Canadian chiropractors’ attitudes towards chiropractic philosophy and scope of practice: implications for the implementation of clinical practice guidelines

摘要

The development of effective implementation strategies for chiropractic clinical practice guidelines (CPGs) presumes knowledge about the attitudes of the Canadian chiropractic profession. The purpose of this study was to explore the attitudes of Canadian chiropractors to philosophy and scope of practice. We hypothesized that given most Canadian chiropractors are trained at one school, the Canadian Memorial Chiropractic College (CMCC) in Toronto, there would be a reasonable degree of consensus about the practice of chiropractic in Canada, and therefore, effective implementation strategies could be developed.Drawing on a stratified random sample of Canadian chiropractors (n = 401), we found that 18.6% of respondents held conservative views, 22% held liberal views and 59.4% held moderate views. Conservative chiropractic philosophy rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer, and emphasizes the scientific validation of chiropractic concepts and methods. A conservative philosophy is associated with a narrow scope of practice in which chiropractic practice is restricted to musculoskeletal problems. A liberal chiropractic philosophy adheres to traditional chiropractic philosophy (offered either by D.D. or B.J. Palmer) and is associated with a broad scope of practice which includes the treatment of non-musculoskeletal conditions. Liberal-minded respondents are more likely to identify chiropractic as an alternate form of health care.Using ANOVA and MCA, the best predictors of the philosophy index were college of training and province of practice. Chiropractors who trained at the CMCC held more conservative views than those who were trained elsewhere. Moreover, we found significant provincial differences among the provinces on the philosophy index. Saskatchewan chiropractors held the most conservative views on the philosophy index; Quebec chiropractors held the most liberal views. We concluded that given the divergence of opinions among Canadian chiropractors, one implementation strategy would not be effective. We also questioned whether CPGs are the most efficacious method of changing clinical behaviour.