"Methodological and epistemological challenges for the chiropractic profession in health care - a study of the history, status quo and future of research and clinical practices."

Myburgh, Corrie (2011-10)

Thesis (DPhil)--University of Stellenbosch, 2005.

Thesis

ENGLISH ABSTRACT: Although a legitimate provider of manipulative therapy, chiropractic largely functions outside mainstream health care in South Africa. A narrow research focus, poor institutional representation and inadequate professional integration all contribute to its undetermined role in health care. This study exploratory, qualitative study sought to investigate the state of the art of chiropractic with respect to beliefs, philosophy, research methods and clinical practices. Semi-structured, interviews were used to extract responses from ten chiropractors, six patients and four researchers. The results were interpreted on three levels; thematically, in relation to chiropractic’s discipline and profession and as a function of the ‘3 worlds’ framework. The thematic analysis revealed that: 1. Beliefs and philosophical traditions play an active role in the practice and science of chiropractic. 2. The chiropractic investigative paradigm has started to mature. 3. The contextual role of research methods is being clarified. 4. Contemporary chiropractic practice is not as evidence-based as it should be. 5. The chiropractic model of practice is significantly different to the perceived standard medical model. 6. Chiropractic clinical practice has a fuzzy identity. 7. Chiropractic’s professional status is unclear. 8. The professional and disciplinary components of chiropractic are still institutionally immature. 9. Chiropractic’s legitimacy is questionable. Themes 1-3 indicated that beliefs and philosophical traditions affect the way in which chiropractors conduct themselves clinically, the way patients view the world of health care and the manner in which researchers study clinical phenomena. Themes 4-6 suggest that the state of the art of chiropractic clinical practice is different from medicine, however the exact nature of its model of practice seems quite fluid. Themes 7, 8 and 9 suggest that the degree of professional and institutional maturity provide chiropractic with only partial legitimization.With regards to the discipline it seems that science and education have an important buffering role to play between the patient and the practitioner, in order to curb metaphysically motivated practices. Furthermore, chiropractic’s investigative paradigm is progressing atypically and hence the view of it conforming to a standard view of science is questioned. With regards to professional matters, our study indicates that chiropractors function on a spectrum which runs between “technicians” and “physicians”. Whilst patients have holistic health care beliefs it seems they are pushed toward chiropractic, through negative allopathic health care experiences and are drawn to the profession by its integrated model of practice. However, the lack of mainstream healthcare integration counter balances this worth and reduces chiropractic’s professional legitimacy. Two cross over themes were revealed. Firstly, chiropractic’s investigative paradigm has started to narrow the gap between applied science and clinical practice and secondly chiropractic’s legitimacy cannot lie in the opinion of medicine. The ‘three worlds’ framework indicated that the first three themes are meta-scientific (W3) reflections on beliefs, philosophical traditions and research methodology. The fourth theme reflects the relationship of research and practice (W2 and W1), and the remaining five themes are reflections clinical practice (W1 activities). Our study contends that chiropractic has the potential to develop into a mainstream health care provider through the implementation of a multi-leveled development strategy.

AFRIKAANSE OPSOMMING: Alhoewel chiropraktyk ’n geoorloofde verskaffer van manipulasieterapie is, funksioneer dit grootliks buite hoofstroomgesondheidsorg in Suid-Afrika. ’n Eng navorsingsfokus, swak institusionele verteenwoordiging en ontoereikende professionele integrasie het tot die onbepaalde rol van chiropraktyk in gesondheidsorg bygedra. Hierdie verkennende kwalitatiewe studie het gepoog om chiropraktiese praktyk ten opsigte van oortuiginge, filosofie, navorsingsmetodes en kliniese praktyke te ondersoek. Semi-gestruktureerde onderhoude is gebruik om response van tien chiropraktisyns, ses pasiënte en vier navorsers te verkry. Die uitslae is op drie vlakke geïnterpreteer: (i) tematies; (ii) met betrekking tot die chiropraktiese dissipline en beroep; en (iii) as ’n funksie van die “drie wêrelde”-raamwerk. Die tematiese analise het die volgende blootgelê: 1. Oortuiginge en filosofiese tradisies speel ’n aktiewe rol in die praktyk en wetenskap van chiropraktyk. 2. Die chiropraktiese ondersoekende paradigma is besig om verder te ontwikkel. 3. Die kontekstuele rol van navorsingsmetodes word duideliker gemaak. 4. Hedendaagse chiropraktiese praktyk is nie soveel op bewyse gegrond as wat dit behoort te wees nie. 5. Die chiropraktiese model van praktyk verskil aansienlik van die aanvaarde standaard- mediese model. 6. Die identiteit van chiropraktiese kliniese praktyk is vaag. 7. Chiropraktyk se professionele status is onduidelik. 8. Die professionele en dissiplinêre komponente van chiropraktyk is steeds institusioneel onderontwikkel. 9. Die legitimiteit van chiropraktyk is betwisbaar. Temas 1 tot 3 het daarop gedui dat oortuiginge en filosofiese tradisies die wyses beïnvloed waarop chiropraktisyns klinies handel, waarop pasiënte die wêreld van gesondheidsorg sien, en waarop navorsers kliniese verskynsels bestudeer. Uit temas 4 tot 6 kan afgelei word dat chiropraktiese kliniese praktyk van geneeskunde verskil; die presiese aard van die praktykmodel kom egter heel onbestendig voor. Uit temas 7, 8 en 9 kan afgelei word dat die graad van professionele en institusionele ontwikkeling chiropraktyk slegs gedeeltelik legitimeer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/16518
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