Relevant bibliographies by topics / Chiropractic

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  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Chiropractic'

Author: Grafiati
Published: 4 June 2021
Last updated: 28 July 2024

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Journal articles on the topic "Chiropractic"

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De la Ruelle, Lobke P., Annemarie de Zoete, Cornelius Myburgh, Hella E. Brandt, and Sidney M. Rubinstein. "The perceived barriers and facilitators for chiropractic care in older adults with low back pain; insights from a qualitative exploration in a dutch context." PLOS ONE 18, no. 4 (April 12, 2023): e0283661. http://dx.doi.org/10.1371/journal.pone.0283661.

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Background Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process. Methods Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim. Results We interviewed 11 older adults with low back pain. During this process four themes emerged that captured their perception and experiences in either seeking or dismissing chiropractic care for their LBP; these being ‘generic’, ‘financial’, ‘expectation’, and ‘the image of the chiropractor’. The focus group members largely confirmed the identified themes, highlighting a lack of awarenes and accessibility as key barriers to care. On the other hand, whe chiropractior as an alternative care provider, with a focus on manual interventions, was seen as a facilitator. Conclusions The lack of knowledge about chiropractic care was found to be the most important barrier to seeking care. The most important facilitator was insufficient resolution of their symptoms following previous care, making patients look further for a solution for their problem. These barriers and facilitators seem not to differ greatly from barriers and facilitators found among younger patients with neck pain. Age and health condition may therefore be weak determinants of care. This new information may help us optimize accessibility for older adults to the chiropractor.
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Fjaagesund, Shauna Dawn, Wayne Graham, Evan Jones, Andrew Ladhams, Mark Sayers, Gary Campbell, Xiang-Yu Hou, Marius-Ionut Ungureanu, and Florin Oprescu. "Chiropractors in Multidisciplinary Teams: Enablers of Colocation Integration in GP-Led Primary Healthcare." Healthcare 12, no. 9 (April 30, 2024): 926. http://dx.doi.org/10.3390/healthcare12090926.

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The aim of this study was to explore and document the enablers and barriers of chiropractic care colocation in general practice at a large-scale private primary care centre in Australia. This study focused on the perceptions of healthcare professionals regarding this integration. The research setting was a large integrated primary care centre located in an outer metro, low-socioeconomic area in the City of Moreton Bay, Queensland, Australia. Participant inclusion criteria included general medical practitioners, practice nurses, and medical managers who self-reported interactions with the physically collocated and integrated chiropractic practice. Data was collected from 22 participants using face-to-face, qualitative, semi-structured interviews with an average duration of 32 min. The data collected included perceptions of chiropractic treatment, enablers to patient referral pathways, and views of the integrated chiropractic care model. A reflexive thematic analysis was conducted on the data set. All participants reported that this was their first exposure to the colocation of a chiropractor within a general medical practice. Four key enablers of chiropractic care integration were identified: (1) the practitioner [chiropractor], (2) the organisation [general practice], (3) consumer flow, and (4) the environment [shared spaces and tenant ecosystem]. The chiropractic integration enhanced knowledge sharing and interprofessional trust among healthcare providers. The formal reporting of patient outcomes and understanding of the chiropractor’s scope of practice further enabled referrals to the service. Shared administrative and business processes, including patient records, booking systems, and clinical meetings, facilitated relationship development between the chiropractor and referring health providers. Colocation as part of a larger primary care centre created proximity and convenience for health providers in terms of interprofessional communication, and for patients, in terms of access to chiropractic services. Existing governance structures supported communication, professional education, and shared values related to the delivery of patient-centred care. Identified barriers included limited public funding for chiropractic services resulting in reduced access for patients of low-socioeconomic status. Additionally, scepticism or negativity towards the discipline of chiropractic care was identified as an initial barrier to refer patients. In most cases, this view towards the chiropractor was overcome by regular patient reporting of positive treatment outcomes to their GP, the delivery of education sessions by the chiropractor for the health providers, and the development of interprofessional trust between the chiropractor and referring health providers. This study provides preliminary evidence and a conceptual framework of factors influencing the successful integration of chiropractic care within an Australian large primary care centre. The data collected indicated that integration of chiropractic care into a primary care centre serving a low-socioeconomic region can be achieved with a high degree of health provider satisfaction.
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Yalden, Philip, Christina Cunliffe, and Adrian Hunnisett. "An investigation into the demographics and motivations of students studying for a chiropractic degree." Journal of Chiropractic Education 27, no. 2 (September 1, 2013): 128–34. http://dx.doi.org/10.7899/jce-13-8.

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Objective This research aimed to investigate motivations for studying chiropractic, and to determine what students look for in a course/college and potential barriers to studying chiropractic. Methods The study design was a cross-sectional survey. Following IRB/Ethical approval, a paper-based questionnaire was distributed to students at McTimoney College of Chiropractic. Demographic data were compared to another chiropractic college in the United Kingdom. Results The questionnaire response rate was 70.8% (n = 121). Motivating factors for studying chiropractic included a desire to help others (54.5%, n = 66), with 44.6% (n = 54) attracted by chiropractic's holistic, drugless approach to health. Previous help from chiropractic influenced 55.4% (n = 67) and 22.3% (n = 27) felt chiropractic had “changed their life.” Just over half of the respondents (55.4%, n = 67) viewed the ability to work while studying as extremely important and 73.6% (n = 89) said they could not have studied chiropractic without this. Conclusion Previous help from chiropractic care was a common motivation for studying chiropractic. The ability to work while studying was seen as vital by many students and, without it, the vast majority felt they could not have studied chiropractic.
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Bernstein, Carolyn, Peter M. Wayne, Pamela M. Rist, Kamila Osypiuk, Audrey Hernandez, and Matthew Kowalski. "Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series." Global Advances in Health and Medicine 8 (January 2019): 216495611983577. http://dx.doi.org/10.1177/2164956119835778.

