Alan Henkin, PhD; Dennis Marchiori, DC
Background: Professionals in chiropractic education retain much of the authority over their work.
Objective: The purpose of this study is to explore associations between empowerment and organizational commitment among chiropractic faculty.
Study design: Full faculty survey utilizing descriptive statistics and multivariable analysis.
Methods: Surveys were distributed to full- and part-time faculty working in the United States and Canada. The survey included Spreitzer's multidimensional measure of psychological empowerment, Meyer and Allen's multidimensional measure of organizational commitment, and additional survey items focusing on faculty demographics and workplace variables, including sex; age; academic rank; employment status; and primary area of work assignment.
Results: More than 54% of the study population (N=609) completed and returned the instrument. A general profile of a chiropractic faculty member emerges as a middle-aged male, employed full-time as a teacher in the academic program. Regression analyses suggested that the observed faculty characteristics and workplace variables are not associated with the fit between the faculty member's work role and his or her own beliefs, norms and behaviors regarding the value of the work-related tasks.
Conclusions: The level of institutional commitment experienced by the faculty member was associated with the fit between the task, goal or purpose of the job, and the internal standards held by the individual.
Key indexing terms: Empowerment; organizational commitment; faculty; chiropractic.
An independent assessment of chiropractic practice guidelines.
Jeffrey Cates, DC; David Young, DC, PhD; David Guerriero, DC; Warren Jahn, DC; Jesse Armine, DC; Alan Korbett, DC, DO; Daniel Bowerman, DC; Robert Porter, MD; Terry Sandman, DC, MPH; Robert King, DC
Objective: To evaluate the quality of the Recommended Clinical Protocols and Guidelines for the Practice of Chiropractic (ICA guidelines), published by the International Chiropractors Association, August 2000.
Methods: The "Appraisal Instrument for Clinical Guidelines" was applied to the ICA guidelines by 10 independent, experienced evaluators. An independent, global assessment also was made by each evaluator.
Results: Mean scores (with 95% confidence limit) for each of the instrument's three dimensions were: Rigour of Development, 27% (5.1); Context and Content, 18.3% (9.4); and Application, 2% (3.9). The unanimous global assessment was "not recommended as suitable for utilization in practice." Comparison of the ICA guideline scores with CCP scores and Mercy-Cluzeau-based scores revealed that the ICA guidelines received slightly higher scores than the CCP guidelines, but substantially lower scores than the Mercy guidelines for all dimensions.
Discussion: The ICA guidelines fail to incorporate input from many of the major organizations representing the profession; to use standard methods of gathering, evaluating and reporting scientific evidence; and to clearly tie recommendations to supporting evidence. These flaws resulted in low scores in several areas of the evaluation. The ICA guidelines scored poorly across all dimensions.
Conclusion: The ICA guidelines were assessed as not suitable for utilization in chiropractic practice.
Key indexing terms: Guidelines; chiropractic; clinical practice; validity.
Research assistants' perspective of clinical trials: results of a focus group.
Jerrilyn Cambron, DC, MPH; Roni Evans, DC
Objective: To better understand the experiences and problems encountered by research assistants (RA) involved in clinical trials, to improve the process of RA training for future studies.
Design: A one-time focus group of RA was conducted.
Setting: A chiropractic college in the United States during a national chiropractic Research Agenda Conference.
Subjects: Eight RAs from two teaching institutions, directly involved in clinical trials, who have patient-centered responsibilities, such as recruiting and interviewing patients, and collecting data.
Main outcome measures: Responses to predetermined questions were compiled qualitatively. Question topics included research assistants' experiences while administering phone screens, questionnaires and informed consents.
Results: Research assistants involved in this focus group expressed they were adequately trained in telephone screening and administering informed consent, but felt they required more training in administering self-report questionnaires to patients. The majority of problems they encountered were related to a lack of information. To improve training of future RAs, more detailed study information is necessary, such as how to describe study treatments and how to give questionnaire instructions.
Conclusions: The comparability of responses by the members of this focus group was interesting. Members had similar experiences within clinical trials, and found that the problems encountered were common across studies.
Key indexing terms: Chiropractic; patient selection; randomized controlled trials.
Patient satisfaction, characteristics, radiology, and complications associated with attending a specialized government-funded multidisciplinary spinal pain unit.
Lynton Giles, PhD; Reinhold Muller, PhD; Gregory Winter, MBBS(Hons), MSpMed
Objective: To prospectively document the satisfaction of a random sample of patients attending a specialized multidisciplinary spinal pain unit in the Australian public health-care system, and to collect associated data on patient characteristics, radiological findings, treatment modalities used and any significant complications.
Design and setting: Spinal pain syndrome patients attended the specialized Multidisciplinary Spinal Pain Unit at Townsville General Hospital and the Kirwan Community Health Centre (Queensland, Australia) for diagnosis and management, i.e., chiropractic spinal manipulation, medication or needle acupuncture. A patient satisfaction questionnaire was sent to a random sample of patients in this Queensland-government-funded study approved by the health authority's Ethics Committee.
