Methodological and epistemological challenges for the chiropractic profession in health care - a study of the history, status quo and future of research and clinical practices.

[摘要] ENGLISH ABSTRACT: Although a legitimate provider of manipulative therapy, chiropractic largely functionsoutside mainstream health care in South Africa. A narrow research focus, poorinstitutional representation and inadequate professional integration all contribute toits undetermined role in health care.This study exploratory, qualitative study sought to investigate the state of the art ofchiropractic with respect to beliefs, philosophy, research methods and clinicalpractices.Semi-structured, interviews were used to extract responses from ten chiropractors,six patients and four researchers.The results were interpreted on three levels; thematically, in relation to chiropractic'sdiscipline and profession and as a function of the '3 worlds' framework.The thematic analysis revealed that:1. Beliefs and philosophical traditions play an active role in the practice andscience of chiropractic.2. The chiropractic investigative paradigm has started to mature.3. The contextual role of research methods is being clarified.4. Contemporary chiropractic practice is not as evidence-based as it should be.5. The chiropractic model of practice is significantly different to the perceivedstandard medical model.6. Chiropractic clinical practice has a fuzzy identity.7. Chiropractic's professional status is unclear.8. The professional and disciplinary components of chiropractic are stillinstitutionally immature.9. Chiropractic's legitimacy is questionable.Themes 1-3 indicated that beliefs and philosophical traditions affect the way in whichchiropractors conduct themselves clinically, the way patients view the world of healthcare and the manner in which researchers study clinical phenomena. Themes 4-6suggest that the state of the art of chiropractic clinical practice is different frommedicine, however the exact nature of its model of practice seems quite fluid.Themes 7, 8 and 9 suggest that the degree of professional and institutional maturityprovide chiropractic with only partial legitimization.With regards to the discipline it seems that science and education have an importantbuffering role to play between the patient and the practitioner, in order to curbmetaphysically motivated practices. Furthermore, chiropractic's investigativeparadigm is progressing atypically and hence the view of it conforming to a standardview of science is questioned. With regards to professional matters, our study indicates that chiropractors functionon a spectrum which runs between 'technicians and 'physicians. Whilst patientshave holistic health care beliefs it seems they are pushed toward chiropractic,through negative allopathic health care experiences and are drawn to the professionby its integrated model of practice. However, the lack of mainstream healthcareintegration counter balances this worth and reduces chiropractic's professionallegitimacy.Two cross over themes were revealed. Firstly, chiropractic's investigative paradigmhas started to narrow the gap between applied science and clinical practice andsecondly chiropractic's legitimacy cannot lie in the opinion of medicine.The 'three worlds' framework indicated that the first three themes are meta-scientific(W3) reflections on beliefs, philosophical traditions and research methodology. Thefourth theme reflects the relationship of research and practice (W2 and W1), and theremaining five themes are reflections clinical practice (W1 activities).Our study contends that chiropractic has the potential to develop into a mainstreamhealth care provider through the implementation of a multi-leveled developmentstrategy.

[发布机构] Stellenbosch University