Hasil untuk "Chiropractic"

Aamer Naeem, Tanja Glucina, Muhammad Umar et al.

Objective To translate the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) into Urdu and to determine the psychometric properties of its Urdu version. Methods This cross-sectional study recruited 300 participants (18–60 years) with non-specific low back pain (NSLBP), who were able to read Urdu. Test-retest reliability was assessed using intra-class correlation coefficient (ICC), and reproducibility through Cronbach’s α. Face and content validity were examined via individual interviews, and construct validity by correlating with relevant reference standards. Exploratory factor analysis (EFA) & confirmatory factor analysis (CFA) was also carried out Results ÖMPSQ was successfully translated into Urdu version with acceptable face and content validity. ÖMPSQ Urdu version showed acceptable internal consistency (α=0.789) & good test-retest reliability (ICC=0.784, 95% confidence interval, p<0.001) while good correlation was demonstrated between ÖMPSQ and Chronic Pain Grade Scale (pain and disability subscales i.e., r=0.809 and 0.807, respectively). However, Roland-Morris Disability Questionnaire showed moderate correlation (r=0.513). Additionally, no significant floor or ceiling effects were observed in the ÖMPSQ Urdu version. EFA revealed a five-factor solution using twenty items, 89.21% was the total item variance in the database, while CFA demonstrated good model fit with strong factor loadings and acceptable fit indices Conclusion The ÖMPSQ Urdu version is valid and reliable for assessing the risk of long-term disability & workplace absence in NSLBP patients.

Logan D. Tlam, Joseph X. Anders, Maggie M. Minett et al.

Background: Intervertebral discs (IVDs) permit resilient deformability and shock absorption between vertebrae. IVD herniation from damage or disease most commonly occurs in the lumbar and cervical spines, in the posterolateral direction, and to a single IVD. This investigation seeks to examine a unique case of successive thoracic anterolateral IVD herniations with gross and magnetic resonance imaging (MRI) analyses and present the case with a literature-based clinical narrative. Methods: The case was discovered in an adult human cadaver. T1-weighted MRI was performed on the implicated spine, and serial cross-sectioning was completed through each IVD. The herniations were photographed at each stage, and linear parameters of the spinal pathologies were measured. Results: The ossified herniations extruded 11.1 ± 2.1 mm from the typical IVD border, and the ossified bridging over the vertebral bodies extruded 6.9 ± 2.6 mm from the typical vertebral body border. The extrusions displaced the functionality of the anterior longitudinal ligament 7.37 mm left of midline, and comparison of gross in situ and cross-sectional imaging with MRI illustrated the extent of IVD herniation and vertebral fusion in the clinical perspective. Conclusions: The present cadaveric case involving multiple uncommon features of IVD herniation accompanied by MRI and clinical narrative may enhance clinical awareness among spine specialists, particularly in recognizing uncommon presentations of thoracic IVD ossification and vertebral hyperostosis. This report may also serve as a valuable reference for to clinical anatomists, Doctors of Chiropractic Medicine, spine neurosurgeons, and other healthcare experts when discussing or treating related patient cases.

Daniel Alvarez, Rob Sillevis, Juan Nicolás Cuenca Zaldívar et al.

