Submitted in partial compliance for a Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Introduction There is a worldwide need for research into headaches in order to improve and add to the current model of literature to develop more efficient management strategies for headaches. Headaches can present clinically similarly and present a diagnostic challenge. Currently it is not known what the clinical accuracy of headache diagnosis is or which management strategies chiropractors prefer to use in practice to manage certain headaches. The aim of this study was to investigate the diagnosis of certain headaches by chiropractors in the greater Durban area and to determine how certain headaches commonly treated by chiropractors were managed. Methodology Based on the quantitative paradigm, this is a descriptive questionnaire based study involving a population of 88 chiropractors practicing in the greater Durban area. The final sample size was 63, a response rate of 72%. The questionnaire was developed specifically for this study and was validated by an expert group and tested by a pilot study to ensure construct and face validity. Data regarding demographic information, diagnostic approach to cervicogenic headache (CEH), intracranial haemorrhage, meningitis, migraine (MEH) and tension type headache (TTH) and management of CEH, TTH and MEH was collected from the sample. SPSS version 22 was used to analyse the data. Descriptive statistics were reported in frequency tables. Continuous variables were compared between independent categories using one way ANOVA tests. Trends were shown in cross tabulations and interpreted descriptively where Chi square tests could not be calculated. Results The sample size consisted of 63 chiropractors in the greater Durban area, South-Africa, of which 49.2% (31) were male and 50.8% (32) were female. The mean age was 37 years (range 25 to 71 years). The majority of the sample had between six- to nine years of practice experience, with the majority being in full time practice (82.5% (52)). The majority (92.1% (58)) of the sample had graduated from DUT. Seventeen point five percent (11) of the sample had additional tertiary qualifications, the most common of which was a Master’s degree of Medical Sciences (Sports Medicine), with a total of 19 additional short courses being reported by 79.4% (50) of the sample. Seventy five point one percent (41) of the sample indicated usage of chiropractic specific journals, with 38.1% (24) of the sample indicating that these journals had an impact on the way they manage headaches in practice. Seventy seven point eight percent (49) of the sample attended health related conferences on a regular basis, with 38.1% (24) of the sample indicating that these conferences influenced their management of headaches in practice. Seventeen point five percent (11) of the sample had practiced internationally, with a range of international practice from one month to 12 years. The majority of the sample indicated that they practiced according to a combination of mixer and evidence based philosophy. The accuracy of diagnostic outcome for meningitis was 98.4% (62), TTH was 47.6% (30), MEH was 82.5% (52), CEH was 82.5% (52) and intracranial haemorrhage was 30.2% (19). The results for the management of CEH, TTH and MEH indicated that a minimum of 98.6% (62) would adjust a patient with these headaches; the sample predominantly preferred application of specific adjustments to fixated segments in the cervical and thoracic spine. A minimum of 66.7% (42) regarded spinal manipulative therapy (SMT) as the primary focus of treatment across all three headaches. The most commonly selected modality to be used in conjunction with SMT was massage therapy (with a minimum selection frequency of 68.3% (43) across CEH, MEH and TTH). Massage therapy was the most commonly selected modality to be used when SMT is contra-indicated (minimum selection frequency of 61.9% (40) across CEH, MEH and TTH). A minimum of 98.4% (62) of the sample indicated that they would treat MFPTs if associated with headaches, most commonly using dry needling. For the majority of the sample, the interval of choice for a second appointment was two to three days and the number of treatments expected for relief of symptoms was two to three treatments. Further investigations were considered necessary by the majority of the sample after seven days without any relief of symptoms. The majority of the sample