Chiropractic Chiropractic
Chiropractic: from Greek chiro- χειρο- "hand-" Chiropractic: dari Yunani chiro-χειρο-"tangan"
+ praktikós πρακτικός "concerned with action" + Praktikós πρακτικός "berkaitan dengan tindakan"
( OED ) ( OED )
Alternative medical systems Alternatif sistem medis
Pastiche manusia berpikir dan menulis; rusuk, tulang, dan tulang pinggul dari kerangka manusia, sebuah tangan memegang gambar lain; dan terkenal Leonardo seorang pria di alun-alun dan lingkaran
Acupuncture · Anthroposophic medicine · Ayurveda · Chiropractic · Herbalism · Homeopathy · Naturopathy · Osteopathy · Siddha medicine · Traditional medicine ( Chinese · Tibetan ) · Unani Akupunktur · Anthroposophic obat · Ayurveda · Chiropractic · jamu · Homeopati · Naturopati · Oesteopati · obat Siddha · obat tradisional ( Cina · Tibet ) · Unani
NCCAM classifications NCCAM klasifikasi
Whole medical systems · Mind-body interventions · Biologically based therapies · Manipulative therapy · Energy therapies sistem medis Whole · pikiran-tubuh intervensi · berdasarkan terapi biologis · terapi manipulatif · terapi Energi
See also Lihat juga
Alternative medicine · Glossary · People Alternatif obat · Glosari · Orang
v • d • e v • d • e
Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system , especially the spine , under the hypothesis that these disorders affect general health via the nervous system . [ 1 ] It is generally categorized as complementary and alternative medicine (CAM), [ 2 ] a characterization that many chiropractors reject. [ 3 ] Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry . [ 4 ] The main chiropractic treatment technique involves manual therapy , including manipulation of the spine , other joints, and soft tissues ; treatment also includes exercises and health and lifestyle counseling. [ 5 ] Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its Innate Intelligence , [ 6 ] a vitalistic notion that brings ridicule from mainstream science and medicine. [ 7 ] Chiropractic adalah perawatan kesehatan disiplin dan profesi yang menekankan diagnosis, pengobatan dan pencegahan dari gangguan mekanik dari sistem muskuloskeletal , terutama tulang belakang , di bawah hipotesis bahwa gangguan ini mempengaruhi kesehatan umum melalui sistem saraf . [1] Hal ini umumnya dikategorikan sebagai pelengkap dan pengobatan alternatif (CAM), [2] karakterisasi yang banyak chiropractors menolak. [3] Walaupun chiropractors memiliki banyak atribut perawatan primer penyedia, chiropractic memiliki lebih dari atribut khas medis seperti kedokteran gigi atau podiatri . [4] utama teknik pengobatan chiropractic melibatkan terapi manual , termasuk manipulasi tulang belakang , sendi lain, dan jaringan lunak ; perawatan juga mencakup latihan-latihan dan kesehatan dan konseling gaya hidup. [5] chiropractic Tradisional menganggap bahwa subluksasi tulang belakang atau sendi tulang belakang disfungsi mengganggu tubuh fungsi dan nya bawaan Intelijen , [6] sebuah vitalistic gagasan yang membawa ejekan dari arus utama sains dan kedokteran. [7]
DD Palmer founded chiropractic in the 1890s and his son BJ Palmer helped to expand it in the early 20th century. [ 8 ] It has two main groups: "straights", now the minority, emphasize vitalism , Innate Intelligence and spinal adjustments , and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise , massage , nutritional supplements , and acupuncture . [ 9 ] Chiropractic is well established in the US, Canada and Australia. [ 10 ] DD Palmer chiropractic didirikan pada tahun 1890 dan putranya BJ Palmer membantu untuk memperluas di awal abad 20. [8] Ada dua kelompok utama: "lurus", sekarang minoritas, menekankan vitalisme , bawaan Intelijen dan penyesuaian tulang belakang , dan mempertimbangkan Subluksasi-subluksasi menjadi penyebab utama penyakit semua; "mixer" lebih terbuka untuk mainstream dan alternatif teknik medis seperti olahraga , pijat , suplemen gizi , dan akupunktur . [9] Chiropractic sudah mapan di AS, Kanada dan Australia. [ 10]
Throughout its history it has been controversial . [ 11 ] [ 12 ] For most of its existence, chiropractic has battled with mainstream medicine , sustained by ideas such as subluxation [ 13 ] that are not based on solid science. [ 14 ] Vaccination remains controversial among chiropractors. [ 15 ] The American Medical Association called chiropractic an "unscientific cult" [ 16 ] and boycotted it until losing an antitrust case in 1987. [ 17 ] Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans in the US, [ 17 ] and evidence-based medicine has been used to review research studies and generate practice guidelines . [ 18 ] Many studies of treatments used by chiropractors have been conducted, with conflicting results. Sepanjang sejarahnya telah kontroversial . [11] [12] Untuk sebagian besar keberadaannya, chiropractic telah berjuang dengan obat utama , ditopang oleh ide seperti subluksasi [13] yang tidak didasarkan pada ilmu pengetahuan yang solid. [14] Vaksinasi masih kontroversial antara chiropractors. [15] The American Medical Association disebut chiropractic sebuah kultus tidak ilmiah "" [16] dan memboikot sampai kehilangan sebuah antitrust kasus pada tahun 1987. [17] Chiropractic telah memiliki basis politik yang kuat dan permintaan yang berkelanjutan untuk jasa, dalam beberapa dekade terakhir , telah mendapatkan legitimasi lebih dan penerimaan yang lebih besar antara medis dokter dan rencana kesehatan di Amerika Serikat, [17] dan berbasis bukti obat telah digunakan untuk meninjau studi penelitian dan menghasilkan pedoman praktek . [18] Banyak studi perawatan yang digunakan oleh chiropractors memiliki telah dilakukan, dengan hasil yang bertentangan. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective , with the possible exception of treatment of back pain . [ 14 ] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. [ 19 ] Although spinal manipulation can have serious complications in rare cases, [ 20 ] [ 21 ] chiropractic care is generally safe when employed skillfully and appropriately. [ 22 ] Secara keseluruhan, tinjauan sistematis dari penelitian ini tidak menunjukkan bahwa manipulasi tulang belakang yang efektif , dengan kemungkinan pengecualian perawatan sakit punggung . [14] Keberhasilan dan efektivitas biaya pemeliharaan perawatan chiropractic tidak diketahui. [19] Meskipun manipulasi tulang belakang dapat memiliki serius komplikasi dalam kasus-kasus yang jarang terjadi, [20] [21] perawatan chiropractic umumnya aman saat bekerja terampil dan tepat. [22]
Contents Isi
[hide]
* 1 Philosophy 1 Filsafat
o 1.1 Straights and mixers 1,1 lurus dan mixer
o 1.2 Vertebral subluxation 1,2 subluksasi vertebra
* 2 Scope of practice 2 Ruang Lingkup praktek
* 3 Treatment techniques 3 Pengobatan teknik
* 4 Education, licensing, and regulation 4 Pendidikan, perizinan, dan regulasi
* 5 Utilization, satisfaction rates, and third party coverage 5 Pemanfaatan, tingkat kepuasan, dan cakupan pihak ketiga
* 6 History and controversy 6 Sejarah dan kontroversi
* 7 Evidence basis 7 Bukti dasar
o 7.1 Effectiveness Efektivitas 7,1
o 7.2 Safety 7,2 Keselamatan
o 7.3 Cost-effectiveness 7,3 efektivitas biaya
* 8 Public health 8 Publik kesehatan
* 9 Criticism 9 Kritik
* 10 References 10 Referensi
* 11 External links 11 Pranala luar
[ edit ] Philosophy [ sunting ] Filosofi
Two chiropractic belief system constructs Dua sistem kepercayaan chiropractic konstruksi THE TESTABLE PRINCIPLE PRINSIP diuji THE UNTESTABLE METAPHOR Metafora teruji
Chiropractic Adjustment Chiropractic Penyesuaian Universal Intelligence Universal Intelligence
↓ ↓ ↓ ↓
Restoration of Structural Integrity Restorasi Integritas Struktural Innate Intelligence Bawaan Intelijen
↓ ↓ ↓ ↓
Improvement of Health Status Peningkatan Status Kesehatan Body Physiology Fisiologi tubuh
MATERIALISTIC: Materialistik: VITALISTIC: VITALISTIC:
— operational definitions possible - Definisi operasional mungkin — origin of holism in chiropractic - Asal holisme di chiropractic
— lends itself to scientific inquiry - Cocok untuk penyelidikan ilmiah — cannot be proven or disproven - Tidak dapat dibuktikan atau tertolak
