Faculty of Health Sciences
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Item The knowledge, attitudes and perceptions of qualified chiropractors and physiotherapists in South Africa regarding the other professional practice(2022) Ravidutt, Micaela; Maharaj, Sonill Sooknunan; Prince, CleoChiropractors and physiotherapists treat patients that present with similar conditions. Arising from this, a sense of competition is perceived between these professionals, as both professions use similar methods of treatment when providing care to their patients. However, chiropractors and physiotherapists may belong to different health paradigms which influences how each profession approaches patient management. There is also an overlap between the roles of each profession in providing healthcare, as the methods of managing patients seem to be similar. This requires an investigation into the knowledge, attitudes and perceptions of qualified chiropractors and physiotherapists in South Africa regarding the other professional practice. This could potentially determine possible misconceptions and myths that the two professions have of each other’s practice. If identified and corrected, this could influence awareness within a multidisciplinary setting to enhance and promote holistic patient-centred care. Aim The aim of this study was to determine the knowledge, attitudes and perceptions of qualified chiropractors and physiotherapists in South Africa regarding the other professional practice. Methodology The research conducted was a quantitative study with a descriptive design which targeted qualified chiropractors and physiotherapists in South Africa. The research tool was an online questionnaire administered through an online platform named the QuestionPro Survey, which included questions and statements relating to the knowledge, attitudes and perceptions of the two professions regarding the other professional practice to meet the objectives of the study. The minimum sample size required for this study comprised of 116 chiropractors and 128 physiotherapists. The data obtained from each group were analysed separately and then a comparative analysis was done. An alpha value of 0.05 and a margin of error of 0.085 were assumed. Results Chiropractors and physiotherapists in South Africa generally demonstrated good knowledge, positive attitudes, and positive perceptions toward the other profession. Both professions were familiar with the other profession’s scope of practice. Chiropractors achieved a mean knowledge score of 75.7%, whereas physiotherapists obtained 59.7% on their knowledge of the examinations performed by the other profession. Chiropractors obtained an average score of 85.3% and physiotherapists achieved 72.0% on their knowledge of the treatment modalities that the other profession may perform for a patient. Both professions had good knowledge about the conditions that the other profession may treat, with chiropractors having achieved a mean knowledge score of 82.4% and physiotherapists having obtained a score of 77.3%. A total of 75.0% of chiropractors and 72.1% of physiotherapists considered the other profession to be competent in examining neuromusculoskeletal conditions. More chiropractors (82.8%) than physiotherapists (70.0%) believed the other profession to be competent in treating neuromusculoskeletal conditions. Each profession acknowledged the role of the other profession within the South African healthcare system. Of the sampled professions, 81.9% of chiropractors and 55.3% of physiotherapists had referred patients to the other profession. It was found that 69.8% of chiropractors, compared to 32.1% of physiotherapists, had patients referred to them by the other profession. A total of 69.0% of chiropractors and 55.3% of physiotherapists were in agreement that they would like to work closely with the other profession. Conclusion In South Africa, chiropractors and physiotherapists had good knowledge and positive attitudes and perceptions of each other’s practices. There also appeared to be a referral relationship between these professions. However, the challenges between the professions were limited and there was insufficient inter-professional awareness and exposure when practicing within the different health paradigms. Therefore, inter-professional education between chiropractors and physiotherapists of their practices as part of the university curriculum within a multidisciplinary team should be enhanced and encouraged. This would enhance and encourage inter-professional relationships between the two professions, thus promoting the delivery of holistic patient-centred care.Item The knowledge and practices of South African chiropractors in performing basic life support(2022-05-13) Caluza, Bongeka; Venketsamy, Yomika; Varatharajullu, Desiree; Hardcastle, Timothy CraigBackground: Basic Life Support is a set of emergency procedures used to keep a patient alive until advanced medical care arrives. Chiropractors are allied healthcare professionals who may encounter life-threatening medical emergencies such as cardiac arrest within their private practice, thus needing to initiate basic life support in certain circumstances. Aim: The aim of this study was to determine the knowledge and practices of South African chiropractors in performing Basic Life Support. Methodology: A QuestionPro® survey link was sent to Chiropractors practicing in South Africa who were registered with the Allied Health Professions Council of South Africa. A total of 160 participants completed the survey and data was captured for statistical analysis. