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Difference between revisions of "Chiropractic"

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Chiropractic is established in the [[U.S.]], [[Canada]], and [[Australia]], and is present to a lesser extent in as many as 90 other countries.<ref name=global-strategy>{{cite web |url=http://chiropracticdiplomatic.com/strategies/global_strategy.pdf |format=PDF |title= Global professional strategy for chiropractic |author= Tetrault M |publisher= [[Chiropractic Diplomatic Corps]] |date=2004 |accessdate=2008-04-18}}</ref>  
 
Chiropractic is established in the [[U.S.]], [[Canada]], and [[Australia]], and is present to a lesser extent in as many as 90 other countries.<ref name=global-strategy>{{cite web |url=http://chiropracticdiplomatic.com/strategies/global_strategy.pdf |format=PDF |title= Global professional strategy for chiropractic |author= Tetrault M |publisher= [[Chiropractic Diplomatic Corps]] |date=2004 |accessdate=2008-04-18}}</ref>  
  
 +
==Accreditation==
 
For Accreditation see: [[Educational accreditation]]
 
For Accreditation see: [[Educational accreditation]]
−
For Regulatory boards see:  [[Regulatory boards]]  
+
==Regulatory boards==
 +
For Regulatory boards see:  [[Regulatory boards]]
  
 
== Utilization, satisfaction rates, and third party coverage ==
 
== Utilization, satisfaction rates, and third party coverage ==

Revision as of 13:42, 22 December 2009

Chiropractic: from Greek chiro- χειρο- "hand-"
+ praktikós πρακτικός "concerned with action"
—(OED)
Pastiche of man thinking and writing; the ribs, vertebrae, and hip bones of a human skeleton; a hand holding another; and Leonardo's famous drawing of a man in square and circle

Definition

Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[1] Though frequently categorized as a complementary or alternative form of medicine, the World Federation of Chiropractic considers that, as a result of the acceptance of chiropractic as a valid treatment option for various muskuloskeletal conditions, the discipline is now in the realm of mainstream.[2]

The primary modality of treatment involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes adjunctive physio-therapeutic modalities, nutritional supplementation, exercises, and health and lifestyle counseling.[3] Modern Chiropractic Doctors explain the basis of a Chiropractic adjustment by scientifically acceptable terms.

The profession is currently dominated by modern progressive Doctors who are attuned to the results of scientific studies, and are more open to other mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. [4] Chiropractic is well established in the U.S., Canada and Australia.[5], although, like any profession, there remains a small faction which refuses to give up a concept based in vitalism, called "innate intelligence". To these people, the mainstream of the profession are considered "mixers", because we include all natural modalitis into the "mix".

(for History, see Chiropractic history)

Assimilation into Mainstream

Chiropractic has gained greater acceptance among medical physicians and health plans in the U.S.,[6] and evidence-based medicine has been used to review research studies and generate practice guidelines.[7] Many studies of treatments used by chiropractors have been conducted. Collectively, systematic reviews of this research has demonstrated that spinal manipulation is effective. Spinal manipulation has been alleged to have serious complications in rare cases (about 1.4/1,000,000),[8][9] this is clearly less than the risk of taking an aspirin tablet, and thus chiropractic care is generally safe when employed skillfully and appropriately.[10]

Chiropractic is autonomous, and competitive with mainstream medicine,[11] and osteopathy outside the U.S. remains primarily a manual medical system;[12] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[11] Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.[13]

WorldWide presence

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in as many as 90 other countries.[5]

Accreditation

For Accreditation see: Educational accreditation

Regulatory boards

For Regulatory boards see: Regulatory boards

Utilization, satisfaction rates, and third party coverage

In the U.S., chiropractic is the third largest healing arts profession,[4] and is the third largest doctoral profession, behind only medicine and dentistry.[14] The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the U.S. and Canada,[15] with a global high of 20% in Alberta.[16] Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors.[17] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[18] most do so specifically for low back pain. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention.[15] Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors.[19]

For Insurance coverage see Insurance coverage


Evidence basis

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care.[7] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims,[1][20][21][22] that have been called ethically suspect when they let practitioners maintain their beliefs to patients' detriment.[1] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills.[23] Continued education enhances the scientific knowledge of the practitioner.[24]

Effectiveness

Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree,[25] and they are typically of low quality.[26] Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by only low levels of scientific evidence[17][27] that does not demonstrate clinically relevant benefits.[28] A 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference,[29] but a 2008 supportive review found serious flaws in the critical approach and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.[30] Most research has focused on spinal manipulation (SM) in general,[31] rather than solely on chiropractic SM.[7] A 2002 review of randomized clinical trials of SM[32] was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular;[33] however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it.[31]

