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Background: The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice. Methods: Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. Results: The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. Conclusions: Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations. [ABSTRACT FROM AUTHOR]

To investigate if chiropractic placement students in the United Kingdom are aware of current pain evidence and how they relate this to the management of chronic pain patients. Moreover, to gain an understanding of how this can lead to improved pain education planning and engagement in the future. The revised Neurophysiology of Pain Questionnaire and the researchers' own questionnaire were administered online to chiropractic placement students. The aggregated total number of correct responses and the individual mean scores were calculated. Statistical analysis included tests of normality and difference using the Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, and Χ2 tests. There was an overall response rate of 21.6% (n = 50). The mean score achieved on the revised neurophysiology of pain questionnaire was 37.8%. A significant difference between individual mean scores on the revised Neurophysiology of Pain Questionnaire was observed between male and female participants. No differences in mean score were observed between age, number of chronic pain patients seen, and previous qualifications. For the study-specific questionnaire, statistically significant differences were found in mean score for previous qualifications, number of patients seen, and sex. Chiropractic placement students in the United Kingdom appear to have a lower level of pain knowledge than other health care professionals and education institutions may wish to consider how to best address this within their curricula. [ABSTRACT FROM AUTHOR]

Background: Databases have become an important tool in understanding trends and correlations in health care by collecting demographic and clinical information. Analysis of data collected from large cohorts of patients can have the potential to generate insights into factors identifying treatments and the characteristics of subgroups of patients who respond to certain types of care. The Care Response (CR) database was designed to capture patient-reported outcome measures (PROMs) for chiropractic patients internationally. Although several papers have been published analysing some of the data, its contents have not yet been comprehensively documented. The primary aim of this study was to describe the information in the CR database. The secondary aim was to determine whether there was suitable information available to better understand subgroups of chiropractic patients and responsiveness to care. This would be achieved by enabling correlations among patient demographics, diagnoses, and therapeutic interventions with machine learning approaches. Methods: Data in all available fields were requested with no date restriction. Data were collected on 12 April 2022. The output was manually scanned for scope and completeness. Tables were created with categories of information. Descriptive statistics were applied. Results: The CR database collects information from patients at the first clinical visit, 14, 30, and 90 days subsequently. There were 32,468 patient responses; 3210 patients completed all fields through the 90 day follow up period. 45% of respondents were male; 54% were female; the average age was 49. There was little demographic information, and no information on diagnoses or therapeutic interventions. We received StartBack, numerical pain scale, patient global impression of change, and Bournemouth questionnaire data, but no other PROMs. Conclusions: The CR database is a large set of PROMs for chiropractic patients internationally. We found it unsuitable for machine learning analysis for our purposes; its utility is limited by a lack of demographic information, diagnoses, and therapeutic interventions. However, it can offer information about chiropractic care in general and patient satisfaction. It could form the basis for a useful clinical tool in the future, if reformed to be more accessible to researchers and expanded with more information collected. [ABSTRACT FROM AUTHOR]

Background: Safety incident (SI) reporting and learning via incident reporting systems (IRSs) is used to identify areas for patient safety improvement. The chiropractic patient incident reporting and learning system (CPiRLS) is an online IRS that was launched in the UK in 2009 and, from time to time, has been licensed for use by the national members of the European Chiropractors' Union (ECU), members of Chiropractic Australia and a Canada-based research group. The primary aim of this project was to analyse the SIs submitted to CPiRLS over a 10-year period to identify key areas for patient safety improvement. Method: All SIs reported to CPiRLS between April 2009 and March 2019 were extracted and analysed. Descriptive statistics were used to describe: (1) the frequency of SI reporting and learning by the chiropractic profession, and (2) the character of reported SIs. Key areas for patient safety improvement were developed following a mixed methods approach. Results: A total of 268 SIs were recorded on the database over the 10-year period, 85% of which originated from the UK. Evidence of learning was documented in 143 (53.4%) SIs. The largest subcategory of SIs related to post-treatment distress or pain (n = 71, 26.5%). Seven key areas for patient improvement were developed including: (1) patient trip/fall, (2) post treatment distress/pain, (3) negative effects during treatment, (4) significant post-treatment effects, (5) syncope, (6) failure to recognize serious pathology, and (7) continuity of care. Conclusion: The low number of SIs reported over a 10-year period suggests significant under-reporting, however, an upward trend was identified over the 10-year period. Several key areas for patient safety improvement have been identified for dissemination to the chiropractic profession. Improved reporting practice needs to be facilitated to improve the value and validity of reporting data. CPiRLS is important in identifying key areas for patient safety improvement. [ABSTRACT FROM AUTHOR]

