Locus of Control: ATool forTailoring Self-care in Clinical Practice

JENNIFER R.JAMISON

Background.. Empowering patients to undertake self-care is becoming an important clinical objective. The ability to discern whether patients respond to internal or external motivation may prove useful in initiating patient self-care. This paper reports on a study evaluating the health locus of control as a tool for refining this aspect of the clinical consultation.
Objective: To undertake a pilot study to ascertain whether patients with a strong internal locus of control actively embrace self-care, select more autonomous self-care initiatives and rely on independent sources of information. Conversely, to ascertain whether patients with a strong external locus of control prefer professionally monitored self-care and authoritative sources of information.
Sample: Convenience sampling of chiropractic patients attending chiropractic clinics in the coastal region of Victoria and Queensland. Eight Australian-trained chiropractors consented to have their patients interviewed. Of the 105 patients invited to participate, 99 agreed.
Method: A case study was undertaken to describe and compare the locus of control of chiropractic patients with their self-care behaviours. Patients were interviewed and asked to complete a locus of control questionnaire. Data collected focused upon participants', smoking, alcohol, maintenance chiropractic care, exercise and nutritional supplementation practices. An attempt was also made to identify sources of information that triggered self-care initiatives.
Results: Overall, the chiropractic patient sample reported a healthy lifestyle. Seventy-six percent (76%) of the sample had maintenance chiropractic care, 67% undertook regular exercise, 49% took nutritional supplements, and 84% were non- smokers. Only one patient reported more than four standard alcoholic drinks per day. Lay persons served as important sources of health information, particularly with respect to chiropractic care and exercise. No clear trends linking locus of control with particular self-care initiatives or self-care information triggers were discerned.
Conclusions: This pilot study failed to identify trends in self-care consistent with behaviours predicted using the health locus of control. As failure to support these hypotheses may be attributable to the small sample size, a larger study is needed before any definitive conclusions can be drawn. The emergence of lay persons as important information sources upon which self-care initiatives are triggered endorses a role for chiropractors in health education.

INDEXTERMS: CHIROPRACTIC; INTERNAL- EXTERNAL CONTROL; SELF-CARE.

Chiropr J Aust 1999; 29: 82-6.

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Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents

PETER I. ROME

This paper seeks to contrast reports concerning major adverse side effects, viz. cerebrovascular accidents (CVAs) attributed to cervical spine manipulation, within a broad perspective of medical procedures. It also seeks to correlate the incidence rates of other adverse events and medical procedures with the general incidence rate of CVAS. On analysis, an accurate position would indicate that cervical spinal manipulation is one of the more conservative, least invasive and safest of procedures in the provision of human health care services. The paper also alludes to the political connotations on the subject.

INDEX TERMS: MeSH: ARTERIES; CEREBROVASCULAR DISORDERS; CERVICAL VERTEBRAE; CHIROPRACTIC; MANIPULATION, ORTHOPEDIC; IATROGENIC DISEASE; ORTHOPEDICS; OSTEOPATHIC MEDICINE; PERSUASIVE COMM UN ICATION ; PHYSICAL THERAPY; SPINE; VERTEBROBASILAR ACCIDENTS.

Chiropr J Aust 1999; 29: 87-102

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Spinal Metastases Masquerading as Thoracolumbar Syndrome

LINDSAY J. ROWE and COLIN CLAREY

Three topics are presented and explored-thoracolumbar syndrome, spinal metastatic disease and carcinoma of the kidney. The thoracolumbar syndrome is a relatively common but frequently overlooked site of lumbar spine pain which is often amenable to chiropractic procedures. It is a referred low-back condition mediated through the corneal nerves from a wide number of thoracolumbar conditions, including metastatic disease. The case presented highlights why the thoracolumbar junction should be assessed clinically and radiologically as a site for referred low-back pain.

INDEX TERMS: MeSH: THORACIC VERTEBRAE; NEOPLASM METASTASIS.

Chiropr J Aust 1999; 29: 103-11.

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Acupuncture and theTreatment of Chronic Low-Back Pain: A Review of the Literature

ANDREW JAY STRAUSS

Purpose:-To systematically review clinical trials assessing the efficacy of acupuncture treatment of chronic low-back pain. Objective Ls. The goals of this critical review of the literature include: 1 ) to determine how strong the research evidence is for acupuncture as a treatment for chronic low-back pain', 2) to evaluate if the research is of an acceptable standard', and 3) to propose a research design to evaluate acupuncture management in the treatment of chronic low-back pain.
Summary ofBackground Data: Chronic low-back pain is a very common condition for which no universally accepted treatment exists. Acupuncture is a commonly used therapy to treat chronic pain. Dala Sources: A computer-aided search of medical indexes for papers published between 1978 and 1998 was conducted. The indices included MEDLINE, CINAHL, MANTIS, AMED, AMI, and the Internet using the terms: acupuncture, low back pain, and Chinese Medicine.
Study Selection.. Four peer-reviewed literature articles were identified. Dala Extraction.. Scores were given for quality based on the following categories: study population, quality of intervention, effect measurement, and data presentation and analysis. Results:-We methods scored in the trials ranged from 20 to 46 points (out of a possible total of 100), indicating that all the trials were of poor qualit :9 Three studies showed a favourable result for acupuncture.
Conclusions: There are flaws in the design of all four studies. The efficacy of acupuncture for patients with chronic low-back pain has not been demonstrated with sound randomized controlled clinical trials. One cannot necessarily conclude from this review whether acupuncture is an effective treatment due to the poor design and/or methodology of the trials. This paper suggests an alternate design and methodology to evaluate the efficacy of acupuncture in the management of chronic low-back pain.

INDEX TERMS: MeSH: LOW BACK PAIN; ACUPUNCTURE; MEDICINE, CHINESE TRADITIONAL.

Chiropr J Aust 1999; 29: 112-8.

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