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Subject: search.filters.subject.Chiropractic--Study and teaching (Graduate)

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    The perceptions and experiences of Chiropractic Master’s students on practicing evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal
    (2023) Tayob, Tasmiya; Varatharajullu, Desiree
    Evidence-based practice (EBP) integrates the best available research evidence in conjunction with clinical expertise with the consideration of patient values. A well-trained clinician should pose clinically relevant questions and access the clinically relevant literature to find, appraise, and use the best valuable evidence in routine clinical care. Patients who receive evidence-based therapy have better outcomes in comparison to patients who do not. Globally, EBP is accepted as a basis of healthcare professional education, which was initially used in medicine, but now extends to allied health professions. In order to achieve the best patient outcomes, healthcare professions should effectively incorporate adequate knowledge, skills and attitudes towards EBP into education programmes. The implementation of EBP is regarded as a key competence for the improvement of healthcare quality. Numerous professions have implemented EBP, such as nursing, physiotherapy, occupational therapy, social care, pharmacy, physical therapy, dietetics, podiatry, radiography, orthotics, speech and hearing therapy, psychology and chiropractic. Evidence-based practice has had an increasing impact on chiropractic education and its implementation in chiropractic care. The importance of EBP is essential as its implementation is a requirement at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Students are required to use EBP when managing and treating patients during their clinical practicum and, thus, it is essential that students are knowledgeable in EBP and know how to use it adequately. Aim of the study The aim of this study was determine the perceptions and experiences of registered Chiropractic Master’s students on the implementation of evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal, South Africa. Methodology This study utilised a qualitative, exploratory and descriptive design. Purposive sampling was used, interviewing 14 Chiropractic Master’s students who have been clinically active for more than four months at a chiropractic teaching clinic in KwaZulu-Natal. Their perceptions and experiences with regard to the implementation of EBP were obtained through semi-structured interviews, which consisted of three key questions, encouraged by relevant probes. The data collected were stored electronically and then transcribed verbatim. Thereafter, the transcripts were coded and analysed by the researcher in order to identify themes along with relevant subthemes. The coded data were then interpreted by the researcher using the previously identified themes and sub-themes. Results There were four main themes identified in this study, namely perceptions and necessity regarding the roles of EBP; undergraduate education and its role in the implementation of EBP; the importance of clinical experience in the implementation of EBP; and the implementation of EBP. Overall, students had a positive perception with regard to EBP with some students reporting limitations to its practice, along with positive perceptions. The students believed that the chiropractic training at the DUT CDC provided a solid foundation but a lack of training in multiple aspects was found. These aspects are discussed comprehensively, including the insufficient training in theoretical and clinical aspects, as well as for pre-clinical preparation. In addition, limitations and barriers were identified, as well as measures of improvement in order to enhance the implementation of EBP were suggested. Conclusion In South Africa, this study is the first to explore the perceptions and experiences of Chiropractic Master’s students on the practice of EBP at a teaching clinic in KwaZulu Natal. The perceptions and experiences were based on various aspects, such as knowledge, application, skills, proficiency, confidence, support structures, training and challenges. Although Chiropractic Master’s students had positive perceptions regarding the implementation of EBP and found the chiropractic training at the DUT to have provided a solid foundation, there were suggested methods of improvement for the chiropractic curriculum to enhance the implementation of EBP. A lack of undergraduate training regarding EBP was one of the key factors that students found to have hindered a more efficient practice of an evidence-based approach. Therefore, it is recommended that the findings of this study be of aid to the Durban University of Technology Chiropractic Department to enhance the quality of the chiropractic curriculum by re-evaluating the context in which the concept of an evidence-based approach was set out in order to encourage EBP by students and consider a different, more coherent method of implementation.
