A comparative audit of jurisprudence, ethics and business management (JEB) courses taught at 21 accredited chiropractic programs worldwide.

Introduction: The objectives of this study was to conduct an updated comparative audit involving a larger and more representative group of accredited chiropractic programs in order to determine if (i) if there has been any changes in the delivery of JEB curricula since the first audit was conducted in 2010, and (ii) provide recommendations that could lead toward a standardized or model JEB curriculum worldwide. Methods: This study was approved by the ERB of the University of South Wales. Twenty-one chiropractic programs agreed to provide JEB course outlines for review. Results: A total of 88 different course outlines, which listed 83 different topics pertaining to JEB course content, were submitted for review. Conclusion: The results of this comparative audit revealed there has been an increase in the variability of JEB course content taught to students over time. Recommendations are provided for the next steps that could lead toward a standardized or model JEB curriculum curricula.

Présentation: L'étude visait à mener un audit comparatif actualisé d'un ensemble représentatif de programmes agréés de chiropratique afin de (i) déterminer si des changements sont intervenus dans la présentation des cours de jurisprudence, d'éthique et de gestion des affaires depuis le premier audit en 2010, et de (ii) formuler des recommandations qui pourraient permettre de normaliser ou de concevoir ces cours à l'échelle internationale. Méthodologie: Le conseil de révision déontologique de l'University of South Wales a donné son autorisation pour mener l'étude. Vingt et une directions de programmes de chiropratique ont accepté de fournir un plan des cours de jurisprudence, d'éthique et de gestion des affaires aux fins d'examen. Résultats: Au total, 88 plans de cours différents, qui présentaient 83 sujets différents relatifs au contenu des cours de jurisprudence, d'éthique et de gestion, ont été soumis aux fins d'examen. Conclusion: Les résultats de l'audit comparatif ont montré une augmentation dans la diversité du contenu des cours de jurisprudence, d'éthique et de gestion proposés aux étudiants au fil des années. Des recommandations qui pourraient permettre de normaliser ou de concevoir ces cours ont été émises pour les prochaines étapes.

Survey of students' perception of the jurisprudence, ethics and business management course at the Canadian Memorial Chiropractic College.

INTRODUCTION: The objective of this study was to survey 2018-2019 Year III students at the Canadian Memorial Chiropractic College in order explore their perceptions of the components of the revised Jurisprudence, Ethics and Business Management course. METHODS: This study was approved by the Research Ethics Board. A paper survey was distributed to all enrolled students. Using a five-point Likert scale, students were asked if they perceived the course material was (i) well-presented and (ii) important for them to know as future chiropractors. Students were required to sign a consent form to participate. RESULTS: Survey response rate was 94%. Over 90% of respondents 'strongly agreed/'agreed' lectures, small group session and course assignments were well presented and important for them to know as future chiropractors. Respondents were more critical of the online business modules (on average, 50% 'strongly agreed/agreed'). CONCLUSIONS: The information from this survey will enable refinement of future versions of this course.

INTRODUCTION: La présente étude visait à sonder des étudiants de 3e année au programme du Canadian Memorial Chiropractic College en 2018­2019 pour connaître leurs opinions sur la nouvelle version du cours de jurisprudence, d'éthique et de gestion d'un cabinet chiropratique. MÉTHODOLOGIE: La présente étude a été approuvée par le comité d'éthique de la recherche. On a mené un sondage auprès de tous les étudiants inscrits. À l'aide d'une échelle de Likert de cinq points, on a demandé aux étudiants si la matière du cours était i) bien présentée et ii) importante pour eux comme futurs chiropraticiens. On a demandé aux étudiants de signer un consentement à la participation à l'étude. RÉSULTATS: Le taux de participation au sondage a été de 94 %. Plus de 90 % des répondants étaient « tout fait d'accord ¼ ou « d'accord ¼ que le cours, les séances en petits groupes et les devoirs étaient bien présentés et avaient de l'importance pour eux comme futurs chiropraticiens. Les répondants se sont montrés plus critiques en ce qui concerne sur les modules en ligne sur la gestion d'un cabinet chiropratique (en moyenne, 50 % étaient tout à fait d'accord ou d'accord). CONCLUSIONS: Les résultats du présent sondage serviront à perfectionner ce cours.

Developing a standardized curriculum for teaching chiropractic technique.

