Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 282-312). Also available on the Internet.

Dissertation submitted in partial compliance with the requirements for a Master’s Degree in Technology: Homeopathy, Durban University of Technology, 2007. / The aim of this study was to assess the perceptions of registered chiropractors towards homeopathy in South Africa. The aim was to establish the knowledge and perceptions of homeopathy and to facilitate greater understanding, co-operation and communication between chiropractors and homeopaths. A questionnaire as a measuring tool was used to carry out this study. The questionnaire was modified from Langworthy and Smink (2000), Maharajh (2005) and Tatalias (2006). A questionnaire was mailed to all chiropractors registered with the Allied Health Professions Council of South Africa currently practising in South Africa. The data for this study was derived from 170 (45%) questionnaires. The data obtained was analysed using the SPSS® for Windows™ and Excel® XP™ statistical package. Descriptive statistics using frequency tables and bar charts were used to study the data. Correlation analysis was performed using Pearson’s Chi Square Test, Phi coefficient, Kendall Tau coefficient and Cramer’s V coefficient to determine whether there was any significant association between the factors collected in the responses. Dendrograms were used to analyse questions that had more than one response. On analysing the results it was found that the majority of respondents were white (89.4%). The majority of respondents were between the ages of 25 and 35 and had been practicing for less than 5 years. The majority of chiropractors had a high level of knowledge of the status of homeopathic education in South Africa. 95.3% perceived that homeopathy is legally recognised in South Africa, 91% perceived that homeopathy has a scientific basis and 98% perceived that it is a legitimate form of medicine. The majority of respondents (87.1%) had consulted with a homeopath before and 12.9% of respondents had not. The majority of respondents perceived that homeopathy is suitable for use in conjunction with chiropractic treatment (95.3%). Communication and co-operation between homeopaths and chiropractors was considered to be moderate to good (68.2%). The majority of chiropractors had referred patients to homeopaths and most homeopaths had made referrals to chiropractors. Most chiropractors gave feedback on referred patients to a homeopath and said that they would like feedback on a referred patient. It can be concluded from the study that chiropractors perceive that homeopathy has a role to play in the health care system of South Africa.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology, Durban University of Technology, 2010. / 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.

Dissertation submitted in partial compliance with the requirements for a Master’s Degree in Technology: Homeopathy, Durban University of Technology, 2007. / The aim of this study was to assess the perceptions of registered chiropractors towards homeopathy in South Africa. The aim was to establish the knowledge and perceptions of homeopathy and to facilitate greater understanding, co-operation and communication between chiropractors and homeopaths. A questionnaire as a measuring tool was used to carry out this study. The questionnaire was modified from Langworthy and Smink (2000), Maharajh (2005) and Tatalias (2006). A questionnaire was mailed to all chiropractors registered with the Allied Health Professions Council of South Africa currently practising in South Africa. The data for this study was derived from 170 (45%) questionnaires. The data obtained was analysed using the SPSS® for Windows™ and Excel® XP™ statistical package. Descriptive statistics using frequency tables and bar charts were used to study the data. Correlation analysis was performed using Pearson’s Chi Square Test, Phi coefficient, Kendall Tau coefficient and Cramer’s V coefficient to determine whether there was any significant association between the factors collected in the responses. Dendrograms were used to analyse questions that had more than one response. On analysing the results it was found that the majority of respondents were white (89.4%). The majority of respondents were between the ages of 25 and 35 and had been practicing for less than 5 years. The majority of chiropractors had a high level of knowledge of the status of homeopathic education in South Africa. 95.3% perceived that homeopathy is legally recognised in South Africa, 91% perceived that homeopathy has a scientific basis and 98% perceived that it is a legitimate form of medicine. The majority of respondents (87.1%) had consulted with a homeopath before and 12.9% of respondents had not. The majority of respondents perceived that homeopathy is suitable for use in conjunction with chiropractic treatment (95.3%). Communication and co-operation between homeopaths and chiropractors was considered to be moderate to good (68.2%). The majority of chiropractors had referred patients to homeopaths and most homeopaths had made referrals to chiropractors. Most chiropractors gave feedback on referred patients to a homeopath and said that they would like feedback on a referred patient. It can be concluded from the study that chiropractors perceive that homeopathy has a role to play in the health care system of South Africa. / M