Abstract Background Cervical neural tension reflects the biomechanical and physiological responses of spinal nerves to positional changes. Although clinical tests exist for the lower cervical spinal nerve, tension patterns in the upper and mid-cervical nerves remain underexplored, limiting the diagnostic accuracy for conditions such as occipital neuralgia. Methods This cadaveric study quantified tensile load changes at the cervical spinal nerve level (C1–C5) during passive cervical spine rotation in five formalin-embalmed cadavers. Tension was measured on the cervical spinal nerves (C1–C5) using force gauges attached proximal to the division between the dorsal and ventral rami. C1 measurements were obtained from a single specimen. Two movement conditions were used: cervical flexion-rotation for C1–C3 and neutral-plane rotation for C4–C5. Results Ipsilateral increases in neural tension were observed in C1–C3 during flexion-rotation movements. By contrast, C4–C5 exhibited a consistent pattern of contralateral load increase during rotation in the neutral plane. Statistically significant variations in the tensile load were observed at the C5 level under different rotation conditions, specifically at C5 left (p = 0.003) and C5 right (p = 0.006). Post-hoc analyses of C5 measurements during neutral-plane rotation revealed significant differences between right and left rotation (p = 0.018) and between left rotation and neutral rotation (p = 0.018) on the left side, as well as between right rotation and left rotation and neutral rotation (p = 0.026, p = 0.024) on the right side. Intraclass correlation coefficients (ICC) indicated good-to-excellent reliability (ICC > 0.75), particularly at C2–C5. Conclusions Cervical rotation influenced neural tension, with distinct patterns observed between the upper cervical segments (tested under flexion-rotation) and the middle cervical segments (tested under neutral plane rotation). These exploratory findings suggest that replacing lateral neck flexion with rotation in the upper-limb tension test may represent a promising direction for future research. Additionally, the flexion-rotation test may provide a basis for clinical validation as a potential indicator of greater occipital nerve tension. These results lay the groundwork for refining neurodynamic assessments and warrant further in vivo investigation.

Casper Nim, Nicole Smith, David Starmer et al.

Abstract Background Although distinct, confidence and competence play a valuable role in healthcare education. For chiropractic students, both may be important in mastering motor skills required to perform spinal manipulative therapy (SMT). However, little is known about how individual factors influence students' confidence and competence. Better understanding of these associations would enable the development of tailored training. Therefore, this study aimed to investigate associations between demographics, anthropometrics, and prior SMT experience and confidence and competence in performing SMT with specific force–time characteristics in chiropractic students. Methods This secondary analysis of a cross-sectional study involved 149 chiropractic students who performed SMT targeting specific peak thrust forces (200 N, 400 N, 800 N). Students were assessed for competence in force–time characteristics (preload, peak thrust force, time to peak force) using the force-sensing table technology, and self-reported their confidence in performing each characteristic. Demographics, anthropometrics, and SMT experience were collected and multivariable linear and logistic regressions were used to assess associations. Results Confidence was higher in male students, students in later years of study, and those with more SMT experience. Competence in time to peak force was higher among males and third-year students, whereas males and taller students were more likely to reach the 800 N peak thrust force. No other associations were found for competencies. Conclusions While certain demographic and experiential factors are associated with increased confidence, these do not consistently translate to competence in SMT force–time characteristics. Targeted training approaches that account for individual student factors to better support them in developing their SMT motor skills are needed.

Shilpa Babbar, Karen B. Williams, Lisa Vawter

Murdi S. Alanazi, Brian Degenhardt, Gwyn Kelley-Franklin et al.

The clinical use of spinal manipulation to treat musculoskeletal conditions has nearly tripled in the United States since 1980, and it is currently recommended by most global clinical guidelines as a conservative treatment for musculoskeletal pain, despite a lack of knowledge concerning its mechanisms of action. This overview highlights evidence of direct neuromuscular responses to high-velocity, low-amplitude spinal manipulation (HVLA-SM) as delivered by chiropractic, osteopathic, and physical therapy clinicians, with an intent to foster greater interprofessional dialogue and collaborative research to better address current gaps in mechanistic knowledge of the neuromuscular response to HVLA-SM. Three databases (PubMed, CINAHL Ultimate (EBSCO), EMBASE (Elsevier)) were searched from 2000 to December 2024 with specific search terms related to thrust HVLA-SM and the neuromuscular response. To focus strictly on neuromuscular responses related to HVLA-SM, this literature overview excluded articles using non-HVLA-SM manual therapy techniques (i.e., massage, non-thrust joint mobilization, and/or combined HVLA-SM with other forms of treatment such as exercise or non-thrust joint mobilization) and studies in which patient-centered outcomes (i.e., pain scores) were the primary outcomes of the HVLA-SM interventions. Pediatric studies, animal studies, and studies in languages other than English were also excluded. One-hundred and thirty six articles were identified and included in this overview. Neuromuscular findings related to HVLA-SM in the areas of electromyography (EMG), muscle thickness, muscle strength, reflexes, electroencephalogram (EEG), and evoked potential were often mixed; however, evidence is beginning to accumulate either in favor of or opposed to particular neuromuscular responses to HVLA-SM as larger and more scientifically rigorous studies are being performed. Recurrent limitations of many HVLA-SM-related studies are small sample sizes, leading to a lack of generalizability, and the non-standardization of HVLA-SM delivery, which has prevented researchers from arriving at definitive conclusions regarding neuromuscular responses to HVLA-SM. Discussions of future neuromuscular research needs related to HVLA-SM are included for clinicians and researchers inside and outside of the field of manual therapy, to advance this field.