OBJECTIVE: This is a report of the results of 4 facilitated workshops aimed at developing a standardized chiropractic technique curriculum. METHODS: Workshops were held at research conferences during 2014, 2016, 2018, and 2019. Participants were tasked with developing recommendations for diagnostic and therapeutic procedures appropriate for chiropractic technique programs. RESULTS: For diagnostic procedures, there was general agreement among participants that chiropractic programs should include diagnostic imaging, postural assessment, gait analysis, palpation (static, motion, and joint play/springing), global range of motion, and evidence-based orthopedic/neurological tests. No consensus could be reached with respect to chiropractic x-ray line marking (spinography) nor heat sensing instruments, and there was only partial consensus on leg length assessment. For therapeutic procedures, all participants agreed that the following should be included: high-velocity, low amplitude spinal and extremity manipulation, adjustments assisted by hand-held instruments, drop tables, flexion-distraction tables, and pelvic blocks. There was unanimous support for teaching mobilization of the spine and peripheral joints, as well as for manual and instrument-assisted soft tissue therapies. There were some overarching issues: participants strongly preferred assessment methods known to be reliable and valid and therapeutic procedures known to be safe and effective. Where evidence was lacking, they insisted that diagnostic and therapeutic methods at minimum have face validity and biological plausibility. However, they cautioned against applying aspects of evidence-based care too rigidly. CONCLUSIONS: Despite differing views on chiropractic terminology, philosophy, and scope of practice, participants' opinions were similar regarding diagnostic and therapeutic procedures that ought to be included in chiropractic technique programs.

COVID-19: how has a global pandemic changed manual therapy technique education in chiropractic programs around the world?

BACKGROUND: Manual therapy is a cornerstone of chiropractic education, whereby students work towards a level of skill and expertise that is regarded as competent to work within the field of chiropractic. Due to the COVID-19 pandemic, chiropractic programs in every region around the world had to make rapid changes to the delivery of manual therapy technique education, however what those changes looked like was unknown. AIMS: The aims of this study were to describe the immediate actions made by chiropractic programs to deliver education for manual therapy techniques and to summarise the experience of academics who teach manual therapy techniques during the initial outbreak of COVID-19 pandemic. METHODS: A qualitative descriptive approach was used to describe the immediate actions made by chiropractic programs to deliver manual therapy technique education during the COVID-19 pandemic. Chiropractic programs were identified from the webpages of the Councils on Chiropractic Education International and the Council on Chiropractic Education - USA. Between May and June 2020, a convenience sample of academics who lead or teach in manual therapy technique in those programs were invited via email to participate in an online survey with open-ended questions. Responses were entered into the NVivo software program and analysed using a reflexive thematic analysis by a qualitative researcher independent to the data collection. RESULTS: Data from 16 academics in 13 separate chiropractic programs revealed five, interconnected themes: Immediate response; Move to online delivery; Impact on learning and teaching; Additional challenges faced by educators; and Ongoing challenges post lockdown. CONCLUSION: This study used a qualitative descriptive approach to describe how some chiropractic programs immediately responded to the initial outbreak of the COVID-19 pandemic in their teaching of manual therapy techniques. Chiropractic programs around the world provided their students with rapid, innovative learning strategies, in an attempt to maintain high standards of chiropractic education; however, challenges included maintaining student engagement in an online teaching environment, psychomotor skills acquisition and staff workload.

Response to 'Methodological flaws on "manual therapy for the pediatric population: a systematic review" by Prevost et al. (2019)'.

Correspondence from Yu et al. identify methodological issues with the systematic review of manual therapy for pediatric manuscript. Like any research study, limitations are important for readers to keep in consideration when reviewing study findings. The primary authors maintain full confidence in the use of the review to provide practicing clinicians with a comprehensive overview of the limited and low-quality available evidence regarding manual therapies for the pediatric patient.

Comparison of chiropractic student lexicon at two educational institutions: a cross-sectional survey.

OBJECTIVE: To evaluate student perceptions of chiropractic cultural authority, role in healthcare and use of terms at two chiropractic institutions, the Canadian Memorial Chiropractic College (CMCC) and Parker University (Parker). METHODS: A unique survey was developed and administered electronically to Year 2-3 students (n=387) at CMCC and as a paper-based surveys to trimester 4-5 (comparison with Year 2) and 6-7 (comparison with Year 3) (n=277) students at Parker. Responses were anonymous. The survey assessed the likelihood that students at both chiropractic programs would use eight different chiropractic terms. The survey also assessed their preference toward different options with respect to chiropractic's cultural authority. RESULTS: Response rates were 36.2% and 78.1% at CMCC and Parker, respectively. Students at both institutions reported that chiropractic cultural authority was 'neuromusculoskeletal' (NMSK); however, CMCC students was more favorable toward 'musculoskeletal' (MSK) care compared to Parker students, whereas students at Parker favored 'wellness' (59.7%) compared to CMCC students (46.4%). Students at CMCC were more likely to use 'impingement' and 'joint dysfunction' whereas Parker students were more likely to use 'innate intelligence' and 'vertebral subluxation'. Both institutions were equally likely to use 'spinal lesion'. CONCLUSION: This survey found significant cultural authority differences between institutions. While this adds to the emerging need in the literature to evaluate the impact of curriculum and co-curriculum within chiropractic training programs on professional identity, explanations were not evaluated.

