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Objectives: Chiropractic in the United States exhibits characteristics of both mainstream health care and complementary and alternative medicine (CAM). The purpose of this project was to investigate the opinions of a sample of chiropractic faculty and practitioners on the appropriate classification of their profession, in terms of CAM versus mainstream. Design: This was a descriptive study conducted by means of an electronically administered survey to a sample of chiropractic college faculty and practicing chiropractors. Sample population: The faculty sample consisted of all faculty members holding Doctor of Chiropractic (D.C.) degrees at 4 chiropractic colleges, 2 in the Midwest and 2 in southern California. The practitioner sample consisted of all 108 participants, located in 32 states in the United States, in a chiropractic practice-based research network. Survey instrument: The survey instrument was based on one used with permission from its authors, who had developed and used it to gather information about respondents' concepts and definitions of health and disease, in order to compare the broad categories of practitioners—mainstream medicine, integrated medicine (IM), and CAM. Results: Of 191 D.C. faculty invited to participate, 71 (37%) completed the survey. Of the 108 practicing D.C.s invited to participate, 61 (57%) completed the survey. Of the total sample of 132, 69% did not agree that chiropractic should be categorized as CAM. Twenty-seven percent (27%) of 132 thought that chiropractors should be classified as IM; 20% of practitioners and 6% of faculty considered chiropractic mainstream medicine. Conclusions: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%). [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]

Objective: Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat. Methods: A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information, (2) whether their chiropractor was their primary care physician, and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients. Results: There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each 'primary care condition' listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly with many conditions showing an affirmative response of higher than 50% especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions. Conclusions: Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions. [ABSTRACT FROM AUTHOR]

The article focuses on the success of the United States Bone and Joint Decade, a multidisciplinary and collaborative effort to improve prevention of bone and joint disorders and to improve the quality of life for those affected. The success has been due to the collaboration of more than 90 patient and professional health organizations and more than 100 medical schools and colleges of medicine. Some of the organizations affiliated include the American Chiropractic Association, the Arthritis Foundation and the Foundation for Chiropractic Education and Research.

Objective: To better understand the experiences and problems encountered by research assistants (RAs) involved in clinical trials to improve the process of RA training for future studies., Design: A 1-time focus group of research assistants was conducted., Setting: A chiropractic college in the United States during a national chiropractic research agenda conference., Subjects: Eight research assistants from 2 teaching institutions, who are directly involved in clinical trials and have patient-centered responsibilities, such as recruiting patients, interviewing patients, and collecting data. Main outcome measures Responses to predetermined questions were qualitatively compiled. Question topics included research assistants' experiences while administering phone screens, questionnaires, and informed consents., Results: Research assistants involved in this focus group expressed they were adequately trained in telephone screening and administering informed consent but felt they required more training in administering self-report questionnaires to patients. The majority of problems they encountered were related to a lack of information. To improve training of future RAs, more detailed study information is necessary, such as how to describe study treatments and how to give questionnaire instructions., Conclusions: The comparability of responses by the members of this focus group was interesting. Members had similar experiences within clinical trials and found that the problems encountered were common across studies.

Objective: There are fundamental differences between the administration of medications and the application of manual procedures, such as those used by chiropractors. The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite, randomized placebo-controlled trial of chiropractic care for women with chronic pelvic pain (CPP)., Design: Pilot study for a multisite, randomized, placebo-controlled clinical trial., Setting: Three chiropractic research clinics in the midwest United States., Subjects: Thirty-nine (39) women with CPP of at least 6 months' duration, diagnosed by board-certified gynecologists., Interventions: The active intervention consisted of the chiropractic technique, lumbar spine flexion-distraction, combined with manual Trigger Point Therapy. The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage (light massage)., Outcome Measures: The primary outcome measure was the change in the Pain Disability Index (PDI) from baseline to the end of treatment (6 weeks), assessed by group and site. If the change score was in the same direction at all sites, the results were to be combined to estimate treatment effect size., Results: Patient characteristics were similar to those of patients with CPP in other studies. Recruitment methods, particularly in respect to the eligibility criteria and screening protocols, would require modification in order to recruit an adequate sample for the planned randomized controlled trial. Clinicians followed standardized procedures with apparently minimal deviation, patients in both groups were satisfied with their care and blinding appeared to be successful. PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated., Conclusions: The technical and personnel resources required to achieve adequate standardization of procedures at multiple sites may make a placebo-controlled trial unfeasible, given our current lack of knowledge about the active agent in manual chiropractic procedures.