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This case series illustrates an integrated model of care for migraine that combines standard neurological care with chiropractic treatment. For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face “hallway” interaction, medical notes, team meetings, and clinical outcomes. Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. Suggestions for future areas of research evaluating integrative approaches are discussed.
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Whedon, James M., Andrew W. J. Toler, Louis A. Kazal, Serena Bezdjian, Justin M. Goehl, and Jay Greenstein. "Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain." Pain Medicine 21, no. 12 (March 6, 2020): 3567–73. http://dx.doi.org/10.1093/pm/pnaa014.

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Abstract Objective Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Design and Setting We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017. Subjects We included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care. Methods We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients). Results The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11–2.17, P = 0.010; in New Hampshire: HR = 2.03, 95% CI = 1.92–2.14, P < 0.0001). Similar differences were observed for the acute groups. Conclusions Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.
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Ebrall, Phillip, Barry Draper, and Adrian Repka. "Towards a 21st Century Paradigm of Chiropractic: Stage 1, Redesigning Clinical Learning." Journal of Chiropractic Education 22, no. 2 (September 1, 2008): 152–60. http://dx.doi.org/10.7899/1042-5055-22.2.152.

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Objective: To describe a formal process designed to determine the nature and extent of change that may enhance the depth of student learning in the pre-professional, clinical chiropractic environment. Methods: Project teams in the Royal Melbourne Institute of Technology (RMIT) School of Health Sciences and the Division of Chiropractic explored questions of clinical assessment in several health care disciplines of the School and the issue of implementing change in a manner that would be embraced by the clinicians who supervise student-learning in the clinical environment. The teams applied to RMIT for grant funding within the Learning and Teaching Investment Fund to support two proposed studies. Results: Both research proposals were fully funded and are in process. Discussion: The genesis of this work is the discovery that the predominant management plan in the chiropractic teaching clinics is based on diagnostic reductionism. It is felt this is counter-productive to the holistic dimensions of chiropractic practice taught in the classroom and non-supportive of chiropractic's paradigm shift towards wellness. A need is seen to improve processes around student assessment in the contemporary work-integrated learning that is a prime element of learning within the clinical disciplines of the School of Health Sciences, including chiropractic. Conclusion: Any improvements in the manner of clinical assessment within the chiropractic discipline will need to be accompanied by improvement in the training and development of the clinicians responsible for managing the provision of quality patient care by Registered Chiropractic Students.
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Skappak, Christopher, and Erik J. Saude. "Back pain in the emergency department: Pathological fracture following spinal manipulation." CJEM 20, no. 2 (April 17, 2017): 307–12. http://dx.doi.org/10.1017/cem.2017.19.

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AbstractBack pain is one of the most common presentations to the emergency department. Though case reports of patients presenting with increased back pain following chiropractic spinal manipulations are rare, we have identified a case rarely reported in the literature where a potential injury from chiropractic manipulation resulted in a diagnosis of multiple myeloma. We have reported a previously healthy 66-year-old male who presented with persistent lower back pain over 4 weeks. An initial evaluation with thoracolumbar radiographs revealed no significant findings. Following initial presentation to the family physician, the patient underwent three treatments of spinal manipulation from his local chiropractor, which resulted in worsening lower back pain. A re-examination and new radiographs in the hospital revealed multiple compression fractures and an underlying diagnosis of multiple myeloma. We have explored current literature examining the prevalence of lower back pain, as well as the incidence of spinal fracture following chiropractic manipulation, and have highlighted a potential complication from chiropractic manipulation in a patient with an undiagnosed underlying neoplastic disorder.
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Mior, Silvano, Jessica Wong, Deborah Sutton, Peter J. H. Beliveau, André Bussières, Sheilah Hogg-Johnson, and Simon French. "Understanding patient profiles and characteristics of current chiropractic practice: a cross-sectional Ontario Chiropractic Observation and Analysis STudy (O-COAST)." BMJ Open 9, no. 8 (August 2019): e029851. http://dx.doi.org/10.1136/bmjopen-2019-029851.

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ObjectivesThere is no current detailed profile of people seeking chiropractic care in Canada. We describe the profiles of chiropractors’ practice and the reasons, nature of the care provided to their patients and extent of interprofessional collaborations in Ontario, Canada.DesignCross-sectional observational study.SettingPrimary care setting in Ontario, Canada.ParticipantsWe randomly recruited chiropractors from a list of registered chiropractors (n=3978) in active practice in 2015. Of the 135 randomly selected chiropractors, 120 were eligible, 43 participated and 42 completed the study.Outcome measuresEach chiropractor recorded information for up to 100 consecutive patient encounters, documenting patient health profiles, reasons for encounter, diagnoses and care provided. Descriptive statistics summarised chiropractor, patient and encounter characteristics, with analyses accounting for clustering and design effects.ResultsChiropractors provided data on 3523 chiropractor-patient encounters. More than 65% of participating chiropractors were male, mean age 44 years and had practised on average 15 years. The typical patient was female (59% of encounters), between 45 and 64 years (43%) and retired (21%) or employed in business and administration (13%). Most (39.4%) referrals were from other patients, with 6.8% from physicians. Approximately 68% of patients paid out of pocket or claimed extended health insurance for care. Most common diagnoses were back (49%, 95% CI 44 to 56) and neck (15%, 95% CI 13 to 18) problems, with few encounters related to maintenance/preventive care (0.86%, 95% CI 0.2 to 3.9) and non-musculoskeletal problems (1.3%, 95% CI 0.7 to 2.3). The most common treatments included spinal manipulation (72%), soft tissue therapy (70%) and mobilisation (35%).ConclusionsThis is the most comprehensive profile to date of chiropractic practice in Canada. People who present to Ontario chiropractors are mostly adults with a musculoskeletal condition. Our results can be used by stakeholders to make informed decisions about workforce development, education and healthcare policy related to chiropractic care.
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Hunnisett, Adrian G. W., and Christina Cunliffe. "A comparison of the academic outcome of chiropractic students on full-time and full-time equivalent chiropractic education routes." Journal of Chiropractic Education 34, no. 2 (August 8, 2019): 140–46. http://dx.doi.org/10.7899/jce-18-4.