A dissertation presented to the Faculty of Health, Durban University of Technology, for the Masters Degree in Technology: Chiropractic, 2009. / Background: The International Classification of Diseases (ICD) provides codes to classify diseases in such a manner, that every health condition is assigned to a unique category. Some of the most common diagnoses made by chiropractors are not included in the ICD-10 coding system, as it is mainly medically orientated and does not accommodate these diagnoses. This can potentially lead to reimbursement problems for chiropractors in future and create confusion for medical aid schemes as to what conditions chiropractors actually diagnose and treat. Aim: To determine the level of compliancy of chiropractors, in South Africa, to the ICD-10 coding procedure and the factors that may influence the use of correct ICD-10 codes. As well as to determine whether the ICD-10 diagnoses chiropractors commonly submit to the medical aid schemes, reflect the actual diagnoses made in practice. Method: The study was a retrospective survey of a quantitative nature. A self-administered questionnaire was e-mailed and posted to 380 chiropractors, practicing in South Africa. The electronic questionnaires were sent out four times at two week intervals for the duration of eight weeks; and the postal questionnaires sent once. A response rate of 16.5% (n = 63) was achieved. Raw data was received from the divisional manager of the coding unit of Discovery Health (Pty) Ltd. in the form of an excel spreadsheet containing the most common ICD-10 diagnoses made by chiropractors in South Africa, for the period June 2006 to July 2007, who had submitted claims to the Medical Scheme. The spreadsheet also contained depersonalised compliance statistics of chiropractors to the ICD-10 system from July 2006 to October 2008. SPSS version 15 was used for descriptive statistical data analysis (SPSS Inc., Chicago, Ill, USA). Results: The age range of the 63 participants who responded to the questionnaire was 26 to 79 years, with an average of 41 years. The majority of the participants were male (74.6%, n = 47). KwaZulu-Natal had 25 participants (39.6%), Gauteng 17 (26.9%), Western Cape 12 (19%), Eastern Cape four (6.3%), Free State and Mpumalanga two (3.1%) each and North West one (1.5%). The mean knowledge score for ICD-10 coding was 43.5%, suggesting a relatively low level of knowledge. The total percentage of mistakes for electronic claims was higher for both the primary and unlisted claims (3.93% and 2.18%), than for manual claims iv (1.57% and 1.59%). The total percentage of mistakes was low but increased marginally each year for both primary claims (1.43% in 2006; 1.99% in 2007; 2.33% in 2008) and unlisted claims (0% in 2006; 2.61% in 2007; 3.07% in 2008). CASA members were more likely to be aware of assistance offered, in terms of ICD-10 coding through the medical schemes and the association (p = 0.131), than non-members. There was a non-significant trend towards participants who had been on an ICD-10 coding course (47.6%; n = 30), having a greater knowledge of the ICD-10 coding procedures (p = 0.147). Their knowledge was almost 10% higher than those who had not been on a course (52.4%; n = 33). Most participants (38.1%; n = 24) did not use additional cause codes when treating cases of musculoskeletal trauma, nor did they use multiple codes (38.7%; n = 24) when treating more than one condition in the same patient. Nearly 70% of participants (n = 44) used the M99 code in order to code for vertebral subluxation and the majority (79.4%; n = 50) believed the definition of subluxation used in ICD-10 coding to be the same as that which chiropractors use to define subluxation. According to the medical aid data, the top five diagnoses made by chiropractors from 2006 to 2007 were: Low back pain, lumbar region, M54.56 (8996 claims); Cervicalgia, M54.22 (6390 claims); Subluxation complex, cervical region, M99.11 (2895 claims); Other dorsalgia, multiple sites in spine, M54.80 (1524 claims) and Subluxation complex, sacral region, M99.14 (1293 claims). According to the questionnaire data, the top five diagnoses (Table 4.24) were: Lumbar facet syndrome, M54.56 (25%); Lumbar facet syndrome, M99.13 (23.3%); Cervical facet syndrome, M99.11 (21.7%); Cervicogenic headache, G44.2 (20%) and Cervicalgia, M54.22 (20%). Conclusion: The sample of South African chiropractors were fairly compliant to the ICD-10 coding system. Although the two sets of data (i.e. from the medical aid scheme and the questionnaire) regarding the diagnoses that chiropractors make on a daily basis correlate well with each other, there is no consensus in the profession as to which codes to use for chiropractic specific diagnoses. These chiropractic specific diagnoses (e.g. facet syndrome) are however, the most common diagnoses made by chiropractors in private practice. Many respondents indicated that because of this they sometimes use codes that they know will not be rejected, even if it is the incorrect code. For more complicated codes, the majority of respondents indicated that they did not know how to or were not interested in submitting the correct codes to comply with the level of specificity required by the medical aid schemes. The challenge is to make practitioners aware of the advantages of correct coding for the profession.