recommended pain free care. Regarding patient advice and education, there was agreement on postural and ergonomic advice, home stretching, stress management techniques and proprioceptive exercises. If treatment goals were not obtained, the majority of the sample agreed to change the treatment plan, reassess all of the previous findings and if necessary refer the patient to another non-chiropractic health care provider. Conclusion Based on the case scenarios used in this study, meningitis, CEH and MEH were accurately diagnosed by the majority of the sample. There appeared to be some confusion with regard to the diagnosis of TTH as nearly half of the sample confused it for CEH. The accuracy with regard to the diagnosis of intracranial haemorrhage was concerning as the minority of the sample correctly diagnosed this condition. A relatively similar approach was used by chiropractors to treat headaches, with relatively little change in the treatment options between CEH, TTH and MEH. Most of the treatment methods, used by most of the sample, have moderate evidence for efficacy in treatment of musculoskeletal conditions. The management options chosen by the majority of the sample could be of potential benefit for the management of the respective headaches. Few differences were noted with regard to the impact of demographic information on the diagnostic outcome and management approaches. Some, but not enough, evidence indicates that the older participants provided less accurate diagnoses. The headaches which were less accurately diagnosed possibly due to an age difference were meningitis, TTH and MEH. With regard to management of headaches the only statistically significant differences were noted for the management of TTH for which age appeared to influence the specificity of adjustments used in TTH. / M

Dissertation presented to the Faculty of Health at Durban University of Technology in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2008. / Aims and Objectives: To assess the demographics, career paths and factors affecting chiropractic graduates of Durban University of Technology (DUT) from June 1994 to June 2007. Method: A retrospective qualitative survey was conducted on 62 chiropractic graduates of DUT. The sample represented 25.5% of the total chiropractic population. Raw data regarding the demographics, respondents’ perception of their education, current career paths, the factors responsible for affecting these career paths, as well as a profile of chiropractic practices in South Africa (SA) was obtained. All data acquired was assessed using SAS (Statistical Analysis System) version 9.1.3. The data was purely descriptive, describing respondents’ career paths and their experiences, and no specific hypothesis was investigated. Results: The average respondent was found to be a married, white male who started his chiropractic career at age 25-26 years. A total of 98.4% (n = 61) of the respondents were currently in practice, with 80.6% (n = 50) indicating career satisfaction. The majority (62.9%; n = 39) of respondents perceived there to be a growing acceptance of chiropractic within the medical community, whilst 98.4% (n = 61) stated that they are currently part of an active referral system between various other medical practitioners. 46% (n = 23) listed DUT as their preferred choice of chiropractic institution. Conclusion and Recommendations: The majority of respondents’ indicated DUT as the preferred choice of chiropractic institution due to its location and the system of chiropractic taught (diversified). However, shortcomings in the education were highlighted to be a lack of practically applicable knowledge taught at undergraduate level, most especially business skills and speciality areas and that respondents’ perceived the qualification not to be as versatile and widely accepted as other international chiropractic qualifications. Factors responsible for positively affecting the career paths of chiropractic graduates were indicated to be the personality type of the graduate, the means to finance a practice, support from parents and spouse or partner and the level of acceptance graduates received from the public and other professions within the medical sector. A recommendation for future studies is that a longer time period be given for questionnaires to be returned and a larger sample group be established in order to ensure that the sample group and total population is homogenous.