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Objective To compare the academic equivalence of full-time (FT) and full-time equivalent (FTE) delivery routes for chiropractic training and to assess nontraditional education delivery as a viable method for training chiropractors. Methods A retrospective analysis of student summative assessment data was undertaken on a total of 196 FT and FTE students studying for the master's in chiropractic degree at a UK chiropractic college between 2009 and graduating by 2017. The analysis consisted of within-group comparison and between-group comparisons using the Kruskal-Wallis test and the Mann-Whitney U test. Results The demographics of the 2 student groups varied in terms of gender and age distribution. The analysis of summative data indicated no differences between the 2 routes of delivery. There was also no difference in the distribution of final degree classification outcome between the 2 routes. Conclusions While it is possible that demographic differences influence the outcomes in each training route, this preliminary study indicates that, based only on analysis of overall achievement, there is no difference in either FT or FTE programs in training chiropractors, allowing them to register with the UK regulatory body. It suggests that a nontraditional mode of delivery is an achievable route to qualification as a chiropractor, enabling a greater number of students to consider chiropractic as a career choice while managing other life commitments.
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de Luca, Katie E., Jordan A. Gliedt, Matthew Fernandez, Greg Kawchuk, and Michael S. Swain. "The identity, role, setting, and future of chiropractic practice: a survey of Australian and New Zealand chiropractic students." Journal of Chiropractic Education 32, no. 2 (March 6, 2018): 115–25. http://dx.doi.org/10.7899/jce-17-24.

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Objective: To evaluate Australian and New Zealand chiropractic students' opinions regarding the identity, role setting, and future of chiropractic practice. Methods: An online, cross-sectional survey was administered to chiropractic students in all chiropractic programs in Australia and New Zealand. The survey explored student viewpoints about the identity, role/scope, setting, and future of chiropractic practice as it relates to chiropractic education and health promotion. Associations between the number of years in the program, highest degree preceding chiropractic education, institution, and opinion summary scores were evaluated by multivariate analysis of variance tests. Results: A total of 347 chiropractic students participated in the study. For identity, most students (51.3%) hold strongly to the traditional chiropractic theory but also agree (94.5%) it is important that chiropractors are educated in evidence-based practice. The main predictor of student viewpoints was a student's chiropractic institution (Pillai's trace =.638, F[16, 1368] = 16.237, p < .001). Chiropractic institution explained over 50% of the variance around student opinions about role/scope of practice and approximately 25% for identity and future practice. Conclusions: Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.
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Dissertations / Theses on the topic "Chiropractic"

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Mortenson, Michelle D. "Identifying predictors of chiropractic outcomes." Online version, 2002. http://www.uwstout.edu/lib/thesis/2002/2002mortensonm.pdf.

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Distler, Michael. "Chiropractic use, patient income, and frequency of visits." Diss., Connect to the thesis, 2008. http://hdl.handle.net/10066/1446.

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Eni, Godwin Onuoha. "Chiropractic medical system : the making of a clientelle." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/27298.

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Most sociological explanations for the success of chiropractic in attracting and maintaining its clientele have failed to consider the clinical context and the nature of the interaction between chiropractors and clients. Rather, most studies have focussed on leadership qualities, the professionalization process, and the ancillary role of chiropractic in health care to account for its success with clients. This study argues that chiropractic in British Columbia is successful in making its clientele because: (1) it is able to persuade new clients toward chiropractic health care by using strategies that are designed to minimize the political, social and economic constraints upon it; (2) chiropractors are able to negotiate successfully, the differences in the health and illness beliefs [HMs] that are held by new clients and chiropractors as well as differences in explanations [EMs] for "present" health problems; and (c) chiropractors are able to provide potential patients with "positive" experiences in chiropractic clinics, which are different, in some respects, from experiences they have had elsewhere, for example, in their relationships with allopathic medicine. This study, therefore, describes how new clients are socialized in chiropractic clinical relationships and subsequently become chiropractic patients. 20 randomly selected chiropractors and a total of 60 new clients were interviewed for their impressions of chiropractic as well as their health beliefs and explanations for "present" health problems prior to encountering each other in the clinical setting. Their interactions were observed in the twenty clinical settings, with special focus on the negotiation of explanatory models. The patients were interviewed again, regarding their experiences and impressions, following their fourth visit to the clinic after their initial encounter. 20 "regular" or long-term chiropractic patients, one from each clinic, were also interviewed regarding their experiences. Data were analyzed by comparing pre- and post-interview results and by describing the nature of clinical interactions, relationships, and negotiation of explanatory models in the context of Kleinman's ethno-medical perspective and Goffman's social ethnographic perspective on interactions in everyday life. It was found that chiropractors (1) provide potential patients with "adequate" information and the opportunity to ask questions; (2) express non-judgemental views on the health problems of clients, which provides new clients with the opportunity to fully explain their health concerns; (3) utilize persuasive interaction structures and processes to minimize both the constraints upon chiropractic and the effects of deviancy and marginality labels, and to manage the impressions of potential patients; and (4) negotiate with potential patients over explanations for the causes of their health problems, which enables the delivery of chiropractic treatment by integrating, "shifting" and modifying clients' explanatory models and, to some extent, their own. These techniques for 'making' the chiropractic clientele appear to be successful. In this study, 53 of the 60 new clients were retained beyond the fifth visit. More generally, chiropractic is now the second largest primary health care provider group in B.C., next to allopathy, and is attracting an increasing number of patients.
Arts, Faculty of
Anthropology, Department of
Graduate
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Folk, Holly. "Vertebral vitalism American metaphysics and the birth of chiropractic /." [Bloomington, Ind.] : Indiana University, 2006. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3223040.