A dissertation presented to the Faculty of Health, Durban University of Technology, for the Masters Degree in Technology: Chiropractic, 2009. / Background: The International Classification of Diseases (ICD) provides codes to classify diseases in such a manner, that every health condition is assigned to a unique category. Some of the most common diagnoses made by chiropractors are not included in the ICD-10 coding system, as it is mainly medically orientated and does not accommodate these diagnoses. This can potentially lead to reimbursement problems for chiropractors in future and create confusion for medical aid schemes as to what conditions chiropractors actually diagnose and treat. Aim: To determine the level of compliancy of chiropractors, in South Africa, to the ICD-10 coding procedure and the factors that may influence the use of correct ICD-10 codes. As well as to determine whether the ICD-10 diagnoses chiropractors commonly submit to the medical aid schemes, reflect the actual diagnoses made in practice. Method: The study was a retrospective survey of a quantitative nature. A self-administered questionnaire was e-mailed and posted to 380 chiropractors, practicing in South Africa. The electronic questionnaires were sent out four times at two week intervals for the duration of eight weeks; and the postal questionnaires sent once. A response rate of 16.5% (n = 63) was achieved. Raw data was received from the divisional manager of the coding unit of Discovery Health (Pty) Ltd. in the form of an excel spreadsheet containing the most common ICD-10 diagnoses made by chiropractors in South Africa, for the period June 2006 to July 2007, who had submitted claims to the Medical Scheme. The spreadsheet also contained depersonalised compliance statistics of chiropractors to the ICD-10 system from July 2006 to October 2008. SPSS version 15 was used for descriptive statistical data analysis (SPSS Inc., Chicago, Ill, USA). Results: The age range of the 63 participants who responded to the questionnaire was 26 to 79 years, with an average of 41 years. The majority of the participants were male (74.6%, n = 47). KwaZulu-Natal had 25 participants (39.6%), Gauteng 17 (26.9%), Western Cape 12 (19%), Eastern Cape four (6.3%), Free State and Mpumalanga two (3.1%) each and North West one (1.5%). The mean knowledge score for ICD-10 coding was 43.5%, suggesting a relatively low level of knowledge. The total percentage of mistakes for electronic claims was higher for both the primary and unlisted claims (3.93% and 2.18%), than for manual claims iv (1.57% and 1.59%). The total percentage of mistakes was low but increased marginally each year for both primary claims (1.43% in 2006; 1.99% in 2007; 2.33% in 2008) and unlisted claims (0% in 2006; 2.61% in 2007; 3.07% in 2008). CASA members were more likely to be aware of assistance offered, in terms of ICD-10 coding through the medical schemes and the association (p = 0.131), than non-members. There was a non-significant trend towards participants who had been on an ICD-10 coding course (47.6%; n = 30), having a greater knowledge of the ICD-10 coding procedures (p = 0.147). Their knowledge was almost 10% higher than those who had not been on a course (52.4%; n = 33). Most participants (38.1%; n = 24) did not use additional cause codes when treating cases of musculoskeletal trauma, nor did they use multiple codes (38.7%; n = 24) when treating more than one condition in the same patient. Nearly 70% of participants (n = 44) used the M99 code in order to code for vertebral subluxation and the majority (79.4%; n = 50) believed the definition of subluxation used in ICD-10 coding to be the same as that which chiropractors use to define subluxation. According to the medical aid data, the top five diagnoses made by chiropractors from 2006 to 2007 were: Low back pain, lumbar region, M54.56 (8996 claims); Cervicalgia, M54.22 (6390 claims); Subluxation complex, cervical region, M99.11 (2895 claims); Other dorsalgia, multiple sites in spine, M54.80 (1524 claims) and Subluxation complex, sacral region, M99.14 (1293 claims). According to the questionnaire data, the top five diagnoses (Table 4.24) were: Lumbar facet syndrome, M54.56 (25%); Lumbar facet syndrome, M99.13 (23.3%); Cervical facet syndrome, M99.11 (21.7%); Cervicogenic headache, G44.2 (20%) and Cervicalgia, M54.22 (20%). Conclusion: The sample of South African chiropractors were fairly compliant to the ICD-10 coding system. Although the two sets of data (i.e. from the medical aid scheme and the questionnaire) regarding the diagnoses that chiropractors make on a daily basis correlate well with each other, there is no consensus in the profession as to which codes to use for chiropractic specific diagnoses. These chiropractic specific diagnoses (e.g. facet syndrome) are however, the most common diagnoses made by chiropractors in private practice. Many respondents indicated that because of this they sometimes use codes that they know will not be rejected, even if it is the incorrect code. For more complicated codes, the majority of respondents indicated that they did not know how to or were not interested in submitting the correct codes to comply with the level of specificity required by the medical aid schemes. The challenge is to make practitioners aware of the advantages of correct coding for the profession.