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) [IBM Corporation, Armonk NY] version 25. Results: The results revealed that the level of Basic Life Support knowledge amongst chiropractors was low. Factors associated with good knowledge were: being female and completing a course in the last year or attending a refresher course within the last two years. Conclusion: The majority of the data collected was in line with the literature on knowledge of Basic Life Support. However, those studies were conducted on other healthcare practitioners such as nurses, doctors, paramedics, physiotherapists and specialists. The findings of this study were unique to chiropractors in South Africa.Item An exploration into factors resulting in career change by qualified chiropractors within the eThekwini Municipality(2019-09-05) Perumall, Joanna; Sibiya, Nokuthula M.; Abdul-Rasheed, AshuraChiropractic in South Africa faces different and greater challenges when compared to chiropractic in other parts of the world because chiropractic is a form of complementary and alternative medicine which is isolated within the healthcare system of South Africa. Chiropractors are burdened by the lack of acceptance and recognition both publicly and professionally. This results in financial challenges thereby impacting negatively on income and the ability to maintain a practice. Furthermore, the perceptions of chiropractors’ are altered after failing to find success in active practice. These factors result in career dissatisfaction. Consequently, they pursue alternate careers to satisfy their personal and professional needs. While many studies have explored career satisfaction among practicing chiropractors, the factors influencing career change by qualified chiropractors have been minimally explored. Aim of the study The aim of the research study was to explore and discuss the factors resulting in career change by qualified chiropractors within the eThekwini municipality. Methodology A qualitative, explorative, descriptive and contextual design was employed to guide the study. A structured interview guide was used to conduct in-depth interviews with 10 non-practicing chiropractors within the eThekwini municipality. The main research questions for this study were “Why are you not a practicing chiropractor?”, “Do you have other professional qualifications?”, “What do you think are the benefits of being in this career as opposed to practicing as a chiropractor?” and “Do you wish to practice as a chiropractor in the future?” Thematic analysis was used to analyse the data of this study The main themes that emerged from the study were the challenges of private practice, perceptions of the chiropractic programme and choosing alternate careers over chiropractic. The participants of this study expressed financial challenges in private practice, a lack of recognition of the profession and the time invested into private practice left no time for family responsibilities. The participants explained that the chiropractic programme and research component is a tedious process with minimal rewards post-qualification. Furthermore, the participants experienced greater benefits and rewards in alternate careers. Conclusion The findings that emerged from this study indicate that chiropractors are faced with numerous challenges post-qualification. Therefore, it is necessary for the DUT chiropractic faculty and staff to actively engage with chiropractic candidates and chiropractic students and vice versa (Leach 2004). Such engagement will adequately equip the students with a better understanding and knowledge of the programme to assist in their success post-qualification.Item A study of the factors that may influence the prevalence of back pain in chiropractors(1996) Tim, Anthony; Till, A. G.The purpose of this study was to assess the prevalence of back pain in chiropractors in South Africa, in terms of workplace factors which surrounded them and individual factors which they possessed, in order to establish under which circumstances, workplace and individual factors possibly influenced the prevalence of back pain in chiropractors.The total population of South African chiropractors (N=138), registered with the Chiropractors, Homoeopaths and Allied Health Service Professions Council of South Africa for 1994, were sent a questionnaire. A total of 68 questionnaires returned, which represented a 49,3 % response rate. The questionnaire consisted of questions regarding : the prevalences of back pain and low back pain; the intensity and frequency of back pain; the prevalence of different pain locations eg. headache, cervical pain, lumbar pain etc.; the workplace factors included : static work postures, bending, twisting and lifting, repetitive work, overexertion, ergonomics, psychological work factors, number of hours and days worked per week; the individual factors included age and gender, anthropometry, posture, physical