taken from Mootz & Phillips 1997 [ 23 ] diambil dari Mootz & Phillips 1997 [23]
Chiropractic's early philosophy was rooted in vitalism , spiritual inspiration and rationalism . Chiropractic awal filsafat berakar pada vitalisme , spiritual inspirasi dan rasionalisme . A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. Sebuah filosofi berdasarkan pengurang dari doktrin tak terbantahkan chiropractic membantu membedakan dari obat, yang diberikan dengan dan politik pertahanan hukum terhadap klaim mempraktikkan kedokteran tanpa lisensi, dan membiarkan chiropractors untuk membangun diri sebagai profesi yang otonom. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method , [ 24 ] and relies on deductions from vitalistic first principles rather than on the materialism of science. [ 23 ] However, most practitioners currently accept the importance of scientific research into chiropractic, [ 24 ] and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness ; [ 23 ] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research. [ 25 ] Ini "lurus" filsafat, diajarkan kepada generasi chiropractors, menolak alasan dapat disimpulkan dari metode ilmiah , [24] dan bergantung pada pemotongan dari vitalistic prinsip-prinsip pertama bukan pada materialisme ilmu pengetahuan. [23] Namun, sebagian besar praktisi saat ini menerima pentingnya penelitian ilmiah ke chiropractic, [24] dan kebanyakan praktisi "mixer" yang berusaha menggabungkan ilmu pengetahuan materialistik reduksionisme dengan metafisika pendahulu mereka dan dengan paradigma holistik kesehatan ; [23] komentar 2008 diusulkan chiropractic yang secara aktif memisahkan diri dari filsafat lurus sebagai bagian dari kampanye untuk menghilangkan teruji dogma dan terlibat dalam pemikiran kritis dan penelitian berbasis bukti. [25]
Although a wide diversity of ideas currently exists among chiropractors, [ 24 ] they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. [ 26 ] Chiropractors study the biomechanics , structure and function of the spine, along with what they say are its effects on the musculoskeletal and nervous systems and its role in health and disease. [ 27 ] Meskipun keanekaragaman ide saat ini ada di antara ahli tulang, [24] mereka berbagi kepercayaan bahwa tulang belakang dan kesehatan yang terkait dengan cara yang mendasar, dan bahwa hubungan ini dimediasi melalui sistem saraf. [26] kiropraktor mempelajari biomekanik , struktur fungsi dan tulang belakang, bersama dengan apa yang mereka katakan adalah dampaknya pada muskuloskeletal dan sistem saraf dan perannya dalam kesehatan dan penyakit. [27]
Chiropractic philosophy includes the following perspectives: [ 23 ] filsafat Chiropractic meliputi perspektif berikut: [23]
* Holism assumes that health is affected by everything in an individual's environment; some sources also include a spiritual or existential dimension. [ 28 ] In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation . [ 25 ] Holisme mengasumsikan bahwa kesehatan dipengaruhi oleh segala sesuatu di individu lingkungan; beberapa sumber juga termasuk spiritual atau eksistensial dimensi. [28] Sebaliknya, reduksionisme di chiropractic mengurangi penyebab dan penyembuhan masalah kesehatan pada faktor tunggal, subluksasi vertebra . [25]
* Conservatism considers the risks of clinical interventions when balancing them against their benefits. Konservatisme mempertimbangkan risiko intervensi klinis ketika menyeimbangkan mereka terhadap keuntungan mereka. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication . [ 27 ] Ini menekankan noninvasif perawatan untuk meminimalkan risiko, dan menghindari operasi dan pengobatan . [27]
* Homeostasis emphasizes the body's inherent self-healing abilities. Homeostasis menekankan yang melekat di badan, penyembuhan diri sendiri kemampuan tersebut. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis. [ 24 ] Gagasan awal yang Chiropractic dari kecerdasan bawaan dapat dianggap sebagai metafora untuk homeostasis. [24]
* Straights tend to use an approach that focuses on the chiropractor's perspective and the treatment model, whereas mixers tend to focus on the patient and the patient's situation. [ 23 ] Lurus cenderung menggunakan pendekatan yang berfokus pada chiropractor perspektif dan model perawatan, sedangkan mixer cenderung berfokus pada pasien dan pasien situasi. [23]
[ edit ] Straights and mixers [ sunting lurus] dan mixer
Range of belief perspectives in chiropractic Rentang dari perspektif kepercayaan chiropractic perspective attribute perspektif atribut potential belief endpoints potensi keyakinan endpoints
scope of practice: ruang lingkup praktek: narrow ("straight") ← sempit ("lurus") ← → broad ("mixer") → luas ("mixer")
diagnostic approach: Pendekatan diagnostik: intuitive ← ← intuitif → analytical → analitis
philosophic orientation: filosofis orientasi: vitalistic ← ← vitalistic → materialistic → materialistik
scientific orientation: ilmiah orientasi: descriptive ← ← deskriptif → experimental → eksperimental
process orientation: proses orientasi: implicit ← ← implisit → explicit → eksplisit
practice attitude: praktek sikap: doctor/model-centered ← dokter / model-berpusat ← → patient/situation-centered → pasien / situasi yang berpusat
professional integration: profesional integrasi: separate and distinct ← terpisah dan berbeda ← → integrated into mainstream → diintegrasikan ke dalam mainstream
taken from Mootz & Phillips 1997 [ 23 ] diambil dari Mootz & Phillips 1997 [23]
Chiropractic is often described as two professions masquerading as one. Chiropractic sering digambarkan sebagai dua profesi yang menyamar sebagai satu. Unlike the distinction between podiatry (a science-based profession for foot disorders) and foot reflexology (an unscientific philosophy which posits that many disorders arise from the feet), in chiropractic the two professions attempt to live under one roof, [ 25 ] albeit with much tension between them. [ 29 ] Tidak seperti perbedaan antara podiatri (sebuah profesi berbasis ilmu pengetahuan untuk kelainan kaki) dan kaki refleksi (sebuah filsafat ilmiah yang menyatakan bahwa banyak penyakit timbul dari kaki), dalam chiropractic dua profesi mencoba untuk hidup di bawah satu atap, [25] meskipun dengan banyak ketegangan di antara mereka. [29]
Straight chiropractors adhere to the philosophical principles set forth by DD and BJ Palmer, and retain metaphysical definitions and vitalistic qualities. Lurus chiropractors mematuhi prinsip-prinsip filosofis yang ditetapkan oleh DD dan BJ Palmer, dan mempertahankan metafisik definisi dan vitalistic kualitas. Straight chiropractors believe that vertebral subluxation leads to interference with an " Innate Intelligence " exerted via the human nervous system and is a primary underlying risk factor for many diseases. chiropractors Lurus percaya bahwa subluksasi tulang belakang menyebabkan gangguan dengan " bawaan Intelligence "diberikan melalui sistem saraf manusia dan merupakan faktor risiko utama untuk penyakit yang mendasari banyak. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for chiropractic treatment. Lurus melihat diagnosa medis dari keluhan pasien (yang mereka anggap sebagai "efek sekunder" dari Subluksasi-subluksasi) untuk tidak diperlukan untuk pengobatan chiropractic. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies. [ 30 ] Their philosophy and explanations are metaphysical in nature and they prefer to use traditional chiropractic lexicon terminology (ie perform spinal analysis, detect subluxation, correct with adjustment, etc.). Jadi, chiropractors lurus prihatin terutama dengan deteksi dan koreksi subluksasi vertebra melalui penyesuaian dan jangan "campuran" jenis terapi. [30] filsafat mereka dan penjelasan metafisis di alam dan mereka lebih suka menggunakan istilah leksikon chiropractic tradisional (yaitu melakukan analisis tulang belakang, mendeteksi subluksasi, benar dengan penyesuaian, dll). They prefer to remain separate and distinct from mainstream health care. Mereka lebih memilih untuk tetap terpisah dan berbeda dari perawatan kesehatan utama.
