Patient or person-centred care (PCC) is an ethical approach1 that aims to provide healthcare that is both receptive and accountable to the patient, as it conforms to the patient’s individualised preferences and principles.[2-4] Evidence based practice (EBP), another strongly encouraged approach to healthcare, is the use of the most current evidence from systematic research coupled with practitioner clinical expertise and patient values when providing health care.[5-7] These competing approaches are deemed the benchmark for quality care by healthcare institutions, healthcare policy makers, practitioners, and researchers alike,[5,8-10] and are strongly dependent on the interpersonal relationships not only between the patient and the professionals providing care, but also through collaboration inter-professionally.[11-12] These interprofessional collaborative relationships are relied upon as medical conditions become more complex[13] with a need for a diverse knowledge base that cannot be provided by a single profession alone and are necessary[13-14] for the delivery of high-quality evidence-based patient centered care. Existing literature highlights interprofessional communication, defined as the manner in which a health professional effectively converses with colleagues, patients and families in the context of the patient’s culture, as a unanimous key competency for useful collaboration between professionals.[15-18]
Often the individual members of a medical interprofessional collaborative team emerge from differing education routes, have specialized skills that use different professional languages that align them to diverse aspects of healthcare.[19-20] Following from this there may be disparities in the understanding and interpretation of the terminologies used to communicate patient conditions and treatment options generating interprofessional communication and coordination strains.[21-22] An additional facet to interprofessional communication for effective interprofessional collaboration is whether the terminology and language actually used by one professional is in fact understandable to other health-care professionals in order to provide accurate information to the specific health-care case.[23-24] These concerns are more pronounced in the South African context where there is an estrangement between mainstream medical healthcare and complimentary chiropractic care[25-26] that could only be aggravated by a communication divide.
Chiropractors in South Africa have been shown to have poor interprofessional-referral relationships with other musculoskeletal professionals, with 60.2% of chiropractors almost never receiving a referral from an orthopaedic specialist.[27] However, with almost a third of South African chiropractors situated in multidisciplinary health-care offices[27] there is an imperative to encourage and sustain chiropractic-medical interprofessional collaboration through communication competency.[28] One way in which this was supported was with the adoption of the education collaboration between international chiropractic programmes (of which both South African institutions are signatories), to detach from chiropractic-specific terminologies and adopt a solely evidence-based chiropractic education. This stance would allow for effective communication in a language clearly understood by all stakeholders in health-care teams.[29]
There is currently no literature on the prevalence of chiropractic-specific words used on South African chiropractors’ websites, and whether the educational collaborative statement has had any impact on the use of chiropractic-specific terminology post 2014. These insights are relevant in documenting the trends of South African chiropractor communication skills. Chiropractic-centric terminology primarily includes the words subluxation, manipulate (-ion), adjust (-ing/-ment), holism (-tic), alignment, practice-member, vital (-ism/-istic), wellness, and innate intelligence.
Subluxation
The term subluxation, although deeply rooted and central in the history of chiropractic,[30] is of little clinical value today.[31] This is emphasised by the fact that their lacks a consensus of its definition among the chiropractic profession in itself.[32-33] Its main chiropractic concept was to describe the misalignment of a vertebra thereby applying pressure to surrounding nerves which cause eventual disease.[30] This is far removed from the medical definition which is “a painful partial dislocation” that is grossly unstable due to ligamentous tearing, that has been recognised as that since the time of Hippocrates.[32] Today, the teaching of the vertebral subluxation complex as a vitalistic construct that claims it is the cause of disease is unsupported by evidence and its inclusion in a modern chiropractic curriculum in anything other than an historical context, is inappropriate and unnecessary.[29,31-32] The fact that early chiropractors utilized the term ‘subluxation’ from medicine, but with a different definition, has caused decades of distrust and misconceptions of the chiropractic profession from medical colleagues.
Adjust (-ing/-ment) and Manipulation
Chiropractic adjustment has been defined as a form of a manual technique administered to a joint of the spine or any other body part, through which a controlled force is used or a low amplitude, high velocity manual thrust to a motion segment or joint. Manipulation is a non-exclusive chiropractic word, and is a commonly accepted medical term. Within the chiropractic community the word ‘adjustment’ is synonymous with manipulation.[33] However, in mainstream medicine manipulation implies a passive movement that is skilfully applied to a joint or soft tissue that is of variable speed and amplitudes.[35-36] The effects of an adjustment are largely mechanical, including a realignment of joint surfaces, an increase in joint mobility, a reduction of muscle spasm, and an improvement of posture and locomotion. There are a number of other elements that could be involved including joint fixation or locking, intra-articular block, inter-articular adhesions, inter-discal block, muscle spasm, myofascial cycle, and periarticular fibrosis and adhesions.[37]
Holism (-tic)
Holism is the philosophy which states that many parts of a whole are so interrelated that they cannot exist individualistically.[38] An understanding of holism within health care is concerned with complete systems rather than with the analysis of, treatment of, or dissection into parts. Holism (-tic) is also not an exclusive chiropractic-specific term and is an approach that involves the physical, mental and spiritual well-being of a patient.[39-40]
Alignment
The historical chiropractic rationale was to visualise the chiropractic subluxation, defined at the time as a ‘bone out of place’, irritating a nerve, and as a result causing disease. This model, often using radiography for the so-called diagnosis, has survived in some parts of the chiropractic profession, despite it lacking evidence or clinical validity.[28] Chiropractic as a profession has a long history of biomechanical analysis of the spine through x-ray imaging. Early chiropractors used x-rays to study spinal alignment to identify the location of a ‘subluxated’ or misaligned vertebrae in order to correct the spinal alignment through the form of spinal manipulation.[41] The measuring of alignment on x-rays has not been found to be a useful method to determine the location of spinal manipulation[42] instead, radiographic imaging must only be used in accordance with the latest evidence-based guidelines.
Vital (-ism/-istic), Innate Intelligence and Wellness
Vitalism refers to the theory that all living organisms are sustained by a vital life force that is both separate from and greater than normal physical or chemical forces. There are many ways of expressing this life force, including Qi, energy, yin-yang, universal intelligence, or innate intelligence.[43] Vitalism within the chiropractic context can be broken down into two sections: universal and individual and is the idea that a vertebra out of place (i.e. the chiropractic ‘subluxation’) is interrupting the flow of vital energy (innate intelligence) within the body and is the cause of disease or pain in the body. Innate intelligence, represents the force that restores health and energy within the body[44-45] in the chiropractic vitalist background. The vitalist paradigm is an unscientific ideology that is unrecognized by other mainstream medical health professions.[46] Wellness-based chiropractic, a form of vitalism, proposes an all-inclusive scope of practice and believes in the ability to address all features of an individual’s health that go beyond the bodily symptomatology and include passionate, mystical and mental aspects of life.[47] Wellness, in this sense, is an ideology that does not align with the modern evidence-based care that the World Federation of Chiropractic (WFC) has outlined.[48]
Therefore, the purpose of this paper was to record the prevalence of these eight identified chiropractic-specific words on South African chiropractors’ websites that were used in a chiropractic-centric manner.