Chiropractic lecturers sit at the interface between theoretical education and the transition to clinical practice. They are central to a positive and high-quality learning environment. This study aimed to explore how chiropractic students in the United Kingdom rate the importance of lecturer qualities and their influence on overall preregistration course experience. An online mixed-method questionnaire was used. Data were converted into proportions with lower and upper limits of the 95% confidence interval (CI). Likert-scale questions were treated as numeric variables with the mean, mode, median, and percentage calculated for combined responses. Thematic analysis reported patterns of data extracted from open-ended questions. Of the population of current UK chiropractic students, 195 completed the questionnaire. Five out of 12 teaching roles were rated as very important, including the ability to deliver high-quality information and evaluate the curriculum (mean = 4.71). Communication ranked as the number 1 personal quality followed by command of the subject. Lecturers were perceived as very important to overall course enjoyment (mean = 4.88) and students' ability to succeed (mean = 4.54). Students felt it was more important that lecturers were clinically active (84%; 95% CI, 78%–89%) than research active (25%; 95% CI, 19%–31%). Chiropractic students in the United Kingdom recognize the significance of lecturers in the educational experience. A range of qualities were considered important relating to overall course enjoyment and student outcomes. Clinically active lecturers facilitate student development. Of importance, students felt course evaluation and curricula development were valuable qualities in the modern-day lecturer. [ABSTRACT FROM AUTHOR]

Background: Remote consultations (RCs) enable clinicians to continue to support patients when face-to-face appointments are not possible. Restrictions to face-to-face care during the COVID-19 pandemic has accelerated a pre-existing trend for their adoption. This is true for many health professionals including some chiropractors. Whilst most chiropractors in the UK have used RCs in some form during the pandemic, others have not. This study seeks to understand the views of chiropractors not using RCs and to explore perceived potential barriers. Methods: A national online survey was completed by 534 registered practicing UK chiropractors on the use of RCs. Respondents had the opportunity of providing open-ended responses concerning lack of engagement in RCs during the COVID-19 pandemic. Textual responses obtained from 137 respondents were coded and analysed using thematic analysis. Results: The use of RCs provided an opportunity for chiropractors to deliver ongoing care during the COVID-19 pandemic. However, many chiropractors expressed concern that RCs misaligned with their strong professional identity of providing 'hands-on' care. Some chiropractors also perceived that patients expected physical interventions during chiropractic care and thus considered a lack of demand when direct contact is not possible. In the absence of a physical examination, some chiropractors had concerns about potential misdiagnosis, and perceived lack of diagnostic information with which to guide treatment. Clinic closures and change in working environment led to practical difficulties of providing remote care for a few chiropractors. Conclusions: The COVID-19 pandemic may have accelerated changes in the way healthcare is provided with RCs becoming more commonplace in primary healthcare provision. This paper highlights perceived barriers which may lead to reduced utilisation of RCs by chiropractors, some of which appear fundamental to their perceived identity, whilst others are likely amenable to change with training and experience. [ABSTRACT FROM AUTHOR]

The world's elderly population is growing at a rapid pace. This has led to an increase in demand on the health and welfare systems due to age-related disorders, with musculoskeletal complaints driving the need for rehabilitation services. However, there are concerns about health services' ability to meet this demand. While chiropractic care is gaining recognition for its benefits in treating older adults with musculoskeletal disorders, there is limited scientific literature on chiropractors' role and experiences in this area. To bridge this gap, we interviewed 21 chiropractors in Great Britain, the Netherlands, Norway, and Sweden. Inductive qualitative content analysis was used to analyse the interviews, and despite differences in integration and regulation between the countries, several common facilitators and barriers in caring for and managing older patients with musculoskeletal complaints emerged. While participants expressed optimism about future collaborations with other healthcare professionals and the integration of chiropractic into national healthcare systems, they also highlighted significant concerns regarding the existing healthcare infrastructure. The participants also felt that chiropractors, with their non-surgical and holistic approach, were well-positioned to be the primary point of contact for older patients. However, there were some common barriers, such as the affordability of care, limited integration of chiropractic, and the need to prioritise musculoskeletal complaints within public healthcare. Our findings suggest that chiropractors experience their clinical competencies as an underutilised resource in the available healthcare systems and that they could contribute to and potentially reduce the escalating burden of musculoskeletal complaints and associated costs among older patients. Additionally, our findings highlight the desire among the participants to foster collaboration among healthcare professionals and integrate chiropractic into the national public healthcare system. Integrating chiropractors as allied health professionals was also perceived to improve coordinated, patient-centred healthcare for older adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bergström et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To compare the academic equivalence of full-time (FT) and full-time equivalent (FTE) delivery routes for chiropractic training and to assess nontraditional education delivery as a viable method for training chiropractors. Methods: A retrospective analysis of student summative assessment data was undertaken on a total of 196 FT and FTE students studying for the master's in chiropractic degree at a UK chiropractic college between 2009 and graduating by 2017. The analysis consisted of within-group comparison and between-group compatisons using the Kruskil-Wallis test and the Mann-Whitney U test. Results: The demographics of the 2 student groups varied in terms of gender and age distribution. The analysis of summative data indicated no differences between the 2 routes of delivery. There was also no difference in the distribution of final degree classification outcome between the 2 routes. Conclusions: While it is possible that demographic differences influence the outcomes in each training route. this preliminary study indicates that, based only on analysis of overall achievement, there is no difference iii either FT or FTE programs iii training chiropractors. allowing them to register with the UK regulatory body. It suggests that a nontraditional mode of delivery is an achievable route to qualification as a chiropractor. enabling a greater number of students to consider chiropractic as a career choice while managing other life commitments. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare biomechanical measures of chiropractic adjustment performance of the McTimoney toggle-torque-recoil (MTTR) technique among students and chiropractors. Fifty-three participants (15 year-3 [Y3] and 16 year-5 chiropractic students and 22 McTimoney chiropractors [DCs]) participated in this study. Each applied 10 MTTR thrusts to a dynamic load cell, 5 each with their left and right hands. Biomechanical variables including preload force, peak force, time to peak force, thrust duration, and total thrust time were computed from each of the force-time histories and compared within groups using a series of 2-way analysis of variance to evaluate the effects of sex and handedness, and between groups to determine the effect of experience using a series of 3-way analysis of variance. The Games-Howell post hoc test was used to further assess pairwise comparisons. Mean time to peak force was more than 3 × shorter for DCs (69.96 ms) compared with Y3 students (230.36 ms) (P =.030). Likewise, mean thrust duration was also found to be nearly 2.5-fold significantly shorter for DCs (117.77 ms) compared with Y3 students (283.84 ms) (P =.030). The DCs took significantly less total thrust time (mean = 1.27 seconds) in administering MTTR thrusts than Y3 students (1.89 seconds) (P =.006). No significant differences were found among any of the 3 clinician groups for peak force or in time to peak force or thrust duration for comparisons of all 10 MTTR thrusts among year-5 students and DCs. Higher peak forces were observed for thrusts delivered with clinicians' dominant hands (P =.001), and the fastest thrusts were found for the dominant hands of DCs (P =.001). Sex had no significant effect on biomechanical variables. The Y3 students had significant greater variability in thrust times for each hand and for analyses of both hands combined (P =.001). Training and experience were found to result in shorter MTTR thrust times and other biomechanical variables that have been identified as important factors in the mechanisms of chiropractic adjustments. Identification of such biomechanical markers as performance outcomes may be of assistance in providing feedback for training in chiropractic education and technique application. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom. This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate. In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P <.05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P <.05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events. In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant. [ABSTRACT FROM AUTHOR]