Submitted in partial compliance for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / The aim of this study was to investigate patient management protocols of low back pain (LBP) by chiropractors in the greater Durban metropolitan area. In this investigation a more generalized approach was chosen to investigate trends within the field of patient management and education for LBP. The study population of 80 chiropractors in the greater Durban metropolitan area, required a minimum response rate of 70% to obtain statistical significance (Esterhuizen, 2008), which was achieved. This study involved a quantitative descriptive design utilizing a questionnaire developed and validated by the researcher and focus group. The questionnaire was comprised of three sections, including personal information, treatment protocols and patient management with advice and education. Statistical analysis involved the use of SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA), a data analysis tool. Descriptive objectives were analysed with frequency tables and cross-tabulation tables (Esterhuizen, 2008). Demographic variables and practice variables were assessed for association with responses to the questionnaire using Pearson’s Chi square test in the case of categorical demographics and responses (Esterhuizen, 2008). Bar graphs were included to reflect the treatments that were always or frequently used by respondents (Esterhuizen, 2008). There appeared to be a wide range of influences on practice philosophy and methods, independent of demographics and training institute. A chiropractor’s age was regarded as significant with regard to philosophical orientation. However, the majority of these chiropractors obtained their qualifications from international colleges. vi Spinal manipulations directed at quadratus lumborum myofascial trigger points were strongly advocated by respondents. Specific short lever manipulations were the preferred manipulation technique for treatment of LBP. Sacroiliac joint manipulation was also considered important by a significant proportion of respondents. Respondents most commonly recommended the use of mobilizations and cryotherapy when contra-indications to manipulation were evident. There was consensus in the number of days before the first follow-up after an initial treatment for a presentation of acute LBP, where 96.42% of respondents recommended follow-up at day 1 or 2. In chronic LBP first follow-up after initial treatment was recommended by 41.1% of respondents on day 2; 28.6% day 3 and 8.9% on day 1. Management protocols for acute LBP appeared to be more uniform when compared to management of chronic LBP. Despite the variances in philosophy and management protocols amongst respondents, there remains consensus that manual articular manipulation remains the mainstay in chiropractic treatment protocols for both acute and chronic LBP.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Tehcnology: Chiropractic, Durban University of Technology, 2009. / Background: The aim of this study was to determine the knowledge, perception and utilisation of vitamins and minerals, natural medicines and pharmacological agents as adjuncts to Chiropractic practice in South Africa. Method: This study was a population based cross sectional survey utilising a descriptive, quantitative questionnaire study design. The questionnaire was distributed to all practicing qualified Chiropractors (n=388) and masters Chiropractic students (n=102) in South Africa. Results: The results obtained (30.4% response rate), indicated that the majority of the respondents (62.8%) felt qualified to advise patients on vitamins and mineral supplements and had a positive view of the use of vitamins and minerals as part of Chiropractic patient management (86.6%). The majority of the practitioners were aware that topical substances are part of the scope of practice and males were nearly twice as likely as females to use them. The majority thought biopuncture should be available to Chiropractors (82%) and felt that Chiropractors should challenge the legislation to incorporate biopuncture as part of the scope of practice (77.5%). Most respondents agreed with the statement indicating that NSAIDS should be part of Chiropractic scope of practice and 71% of respondents felt that being able to use NSAIDS in non-emergency situations would enhance patient retention. This study revealed that amongst the student population the majority, if allowed, would consider administering pharmacological agents in practice (55.1%). Conclusion: A correlation exists between the perception, knowledge and utilisation of vitamins and minerals, natural medicines and pharmacological agents in the Chiropractic profession with respect to the demographic data and there is a significant difference in opinion between qualified Chiropractors and Chiropractic masters students regarding perception, knowledge and utilisation of these adjuncts to practice.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2013. / Background: Considering the quadruple burden of disease and chronic shortages of health care professionals in South Africa, the stance of the chiropractic profession on public health (PH) matters has not been established. Therefore, this study aimed to determine the attitudes and perceptions of chiropractors practicing in South Africa on PH, health promotion (HP) and disease prevention (DP). The objectives were to determine demographic profile, lifestyle practices and attitudes and perceptions of practicing chiropractors in South Africa regarding PH agencies, HP and DP. Methods: An IRB approved quantitative survey (electronic and postal) was used to collect data from a total sample of practicing chiropractors in South Africa (meeting inclusion criteria). Follow up email and telephone calls were made to encourage response from participants. After a 17 - week period, returned questionnaires were collected and data analysed. Results: A response rate of 45% was obtained. Of the participants, 51.7% were female, 60.3% practiced in upper – middle income communities and 66.4% perceived themselves as neuro - musculoskeletal specialists. Over 90% of practitioners regularly counselled patients on postural habits, injury prevention and ergonomic risk reduction. Where as 35.1% agreed to counselling patients on STI / HIV prevention, tobacco cessation and related risks (41.4%), alcohol abuse (53.4%) and cancer prevention (56.9%). Regarding evidence – based practice (EBP) and PH agencies, 39.1% could not identify the statistical significance of the p value and 46% were unable to provide examples to journals they used to inform best practice. Similarly, 59% of the participants could not identify PH agencies to refer to for information on smoking cessation / risks or PH agencies to refer patients on HIV (57%), notifiable diseases (59%) and terminal illnesses (45%). Conclusion: The results suggest that chiropractors from this study were proficient on topics of DP, but were reletively less proficient in regards to PH, HP and EBP. It was recommended that further research be done regarding EBP within the profession and that greater emphasis be placed on topics of HP and PH in chiropractic training programmes.

submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic and Somatology, Durban University of Technology, Durban, South Africa, 2016. / Background: The recent increase in the implementation of evidence-based practice (EBP) in the Chiropractic profession and the call within the profession for validation of its claims has seen a growing interest in good quality research. It is advocated that the future of Chiropractic research and thus the success of the profession is dependent on future practitioner and student research endeavours. It was the aim of this study to evaluate the student research agendas at the Durban University of Technology (DUT). Secondly, local Chiropractors were asked what they perceived to be clinically relevant Chiropractic research agendas. The agendas that were under-studied by the students, but perceived as important by the practitioners, were recommended as suggestions for more clinically relevant future student research. The intention of this was that future student research would become more congruent with local and international Chiropractic research trends. Methodolody: The study was a prospective exploratory study, which utilised a mixed method approach. Documented evidence giving an overview of student research completed at the DUT was combined with a qualitative questionnaire that was circulated to all Chiropractors practicing in KwaZulu-Natal. The questionnaire aimed to give insight into the research agendas perceived to be most relevant for future research by Chiropractic professionals. Incongruence between the research completed at the DUT and the research that is perceived to be of highest professional relevance by Chiropractors in KwaZulu-Natal was determined. All the Chiropractors practicing in KwaZulu-Natal as per the AHPCSA list received the questionnaire. A neutral third party at DUT collected the returned questionnaires and data analysis followed. The student research completed at the DUT between 1994 and 2013 was obtained from the Institutional Repository (IR) and library archives. These studies were descriptively analysed and compared with the respondents’ perceptions of clinically important Chiropractic research. Data analysis highlighted the overlap of agendas and gaps in the research. Following this was a statistical analysis of the questionnaire responses using Pearson’s chi square tests for two independent samples. A p value of ≤ 0.05 was considered as statistically significant. The results were interpreted using frequency tables and bar charts for categorical variables, while summary statistics such as mean, standard deviation and range were used for continuous variables. A descriptive comparison was performed to determine the congruency between the student research agendas and the research perceived to be of relevance by Chiropractors practicing in KwaZulu-Natal. Results: The response rate of 66.3 % was regarded as representative of the entire Chiropractic population. The overall practitioner perception of research was positive with 64.4% of the respondents perceiving improved Chiropractic abilities due to previous research experience. The prevailing practitioner reason for research conducted was that it increased recognition as an EBP, increased development within the profession and validated its claims and theories. An investigation into the student studies found that the majority of the research agendas recommended by the respondents had been undertaken at DUT. Future research into the following areas is encouraged:  Neurological testing.  Orthopaedic testing.  Reduction of posture related disorders.  Gross anatomical changes as a result of the Chiropractic manipulation.  Range of Motion (ROM) assessment.  Muscular testing, motion and/ or static palpation.  Gait and posture assessment. The respondents were asked to give recommendations for future Chiropractic research; the majority was willing to contribute a database of shared research ideas. It was anticipated that the sharing of the practitioner ideas with the students would result in more clinically relevant student research being produced. Conclusion: A comparison of the DUT student research agendas and those of Chiropractors in KwaZulu-Natal highlighted an incongruence of purpose between the two. The research agendas recommended by the Chiropractic respondents were recommended for future student uptake. A shared database of student and practitioner research ideas aimed to encourage future student research that is more clinically relevant and in line with local and international research trends. / M