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    Identification and management of yellow flags in chronic low back pain by Chiropractic Master's students at a University of Technology teaching clinic
    (2023-05-31) Egumbo, Shameez; Ghuman, Shanaz
    Chronic low back pain (CLBP) is one of the leading causes of disability worldwide, preventing many people from performing day to day tasks. Low back pain is the third most common reason for visits to the doctors, right after skin disorders and osteoarthritis. Even though doctors of chiropractic treat more than just back pain, many patients initially visit a chiropractor looking for relief from this persuasive condition. Yellow flags are psychosocial issues that can be indicative of long-term chronicity in low back pain. It is therefore appropriate for chiropractors to know how to manage yellow flags in patients with low back pain, since the two are related. The aim of this study, therefore, is to investigate the identification, knowledge, and the management of yellow flags at teaching clinic by chiropractic master’s students. AIM AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe the identification and management of yellow flags in chronic low back pain by chiropractic master’s students at a university of technology teaching clinic. METHODOLOGY A qualitative, exploratory, descriptive study was conducted. Master’s degree chiropractic students, who had been clinically active for five months and treated a minimum of five low back pain patients were interviewed to establish their identification and management of yellow flags in CLBP. Semi-structured interviews were conducted in English, which were then transcribed to a Microsoft Word document. The transcripts were analysed using Tsech’s eight steps of thematic analysis to establish the themes, categories and codes. RESULTS AND DISCUSSION This qualitative, descriptive study explored 10 chiropractic master’s students’ identification and management of yellow flags in their chronic low back pain patients. It was found that the chiropractic master’s students had limited understanding of psychosocial factors. Their lack of information and clinical expertise lead to uncertainty pertaining to the identification, assessment and management of yellow flags. The participants acknowledged their shortcomings and suggested numerous limitations to the integration of psychosocial assessments as part of routine practice. The lack of formal education in the theory, assessment and management was the most frequently cited barrier among those raised by the participants. The review of the chiropractic curricula was outside the purview of this study. Nevertheless, considering the comparable findings reported in the literature further supported this, it may suggest a need for chiropractic education of yellow flag assessment and management to be reviewed and strengthened. CONCLUSIONS This is the first South African study that had been conducted on registered master’s degree chiropractic students’ identification and management of yellow flags in chronic low back pain. This study will add to the existing literature and enable other registered master’s degree students and new graduate chiropractors to have a better understanding of the of the management of yellow flag patients.
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    The experience of first-time registered chiropractic students at a South African University of Technology regarding the transition from high school to university
    (2022-09-29) Boosi, Keiron-Ashleigh; Varatharajullu, Desiree
    BACKGROUND There has been a vast amount of literature that has contributed to the topic of transition regarding first-year university students. Much of these studies address the challenges that university students face in their first-year, but few discuss the actual experience that students may face entering university for the very first time. In the realm of chiropractic education there has been abundant literature on the mental health of chiropractic students, as well as the curriculum and the accreditation of chiropractic programmes. Interestingly, unlike other healthcare professional programmes, literature regarding the transition of the chiropractic student into the course, from secondary school, and how that experience affects the attrition rate of the programme is scarce. This study recorded the experiences of first-time registered chiropractic students at a South African university of technology regarding their transition from high school to university. AIM The aim of this study was to explore and understand the experiences of first-time registered chiropractic students at a university of technology. METHOD A qualitative, exploratory, descriptive approach was utilised for this research. A purposive sample of 17 first time registered, first-year chiropractic students was interviewed. Their experience regarding their transition from high school to university was obtained through semi-structured interviews. A total of five key questions, each relating to a specific aspect of the transition process, were used to stimulate a discussion. The data were recorded electronically and thereafter transcribed. Thematic analysis was used to interpret the data. RESULTS The participants indicated that, for the most part, their experience regarding their transition into first year was pleasurable but that it was not devoid of its own set of challenges. The participants indicated difficulties regarding certain modules, the volume of the workload, as well as challenges that were congruent with the literature regarding the obstacle that South African students face in general. The participants highlighted developing relationships with their peers and having a successful orientation as positive factors in their transition experience. The SARS-CoV-2 pandemic had an additional influence on the results of this study and its effect was particularly noted by the participants. CONCLUSION This is the first South African study to document the experiences of first time registered first-year chiropractic students regarding their transition to university. These experiences were based on a variety of external and internal factors in relation to the university, course content and participants’ homelife environments. While participants acknowledged and appreciated the positive factors in their experience in their firstyear, they also provided constructive feedback on matters needing improvement to enhance the overall first-year experience in the chiropractic course at the university. For many participants, the mismatch between their prior expectations of university and their actual experience at university presented them with most of their challenges. It is recommended that the findings of this study be utilised by educational institutions and stakeholders within chiropractic education to enhance chiropractic education in South Africa and ensure that attrition rates for this course are lowered.
