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Chiropractic

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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

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] The World Federation of Chiropractic has determined to no longer consider Chiropractic to be complementary and alternative medicine,[2] a characterization that many chiropractors reject.[3]

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.[4] Modern Chiropractic Doctors explain the basis of a Chiropractic adjustment by scientifically acceptable terms. Some do cling to an outmoded theory known by the acronym "BOOP", or "bone out of place" now rejected by the mainstream profession. [5] This is a notion that brings ridicule from mainstream Chiropractic scientists and medicine as well.[6]


D.D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century.[7] 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. [8] Chiropractic is well established in the U.S., Canada and Australia.[9], although, like any profession, there remains a small faction which refuses to give up a concept based in vitalism, called "innate intelligence" and consider subluxations to be the leading cause of all disease; "mixers"

Chiropractic has a strong political base, and sustained demand for services; in recent decades, it has gained greater acceptance among medical physicians and health plans in the U.S.,[10] and evidence-based medicine has been used to review research studies and generate practice guidelines.[11] 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),[12][13] this is clearly less than the risk of taking an aspirin tablet, and thus chiropractic care is generally safe when employed skillfully and appropriately.[14]

Alternative medical systems - edit
NCCAM classifications
  1. Category:Alternative medical systems
  2. Category:Mind-body interventions
  3. Biologically based therapy
  4. Manipulative and body-based methods
  5. Energy therapy
See also


Chiropractic is autonomous, and competitive with mainstream medicine,[15] and osteopathy outside the U.S. remains primarily a manual medical system;[16] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession.[15] 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.[17]

WorldWide presence

Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.[9] In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK.[18][19] CCEs in the U.S., Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally.[20] Today, there are 18 accredited Doctor of Chiropractic programs in the U.S.,[21] 2 in Canada,[22] 6 in Australasia,[23] and 5 in Europe.[24] All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges.[25]

Regulatory colleges and chiropractic boards in the U.S., Canada, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.[26][27] There are an estimated 53,000 chiropractors in the U.S. (2006),[28] 7,000 in Canada (2009),[29] 2,500 in Australia (2000),[30] and 1,500 in the UK (2000).[31]

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians.[32] A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).[33]

Utilization, satisfaction rates, and third party coverage

In the U.S., chiropractic is the largest alternative medical profession,[8] and is the third largest doctoral profession, behind medicine and dentistry.[34] 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,[35] with a global high of 20% in Alberta.[36] Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors.[37] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints;[38] 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.[35] 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.[39]

Insurance coverage

In the U.S., most states require insurers to cover chiropractic care, and most HMOs cover these services.[37] The Federal Government also covers chiropractic services under both MediCare and CHAMPUS (for servicemen/women). In Canada, there is lack of coverage under the universal public health insurance system.[40] In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner.[41]

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.[11] 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][6][42][43] 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.[44] Continued education enhances the scientific knowledge of the practitioner.[45]

Effectiveness

Opinions differ as to the efficacy of chiropractic treatment.[25] Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree,[46] and they are typically of low quality.[47] Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by only low levels of scientific evidence[37][48] that does not demonstrate clinically relevant benefits.[49] 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,[50] 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.[51] Most research has focused on spinal manipulation (SM) in general,[52] rather than solely on chiropractic SM.[11] A 2002 review of randomized clinical trials of SM[53] was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular;[54] 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.[52]

There is a wide range of ways to measure treatment outcomes.[55] Chiropractic care, like all medical treatment, benefits from the placebo response.[56] 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.[57] The efficacy of maintenance care in chiropractic is unknown.[58]

Safety

Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis.[14] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[13]

Spinal manipulation is associated with frequent, mild and temporary adverse effects,[12][13] including new or worsening pain or stiffness in the affected region.[59] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours.[60] Rarely,[14] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[12] and children.[61] Estimates vary widely for the incidence of these complications,[60] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern.[12] Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[62][63] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[64]

Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation; practice guidelines aim to reduce unnecessary radiation exposure,[65] which increase cancer risk in proportion to the amount of radiation received.[66]

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.[67] 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.[68] 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.[69] The cost-effectiveness of maintenance chiropractic care is unknown.[58]

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,[70][30] one of the most cost-effective public health interventions available.[71] 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. [30] The Canadian Chiropractic Association supports vaccination;[70] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[72]

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.[73]

References

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da:Kiropraktikeo:Kiropraktiko fa:کایروپرکتیکko:카이로프랙틱he:כירופרקטיקה nl:Chiropraxie ja:カイロプラクティック no:Kiropraktor pl:Kręgarstwo pt:Quiropraxia fi:Kiropraktiikka sv:Kiropraktik tr:Kiropraktik ur:معالجہ بالید