Sociological studies of the complementary and alternative medicine (CAM) occupations have documented the professionalisation strategies these groups use to establish boundaries between themselves and their competitors, including seeking educational accreditation and statutory regulation/licensure. Chiropractic has been particularly successful at professionalising and in Australia and the UK it is taught within public universities. Recent events have threatened chiropractic's university foothold, however, showing that professionalisation needs to be understood as an ongoing process of negotiation. Based on interviews with chiropractors in Australia and the UK, this paper examines the professionalisation strategies deployed by chiropractors within and outside of the university. Highly divergent strategies are identified across different sectors of the profession, relating to defining the chiropractic paradigm, directing education and constructing professional identity. In each domain, chiropractic academics tended to prioritise building the evidence base and becoming more aligned with medicine and other allied health professions. Although some practitioners supported this agenda, others strove to preserve chiropractic's vitalistic philosophy and professional distinction. Following Bourdieu, these intra-professional struggles are interpreted as occurring within a field in which chiropractors compete for different forms of capital, pulled by two opposing poles. The differing orientations and strategies pursued at the two poles of the field point to a number of possible futures for this CAM profession, including a potential split within the profession itself. [ABSTRACT FROM AUTHOR]

This review considers the history of regulation of clinical disciplines and recent statutory approaches to complementary therapies such as osteopathy and chiropractic. It considers the role of professional organisations in promoting the need for regulation and the failure of those interested inhijamato achieve a consensus as to how best to regulate the profession and ensure that high standards are achieved and maintained. The issue of practitioner competence had been a significant factor in the regulation of both chiropractors and osteopaths.Hijamaand acupuncture share a number of features and the treatment of acupuncture as a trade provides some pointers as to ways in whichhijamamay come to be regulated in the short term. Local council monitoring, visits by “enforcers” as well as reviews of advertisements by the Advertising Standards Authority are almost inevitable and will be precipitated by negligent practitioners. A failure byhijamapractitioners to put their own house in order may lead to adverse legislation, especially if there are any serious untoward incidents. As a united approach is unlikely to materialise, the Australian negative licensing model is probably the best that can be hoped for with practitioners who contravene a general code of conduct based in statute losing the right to continue in practice. [ABSTRACT FROM PUBLISHER]

Background: Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs (i.e., the patient-practitioner relationship, patient's and practitioner's beliefs/characteristics, treatment characteristics, and environment) have not been widely evaluated by musculoskeletal practitioners. Understanding their views has the potential to improve treatment quality and effectiveness. Drawing on a panel of United Kingdom practitioners' expertise, this study aimed to investigate their perceptions of CFs during the management of patients presenting with chronic low back pain (LBP)., Methods: A modified two-round online Delphi-consensus survey was conducted to measure the extent of panel agreement regarding the perceived acceptability and influence of five main types of CFs during clinical management of patients with chronic LBP. Qualified musculoskeletal practitioners in the United Kingdom providing regular treatment for patients with chronic LBP were invited to take part., Results: The successive Delphi rounds included 39 and 23 panellists with an average of 19.9 and 21.3 years of clinical experience respectively. The panel demonstrated a high degree of consensus regarding approaches to enhance the patient-practitioner relationship (18/19 statements); leverage their own characteristics/beliefs (10/11 statements); modify the patient's beliefs and consider patient's characteristics (21/25 statements) to influence patient outcomes during chronic LBP rehabilitation. There was a lower degree of consensus regarding the influence and use of approaches related to the treatment characteristics (6/12 statements) and treatment environment (3/7 statements), and these CFs were viewed as the least important. The patient-practitioner relationship was rated as the most important CF, although the panel were not entirely confident in managing a range of patients' cognitive and emotional needs., Conclusion: This Delphi study provides initial insights regarding a panel of musculoskeletal practitioners' attitudes towards CFs during chronic LBP rehabilitation in the United Kingdom. All five CF domains were perceived as capable of influencing patient outcomes, with the patient-practitioner relationship being perceived as the most important CF during routine clinical practice. Musculoskeletal practitioners may require further training to enhance their proficiency and confidence in applying essential psychosocial skills to address the complex needs of patients with chronic LBP., (© 2023. The Author(s).)