OBJECTIF: Évaluer la perception des étudiants sur l'autorité culturelle de la chiropratique, le rôle dans les soins de santé et l'utilisation des termes dans deux établissements chiropratiques, le Canadian Memorial Chiropractic College (CMCC) et l'Université de Parker (Parker). MÉTHODOLOGIE: Un sondage unique a été élaboré et envoyé par courriel aux étudiants de 2e et 3e année (387 étudiants) du CMCC et en format papier aux étudiants du trimestre 4­5 (en comparaison avec la 2e année) et 6­7 (en comparaison avec la 3e année) (277 étudiants) de l'Université de Parker. Les réponses étaient anonymes. Le sondage a évalué la probabilité que les étudiants des deux programmes de chiropratique utilisent huit termes chiropratiques différents. Le sondage a également évalué leur préférence pour différentes options en ce qui concerne l'autorité culturelle de la chiropratique. RÉSULTATS: Les taux de réponses étaient de 36,2 % au CMCC et de 78,1 % à l'Université de Parker. Les étudiants des deux établissements ont déclaré que l'autorité culturelle en chiropratique était les soins « neuro-musculo-squelettiques ¼. Cependant, les étudiants du CMCC étaient plus favorables aux soins « musculo-squelettiques ¼ contrairement aux étudiants de l'Université de Parker, qui eux étaient plus favorables aux soins « bien-être ¼ (59,7 %) contrairement aux étudiants du CMCC (46,4 %). Les étudiants du CMCC étaient plus susceptibles d'utiliser les termes « impact ¼ et « dysfonctionnement articulaire ¼, tandis que les étudiants de l'Université de Parker étaient plus susceptibles d'utiliser « intelligence innée ¼ et « subluxation vertébrale ¼. Les deux établissements étaient également susceptibles d'utiliser « lésion épinière ¼. CONCLUSION: Ce sondage a révélé d'importantes différences d'autorité culturelle entre les établissements. Bien que, dans la documentation, cela s'ajoute au besoin émergent d'évaluer les répercussions du programme et du coprogramme d'études des programmes de formation en chiropratique sur l'identité professionnelle, les explications n'ont pas été évaluées.

Manual therapy for the pediatric population: a systematic review.

BACKGROUND: This systematic review evaluates the use of manual therapy for clinical conditions in the pediatric population, assesses the methodological quality of the studies found, and synthesizes findings based on health condition. We also assessed the reporting of adverse events within the included studies and compared our conclusions to those of the UK Update report. METHODS: Six databases were searched using the following inclusion criteria: children under the age of 18 years old; treatment using manual therapy; any type of healthcare profession; published between 2001 and March 31, 2018; and English. Case reports were excluded from our study. Reference tracking was performed on six published relevant systematic reviews to find any missed article. Each study that met the inclusion criteria was screened by two authors to: (i) determine its suitability for inclusion, (ii) extract data, and (iii) assess quality of study. RESULTS: Of the 3563 articles identified, 165 full articles were screened, and 50 studies met the inclusion criteria. Twenty-six articles were included in prior reviews with 24 new studies identified. Eighteen studies were judged to be of high quality. Conditions evaluated were: attention deficit hyperactivity disorder (ADHD), autism, asthma, cerebral palsy, clubfoot, constipation, cranial asymmetry, cuboid syndrome, headache, infantile colic, low back pain, obstructive apnea, otitis media, pediatric dysfunctional voiding, pediatric nocturnal enuresis, postural asymmetry, preterm infants, pulled elbow, suboptimal infant breastfeeding, scoliosis, suboptimal infant breastfeeding, temporomandibular dysfunction, torticollis, and upper cervical dysfunction. Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Twenty studies reported adverse events, which were transient and mild to moderate in severity. CONCLUSIONS: Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed. TRIAL REGISTRATION: PROSPERA registration number: CRD42018091835.

Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update.

