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.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2006 116 leaves / The aim was to evaluate the prevalence of hand and wrist pain, as well as the relationships between occupational overuse syndromes in the hands and wrists of chiropractors in South Africa as a result of their daily use of manual therapy techniques while at work. There are very few statistics available that disclose the nature and incidence of work related injuries. However those statistics that do exist suggest that hands on patient activities place physical therapists at greater risk of injury in comparison to other health care workers (Lunne et al., 2000). A study conducted by Bork et al.(1996) determined the prevalence of work-related musculoskeletal injuries sustained by physical therapists. Hand pain (29.6%) and back pain (45%) where the leading cause of pain in physical therapists (Bork et al., 1996.) Chiropractic and physiotherapy are both health care professions that specialize in the treatment of disorders pertaining to the neuro-musculo-skeletal system (Hunter, 2004). Physical therapists use manual therapy techniques as part of their daily working activities, so it can be assumed that chiropractors too will have a high prevalence of hand and wrist pain as they utilize similar therapeutic techniques to physical therapists. Cromie et al.(2000) evaluated the prevalence, severity, risks, and responses of disorders in physical therapists. He identified 4 categories of major risk factors commonly associated with workers musculo-skeletal disorders in physical therapists 1. Risk factors related to specific activities. 2. Postural risk factors. 3. Risk factors with regard to work load issues 4. Risk factors in regard of work capacity and health of the participant (Cromie et al., 2000). Physical risk factors found to be associated with neck, shoulder, or hand and wrist disorders in cross sectional studies are heavy lifting, monotonous work, static work postures, vibrations and repetitive jobs, and a high work pace (Alfredsson et al., 1999). Other factors that have been associated with musculoskeletal pain are higher age and female gender (de Zwart et al., 2001; Wahlstedt et al., 2001; Feveile et al., 2002).

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Chiropractic in Israel has become a more integrated part of many aspects of health care policies, in that it is practised in multidisciplinary medical teams, is now included in HMOs and hospitals services, and has contributed to research and military programmes. However, the chiropractic profession still has its problems. Without laws or legitimate recognition to protect chiropractors, the playing fields could never be levelled for all chiropractors in Israel. Patient use and demand for complementary and alternative practitioners, including chiropractors, is gradually increasing. However, there has been no research to investigate the perceptions of chiropractors, medical doctors and chiropractic patients (i.e. key stakeholders) regarding the integration of the chiropractic profession in the Israeli health care system. The purpose of this study was to explore and describe the perceptions of a selected group of stakeholders about the integration of the chiropractic profession in the Israeli health care system. Such an exploration might help the profession to secure its position and claim a higher status in society. This is desirable to educate the public and the authorities on the many positive advantages of chiropractic, include access to chiropractic services for people who traditionally have not been able to use these services because of economic barriers or internal government and authorities limiting laws, as well to enhance its public image such as honesty, integrity and objectivity in the health care, and to avoid any criticism of organized medicine. It therefore stands to reason that the factors that might contribute to this type of development should be considered as soon as possible in those countries where chiropractors practise. This type of investigation is important not only in the Israeli setting, but indeed in every country where the profession is aiming toward increased recognition and awareness of the contribution of chiropractic to health care. Chiropractic now has the opportunity to expand its influence and take a more active role in health care issues. Therefore, although geographically removed, South Africa stands to gain interesting and useful information from an investigation of this nature. The investigation was carried out within a post positivist approach close to that of critical realism, using an interpretive methodology. The sampling was purposive as individuals were targeted for their knowledge in three main topics, these being the scope of chiropractic practice, inter-professional relations between Doctors of Chiropractic (DCs) and Medical Doctors (MDs), and developmental issues. The participants included five chiropractors, three medical doctors and three chiropractic patients, who all resided in the metropolitan area of Tel Aviv. were presented in tabular form in order to facilitate analysis and interpretation. Although there were some discrepancies regarding the knowledge and background of the participants about the topics discussed, all the participants met the inclusion criteria. The results show that chiropractic stands at the crossroads of mainstream and alternative medicine. Therefore it is important to establish a leading statement on identity, which must be clear, concise and immediately relevant to both the public and the profession. Although inter-professional relations between MDs and DCs in Israel are improving, further research should be conducted to provide suggestions on how chiropractors can overcome barriers and improve communication with MDs and other health care professionals in the Israeli health care system. In general, the participants agreed that governmental legislation, recognition and support are important endorsements with respect to the societal relevance and development of the profession. Therefore issues such as public awareness of chiropractic education and scope of practice, research and evidence-based practice must be emphasized accordingly in order to facilitate the development of chiropractic practice in Israel. / M

This study showed that state laws and policies constrain the locational preferences of alternative health care providers to varying degrees, depending on the particular profession and level of legal status. Three separate surveys were conducted, focusing on acupuncturists, chiropractors and homeopaths in Maryland, Virginia, North Carolina, and the District of Columbia. The acupuncture findings revealed intraprofessional divisions that lead to a strong influence of legal constraints on the locational behavior of non-MD acupuncturists. Results from the chiropractic survey reflected an established profession with a less pronounced, but moderate, influence of state laws and policies on location and mobility. The homeopathy findings, while based on a much smaller sample, did not reveal a strong relationship between legal constraints and spatial characteristics, except in the extreme case of North Carolina's recent prohibition. This study also postulated a model to explain the progression of alternative health care professions toward legitimation. The variables of public acceptance and legal constraints on location were plotted on the model to identify particular levels of progression. The importance of this research is highlighted by impending health care reforms, the need for access to professional health services, skyrocketing biomedical costs, and the documented utilization of alternative health care in this country. / Master of Science

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