This thesis was initiated by an awareness of the impact of low back pain in Western society in general and Australian society in particular. The studies and experiments in this thesis contribute towards an understanding of chiropractic as a professional entity in Victoria and the nature of its clinical practice. The issue of male adolescent LBP has been explored and in addition to an epidemiological description of this clinical entity, its anthropometric dimensions have been documented. The qualitative review of the literature provides ample justification for the management of patients with LBP by chiropractors, using manual or manipulative techniques. The observational study of the Victorian context in which chiropractors are educated, registered, and entitled to practice, demonstrates that Victorian chiropractors are appropriate providers of manipulative health care. They perform the role of primary contact, primary health care providers with diagnostic, treatment and management skills focussed mainly on musculoskeletal conditions, but with a small proportion of practice based in the health or preventive context, and are well placed to provide the manual and manipulative services required in the management of LBP patients. The profession is shown to have strategies in place to ensure continued legal and community acceptance. The strategies include those at entry level to the profession, such as the legislative provisions of government and the competencies required for registration as instilled during the professional education process, and those which are more of the nature to maintain the integrity of professional practice, such as the " standards of practice" concept. These are important characteristics given it is shown that the Victorian chiropractic profession is not homogenous with respect to educational standards, has a disparate gender balance, the presence of a few non-registered 'chiropractors', and a disparity in utilisation patterns with a significant tail to the right. However the chiropractic profession is shown to hold a position of strength and leadership in the Australian context with respect to the provision of manipulative health care. Indeed, it could be said that chiropractors are at the leading edge of the quality process with respect to the provision of manipulative health care in Australia. The description of chiropractic practice shows a patient base of all ages, including adolescents, presenting with a range of possible diagnoses, often funded by a third party, and with a high proportion of return visits suggestive of patient compliance and satisfaction. It is convincingly demonstrated that persons with work-related LBP attend to chiropractors in Victoria and are effectively managed with the aim being the restoration of optimal spinal function and, in the case of work-injured patients, an early return to work. This thesis includes utilisation data which suggest only a minority of Victorian chiropractors practice outside the responsible parameters described above. The case-mix data and patient profiles presented in this thesis are congruent and complement each other, suggesting a high level of patient satisfaction indicated by the high proportion of return visits by regular patients and a faster, return-to-work by work-injured claimants. The point and sample prevalence of LBP in a population of suburban male adolescents is described and shown to be similar to those found in comparable Western societies. The data for a sample of traditional Australian male adolescents describes the LBP experience for the first time in such a population and emphasises the wide variance between societies which is now being identified in the literature. The LBP experience of a typical suburban Australian male adolescent is identified and described in terms of chronicity, frequency and episode duration. Typically the male adolescent with LBP has a chronic (> 90 d) problem with frequent episodes of pain (from 2 or 3 times a month to 2 or 3 times week) which last a few hours. The pain is a little limiting but allows the performance of the Activities of Daily Living. While some limitation of general sporting activity due to pain is experienced, school attendance is generally not compromised. A particular clinical instrument, the Metrecom computerised electro-goniometer, is studied and found to be appropriate for use in gathering anthropometric dimensions to test hypotheses relating to an association between anthropometric dimensions and LBP in a male adolescent population. The applied level of uncertainty of the instrument is within acceptable limits for these dimensions. The anthropometric study tests the broad null hypothesis that the mean of specific anthropometric dimensions would be equal among samples of male adolescents drawn from the Australian population. The actual groups are a Melbourne 'Pain' group, a Melbourne 'No Pain' group, and a 'Traditional No Pain' group. The pain group reported either current LBP or a positive history of LBP, while the 'no pain' groups denied either current or historical LBP. The alternate hypothesis will be shown to be proven for the dimensions 'sitting height', 'upper body' length, 'pelvic height', and the ratio of the 'upper:lower' body segment in a population of male adolescents with idiopathic or mechanical LBP. This thesis meets its objectives of describing the chiropractic profession and its practise in the Victorian context, demonstrates the prevalence of LBP in a male adolescent population, and identifies particular anthropometric dimensions associated with those who report a LBP experience. The fact that a number of anthropometric dimensions are detectable in adolescence may allow the development of appropriate screening programs which in turn may lead to the design and introduction of suitable prophylactic interventional programs for persons found to be potentially prone to idiopathic or mechanical LBP, at the least reducing the severity and at most reducing the onset of this expensive problem in adulthood. The ratio of the upper body segment to the lower body segment would appear to be most appropriate indicator; it is robust in that it is a prime dimension, easily accessible, and with a low level of measurement uncertainty. Most importantly it would appear to hold validity throughout adolescence as it does not have a linear relationship with age.
| Identifer | oai:union.ndltd.org:ADTP/210501 |
| Date | January 1999 |
| Creators | Ebrall, Phillip Stuart, Phillip.ebrall@rmit.edu.au |
| Publisher | RMIT University. Health Sciences |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://www.rmit.edu.au/help/disclaimer, Copyright Phillip Stuart Ebrall |
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