Introduction:The objective of this study was to conduct a comparative audit of geriatric courses taught at English-speaking accredited chiropractic educational programs (CEPs) worldwide. Methods:Using purposeful sampling course coordinators or administrators were asked to provide geriatric course outlines. Data on learning objectives, course structures and topical outlines were extracted, with data presented descriptively. Results:Thirty-four CEPs were invited to participate and data sets of 17 CEPs (Australia, Canada, Puerto Rico, United Kingdom and the United States) were analyzed. All course content was delivered by lectures, the majority assessed students with written examinations and assignments and all teaching faculty were chiropractors. The five most taught topics were neurological disorders, chiropractic care, cognitive disorders, geriatric assessment and falls. Conclusion:We identified consistency between CEPs with respect to course delivery, assessment and faculty but there was a great deal of variability with respect to course topics. Further research to develop core competencies for geriatric chiropractic education is warranted.

"The only constant is change" - Heraclitus, Greek Philosopher The objective of this article, Part 1 of a two part series, is to provide a narrative review of the evolution of teaching chiropractic manual skills by four tutors who taught in the technique trenches at the Canadian Memorial Chiropractic College collectively for 120 years. Based on their collective memories, this narrative review describes the evolution of: central demonstrations; inconsistency between tutors with respect to demonstrating and grading chiropractic manual skills; determining course content; policy on students providing high velocity, low amplitude thrusts on each other during class time and testing; quantitative versus qualitative grading; remediation; acknowledgment of risk and; changes to technique class due to Covid. The results of a unique survey evaluating students' perception of these changes is presented. The intent of this article is for faculty at other accredited educational programs to learn from our experiences and potentially strengthen their pedagogical approach to teaching chiropractic manual skills.

The objectives of this article, Part 2 of a two part series, are twofold: (i) To provide a narrative review of the research evidence authored by faculty of the Canadian Memorial Chiropractic College (CMCC) and; (ii) discussion of the impact this research evidence had on teaching chiropractic manual skills at CMCC and - theoretically - to the broader chiropractic educational community. Research evidence discussed are in the areas of: Experimental studies linked to biomechanics; Measuring Force - Integration of Force Sensing Table Technology (FSTT®) into technique labs; Characteristics of injuries sustained by chiropractic students during technique labs; Finding the clinical target for therapeutic intervention and; Recommendations toward a model technique curriculum. The intent of this article is for faculty at current and future accredited educational programs to incorporate this research evidence into their technique curricula and to potentially strengthen the pedagogical approach used to teach chiropractic manual skills.

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.

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.

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.

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.

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.

We wish to thank the author of the articulate and well-referenced letter to the editor. We certainly agree that there are many other commonly used nonthrust types of manipulation procedures, such as flexion-distraction and instrument-assisted techniques. Nonthrust techniques may, indeed, be viable and alternative options to thrust manipulation procedures. Any decision concerning patient treatment must be informed by evidence, clinician experience, and/or patient preference to achieve the optimal outcome. Response to “Best Practices for Chiropractic Care for Older Adults: A Systematic Review and Consensus Update”Journal of Manipulative & Physiological TherapeuticsVol. 40Issue 7PreviewHawk et al.1 reported a Delphi study on the effectiveness or efficacy of spinal manipulation thearpy (SMT) in persons over age 65 years and the adverse events associated with chiropractic care, including SMT. Complementing this study is a review by Nielsen et al.,2 who identified 118 studies on the adverse and serious adverse events associated with SMT; 54 (46%) reported that it is safe, 15 (13%) reported that it is harmful, and 49 (42%) were neutral or unclear. Nielsen et al. stated that it is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of serious adverse events reported can, indeed, be significant, indicating that some risk is present. Full-Text PDF

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.

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.

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.

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.

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.

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.

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.

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.

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.