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Chiropractic Journal of Australia : CJA September 2013
104 Chiropractic Journal of Australia Volume 43 Number 3 September 2013 RESEARCH SEMINAR REPORT SWAIN et al subgroups: An analysis of longitudinal routine clinical data.” The interactive discussion forum provided a platform for attendees to discuss issues surrounding chiropractic research in Australia. Guided by Mark Hancock, a diverse panel of chiropractors (Roger Engel, Peter Tuchin of COCA, Alice Kongsted and Bryce Conrad, chiropractor and member of the CAA Executive) provided their perspective on two forum questions: (1) How does the chiropractic profession facilitate research in Australian chiropractic institutions? and; (2) How can community chiropractors facilitate chiropractic research in Australia? THE DANISH RESEARCH MODEL The Foundation for Chiropractic Research and Post Graduate Education (The chiropractic fund) was established in 1990 as part of the contract between the Danish Health Insurance and the Danish Chiropractors’Association with the purpose of advancing chiropractic research and postgraduate education in Denmark.3 The Foundation provides funding for The Nordic Institute of Chiropractic and Clinical Biomechanics and scientifc positions such as professorships at the University of Southern Denmark (SDU), PhD projects, and individual initiatives for research projects and quality development. The chiropractic fund constitutes a source of continuous fnancial support that has been arguably the single most important factor for developing a successful chiropractic research environment in Denmark, with chiropractors being central players in musculoskeletal research and teaching of musculoskeletal medicine at a university level. Since the fund was established 17 Danish chiropractors have completed a PhD degree and 14 chiropractors are currently PhD candidates at Danish universities. A strong evidence based approach to chiropractic has led to Danish chiropractic education being integrated with medicine in a Faculty of Health at a comprehensive state university, and Danish chiropractors achieving leading academic positions within the chiropractic profession internationally. Furthermore, this academic development has strongly contributed to ensuring that chiropractors are highly integrated into the Danish healthcare system and are recognised as trustworthy contributors to primary health care. The Danish chiropractic fund constitutes the fnancial foundation for the academic development of chiropractic in Denmark and has made an important contribution to establishing a multidisciplinary musculoskeletal research environment in Denmark with chiropractors as key stakeholders. OBSERVATIONS AND REFLECTIONS The interactive discussion forum, as well as question time following dialogues and research presentations, provided all attendees (chiropractors, students, academics and members of the public) an opportunity to express their opinion on issues surrounding chiropractic research in Australia. The following discussion offers observations and refections on the key themes that were discussed. Defning the Professional Identity There is noticeable diversity in the way individual Australian chiropractors view their core purpose. Subsequently the role of the chiropractic profession in Australia is poorly established. This may lead to the lack of a clearly defned research direction and could be one barrier to increased research output in Australia. Also, there are only a very small number of appropriately qualifed academics in Australia with the ability to drive a research oriented culture into the professional Identity. In contrast, this is not the case for chiropractors in Denmark, who have developed a clear identity as healthcare providers who diagnose, treat, and prevent musculoskeletal pain.4 Danish chiropractors primarily see themselves as musculoskeletal experts and practitioners. This is also how the Danish Chiropractors'Association brand chiropractic. Danish chiropractors have a clear role as primary care clinicians, who embrace the biopsychosocial approach and take responsibility for diagnosing and managing musculoskeletal problems. The research direction taken by Danish chiropractors aligns well with the professional identity and the practitioner function. Indeed research now clarifes the chiropractic identity in Denmark, as a musculoskeletal expert. If the Australian chiropractic profession wants to take on responsibility as expert musculoskeletal health care providers there is clearly a need to be engaged in research to enhance knowledge about musculoskeletal conditions. If, on the other hand, chiropractors want to be only manipulative therapists who function in an undefned health/wellbeing role that is outside of the established healthcare system, the need for broad musculoskeletal research is limited. The frst step is a frm decision on professional identify. Separation of Politics and Professional/Academic Issues Chiropractors in Australia have become increasingly aware that having more than one association is damaging for the profession. It would appear that the CAA and COCA (and also the Australian Spinal Research Foundation) each deal with similar political and professional issues, but often without a united position. One strategy towards easing inter-body tension and increasing effectiveness for the profession is to separate the political and professional domains. Using Denmark as a case example, this system has a highly organised, single chiropractic association, The Danish Chiropractic Association5 (DCA). This organisation evolved into a sophisticated corporate structure that ensures that political issues (roughly spoken what is best for the chiropractors) are dealt with by the DCA whereas professional issues (what is best for the patients and for society) to a large extent are handled by the Nordic Institute for Chiropractic and Clinical Biomechanics. This is funded by both the profession and the Danish national health insurance and therefore it operates in the interests of both chiropractors and society. Its functions include postgraduate education, high-quality research, and the management of the mandatory professional internship. Denmark has one Chiropractic Association that covers all chiropractors and speaks for chiropractic on all political issues. Speaking with one voice makes it clearer for stakeholders to know what chiropractic is. In Australia it does appear that the CAA and COCA have occupied both political and professional (education/ professional development, research, evidence base) domains in years gone by. At the seminar prior tensions were acknowledged and commitment to a future alliance was indicated. Moving forward, opportunity exists for Australian chiropractic groups to unite in the formation of one political and professional entity, mitigating the risk of any further divergent actions in the future.
CJA June 2013
CJA December 2013