fitness, spinal mobility, psychological factors, social factors, environmental factors and the number of years in practice. The results were statistically analyzed using crosstabulation and Log-linear analysis. The results were represented by cross-tabulations, bar and pie charts and then descriptively analyzed. The overall prevalence of back pain amongst South African chiropractors was 55,9% and the low back pain prevalence was 65,1%. Among other findings, certain ergonomic factors such as desk and physical examination table heights were found to be significantly associated with the respondents having more back pain. Those respondents who exercised for longer than 60 minutes per exercise session had significantly less back pain than those respondents who exercised for shorter periods of time. Of interest was that those respondents who used adjustment techniques which required the use of force, had significantly more back pain than those who used non-force techniques. It must be emphasized that extreme caution should be exercised in attempting to generalise the findings of this survey, since the workplace and individual factors associated with back pain were based on the respondent's subjective evaluations. This study was not designed to establish cause and. effect relationships between workplace and individual factors, and the prevalence of back pain amongst chiropractors.Item Practice characteristics of chiropractic delegates attending the World Federation of Chiropractic's 12th Biennial Congress, 2013(2016) Bezuidenhout, Lauren Leigh; O'Connor, Laura; Shaik, JunaidBackground Chiropractic is practiced in over 100 countries and is considered to be the fastest growing health care profession internationally. Several studies investigating the practice characteristics of chiropractors have been conducted in selected countries, however, as far as is known, no study has been conducted where chiropractors from countries across the globe are assessed for their practice characteristics in order to determine if regional differences exist. Gaining insight into chiropractic practice and its influencing factors, relating to both the profession itself and the chiropractor can enable organisations such as the World Federation of Chiropractic to have a greater understanding of how chiropractors are currently practicing and how the profession is being utilised by the public. Improved insight into the profession provides a baseline description for the public and other health care practitioners to fully comprehend what chiropractors can offer to the health care system. Aim: The aim of this study was to determine the demographic profile and practice characteristics of chiropractic delegates attending the World Federation of Chiropractic’s 12th Biennial Congress 2013. Method A pre-validated questionnaire and letter of information and consent was distributed to all registered chiropractic delegates (N = 406) attending the World Federation of Chiropractic Congress in Durban, Kwa-Zulu Natal 2013. The questionnaire was part of the delegate packages and they self-selected to participate. Due to a low response rate at the congress, the questionnaire was made available electronically on Survey Monkey®, for six weeks after the congress. Questions relevant to this study were coded, reduced where necessary and utilised for data analysis with IBM SPSS Version 21. Descriptive data was then summarised and presented using tables and graphs. The study was approved by the Durban University of Technology’s Institutional Research Ethics committee. Results: The response rate was 34.72%, with 52.5% being female, mean age was 42 (SD ± 13years, and all seven geographical regions were represented. The majority of respondents were from Africa (51.1%), followed by North America (22.7%) then Europe (14.2%). South Africa (48.6%) was the most represented country. Respondents held either a Master’s degree in Chiropractic (51.8%) or a Doctor of Chiropractic (DC) degree (48.2%). The mean years since graduating as a chiropractor was 15.7 years (SD ± 3.6). The majority of respondents (71.2%) engaged in full-time clinical practice, for between 5 to 15 years (39.8%) with 51.4% purporting to have an evidence based philosophical approach to practice. The majority (72.5%) viewed the role of a chiropractor in the health care system as a primary health care practitioner with a focused scope of practice. The majority of respondents (n = 52) personally treated 50 patients or less per week, with approximately one third of the respondents (n = 34) having high volume practices (>100 patients weekly). The respondents favoured being one of two chiropractors (36.9%) in a practice setting followed by sole practices (31.6%). The top chiropractic technique utilised was the diversified technique (74.5%) followed by extremity adjusting (68.8%). Various adjunctive, active and passive, axillary techniques were utilised in the daily management of patients. The patient demographics were majority female (55.7%), older than 30 years of age (66.7%) and Caucasian (77%), complaining of head, neck, mid-back and low back pain, which was mostly acute in nature. Trends suggested that females were more likely to select an evidence-based philosophical orientation than males. Females