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background Currently, chiropractic is not incorporated into the South African public healthcare sector despite its emphasis on the values of wellness and health. This is due to a poor relationship with mainstream medical practitioners, the construct of chiropractic education and its long standing isolation within the healthcare system within South Africa. The public healthcare sector in South Africa is strained. Low back pain is one of the main reasons patients seek medical attention from primary medical doctors. A growing body of evidence is now emerging which supports the role of chiropractic in post-­surgical rehabilitation and the treatment of extraspinal non-­pathological musculoskeletal conditions. Based on the findings of these studies, an argument could be made for the transition of chiropractic from a mainly private practice base to one that would enable it to reach to the wider population in the public healthcare sector. Aim The aim of the research study was to explore and describe the perceptions that chiropractors have about the integration of the chiropractic profession into the South African public healthcare sector. Method A descriptive exploratory qualitative approach was used to guide the study. In-­ depth interviews were conducted with ten chiropractors within the eThekwini municipality. The main research question for this study was “What are the perceptions of chiropractors in the eThekwini Municipality on the integration of chiropractic into the public healthcare sector of South Africa?” The data was analysed through thematic analysis. Results The main themes that emerged were the role of chiropractic in the healthcare system, the integration of chiropractic into the healthcare sector and the challenges facing chiropractors in the healthcare system. The themes and sub-­ themes were as follows;; • Theme 1 Role of chiropractic in the healthcare system Sub-­theme 1.1 Primary contact for neuromuscular medicine. • Theme 2 Integration of chiropractors into the public healthcare sector Sub-­theme 2.1 Relief of overworked healthcare workers. Sub-­theme 2.2 Decrease costs in surgical and medication use. Sub-­theme 2.3 Increased learning opportunities. Sub-­theme 2.4 Use of chiropractic in post-­surgical care. Sub-­theme 2.5 Need for pre-­surgical assessment. Sub-­theme 2.6 Integration facilitated by the Chiropractic Association of South Africa (CASA). • Theme 3 Challenges facing chiropractors in the public healthcare sector Sub-­theme 3.1 Opposition from medical doctors. Sub-­theme 3.2 Opposition from within the chiropractic profession. Sub-­theme 3.3 Inability to function as the primary practitioners. Sub-­theme 3.4 Unfamiliar structure of the public health care sector. Conclusion A lack of clarity on the identity and role of chiropractic in the public healthcare sector emerged from the findings of this study. Individual chiropractors, the professional body (CASA) and the Allied Health Professions Council of South Africa (AHPCSA) need to engage in active roles in the integration of chiropractic into the public healthcare sector of South Africa. / M

M.Tech. (Homeopathy) / Students of Chiropractic, attending the University of Johannesburg (UJ), start the practical component of their training from their third year of study (Bunge & Tyranes, 2007). Each student must be proficient in 250 adjustments (200 of which must be spinal) by the end of their fifth year of study (Fletcher et al., 2005). As these manual manipulations are complex psychomotor skills, they require a good deal of practice to master (Bunge & Tyranes, 2007). Due to the practical nature of the course, Chiropractic students are required to practice their techniques of adjustment on each other. This places the students under a great deal of physical and mental strain as adjustments and techniques designed to reduce pain and restore normal musculoskeletal and neurological function in the presence of pathology are being consistently and repetitively applied to healthy individuals (Ebrall, 2003). This in turn results in the individuals experiencing various adverse effects such as headaches, muscular pain and joint pain (Bergman & Peterson, 2011; Botha, 2011; Venter, 2011). Conventional treatment for musculoskeletal pain (such as the use of non-steroidal anti-inflammatories and analgesic drugs) can be costly and are known to have potential adverse effects (Neal, 2002). No research has been done to date on the effect of Homoeopathic Similimum treatment on musculoskeletal pain, as a result of practicing adjustments in Chiropractic students. The aim of this study was to determine the efficacy of the Homoeopathic Similimum on musculoskeletal pain produced in Chiropractic students (attending the University of Johannesburg) as a result of practicing adjustments, by means of a Numeric Pain Scale Rating as well as via a 5-Point (Likert-type) Treatment Satisfaction Scale. This was a 2 week, randomised double-blind placebo-controlled, matched-pair study using 30 participants (third to fifth year UJ Chiropractic students, males and females, aged 20-35). Participants who met the inclusion criteria were matched according to the body-region affected (i.e. head, upper limb, back, lower