OBJECTIVE: The purpose of this study was to update evidence-based recommendations on the best practices for chiropractic care of older adults. METHODS: The project consisted of a systematic literature review and a consensus process. The following were searched from October 2009 through January 2016: MEDLINE, Index to Chiropractic Literature, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine Database), Alt HealthWatch, Cochrane Database of Systematic Reviews, and Cochrane Registry of Controlled Trials. Search terms were: (manipulation, spinal OR manipulation, chiropractic OR chiropract*) AND (geriatric OR "older adult*"). Two reviewers independently screened articles and abstracts using inclusion and exclusion criteria. The systematic review informed the project steering committee, which revised the previous recommendations. A multidisciplinary panel of experts representing expertise in practice, research, and teaching in a variety of health professions serving older adults rated the revised recommendations. The RAND Corporation/University of California, Los Angeles methodology for a modified Delphi consensus process was used. RESULTS: A total of 199 articles were found; after exclusion criteria were applied, 6 articles about effectiveness or efficacy and 6 on safety were added. The Delphi process was conducted from April to June 2016. Of the 37 Delphi panelists, 31 were DCs and 6 were other health care professionals. Three Delphi rounds were conducted to reach consensus on all 45 statements. As a result, statements regarding the safety of manipulation were strengthened and additional statements were added recommending that DCs advise patients on exercise and that manipulation and mobilization contribute to general positive outcomes beyond pain reduction only. CONCLUSIONS: This document provides a summary of evidence-informed best practices for doctors of chiropractic for the evaluation, management, and manual treatment of older adult patients.

Sexual harassment of female chiropractors by their patients: a pilot survey of faculty at the Canadian Memorial Chiropractic College.

BACKGROUND: The purpose of this study was to survey a group of female chiropractors and inquire as to whether or not they had been sexually harassed by their patients. METHODS: An online questionnaire was emailed via Survey Monkey to 47 female faculty members at the Canadian Memorial Chiropractic College (CMCC). Respondents were asked if they had been sexual harassed and, if so, the characteristics of the incident(s), their response to it, how serious they perceived the problem to be and whether or not they felt prepared to deal with it. RESULTS: Nineteen of 47 questionnaires were completed and returned. Of these 19, eight respondents reported being sexually harassed by a patient (all male), most commonly within the first 5 years of practice and most commonly involving a 'new' patient. It was rarely anticipated. The nature of the harassment varied and respondents often ignored the incident. Most respondents perceive this to be a problem facing female chiropractors. DISCUSSION: Although this is the first survey of its kind, this is a significant problem facing other healthcare professionals. CONCLUSIONS: Among this group of respondents, sexual harassment by patients was a common occurrence. More training on how to handle it, during either a student's chiropractic education or offered as a continuing education program, may be warranted.

HISTORIQUE: L'objectif de cette étude était de sonder un groupe de chiropraticiennes afin de savoir si elles avaient été harcelées sexuellement par leurs patients. MÉTHODOLOGIE: Un questionnaire en ligne a été envoyé par l'intermédiaire de Survey Monkey à 47 chiropraticiennes membres du corps professoral du Canadian Memorial Chiropractic College (CMCC). On a demandé aux personnes interrogées si elles avaient été harcelées sexuellement et, si oui, quelles étaient les caractéristiques de l'incident, leur réaction face à celui-ci, la gravité du problème selon elles et si elles se sentaient préparées à y faire face. RÉSULTATS: Sur les 47 questionnaires, 19 ont été remplis et retournés. Parmi ces 19 questionnaires, huit personnes ont indiqué avoir été harcelées sexuellement par un patient (tous des hommes), la plupart du temps au cours de leurs cinq premières années de pratique et il s'agissait le plus souvent d'un « nouveau ¼ patient. C'était rarement anticipé. La nature du harcèlement variait et les chiropraticiennes ont souvent ignoré l'incident. La plupart des personnes interrogées pensent que ce problème est propre aux chiropraticiennes. DISCUSSION: Bien qu'il s'agisse de la première étude de ce type, on a affaire à un problème important qui touche d'autres professionnels de la santé. CONCLUSIONS: Parmi ce groupe de personnes interrogées, le harcèlement sexuel provenant de patients est fréquent. Une meilleure formation sur la manière de gérer le problème peut être justifiée, que ce soit au cours d'une formation d'étudiants en chiropratique ou en tant que programme de formation continue.

What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature.

The purpose of this study was to provide a narrative review of the literature of studies describing the management of disorders of the gastro-intestinal (GI) tract using 'chiropractic therapy' broadly defined here as spinal manipulation therapy, mobilizations, soft tissue therapy, modalities and stretches. Search limiters include access to full text studies published between 1980 and November 2012 in peer-reviewed journals, English language only involving human subjects. Twenty-one articles were found that met our inclusion criteria. Retrievable articles varied from case reports to clinical trials to review articles of management options. The majority of articles chronicling patient experiences under chiropractic care reported they demonstrated mild to moderate improvements in presenting symptoms. No adverse side effects were reported. This suggests chiropractic care can be considered as an adjunctive therapy for patients with various GI conditions providing there are no co-morbidities.