were more likely to delegate adjunctive therapies to non-chiropractic assistants (p = 0.029), and favoured sending patients to a physical therapist (p = 0.018), whereas males were more likely to refer to nutritionists and paediatricians (p = 0.030 and p = 0.038, respectively). Females were less likely to utilise mobilisation techniques (p = 0.008), massage therapy (p = 0.018) and nutritional counselling (p = 0.032). In terms of age, those selecting an evidence-based approach were significantly older than those who adopted a mixer approach to practicing (p = 0.002). The mean age of the respondents, irrespective of the region, was not significantly associated with the number of patients treated per week (p = 0.377) or the hours worked per week (p = 0.474). Trends show that the number of years spent in practice differed among the regions with North American chiropractors spending more years in practice than those from Europe and Australasia. The respondents from South Africa spent fewer years in practice (15 years or less) than respondents from Asia, Australasia, Europe and North America. Geographic region was not significantly associated with practice setting (p = 0.182). The only chief complaint that differed between regions was patients presenting with headaches accompanied by neck pain (p = 0.007), where Asian and North American respondents reported seeing less patients than their colleagues from other regions. Trends suggested that the respondents who attained a Masters of Technology in Chiropractic were more inclined to select a mixer orientation whereas those with a DC qualification selected an evidence-based philosophical approach. Conclusion: The WFC congress provided a platform to successfully determine the demographic profile and practice characteristics of chiropractors from various regions. Similar demographics were evident, with males no longer showing dominance within the profession. Chiropractors adopting an evidence-based and mixer philosophical orientation are synonymous in the role that they play in the health care system and display similarities in chiropractic practice and patient management. Investigating chiropractors who adopt a straight philosophical approach would be beneficial as it will allow for better comparison of demographics and practice characteristics. It is evident that selected demographics do influence how one would opt to practice, with regional differences showing that the chiropractic profession in South Africa is still relatively young.Item The perceptions of South African chiropractors, regarding their professional identity(2010) Keyter, Karin; Wilson, Laura Maie; Kruger, Brian D.It is well documented that the chiropractic profession has been searching for a unified professional identity. Acknowledging this need for a professional identity relevant to the public, the World Federation of Chiropractic (WFC) attempted to address these concerns by conducting an international questionnaire based Identity Consultation. However, of the 3689 chiropractors who responded, only 34 were from South Africa. Therefore this study aimed to determine the perception of South African chiropractors regarding their public identity and to compare the results with those from international studies. Objectives: To determine the demographic profile of South African chiropractors, and how they perceived their professional identity relative to their own opinions, those of the public and those of medical doctors. This study investigated how South African chiropractors saw their profession relative to physiotherapy and South African chiropractor’s knowledge of the WFC Identity Consultation. Method: The study was a population based demographic study making use of a descriptive, observational, cross sectional design. It was a quantitative selfadministered questionnaire distributed to those South African chiropractors meeting the inclusion criteria (n=398). The WFC Identity Consultation questionnaire was modified and developed by the researcher to suit a South African audience after permission was obtained from the chairperson of the WFC. Results: A response rate of 30.15% was obtained. Ninety percent of South African chiropractors felt that it was important for their profession to have a clear identity. However, only 1.7% agreed that it did have a clear identity. When asked how the public viewed chiropractic, 45% felt that the public had no clear perception of the profession, with 92.5% viewing it as Complementary and The Perceptions of South African Chiropractors, Regarding Their Professional Identity iv Alternative Medicine (CAM). However, 89.2% of South African chiropractors would like the public to perceive chiropractic as mainstream medicine. When asked how chiropractic was viewed by South African chiropractors relative to physiotherapy, it was agreed that they were two separate professions each with their own identity (74.2%). The chiropractic adjustment was seen as a strong brand advantage over physiotherapy. When asked how they thought medical doctors viewed chiropractic, 73.3% felt that they did not have a clear perception of the profession, with 96.7% considering medical doctors to view chiropractic as CAM. Medical doctors’ perceptions were considered to be very important with