Characteristics of chiropractic patients treated at the University of Johannesburg chiropractic student clinic and relevance to the educational process

South African Chiropractic Students' Intentions, Motivations, and Considerations for Emigration: A Cross-Sectional Study

Objective

The purpose of this study was to investigate the emigration intentions of South African senior chiropractic students upon graduation, emphasizing motivations and considerations guiding migration decisions.

Methods

A cross-sectional, quantitative, and exploratory approach was employed, utilizing an anonymous and adapted online survey administered to chiropractic students at 2 South African institutions (n = 177) between March 15 and May 19, 2021. Data were analyzed using frequencies, descriptions, and cross-tabulations to identify trends and interrelationships related to students' intentions to emigrate postqualification.

Results

Findings indicate that 75.5% of South African chiropractic senior students intend to emigrate. Motivations for emigration include improved quality of life and seeking of opportunities. Economic instability in South Africa (SA) (82.7%) and concern for the National Health Insurance implementation (57.7%) serve as a significant push factor, whereas economic stability abroad (85.7%) emerged as a key pull factor. Preferred emigration destinations are primarily developed countries with established chiropractic communities.

Conclusion

High emigration intentions among students were driven by diverse push factors in SA, including economic decline, socio-political climates, and safety concerns, contrasting with pull factors abroad, such as better opportunities, living conditions, and economic stability. Concerns regarding healthcare reforms, particularly the National Health Insurance, are also highlighted. Destinations in order of preference such as the United Kingdom, Canada, and Australia offer valuable insights for policy interventions. Understanding these dynamics is crucial for developing effective retention strategies and addressing socio-economic challenges.

Chiropractic attitude and utilisation of evidence-based practice in South Africa: a secondary analysis

BACKGROUND

Evidence-Based Practice (EBP) is a model utilised by the majority of healthcare professionals and is a clinical framework that assists with decision-making related to patient care, to improve outcomes and patient satisfaction. The study aimed to analyse the attitudes, skills, and utilization of evidence-based practice (EBP) among South African chiropractors, focusing on perceived skill levels, training, use and identifying facilitators and barriers to EBP application.

METHODS

A descriptive cross-sectional quantitative secondary analysis was conducted by inviting registered chiropractors in South Africa (n = 920) to participate in an anonymous online questionnaire using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE).

RESULTS

A total of 132 chiropractors completed the survey, yielding a response rate of 14.4%. Of the respondents, 59.9% were female, 52.3% were between 26 and 35 years old, and 63.3% had graduated from the University of Johannesburg. A third of respondents stated they have poor clinical research skills. Over half of the respondents (56.8%) indicated that EBP constituted a significant part of their education except for completing systematic reviews or meta-analyses. Published clinical evidence was ranked 6th as a source of information for clinical decisions. The obstacles indicated were time constraints and a lack of clinical research in complementary and alternative medicine. Access to the internet, databases and research tools were facilitators that were deemed to be "very useful" in promoting EBP.

CONCLUSION

The majority of South African chiropractors are generally favourable towards EBP, and this practice therefore appears to be utilised and embraced, with the requisite skills.

The prevalence of chiropractic-related terminology on South African chiropractors' webpages: a cross-sectional study

BACKGROUND

Effective communication is imperative for successful interprofessional collaborative interactions that augment both patient-centred and evidence based care. Inquiry into the prevalence of chiropractic-related terminology on South African chiropractor's webpages has not been explored to date. The implications of such analysis could indicate the professions' ability to effectively communicate in interdisciplinary settings.

METHOD

From 1 to 15 June 2020, Google search was used to identify the webpages (excluding social media accounts) of South African private practice chiropractors registered with the Allied Health Professions Council of South Africa (AHPCSA). Webpages were word-searched for eight chiropractic terms with context: subluxation; manipulate(-ion); adjust(-ing/-ment); holism(-tic); alignment; vital(-ism/-istic); wellness; and innate intelligence. Data collected was transferred to an Excel spreadsheet. Accuracy of information was verified by the researchers through a process of double checking. The number of instances each term was used, and certain socio-demographic data were recorded. Descriptive statistics and bivariate analyses were used to summarise and analyse the data.

RESULTS

Among 884 AHPCSA-registered South African chiropractors, 336 webpages were identified and analysed. From 1 to 15 June 2020, the most commonly found terms on 336 South African chiropractic webpages were 'adjust(-ing/-ment)', 'manipulate/manipulation', and 'wellness', with prevalence estimates of 64.1% (95% confidence interval [CI], 59.0% to 69.2%), 51.8% (95% CI, 46.5% to 57.1%), and 33.0% (95% CI, 28.2% to 38.2%), respectively. The least commonly found terms were 'innate intelligence' and 'vital(-ism/-istic)', with prevalence estimates of 0.60% (95% CI, 0.16% to 2.1%) and 0.30% (95% CI, 0.05% to 1.7%), respectively. Manipulate(-ion) was used more by male chiropractors (p = 0.015). The longer a chiropractor was in practice the more likely they were to use profession-specific terms (p = 0.025). The most frequently occurring combination of terms were adjust(-ing/-ment) and manipulate(-ion), found in 38 out of 336 webpages (11.3%; 95% CI, 8.4% to 15.1%).

CONCLUSION

The use of chiropractic-related terminology on South African chiropractic webpages was common, with the prevalence of term use varying by type of terms, by gender of the chiropractor, and by clinical practice experience. Better understanding of the effects of chiropractic terminology use on interprofessional and patient interactions and communication is warranted.

Musculoskeletal healthcare at a Swiss university hospital chiropractic medicine outpatient clinic in 2019: a health services research study

BACKGROUND

The Balgrist University Hospital in Zurich, Switzerland, is an academic hospital focused on musculoskeletal disorders. An integrated chiropractic medicine clinic provides chiropractic care to a broad patient population. This health services research study aims to advance understanding of chiropractic healthcare service for quality assurance and healthcare quality improvement.

METHODS

We performed an observational clinical cohort study at the Balgrist chiropractic medicine outpatient clinic in 2019. The records of all patients with initial visits or returning initial visits (> 3 months since last visit) and their subsequent visits from January 1, 2019, to December 31, 2019, were used to create the study dataset. Data collected included demographic characteristics, diagnoses, imaging data, conservative treatments, surgeries, and other clinical care data. Descriptive statistics were used to summarize data.

RESULTS

1844 distinct patients (52% female, mean age 48 ± 17 years) were eligible and included in the study. 1742 patients had a single initial visit, 101 had 2 initial visits, and 1 patient had 3 initial visits during the study period (total of 1947 initial visit records). The most common main diagnoses were low back pain (42%; 95% CI 40-46%), neck pain (22%; 20-24%), and thoracic pain (8%; 7-9%). 32% of patients presented with acute (< 4 weeks) symptoms, 11% subacute (4-12 weeks), and 57% chronic (> 12 weeks). Patients had a median of 5 chiropractic visits during their episode of care within a median of 28 days duration. Only 49% (95% CI 47-52%) of patient records had a clinical outcome that was extractable from routine clinical documentation in the hospital information system.

CONCLUSION

This health services study provides an initial understanding of patient characteristics and healthcare delivered in a Swiss academic hospital chiropractic outpatient setting and areas for improved clinical data quality assurance. A more concerted effort to systematically collect patient reported outcome measures would be a worthwhile healthcare quality improvement initiative.