Results: 1,775 new patients (945 males, 821 females; aged 10 to 91 years; average age = 43 years) visited the unit. Medical referral accounted for 40% of patients, chiropractic for 2%, osteopathy for 1%, and other referrals for 0.7%; 40.3% were self-referred and 16% were specifically referred for a medicolegal consultation and examination following work-related or motor-vehicle-accident injuries. Thirty-nine patients (2.2%) were found to have acute pain (< 28 days). Of 941 patients who could accurately recall when symptoms first began, 69 (7.3%) presented with subacute pain (4-12 weeks), and 872 (92.7%) with chronic spinal pain syndromes (>12 weeks duration). Following extensive investigations, 1,474 (83%) patients had radiologically identifiable abnormalities, including osseous or soft-tissue anomalies. There was only one significant complication (pneumothorax) out of 7,831 acupuncture treatment sessions, representing 0.01% of patients, and 0.006% of a total of 16,936 examinations and treatments administered at the unit. The patient satisfaction questionnaire resulted in an extremely high satisfaction score.
Conclusion: A public hospital or community health-center-based specialized spinal pain syndrome unit is useful for referring clinicians who wish to obtain a further opinion for challenging spinal pain syndrome patients in the lower socioeconomic group who cannot afford private health care.
Key indexing terms: Multi-disciplinary pain centers; acupuncture; chiropractic; medicine.
Several pathways in the evolution of chiropractic manipulation.
Joseph Keating, Jr., PhD
A chiropractor's manual methods of healing have diverse origins. Unlike the older traditions of bonesetters, chiropractors apply their techniques to health problems beyond the musculoskeletal system. The ideas of the Palmers were seminal, but innovation has been a prominent characteristic in the evolution of technique, and borrowing of methods between "brand-name" techniques has been common. Manipulative strategies have also been influenced by various instruments for diagnosing (i.e., detecting) putative subluxations. Influences from beyond the profession (e.g., from osteopathy) are also apparent; chiropractors have not confined themselves to the high-velocity adjustive procedures that marked the profession's inception. Technique has been a source of controversy within the profession, but little has been done to determine the relative merits of various manual assessment and intervention procedures. The proprietary nature of many chiropractic methods has promoted both innovation and secrecy. Extensive research will be needed to separate the chaff from the wheat.
Key indexing terms: Chiropractic; history.
Effect of a topical herbal cream on osteoarthritis of the hand and knee: a pilot study.
Hugh Gemmell, DC, EdD; Bert Jacobson, EdD; Brad Hayes, DC
Objective: To compare the efficacy of an herbal ointment to a sham ointment for relieving pain and stiffness associated with osteoarthritis of the hand and knee.
Method: Single-blind, randomized, controlled clinical trial conducted in three chiropractic medicine practices. Subjects were solicited from patients attending the three centers. Selection of subjects with osteoarthritis of the hand or knee was based on the criteria developed by the American College of Rheumatology. Subjects were randomized to an active (n=17) or a sham (n=19) group. Subjects applied the herbal ointment to the affected joint(s) for 42 consecutive days and recorded level of pain and stiffness daily on visual analog scales.
Results: Thirty subjects completed the study (15 active and 15 sham). Significant differences in pain (p=.003) and stiffness (p=.0008) were found between the first 21 days of application and the last 21 days of application for the experimental group, but not for the sham group. Gain scores between the experimental and sham groups were significant for pain (p=.026) and stiffness (p=.042).
Conclusion: An herbal ointment showed significant improvement in pain and stiffness for patients with hand and knee osteoarthritis who applied the ointment to the affected joint(s) for 42 consecutive days.
Key indexing terms: Osteoarthritis; herbal medicine; complementary and alternative medicine.
Clinical and radiological manifestations of the rheumatoid wrist. A comprehensive review.
Deborah Brahee, DC; Claude Pierre-Jerome, MD, PhD; Norman Kettner, DC
Objective: To present the common clinical and radiological features of the rheumatoid wrist, as seen in everyday practice. Imaging of the rheumatoid wrist is discussed with emphasis on magnetic resonance imaging (MRI) and its current and future role in the diagnosis and treatment follow-up of the disease.
Data source: A search of the current medical literature from 1990-present through PubMed was performed without constraints. Search terms used included: MRI; rheumatoid arthritis (RA); wrist; treatment; diagnosis; radiology; clinical manifestations; and incidence.
Study selection: The articles included in this review were selected by historical significance; date of publication; pertinent review information; and most specifically, those articles studying the current uses for imaging the rheumatoid wrist.
Data synthesis: This review demonstrated an overall agreement between numerous studies that the usefulness of MRI evaluation of the rheumatoid wrist is in its early stages of development. Many of the features of this examination of the wrist are discussed and contrasted with plain-film radiographic examination.
Results: The role of the clinician in the diagnosis and treatment, including complementary care, as well as the follow-up of rheumatoid arthritis in the wrist, is unquestionable. The role of plain film examination as a diagnostic tool is excellent. The current and future role of MRI of rheumatoid arthritis is becoming obvious and will likely become the diagnostic imaging tool of choice in the near future.
Conclusion: MRI provides more specific information on rheumatoid lesions in the wrist than plain film imaging. This is especially true when intravenous contrast is utilized. The clinician's use of physical examination, laboratory examination, radiography, and MRI will provide for early diagnosis, treatment and follow-up of RA in the wrist.
Key indexing terms: Wrist; rheumatoid arthritis; diagnosis; radiography; magnetic resonance imaging.
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