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1.  Chiropractors & Osteopaths Musculo-Skeletal Interest Group (COMSIG) 
COMSIG Review  1992;1(1):2.
The Chiropractors & Osteopaths Musculo-Skeletal Interest Group evolved from regular clinical meetings at Ringwood Clinic, a multi-disciplinary clinic in Melbourne
In 1987 the Directors of the clinic Bruce F. Walker D.C. and Alison Hogg MB.BS. (Hons), FRACGP. Decided to invite a range of guest speakers (on musculo-skeletal topics) to give an address every 6 weeks
Local practitioners of all persuasions were invited to attend these meetings. Although all groups were represented, by far the greatest interest shown by the chiropractors and osteopaths
In 1989 Peter D. Werth B.App.Sc.(Chiro) joined the team and together with the writer formulated a plan to broaden the list of invited guests to all registered chiropractors and osteopaths in Melbourne
Naturally, this required a larger venue and organisation. After several successful meetings attracting groups of 60 to 70 practitioners we formalised the COMSIG organisation and gained the invaluable assistance of David de l Harpe B.Sc., B.App.Sc.(Chiro), MB.,BS., Shane Carter B.App.Sc.(Chiro) and Simon Clement D.O. on our committee. More recently Shane Carter left for overseas and was ably replaced by Miriam Bourke B.App.Sc.(Chiro)
This year COMSIG incorporated under the name of the long established Chiropractic & Osteopathic College of Australasia
So, what is COMSIG and what are it’s objectives? COMSIG is a special interest group of the Chiropractic & Osteopathic College of Australasia. More specifically, it is an affiliation of Chiropractors and Osteopaths with interests pertaining to the musculo-skeletal system
The objectives for which COMSIG was established are: to promote knowledge of disorders of the musculo-skeletal provide a forum for the interchange of ideas related to such educate chiropractors, osteopaths and other health professionals about the diagnosis and management of such encourage the diagnosis and management of musculo-skeletal disorders in a scientific and ethical conduct, promote, and arrange meetings, seminars, symposia, conferences, and lectures on musculo-skeletal foster research into musculo-skeletal disorders.
Importantly, COMSIG is not a political organisation but rather an academic organisation arising from the practitioner ranks of the professions
We encourage all those with an interest in musculo-skeletal disorders to join COMSIG and participate in its development. An application form is enclosed, or available from the Secretary…
PMCID: PMC2050005  PMID: 17989738
Chiropractic; osteopathy; Australia; education
2.  Interrater Reliability of Motion Palpation in the Thoracic Spine 
Introduction. Manual therapists commonly use assessments of intervertebral motion to determine the need for spinal manipulation, but the reliability of these procedures demonstrates conflicting results. The objectives of this study were to investigate the interrater reliability of thoracic spine motion palpation for perceived joint restriction and pain. Methods. Twenty-five participants between the ages of 18 and 70, with or without mid-back pain, were enrolled. Two raters motion palpated marked T5–T12 levels using two methods (standardised and pragmatic) and noted any restricted or painful segments. We calculated agreement between two raters by generating raw agreement percentages and Kappa coefficients with 95% confidence intervals. Results. There was poor to low level of agreement between the raters for both joint stiffness and pain localization using both pragmatic and standardized approaches. The results did not improve significantly when we conducted a post hoc analysis where three spinal levels were collapsed as one and right and left sides were also combined. Conclusions. The results for interrater reliability were poor for motion restriction and pain. These findings may have unfavourable implications for all manual therapists who use motion palpation to select patients appropriate for spinal manipulation.
PMCID: PMC4480941  PMID: 26170883
3.  The simulated early learning of cervical spine manipulation technique utilising mannequins 
Trivial pain or minor soreness commonly follows neck manipulation and has been estimated at one in three treatments. In addition, rare catastrophic events can occur. Some of these incidents have been ascribed to poor technique where the neck is rotated too far. The aims of this study were to design an instrument to measure competency of neck manipulation in beginning students when using a simulation mannequin, and then examine the suitability of using a simulation mannequin to teach the early psychomotor skills for neck chiropractic manipulative therapy.