L'objectif de cette étude était d'offrir un examen narratif des documents d'études décrivant la gestion de troubles du tractus gastro-intestinal (GI) à l'aide d'un traitement chiropratique ici au sens large, comme la manipulation vertébrale, les mobilisations, le traitement des tissus mous, les modalités et les étirements. Les limites de la recherche comprennent l'accès aux textes d'étude complets entre 1980 et novembre 2012 dans les journaux révisés par des pairs en anglais concernant des sujets humains. Vingt et un articles correspondant à nos critères d'inclusion ont été trouvés. Les articles consultables vont des exposés de cas et essais cliniques aux articles de revues sur les options de gestion. La majorité des articles rapportant des expériences de patients de soins chiropratiques indiquent qu'ils ont connu une amélioration légère à moyenne des symptômes présentés. Aucune réaction indésirable n'a été signalée, ce qui laisse entendre qu'on peut considérer les soins chiropratiques comme un traitement auxiliaire pour plusieurs maladies gastro-intestinales en absence de comorbidité.

Chiropractic identity, role and future: a survey of North American chiropractic students.

BACKGROUND: The literature pertaining to chiropractic students' opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America. OBJECTIVE: The purpose of this study is to investigate North American chiropractic students' opinions concerning professional identity, role and future. METHODS: A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed. RESULTS: A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments. CONCLUSION: The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.

On Vaccination & Chiropractic: when ideology, history, perception, politics and jurisprudence collide.

The Palmers espoused anti-vaccination opinions in the early part of the 20(th) century, rejecting the germ theory of disease in favor of a worldview that a subluxation-free spine, achieved by spinal adjustments, would result in an unfettered innate intelligence; this, along with other healthful lifestyle choices, would allow a person to thwart disease by marshaling the body's natural recuperative abilities. Some chiropractors continue to staunchly champion the Palmer postulates, while others do not. At the national level, advocacy organizations publish conflicting position statements. We explore how this divisiveness has impacted chiropractic ideology, perceptions among students and practitioners, politics and issues of jurisprudence as reflected by the evolution of a standard of chiropractic practice in at least one Canadian province (Ontario). We opine that the chiropractic profession should champion a health promotion and disease prevention approach to vaccination, which would allow it to align itself with the broader healthcare community while not abandoning its traditional tenets.

Au début du 20e siècle, les Palmer ont soutenu des opinions anti-vaccination, rejetant la théorie microbienne des maladies en faveur d'une idée répandue mondialement suivant laquelle une colonne vertébrale sans subluxation, résultat d'ajustements vertébraux, se traduirait par une intelligence innée et sans contrainte. Ceci, accompagné d'autres choix sains de mode de vie, permettrait à une personne d'écarter les maladies en faisant appel aux capacités de récupération naturelles de son corps. Certains chiropraticiens continuent de défendre farouchement la thèse de Palmer, alors que d'autres s'y opposent. À l'échelle nationale, divers groupes de défense publient des opinions contradictoires. Nous examinons l'impact de cette divergence d'opinion sur l'idéologie de la chiropratique, les perceptions des étudiants et des praticiens, les politiques et les enjeux de jurisprudence, comme le reflète l'évolution de normes de pratique de la chiropratique dans au moins une province canadienne (Ontario). Nous sommes d'avis que la profession de la chiropratique devrait favoriser une approche de promotion de la santé et de prévention des maladies concernant la vaccination, ce qui lui permettra de s'harmoniser avec le reste de la communauté médicale sans pour autant abandonner ses principes traditionnels.

Attitudes toward vaccination: A cross-sectional survey of students at the Canadian Memorial Chiropractic College.

INTRODUCTION: The purpose of this study was to conduct an online survey of chiropractic students in the 2011/12 academic year at CMCC in order to determine their attitudes toward vaccination, their history of vaccination and their opinions towards their level of preparedness and confidence to discuss vaccination with patients. METHOD: All students enrolled in the program at CMCC were eligible to participate in this anonymous survey modeled after a similar survey administered in 1999/2000. RESULTS: The response rate was 43%. Over 90% of all students reported they had been vaccinated. Roughly half of students felt they were well prepared to discuss vaccination with their patients and two-thirds felt they were confident to do so. Between 83.9% and 90% of students in various years of the program expressed a positive attitude toward vaccination. DISCUSSION: Separate Welsh t-test for each year of study indicated statistically significant differences between our survey and the survey published in 1999/2000, with students in our study expressing a more positive attitude toward vaccination. CONCLUSION: Students enrolled in the chiropractic program at CMCC in the 2011/12 expressed a positive attitude toward vaccination.