Mixer chiropractors "mix" diagnostic and treatment approaches from osteopathic, medical, and chiropractic viewpoints. chiropractors Mixer "campuran" pendekatan diagnostik dan pengobatan dari osteopathic, medis, dan chiropractic sudut pandang. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and they incorporate mainstream medical diagnostics and employ many treatments including conventional techniques of physical therapy such as exercise, massage , ice packs , and moist heat , along with nutritional supplements , acupuncture , homeopathy , herbal remedies , and biofeedback . Tidak seperti chiropractors lurus, mixer percaya subluksasi adalah salah satu penyebab banyak penyakit, dan mereka menggabungkan diagnosa medis utama dan mempekerjakan banyak perawatan termasuk teknik konvensional terapi fisik seperti olahraga, pijat , kompres es , dan panas lembab , bersama dengan suplemen gizi , akupunktur , homeopati , pengobatan herbal , dan biofeedback . Mixers tend to be open to mainstream medicine and are the majority group. [ 9 ] Mixer cenderung terbuka untuk obat utama dan kelompok mayoritas. [9]
[ edit ] Vertebral subluxation [ sunting ] subluksasi vertebra
Main article: Vertebral subluxation Artikel utama: subluksasi vertebra
Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations , interfered with the body's function and its inborn (innate) ability to heal itself. [ 6 ] DD Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. Palmer hipotesis bahwa misalignments sendi tulang belakang, yang disebutnya Subluksasi-subluksasi vertebra, campur dengan tubuh fungsi dan bawaan nya (bawaan) kemampuan untuk menyembuhkan dirinya sendiri. [6] DD Palmer menolak teori sebelumnya bahwa Subluksasi-subluksasi tulang belakang yang disebabkan terjepit saraf di ruang intervertebralis mendukung dari Subluksasi-subluksasi menyebabkan getaran saraf berubah, baik terlalu tegang atau terlalu kendur, mempengaruhi nada (kesehatan) dari organ akhir. DD Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. DD Palmer, dengan menggunakan pendekatan vitalistic, diilhami dari subluksasi panjang dengan metafisis dan filosofis makna. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic. [ 31 ] This concept was later expanded upon by his son, BJ Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. Dia memenuhi syarat ini dengan mencatat bahwa pengetahuan kecerdasan bawaan tidak penting untuk praktik chiropractic kompeten. [31] Konsep ini kemudian diperluas oleh putranya, BJ Palmer dan berperan penting dalam memberikan dasar hukum untuk membedakan obat chiropractic dari obat konvensional . In 1910, DD Palmer theorized that the nervous system controlled health: Pada 1910, DD Palmer berteori bahwa kesehatan sistem saraf dikendalikan:
"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease." [ 32 ] "Fisiologi membagi-serat saraf, yang membentuk saraf, menjadi dua kelas, Tayangan aferen dan eferen dibuat pada ujung-serat aferen perifer;. Ini membuat sensasi yang dikirim ke pusat sistem saraf. Eferen saraf-serat membawa impuls keluar dari pusat ke ujung Kebanyakan mereka pergi ke otot dan karena itu disebut impuls motor;. beberapa kelenjar sekresi dan masukkan, porsi yang menghambat fungsi mereka sedang menahan sekresi. Dengan demikian, saraf membawa impuls sensasi luar dan dalam. aktivitas dari saraf, atau lebih tepatnya serat mereka, dapat menjadi gembira atau disembuhkan oleh tubrukan, hasil modifikasi menjadi fungsi-terlalu banyak atau tidak cukup tindakan-yang adalah penyakit. " [32]
Vertebral subluxation, a core concept of chiropractic, remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades. [ 7 ] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. subluksasi vertebra, konsep inti dari chiropractic, tetap tidak berdasar dan sebagian besar belum teruji, dan perdebatan tentang apakah ingin tetap dalam paradigma chiropractic telah berlangsung selama puluhan tahun. [7] Secara umum, kritik chiropractic subluksasi berbasis tradisional (termasuk chiropractors) skeptis nilai klinis, dogmatis kepercayaan dan pendekatan metafisik. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community. [ 7 ] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic still teaching the traditional/straight subluxation-based chiropractic, while others have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions. [ 33 ] [ 34 ] Sementara chiropractic lurus masih mempertahankan vitalistic tradisional membangun dianut oleh para pendiri, chiropractic berbasis bukti-bukti menunjukkan bahwa pandangan mekanistik akan memungkinkan perawatan chiropractic untuk menjadi terintegrasi ke dalam pelayanan kesehatan masyarakat luas. [7] ini masih merupakan sumber perdebatan terus dalam chiropractic profesi juga, dengan beberapa sekolah chiropractic masih mengajar lurus / chiropractic subluksasi berbasis tradisional, sementara yang lain telah bergerak menuju berbasis bukti chiropractic yang menolak foundings metafisik dan batasan sendiri untuk terutama kondisi neuromusculoskeletal. [33] [34]
A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex , and that when asked to estimate the percent of disorders of internal organs (such as the heart, the lungs, or the stomach) that subluxation significantly contributes to, the mean response was 62%. [ 35 ] In 2005, the chiropractic subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity." Sebuah survei tahun 2003 chiropractors Utara Amerika menemukan bahwa 88% ingin mempertahankan subluksasi vertebra kompleks panjang, dan ketika diminta untuk memperkirakan persen gangguan organ internal (seperti jantung, paru-paru, atau perut) yang memberikan kontribusi signifikan subluksasi untuk, respon rata-rata adalah 62%. [35] Pada tahun 2005, subluksasi chiropractic didefinisikan oleh Organisasi Kesehatan Dunia sebagai "lesi atau disfungsi dalam segmen atau gerakan bersama di mana keselarasan, gerakan integritas dan / atau fungsi fisiologis yang berubah , meskipun kontak antara permukaan sendi tetap utuh. Ini pada dasarnya adalah sebuah entitas fungsional, yang dapat mempengaruhi integritas biomekanik dan syaraf. " This differs from the medical definition of subluxation as a significant structural displacement, which can be seen with static imaging techniques such as X-rays . [ 22 ] The 2008 book Trick or Treatment states "X-rays can reveal neither the subluxations nor the innate intelligence associated with chiropractic philosophy, because they do not exist." [ 36 ] Attorney David Chapman-Smith, Secretary-General of the World Federation of Chiropractic , has stated that "Medical critics have asked how there can be a subluxation if it cannot be seen on x-ray. The answer is that the chiropractic subluxation is essentially a functional entity, not structural, and is therefore no more visible on static x-ray than a limp or headache or any other functional problem." [ 37 ] Ini berbeda dari definisi medis subluksasi sebagai perpindahan struktural yang signifikan, yang dapat dilihat dengan teknik pencitraan statis seperti sinar-X . [22] Buku 2008 Trik atau Perlakuan negara "X-sinar dapat mengungkapkan baik Subluksasi-subluksasi maupun bawaan kecerdasan yang terkait dengan filosofi chiropractic, karena mereka tidak ada. " [36] Jaksa David Chapman-Smith, Sekretaris Jenderal World Federation of Chiropractic , telah menyatakan bahwa "Kedokteran kritikus bertanya bagaimana bisa ada subluksasi jika tidak dapat terlihat pada x-ray. Jawabannya adalah bahwa subluksasi chiropractic pada dasarnya adalah sebuah entitas fungsional, bukan struktural, dan karena itu tidak lebih terlihat pada x-ray statis dari pincang atau sakit kepala atau masalah fungsional lainnya. " [37]
[ edit ] Scope of practice [ sunting ] Ruang Lingkup praktek
Chiropractors, also known as doctors of chiropractic or chiropractic physicians [ 38 ] in many jurisdictions, [ 39 ] emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery, [ 22 ] with special emphasis on the spine. [ 1 ] Chiropractic combines aspects from mainstream and alternative medicine, and there is no agreement about how to define the profession: although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry . [ 4 ] It has been proposed that chiropractors specialize in nonsurgical spine care, instead of attempting to also treat other problems, [ 25 ] [ 4 ] but the more expansive view of chiropractic is still widespread. [ 40 ] Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM); [ 2 ] and a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine. [ 3 ] Aligning with conventional medicine could give chiropractors more university affiliation and access to hospitals and long-term facilities; aligning with the CAM movement could bring more patients looking for nonmedical approaches. [ 41 ] Chiropractors, juga dikenal sebagai dokter chiropractic atau dokter chiropractic [38] dalam yurisdiksi banyak, [39] menekankan manajemen konservatif sistem neuromusculoskeletal tanpa menggunakan obat atau operasi, [22] dengan penekanan khusus pada tulang belakang. [1] Chiropractic mengkombinasikan aspek dari arus utama dan alternatif obat, dan tidak ada kesepakatan tentang cara menetapkan profesi: chiropractors meskipun memiliki banyak atribut perawatan primer penyedia, chiropractic memiliki lebih dari atribut khas medis seperti kedokteran gigi atau podiatri . [4] Ini telah diusulkan bahwa chiropractors mengkhususkan dalam perawatan tulang belakang nonsurgical, bukannya berusaha untuk juga memperlakukan masalah lain, [25] [4] tetapi pandangan lebih luas chiropractic masih luas. [40] perawatan kesehatan Mainstream dan organisasi pemerintah seperti Dunia Organisasi Kesehatan menganggap chiropractic untuk pengobatan komplementer dan alternatif (CAM); [2] dan sebuah studi 2008 melaporkan bahwa 31% dari yang disurvei chiropractors chiropractic dikategorikan sebagai CAM, 27% sebagai obat terpadu, dan 12% sebagai obat utama. [3] Menyelaraskan dengan obat konvensional dapat memberikan chiropractors afiliasi universitas lebih dan akses ke rumah sakit dan fasilitas jangka panjang, menyelaraskan dengan gerakan CAM bisa membawa lebih banyak pasien mencari pendekatan nonmedis. [41]