David Poulter, Alvisa Palese, Lia Rodeghiero et al.

G.J. Paton, S.A. Williams, S. Nalla et al.

Purpose: This study sought to establish the prevalence and morphological characteristics of lumbosacral transitional vertebrae (LSTV) in the South African population and its correlation with South African's population affinities. Methods: A retrospective review was performed of 3096 consecutive thoracic-abdominal-pelvic radiographs at two large public hospitals in South Africa. Categorisation of LSTV was classified according to Castellvi et al. (1984): Types II, III, and IV with unilateral (A) or bilateral (B) subtypes present. The three largest South African population groups (participant self-identified), namely Black African, Coloured and White population affinities were equally sampled, comprising 1032 radiographs for each population affinity. Results: The overall prevalence of LSTV was 10 % (N = 308 of 3096). Prevalence by classification/type was 67.9 %, 27.6 % and 4.5 % for II, III, and IV, respectively. The most prevalent subtype was Type IIA (41.9 %), Type IIB (26 %), Type IIIB (21.8 %), and Type IV (5.8 %), respectively. Prevalence by frequency of side was bilateral (47.7 %), left (26.6 %), right (21.1 %), while 4.5 % could not be sided (Type IV morphology). The sex distribution was 53.9 % (166/308) female and 46.1 % (142/308) male. Prevalence by population affinity was 10.5 %, 9.3 % and 9.9 % for the Black African, Coloured and White population affinities, respectively. Analyses of all groups found that the Black African and Coloured populations demonstrated two statistically significant results: greater affinity for the prevalence of sacralisation (95 % CI: 0.396–4.33, p = 0.008), and sacralisation amongst males (95 %, CI: 0.42–3.36, p = 0.010). Conclusion: This study was the first dedicated study of LSTV prevalence in a South African population. There was no significant difference in the prevalence of LSTV between the three largest population groups. Statistically, sacralisation was observed in greater proportions in the Black African and Coloured populations, particularly among males.

ZHANG Siya, LIU Xiaolong, HU Yanqi, HE Lei, XU Xiaojing, JIN Zikai, YIN Xunlu, WANG Xingyu, ZHANG Jianhua, LIANG Long

Neck pain is often caused by cervical degenerative diseases, which is easy to cause adverse effects on neck function and quality of life of patients. To provide the best and effective diagnosis and treatment plan, the National University of Health Sciences published its evidence-based clinical practice guidelines for neck pain in 2019. The author in fully study the latest version guidelines on the basis of diagnosis and treatment content, from the diagnosis, treatment, matters needing attention in three aspects, and search the relevant literature research longitudinal contrast multiple high quality neck pain guidelines, from the biomechanics and neurobiological analysis of scientific treatment, and combined with the analysis of Chinese diagnosis and treatment status that the recommended treatment and treatment process is feasible in China, based on this that should through existing evidence-based medical evidence combined with Chinese Traditional Medicine guide clinical practice, hope to reference to domestic clinical treatment today.