Background: There are many professional associations representing chiropractors and chiropractic in the United Kingdom (UK). Each has its unique selling points (USPs) and chiropractors can choose to join as many as they like; however, cost of membership has to be weighed against perceived benefits. The predictors of UK chiropractic association membership and motivational factors to join these associations, have not formally been identified. This research study aimed to identify some of the factors and motivations in Welsh Institute of Chiropractic (WIOC) Alumni regarding their decision to join (or not) a UK chiropractic professional association. Methods: An online survey instrument, comprising 23 questions, was administered from November-December 2015 via a link announced on 'The WIOC Alumni' Facebook group (N = 655), the active platform for the WIOC Alumni Organisation. Results: One hundred forty-eight respondents (approximately 22.6 % of 'The WIOC Alumni' Facebook group membership) completed the survey. Ten factors were reported to be important in decision making: 'promoting public awareness of chiropractic' (91.2 %), 'access to professional indemnity insurance' (89.2 %), 'overall professionalism of the association' (87.2 %), 'the identity of the association' (77.7 %), 'positive attitude to research' (77.0 %), 'workplace support and advice' (68.9 %), 'access to events \ courses \ seminars' (64.2 %), 'Continuing Professional Development (CPD) activities' (62.2 %), 'cost of membership' (59.5 %) and 'addresses my area of interest' (56.1 %). 'Many of my friends have joined' (71.6 %) was considered unimportant, whereas 'Lobbying: Influencing policy' and 'career development' were considered important by almost twice as many as those that consider them unimportant (45.3 %: 25.7 % and 43.9 %: 27.0 % respectively), 'requirement of employment' and 'associations newsletter' were seen as unimportant by roughly twice as many as those considering them important (44.6 %: 28.4 % and 35.8 %: 28.4 % respectively). Should it become an option, almost 71 % of respondents would support the unification of the four main UK chiropractic associations, (the British, McTimoney, Scottish and United, Chiropractic Associations: BCA MCA, SCA and UCA, respectively). Conclusions: Several factors have an important effect on motivations to join UK chiropractic professional associations. Further research is required to determine if this is WIOC specific or can be extrapolated more generally. [ABSTRACT FROM AUTHOR]

This service evaluation investigated an interdisciplinary allied professional health care strategy to address the problem of suboptimal breastfeeding. A clinic of midwives and chiropractors was developed in a university-affiliated clinic in the United Kingdom to care for suboptimal feeding through a multidisciplinary approach. No studies have previously investigated the effect of such an approach. The aim was to assess any impact to the breastfeeding dyad and maternal satisfaction after attending the multidisciplinary clinic through a service evaluation. Eighty-five initial questionnaires were completed and 72 (85%) follow-up questionnaires were returned. On follow-up, 93% of mothers reported an improvement in feeding as well as satisfaction with the care provided. Prior to treatment, 26% of the infants were exclusively breastfed. At the follow-up survey, 86% of mothers reported exclusive breastfeeding. The relative risk ratio for exclusive breastfeeding after attending the multidisciplinary clinic was 3.6 (95% confidence interval = 2.4-5.4). [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is the world's leading cause of disability and yet poorly understood. Cross-national comparisons may motivate hypotheses about outcomes being condition-specific or related to cultural differences and can inform whether observations from one country may be generalised to another. This analysis of data from three cohort studies explored whether characteristics and outcomes differed between LBP patients visiting chiropractors in Sweden, Denmark and the UK.Methods: LBP patients completed a baseline questionnaire and were followed up after 3, 5, 12 and 26 weeks. Outcomes were LBP intensity (0-10 scales) and LBP frequency (0-7 days the previous week). Cohort differences were tested in mixed models accounting for repeated measures. It was investigated if any differences were explained by different baseline characteristics, and interaction terms between baseline factors and nations tested if strength of prognostic factors differed across countries.Results: The study sample consisted of 262, 947 and 453 patients from Sweden, Denmark and the UK respectively. Patient characteristics were largely similar across cohorts although some statistically significant differences were observed. The clinical course followed almost identical patterns across nations and small observed differences were not present after adjusting for baseline factors. The associations of LBP intensity and episode duration with outcome differed in strength between countries.Conclusions: Chiropractic patients with low back pain had similar characteristics and clinical course across three Northern European countries. It is unlikely that culture have substantially different impacts on the course of LBP in these countries and the results support knowledge transfer between the investigated countries. [ABSTRACT FROM AUTHOR]