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    Upper extremity work-related musculoskeletal injuries among chiropractic students at the Durban University of Technology
    (2021-05-27) Singh, Kyle Andrew; Padayachy, Keseri
    Background: Chiropractic students the world over undergo rigorous training in manual therapy, specifically musculoskeletal manipulation and adjustment. These therapeutic modalities involve the use of the upper extremity to deliver its effects, usually with high velocity and force. This leaves the upper extremity vulnerable to injury, as a result of the repetitive and forceful nature of these manual techniques. Despite this risk, the research available on work-related musculoskeletal injuries of chiropractic students in South Africa is limited. This study aims to determine the prevalence of upper extremity work-related musculoskeletal injuries among chiropractic students at the Durban University of Technology, and selected risk factors associated with work-related musculoskeletal injuries. Method: The study design was a quantitative, descriptive, self-administered questionnaire study that used the total available population. The questionnaire was adapted from a similar study and included the use of a pilot study. The questionnaire had three sections: the first for demographic data, the second was applicable for any new injury to the upper extremity from work-related tasks, and the third was applicable for any old injuries to the upper extremity that were aggravated by work-related tasks. Prevalence was estimated using 95% confidence intervals. Factors associated with injury were assessed at univariate level, using Pearson’s chi-square tests and t-tests, and factors associated at the <0.1 level were selected as independent variables in a multiple logistic regression model to predict risk of injury. The odds ratios and 95% confidence intervals were reported. A stepwise backward selection method, based on likelihood ratios, was used to arrive at a final model consisting only of statistically significant risk factors (p<0.05). Chi-square testing and cross-tabulations were performed on the use of dominant hand and injury. Results: Eighty-six chiropractic students (n=86) were eligible for the study, seventy-seven elected to participate in the study, giving a response rate of 93.9%. The period prevalence of upper extremity work-related musculoskeletal injuries was 59.7% (95% CI 47.93 to 70.57%). The most commonly injured areas were the wrist (60%), shoulder (20%) and hand (17%), with majority of the injuries involving the soft tissue structures: muscle/ tendon strain (42%), ligament sprain (17%) and tendinitis (17%). Most injuries occurred during adjustive procedures (74%) and ischemic compression (19%). None of the demographic variables showed a significant association with prevalence of injury, apart from a moderately non-significant association with year of study (p=0.080). The frequent use of electro-modalities (p=0.073) and temperature therapy (p=0.077) were suggestive of possible associations, however, were not statistically significant. The results showed no significant differences between frequency of adjustments and injury. Despite an absence of statistical significance, a trend was noted showing an increased likelihood of injury when adjusting with the dominant hand. Conclusion: The study findings are consistent with those of similar international and local studies on the chiropractic profession (both academic training and professional), determining a high prevalence of work-related musculoskeletal injuries. The wrist was most commonly injured when performing adjustive procedures with the dominant hand. This study is in response to a call for further investigation and will help in future efforts to develop an injury preventative strategy for chiropractic training institutions.
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    Clinical experiences of first-time registered Master's chiropractic students during their clinical practicum
    (2017) Ganesh, Nivida; Varatharajullu, Desiree; Sibiya, Maureen Nokuthula
    Background The imperative of clinical education in chiropractic is to endow students with the clinical competencies and professional attributes necessary for independent practice. The clinical practicum exposes chiropractic students to the realities, demands and expectations of patient care through immersion into the clinical learning environment. Various authors emphasise the importance of obtaining a student’s perspective of their experiences within this environment as it is essential to curriculum development and improvement, delivery of quality clinical education, and student satisfaction with their standard of education. Interestingly, unlike in other health professions’ disciplines, the clinical experiences of chiropractic students who have commenced their clinical practicum have scarcely been described in international literature. This study is the first of its kind to record the clinical experiences of chiropractic students during their clinical practicum in South Africa. Aim The aim of this study was to explore and describe the clinical experiences of first-time registered Master’s chiropractic students during their clinical practicum component at the Durban University of Technology Chiropractic Day Clinic in 2016. Method A qualitative, exploratory, descriptive approach was utilised. A purposive sample of 15 first-time registered Master’s chiropractic students was interviewed. Their clinical experiences during the clinical practicum were obtained through semi-structured interviews. Seven key questions, each relating to a specific aspect of the clinical practicum, were used to stimulate discussion. The data were recorded electronically and thereafter transcribed. Thematic analysis was used to interpret the data. Results Four main themes were identified, viz. undergraduate education and pre-clinical preparation; experiences within the clinical learning environment; inter-personal relationships in a clinical learning environment, and appraisal of the clinical practicum. Participants reported that the undergraduate and pre-clinical preparatory phase needed to be more practically orientated in order to provide relevance and cohesion to clinical learning. Significant experiences in the clinical learning environment included personal and professional growth and development, perceptions of preparedness for independent practice, perceptions of patient responses to chiropractic care, administrative duties and clinic infrastructure. The interpersonal relationships that contributed to the overall clinical experience were between students and their clinical supervisors, and students and the administrative staff. The appraisal of the clinical practicum included highlights and positive aspects that shaped the attitudes, values and philosophies of students, as well as the challenges and obstacles they encountered within the clinical learning environment. Conclusion This is the first South African study to document the clinical experiences of first-time registered Master’s chiropractic students. These clinical experiences were based on a variety of organisational and curriculum-orientated factors, as well as interpersonal dynamics. While students acknowledged and appreciated the critical importance of clinical education, and valued the learning opportunities within the clinical setting, they also provided constructive feedback on matters needing improvement to enhance the overall clinical experience. The lack of exposure to patient care prior to the commencement of the clinical practicum negatively impacted the clinical experiences. It is recommended that the findings of this study be utilised by the key stakeholders within chiropractic education to enhance chiropractic clinical education in South Africa.