We developed an initial set of questionnaire items and then used an expert panel to assess an instrument for neck manipulation competency among chiropractic students. The study sample comprised all 41 fourth year 2014 chiropractic students at Murdoch University. Students were randomly allocated into either a usual learning or mannequin group. All participants crossed over to undertake the alternative learning method after four weeks. A chi-square test was used to examine differences between groups in the proportion of students achieving an overall pass mark at baseline, four weeks, and eight weeks.
This study was conducted between January and March 2014. We successfully developed an instrument of measurement to assess neck manipulation competency in chiropractic students. We then randomised 41 participants to first undertake either “usual learning” (n = 19) or “mannequin learning” (n = 22) for early neck manipulation training. There were no significant differences between groups in the overall pass rate at baseline (χ2 = 0.10, p = 0.75), four weeks (χ2 = 0.40, p = 0.53), and eight weeks (χ2 = 0.07, p = 0.79).
This study demonstrates that the use of a mannequin does not affect the manipulation competency grades of early learning students at short term follow up. Our findings have potentially important safety implications as the results indicate that students could initially gain competence in neck manipulation by using mannequins before proceeding to perform neck manipulation on each other.
PMCID: PMC4522963  PMID: 26240752
Chiropractic; Education; Neck manipulation; Randomised trial; Mannequin; Simulated learning
4.  Chiropractic & Osteopathy. A new journal 
Both chiropractic and osteopathy are over a century old. They are now regarded as complementary health professions. There is an imperative for both professions to research the principles and claims that underpin them, and the new journal Chiropractic & Osteopathy provides a scientific forum for the publication of such research.
PMCID: PMC1151649  PMID: 15967045
5.  The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising 
The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors.
183 adults, aged 20–85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score.
There were no significant associations between pain diagram area and any of the clinical variables.
Our findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.
PMCID: PMC3899615  PMID: 24438468
6.  A survey of Australian chiropractors’ attitudes and beliefs about evidence-based practice and their use of research literature and clinical practice guidelines 
Research into chiropractors’ use of evidence in clinical practice appears limited to a single small qualitative study. The paucity of research in this area suggests that it is timely to undertake a more extensive study to build a more detailed understanding of the factors that influence chiropractors’ adoption of evidence-based practice (EBP) principles. This study aimed to identify Australian chiropractors’ attitudes and beliefs towards EBP in clinical practice, and also examine their use of research literature and clinical practice guidelines.
We used an online questionnaire about attitudes, beliefs and behaviours towards the use of EBP in clinical practice that had been developed to survey physiotherapists and modified it to ensure that it was relevant to chiropractic practice. We endeavoured to survey all registered Australian chiropractors (n = 4378) via email invitation distributed by Australian chiropractic professional organisations and the Chiropractic Board of Australia. Logistic regression analyses were conducted to examine univariate associations between responses to items measuring attitudes and beliefs with items measuring: age; years since registration; attention to literature; and use of clinical practice guidelines.
Questionnaires were returned by 584 respondents (response rate approximately 13%). The respondents’ perceptions of EBP were generally positive: most agreed that the application of EBP is necessary (77.9%), literature and research findings are useful (80.2%), EBP helps them make decisions about patient care (66.5%), and expressed an interest in learning or improving EBP skills (74.9%). Almost half of the respondents (45.1%) read between two to five articles a month. Close to half of the respondents (44.7%) used literature in the process of clinical decision making two to five times each month. About half of the respondents (52.4%) agreed that they used clinical practice guidelines, and around half (54.4%) agreed that they were able to incorporate patient preferences with clinical practice guidelines. The most common factor associated with increased research uptake was the perception that EBP helps make decisions about patient care.
Most Australian chiropractors hold positive attitudes towards EBP, thought EBP was useful, and were interested in improving EBP skills. However, despite the favourable inclination towards EBP, many Australian chiropractors did not use clinical practice guidelines. Our findings should be interpreted cautiously due to the low response rate.
PMCID: PMC3878410  PMID: 24345082
7.  How to proceed when evidence-based practice is required but very little evidence available? 
All clinicians of today know that scientific evidence is the base on which clinical practice should rest. However, this is not always easy, in particular in those disciplines, where the evidence is scarce. Although the last decades have brought an impressive production of research that is of interest to chiropractors, there are still many areas such as diagnosis, prognosis, choice of treatment, and management that have not been subjected to extensive scrutiny.