Background: With increasing morbidity and mortality attributable to non-communicable disease, primary healthcare providers are urged to increasingly support people in making healthy lifestyle choices. Many chronic physical diseases associated with lifestyle behaviours have been linked to neuromusculoskeletal disorders and pain. Chiropractors, as primary healthcare professionals, are in a position to provide preventative and promotional healthcare to patients, however, it is unknown to what extent such care is provided, particularly in the United Kingdom (UK). Method: This study was a cross sectional online questionnaire distributed to four UK chiropractic associations. The responses were collected over a period of two months from March 26th 2012 to May 25th 2012. Descriptive analyses were performed to identify the trends in current practice of chiropractors in the UK. Additionally, subgroup analyses of all items were performed using Pearson Chi-Square tests to determine statistically significant differences between respondents based on gender, years in practice, educational institution and association membership. Results: Of the 2,448 members in the four participating associations, 509 chiropractors (approximately 21%) completed the survey. The great majority of UK chiropractors surveyed report evaluating and monitoring patients in regards to posture (97.1%), inactivity/overactivity (90.8%) and movement patterns (88.6%). Slightly fewer provide this type of care for psychosocial stress (82.3%), nutrition (74.1%) and disturbed sleep (72.9%). Still fewer do so for smoking (60.7%) and over-consumption of alcohol (56.4%). Verbal advice given by the chiropractor was reported as the most successful resource to encourage positive lifestyle changes as reported by 68.8% of respondents. Goal-setting is utilised by 70.7% to 80.4% of respondents concerning physical fitness issues. For all other lifestyle issues, goal-setting is used by approximately two-fifths (41.7%) or less. For smoking and over-consumption of alcohol, a mere one-fifth (20.0% and 20.6% respectively) of the responding chiropractors set goals. Conclusions: UK chiropractors are participating in promoting positive lifestyle changes in areas common to preventative healthcare and health promotion areas; however, more can be done, particularly in the areas of smoking and over-consumption of alcohol. In addition, goal-setting to support patient-provider relationships should be more widespread, potentially increasing the utility of such valuable advice and resources. [ABSTRACT FROM AUTHOR]

Background The right to prescribe drugs remains a contentious issue within the chiropractic profession. Nevertheless, drug prescription by manual therapy providers is currently an important topic. Notably, physiotherapists in the United Kingdom were recently granted limited independent prescribing rights. Reports suggest that physiotherapists in Australia now want those same rights, and as such a review of chiropractors' general attitudes toward drug prescription is needed. Objective To examine the literature concerning chiropractors' attitudes toward drug prescription rights and to compare the opinions of chiropractors currently licensed to prescribe medication with those in the profession who are not. Methods This was a narrative review, consisting of a formal literature search and summary of included articles. Electronic databases searched included the Cumulative Index to Nursing and Allied Health Literature, PubMed, and the Index to Chiropractic Literature. Inclusion criteria consisted of prospective studies published in English in peer-reviewed journals. Studies were required to contain data on chiropractors' opinions toward medication prescription rights. Results Of 33 articles identified, a total of seven surveys were included in the review. Of these, there was a general split in opinion among chiropractors regarding the right to prescribe drugs in chiropractic practice. Those supportive of prescribing rights favoured a limited number of over-the-counter and/or prescription-based medications such as analgesics, anti-inflammatories, and muscle relaxants. When questioned on full prescribing rights, however, chiropractors were generally opposed. In jurisdictions where chiropractors are currently licensed to prescribe from a limited formulary, such as in Switzerland, the majority perceived this right as an advantage for the profession. Moreover, continuing education in pharmacology was viewed as a necessary component of this privilege. Conclusions Based on the literature to date there is a general split in chiropractors' attitudes toward drug prescription rights. This split is most pronounced in countries where chiropractors are not licensed to prescribe medications. Notwithstanding, this is an important topic in chiropractic currently and warrants both further discussion and research to determine future directions and the implications of either pursuit or denial of prescription rights by chiropractors. Future surveys and/or qualitative studies of other chiropractors' opinions toward gaining prescription privileges would be timely. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to investigate motivations for studying chiropractic, and to determine what students look for in a course/college and potential barriers to studying chiropractic. Methods: The study design was a cross-sectional survey. Following IRB/Ethical approval, a paper-based questionnaire was distributed to students at McTimoney College of Chiropractic. Demographic data were compared to another chiropractic college in the United Kingdom. Results: The questionnaire response rate was 70.8% (n = 121). Motivating factors for studying chiropractic included a desire to help others (54.5%, n = 66), with 44.6% (n = 54) attracted by chiropractic's holistic, drugless approach to health. Previous help from chiropractic influenced 55.4% (n = 67) and 22.3% (n = 27) felt chiropractic had "changed their life." Just over half of the respondents (55.4%, n = 67) viewed the ability to work while studying as extremely important and 73.6% (n = 89) said they could not have studied chiropractic without this. Conclusion: Previous help from chiropractic care was a common motivation for studying chiropractic. The ability to work while studying was seen as vital by many students and, without it, the vast majority felt they could not have studied chiropractic. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented including first related to a court case between chiropractic physician Thomas Bielecki and the Director of Public Prosecutions (DPP) of Great Britain and second letter is written in response to the first letter, and third in response to an article related to cyberstalking.