INTRODUCTION: L'objet de cette étude était de mener une enquête en ligne auprès des étudiants en chiropratique de l'année scolaire 2011­2012 à CMCC afin de connaître leurs attitudes envers la vaccination, leurs propres antécédents de vaccination, et leurs opinions sur leur niveau de préparation et de confiance pour discuter de la vaccination avec leurs patients. MÉTHODOLOGIE: Tous les étudiants inscrits au programme à CMCC étaient admissibles à participer de façon anonyme à cette enquête modelée sur une enquête similaire menée en 1999­2000. RÉSULTATS: Le taux de participation a été de 43 %. Plus de 90 % des étudiants ont indiqué qu'ils ont été vaccinés. Environ la moitié des étudiants s'estimaient être bien préparés pour discuter de la vaccination avec leurs patients, et les deux tiers pensaient le pouvoir faire en toute confiance. Entre 83,8 % et 90 % des étudiants de différentes années du programme ont exprimé une attitude positive envers la vaccination. DISCUSSION: Un test t de Welch distinct pour chaque année d'étude a indiqué la présence de différences statistiquement significatives entre notre enquête et celle publiée en 1999­2000, révélant une attitude plus positive des étudiants de notre enquête envers la vaccination. CONCLUSION: Les étudiants en chiropratique à CMCC de l'année 2011­2012 ont représenté une disposition positive envers la vaccination.

Frequency of use of diagnostic and manual therapeutic procedures of the spine currently taught at the Canadian Memorial Chiropractic College: A preliminary survey of Ontario chiropractors. Part 2 - procedure usage rates.

OBJECTIVE: The purpose of this study was to determine which diagnostic and therapeutic procedures of the spine are most commonly utilized by chiropractors practicing in Ontario, based on a list of currently taught procedures at CMCC. In Part 1 of this study (published previously), the demographics and practice patterns of the respondents were presented. Part 2 of this study (presented here) reports on the utilization rates of spinal diagnostic and therapeutic procedures by the respondents. METHODS: The study consisted of a paper-based survey that was sent to 500 randomly selected Ontario chiropractors who responded confidentially. Survey questions inquired into demographic and practice style characteristics as well as the frequency with which spinal diagnostic and therapeutic procedures were performed. RESULTS: There were 108 respondents to the survey, giving a response rate of 22.4%. Frequency of use of diagnostic procedures fell into three broad categories: (i) those tests that are almost always performed, (ii) those tests that are almost always performed by two-thirds to one-half of patients, and (iii) those tests that are virtually never used. By comparison, respondents utilized the same therapeutic procedures for patients care less consistently. CONCLUSIONS: Despite a low response rate, respondents reported mostly relying on static and motion palpation, joint play, neurological tests, and ranges of motion when assessing their patients. Due to a low response rate, the results of this study may not be generalizable to all Ontario chiropractors.

OBJECTIF: Le but de cette étude était de déterminer les procédures diagnostiques et thérapeutiques de la colonne vertébrale les plus couramment utilisées par les chiropraticiens qui exercent en Ontario, en fonction d'une liste de procédures enseignées au Canadian Memorial Chiropractic College (CMCC). Dans la première partie de cette étude (publiée précédemment) les données démographiques et les habitudes de pratique des répondants ont été présentées. La deuxième partie de cette étude (décrite ici) rapporte les résultats des taux d'utilisation des procédures diagnostiques et thérapeutiques pour la colonne vertébrale utilisées par les répondants. MÉTHODOLOGIE: L'étude a été menée par l'entremise d un questionnaire papier envoyé à 500 chiropraticiens de l'Ontario, choisis de manière aléatoire et qui ont répondu de façon confidentielle. Les questions du sondage enquêtaient sur les données démographiques et les caractéristiques des styles de pratique ainsi que la fréquence à laquelle les procédures diagnostiques et thérapeutiques pour la colonne vertébrale sont effectuées. RÉSULTATS: Il y avait 108 répondants au sondage, soit un taux de réponse de 22,4 %. La fréquence de l'utilisation de procédures diagnostiques se classe dans trois grandes catégories : (i) ces tests sont presque toujours effectués, (ii) ces tests qui sont utilisés sur deux-tiers à la moitié des patients, et (iii) ces tests qui ne sont presque jamais utilisés. En comparaison, les répondants ont utilisé les mêmes procédures thérapeutiques concernant les soins pour les patients de façon moins systématique. CONCLUSION: En dépit d'un taux de réponse faible, les répondants ont rapporté qu'ils utilisaient généralement la palpation statique et dynamique, des mobilisations d'articulation et plusieurs méthodes dynamiques lors de l'évaluation de leurs patients. En raison d'un faible taux de réponse, les résultats de cette étude ne devraient pas être généralisés à tous les chiropraticiens de l'Ontario.

Anterior cruciate ligament laxity related to the menstrual cycle: an updated systematic review of the literature.