respect to inter-professional relations. Just over half (54.2%) of South African chiropractors knew about the WFC identity, less than half of whom (47.5%) agreed with it. Conclusions: The study revealed that there was a significant difference between how South African chiropractors thought the public and medical doctors currently perceived chiropractic and how they would like to be perceived. It revealed that like their international counterparts chiropractors in South Africa are striving for a unified identity that is different to the way they are currently perceived by the health care stakeholders.Item The current role of the chiropractor in the patient-centered approach to stress management(2009) Deonarain, Jitesh; Young, KarinObjectives: The aim of this study was to determine the current role of the Chiropractor in the Patient-Centred Approach to Stress Management. Methods: Chiropractors were contacted telephonically in order to discuss a convenient time in which they are free to receive the questionnaire at their practice. The questionnaire was developed specifically for this particular research project and verified through the use of a focus group and pilot testing. The researcher waited outside the room whilst the Chiropractor completed the questionnaire. The questionnaire was then collected after completion prior the researcher leaving the practice, in order to improve the return of the questionnaires. Results: Seventy-five percent of chiropractors, in the study indicated that they took a psychosocial history which may indicate that they utilised the fundamental biopsychosocial theme of ‘patient-centeredness’. 68.9% of chiropractors who took a psychosocial history indicated that they are equipped with the necessary skills to evaluate psychosocial stressors in patients and 55.6% indicated that their patients responded ‘Very Positively’ to their stress management protocols. All the Chiropractors in the study indicated that they had consulted patients who had associated their main complaint with stress related issues. 38.3% of Chiropractors felt that their patients ‘Often’ associated their main complaint with stress-related issues whilst 35% felt that their patients ‘Very Often’ relate their main complaint with stress-related issues. Muscle spasm (85%) was the most common symptom or sign found or elicited in a patient suffering with chronic stress. Referral was the most common primary method of treatment with 36% of Chiropractors utilising this method in the clinical setting when dealing with a stressed patient. iii Conclusion: Chiropractors in the study indicated that they took a psychosocial history therefore they utilised the fundamental biopsychosocial theme of ‘patientcenteredness’ and that the majority indicated that they are equipped with the necessary skills to evaluate psychosocial stressors in patients and that patients responded positively to their stress management protocols.Item A study to determine the international federations' perception and utilization of chiropractors and other sports medical personnel(2008) Cloete, Kirsten Leigh; Korporaal, Charmaine MariaObjectives: To investigate the International Sports Federations’ (IFS) perception and utilization of chiropractors and other sports medical personnel, and to compare results between the executive committees and medical commissions within federations. Methods: A specially designed, quantitative questionnaire was used to collect data from the 65 federations belonging to the General Assembly of International Federations of Sport (GAIFS). The questionnaire distribution took place via e-mail, with the secretary of each federation being requested to forward a copy of the questionnaire to a member of the federation’s executive committee and medical commission respectively. Follow-up telephone calls were also made to further encourage a response from participants. After an 8-week period, returned questionnaires were collected and data was analyzed. Results: From the results obtained (30% response rate), it would seem that perceptions vary greatly. This is most evident when one compares the perceptions of the medical commission members to those of the executive committee members. The medical commission on a whole, appears to favour the more traditional medical professions, while the executive committee seems to be more holistic in their approach to treatment options. In terms of current utilization, chiropractors are currently represented on 16% of medical teams, although chiropractors are able, within their scope of practice, to provide 70% of the federations’ most requested techniques / modalities for competitions. There appears to be little / no criteria governing the selection of medical personnel, however most of the federations agreed that a chiropractor with a post-graduate diploma in sports injuries, would be seen in a more favourable light for selection. Conclusions: The perceptions and utilization of chiropractors and other sports medical personnel varies greatly between federations, which may be due to a number of factors related to the formulation of perception itself. In addition, there appears to be a discrepancy between the opinions of the executive committees and medical commission of the participating federations.