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Thesis (Ph.D.)--Indiana University, Dept. of Religious Studies, 2006.
"Title from dissertation home page (viewed June 26, 2007)." Source: Dissertation Abstracts International, Volume: 67-06, Section: A, page: 2291. Adviser: Stephen J. Stein.
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Field, Jonathan Roger. "Collecting and predicting patient reported outcomes in chiropractic practice." Thesis, University of Portsmouth, 2016. https://researchportal.port.ac.uk/portal/en/theses/collecting-and-predicting-patient-reported-outcomes-in-chiropractic-practice(29fdc29d-f462-4dd7-a3ac-a65876736cdb).html.

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The eight refereed publications and four abstracts of presentations which form the basis of this PhD each deal with patient health outcomes. The publications are drawn predominantly from practice based research in chiropractic services. In a systematic review of the impact of Patient Reported Outcome Measures (PROMs) on the process and outcomes of care for a single patient, Paper 1 describes this occurring across four domains; patient assessment and initial clinical decision making, tracking progress and evaluating current treatment efficacy, influencing the patient / clinician relationship and there is weak evidence to suggest they directly influence patient outcomes. Paper two is a descriptive review of the utility of PROMs to include their ability to improve communication and shared decision making in the patient / clinician relationship. Care Response is a novel, free to use multilingual electronic PROM system developed by the author. It has had significant impact in the chiropractic profession in Europe and Canada and has contributed data to 11 peer reviewed papers and four post graduate degrees (Abstract 1) Electronic PROM systems suffer from lower response rates than paper based systems. Abstract 2 reports a study looking at the impact of this missing information on the generalisability of the overall data collected. Non respondents to an emailed assessment 30 days after starting care were less likely to have had >30 days pain in the last year but were not otherwise significantly different from those returning electronic assessments. In a telephone survey comparing respondents and non respondents, patients global impression of change (PGIC) scores were identical and there was no statistical difference in pain scores. Paper 3 sought to ascertain if patient less likely to do well with chiropractic care could be identified from data routinely collected at baseline in chiropractic practice. Longer duration of symptoms at presentation, females with higher social disability scores and males with more adverse scores for depression were found less likely to describe themselves as much improved a month after starting care. In investigating for a relationship between outcome and components of the fear-avoidance model for chronicity in lower back pain, paper 4 found only a week relationship with catastrophisation at baseline however patient’s scores of catastrophisation, fear avoidance beliefs and low self efficacy just before their second visit were significantly associated with a poorer outcome. Paper 5 looking into a relationship between the risk category patients were placed into by the STarT Back Tool reported that whilst HIGH risk patients has more adverse scores for pain at presentation this rapidly faded and at 30 and 90 days there was no significant difference between the risk groups and patients reports of their recovery (PGIC) . Comparing the health outcomes of 8222 patients accessing chiropractic services either via the NHS or privately Paper 6 described those accessing a NHS route to have had symptoms for longer and more adverse scores across a range of health domains at presentation and to be less well 30 & 90 days later. However both NHS and private patient groups improved well and differences between the two disappeared when controlling for differences at baseline. Paper 7 sought to explore the ability of chiropractic clinicians working from 5 linked practices to identify those patients less likely to do well with care at the time of their initial assessment. It concluded that they generally failed to reliably predict outcomes with most practitioners doing no better than chance. The STarT Back Tool is increasingly being recommended to guide decisions as to care pathway for patients with spinal pain. Paper 8 looked to see if the timing of when this assessment was made had any impact on its ability to detect groups of patients responding differently when undergoing a course of chiropractic care. In the assessed population (n=749) attending 1 of 11 clinics in the UK there was a significant difference with ranking at the time of presentation being unrelated to outcome. When repeated a few days post initial visit over one third of patients had changed risk group with this subsequent group being found to be an independent predictor of improvement in multivariate analysis.
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Wilson, Francis James. "The origins and professional development of chiropractic in Britain." Thesis, University of Southampton, 2012. https://eprints.soton.ac.uk/341659/.

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In June 2001 the title ‘chiropractor’ came to be protected under British law and those who called themselves chiropractors attained a position of increased legitimacy within British society. Yet the details of chiropractic’s journey to statutory recognition have not been thoroughly explored in contemporary literature. The origins and development of chiropractic in Britain have received meagre attention from historical scholars. This thesis uses a neo-Weberian approach to explore the history of chiropractic in Britain through the lens of ‘professionalisation’. It investigates the emergence of chiropractic in Britain, and details how and why chiropractic developed in the way that it did, assessing the significance of processes and events in respect to chiropractic’s professionalisation, and examining intra- and inter-occupational tensions. The thesis is primarily a product of documentary research, but is also informed by interviews undertaken to provide oral testimonies. Although the origins of chiropractic are usually traced back to the 1890s, to Davenport, Iowa, and to the practice of Daniel David Palmer, it is argued in this thesis that it is misleading to claim that chiropractic was ‘discovered’ by Daniel Palmer, or that chiropractic in Britain was entirely an ‘import’ from the United States. Instead, chiropractic’s origins were complex and multifarious and form part of a broader history of manipulative practices. With regard to the development of chiropractic in Britain, chiropractic’s history is intertwined with that of osteopathy, and has involved medicalisation. This study demonstrates that through the course of its evolution chiropractic was subject to processes that can usefully be described in terms of professionalisation, sharing features in common with the professionalisation of other occupational groups described in historical and sociological literature. Even so, chiropractors did not attain the social presence or cultural authority of archetypal professionals such as medical doctors or lawyers. Although protection of title was achieved, many problems have remained, including divisions within the occupation.
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Bezuidenhout, Lauren Leigh. "Practice characteristics of chiropractic delegates attending the World Federation of Chiropractic's 12th Biennial Congress, 2013." Thesis, 2016. http://hdl.handle.net/10321/1776.