In this paper we argue that a simple system consisting of three questions will help clinicians deal with some of the complexities of clinical practice, in particular what to do when clear clinical evidence is lacking. Question 1 asks: are there objectively tested facts to support the concept? Question 2: are the concepts that form the basis for this clinical act or decision based on scientifically acceptable concepts? And question three; is the concept based on long-term and widely accepted experience? This method that we call the “Traffic Light System” can be applied to most clinical processes.
We explain how the Traffic Light System can be used as a simple framework to help chiropractors make clinical decisions in a simple and lucid manner. We do this by explaining the roles of biological plausibility and clinical experience and how they should be weighted in relation to scientific evidence in the clinical decision making process, and in particular how to proceed, when evidence is missing.
PMCID: PMC3717011  PMID: 23837495
Chiropractic; Evidence-based practice; Biological plausibility
8.  A Royal Chartered College joins Chiropractic & Manual Therapies 
From January 2013, The UK College of Chiropractors joins the partnership between the Chiropractic and Osteopathic College of Australasia (COCA) and the European Academy of Chiropractic (EAC) to publish Chiropractic & Manual Therapies. This new partnership will enable the journal to grow and flourish and further improve access to high quality research publications for interested researchers and clinicians worldwide.
PMCID: PMC3563517  PMID: 23289610
9.  Subgrouping Patients With Low Back Pain 
Sports Health  2011;3(6):534-542.
Low back pain (LBP) is a prevalent condition imposing a large socioeconomic burden. Despite intensive research aimed at the efficacy of various therapies for patients with LBP, most evidence has failed to identify a superior treatment approach. One proposed solution to this dilemma is to identify subgroups of patients with LBP and match them with targeted therapies. Among the subgrouping approaches, the system of treatment-based classification (TBC) is promoted as a means of increasing the effectiveness of conservative interventions for patients with LBP.
Evidence acquisition:
MEDLINE and PubMed databases were searched from 1985 through 2010, along with the references of selected articles.
TBC uses a standardized approach to categorize patients into 1 of 4 subgroups: spinal manipulation, stabilization exercise, end-range loading exercise, and traction. Although the TBC subgroups are in various stages of development, recent research lends support to the effectiveness of this approach.
While additional research is required to better elucidate this method, the TBC approach enhances clinical decision making, as evidenced by the improved clinical outcomes experienced by patients with LBP.
PMCID: PMC3445227  PMID: 23016055
low back pain; classification; decision making; exercise; manual therapy
10.  The validity of a portable clinical force plate in assessment of static postural control: concurrent validity study 
The broad use of force plates in clinical settings for postural control assessment suggests the need for instruments that are easy to use, affordable and readily available. In addition, these instruments of measurement should be reliable and valid as adequate reliability and validity are prerequisites to making correct inferences. The aim of this study was to examine the concurrent validity of postural control measures obtained with a clinical force plate.
Thirty-one healthy adults were recruited. Participants completed 1 set of 5 trials on each force plate. Postural control measures (centre of pressure [COP] average velocity and sway area) were collected and compared using the Midot Posture Scale Analyzer (clinical force plate) and the Accugait force plate (criterion measure). Intra class correlation coefficient (ICC), standard error of measurement , and paired t-tests were calculated and Bland-Altman plots were constructed to compare the force plates and assess consistency of measurement and agreement between them.
The ICC values (ICC = 0.14-0.60) between the two force plates were lower than the acceptable value for both COP average velocity and sway area. There was significant difference (p > 0.05) in COP average velocity and sway area between the force plates. Examination of the plots revealed that there is less difference between the force plates in lower magnitudes of COP for average velocity and sway area however, the greater the average velocity and sway area, the greater the difference between the measures obtained from the two force plates.
Findings of this study showed poor concurrent validity of the clinical force plate. This clinical force plate cannot be a replacement for known reliable and valid force plates and consequently measures obtained from this force plate should be treated with caution especially in a clinical population.