Background: Two recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor. Methods: The fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author. Results: A total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi. Conclusion: Although no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia. [ABSTRACT FROM AUTHOR]

Background: The literature on chiropractic safety tends to focus on adverse events and little is known about how chiropractors ensure safety and manage risk in the course of their daily practice. The purpose of this study was to investigate how chiropractors manage potentially risky clinical scenarios. We also sought to establish how chiropractors perceive the safety climate in their workplace and thus whether there is an observable culture of safety within the profession. Methods: An online questionnaire was designed to determine which of nine management options would be chosen by the respondent in response to four defined clinical case scenarios. Safety climate within the respondent's practice setting was measured by seeking the level of agreement with 23 statements relating to six different safety dimensions. 260 licensed chiropractors in Switzerland and 1258 UK members of The Royal College of Chiropractors were invited to complete the questionnaire. Questionnaire responses were analysed quantitatively in respect of the four clinical scenarios and the nine management options to determine the likelihood of each option being undertaken, with results recorded in terms of % likelihood. Gender differences in response to the management options for each scenario were evaluated using the Mann-Whitney U (MWU) test. Positive agreement with elements comprising each of the six safety dimensions contributed to a composite '% positive agreement' score calculated for each dimension. Results: Questionnaire responses were received from 76% (200/260) of Swiss participants and 31% (393/1258) of UK members of The Royal College of Chiropractors. There was a general trend for Swiss and UK chiropractors to manage clinical scenarios where treatment appears not to be successful, not indicated, possibly harmful or where a patient is apparently getting worse, by re-evaluating their care. Stopping treatment and/or incident reporting to a safety incident reporting and learning system were generally found to be unlikely courses of action. Gender differences were observed with female chiropractors appearing to be more risk averse. Conclusions: Swiss and UK chiropractors tend to manage potentially risky clinical scenarios by re-evaluating the case. The unlikeliness of safety incident reporting is probably due to a range of recognised barriers, although Swiss and UK chiropractors are positive about local communication and openness which are important tenets for safety incident reporting. The observed positivity towards key aspects of clinic safety indicates a developing safety culture within the Swiss and UK chiropractic professions. [ABSTRACT FROM AUTHOR]

Summary: Introduction: When comparing satisfaction studies of medical and chiropractic back pain care, chiropractic care does better than medical care overall. Treatment length may be a contributing factor as may treatment frequency. There is no current literature that compares chiropractic styles and satisfaction, therefore inter-satisfaction differences between the various styles of chiropractic practice is not known. An understanding of these factors is a key part of increasing patient satisfaction and confidence. Methods: The study design was a cross sectional survey. A self-administered questionnaire was mailed out to a number of pre-recruited chiropractic clinics in varying locations in the UK. The questionnaires were completed anonymously by the patients in these clinics. Results: A total of 186/250 valid questionnaires were received, giving a response rate of 75%. Most respondents attended chiropractic clinics for the treatment of back pain. The results showed some clear and important opinions regarding treatment length and frequency. Overall satisfaction and quality of life scores were highest in clinics with treatments times over 20min. In addition clinics practising wellness care had lower satisfaction scores with higher frequency of care, than those with less frequent care sessions. Conclusion: The results would imply more emphasis is placed on patient choice for treatment frequency. This element, along with less frequency, may optimise satisfaction. The results of this study have shown that patient satisfaction is influenced by different chiropractic styles, but further studies are required to clarify a wider range of variables. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias. Methods: Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups. Results: One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively). Conclusions: In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent. [Copyright &y& Elsevier]

Increased awareness and improved tests have contributed to the identification of rising numbers of dyslexic students entering higher education in the United Kingdom. Nearly half of these students are not diagnosed until they start their HE courses. Studies of experiences of dyslexic students diagnosed as children exist; however, there is little comparable information on dyslexic students diagnosed as adults. This qualitative study explores the experiences of six students diagnosed with dyslexia after starting their Masters degrees. Their personal accounts were analysed using thematic analysis. The major themes identified were: • Distress • Self-doubt • Embarrassment • Frustration • Relief • Confidence • Motivation The findings revealed that being diagnosed with dyslexia as an adult can be cathartic or devastating depending on the individual’s current emotional status and personality. However, as they develop a deeper understanding of what dyslexia means and how it affects them as individuals, the diagnosis becomes a liberating revelation. Once the label is accepted, the individual can embrace the change in lifestyle that the diagnosis necessitates. This study provides a deeper understanding of the consequences of a late diagnosis and highlights the need for management approaches to be individually tailored to specific needs. [ABSTRACT FROM PUBLISHER]

The article focuses on the concept of defensive problem-solving practice with a view to pragmatic decision-making amenable to real-world application in order to validate the potential of 3-questions model. It mentions that clinical decision-making in chiropractic practice is not revolves on common presentation but also covers the examination and screening of presentations. It says that the 3-questions model is proposed as reference-point and guide for pragmatic decision-making by chiropractors.

