone of chiropractic for a while before it developed, I would rather not rely on it in my practice. There has been insufficient evidence to support this theory, and my practice will be based purely on evidence-based methods. The chiropractic paradigm states that the principle of chiropractic is that the power of recuperation of the body is integrated by the nervous system8. This is a major difference between Coulter’s earlier recommendations and clause 5 of the 2014 statement.

My practice will avoid all methods of treatment that may cause undue dependency of the patient, or in any way, fail to improve the patient’s quality of life. In fact, except where absolutely necessary, I will avoid chemical medication. A recent study has shown that Nexium tablet, which are often used to treat acid reflux, in fact exacerbate the condition, causing dependence on the drugs. This is just one example of unnecessary medication that does more harm than good, that I intend to avoid in my practice.

In a paper by Gliedt et al9, based on a research in North American colleges, majority of the respondents did not think it would be a good idea to include the recommendation of medication as a part of chiropractic practice. A large percentage of the respondents would prefer if there was greater emphasis on subluxation correction. However, even more students would prefer evidence-based practice. It is therefore difficult to tell what the reception would be if the field made a transition to biopsychosocial methods from vitalistic methods, since many students seemed to want to explore newer and better-researched methods, whilst still holding on to traditional theory10. However, clause 7 of the Position Statement on Clinical and Professional Chiropractic Education 2014 offers a better way of dealing with this. By adhering to the standards of ethical practice that emphasise confidentiality, appropriate medication and relationship between the chiropractor and the patient I believe my practice will be well within clinical practice standards.

1 Clinical and Professional Chiropractic Education: a Position Statement. The European-South African-Australian Education Collaboration [press release]. 2014

3 Sackett DL. Evidence-based medicine (Editorial). Spine 1999; 23(10):1085-1086.

4 Wagner, UA. and Fend, J., 1998. Treatment of sudden deafness by manipulation of the cervical spine. Manuelle Medizin, 36(5), pp.269-271.

5 Seidman, MB, Vining RD, Salsbury SA. Collaborative care for a patient with complex low back pain and long-term tobacco use: a case report. The Journal of the Canadian Chiropractic Association. 2015 Sep;59(3):216.

8 Coulter, ID. The chiropractic paradigm. J Manipulative Physiol Ther 1990;13:279-87.

9 Gliedt JA, Hawk C, Anderson M, Ahmad K, Bunn D, Cambron J, Gleberzon B, Hart J, Kizhakkeveettil A, Perle SM, Ramcharan M. Chiropractic identity, role and future: a survey of North American chiropractic students. Chiropractic & manual therapies. 2015 Feb 2;23(1):1.

10 Howard V. Historical overview and update on subluxation theories ☆. ECHU 2010;17:22-32.