There is a wide range of ways to measure treatment outcomes.[34] Chiropractic care, like all medical treatment, benefits from the placebo response.[35] It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect.[36] The efficacy of maintenance care in chiropractic is unknown.[37]

For Safety, see Chiropractic safety

Cost-effectiveness

A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings.[38] A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects) remains uncertain.[39] A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention.[40] The cost-effectiveness of maintenance chiropractic care is unknown.[37]

Public health

Most chiropractors do NOT oppose reasonable vaccination or water fluoridation, which are common public health practices. Although within the chiropractic community there are significant disagreements about vaccination,[41][42] one of the most cost-effective public health interventions available.[43] Most chiropractors have embraced a reasonable approach to vaccination, but some of the profession, as in any large group rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing.

The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws. A 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. [42] The Canadian Chiropractic Association supports vaccination;[41] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[44]

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.[45]

References

  1. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Nelson
  2. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Chapman-Smith
  3. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named content-of-practice
  4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Kaptchuk-Eisenberg
  5. ↑ 5.0 5.1 Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps. http://chiropracticdiplomatic.com/strategies/global_strategy.pdf. Retrieved 2008-04-18. 
  6. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Cooper
  7. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Villanueva-Russell
  8. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Ernst-adverse
  9. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named CCA-CFCREAB-CPG
  10. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named WHO-guidelines
  11. ↑ 11.0 11.1 Pettman E (2007). "A history of manipulative therapy". J Man Manip Ther 15 (3): 165–74. PMID 19066664. 
  12. ↑ Baer HA (2006). "The drive for legitimization by osteopathy and chiropractic in Australia: between heterodoxy and orthodoxy". Complement Health Pract Rev 11 (2): 77–94. doi:10.1177/1533210106292467. 
  13. ↑ Norris P (2001). "How 'we' are different from 'them': occupational boundary maintenance in the treatment of musculo-skeletal problems". Sociol Health Illn 23 (1): 24–43. doi:10.1111/1467-9566.00239. 
  14. ↑ "Establishing a database of U.S. chiropractic health manpower data: furthering the development of research infrastructure.". National Library of Medicine. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102184948.html. Retrieved 2008-05-06. 
  15. ↑ 15.0 15.1 Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat 15: 2. doi:10.1186/1746-1340-15-2. PMID 17241465. PMC 1784103. http://chiroandosteo.com/content/15/1/2. 
  16. ↑ Crownfield PW (2007). "Chiropractic in Alberta: a model of consumer utilization and satisfaction". Dyn Chiropr 25 (6). http://chiroweb.com/archives/25/06/02.html. 
  17. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Kemper
  18. ↑ Hurwitz EL, Chiang LM (2006). "A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03". BMC Health Serv Res 6 (49): 49. doi:10.1186/1472-6963-6-49. PMID 16600038. PMC 1458338. http://www.biomedcentral.com/1472-6963/6/49. 
  19. ↑ Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review of the literature". J Manipulative Physiol Ther 29 (6): 455–62. doi:10.1016/j.jmpt.2006.06.013. PMID 16904491. 
  20. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Keating-subluxation
  21. ↑ Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. http://data.memberclicks.com/site/ahc/ChiroHistoryPrimer.pdf. Retrieved 2008-06-16. "A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. Chiropractors' tendency to assert the meaningfulness of various theories and methods as a counterpoint to allopathic charges of quackery has created a defensiveness which can make critical examination of chiropractic concepts difficult (Keating and Mootz 1989). One example of this conundrum is the continuing controversy about the presumptive target of DCs' adjustive interventions: subluxation (Gatterman 1995; Leach 1994)." 
  22. ↑ Science, antiscience, materialism and vitalism:
    • Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq 21 (4): 37–43. 
    • Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". in Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. 
  23. ↑ Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731. 
  24. ↑ Feise RJ, Grod JP, Taylor-Vaisey A (2006). "Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care". Chiropr Osteopat 14: 18. doi:10.1186/1746-1340-14-18. PMID 16930482. PMC 1560147. http://chiroandosteo.com/content/14/1/18. 
  25. ↑ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. PMC 1420782. http://www.jrsm.org/cgi/content/full/99/4/192. Lay summary – BBC News (2006-03-22). 
  26. ↑ Quality of SM studies:
    • Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther 36 (3): 160–9. PMID 16596892. 
    • Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113. 
  27. ↑ Gotlib A, Rupert R (2008). "Chiropractic manipulation in pediatric health conditions - an updated systematic review". Chiropr Osteopat 16: 11. doi:10.1186/1746-1340-16-11. PMID 18789139. PMC 2553791. http://chiroandosteo.com/content/16/1/11. 
  28. ↑ Ernst E (2009). "Chiropractic manipulation, with a deliberate 'double entendre'". Arch Dis Child 94 (6): 411. doi:10.1136/adc.2009.158170. PMID 19460920. 
  29. ↑ Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103. 
  30. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Bronfort-2008
  31. ↑ 31.0 31.1 Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med 137 (8): 702. http://annals.org/cgi/reprint/137/8/701.pdf. 
  32. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Meeker-Haldeman
  33. ↑ Ernst E (2002). "Chiropractic" (PDF). Ann Intern Med 137 (8): 701. PMID 12379081. http://annals.org/cgi/reprint/137/8/701.pdf. 
  34. ↑ Khorsan R, Coulter ID, Hawk C, Choate CG (2008). "Measures in chiropractic research: choosing patient-based outcome assessments". J Manipulative Physiol Ther 31 (5): 355–75. doi:10.1016/j.jmpt.2008.04.007. PMID 18558278. 
  35. ↑ Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med 136 (11): 817–25. PMID 12044130. http://annals.org/cgi/reprint/136/11/817.pdf. 
  36. ↑ Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother 52 (2): 135–8. PMID 16764551. http://ajp.physiotherapy.asn.au/AJP/vol_52/2/AustJPhysiotherv52i2Hancock.pdf. 
  37. ↑ 37.0 37.1 Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic - what do we know?". Chiropr Osteopat 16: 3. doi:10.1186/1746-1340-16-3. PMID 18466623. PMC 2396648. http://chiroandosteo.com/content/16/1/3. 
  38. ↑ Mootz RD, Hansen DT, Breen A, Killinger LZ, Nelson C (2006). "Health services research related to chiropractic: review and recommendations for research prioritization by the chiropractic profession". J Manipulative Physiol Ther 29 (9): 707–25. doi:10.1016/j.jmpt.2006.09.001. PMID 17142165. 
  39. ↑ Canter PH, Coon JT, Ernst E (2006). "Cost-effectiveness of complementary therapies in the United kingdom—a systematic review". Evid Based Complement Alternat Med 3 (4): 425–32. doi:10.1093/ecam/nel044. PMID 17173105. PMC 1697737. http://ecam.oxfordjournals.org/cgi/content/full/3/4/425. 
  40. ↑ van der Roer N, Goossens MEJB, Evers SMAA, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? a systematic review". Best Pract Res Clin Rheumatol 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783. 
  41. ↑ 41.0 41.1 Busse JW, Morgan L, Campbell JB (2005). "Chiropractic antivaccination arguments". J Manipulative Physiol Ther 28 (5): 367–73. doi:10.1016/j.jmpt.2005.04.011. PMID 15965414. http://jmptonline.org/article/S0161-4754(05)00111-9/fulltext. 
  42. ↑ 42.0 42.1 Campbell JB, Busse JW, Injeyan HS (2000). "Chiropractors and vaccination: a historical perspective". Pediatrics 105 (4): e43. doi:10.1542/peds.105.4.e43. PMID 10742364. http://pediatrics.aappublications.org/cgi/content/full/105/4/e43. 
  43. ↑ Ehreth J (2003). "The global value of vaccination". Vaccine 21 (7–8): 596–600. doi:10.1016/S0264-410X(02)00623-0. PMID 12531324. 
  44. ↑ Russell ML, Injeyan HS, Verhoef MJ, Eliasziw M (2004). "Beliefs and behaviours: understanding chiropractors and immunization". Vaccine 23 (3): 372–9. doi:10.1016/j.vaccine.2004.05.027. PMID 15530683. 
  45. ↑ Jones RB, Mormann DN, Durtsche TB (1989). "Fluoridation referendum in La Crosse, Wisconsin: contributing factors to success" (PDF). Am J Public Health 79 (10): 1405–8. doi:10.2105/AJPH.79.10.1405. PMID 2782512. PMC 1350185. http://www.ajph.org/cgi/reprint/79/10/1405.pdf. 

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ca:Quiropràctica

da:Kiropraktikeo:Kiropraktiko fa:کایروپرکتیک fi:Kiropraktiikkahe:כירופרקטיקהja:カイロプラクティック ko:카이로프랙틱 nl:Chiropraxie no:Kiropraktor pl:Kręgarstwo pt:Quiropraxia ru:Хиропрактик ru:Кайропрактик (alternative spelling) sv:Kiropraktik tr:Kiropraktik ur:معالجہ بالید

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