Chu ECP, Lee LYK

Eric Chun-Pu Chu,1,2,&ast; Linda Yin-King Lee2,&ast; 1New York Chiropractic & Physiotherapy Center, New York Medical Group, Hong Kong, Hong Kong SAR, People’s Republic of China; 2School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Eric Chun-Pu Chu, New York Chiropractic and Physiotherapy Center, 41/F Langham Place Office Tower, 8 Argyle Street, Hong Kong, Hong Kong SAR, People’s Republic of China, Tel +852-3594-7844, Fax +852-3594-6193, Email eric@nymg.com.hkAbstract: The present case study describes the long-term symptomatic remission in a patient with fibromyalgia (FM) after multimodal spinal manipulation. A 44-year-old woman presented with a chronic headache, severe neck pain, shoulder pain, and back pain lasting for 2 years after experiencing domestic violence. She had sleep disorders, fatigue, and depressive mood. Her primary care physician diagnosed her with FM and comorbid depression. Despite treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-epileptics, acupuncture, and aqua-therapy, she experienced no appreciable relief from her symptoms. The patient then sought a chiropractic evaluation and potential treatment for her symptoms. At presentation, widespread tenderness was palpable over the neck, shoulder, back, anterior chest, abdominal wall, and buttock. Radiographs showed loss of cervical lordosis, widespread degenerative spondylosis, and osteitis pubis. Surface electromyography (sEMG) revealed neck and thoracic paraspinal muscular spasms. The patient was diagnosed with FM based on the American College of Rheumatology diagnostic criteria and the associated comorbidities. Multimodal chiropractic approaches, which consisted of spinal manipulation, massage, and intermittent motorized cervical traction, were used twice weekly to relieve soft-tissues and intervertebral joints and stretch core musculatures. The patient’s physical and mental complaints were mostly resolved near the end of 9 months of treatment. Her symptom alleviation was associated with corresponding change in normalized sEMG signal and cervical spine realignment at the 16th- and 26th-month follow-ups. Widespread pain in FM can lead to confused thinking and a lack of awareness of cervical spondylosis. In this example, it is assumed that the noxious cervical inputs triggered an ongoing FM process. Chiropractic treatment blocked noxious inputs coming from pain sources, corrected pain thresholds, and lowered excitability, thereby eradicating FM symptoms.Keywords: chiropractic, degenerative spondylosis, electromyography, fibromyalgia, neck pain

Kevin K. Haussler, Amie L. Hesbach, Laura Romano et al.

Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization (<i>n</i> = 5) or manipulation (<i>n</i> = 8) of the axial skeleton. Study quality was low (<i>n</i> = 4), moderate (<i>n</i> = 7), and high (<i>n</i> = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

Zachary A. Cupler, Clinton J. Daniels, Derek R. Anderson et al.

Abstract Background Suicide is a major public health concern that has wide-reaching implications on individuals, families, and society. Efforts to respond to a public health concern as a portal-of-entry provider can reduce morbidity and mortality of patients. The objective of this commentary is a call to action to initiate dialogue regarding suicide prevention and the role the chiropractic profession may play. Discussion This public health burden requires doctors of chiropractic to realize current strengths and recognize contemporaneous deficiencies in clinical, research, and policy environments. With this better understanding, only then can the chiropractic profession strive to enhance knowledge and promote clinical acumen to target and mitigate suicide risk to better serve the public. Conclusion We implore the profession to transition from bystander to actively engaged in the culture of suicide prevention beholden to all aspects of the biopsychosocial healthcare model. The chiropractic profession’s participation in suicide prevention improves the health and wellness of one’s community while also impacting the broader public health arena.

Kristin Steinmoen Halle, Aksel Granhus

Spondylosis deformans is a spinal disease common to several dog breeds, and several treatments including veterinary chiropractic may be used to treat affected dogs. Little is known, however, about the efficacy of chiropractic treatment as precautionary measure, aiming to reduce the probability of spondylosis development. We performed a randomized study where one half of the Boxer puppies from 17 litters were given veterinary chiropractic treatment at monthly intervals from eight weeks of age until they were one year old, while the other half were given no treatment (treated: <i>n</i> = 44, controls: <i>n</i> = 43). At an age of one year, spondylosis occurrence was recorded based on a scoring of X-ray images of the spine. The frequency of occurrence was significantly lower (<i>p</i> = 0.0478) in the treated dogs (25.0%) than in the controls (46.5%). We also tested if spondylosis occurrence in the treated dogs correlated with the average number of spinal joints with decreased mobility found per chiropractic treatment. No such effect was found, however. In summary, our results suggest that veterinary chiropractic treatment may be successfully used to reduce the probability of early development of spondylosis in young Boxers.

Shawn M. Neff, Christopher B. Roecker, Casey S. Okamoto et al.