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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 Chiropractic is practiced in over 100 countries and is considered to be the fastest growing health care profession internationally. Several studies investigating the practice characteristics of chiropractors have been conducted in selected countries, however, as far as is known, no study has been conducted where chiropractors from countries across the globe are assessed for their practice characteristics in order to determine if regional differences exist. Gaining insight into chiropractic practice and its influencing factors, relating to both the profession itself and the chiropractor can enable organisations such as the World Federation of Chiropractic to have a greater understanding of how chiropractors are currently practicing and how the profession is being utilised by the public. Improved insight into the profession provides a baseline description for the public and other health care practitioners to fully comprehend what chiropractors can offer to the health care system. Aim: The aim of this study was to determine the demographic profile and practice characteristics of chiropractic delegates attending the World Federation of Chiropractic’s 12th Biennial Congress 2013. Method A pre-validated questionnaire and letter of information and consent was distributed to all registered chiropractic delegates (N = 406) attending the World Federation of Chiropractic Congress in Durban, Kwa-Zulu Natal 2013. The questionnaire was part of the delegate packages and they self-selected to participate. Due to a low response rate at the congress, the questionnaire was made available electronically on Survey Monkey®, for six weeks after the congress. Questions relevant to this study were coded, reduced where necessary and utilised for data analysis with IBM SPSS Version 21. Descriptive data was then summarised and presented using tables and graphs. The study was approved by the Durban University of Technology’s Institutional Research Ethics committee. Results: The response rate was 34.72%, with 52.5% being female, mean age was 42 (SD ± 13years, and all seven geographical regions were represented. The majority of respondents were from Africa (51.1%), followed by North America (22.7%) then Europe (14.2%). South Africa (48.6%) was the most represented country. Respondents held either a Master’s degree in Chiropractic (51.8%) or a Doctor of Chiropractic (DC) degree (48.2%). The mean years since graduating as a chiropractor was 15.7 years (SD ± 3.6). The majority of respondents (71.2%) engaged in full-time clinical practice, for between 5 to 15 years (39.8%) with 51.4% purporting to have an evidence based philosophical approach to practice. The majority (72.5%) viewed the role of a chiropractor in the health care system as a primary health care practitioner with a focused scope of practice. The majority of respondents (n = 52) personally treated 50 patients or less per week, with approximately one third of the respondents (n = 34) having high volume practices (>100 patients weekly). The respondents favoured being one of two chiropractors (36.9%) in a practice setting followed by sole practices (31.6%). The top chiropractic technique utilised was the diversified technique (74.5%) followed by extremity adjusting (68.8%). Various adjunctive, active and passive, axillary techniques were utilised in the daily management of patients. The patient demographics were majority female (55.7%), older than 30 years of age (66.7%) and Caucasian (77%), complaining of head, neck, mid-back and low back pain, which was mostly acute in nature. Trends suggested that females were more likely to select an evidence-based philosophical orientation than males. Females were more likely to delegate adjunctive therapies to non-chiropractic assistants (p = 0.029), and favoured sending patients to a physical therapist (p = 0.018), whereas males were more likely to refer to nutritionists and paediatricians (p = 0.030 and p = 0.038, respectively). Females were less likely to utilise mobilisation techniques (p = 0.008), massage therapy (p = 0.018) and nutritional counselling (p = 0.032). In terms of age, those selecting an evidence-based approach were significantly older than those who adopted a mixer approach to practicing (p = 0.002). The mean age of the respondents, irrespective of the region, was not significantly associated with the number of patients treated per week (p = 0.377) or the hours worked per week (p = 0.474). Trends show that the number of years spent in practice differed among the regions with North American chiropractors spending more years in practice than those from Europe and Australasia. The respondents from South Africa spent fewer years in practice (15 years or less) than respondents from Asia, Australasia, Europe and North America. Geographic region was not significantly associated with practice setting (p = 0.182). The only chief complaint that differed between regions was patients presenting with headaches accompanied by neck pain (p = 0.007), where Asian and North American respondents reported seeing less patients than their colleagues from other regions. Trends suggested that the respondents who attained a Masters of Technology in Chiropractic were more inclined to select a mixer orientation whereas those with a DC qualification selected an evidence-based philosophical approach. Conclusion: The WFC congress provided a platform to successfully determine the demographic profile and practice characteristics of chiropractors from various regions. Similar demographics were evident, with males no longer showing dominance within the profession. Chiropractors adopting an evidence-based and mixer philosophical orientation are synonymous in the role that they play in the health care system and display similarities in chiropractic practice and patient management. Investigating chiropractors who adopt a straight philosophical approach would be beneficial as it will allow for better comparison of demographics and practice characteristics. It is evident that selected demographics do influence how one would opt to practice, with regional differences showing that the chiropractic profession in South Africa is still relatively young.
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Shen, Lu-Chi, and 沈祿集. "The Practices of Chiropractic Care." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/49691263434987262914.

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Huang, Joyce Ju-Yu, and 黃如玉. "Conventional Medicine Practitioners’Perception on Chiropractic." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/20061325609243934992.