OBJECTIVES: The purpose of this study was to conduct a systematic review regarding the purported differences in anterior cruciate ligament (ACL) laxity throughout the course of the menstrual cycle. METHODS: A systematic review was performed by searching electronic databases, along with hand-searching of journals and reference tracking for any study that assessed ACL integrity throughout the menstrual cycle from 1998 until 2011. Studies that met the pre-defined inclusion criteria were evaluated using the Modified Sackett Score (MSS) instrument that assessed their methodological quality. RESULTS: Thirteen articles out of a possible 28 met the inclusion criteria. CONCLUSIONS: This systematic review found 13 clinical trials investigating the effect of the menstrual cycle on ACL laxity. There is evidence to support the hypothesis that the ACL changes throughout the menstrual cycle, with it becoming more lax during the pre-ovulatory (luteal) phase. Overall, these reviews found statistically significant differences for variation in ACL laxity and injury throughout the menstrual cycle, especially during the pre-ovulatory phase. Female athletes may need to take precautions in order to reduce the likelihood of ACL injury. However, the quality of the assessments was low and the evidence is still very limited. More and better quality research is needed in this area.

OBJECTIFS: Le but de cette étude était de procéder à un examen systématique concernant les prétendues différences dans le laxisme du ligament croisé antérieur (LCA) tout au long du cycle menstruel. MÉTHODOLOGIE: Un examen systématique a été effectué en recherchant des bases de données électroniques, ainsi qu'en effectuant une recherche manuelle des revues et un suivi de références pour toute étude de 1998 jusqu'en 2011 qui a évalué l'intégrité du ligament croisé antérieur LCA tout au long du cycle menstruel. Les études qui repondaient aux criteres d'inclusion predefinis ont ete evaluees en utilisant le score modifie de Sackett (MSS) qui a évalué la qualité de leur méthodologie. RÉSULTATS: Treize articles, sur un total possible de 28, répondaient aux critères d'inclusion. CONCLUSIONS: Cet examen systématique a découvert 13 essais cliniques portant sur l'effet du cycle menstruel sur le laxisme du LCA. Il existe des preuves pour étayer l'hypothèse que le LCA change tout au long du cycle menstruel, devenant plus relâché lors de la phase pré-ovulatoire (lutéale). Dans l'ensemble, ces examens ont montre des differences statistiquement significatives entre la variation de laxisme et de blessures du LCA tout au long du cycle menstruel, en particulier pendant la phase pré-ovulatoire. Les athlètes de sexe féminin devraient peut-être prendre des précautions pour réduire le risque de blessures du LCA. Cependant, les evaluations qualitatives etaient insuffisantes et les preuves sont encore très limitées. Donc, il faut effectuer plus de recherches, et de meilleure qualité, dans ce domaine.

Frequency of use of diagnostic and manual therapeutic procedures of the spine taught at the Canadian Memorial Chiropractic College: A preliminary survey of Ontario chiropractors. Part 1 - practice characteristics and demographic profiles.

BACKGROUND: Students learn a plethora of physical examination and manual therapy procedures over the course of their chiropractic education. However, it is uncertain to what extent they continue to use these procedures in practice after graduation. OBJECTIVE: The purpose of this study was to determine which diagnostic and therapeutic procedures of the spine are most commonly utilized by chiropractors practicing in Ontario. In Part 1 of this study (presented here), the demographics and practice patterns of the respondents are presented. Part 2 of this study will present the results of the utilization rates of diagnostic and therapeutic procedures used by respondents. METHODS: The study consisted of a paper-based survey that was sent to 500 pseudo-randomly selected Ontario chiropractors who responded confidentially. Survey questions inquired into demographic and practice style characteristics. RESULTS: There were 108 respondents to the survey, giving a response rate of 22.4%. Many chiropractors self-identified themselves with more than one practice style characteristic such as 72.4% of the self-described pain-based chiropractors who also described themselves as evidence-based, compared with 51.9% of subluxation-based chiropractors who also described themselves as evidence-based. Diversified technique was the most commonly employed technique used by 90.7% of respondents, followed by trigger point therapy indicated by 57.4% of respondents. CONCLUSIONS: Despite a low response rate, respondents reported practice characteristics in this study that were similar to practice characteristics previously published, particularly in terms of professional demographics and techniques employed. While Diversified was the most commonly used technique, respondents reported higher levels of use of proprietary soft tissue techniques systems and upper cervical techniques than have been previously reported.