PMCID: PMC3502125  PMID: 22620857
Concurrent validity; Force plate; Postural control
11.  The reliability of a portable clinical force plate used for the assessment of static postural control: repeated measures reliability study 
Force plates are frequently used for postural control assessments but they are expensive and not widely available in most clinical settings. Increasingly, clinicians are using this technology to assess patients, however, the psychometric properties of these less sophisticated force plates is frequently unknown. The purposes of the study were to examine the test-retest reliability of a force plate commonly used by clinicians and to explore the effect of using the mean value from multiple repetitions on reliability.
Thirty healthy volunteer adults were recruited. Postural control measures were obtained using the Midot Posture Scale Analyzer (MPSA). Data were collected in 2 sessions. Five successive repetitions each of 60 seconds duration were obtained from each participant in each session.
The reliability coefficients obtained using single measures were low (ICC3,1 = 0.06 to 0.53). The average of two measures allowed for reliable measurements of COP mean velocity and average location of COP. The average of three and five measures was required to obtain acceptable reliability (ICC ≥ 0.70) of relative weight bearing on legs and sway area, respectively. Higher measurement precision values were seen by averaging four or five repetitions for all variables.
Single measures did not provide reliable estimates of postural sway, and the averaging of multiple repetitions was necessary to achieve acceptable levels of measurement error. The number of repetitions required to achieve reliable data ranged from 2 to 5. Clinicians should be wary of using single measures derived from similar equipment when making decisions about patients.
PMCID: PMC3502132  PMID: 22620678
Reproducibility; Posture; Stability; Balance; Force plate
12.  Management of people with acute low-back pain: a survey of Australian chiropractors 
Chiropractors commonly provide care to people with acute low-back pain (LBP). The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active.
This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s) they would order, and which intervention(s) they would recommend or undertake.
Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%). Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI): 64%, 71%) of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56%) indicated they would give advice to stay active when it was indicated. For the vignette where a fracture was suspected, 95% (95% CI: 91%, 97%) of chiropractors would order an x-ray.
The intention of chiropractors surveyed in this study shows low adherence to two recommendations from an evidence-based guideline for acute LBP. Quality of care for these patients could be improved through effective implementation of evidence-based guidelines. Further research to find cost-effective methods to increase implementation is warranted.
PMCID: PMC3265419  PMID: 22171632
13.  Outcomes of usual chiropractic, harm & efficacy, the ouch study: study protocol for a randomized controlled trial 
Trials  2011;12:235.
Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention.
One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation.
Trial registration
Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000542998
PMCID: PMC3224760  PMID: 22040597
14.  Delineating inflammatory and mechanical sub-types of low back pain: a pilot survey of fifty low back pain patients in a chiropractic setting 
An instrument known as the Mechanical and Inflammatory Low Back Pain (MAIL) Scale was drafted using the results of a previous expert opinion study. A pilot survey was conducted to test the feasibility of a larger study designed to determine the MAIL Scale's ability to distinguish two potential subgroups of low back pain: inflammatory and mechanical.
Patients with a primary complaint of low back pain (LBP) presenting to chiropractic clinics in Perth, Western Australia were asked to fill out the MAIL Scale questionnaire. The instrument's ability to separate patients into inflammatory and mechanical subgroups of LBP was examined using the mean score of each notional subgroup as an arbitrary cut-off point.
Data were collected from 50 patients. The MAIL Scale did not appear to separate cases of LBP into the two notionally distinct groups of inflammatory (n = 6) or mechanical (n = 5). A larger "mixed symptom" group (n = 39) was revealed.
In this pilot study the MAIL Scale was unable to clearly discriminate between what is thought to be mechanical and inflammatory LBP in 50 cases seen in a chiropractic setting. However, the small sample size means any conclusions must be viewed with caution. Further research within a larger study population may be warranted and feasible.
PMCID: PMC3048575  PMID: 21299867
15.  The journal 'chiropractic & osteopathy' changes its title to 'chiropractic & manual therapies'. a new name, a new era 
Chiropractic & Osteopathy changes its title to Chiropractic & Manual Therapies in January 2011. This change reflects the expanding base of submissions from clinical scientists interested in the discipline of manual therapy. It is also in accord with the findings of a review of the journal content and a joint venture between the original parent organisation the Chiropractic and Osteopathic College of Australasia and a new partner the European Academy of Chiropractic, which is a subsidiary body of the European Chiropractors' Union. The title change should encourage submissions from all professionals interested in manual therapy including chiropractors, osteopaths, physiotherapists, medical doctors and scientists interested in this field.
