Introduction The chiropractic profession encompasses diverse philosophical orientations, creating challenges in establishing a unified professional identity. The International Chiropractic Education Collaboration (ICEC) Education Position Statement promotes evidence-based practice (EBP), interprofessional collaboration, and the rejection of vitalistic, non-scientific paradigms. To date, no study has assessed student alignment with ICEC principles in a South African context. Methods A web-based, cross-sectional survey was conducted among chiropractic students at the University of Johannesburg during the 2023 academic year. All enrolled students (first-year BHSc to second-year MHSc) were invited to participate. Participants rated their agreement with statements derived from the ICEC Education Position Statement, as well as items measuring attitudes towards EBP, vitalistic philosophy, and interprofessional collaboration, using a 10-point Likert scale. Internal consistency was assessed using Cronbach's alpha and mean inter-item correlations. The Mann-Whitney U test compared attitudes between junior (first to third year) and senior (fourth to sixth year) students. Results A total of 144 students participated (response rate: 58.78%). Students demonstrated high agreement with EBP (mean 7.87), interprofessional collaboration (mean 8.13), and most ICEC statements (mean 8.47), although agreement with the vertebral subluxation statement was neutral (mean 5.98). Vitalistic philosophy agreement was neutral overall (mean 5.23). Senior students exhibited significantly lower agreement with vitalistic philosophy (N < 0.001) and interprofessional collaboration (N = 0.04) compared to juniors. A significant difference was observed between groups regarding "Evidence-based Practice, Scope of Practice, Identity and Setting" (N < 0.001). No significant difference was found for the ICEC Education Position Statement (N = 0.84). Conclusion Chiropractic students at the University of Johannesburg demonstrate strong alignment with evidence-based principles, interprofessional collaboration, and the majority of ICEC principles. Cross-sectional comparisons revealed lower agreement with vitalistic philosophy among senior students, suggesting an association with academic progression. These findings highlight the potential role of structured educational frameworks in shaping professional identity, although causal inferences cannot be drawn from this cross-sectional design.

BACKGROUND:Manual therapy is recommended for the management of low back pain (LBP). However, there are gaps in our knowledge about how individuals understand and view the role of manual therapy in the management of their LBP. Beliefs about manual therapy may influence behaviors and clinical outcomes. This study aimed to develop an in-depth understanding of the beliefs about manual therapy held by a group of individuals experiencing LBP. METHODS:Twenty-one participants with a history of LBP and varied experience of manual therapy participated in semi-structured interviews. The interviews were transcribed verbatim, and the dataset was analyzed using reflexive thematic analysis. A patient and public involvement group contributed to the design of the study. RESULTS:Five themes were generated: (1) Manual therapy as movement. Manual therapy is predominantly believed to be a transient mechanical treatment aimed at addressing restriction in the back. (2) Self-management and manual therapy go 'hand in hand'. Self-management was seen as a fundamental and complementary element of manual therapy. (3) Helping me manage or trying to 'fix' my back. The participants who believed that manual therapy was an appropriate long-term treatment felt that it could help manage their LBP rather than provide a permanent 'fix'. (4) All or nothing: the value of the therapeutic alliance. Beliefs about the importance of the therapeutic alliance with a manual therapist varied considerably, with some participants being dismissive of its value. (5) In safe hands? Most participants had no concerns about the safety of manual therapy, conditional on their trust in the manual therapist. However, some participants expressed significant concerns about safety. CONCLUSION:Participants' beliefs about their LBP and the role of manual therapy were shaped by a predominantly mechanical model. However, participants with greater experience of manual therapy often perceived the therapeutic alliance as beneficial for managing their LBP and addressing psychosocial factors. Manual therapists should be aware of unhelpful beliefs held by LBP patients that can potentially influence behaviors and outcomes. In addition, patients' beliefs about the risks and benefits of treatment should be explored to facilitate shared decision making around the use of manual therapy.

Background Safety incident (SI) reporting and learning via incident reporting systems (IRSs) is used to identify areas for patient safety improvement. The chiropractic patient incident reporting and learning system (CPiRLS) is an online IRS that was launched in the UK in 2009 and, from time to time, has been licensed for use by the national members of the European Chiropractors' Union (ECU), members of Chiropractic Australia and a Canada-based research group. The primary aim of this project was to analyse the SIs submitted to CPiRLS over a 10-year period to identify key areas for patient safety improvement. Method All SIs reported to CPiRLS between April 2009 and March 2019 were extracted and analysed. Descriptive statistics were used to describe: (1) the frequency of SI reporting and learning by the chiropractic profession, and (2) the character of reported SIs. Key areas for patient safety improvement were developed following a mixed methods approach. Results A total of 268 SIs were recorded on the database over the 10-year period, 85% of which originated from the UK. Evidence of learning was documented in 143 (53.4%) SIs. The largest subcategory of SIs related to post-treatment distress or pain (n = 71, 26.5%). Seven key areas for patient improvement were developed including: (1) patient trip/fall, (2) post treatment distress/pain, (3) negative effects during treatment, (4) significant post-treatment effects, (5) syncope, (6) failure to recognize serious pathology, and (7) continuity of care. Conclusion The low number of SIs reported over a 10-year period suggests significant under-reporting, however, an upward trend was identified over the 10-year period. Several key areas for patient safety improvement have been identified for dissemination to the chiropractic profession. Improved reporting practice needs to be facilitated to improve the value and validity of reporting data. CPiRLS is important in identifying key areas for patient safety improvement.

BACKGROUND:Manual therapy (MT) is commonly used to manage low back pain (LBP) and involves a complex interaction between the practitioner and patient. Attitudes and beliefs about MT may play a role in the outcomes seen in patients experiencing LBP. However, knowledge of patients' attitudes and beliefs regarding MT is currently limited. OBJECTIVE:To map the existing published literature on the attitudes and beliefs about MT in patients experiencing LBP. DESIGN:Scoping Review. METHOD:A systematic search was conducted across the PubMed, CINAHL, PsycINFO and Scopus databases. Study selection involved screening 1) title and abstracts and 2) full text articles. Data was analyzed to provide a descriptive summary of the studies and to develop themes of patients' attitudes and beliefs about MT. RESULTS:A total of 767 records were identified from the initial search strategy. Following study selection, 14 articles were included for data analysis. Five themes related to patients' attitudes and beliefs about MT were developed from the existing literature. Attitudes and beliefs about MT are explored and measured inconsistently with only one validated tool available. CONCLUSION:MT is believed to be a preferential and effective treatment with accepted levels of post-treatment soreness. This review indicated that patients believe that MT has a biomedical mechanism of action and is suitable for biomedical causes of LBP. Several gaps in the literature are present that require further investigation.