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

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.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Objectives: Collaboration between health care practitioners has many advantages including a focus on disease prevention and health promotion, improving service access and the provision of multidisciplinary health care teams. To achieve this ideal health care provision, understanding the current landscape of referral/interaction between practitioners and the factors which influence this network are important. This enables effective delivery of health care demanded by the public. As identified factors impacting the inter-referral of patients between practitioners are contextual, they differ in different contexts. Thus, this study aimed to investigate the factors affecting the referral of patients between chiropractors and physiotherapists in the eThekwini municipality.

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

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.