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碩士
國立臺灣大學
醫療機構管理研究所
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Background: Chiropractic is a health care profession in the Western society for over a century. It is the largest profession in the Complementary and Alternative Medicine system, and is considered as the closest to the mainstream. After massive amount of research, it is evident that chiropractic not only gains high patient satisfactory rate, it is also a very cost-effective approach on treating neuromusculoskeletal conditions. However, it is not widely introduced in the Asian countries, especially in Taiwan. Public, as well as health care workers may not have a clear understanding of what chiropractic profession is all about. Objective: The objective of this study is to understand medical doctors’ perception on chiropractic and to determine the necessity of establishment of such a profession in Taiwan. Method: In-depth, semi-structured interviews were conducted in Mandarin language to twelve licensed medical doctors in Taiwan. Results in the form of narratives were analyzed using common coding technique. Result: Among the twelve medical doctors, most associate chiropractic with rehabilitation or folk therapy. All of them have heard of the term chiropractic, but most have limited knowledge about the scope of practice, length and content of education of the profession. Most participants do not know that chiropractors earn a doctoral credential, and thus relate chiropractors to therapists or technicians. Almost all participants support the legislation to regulate those who perform spinal manipulations, but qualification is a debate. About half of the respondents emphasize on the importance of evidence-based practice. Conclusion: After these in-depth interviews and the narrative analysis, it is evident that numerous misunderstanding about the profession due to lack of knowledge have impeded the development of chiropractic profession in Taiwan. Further research including long-term randomized controlled trials on the efficacy and public demand of chiropractic in Taiwan are recommended.
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Bromfield, Bridget Francoise. "Chiropractic management of primary dysmenorrhea." Thesis, 1996. http://hdl.handle.net/10321/2056.

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A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1996.
The purpose of this investigation was to determine the efficacy of chiropractic treatment in the management of primary dysmenorrhea. The sample consisted of 30 patients who were randomly assigned to 2 groups, the control and experimental. This single blind study consisted of 16 visits, twice a week for the first 4 weeks and thereafter once a week for the next 8 weeks. During a menstrual cycle, prior to commencement of treatment, the patients were required to complete a Short-Form McGill Pain Questionnaire on the last day of dysmenorrhea and a Numerical Pain Rating Scale 101 on each day of experienced menstrual pain. These questionnaires were completed at home. Treatment for the experimental group consisted of soft tissue massage of the lumbar and thoraco-lumbar paravertebral. musculature combined with spinal manipulative therapy of the areas of fixation in the' lumbar and sacra-iliac regions. The control group received purely soft tissue massage of the lumbar and thoraco-lumbar paravertebral musculature. The areas of fixation were determined by motion palpation, joint challenge and tenderness to spinal palpation. There was no follow-upvisit conducted in this study. An analysis of the data revealed a statistically signiflcant improvement in the experimental group in terms of the Short Form McGill Pain Questionnaire (p=< 0,001) as well as for the control group (p=< 0,01), whilst in terms of the Numerical Pain Rating Scale 101 the experimental group showed an improvement (p=< 0,05) but the control group failed to show a significant change (p= 0,068).
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Books on the topic "Chiropractic"

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Ernst, Edzard. Chiropractic. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-53118-8.

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New York (State). State Board for Chiropractic, ed. Chiropractic. Albany, N.Y: University of the State of New York, State Education Dept., 1985.

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Christensen, Kim D. Chiropractic rehabilitation. Ridgefield, Wash: C.R.A., 1991.

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University of the State of New York. Division of Professional Licensing Services., ed. Chiropractic handbook. Albany, N.Y: University of the State of New York, State Education Dept., Office of the Professions, Cultural Education Center, 1988.

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Strauss, Joseph B. Chiropractic philosophy. [S.l.]: Foundation for the Advancement of Chiropractic Education, 1991.

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University of the State of New York. Division of Professional Licensing Services., ed. Chiropractic handbook. Albany, N.Y: University of the State of New York, State Education Dept., Office of the Professions, Cultural Education Center, 1990.

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1948-, Redwood Daniel, ed. Contemporary chiropractic. New York: Churchill Livingstone, 1997.

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Plaugher, Gregory, and Claudia A. Anrig. Pediatric chiropractic. 2nd ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health, 2012.

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Esteb, William D. Chiropractic Patientology: Further observations of a chiropractic advocate. Colorado Springs, CO: Orion Associates, 1996.

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Institute, Trends Research. The new millennium chiropractor: A trend forecast for the chiropractic profession. Rhinebeck, NY: Trends Research Institute, 1996.

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Book chapters on the topic "Chiropractic"

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Knowlton, Christin A., Michelle Kolton Mackay, Tod W. Speer, Robyn B. Vera, Douglas W. Arthur, David E. Wazer, Rachelle Lanciano, et al. "Chiropractic." In Encyclopedia of Radiation Oncology, 99. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-540-85516-3_1297.

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Mantle, Fiona. "Chiropractic." In Complementary Therapy, 34–41. London: Macmillan Education UK, 1993. http://dx.doi.org/10.1007/978-1-349-13407-6_6.

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Richards, Jacqueline, and Hugh Gemmell. "Chiropractic." In Foundations of Complementary Therapies and Alternative Medicine, 292–302. London: Macmillan Education UK, 2010. http://dx.doi.org/10.1007/978-1-137-05902-4_25.

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Barnett, Jeffrey E., Allison J. Shale, Gary Elkins, and William Fisher. "Chiropractic." In Complementary and alternative medicine for psychologists: An essential resource., 195–208. Washington: American Psychological Association, 2014. http://dx.doi.org/10.1037/14435-014.

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Trevelyan, Joanna, and Brian Booth. "Chiropractic." In Complementary Medicine, 189–99. London: Macmillan Education UK, 1994. http://dx.doi.org/10.1007/978-1-349-13252-2_14.