limb or whole body) (Appendix C); they were then randomly divided into either the placebo or treatment group. Thereafter, an initial case-taking and focused physical examination (including vital signs) was conducted and the initial Numeric Pain Scores (baseline measurements) obtained (Appendix C) (Cox, 2010). The participant’s case was analysed, repertorised (using the Mercurius Computer Repertory-The Complete Repertory 2012) and the Similimum remedy was selected. The Homoeopathic Dispenser dispensed the medications and participants received either their Similimum remedy (in a 30cH potency to be administered in a dosage of 5 pillules once a day and as needed by the individual participant) or the placebo (composed of unmedicated pillules with identical dosage instructions). A follow-up consultation (on day 7) was conducted to assess progress, obtain the participant’s intermediate numeric pain score and to assess the prescription (Appendix E). After careful evaluation of the case, the researcher considered (depending on the participant’s response to the initial treatment) whether to change the prescription, alter the repetition of the dose, continue the same course of treatment or to stop the prescription altogether. On day 14 a final consultation was conducted (including a final physical examination) to assess overall progress, obtain final Numeric Pain (Appendix E) and Treatment Satisfaction Scores (Appendix F) (Cox, 2010; Pellegrin et al., 2001) and terminate prescriptions. Data collected from the Numeric Pain Scale Ratings and Treatment Satisfaction Score Sheets was analysed by STATKON. Frequencies, descriptives and cross-tabulations were done. The Shapiro-Wilk test assessed normality. A Mann-Whitney test was used to compare the two groups. Comparisons over time for each group were assessed using a Friedman test and a Wilcoxon Signed Ranks test was done to ascertain where the differences occurred (Smith, 2011). The Friedman test results showed significant differences in both groups (i.e. the pain scores decreased in comparable increments for both groups over the two-week study period) and the Wilcoxon Signed Ranks test showed that both groups’ pain scores started to decrease at the 2nd consultation (i.e. at the end of week one). The results of the Mann-Whitney test showed that there were no statistically significant differences between the treatment and placebo groups, either in terms of reduction of pain or participant satisfaction with treatment. Therefore it can be concluded that the Homoeopathic Similimum was not more effective than placebo in the treatment of musculoskeletal pain experienced by UJ Chiropractic students as a result of practicing adjustments. However, further research utilising a larger study sample and a longer period of study should be conducted before any definitive conclusions can be drawn.

M. Tech. / The main purpose of this study was: • To determine the different diagnostic techniques chiropractors use in Gauteng South Africa. Objectives included: • To determine chiropractics attitude and opinions regarding the different Diagnostic Techniques they use in their practices. • To determine any statistically significantly correlations between answers. • To develop a demographic profile of Chiropractors in Gauteng South Africa. In the world today there are 80 000 chiropractors who are the primary physicians performing manipulations in order to treat problems such as lower back pain. Incidentally 85% of the western world will suffer from at some stage of their lives (Hecker and Daniel, 2004). The identification of the common functional and structural components of the adjustable lesion is critical to the management of these conditions. Unfortunately it has also contributed to the misconception that all manipulative disorders have the same pathological basis (Bergman, 2002). A questionnaire-based study comprising a non-probabilistic, non-random, convenience sample was used to determine the diagnostic techniques used v by the chiropractors actively practicing in Gauteng South Africa. A total of 58 Chiropractors responded to the questionnaire, forming the sample population that was used to calculate results. According to this study, all the responding chiropractors practicing here in Gauteng South Africa (n=58/58 100%), examine the spine to identify areas or subluxations that require adjustments/manipulation. There are a variety of diagnostic techniques methods that they use in everyday practice. Most commonly motion palpation(96.5%), static palpation(93.1%), pain description of the patient(82.8%), leg length discrepancy(55%), neurological tests(77.6%), visual postural analysis(61.4%), orthopedic tests(75%), plain static and stress x-rays(44.5%) and kinesiology muscle testing(10.4%) are used. The perceived reliability of these diagnostic techniques are also considered to be good.

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic at the Durban Institute of Technology, 2004. / Scholars, researchers and health care practitioners have long known that patients not only benefit from the specific manual therapy given from their health care providers, but also from the manner in which it is given. The latter is believed to have significant effects on the patient's perception of quality of care and clinical outcome. / M