The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation. [ 22 ] A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. [ 4 ] Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle counseling. [ 5 ] Praktek kedokteran chiropractic melibatkan berbagai metode diagnostik termasuk pencitraan tulang, dan taktil penilaian observasi, dan ortopedi dan evaluasi neurologis. [22] chiropractor juga bisa merujuk pasien ke spesialis yang tepat, atau bersama-mengelola dengan penyedia layanan kesehatan lain . [4] manajemen pasien umum melibatkan manipulasi tulang belakang (SM) dan terapi manual lainnya ke sendi dan jaringan lunak, latihan rehabilitasi, promosi kesehatan, modalitas listrik, prosedur komplementer, dan konseling gaya hidup. [5]
Chiropractors are not licensed to write medical prescriptions or perform major surgery in the US, [ 42 ] but that recently changed when New Mexico became the first state to allow "advanced practice" trained chiropractors the ability to prescribe certain medications. [ 43 ] [ 44 ] Their scope of practice varies by state, based on inconsistent views of chiropractic care: some states, such as Iowa, broadly allow treatment of "human ailments"; some, such as Delaware, use vague concepts such as "transition of nerve energy" to define scope of practice; others, such as New Jersey, specify a severely narrowed scope. [ 45 ] States also differ over whether chiropractors may conduct laboratory tests or diagnostic procedures, dispense dietary supplements , or use other therapies such as homeopathy and acupuncture; in Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. [ 42 ] A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs . [ 35 ] A related field, veterinary chiropractic , applies manual therapies to animals and is recognized in a few US states, [ 46 ] but is not recognized by the American Chiropractic Association as being chiropractic. [ 47 ] Chiropractors tidak diberi izin untuk menulis resep medis atau melakukan operasi besar di Amerika Serikat, [42] tetapi baru-baru ini berubah ketika New Mexico menjadi negara pertama untuk membolehkan "praktek lanjutan" chiropractors dilatih kemampuan untuk resep obat tertentu. [43] [44 ] ruang lingkup praktek mereka beragam menurut negara, berdasarkan pandangan yang tidak konsisten dari perawatan chiropractic: beberapa negara, seperti Iowa, luas memungkinkan pengobatan "penyakit manusia", beberapa, seperti Delaware, menggunakan konsep yang jelas, seperti "transisi saraf energi" untuk menentukan ruang lingkup praktek; lain, seperti New Jersey, tentukan lingkup menyipit parah. [45] Amerika juga berbeda tentang apakah chiropractors dapat melakukan tes laboratorium atau prosedur diagnostik, mengeluarkan suplemen makanan , atau menggunakan terapi lain seperti homeopati dan akupunktur; di Oregon mereka dapat menjadi bersertifikat untuk melakukan operasi kecil dan untuk memberikan anak-anak melalui melahirkan normal. [42] Sebuah survei 2003 dari Amerika Utara chiropractors menemukan bahwa mayoritas disukai sedikit memungkinkan mereka untuk menulis resep untuk -the-counter obat di atas . [35] Sebuah bidang terkait, hewan chiropractic , terapi manual berlaku untuk hewan dan diakui di beberapa negara bagian Amerika Serikat, [46] namun tidak diakui oleh American Chiropractic Association sebagai chiropractic sedang. [47]
Chiropractic overlaps with several other manual-therapy professions, including massage therapy , osteopathy , and physical therapy . [ 48 ] Chiropractic is autonomous and competitive with mainstream medicine, [ 49 ] and osteopathy outside the US remains primarily a manual medical system; [ 50 ] physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the US has merged with the medical profession. [ 49 ] Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise. [ 48 ] Chiropractic tumpang tindih dengan beberapa profesi manual-terapi lain, termasuk terapi pijat , osteopathy , dan terapi fisik . [48] Chiropractic adalah otonomi dan kompetitif dengan obat utama, [49] dan osteopathy di luar AS tetap terutama sistem medis manual; [50] terapis fisik bekerja bersama dan bekerja sama dengan obat utama, dan obat osteopathic di AS telah bergabung dengan profesi medis. [49] Anggota membedakan profesi ini bersaing dengan retoris strategi yang mencakup klaim bahwa, dibandingkan dengan profesi lain, chiropractors sangat menekankan manipulasi tulang belakang, cenderung menggunakan teknik-teknik manipulatif lebih kencang, dan mempromosikan perawatan pemeliharaan; yang osteopath menggunakan berbagai prosedur pengobatan yang lebih luas, dan yang menekankan mesin terapi fisik dan olahraga. [48]
No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. Tidak ada profesi tunggal "memiliki" manipulasi tulang belakang dan ada sedikit kesepakatan sebagai profesi yang harus mengelola SM, meningkatkan keprihatinan oleh chiropractors bahwa dokter medis ortodoks bisa "mencuri" prosedur SM dari chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. [ 18 ] Two US states (Washington and Arkansas) prohibit physical therapists from performing SM, [ citation needed ] some states allow them to do it only if they have completed advanced training in SM, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Fokus pada SM berdasarkan penelitian-bukti juga telah menyuarakan keprihatinan bahwa pedoman praktek yang dihasilkan bisa membatasi ruang lingkup praktek chiropractic untuk mengobati punggung dan leher. [18] Dua negara bagian Amerika Serikat (Washington dan Arkansas) melarang terapis fisik dari SM melakukan, [ kutipan diperlukan ] beberapa negara memungkinkan mereka untuk melakukannya hanya jika mereka telah menyelesaikan pelatihan tingkat lanjut di SM, dan beberapa negara mengizinkan hanya chiropractors untuk melakukan SM, atau hanya ahli tulang dan dokter. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations. [ 51 ] Tagihan untuk lebih melarang non-chiropractors dari SM melakukan secara teratur diperkenalkan ke dalam badan legislatif negara dan ditentang oleh organisasi terapis fisik. [51]
[ edit ] Treatment techniques [ sunting ] Teknik Perawatan
Main articles: Chiropractic treatment techniques and Spinal adjustment Artikel utama: teknik pengobatan Chiropractic dan Spinal penyesuaian
Spinal manipulation , which chiropractors call "spinal adjustment" or "chiropractic adjustment", is the most common treatment used in chiropractic care; [ 52 ] in the US, chiropractors perform over 90% of all manipulative treatments. [ 53 ] Spinal manipulation is a passive manual maneuver during which a three-joint complex is taken past the normal range of movement, but not so far as to dislocate or damage the joint; its defining factor is a dynamic thrust, which is a sudden force that causes an audible release and attempts to increase a joint's range of motion. manipulasi tulang belakang , yang chiropractors panggilan "penyesuaian tulang belakang" atau "penyesuaian chiropractic", adalah perawatan yang paling umum digunakan dalam perawatan chiropractic; [52] di Amerika Serikat, chiropractors melakukan lebih dari 90% dari semua perlakuan manipulatif. [53] Spinal manipulasi adalah Manuver manual pasif selama tiga kompleks-bersama adalah diambil masa lalu kisaran normal gerakan, tetapi tidak terlalu jauh dengan merusak atau kerusakan sambungan; faktor yang menentukan adalah dorongan dinamis, yang merupakan kekuatan tiba-tiba yang menyebabkan rilis terdengar dan upaya untuk meningkatkan kisaran bersama tentang gerak. More generally, spinal manipulative therapy (SMT) describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. [ 54 ] Secara umum, terapi manipulatif tulang belakang (TPS) menggambarkan teknik dimana tangan digunakan untuk memanipulasi, pijat, memobilisasi, menyesuaikan, merangsang, berlaku traksi, atau sebaliknya mempengaruhi tulang belakang dan jaringan terkait. [54]