PMCID: PMC3039828  PMID: 21247414
16.  Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol 
Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care. A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines. Further, the review recommended the use of theory in the development of implementation interventions. A clinical practice guideline for the management of acute low-back pain has been developed in Australia (2003). Acute low-back pain is a common condition, has a high burden, and there is some indication of an evidence-practice gap in the allied health setting. This provides an opportunity to develop and test a theory-based implementation intervention which, if effective, may provide benefits for patients with this condition.
This study aims to estimate the effectiveness of a theory-based intervention to increase allied health practitioners' (physiotherapists and chiropractors in Victoria, Australia) compliance with a clinical practice guideline for acute non-specific low back pain (LBP), compared with providing practitioners with a printed copy of the guideline. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray, and improving mean level of disability for patients three months post-onset of acute LBP.
The design of the study is a cluster randomised trial. Restricted randomisation was used to randomise 210 practices (clusters) to an intervention or control group. Practitioners in the control group received a printed copy of the guideline. Practitioners in the intervention group received a theory-based intervention developed to address prospectively identified barriers to practitioner compliance with the guideline. The intervention primarily consisted of an educational symposium. Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period, three months post the intervention symposia, are eligible for inclusion. Sample size calculations are based on recruiting between 15 to 40 patients per practice. Outcome assessors will be blinded to group allocation.
Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12609001022257 (date registered 25th November 2009)
PMCID: PMC2994785  PMID: 21067614
17.  Chiropractic care for children: too much, too little or not enough? 
This editorial provides an overview of this Thematic Series of the journal titled Chiropractic Care for Children. In commissioning this series of articles we aimed to bring the busy clinician up to date with the current best evidence in key aspects of evaluation and management of chiropractic care for children. Individual articles address a chiropractic approach to the management of children, chiropractic care of musculoskeletal conditions in children and adolescents, chiropractic care of non-musculoskeletal conditions in children and adolescents, chiropractic care for attention-deficit/hyperactivity disorder and possible adverse effects from chiropractic management of children. The final article by Charlotte Leboeuf-Yde and Lise Hestbæk is an overview of the current state of the evidence and future research opportunities for chiropractic care for children. We conclude this editorial discussing the strengths and weaknesses of contemporary research relevant to chiropractic care of children and the implications for chiropractic practice.
PMCID: PMC2890688  PMID: 20525201
18.  Low back pain risk factors in a large rural Australian Aboriginal community. An opportunity for managing co-morbidities? 
Low back pain (LBP) is the most prevalent musculo-skeletal condition in rural and remote Australian Aboriginal communities. Smoking, physical inactivity and obesity are also prevalent amongst Indigenous people contributing to lifestyle diseases and concurrently to the high burden of low back pain.
This paper aims to examine the association between LBP and modifiable risk factors in a large rural Indigenous community as a basis for informing a musculo-skeletal and related health promotion program.
A community Advisory Group (CAG) comprising Elders, Aboriginal Health Workers, academics, nurses, a general practitioner and chiropractors assisted in the development of measures to assess self-reported musculo-skeletal conditions including LBP risk factors. The Kempsey survey included a community-based survey administered by Aboriginal Health Workers followed by a clinical assessment conducted by chiropractors.
Age and gender characteristics of this Indigenous sample (n = 189) were comparable to those reported in previous Australian Bureau of Statistics (ABS) studies of the broader Indigenous population. A history of traumatic events was highly prevalent in the community, as were occupational risk factors. Thirty-four percent of participants reported a previous history of LBP. Sporting injuries were associated with multiple musculo-skeletal conditions, including LBP. Those reporting high levels of pain were often overweight or obese and obesity was associated with self-reported low back strain. Common barriers to medical management of LBP included an attitude of being able to cope with pain, poor health, and the lack of affordable and appropriate health care services.
Though many of the modifiable risk factors known to be associated with LBP were highly prevalent in this study, none of these were statistically associated with LBP.