CONTEXTE: Les étudiants apprennent une pléthore d'examens physiques et de procédures de thérapie manuelle au cours de leur formation en chiropratique. Cependant, on ne sait pas dans quelle mesure ils continuent à utiliser ces procédures dans la pratique après l'obtention du diplôme. OBJECTIF: Le but de cette étude était de déterminer les procédures diagnostiques et thérapeutiques de la colonne vertébrale les plus couramment utilisées par les chiropraticiens qui exercent en Ontario. Dans la première partie de cette étude, décrite ici, les données démographiques et les habitudes de pratique des répondants sont présentées. La deuxième partie de cette étude présentera les résultats des taux d'utilisation des procédures diagnostiques et thérapeutiques utilisées par les répondants. MÉTHODOLOGIE: L'étude était basée sur un questionnaire qui a été envoyé à 500 chiropraticiens de l'Ontario, choisis de manière pseudo-aléatoire, qui ont répondu de façon confidentielle. Les questions du sondage enquêtaient sur les données démographiques et les caractéristiques des styles de pratique. RÉSULTATS: Il y avait 108 répondants au sondage, soit un taux de réponse de 22,4 %. De nombreux chiropraticiens se sont définis comme possédant plus d'une caractéristique de style de pratique. Par exemple, 72,4 % des chiropraticiens qui disent traiter en fonction des douleurs, disent également prescrire des traitements fondés sur des preuves, alors que 51,9 % d'entre eux qui traitent les subluxations disent aussi prescrire des traitements fondés sur des preuves. La technique diversifiée est la technique la plus couramment employée par 90,7 % des répondants, suivi par le traitement de points de déclenchement indiqué par 57,4 % des répondants. CONCLUSIONS: Malgré le faible taux de réponse, les répondants de cette étude ont manifesté des caractéristiques de pratique qui étaient semblables aux caractéristiques de pratique d'études publiées précédemment, notamment du point de vue des données démographiques et des techniques professionnelles employées. Bien que la technique diversifiée ait été la technique la plus couramment utilisée, les répondants ont indiqué avoir utilisé beaucoup plus qu'auparavant des techniques exclusives de tissus mous et des techniques de manipulation des vertèbres cervicales supérieures.

Review of methods used by chiropractors to determine the site for applying manipulation.

BACKGROUND: With the development of increasing evidence for the use of manipulation in the management of musculoskeletal conditions, there is growing interest in identifying the appropriate indications for care. Recently, attempts have been made to develop clinical prediction rules, however the validity of these clinical prediction rules remains unclear and their impact on care delivery has yet to be established. The current study was designed to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation. METHODS: Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives, to identify studies of the diagnostic reliability and validity of common methods used to identify the site of treatment application. To be included, studies were to present original data from studies of human subjects and be designed to address the region or location of care delivery. Only English language manuscripts from peer-reviewed journals were included. The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate. Data were extracted and synthesized, and were evaluated in terms of strength of evidence and the degree to which the evidence was favourable for clinical use of the method under investigation. RESULTS: A total of 2594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favoured clinical application of the diagnostic methods reviewed. The most convincing favourable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region. There was also high quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality. Evidence of mixed quality supported the use, with limitations, of postural evaluation. The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays. The evidence was of mixed quality, but unfavourable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement. CONCLUSIONS: A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favourable to strongly unfavourable in regard to using these methods. In general, the stronger and more favourable evidence is for those procedures which take a direct measure of the presumptive site of care- methods involving pain provocation upon palpation or localized tissue examination. Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine-such as skin conductance or thermography-tend not to be supported by the available evidence.

Degree of vertical integration between the undergraduate program and clinical internship with respect to cervical and cranial diagnostic and therapeutic procedures taught at the canadian memorial chiropractic college.

OBJECTIVE: The purpose of this study was to determine if diagnostic and therapeutic procedures for the cervical and cranial spine taught to students during the undergraduate program at Canadian Memorial Chiropractic College are required to be used during their internship by their supervising clinicians and, if so, to what extent these procedures are used. METHODS: Course manuals and course syllabi from the Applied Chiropractic and Clinical Diagnosis faculty of the undergraduate chiropractic program for the academic year 2009-2010 were consulted and a list of all diagnostic and therapeutic procedures for the cranial and cervical spine was compiled. This survey asked clinicians to indicate if they themselves used or if they required the students they were supervising to use each procedure listed and, if so, to what extent each procedure was used. Demographic information of each clinician was also obtained. RESULTS: In general, most diagnostic procedures of the head and neck were seldom used, with the exception of postural observation and palpation. By contrast, most cervical orthopaedic tests were often used, with the exception of tests for vertigo. Most therapeutic procedures were used frequently with the exception of prone cervical and "muscle" adjustments. CONCLUSION: There was a low degree of vertical integration for cranial procedures as compared to a much higher degree of vertical integration for cervical procedures between the undergraduate and clinical internship programs taught. Vertical integration is an important element of curricular planning and these results may be helpful to aid educators to more appropriately allocate classroom instruction.