The article presents a study which is aimed to identify the prognostic indicators for short-term improvement in primary care patients with acute and persistent musculoskeletal conditions. The researchers have measured the episodes of musculoskeletal pain and self-report improvement outcomes using multivariate regression analysis. The study reinforces the elusive nature of baseline characteristics that can predict early outcomes for patients with persistent painful musculoskeletal conditions.

In this article the author discusses initiatives which have been created in several European companies to improve the continuing professional development of chiropractors and the reporting rates of adverse incidents related to chiropractic care. He is supportive of the initiatives and of continuing professional development for chiropractors which relates to life long learning by reflection and evidence.

Summary: Objective: It has been demonstrated that the ‘audible release’ is not necessarily an indicator of a successful chiropractic adjustment. However, it seems widely believed that patients attribute a therapeutic value to the cracking noise. The objective of this study is to understand the patient opinion on the mechanism and perceived therapeutic value of joint cavitation, and associated audible release. Design: A qualitative semi-structured interview study. Setting: Interviews were carried out on a one to one basis at the Anglo-European College of Chiropractic (AECC). Subjects: Eight patients were recruited from the AECC clinic reception. Patients were invited to participate in the study if they had been suffering from a long-standing problem treated with manipulative chiropractic care and had attended the AECC clinic for a minimum of 4 months. Students from the AECC were excluded. Methods: Signed informed consent was gained. Interviews were recorded and transcribed verbatim. The eight transcripts were then analysed through a process of thematic analysis. Results: Patients perceived the audible release as resulting from bones being moved, or the sound to a release of gas bubbles from the joint space. Patients showed a divergence of opinion as to whether the audible release guaranteed a successful adjustment. Conclusion: Patients do not need to have a deep understanding of the mechanisms for the sound they hear. The majority of the patients associate the crack with a physical feeling of release; therefore they assume that the sound is proof of a well-achieved adjustment. Nevertheless, patients do not discard the therapeutic benefit of an adjustment that did not achieve the audible release. This appears to be due to their past experiences and their trust in the chiropractor. [Copyright &y& Elsevier]

The British Chiropractic Association recently won a libel case against the science writer and CAM ‘skeptic’ Dr Simon Singh for publishing an article in a British newspaper in which he accused them of promoting ‘bogus’ treatments. This has ignited a campaign in the UK to ‘keep the libel laws out of science’. In this article, the tension between media freedom of expression and defamation law is examined, and possible ramifications for CAM in the UK explored. [ABSTRACT FROM AUTHOR]

Objective: This study explores the implementation of consent procedures in a sample of chiropractors in the United Kingdom (UK) and the United States (US) and how well they satisfy the core ethical principles of autonomy, veracity, justice, nonmaleficence, and beneficence. Methods: A precoded questionnaire was sent to 500 geographically stratified, randomly selected chiropractors in the UK and 500 similarly selected chiropractors within 10 states (50 from each) across the US. Questionnaires were dispatched 100 per month over a 5-month period. Nonresponders were followed up twice. Quantitative data were analyzed descriptively. Qualitative data were charted and examined for emergent themes. Results: The overall response rate was 35% (346 of 1000), equating to 23% (n = 117) of the US and 46% (n = 231) of the UK cohort. Results suggest chiropractors view consent as an event rather than a process and revealed important omissions in key areas. Reasons specified for the nondisclosure of risk have important negative implications on the principles of autonomy, veracity, and justice, whereas paternalistic tendencies are indicative of tension between beneficence and paternalism. Conclusion: Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Practitioners felt that a serious adverse event occurred so infrequently that this, coupled with a lack of convincing evidence regarding the risk associated with certain treatment, rendered the routine discussion of major risk unnecessary. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is a common and costly problem. Initiatives designed to assist practitioner and patient decisions about appropriate healthcare for LBP include printed evidence-based clinical guidelines. The three professional groups of chiropractic, osteopathy and musculoskeletal physiotherapy in the UK share common ground with their approaches to managing LBP and are amongst those targeted by LBP guidelines. Even so, many seem unaware that such guidelines exist. Furthermore, the behaviour of at least some of these practitioners differs from that recommended in these guidelines. Few randomised controlled trials evaluating printed information as an intervention to change practitioner behaviour have utilised a no-intervention control. All these trials have used a cluster design and most have methodological flaws. None specifically focus upon practitioner behaviour towards LBP patients. Studies that have investigated other strategies to change practitioner behaviour with LBP patients have produced conflicting results. Although numerous LBP guidelines have been developed worldwide, there is a paucity of data on whether their dissemination actually changes practitioner behaviour. Primarily because of its low unit cost, sending printed information to large numbers of practitioners is an attractive dissemination and implementation strategy. The effect size of such a strategy, at an individual practitioner level, is likely to be small. However, if large numbers of practitioners are targeted, this strategy might achieve meaningful changes at a population level. Methods: The primary aim of this prospective, pragmatic randomised controlled trial is to test the short-term effectiveness (six-months following intervention) of a directly-posted information package on the reported clinical behaviour (primary outcome), attitudes and beliefs of UK chiropractors, osteopaths and musculoskeletal physiotherapists. We sought to randomly allocate a combined sample of 1,800 consenting practitioners to receive either the information package (intervention arm) or no information above that gained during normal practice (control arm). We collected questionnaire data at baseline and six-months post-intervention. The analysis of the primary outcome will assess between-arm differences of proportions of responses to questions on recommendations about activity, work and bed-rest, that fall within categories previously defined by an expert consensus exercise as either 'guideline-consistent' and 'guideline-inconsistent'. [ABSTRACT FROM AUTHOR]