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Tehcnology: Chiropractic, Durban University of Technology, 2009. / Background: The aim of this study was to determine the knowledge, perception and utilisation of vitamins and minerals, natural medicines and pharmacological agents as adjuncts to Chiropractic practice in South Africa. Method: This study was a population based cross sectional survey utilising a descriptive, quantitative questionnaire study design. The questionnaire was distributed to all practicing qualified Chiropractors (n=388) and masters Chiropractic students (n=102) in South Africa. Results: The results obtained (30.4% response rate), indicated that the majority of the respondents (62.8%) felt qualified to advise patients on vitamins and mineral supplements and had a positive view of the use of vitamins and minerals as part of Chiropractic patient management (86.6%). The majority of the practitioners were aware that topical substances are part of the scope of practice and males were nearly twice as likely as females to use them. The majority thought biopuncture should be available to Chiropractors (82%) and felt that Chiropractors should challenge the legislation to incorporate biopuncture as part of the scope of practice (77.5%). Most respondents agreed with the statement indicating that NSAIDS should be part of Chiropractic scope of practice and 71% of respondents felt that being able to use NSAIDS in non-emergency situations would enhance patient retention. This study revealed that amongst the student population the majority, if allowed, would consider administering pharmacological agents in practice (55.1%). Conclusion: A correlation exists between the perception, knowledge and utilisation of vitamins and minerals, natural medicines and pharmacological agents in the Chiropractic profession with respect to the demographic data and there is a significant difference in opinion between qualified Chiropractors and Chiropractic masters students regarding perception, knowledge and utilisation of these adjuncts to practice.

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M

Submitted to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Neck pain is an extremely common condition and the treatment of neck pain forms an integral part of chiropractic practice. The optimal treatment of neck pain is provided when practitioners incorporate available evidence, experience, and knowledge regarding the clinical presentation of the patient into their treatment regimes. Current evidence suggests that a combination of manual therapy, specifically manipulation and/or mobilization, and rehabilitation may offer the optimum treatment for mechanical neck pain. However, numerous factors other than available evidence, experience and clinical presentation may influence treatment choices made by practitioners. Through the assessment of practice patterns, one may asses if the optimal treatment for a neck pain is being provided by practitioners and assess if factors specific to a practitioner may influence the treatment of neck pain. Objectives: The aim of this study is to determine the chiropractic treatment and management of mechanical neck pain, to compare this to evidence based recommendations for the conservative treatment of mechanical neck pain and to assess if factors other than the available evidence may influence the treatment of mechanical neck pain. Method: A quantitative, cross-sectional descriptive survey compiled using available literature and validated by means of a focus group and pilot testing, was administered to chiropractors practicing in KwaZulu-Natal. Upon completion of the questionnaire, the data was coded into an Excel spread sheet and imported into IBM SPSS version 20 for statistical analysis. This research protocol was approved by the Durban University of Technology Institutional Research Ethics Committee (REC 82/13) and the study took place from March to July 2014. Results: Ninety-six practitioners responded to the study which is a response rate of greater than 70%. Practitioners favoured the use of spinal manipulation, auxiliary therapeutic techniques (specifically those which were manual in nature), rehabilitation, and numerous forms of education. Specific variations in treatment pattern existed when comparing various patient presentations indicating that practitioner based factors impacted on treatment choices made by practitioners. The most significant findings included the increased utilisation of auxiliary therapeutic techniques by female practitioners, the increased utilisation of traction by practitioners identifying with the straight philosophy of chiropractic. Other significant findings included the increased utilisation of cervical collars by practitioners of increased age and experience and the increased utilisation of auxiliary therapeutic techniques by practitioners who did not attend health related conferences at least once every second year or did not attend short courses or subscribe to journals or magazines since qualification. Conclusions: This study indicates that treatment for mechanical neck pain offered by chiropractors in KwaZulu-Natal is in line with current evidence based recommendations for the treatment of mechanical neck pain, with practitioners commonly using modalities which were recommended, whilst rarely using modalities which were not recommended. The use of rehabilitation was, however, slightly lower than expected. Patient presentation and practitioner based factors were found to influence the treatment of mechanical neck pain; however, as a whole these variations were small with the majority of practitioners favouring the use of modalities which were recommended within the literature. Future studies should address the gap in the literature regarding the conservative treatment of cervical radiculopathy. / M