Chiropractic as spine care: a model for the profession

Chiropractic & Osteopathy - Tập 13 - Trang 1-17 - 2005
Craig F Nelson1, Dana J Lawrence2, John J Triano3, Gert Bronfort4, Stephen M Perle5, R Douglas Metz1, Kurt Hegetschweiler1, Thomas LaBrot1
1American Specialty Health, San Diego, USA
2Palmer Centre for Chiropractic Research, Palmer College of Chisopractic, Davenport, USA
3Texas Back Institute, Plano, USA
4Northwestern Health Sciences University, Bloomington, USA
5University of Bridgeport, Bridgeport, USA

Tóm tắt

More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

Tài liệu tham khảo

Ryan J: Measuring subluxation; A report on public response. Chiropractic Business. 2000, Fall/Autumn accessed March 23, 2005, [http://www.idealspine.com/pages/cbp_technique.htm] Hughes EC: Professions. Daedalus. 1963, 92: 655-68. McDonald WP, Durkin K, Iseman S, Pfefer M, Randall B, Smoke L, et al: How chiropractors think and practice: the survey of North American chiropractors. 2003, Ada, OH: Institute for Social Research, Ohio Northern University Alcock JE: Alternative medicine and the psychology of belief. Sci Rev Alt Med. 1999, 3: 45-52. Keating JC: Toward a philosophy of the science of chiropractic: A primer for clinicians. 1992, Stockton, CA: Stockton Foundation for Chiropractic Research Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL: Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993, 328: 246-52. 10.1056/NEJM199301283280406. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al: Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998, 280: 1569-75. 10.1001/jama.280.18.1569. Tindle HA, Davis RB, Phillips RS, Eisenberg DM: Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005, 11: 42-9. Cooper RA: Healthcare workforce for the twenty-first century: the impact of nonphysician clinicians. Ann Rev Med. 2001, 52: 51-61. 10.1146/annurev.med.52.1.51. Cooper RA, Laud P, Dietrich CL: Current and projected workforce of nonphysician clinicians. JAMA. 1998, 280: 788-94. 10.1001/jama.280.9.788. Cooper RA, McKee HJ: Chiropractic in the United States: trends and issues. Milbank Q. 2003, 81: 107-38. 10.1111/1468-0009.00040. accessed March 23, 2005, [http://www.chirocolleges.org/paradigm_scopet.html] Donaldson MS, Yordy KD, Lohr KN, Vanselow NA: Primary care: America's health in a new era. 1996, Washington, DC; National Academy Press Cote P, Cassidy JD, Carroll L: The treatment of neck and low back pain: who seeks care? who goes where?. Med Care. 2001, 39: 956-67. 10.1097/00005650-200109000-00006. Palinkas LA, Kabongo ML, the San Diego Unified Practice Research in Family Medicine Network: The use of complementary and alternative medicine by primary care patients. ASURF*NET study. J Fam Pract. 2000, 49: 1121-30. Sherman KJ, Cherkin DC, Connelly MT, Erro J, Savetsky JB, Davis RB, Eisenberg DM: Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?. BMC Complement Altern Med. 2004, 19: 4-9. Cherkin DC, Deyo RA, Sherman KJ, Hart LG, Street JH, Hrbek A, Davis RB, Cramer E, Milliman B, Booker J, Mootz R, Barassi J, Kahn JR, Kaptchuk TJ, Eisenberg DM: Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians. J Am Board Fam Pract. 2002, 15: 463-72. Sharma R, Haas M, Stano M: Patient attitudes, insurance, and other determinants of self-referral to medical and chiropractic physicians. Am J Public Health. 2003, 93: 2111-7. Coulter ID, Hurwitz EL, Adams AH, Genovese BJ, Hays R, Shekelle PG: Patients using chiropractors in North America: who are they, and why are they in chiropractic care?. Spine. 2002, 27: 291-6. 10.1097/00007632-200202010-00018. Hurwitz EL, Coulter ID, Adams AH, Genovese BJ, Shekelle PG: Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health. 1998, 88: 771-6. Nyiendo J, Phillips RB, Meeker WC, Konsler G, Jansen R, Menon M: A comparison of patients and patient complaints at six chiropractic college teaching clinics. J Manipulative Physiol Ther. 1989, 12: 79-85. Nyiendo J, Haldeman S: A prospective study of 2,000 patients attending a chiropractic college teaching clinic. Med Care. 1987, 25: 516-27. Abbott A: A System of professions: An essay on the division of expert labor. 1988, Chicago, IL: University of Chicago Press, 25- Goetzel RA, Hawkins K, Ozminkowski RJ, Wang S: The health and productivity cost burden of the top 10 physical and mental conditions affecting six large US employers. JOEM. 2003, 45: 5-14. accessed March 23, 2005, [http://www.amerchiro.org/government/white_house/1000_testimony.shtml] accessed March 23, 2005, [http://www.amerchiro.org/media/whatis/history_chiro.shtml] Relman AS: Assessment and accountability: the third revolution in medical care. N Engl J Med. 1988, 319: 1220-222. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS: Evidence based medicine: what it is and what it isn't. Br Med J. 1996, 312: 71-223. Daltroy LH, Iversen MD, Larson MG, et al: A controlled trial of an educational program to prevent low back injuries. N Engl J Med. 1997, 337: 322-8. 10.1056/NEJM199707313370507. Autret-Leca E, Giraudeau B, Ployet MJ, Jonville-Bera AP: Amoxicillin/clavulanic acid is ineffective at preventing otitis media in children with presumed viral upper respiratory infection: a randomized, double-blind equivalence, placebo-controlled trial. Br J Clin Pharmacol. 2002, 54: 652-6. 10.1046/j.1365-2125.2002.t01-6-01689.x. CAST II Investigators: Effect of Antiarrhythimic Agent Moricizine on Survival after Myocardial Infaraction. New Eng J Med. 1992, 327: 227-33. Epstein AE, Hallstrom AP, Rogers WJ, et al: Mortality following ventricular arrhythmia suppression by encainide, flecainide, and moricizine after myocardial infarction. The original design concept of the Cardiac Arrhythmia Suppression Trial (CAST). JAMA. 1993, 270: 2451-5. 10.1001/jama.270.20.2451. Angell M, Kassirer JP: Alternative medicine – the risks of untested and unregulated remedies. N Engl J Med. 1998, 339: 839-41. 10.1056/NEJM199809173391210.