There are several schools of chiropractic adjustive techniques, although most chiropractors mix techniques from several schools. Ada beberapa sekolah teknik adjustive chiropractic, meskipun sebagian besar teknik chiropractors campuran dari beberapa sekolah. The following adjustive procedures were received by more than 10% of patients of licensed US chiropractors in a 2003 survey: [ 52 ] Diversified technique (full-spine manipulation, employing various techniques), extremity adjusting, Activator technique (which uses a spring loaded tool to deliver precise adjustments to the spine), Thompson Technique (which relies on a drop table and detailed procedural protocols), Gonstead (which emphasizes evaluating the spine along with specific adjustment that avoids rotational vectors), Cox/flexion-distraction (a gentle, low-force adjusting procedure which mixes chiropractic with osteopathic principles and utilizes specialized adjusting tables with movable parts), adjustive instrument, Sacro-Occipital Technique (which models the spine as a torsion bar), Nimmo Receptor-Tonus Technique , Applied Kinesiology (which emphasises "muscle testing" as a diagnostic tool), and cranial. [ 55 ] Medicine-assisted manipulation, such as manipulation under anesthesia , involves sedation or local anesthetic and is done by a team that includes an anesthesiologist ; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain. [ 56 ] Prosedur adjustive berikut ini telah diterima oleh lebih dari 10% pasien dari chiropractors US berlisensi dalam survei 2003: [52] Diversifikasi teknik (penuh manipulasi tulang belakang, menggunakan berbagai teknik), menyesuaikan ekstremitas, teknik Activator (yang menggunakan alat dimuat musim semi untuk memberikan penyesuaian yang tepat pada tulang belakang), Thompson Teknik (yang bergantung pada meja drop dan protokol rinci prosedural), Gonstead (yang menekankan mengevaluasi tulang belakang bersama dengan penyesuaian tertentu yang menghindari vektor rotasi), Cox / fleksi-gangguan (yang lembut, rendah kekuatan menyesuaikan prosedur yang campuran chiropractic dengan prinsip osteopathic dan menggunakan tabel khusus menyesuaikan dengan bagian-bagian bergerak), instrumen adjustive, Sacro-oksipital Teknik (yang model tulang belakang sebagai bar torsi), Nimmo Lubang-tonus Teknik , Applied Kinesiology (yang menekankan "otot pengujian" sebagai alat diagnostik), dan tengkorak. [55] yang dibantu Kedokteran manipulasi, seperti manipulasi di bawah anestesi , melibatkan sedasi atau obat bius lokal dan dilakukan oleh tim yang mencakup anestesi ; sistematis penilaian tahun 2008 tidak menemukan cukup bukti untuk membuat rekomendasi tentang penggunaannya untuk nyeri pinggang kronis. [56]
Many other procedures are used by chiropractors for treating the spine, other joints and tissues, and general health issues. Banyak prosedur lain yang digunakan oleh ahli tulang untuk mengobati tulang belakang, sendi dan jaringan lain, dan masalah kesehatan umum. The following procedures were received by more than 1/3 of patients of licensed US chiropractors in a 2003 survey: Diversified technique (full-spine manipulation; mentioned in previous paragraph), physical fitness / exercise promotion, corrective or therapeutic exercise, ergonomic / postural advice, self-care strategies, activities of daily living , changing risky/unhealthy behaviors, nutritional/dietary recommendations, relaxation / stress reduction recommendations, ice pack/cryotherapy , extremity adjusting (also mentioned in previous paragraph), trigger point therapy , and disease prevention /early screening advice. [ 52 ] Prosedur berikut ini telah diterima oleh lebih dari 1 / 3 dari penderita chiropractors US berlisensi dalam survei 2003: teknik Diversifikasi (lengkap manipulasi tulang belakang; disebutkan dalam ayat sebelumnya), kebugaran fisik / latihan promosi, atau terapi latihan perbaikan, ergonomis / postural saran, perawatan diri strategi, aktivitas hidup sehari-hari , mengubah berisiko / perilaku tidak sehat, gizi makanan / rekomendasi, relaksasi / mengurangi stres rekomendasi, pak es / cryotherapy , menyesuaikan ekstremitas (juga disebutkan dalam paragraf sebelumnya), memicu titik terapi , dan penyakit pencegahan / awal skrining saran. [52]
[ edit ] Education, licensing, and regulation [ sunting ] Pendidikan, perizinan, dan regulasi
Main articles: Chiropractic education and List of chiropractic schools Artikel utama: pendidikan Chiropractic dan Daftar sekolah chiropractic
Chiropractors obtain a first professional degree in the field of chiropractic. [ 57 ] Although chiropractors often argue that this education is as good as or better than medical physicians', most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing . [ 45 ] Accredited chiropractic programs require that applicants have 90 semester hours of undergraduate education with a grade point average of at least 2.5; many programs require at least three years of undergraduate education, and more are requiring a bachelor's degree. [ 58 ] Canada requires a minimum three years of undergraduate education for applicants, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program. [ 59 ] The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Chiropractors memperoleh gelar profesional pertama di bidang chiropractic. [57] Meskipun chiropractors sering berpendapat bahwa pendidikan ini adalah sebagai baik atau lebih baik daripada kebanyakan, chiropractic pelatihan dokter medis terbatas pada ruang kelas dengan banyak waktu yang dihabiskan belajar teori, penyesuaian, dan pemasaran . [45] program chiropractic terakreditasi mengharuskan pelamar memiliki jam semester 90 dari pendidikan sarjana dengan rata-rata indeks prestasi minimal 2,5; banyak program yang membutuhkan setidaknya tiga tahun pendidikan sarjana, dan lebih banyak membutuhkan sarjana gelar. [58] Kanada membutuhkan minimal tiga tahun dari pendidikan sarjana untuk pelamar, dan setidaknya 4200 jam pembelajaran (atau setara) waktu chiropractic Pendidikan-lengkap untuk matrikulasi melalui program chiropractic terakreditasi. [59] The Organisasi Kesehatan Dunia (WHO) menyarankan tiga pedoman pendidikan jalur utama waktu-penuh yang berpuncak pada baik DC, DCM, BSc, atau MSc derajat. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. [ 22 ] Selain waktu jalan penuh, mereka juga menyarankan program konversi bagi orang-orang dengan pendidikan kesehatan lainnya perawatan dan program-program pelatihan yang terbatas untuk daerah di mana undang-undang tidak mengatur chiropractic. [22]
Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction. [ 60 ] [ 61 ] Depending on the location, continuing education may be required to renew these licenses. [ 62 ] [ 63 ] Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics . [ 64 ] Setelah lulus, mungkin ada persyaratan untuk lulus nasional, negara, atau pemeriksaan dewan provinsi sebelum yang berlisensi untuk praktek dalam yurisdiksi tertentu. [60] [61] Tergantung pada lokasi, pendidikan berkelanjutan mungkin diperlukan untuk memperbarui lisensi tersebut. [ 62] [63] pelatihan khusus tersedia melalui program pendidikan pascasarjana waktu-bagian seperti chiropractic ortopedi dan chiropractic olahraga, dan melalui program-waktu residensi lengkap seperti radiologi atau ortopedi . [64]
Chiropractic is established in the US , Canada , and Australia , and is present to a lesser extent in many other countries. [ 10 ] In the US, chiropractic schools are accredited through the Council on Chiropractic Education (CCE) while the General Chiropractic Council (GCC) is the statutory governmental body responsible for the regulation of chiropractic in the UK. [ 65 ] [ 66 ] The US CCE requires a mixing curriculum, which means a straight-educated chiropractor may not be eligible for licensing in states requiring CCE accreditation. [ 45 ] CCEs in the US, Canada, Australia and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. [ 67 ] Today, there are 18 accredited Doctor of Chiropractic programs in the US, [ 68 ] 2 in Canada, [ 69 ] 6 in Australasia, [ 70 ] and 5 in Europe. [ 71 ] All but one of the chiropractic colleges in the US are privately funded, but in several other countries they are in government-sponsored universities and colleges. [ 12 ] Chiropractic curricula in the US have been criticized for failing to meet generally accepted standards of evidence-based medicine. [ 72 ] Chiropractic didirikan di Amerika Serikat , Kanada , dan Australia , dan hadir ke tingkat yang lebih rendah di banyak negara lain. [10] Di Amerika Serikat, sekolah chiropractic telah diakreditasi melalui Dewan Pendidikan Chiropractic (CCE) sedangkan Chiropractic Umum Dewan ( GCC) adalah badan pemerintah wajib bertanggung jawab atas regulasi chiropractic di Inggris. [65] [66] The CCE AS mewajibkan kurikulum pencampuran, yang berarti berpendidikan chiropractor lurus mungkin tidak memenuhi persyaratan untuk lisensi di negara-negara yang membutuhkan akreditasi CCE. [45] CCEs di Amerika Serikat, Kanada, Australia dan Eropa telah bergabung untuk membentuk CCE-Internasional (CCE-I) sebagai model standar akreditasi dengan tujuan memiliki mandat portabel internasional. [67] Hari ini, ada 18 Dokter terakreditasi program Chiropractic di Amerika Serikat, [68] 2 dalam Kanada, [69] 6 di Australasia, [70] dan 5 di Eropa. [71] Semua kecuali salah satu perguruan tinggi chiropractic di AS didanai secara pribadi, tetapi di beberapa lainnya negara mereka berada di universitas yang disponsori pemerintah dan perguruan tinggi. [12] kurikulum Chiropractic di AS telah dikritik karena gagal memenuhi standar yang berlaku umumnya obat berbasis bukti. [72]
