CJA Vol.23 Issue 4Editorial ...And The Adventure Continues .... A Classification System for Use Within the Case-Mix
Context of Chiropractic Practice. Pain Drawings: An evaluation of Scoring Criteria by
Chiropractors. The Effects of Chiropractic on the Immune System: A
Review of the Literature. Acceptance and Identity: The Conundrum of
Contemporary Chiropractic. "Informed Consent" and All That Jazz. Murder They Wrote: The Death of D.D. Palmer and Its
Aftermath. Historical Notes: The International College of Chiropractors
Incorporated. ABSTRACTS A Classification System for Use Within the Case-Mix Context of Chiropractic Practice PHILLIP S. EBRALL The objective of this study was to attempt to classify chiropractic patient visits into one of four levels within a disease/health context paradigm. Twenty-five registered chiropractors in private practice drawn from 6 of the 8 jurisdictions in Australia, and who were members of the Chiropractors' Association of Australia, were asked to record data of 100 consecutive patient visits from Monday, 7 September 1992. Each practitioner was supplied with a plain-language explanation of the classification scheme: levels 1 and 2 represented the disease context, and levels 3 and 4, the health context. Of the 2,500 patient visits recorded, 2,497 were categorised by the practitioners: 962 as level 1, 1027 as level 2, 426 as level 3 and 82 as level 4. The levels and their implications are discussed. A wide variance of classification is noted between jurisdictions in Australia. An extremely small number of patient visits (8, 3.5%) where payment was by a worker's compensation scheme (n=230) were classified within the health context. The rate of patient visits where the working diagnosis was a visceral complaint only was highest in the health context, at 23.6 per thousand. The majority of contemporary chiropractic practice in Australia, as represented by the key indicator group of this study, is based on sound, defensible management protocols. It remains imperative for the "Type M/Type O" fetter to be jettisoned and replaced with the search for those quantitative components that have not yet been identified within the schedules of maintenance and prophylactic care which are essential to the "health" context of the chiropractic paradigm. INDEX TERMS: MeSH: diagnostic related groups; quality assurance, health care, physician's practice patterns; chiropractic Chiropractic J Aust 1993 Sep;23(3):122-6 Pain Drawings: An evaluation of Scoring Criteria by Chiropractors PETER BRYNER Chiropractors attribute low-back pain to physical causes, at least by virtue of their treatment, rather than to psychological causes. It was decided to examine chiropractors' responses to the suggestion that certain characteristics of pain drawings can identify psychological problems. The Ransford scoring criteria were used to devise seven drawings along with seven drawings of common pain distribution. The six main additional features used to generate a Ransford score were also illustrated. These drawings were shown to three different groups of chiropractors who responded to each drawing using a visual analogue scale on a questionnaire. They were asked to respond as to how common they were, and how likely they thought each indicated psychological problems in low-back pain patients within their practices. The mean practice experience of respondents was eight years, and 48% did not use pain drawings. Respondents identified that the seven non-Ransford drawings occurred more in practice (5.4/10) than the Ransford-derived drawings (2.8/10). They did not feel that the Ransford-derived drawings indicated a greater psychological involvement (2.2 vs 2.7/10). This could indicate that chiropractors are consulted by people with unusual pain patterns which contribute to the Ransford score. The common value above zero could indicate that chiropractors feel that all pain has a psychological component. Firm conclusions are not possible from this data set, but combined with conclusions from other studies there is some doubt about the value of scoring drawings for psychological involvement in a chiropractic setting. Doubt is most directed at interpretations of pain patterns within the body outline which contribute to the Ransford score. INDEX TERMS: MeSH: chiropractic; pain measurement. Other: pain drawing. Chiropractic J Aust 1993 Sep;23(3):127-31 The Effects of Chiropractic on the Immune System: A Review of the Literature JAMES M. ALLEN This paper outlines the many components of the mammalian immune system and the anatomical and physiological connections suggesting that the nervous system plays a role in the modulation of immune response. The few studies attempting to measure the effect of chiropractic or manipulative treatment on the immune system are reviewed. Their results suggest that chiropractic or manipulative treatment may influence T and B lymphocyte numbers, NK cell numbers, antibody levels, phagocytic activity and plasma beta-endorphin levels. The influence of these effects on the outcome of host resistance is unknown. There is now a need for large, well-planned clinical trials using some of the more sophisticated measures of immune function to establish whether chiropractic treatment can influence the immune response in a clinically significant manner. INDEX TERMS: MeSH: chiropractic; manipulation, orthopedic; immune system. Other manipulation, chiropractic. Chiropractic J Aust 1993 Sep;23(3):132-5 Acceptance and Identity: The Conundrum of Contemporary Chiropractic JENNIFER R. JAMISON A plausible rationale used to functionally limit, if not exclude, chiropractic from participation in conventional health care is the paucity of scientifically acceptable evidence to support the clinical practice of these practitioners. The most respected type of scientific evidence in health care is based largely upon the assumptions of the mechanistic paradigm and quantitative research methodology-neither of which are necessarily conducive to good chiropractic practice. Chiropractic rhetoric would in any event suggest that chiropractic is a holistic profession. Conventional holism, although largely compatible with chiropractic clinical interaction, nonetheless fails to provide a forum in which clinical observations can be adequately explained and chiropractic uniqueness satisfactorily preserved. As functional description of chiropractic holism would appear to need to address the issues of chiropractic uniqueness and scientific legitimacy, it is desireable to explore a variety of models. The infomedical model is proposed as one option wherein chiropractic holism may evolve. INDEX TERMS: MeSH chiropractic; Other: holism; identity; legitimacy. Chiropractic J Aust 1993 Sep;23(3):136-40 "Informed Consent" and All That Jazz STANLEY P. BOLTON The American doctrine of "informed consent" has not been given legal form in Australia, but questions surrounding aspects of informed choice in relation to medical negligence continue to occupy legal processes. In 1992 the High Court of Australia-the nation's highest judicial body- moved away from both the American legal doctrine of "informed consent" and the English Bolam legal principle. These two aspects in negligence deal with the scope of the doctor's duty to inform of risks in treatment and the power of the court to override evidence of expert witnesses. This paper notes the High Court's significant recent dicta which have bearing on chiropractic practice and implications for chiropractic standards. INDEX TERMS: chiropractic; chiropractic, legislation & jurisprudence; informed consent malpractice. Chiropractic J Aust 1993 Sep;23(3):141-2 Murder They Wrote: The Death of D.D. Palmer and Its Aftermath ROLF E. PETERS and MARY ANN CHANCE D.D. Palmer, the discoverer of chiropractic, who died 80 years ago, on 20 October 1913, is briefly remembered in the aftermath of his death, his son B.J. Palmer was accused of premeditated, intentional and malicious patricide, and a suit was pressed by the owners of a rival chiropractic school and the legal coursel of a rival chiropractic trade association. The case was thrown out of court three times, and the perpetrators of the suits were warned by the Grand Jury that another appearance before them would bring an investigation into their motives for possible indictment for a criminal offence. As the allegations of patricide tend to reappear intermittently, a retelling of B.J. Palmer's defence is presented to acquaint a new generation of chiropractors with the events of that time. INDEX TERMS: MeSH: chiropractic/history; historical article; history of medicine, 20th century. Other: history or chiropractic Chiropractic J Aust 1993 Sep;23(3):143-8 |
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