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Caplan, Ronald Lee. "Chiropractic." In Alternative Medicines, 80–113. London: Routledge, 2022. http://dx.doi.org/10.4324/9781003294900-4.

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Ernst, Edzard. "Introduction." In Chiropractic, 1–3. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-53118-8_1.

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Ernst, Edzard. "Effectiveness of Spinal Manipulation for Spinal Problems." In Chiropractic, 93–103. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-53118-8_10.

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Ernst, Edzard. "Effectiveness of Spinal Manipulation in Other Problems." In Chiropractic, 105–17. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-53118-8_11.

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Ernst, Edzard. "Chiropractic for Children." In Chiropractic, 119–29. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-53118-8_12.

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Conference papers on the topic "Chiropractic"

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Awwad, Andy, William L. Hennrikus, and Douglas Armstrong. "Pediatric Orthopaedic Consults from Chiropractic Care." In Selection of Abstracts From NCE 2016. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/peds.141.1_meetingabstract.636.

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Ramos, Gabriel Bortoli, Rebecca Ranzani Martins, Júlia Carvalhinho Carlos de Souza, Cesar Castello Branco Lopes, and Guilherme Diogo Silva. "Spinal cord lesion and ischemic stroke after chiropractic: a case report." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.337.

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Context: Chiropractic is a form of spinal manipulation used to treat cervical pain. This therapy is considered safer than chronic use of anti-inflammatory drugs, opioids or spine surgery. However, chiropractic may cause severe complications such as myelopathy and ischemic stroke. Case report: A 48-year-old woman was admitted to our hospital due to acute tetraparesis. During a chiropractic session for chronic neck pain, patient referred lancinating cervical pain, weakness in the upper and lower limbs, and numbness below the level of the neck. Neurologic examination showed grade two tetraparesis with preserved arm abduction. Pain and vibratory sensation were reduced in trunk, upper and lower limbs. We considered a C5 level spinal cord injury. Cervical spine magnetic resonance imaging revealed a transdiscal fracture of C5-C6 vertebrae. The fracture led to an epidural hematoma and spinal cord compression. Cervical spine displayed ligamenta flava thickening, which may be associated with an undiagnosed ankylosing spondylitis. We also found bilateral vertebral occlusion of V1 and V2 segments. Cerebellar restricted diffusion suggested posterior circulation stroke. We believe that rigidity associated with ankylosing spondylitis favored spinal fracture during chiropractic. Patient was treated with 24mg/day of dexamethasone and 100mg/day of aspirin. Spinal cord decompression surgery was indicated. Unfortunately, in the last followup there was no improvement in patient motor status. Conclusions: Transdiscal C5-C6 fracture led to compressive myelopathy and cerebellar stroke. Safety of chiropractic should be better investigated in specific populations such as ankylosing spondylitis patients.
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Gudavalli, Maruti R., and Robert M. Rowell. "Three-Dimensional Quantification of Multi-Point Contact Loads During Lumbar Spinal Manipulation." In ASME 2004 International Mechanical Engineering Congress and Exposition. ASMEDC, 2004. http://dx.doi.org/10.1115/imece2004-59183.

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The objective of this study was to measure the complete three-dimensional loads at each of the support contacts namely both hand contacts, and the support loads at the rib cage and the pelvis during chiropractic treatments for low back pain. Two small force transducers were used to measure hand contact loads, and a specially instrumented force plate table was used for measuring support loads. A doctor of chiropractic delivered fourteen spinal manipulations to the lumbar spines of five subjects during a period of three weeks. The results showed that there are three dimensional loads at each of the four contact points. The loads at the thrusting hands reached as high as 382N. For the stabilizing hands the maximum loads were 160N. The support loads reached as high as 727N at the pelvic support and 660N at the rib cage support. This study reports for the first time data on the loads at each of the hand contact points and the support locations during chiropractic spinal manipulation.
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Gudavalli, Maruti R., James M. Cox, James A. Baker, Gregory D. Cramer, and Avinash G. Patwardhan. "Intervertebral Disc Pressure Changes During a Chiropractic Procedure." In ASME 1997 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1997. http://dx.doi.org/10.1115/imece1997-0305.

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Abstract Some of the treatments for low back pain use traction as the loading mechanism to the spine. One such treatment protocol used by chiropractic physicians in the treatment of low back pain is the Cox flexion-distraction procedure (1). The Cox procedure consists of placing the patient in a prone position on a flexion-distraction table and then creating traction and flexion motions at the joint of interest. The treatment is based on the hypothesis that the intradiscal pressure decreases during the procedure and may provide an opportunity for the disc bulge to reduce. However, no data exist to support this hypothesis. The purpose of the present study was to measure the changes in the intradiscal pressures in the lumbar spine on unembalmed cadavers during the flexion-distraction procedure.
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Gudavalli, Maruti Ram, Vikas Yadav, Robert Vining, Michael Seidman, Stacie Salsbury, Paige Morgenthal, Avinash Patwardhan, and Christine Goertz. "Development of Force-Feedback Technology for Training Clinicians to Deliver Manual Cervical Distraction." In ASME 2013 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2013. http://dx.doi.org/10.1115/imece2013-64509.

