While the use of complementary, alternative and integrative medicine (CAIM) is substantial, it continues to exist at the periphery of allopathic medicine. Understanding the attitudes of medical students toward CAIM will be useful in understanding future integration of CAIM and allopathic medicine. This study was conducted to develop and evaluate an instrument and assess medical students’ attitudes toward CAIM. The Complementary, Alternative and Integrative Medicine Attitudes Questionnaire (CAIMAQ) was developed by a panel of experts in CAIM, allopathic medicine, medical education and survey development. A total of 1770 CAIMAQ surveys (51% of US medical schools participated) were obtained in a national sample of medical students in 2007.

Factor analysis of the CAIMAQ revealed five distinct attitudinal domains:

• desirability of CAIM therapies,
• progressive patient/physician health care roles,
• mind-body-spirit connection,
• principles of allostasis and
• a holistic understanding of disease.

The students held the most positive attitude for the “mind-body-spirit connection” and the least positive for the “desirability of CAIM therapies”. This study provided initial support for the reliability of the CAIMAQ. The survey results indicated that in general students responded more positively to the principles of CAIM than to CAIM treatment. A higher quality of CAIM-related medical education and expanded research into CAIM therapies would facilitate appropriate integration of CAIM into medical curricula. The most significant limitation of this study is a low response rate, and further work is required to assess more representative populations in order to determine whether the relationships found in this study are generalizable.

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By Daniel Redwood, D.C., professor, Cleveland Chiropractic College

©2010 Cleveland Chiropractic College – Kansas City and Los Angeles

Chiropractic Research & Practice

State of the Art

Since chiropractic’s breakthrough decade in the 1970s — when the U.S. federal government included chiropractic services in Medicare and federal workers’ compensation coverage, approved the Council on Chiropractic Education (CCE) as the accrediting body for chiropractic colleges, and sponsored a National Institutes of Health (NIH) conference on the research status of spinal manipulation — the profession has grown and matured into an essential part of the nation’s healthcare system.

OBJECTIVE:   The purpose of this study was to report demographic characteristics, chiropractic treatment methods and frequency, and clinical outcomes for chiropractic management of neck pain in a sample of veteran patients.

METHODS:   This is a retrospective case series of 54 veterans with a chief complaint of neck pain who received chiropractic care through a Veterans Health Administration medical center. Descriptive statistics and paired t tests were used with the numeric rating scale and Neck Bournemouth Questionnaire serving as the outcome measures. A minimum clinically important difference was set as 30% improvement from baseline for both outcomes.

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by Steven Yeomans, D.C.

Today more than ever, chiropractors are faced with the challenge of running a busy practice and, at the same time, juggling the documenting requirements in light of Medicare audits, proving “medical necessity” to private insurers, and producing documentation that minimizes risk in this litigious world. The requirement of creating a legible, concise account of the patient encounter that includes patient centered functional goals and methods of tracking functional improvements that occur during care, emphasizes the need for the inclusion of outcomes assessment tools in the documentation process. The goal of this article is to provide you with the “knowledge ammunition” needed to accomplish this task without expending volumes of time and effort.

Outcomes assessment tool availability is not a new concept. Back in the 1970’s, long, impractical outcomes tools surfaced that were too cumbersome for routine use in a primary care setting, but shortly thereafter, in 1980, Fairbank introduced the Oswestry (Low Back) Disability Index (ODI). An interesting point is that the original purpose of the ODI was to identify patients that may require “…positive intervention” in the form of psychological care when scores exceeded 60% (defined as “crippled”).

However, it was (also) found to be an effective tool to be used in serial manner to show patient progress over time and identify endpoints of care or plateaus in progress, prompting a change in the treatment planning for the patient. This was followed by other “gold standard” tools including the Roland-Morris Low Back Disability Questionnaire in 1984, and the chiropractic contribution of Vernon and Mior’s Neck Disability Index in 1988.

A gradual increase in the use of these tools occurred in the 1990’s with introduction of many other condition specific tools for headaches, dizziness, carpal tunnel, shoulder pain, hip, knee, and ankle pain, as well as general health tools, and psychometric tools for depression and anxiety assessment. In fact, there are now so many tools available, it may be quite a challenge to decide which ones are most important.

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Patient self-perception of the health care experience is becoming an important component of clinical outcomes assessment. In light of the progression toward a more closely managed health care system, chiropractors are being expected to document and quantify clinical progress. Functional health status instruments are an economical & efficient way of accomplishing that task. [1]

The RAND Health Survey measures physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, sense of emotional well-being, energy/fatigue levels, pain, general health perception, and health change. These questions focus on areas of clinical complaint that many patients are experiencing upon presentation to the chiropractic office.

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The Outcome Assessment Page contains, or links to, most of the best-supported OA questionnaires. It also has a collection of articles about the use of OA in the field.

You may find the Outcome Assessment Guidelines Section of interest.

That page is one of many of the useful tools found in the
Clinical Documentation Section.

Data was collected from 28,807 treatment consultations (19,722 patients) and 13,873 follow-up treatments. The presenting symptoms of “neck pain”, “shoulder, arm pain”, “reduced neck, shoulder, arm movement, or stiffness”, “headache”, and “upper, mid back pain” all emerged in the final model as significant predictors for immediate improvement. The presence of any 4 of these predictors raised the probability of an immediate improvement in presenting symptoms after treatment from 70% to approximately 95%.

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