Regulatory colleges and chiropractic boards in the US, Canada, and Australia are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. [ 73 ] [ 74 ] There are an estimated 53,000 chiropractors in the US (2006), [ 75 ] 7,000 in Canada (2009), [ 76 ] 2,500 in Australia (2000), [ 77 ] and 1,500 in the UK (2000). [ 78 ] Peraturan dan perguruan tinggi papan chiropractic di AS, Kanada, dan Australia bertanggung jawab untuk melindungi masyarakat, standar praktek, masalah disiplin, jaminan kualitas dan pemeliharaan kompetensi. [73] [74] Ada sebuah 53.000 chiropractors diperkirakan di Amerika Serikat ( 2006), [75] 7.000 orang di Kanada (2009), [76] 2.500 di Australia (2000), [77] dan 1.500 di Inggris (2000). [78]
A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery , which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. [ 25 ] A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20). [ 79 ] Sebuah komentar 2008 diusulkan bahwa profesi chiropractic aktif mengatur diri sendiri untuk melawan penyalahgunaan, penipuan, dan perdukunan , yang lebih menonjol di chiropractic dari dalam profesi kesehatan lain, melanggar kontrak sosial antara pasien dan dokter. [25] Sebuah studi California disiplin statistik selama 1997-2000 melaporkan 4,5 tindakan disipliner per 1000 chiropractors per tahun, dibandingkan dengan 2,27 untuk orthopaedi; tingkat insiden untuk penipuan adalah 9 kali lebih besar di antara chiropractors (1,99 per 1000 chiropractors per tahun) dari kalangan orthopaedi (0,20). [79]
[ edit ] Utilization, satisfaction rates, and third party coverage [ sunting Pemanfaatan], tingkat kepuasan, dan cakupan pihak ketiga
In the US, chiropractic is the largest alternative medical profession, [ 9 ] and is the third largest doctored profession, behind medicine and dentistry . [ 80 ] The percentage of population that utilizes chiropractic care at any given time generally falls into a range from 6% to 12% in the US and Canada, [ 81 ] with a global high of 20% in Alberta . [ 82 ] Chiropractors are the most common CAM providers for children and adolescents, who consume up to 14% of all visits to chiropractors. [ 83 ] The vast majority who seek chiropractic care do so for relief from back and neck pain and other neuromusculoskeletal complaints; [ 84 ] most do so specifically for low back pain. Di AS, chiropractic merupakan alternatif profesi medis terbesar, [9] dan merupakan mengobati profesi terbesar ketiga, di belakang kedokteran dan kedokteran gigi . [80] Persentase penduduk yang memanfaatkan perawatan chiropractic pada waktu tertentu pada umumnya jatuh ke kisaran dari 6 % sampai 12% di Amerika Serikat dan Kanada, [81] dengan global tinggi 20% di Alberta . [82] kiropraktor adalah penyedia CAM kebanyakan untuk anak-anak dan remaja, yang mengkonsumsi sampai 14% dari semua kunjungan ke chiropractors. [83] Sebagian besar yang mencari perawatan chiropractic melakukannya untuk bantuan dari belakang dan nyeri leher dan keluhan neuromusculoskeletal lainnya; [84] kebanyakan melakukannya secara khusus untuk rendah kembali sakit. Practitioners such as chiropractors are often used as a complementary form of care to primary medical intervention. [ 81 ] Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 US survey reporting 83% of respondents satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors. [ 85 ] Praktisi seperti chiropractors sering digunakan sebagai pelengkap bentuk kepedulian terhadap intervensi medis yang utama. [81] tarif Kepuasan biasanya lebih tinggi untuk perawatan chiropractic dibandingkan dengan perawatan medis, dengan survei 1998 US pelaporan 83% responden puas atau sangat puas dengan mereka peduli; kualitas komunikasi tampaknya menjadi prediktor kepuasan pasien konsisten dengan chiropractors. [85]
Chiropractic does not have the same level of mainstream credibility as other healthcare professions. Chiropractic tidak memiliki tingkat sama kredibilitas mainstream sebagai profesi kesehatan lainnya. Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 Gallup Poll of US adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for the other professions ranged from 62% for dentists to 84% for nurses. [ 25 ] [ 86 ] [ 87 ] The 2008 book Trick or Treatment states chiropractors, especially in America, have a reputation for unnecessarily treating patients, and in many circumstances the focus seems to be put on economics instead of health care. [ 36 ] Many chiropractors have sought to address their minor status within the US medical community by attending practice-building seminars to assist chiropractors to persuade their patients of the efficacy of their treatments, increase their revenue, and boost their morale as unorthodox medical practitioners. [ 88 ] Unsubstantiated claims about the efficacy of chiropractic have continued to be made by individual chiropractors and chiropractic associations. [ 14 ] The largest chiropractic associations in the US and Canada distributed patient brochures which contained unsubstantiated claims. [ 89 ] Sustained chiropractic care is promoted as a preventative tool but unnecessary manipulation could possibly present a risk to patients. persepsi umum chiropractic kurang menguntungkan dibandingkan dengan obat utama berkaitan dengan etika dan kejujuran: dalam tahun 2006 Gallup Poll orang dewasa AS, chiropractors rate terakhir di antara tujuh perawatan profesi kesehatan untuk menjadi sangat tinggi atau tinggi dalam kejujuran dan standar etika, dengan 36% dari jajak pendapat chiropractors responden rating sangat tinggi atau tinggi, peringkat yang sesuai untuk profesi lain berkisar dari 62% untuk dokter gigi sampai 84% untuk perawat. [25] [86] [87] Buku 2008 Trik atau Perawatan chiropractors negara, khususnya di Amerika, telah reputasi untuk merawat pasien yang tidak perlu, dan dalam keadaan banyak fokus tampaknya diletakkan pada ekonomi bukan perawatan kesehatan. [36] Banyak ahli tulang telah berusaha untuk mengatasi status kecil mereka dalam komunitas medis AS dengan menghadiri seminar praktek pembangunan untuk membantu chiropractors untuk membujuk pasien mereka tentang kemanjuran pengobatan, meningkatkan pendapatan mereka, dan meningkatkan semangat mereka sebagai praktisi medis ortodoks. [88] yang belum terbukti kebenarannya tentang kemanjuran chiropractic terus dilakukan oleh individu dan asosiasi chiropractors chiropractic. [14] The asosiasi chiropractic terbesar di AS dan Kanada didistribusikan brosur yang berisi pasien yang belum terbukti kebenarannya. [89] Diterima perawatan chiropractic dipromosikan sebagai alat pencegahan tapi manipulasi yang tidak perlu mungkin bisa menimbulkan resiko pada pasien. Some chiropractors are concerned by the routine unjustified claims chiropractors have made. [ 14 ] Beberapa chiropractors prihatin oleh klaim tidak berdasar chiropractors rutin telah dibuat. [14]
Utilization of chiropractic care is sensitive to the costs incurred by the co-payment by the patient. [ 2 ] The use of chiropractic declined from 9.9% of US adults in 1997 to 7.4% in 2002; this was the largest relative decrease among CAM professions, which overall had a stable use rate. [ 90 ] Employment of US chiropractors is expected to increase 14% between 2006 and 2016, faster than the average for all occupations. [ 75 ] Pemanfaatan perawatan chiropractic sensitif terhadap biaya yang dikeluarkan oleh rekan pembayaran oleh pasien. [2] Penggunaan chiropractic menurun dari 9,9% orang dewasa Amerika Serikat pada tahun 1997 menjadi 7,4% pada tahun 2002, ini adalah penurunan relatif terbesar di antara profesi CAM , yang secara keseluruhan memiliki tingkat penggunaan yang stabil. [90] Tenaga Kerja chiropractors AS diperkirakan akan meningkat 14% antara tahun 2006 dan 2016, lebih cepat daripada rata-rata untuk semua pekerjaan. [75]
In the US, most states require insurers to cover chiropractic care, and most HMOs cover these services. [ 83 ] In Canada, there is lack of coverage under the universal public health insurance system. [ 91 ] In Australia, most private health insurance funds cover chiropractic care, and the federal government funds chiropractic care when the patient is referred by a medical practitioner. [ 92 ] Di Amerika Serikat, negara yang paling membutuhkan asuransi untuk menutup perawatan chiropractic, dan yang paling HMO menutup layanan tersebut. [83] Di Kanada, ada kurangnya cakupan bawah sistem asuransi kesehatan masyarakat universal. [91] Di Australia, sebagian besar dana asuransi kesehatan swasta meliputi perawatan chiropractic, dan dana pemerintah federal perawatan chiropractic ketika pasien disebut oleh praktisi medis. [92]
[ edit ] History and controversy [ sunting Sejarah] dan kontroversi
Main articles: Chiropractic history and Chiropractic controversy and criticism Artikel utama: Sejarah Chiropractic dan kontroversi dan kritik Chiropractic
Setengah-panjang duduk potret manusia dalam lima puluhan dengan jenggot abu-abu besar dan kumis, memakai jas dan rompi
DD Palmer DD Palmer