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Objective: Neck pain is a prevalent musculoskeletal (MSK) complaint and costly societal burden. Doctors of chiropractic (DCs) provide manual therapies for neck pain patients to relieve discomfort and improve physical function. Manual cervical distraction (MCD) is a chiropractic procedure for neck pain. During MCD, the patient lies face down on a specially designed chiropractic table. The DC gently moves the head and neck in a cephalic direction while holding a gentle broad manual contact over the posterior neck, to create traction effects. MCD traction force profiles vary between clinicians making standardization of treatment delivery challenging. This paper reports on a bioengineering technology developed to provide clinicians with auditory and graphical feedback on the magnitude of cervical traction forces applied during MCD to simulated patients during training for a randomized controlled trial (RCT). Methods: The Cox flexion-distraction chiropractic table is designed with a moveable headpiece. The table allows for long axis horizontal movement of the head and neck, while the patient’s trunk and legs rest on fixed table sections. We instrument-modified this table with three-dimensional force transducers to measure the traction forces applied by the doctor. Motion Monitor software collects data from force transducers. The software displays the magnitude of traction forces graphically as a function of time. Real-time audible feedback produces a steady tone when measured traction forces are <20N, no tone when forces range between 20–50N, and an audible tone when forces exceed 50N. Peer debriefing from simulated patients reinforces traction force data from the bioengineering technology. Results: We used audible and graphical feedback to train and certify DCs to apply traction forces to the cervical spine of simulated patients within three specific ranges. This technology supports a RCT designed to assess the ability of clinicians to deliver MCD within specified force ranges to patients randomized to different force dosages as an intervention. Future applications may include training chiropractic students and clinicians to deliver the MCD treatment.
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Rozin, AP. "AB0148 Chiropractic management of shoulder capsulitis and knee osteoarthritis." In Annual European Congress of Rheumatology, Annals of the rheumatic diseases ARD July 2001. BMJ Publishing Group Ltd and European League Against Rheumatism, 2001. http://dx.doi.org/10.1136/annrheumdis-2001.410.

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Kreuzpointner, R., and M. Ludwig. "Multivessel dissection as a consequence of chiropractic cervical manipulation." In 62. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe – DGGG'18. Georg Thieme Verlag KG, 2018. http://dx.doi.org/10.1055/s-0038-1671547.

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Shah, Iti, Carolyn Butler, and Muhammad Salman. "Cost-Effective Method Using Force Sensors for Chiropractic Teaching." In ASME 2023 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2023. http://dx.doi.org/10.1115/imece2023-113973.

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Abstract The popularity of chiropractic medicine has increased in recent times, but the tools required for this field can be expensive, bulky, and impractical. To assist students in this field, various equipment such as pressure-sensing tables and actuators are utilized. However, some of these tools can be ineffective despite indicating the amount and location of pressure applied. To address this issue, a new glove design has been proposed in this paper, which utilizes Force Sensitive Resistor Sensors (FRSs), Raspberry Pi Pico W (Pico), Thonny (IDE) software, and an Analog to Digital converter (ADC) to achieve cost-effectiveness without compromising on efficiency. This research has significant benefits for the teaching of chiropractic mechanisms, improving accuracy and reducing costs. The device can also be used by different species in specific fields, potentially preventing workplace injuries, and enhancing teaching quality in this rapidly growing field.
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Gudavalli, Maruti R., and Robert M. Rowell. "Three Dimensional Doctor-Patient Contact Forces During Chiropractic Spinal Treatments." In ASME 2003 International Mechanical Engineering Congress and Exposition. ASMEDC, 2003. http://dx.doi.org/10.1115/imece2003-43172.

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This paper reports on the three-dimensional loads measured during chiropractic treatments delivered during low back spinal procedures. A three dimensional force transducer was placed between the doctors hand and the patient while delivering the treatment. Two doctors have delivered treatments to a total of five subjects on two consecutive days. A laptop computer was used to collect data using labview software and Keithly instruments PCMCIA card. The data was analyzed using Mathcad software to determine the magnitudes of the forces delivered. The results show three-dimensional loads are applied by the doctor at the doctor’s hand-patient interface. The compressive forces reached as high as 450 Newtons, and the shear forces have reached as high as 150 Newtons. The moments have reached as high as 4Nm. This information is valuable in further understanding the effects of these loads on the spine.
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Madigan, D., E. Quinlan-Ruof, J. Cambron, L. Forst, J. Zanoni, and LS Friedman. "1489 Occupational health history taking attitudes and behaviours of chiropractic interns." In 32nd Triennial Congress of the International Commission on Occupational Health (ICOH), Dublin, Ireland, 29th April to 4th May 2018. BMJ Publishing Group Ltd, 2018. http://dx.doi.org/10.1136/oemed-2018-icohabstracts.296.

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Reports on the topic "Chiropractic"

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Carmichael, Joel, Kent Stuber, Katherine Pohlman, Amy Ferguson, and Michele Maiers. Chiropractic clinical registries: a scoping review protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, June 2023. http://dx.doi.org/10.37766/inplasy2023.6.0064.

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Hartlieb, Kathryn Brogan, Kent Stuber, Chris Malaya, and Amy Ferguson. Motivational Interviewing in Chiropractic: a Scoping Review Protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, January 2024. http://dx.doi.org/10.37766/inplasy2024.1.0048.

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Stuber, Kent, Michele Maiers, Katie de Luca, and Rose Olson. Chiropractic for older adults with spinal conditions: a scoping review protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, June 2024. http://dx.doi.org/10.37766/inplasy2024.6.0116.

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Xu, Xinwei, Jianzhen Jiang, Zihao Xia, Bo Zhao, Haochen Tong, Kuiyu Ren, Dengpeng Wen, and Dezhong Peng. Comparison of efficacy and safety between chiropractic and single western medicine treatment for functional constipation(FC): a protocol for systematic review and network meta-analysis. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, December 2020. http://dx.doi.org/10.37766/inplasy2020.12.0029.

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Health hazard evaluation report: HETA-2000-0363-2834, Pappas Chiropractic Center, Piscataway, New Jersey. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, March 2001. http://dx.doi.org/10.26616/nioshheta200003632834.

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