Introduction The COVID-19 pandemic led to unprecedented changes, as many state and local governments enacted stay-at-home orders and non-essential businesses were closed. State chiropractic licensing boards play an important role in protecting the public via regulation of licensure and provision of guidance regarding standards of practice, especially during times of change or uncertainty. Objective The purpose of this study was to summarize the guidance provided in each of the 50 United States, related to chiropractic practice during the COVID-19 pandemic. Methods A review of the public facing websites of governors and state chiropractic licensing boards was conducted in the United States. Data were collected regarding the official guidance provided by each state’s chiropractic licensing board as well as the issuance of stay-at-home orders and designations of essential personnel by state governors. Descriptive statistics were used to report the findings from this project. Results Each of the 50 state governor’s websites and individual state chiropractic licensing board’s websites were surveyed. Stay-at-home or shelter-in-place orders were issued in 86% of all states. Chiropractors were classified as essential providers in 54% of states, non-essential in one state (2%), and no guidance was provided in the remaining 44% of all states. Fourteen states (28%) recommended restricting visits to only urgent cases and the remaining states (72%) provided no guidance. Twenty-seven states (54%) provided information regarding protecting against infectious disease and the remaining states (46%) provided no guidance. Twenty-two states (44%) provided recommendations regarding chiropractic telehealth and the remaining states (56%) provided no guidance. Seventeen states (34%) altered license renewal requirements and eight states (16%) issued warnings against advertising misleading or false information regarding spinal manipulation and protection from COVID-19. Conclusion State guidance during the COVID-19 pandemic was heterogenous, widely variability in accessibility, and often no guidance was provided by state chiropractic licensing boards. Some state chiropractic licensing boards chose to assemble guidance for licensees into a single location, which we identified as a best practice for future situations where changes in chiropractic practice must be quickly communicated.

Claire D. Johnson

Objective The purpose of this paper is to review and discuss historical concepts about the celebration of Chiropractic Day. Discussion Daniel David Palmer attributed September 18, 1895 to be the day that he delivered the first chiropractic adjustment. As the chiropractic profession grew, the celebration of Chiropractic Day became more widespread throughout the United States and the world. This paper offers suggestions about how to celebrate Chiropractic Day. Activities include educating, learning, honoring, volunteering, and engaging. Conclusion The chiropractic profession celebrates its birth on September 18. Regardless of the many different names used over the past 125 years, including Chiropractic Founder's Day, Chiropractic Rally Day, Chiropractic Anniversary, and Chiropractic Discovery Day, the celebration of this special day provides an opportunity to reflect on how far the profession has come and how chiropractors continue to help and serve their patients.

Yüksel Uğur Yaradılmış, Ali Teoman Evren, Mustafa Caner Okkaoğlu et al.

Background: YouTube is the most popular and the largest video portal and is a source of information in all areas. In our study, we aim to investigate the quality of videos on spondylolisthesis in the YouTube video portal and to detail the parameters for low-quality videos. Material and methods: A search was made by using keyword “spondylolisthesis” on the YouTube search portal. 50 most watched videos were included in the study. The duration of the videos, view counts, like counts, dislike counts, number of comments, the date the video was published, and the video's release time were noted. Popularity of the video is determined by Video Power Index (VPI) and video quality is evaluated with DISCERN (Quality Criteria for Consumer Health Information), JAMA (Journal of the American Medical Association), and Global Quality Score (GQS) scoring systems. Video content was categorized as physician and non-physician, video length, release date, view count, daily view count, VPI, comments/year. The relationship between the groups and video quality was evaluated. Results: Video uploaders consist of 27 physicians (54%), 7 health channels, 6 physiotherapists, 4 patients, 4 hospital channels, 1 chiropractic, 1 fitness coach. The mean JAMA score was 2.7 ± 0.6 (1–4), the mean DISCERN score was 35 ± 11.1 (16–64) and the mean GQS score was 2.84 ± 1.05. DISCERN, JAMA, and GQS scores correlate among themselves. In linear regression analysis, there was a significant difference between the duration of the videos, the view counts and the video quality scores (DISCERN and JAMA) (p < 0.05), no significant difference was observed between the daily view counts, like counts, dislike counts, VPI and comment count (p > 0.05). Conclusion: The video quality of videos on Spondylolisthesis on YouTube was found to be low. Especially videos by non-physician uploaders, short videos, most viewed videos were found to have low quality.