Addressing particular modifiable risk factors associated with LBP such as smoking, physical inactivity and obesity may also present a wider opportunity to prevent and manage the high burden of illness imposed by co-morbidities such as heart disease and type-2 diabetes.
PMCID: PMC1277832  PMID: 16197555
Low back pain; risk factors; chiropractic; general health; Australian; Aboriginal; Indigenous
19.  The establishment of the Chiropractic & Osteopathic College of Australasia in Queensland (1996–2002) 
For chiropractors and osteopaths after graduation, the learning process continues by way of experience and continuing education (CE). The provision of CE and other vocational services in Queensland between 1996 and 2002 is the subject of this paper.
The Chiropractic & Osteopathic College of Australasia (COCA) implemented a plan, which involved continuing education, with speakers from a broad variety of health provider areas; and the introduction of the concepts of evidence-based practice. The plan also involved building membership.
Membership of COCA in Queensland grew from 3 in June 1996 to 167 in 2002. There were a total of 25 COCA symposia in the same period. Evidence-based health care was introduced and attendees were generally satisfied with the conferences.
The development of a vocational body (COCA) for chiropractors and osteopaths in Queensland was achieved. Registrants in the field have supported an organisation that concentrates on the vocational aspects of their practice.
PMCID: PMC1151651  PMID: 15967046
Chiropractic; osteopathy; continuing education; vocational education; evidence-based practice; Queensland
20.  Editorial Note 
Australasian Chirpractic & Osteopathy has re-ordered its Volume and Issue numbers. It has skipped from Volume 11, Issue number 2, July 2003, to Volume 12, Issue 1, July 2004. This re-ordering was necessary after an unusual and unexpected set of editorial delays. ACO apologises for this change but advises subscribers that there will be no loss in the number of issues they receive.
PMCID: PMC2051315
21.  Risk Management for Chiropractors and Osteopaths. Informed consent 
Obtaining the informed consent of a patient before undertaking chiropractic or osteopathic treatment is a common law requirement in Australia. This paper outlines the essential elements of informed consent and provides some practice tips on streamlining the process.
PMCID: PMC2051308  PMID: 17987206
Chiropractic; osteopathy; informed consent; risk management
This article is the second in a series of articles dealing with risk management in the practise of chiropractic and osteopathy, prepared by the COCA Risk Management Subcommittee.
Background: Radiographic examination carries risks that must be weighed against the possible benefits when determining patient care.
Objective: The objective of this article is to propose guidelines for the use of imaging in chiropractic and osteopathic practice.
Discussion: Plain film radiography, CT scan, magnetic resonance imaging (MRI) and other forms of imaging are available for use in chiropractic and osteopathic practice in Australia. The astute practitioner utilises these imaging procedures for clinical decision making in order to make an accurate diagnosis that will determine a patient’s management. This article attempts to guide the practitioner in the proper use of these imaging procedures for different regions of the body.
PMCID: PMC2051318  PMID: 17987210
Chiropractic; risk management; osteopathy
Although rare, vertebrobasilar stroke is the best known of the possible side effects of cervical manipulation. Due to the serious sequelae that may result from cervical manipulation, chiropractors and osteopaths must take the appropriate steps to ensure the risk is minimised. This article outlines how the astute practitioner can minimise this risk. Practitioners must decide on the options for treatment of a patient with neck problems. Practitioners must also advise the patient of these options as part of an appropriate informed consent.
PMCID: PMC2051301  PMID: 17987199
Chiropractic; stroke; manipulation
The objective of this research was to identify the most common combination of methods used by chiropractors in Victoria to identify manipulable lesions or subluxations. A postal survey of chiropractors in Victoria achieved an 85% response rate and revealed that eight methods are commonly used in combination to detect subluxation. They are: visual posture analysis, pain description of the patient, plain static erect x-rays, leg length discrepancy, neurological tests, motion palpation, static palpation, orthopaedic tests. These methods have also been found to be used commonly and regarded as reliable.
PMCID: PMC2050806  PMID: 17987160
Subluxation; manipulable lesion; spine; chiropractic; diagnosis
A discussion is presented outlining the necessary elements required of chiropractors to work successfully in hospitals.
PMCID: PMC2050637  PMID: 17989759
Chiropractic; hosiptal; employment

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