In conjunction with its growing popularity, complementary and alternative medicine (CAM) in the United Kingdom has witnessed increasing professionalization, partly prompted by the landmark Parliamentary Inquiry that reported in November 2000. Professionalization has become a significant strategy for practitioner associations and a key focus for the government, media, and patient groups. It is being driven by concern over the interests of patients and consumers, and in relation to the possible integration of certain forms of CAM into publicly funded healthcare. It is, moreover, being reconfigured in explicitly national terms. This paper draws on research into practitioner associations representing nine CAM modalities in the UK—aromatherapy, Chinese herbal medicine, chiropractic, crystal healing, feng shui, ‘lay’ homeopathy, medical homeopathy, osteopathy, and Radionics—, examining the recent wave of professionalization in relation to Foucault''s concern with ‘techniques of the self.’ It highlights the contrasting experience of an association of Chinese herbalists seeking statutory self-regulation (SSR) and an association of chiropractors that was instrumental in securing SSR for chiropractic. [Copyright &y& Elsevier]

Recent changes in the National Health Service (NHS) in the UK have included a major push towards improving the quality of patient care and the safety of the offered services under the mantle of clinical governance. The various elements that constitute clinical governance are, in the main, just as relevant to the chiropractic profession as they are to the NHS. Some of these elements, such as “clinical risk management” and “openness and accountability” may perhaps be more challenging to adopt by organisations and their members, as changes in organisational culture are required. These issues are discussed and an opinion on how they may relate to the chiropractic profession is offered. [Copyright &y& Elsevier]

Compares the chiropractic and hospital outpatient treatment for managing low back pain in Great Britain. Effectiveness of chiropractic treatment on patients with chronic pain; Benefits of the chiropractic; Tests of the lumbar flexion and leg raising.

Asthma patients often try some form of alternative medicine. This article questions whether this is good or bad. Systematic reviews fail to demonstrate that the treatments in question are demonstrably effective. Other data raise considerable concern over the safety of some forms of alternative medicine. Thus the risk-benefit balance fails to be positive. Patients are often mislead to believe otherwise and physicians should inform their asthma patients responsibly about the value of alternative medicine. [ABSTRACT FROM AUTHOR]

The article presents the schedule of events in alternative medicine. The Canadian National Chiropractic Convention will take place in Vancouver, British Columbia in November 2006. The University of Exeter in Great Britain will present the 13th Annual Symposium on Complementary Health Care in December 2006. The American Pharmacists Association will be holding its Annual Meeting & Exposition in Atlanta, Georgia in March 2007.

David Colquhoun works on single ion channel function, both theory and experiment, and their relationship to synaptic function. He held the A.J. Clark chair of Pharmacology at UCL, and was previously honorary director of the Wellcome Laboratory for Molecular Pharmacology. He runs the Improbable Science blog. [ABSTRACT FROM AUTHOR]

The article focuses on the libel case between British science writer Simon Singh and the British Chiropractic Association in Great Britain. It notes that the British Chiropractic Association has sued Singh for libel for challenging the claims made by the association that spinal manipulation could treat several childhood health problems. It also mentions that the case has prompted the British government to reassess its libel laws.

Since 1994 chiropractic has been regulated by statute in the UK. Despite this air of respectability, a range of important problems continue to bedevil this profession. Professional organizations of chiropractic and their members make numerous claims which are not supported by sound evidence. Many chiropractors adhere to concepts which fly in the face of science and most seem to regularly violate important principles of ethical behaviour. The advice chiropractors give to their clients is often dangerously misleading. If chiropractic in the UK is to grow into an established health care profession, the General Chiropractic Council and its members should comply with the accepted standards of today's health care. [ABSTRACT FROM AUTHOR]

The article reports on the support received by British science broadcaster and writer Simon Singh from leading academics, journalists, science writers, libel lawyers and Members of Parliament (MP). Singh is facing a libel action from the British Chiropractic Association for alleging that the association is promoting unfounded treatments. At a pretrial hearing held in May 2009, a court official stated that Singh's action was defamatory. Liberal Democrat MP Evan Harris claims the ruling has a potential to undermine free scientific discourse.

The article discusses the effect of statutory regulation of osteopathy and chiropractic on research activity in Great Britain. Unlike chiropractors and osteopaths, complementary and alternative medicine (CAM) in Great Britain are not regulated by statute. Virtually all experts agree that CAM is grossly under-researched and that even the most fundamental questions about efficacy and safety cannot be answered. Current initiatives in regulating CAM should insist that research is an integral part of any regulated healthcare profession.

Addresses the issue of informed consent in British complementary medicine. Laws governing informed consent in complementary medical practice in the country; Information that should be considered necessary and relevant for obtaining informed consent; Areas of the practice that should be explained by chiropractors to patients.