Relative responsiveness of 3 different types of clinical outcome measures on chiropractic patients with low back pain.
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Adult↗
Biomedical subjects
Dana J Lawrence
Publications and source records attributed to Dana J Lawrence.
Do chiropractic college faculty understand informed consent: a pilot study.
BACKGROUND: The purpose of this study was to survey full-time faculty at a single chiropractic college concerning their knowledge of Institutional Review Board (IRB) policies in their institution as they pertain to educational research. METHODS: All full-time faculty were invited to participate in an anonymous survey. Four scenarios involving educational research were described and respondents were asked to select from three possible courses of action for each. In addition, respondents were queried about their knowledge of IRB policies, how they learned of these policies and about their years of service and departmental assignments. RESULTS: The response rate was 55%. In no scenario did the level of correct answers by all respondents score higher than 41% and in most, the scores were closer to just under 1 in 3. Sixty-five percent of respondents indicated they were unsure whether Palmer had any policies in place at all, while 4% felt that no such policies were in place. Just over one-quarter (27%) were correct in noting that students can decline consent, while more than half (54%) did not know whether there were any procedures governing student consent. CONCLUSION: Palmer faculty have only modest understanding about institutional policies regarding the IRB and human subject research, especially pertaining to educational research. The institution needs to develop methods to provide knowledge and training to faculty. The results from this pilot study will be instrumental in developing better protocols for a study designed to survey the entire chiropractic academic community.
Journal Article↗
Management of chest pain: exploring the views and experiences of chiropractors and medical practitioners in a focus group interview.
BACKGROUND: We report on a multidisciplinary focus group project related to the appropriate care of chiropractic patients who present with chest pain. The prevalence and clinical management, both diagnosis and treatment, of musculoskeletal chest pain in ambulatory medical settings, was explored as the second dimension of the focus group project reported here. METHODS: This project collected observational data from a multidisciplinary focus group composed of both chiropractic and medical professionals. The goals of the focus group were to explore the attitudes and experiences of medical and chiropractic clinicians regarding their patients with chest pain who receive care from both medical and chiropractic providers, to identify important clinical or research questions that may inform the development of 'best practices' for coordinating or managing care of chest pain patients between medical and chiropractic providers, to identify important clinical or research questions regarding the diagnosis and treatment of chest pain of musculoskeletal origin, to explore various methods that might be used to answer those questions, and to discuss the feasibility of conducting or coordinating a multidisciplinary research effort along this line of inquiry. The convenience-sample of five focus group participants included two chiropractors, two medical cardiologists, and one dual-degreed chiropractor/medical physician. The focus group was audiotaped and transcripts were prepared of the focus group interaction. Content analysis of the focus group transcripts were performed to identify key themes and concepts, using categories of narratives. RESULTS: Six key themes emerged from the analysis of the focus group interaction, including issues surrounding (1) Diagnosis; (2) Treatment and prognosis; (3) Chest pain as a chronic, multifactorial, or comorbid condition; (4) Inter-professional coordination of care; (5) Best practices and standardization of care; and (6) Training and education. CONCLUSION: This study carries implications for chiropractic clinical training relative to enhancing diagnostic competencies in chest pain, as well as the need to ascertain and improve those skills, competencies, and standards for referrals and sharing of clinical information that may improve cross-disciplinary coordination of care for chest pain patients.
Journal Article↗
Chiropractic as spine care: a model for the profession.
BACKGROUND: More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. OBJECTIVE: To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. DISCUSSION: The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. CONCLUSION: This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.
Journal Article↗
An exploration of community leader perspectives about minority involvement in chiropractic clinical research.
OBJECTIVE: The aim of this study was to examine the perspectives of individuals in leadership or advocacy positions from two different minority groups about involvement with chiropractic clinical research. DESIGN: The narratives from two focus groups provided the primary source data. Purposive sampling was used for participant selection. Within- and across-group analyses of focus group data were conducted using a matrix consisting of the core constructs awareness, acceptance, and access. SETTING: The Palmer Center for Chiropractic Research in Davenport, Iowa, was the setting. SUBJECTS: Participants were in leadership or advocacy positions from two minority communities in the greater Quad Cities area of Iowa. Eight (8) participants were in the Hispanic/Latino focus group, and 6 were in the Black/African-American focus group. RESULTS: The findings suggest that there is limited awareness about chiropractic and chiropractic research in the Hispanic/Latino and Black/African-American communities. Cultural and ethnic representation will facilitate efforts toward increasing awareness, acceptance, and access to the community. Generational differences exist in acceptance of chiropractic and chiropractic research by both communities. Gaining the trust of the Black/African-American community is essential before they will become involved in research. Participants from both groups reported that negative beliefs by health professionals impede access to chiropractic services. The participants identified a myriad of venues and methods for collaborating with their constituents. CONCLUSIONS: Honoring the perspectives and needs of the Hispanic/Latino and the Black/African-American community is essential to facilitate participation in chiropractic clinical research. The study calls on research institutions to reconceptualize how they interact with the community to foster a more relational approach.
Adult↗
On the subject of human subjects.
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Ethics Committees, Research↗
Commentary: the National Workshop to Develop the Chiropractic Research Agenda: 10 years on, a new set of white papers.
This commentary reports on the advances that have occurred over the 10-year period since the first National Workshop to Develop the Chiropractic Research Agenda was held and introduces the second set of white papers that were produced as a result of the 10th annual Research Agenda Conference. Four working groups were convened to update the original 5 white papers that represented the most significant results from the first workshop in 1996. Each group was to review the first report, examine the action steps and recommendations that were published in each report to see how much had been completed in the past decade, and develop new action steps and recommendations for the future. Four new articles were developed, each updating and adding significant amounts of new research to the original versions. New action steps and recommendations will help move the profession forward into the future. Chiropractic scientists have worked diligently over the past decade to address the recommendations noted in the first set of white papers. Despite significant advances in knowledge and scientific capacity, the chiropractic profession is still confronted with a large number of research challenges.
Chiropractic↗
Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol.
OBJECTIVE: To describe the chiropractic management of a 30-year-old woman with temporomandibular joint (TMJ) pain and to discuss the general etiology and management of TMJ conditions. CLINICAL FEATURES: The patient suffered from daily unremitting jaw pain for 7 years, which was the apparent sequela of a series of 8 root canals on the same tooth. Pain radiated from her TMJ into her shoulder and was accompanied by headache, tinnitus, decreased hearing, and a feeling of congestion in her right ear. Symptoms were not reduced by medication or other dental treatments. OUTCOME AND INTERVENTION: The patient underwent a series of chiropractic treatments using the instrument and protocol of Activator Methods, International. During the first 5 months, her VAS rating of jaw pain decreased from 60 (on a scale of 0 to 100) to 9, her ability to eat solid foods increased, headache intensity and frequency diminished, and her maximum mouth opening without pain measurement increased from 22 to 28 mm. Overall, 20 months of chiropractic treatment along with 2 concurrent months of massage therapy yielded slow but continual progress that finally resulted in total resolution of all symptoms except some fullness of the right cheek. CONCLUSION: Use of the Activator Methods protocol of chiropractic treatment was beneficial for this patient and merits further study in similar cases.
Adult↗