Karl Vincent, Emeritus Olivier Gagey, Charlotte Leboeuf-Yde

Abstract Background The clinical follow-up of patients for degeneration of the supraspinatus tendon is limited by the lack of objective assessment of pain evolution over time. We therefore tested a new method to collect follow-up data on patients treated either by surgical cuff repair or rehabilitation. Objectives We report the feasibility this method in terms of recruitment of clinicians and patients and their compliance. Methods In this multicenter longitudinal observational study, between September 2015 and March 2019, patients consulting either for surgical repair or rehabilitation were examined at baseline and after twelve months by their clinician, including the Mini-DASH questionnaire. Fortnightlys, during one year, patients were asked about number of days their shoulder problem affected their daily life, number of nights woken up from shoulder pain, and present pain score, using text-messages for sending and responding to questions. A system administrator supervised responses and non-compliant subjects were contacted and assisted with the procedure. The CONSORT statement for pilot studies was followed. Results Four of 11 invited clinicians accepted participation and collected data till the end. Of the 410 patients we originally planned for, 252 were included in the study, but complete data for the clinicians’ follow-up at 12 months were missing for 30. Of the 222 subjects with SMS data files, 190 (85%) provided at least 80% of their fortnightly messages. All three SMS messages were answered equally often. In total, 160 study subjects answered at least 80% of times and had clinical data at twelve months, i.e. 39% of the intended study sample and 72% of the 222 subjects with SMS data. Conclusion The most important difficulty of this study was the enrolment and compliance of clinicians. The collection of SMS data was less successful than in previous studies, but French people accepted well this new method which is much easier and specific than collecting data through clinical records. The quality of the SMS data was acceptable. However, because of the limited number of complete datasets, only a limited number of questions from the original study protocol can be answered.

Stanley I. Innes, Vicki Cope, C. Leboeuf‐Yde et al.

BackgroundThe aim of this study was to report on key informant opinions of Councils on Chiropractic Education (CCE) regarding recent research findings reporting on improving accreditation standards and processes for chiropractic programs (CPs).MethodsThis qualitative study employed in-depth semi-structured interviews with key experienced personnel from the five CCEs in June and July of 2018. The interviews consisted of open-ended questions on a range of issues surrounding accreditation, graduate competency standards and processes. All interviews were audio-recorded, and transcribed verbatim. The transcripts were analysed to develop codes and themes using thematic analysis techniques assisted by NVivo coding software. The study followed the COREQ guidelines for qualitative studies.ResultsSix themes were isolated from the interview transcripts; they were: professional differences; keep it in the family; to focus on outcomes or be prescriptive?; more resources please; inter-profession integration; and CPs making ends meet. Most respondents saw a need for CCEs standards and processes to improve interdisciplinarity while at the same time preserving the ‘uniqueness’ of chiropractic. Additionally, informants viewed CCEs as carrying out their functions with limited resources while simultaneously dealing with vocal disparate interest groups. Diverse views were observed on how CCEs should go about their business of assessing chiropractic programs for accreditation and re-accreditation.ConclusionsAn overarching confounder for positive changes in CCE accreditation standards and processes is the inability to clearly define basic and fundamental terms such as ‘chiropractic’ and its resultant scope of practice. This is said to be because of vocal, diverse and disparate interest groups within the chiropractic profession. Silence or nebulous definitions negotiated in order to allow a diversity of chiropractic practice to co-exist, appears to have complicated and hindered the activities of CCEs. Recommendations are made including an adoption of an evidence-based approach to accreditation standards and processes and the use of expertise from other health professions. Further, the focus of attention should be moved away from professional interests and toward that of protection of the public and the patient.

David G. Russell

K. Hammerich, K. Stuber, S. Hogg-Johnson et al.

Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students’ attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs. To assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide. We conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students’ patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores. There were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17–58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals. This is the first international study assessing students’ attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.