Chiropractic was founded in the 1890s by Daniel David (DD) Palmer in Davenport, Iowa . Chiropractic didirikan pada tahun 1890-an oleh Daniel David (DD) Palmer di Davenport, Iowa . Palmer, a magnetic healer , hypothesized that manual manipulation of the spine could cure disease. Palmer, seorang penyembuh magnetik , hipotesis bahwa manipulasi manual tulang belakang bisa menyembuhkan penyakit. Chiropractic competed with its predecessor osteopathy , another medical system based on magnetic healing and bonesetting ; both systems were founded by charismatic midwesterners in opposition to the conventional medicine of the day, and both postulated that manipulation improved health. [ 93 ] Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it to a few students at his new Palmer School of Chiropractic . Chiropractic bersaing dengan pendahulunya osteopathy , sistem lain penyembuhan medis berdasarkan magnetik dan bonesetting ; kedua sistem yang didirikan oleh midwesterners karismatik bertentangan dengan obat konvensional hari itu, dan keduanya menduga bahwa manipulasi peningkatan kesehatan. [93] Walaupun awalnya sebuah chiropractic menjaga rahasia keluarga, Palmer pada tahun 1898 mulai mengajarkannya kepada beberapa murid di baru Palmer School of Chiropractic . One student, his son Bartlett Joshua (BJ) Palmer , became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment. [ 8 ] Satu mahasiswa, anaknya Yosua Bartlett (BJ) Palmer , menjadi berkomitmen untuk mempromosikan chiropractic, mengambil alih Sekolah Palmer pada tahun 1906, dan pendaftaran yang cepat berkembang. [8]
Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence , a vital nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions. Awal chiropractors percaya bahwa semua penyakit disebabkan oleh gangguan aliran kecerdasan bawaan , yang penting energi yang gugup atau kekuatan hidup yang diwakili Kehadiran Tuhan dalam diri manusia; pemimpin chiropractic sering dipanggil pencitraan keagamaan dan tradisi moral. DD and BJ both seriously considered declaring chiropractic a religion, which might have provided legal protection under the US constitution , but decided against it partly to avoid confusion with Christian Science . [ 8 ] [ 94 ] Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts , among which they included the American Medical Association (AMA). [ 8 ] DD dan BJ kedua menyatakan chiropractic dianggap serius agama, yang mungkin telah memberikan perlindungan hukum di bawah konstitusi AS , tetapi memutuskan untuk tidak sebagian untuk menghindari kerancuan dengan Christian Science . [8] [94] chiropractors awal juga mengetuk ke dalam Kerakyatan gerakan, menekankan kerajinan, kerja keras, kompetisi, dan iklan, menyelaraskan diri dengan orang-orang biasa terhadap kaum intelektual dan percaya , di antara yang mereka termasuk American Medical Association (AMA). [8]
Chiropractic has seen considerable controversy and criticism . [ 11 ] [ 12 ] Although DD and BJ were "straight" and disdained the use of instruments, some early chiropractors, whom BJ scornfully called "mixers", advocated the use of instruments. Chiropractic telah melihat cukup kontroversi dan kritik . [11] [12] Meskipun DD dan BJ adalah "lurus" dan meremehkan penggunaan instrumen, beberapa ahli tulang awal, yang mencemooh BJ disebut "mixer", menganjurkan penggunaan instrumen. In 1910 BJ changed course and endorsed X-rays as necessary for diagnosis; this resulted in a significant exodus from the Palmer School of the more conservative faculty and students. Pada tahun 1910 BJ mengubah arah dan didukung X-sinar yang diperlukan untuk diagnosis, ini mengakibatkan eksodus signifikan dari Sekolah Palmer dari fakultas lebih konservatif dan mahasiswa. The mixer camp grew until by 1924 BJ estimated that only 3,000 of the US's 25,000 chiropractors remained straight. Kamp mixer tumbuh sampai dengan 1924 BJ diperkirakan hanya 3.000 dari 25.000 di AS itu chiropractors tetap lurus. That year, BJ's invention and promotion of the neurocalometer, a temperature-sensing device, was highly controversial among BJ's fellow straights. Tahun itu, penemuan BJ dan promosi dari neurocalometer, perangkat suhu-sensing, sangat kontroversial antara sesama BJ lurus. By the 1930s chiropractic was the largest alternative healing profession in the US [ 8 ] The 2008 book Trick or Treatment states that in 1913 BJ Palmer ran over his father, DD Palmer, at a homecoming parade for the Palmer School of Chiropractic in Davenport, Iowa. Pada tahun 1930-an chiropractic adalah penyembuhan alternatif profesi terbesar di AS [8] Buku 2008 Trik atau Perawatan menyatakan bahwa pada tahun 1913 BJ Palmer berlari ayahnya, DD Palmer, pada parade homecoming untuk Sekolah Palmer of Chiropractic di Davenport, Iowa . Weeks later DD Palmer died in Los Angeles. DD Palmer minggu kemudian meninggal di Los Angeles. The official cause of death was recorded as typhoid . Penyebab kematian resmi tercatat sebagai tifus . The book Trick or Treatment indicated "it seems more likely that his death was a direct result of injuries caused by his son." [ 95 ] Chiropractic historian Joseph C. Keating, Jr. has described the attempted patricide of DD Palmer as a "myth" and "absurd on its face" and cites an eyewitness who recalled that DD was not struck by BJ's car, but rather, had stumbled. [ 96 ] He also says that "Joy Loban, DC, executor of DD's estate, voluntarily withdrew a civil suit claiming damages against BJ Palmer, and that several grand juries repeatedly refused to bring criminal charges against the son." [ 96 ] Buku ini Trik atau Treatment menunjukkan "tampaknya lebih mungkin bahwa kematiannya adalah akibat langsung dari luka yang disebabkan oleh anaknya". [95] Chiropractic sejarawan Joseph C. Keating, Jr telah menggambarkan percobaan pembunuhan ayah DD Palmer sebagai "mitos "dan" konyol di wajah "dan mengutip seorang saksi mata yang ingat bahwa DD tidak terkena mobil BJ, melainkan, sudah tersandung. [96] Ia juga mengatakan bahwa "Joy Loban, DC, pelaksana's real DD, secara sukarela menarik sebuah kerusakan mengklaim gugatan perdata terhadap BJ Palmer, dan bahwa beberapa juri grand berulang kali menolak untuk membawa tuduhan kriminal terhadap anak. " [96]
Chiropractors faced heavy opposition from organized medicine. Chiropractors menghadapi oposisi berat dari obat teratur. Thousands of chiropractors were prosecuted for practicing medicine without a license , and DD and many other chiropractors were jailed. Ribuan chiropractors dituntut untuk mempraktikkan kedokteran tanpa lisensi , dan DD dan chiropractors lainnya dipenjara. To defend against medical statutes BJ argued that chiropractic was separate and distinct from medicine, asserting that chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxations rather than "treated" disease. Untuk mempertahankan melawan ketetapan medis BJ berpendapat bahwa chiropractic terpisah dan berbeda dari kedokteran, menyatakan bahwa chiropractors "dianalisis" daripada "didiagnosis", dan "disesuaikan" Subluksasi-subluksasi bukan "diperlakukan" penyakit. BJ cofounded the Universal Chiropractors' Association (UCA) to provide legal services to arrested chiropractors. BJ dirikan pada kiropraktor Universal 'Association (UCA) untuk memberikan pelayanan hukum kepada chiropractors ditangkap. Although the UCA won their first test case in Wisconsin in 1907, prosecutions instigated by state medical boards became increasingly common and in many cases were successful. Meskipun UCA tes pertama mereka memenangkan kasus di Wisconsin pada tahun 1907, penuntutan dihasut oleh dewan negara medis menjadi semakin umum dan dalam banyak kasus yang berhasil. In response, chiropractors conducted political campaigns to secure separate licensing statutes, eventually succeeding in all fifty states, from Kansas in 1913 through Louisiana in 1974. [ 30 ] The longstanding feud between chiropractors and medical doctors continued for decades. Sebagai tanggapan, chiropractors melakukan kampanye politik untuk mengamankan undang-undang perizinan terpisah, akhirnya berhasil di semua negara lima puluh, dari Kansas pada tahun 1913 melalui Louisiana pada tahun 1974. [30] The perseteruan lama antara ahli tulang dan dokter medis terus selama beberapa dekade. The AMA labeled chiropractic an "unscientific cult " in 1966, [ 16 ] and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners". [ 97 ] This culminated in a landmark 1987 decision, Wilk v. AMA , in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic. [ 17 ] In 2008 and 2009, chiropractors, including the British Chiropractic Association , used libel lawsuits and threats of lawsuits against their critics, [ 98 ] however, a libel case against critic and science writer Simon Singh ended with the BCA withdrawing its suit in 2010. [ 99 ] [ 100 ] AMA berlabel chiropractic sebuah "ilmiah sekte "pada tahun 1966, [16] dan sampai dengan tahun 1980 menyatakan bahwa hal itu tidak etis untuk dokter medis untuk mengasosiasikan dengan "praktisi tidak ilmiah". [97] tengara ini memuncak pada tahun 1987 keputusan, Wilk v. AMA , di mana pengadilan menemukan bahwa AMA telah terlibat dalam menahan diri tidak masuk akal perdagangan dan konspirasi, dan yang berakhir AMA de boikot facto chiropractic. [17] Pada tahun 2008 dan 2009, chiropractors, termasuk British Chiropractic Association , digunakan fitnah tuntutan hukum dan ancaman dari tuntutan terhadap kritik mereka, [98] Namun, kasus pencemaran nama baik terhadap kritik dan penulis sains Simon Singh berakhir dengan BCA menarik gugatan pada 2010. [99] [100]
Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. Serius penelitian untuk menguji teori chiropractic tidak dimulai sampai tahun 1970, dan terus menjadi terhambat oleh apa yang ditandai sebagai anti-ilmu dan keilmu-ilmuan ide yang berkelanjutan profesi dalam pertempuran panjang dengan obat terorganisir. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to improve service quality and establish clinical guidelines that recommended manual therapies for acute low back pain. [ 30 ] In recent decades chiropractic gained legitimacy and greater acceptance by medical physicians and health plans , and enjoyed a strong political base and sustained demand for services. Pada pertengahan 1990-an ada minat ilmiah tumbuh di chiropractic, yang membantu upaya-upaya untuk meningkatkan kualitas pelayanan dan menetapkan pedoman terapi klinis yang direkomendasikan manual untuk nyeri pinggang akut. [30] Dalam beberapa dekade terakhir chiropractic mendapatkan legitimasi dan penerimaan yang lebih besar oleh dokter medis dan rencana kesehatan , dan menikmati basis politik yang kuat dan berkelanjutan untuk permintaan layanan. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. Namun, masa depannya tampak tidak pasti: karena jumlah praktisi tumbuh, obat berbasis bukti bersikeras perawatan dengan nilai menunjukkan, dikelola perawatan Pembatasan pembayaran, dan persaingan tumbuh dari terapis pijat dan profesi kesehatan lainnya. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care . [ 17 ] Profesi menanggapinya dengan pemasaran produk alam dan perangkat lebih agresif, dan dengan menjangkau lebih dalam pengobatan alternatif dan perawatan primer . [17]
[ edit ] Evidence basis [ sunting Bukti dasar]
The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care . [ 18 ] Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs what is considered by many chiropractic researchers to be antiscientific reasoning and unsubstantiated claims, [ 1 ] [ 7 ] [ 13 ] [ 101 ] that have been called ethically suspect when they let practitioners maintain their beliefs to patients' detriment. [ 1 ] A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice, which may have resulted from a lack of research education and skills. [ 102 ] Continued education enhances the scientific knowledge of the practitioner. [ 103 ] Prinsip-prinsip berbasis bukti obat telah digunakan untuk meninjau studi penelitian dan menghasilkan pedoman praktek yang menguraikan standar profesional yang menetapkan perawatan chiropractic yang sah dan mungkin ditagih kembali di bawah perawatan dikelola . [18] -didasarkan pedoman Bukti didukung oleh salah satu ujung sebuah ideologi kontinum antara chiropractors; ujung yang lain menggunakan apa yang dianggap oleh banyak peneliti chiropractic menjadi anti-ilmu penalaran dan belum terbukti kebenarannya, [1] [7] [13] [101] yang telah disebut etis tersangka ketika mereka membiarkan praktisi mempertahankan kepercayaan mereka kepada pasien 'merugikan. [1] Sebuah survei tahun 2007 sebesar Alberta chiropractors menemukan bahwa mereka tidak konsisten menerapkan penelitian dalam praktek, yang mungkin dihasilkan dari kurangnya pendidikan dan keterampilan penelitian. [102] Lanjutan meningkatkan pendidikan ilmu pengetahuan praktisi. [ 103]
[ edit ] Effectiveness [ sunting ] Efektivitas
Opinions differ as to the efficacy of chiropractic treatment. [ 12 ] Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree, [ 104 ] and they are typically of low quality. [ 105 ] Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by only low levels of scientific evidence [ 83 ] [ 106 ] that does not demonstrate clinically relevant benefits. [ 107 ] A 2010 Cochrane review determined the effects of combined chiropractic interventions were "slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions." [ 108 ] A 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, [ 14 ] but a 2008 supportive review found serious flaws in the critical approach and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. [ 109 ] Most research has focused on spinal manipulation (SM) in general, [ 110 ] rather than solely on chiropractic SM. [ 18 ] A 2002 review of randomized clinical trials of SM [ 4 ] was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular; [ 111 ] however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it. [ 110 ] Berbeda pendapat mengenai keampuhan pengobatan chiropractic. [12] Banyak studi klinis terkendali manipulasi tulang belakang (SM) tersedia, tapi hasilnya tidak setuju, [104] dan mereka biasanya kualitas rendah. [105] Kesehatan klaim yang dibuat oleh chiropractors tentang penggunaan manipulasi untuk kondisi kesehatan anak hanya didukung oleh rendahnya tingkat bukti ilmiah [83] [106] yang tidak menunjukkan manfaat klinis yang relevan. [107] A 2010 Cochrane review menentukan dampak chiropractic intervensi gabungan telah sedikit membaik sakit "dan disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions." [ 108 ] A 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, [ 14 ] but a 2008 supportive review found serious flaws in the critical approach and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. [ 109 ] Most research has focused on spinal manipulation (SM) in general, [ 110 ] rather than solely on chiropractic SM. [ 18 ] A 2002 review of randomized clinical trials of SM [ 4 ] was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular; [ 111 ] however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it. [ 110 ]
There is a wide range of ways to measure treatment outcomes. [ 112 ] Chiropractic care, like all medical treatment, benefits from the placebo response . [ 113 ] It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. [ 114 ] The efficacy of maintenance care in chiropractic is unknown. [ 19 ] Ada berbagai cara untuk mengukur hasil pengobatan. [112] Chiropractic perawatan, seperti perawatan medis, manfaat dari respon plasebo . [113] Sulit untuk membangun sebuah plasebo terpercaya untuk uji klinis dari terapi manipulatif tulang belakang (TPS) , sebagai ahli sering tidak sepakat tentang apakah sebenarnya yang diusulkan plasebo tidak memiliki efek. [114] Efektivitas perawatan perawatan chiropractic tidak diketahui. [19]
Available evidence covers the following conditions: Tersedia bukti meliputi kondisi berikut:
* Low back pain . Rendah kembali sakit . There is continuing conflict of opinion on the efficacy of SMT for nonspecific (ie, unknown cause) low back pain. [ 115 ] A 2008 review found strong evidence that SM is similar in effect to medical care with exercise. [ 109 ] A 2007 review found good evidence that SM is moderately effective for low back pain lasting more than 4 weeks; [ 116 ] a 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration. [ 117 ] Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review [ 118 ] found that SM or mobilization is no more or less effective than other standard interventions for back pain. [ 104 ] Methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability. [ 115 ] Ada konflik pendapat tentang kemanjuran dari TPS untuk spesifik (yaitu, penyebab) tidak diketahui rendah terus sakit punggung adalah. [115] Sebuah penilaian tahun 2008 menemukan bukti kuat bahwa SM serupa berlaku untuk perawatan medis dengan olahraga. [109] A review 2007 menemukan bukti kuat bahwa SM adalah cukup efektif untuk nyeri pinggang yang berlangsung lebih dari 4 minggu; [116] sastra sintesis 2008 menemukan bukti kuat untuk mendukung SM nyeri pinggang tanpa durasi. [117] Dari empat tinjauan sistematis diterbitkan antara tahun 2000 dan Mei 2005, hanya satu SM yang direkomendasikan, dan 2004 Cochrane review [118] menemukan bahwa SM atau mobilisasi tidak lebih atau kurang efektif daripada intervensi standar lain untuk sakit punggung. [104] Metode untuk merumuskan pedoman pengobatan untuk nyeri punggung bawah berbeda secara signifikan antara negara-negara , casting beberapa keraguan pada keandalan mereka. [115]
* Whiplash and other neck pain . Whiplash dan lain nyeri leher . There is no overall consensus on manual therapies for neck pain. [ 119 ] A 2009 systematic review of controlled clinical trials found no evidence that chiropractic spinal manipulation is effective for whiplash injury. [ 120 ] A 2008 review found evidence that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SM, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis . [ 121 ] A 2007 review found that SM and mobilization are effective for neck pain. [ 119 ] Of three systematic reviews of SM published between 2000 and May 2005, one reached a positive conclusion, and a 2004 Cochrane review [ 122 ] found that SM and mobilization are beneficial only when combined with exercise. [ 104 ] A 2005 review found consistent evidence supporting mobilization for acute whiplash, and limited evidence supporting SM for whiplash. [ 123 ] Tidak ada konsensus keseluruhan pada terapi manual untuk nyeri leher. [119] Sebuah sistematis review 2009 dari uji klinis terkontrol tidak menemukan bukti bahwa manipulasi chiropractic adalah tulang belakang yang efektif untuk cedera whiplash. [120] Sebuah penilaian tahun 2008 menemukan bukti bahwa video pendidikan, mobilisasi, dan latihan tampak lebih bermanfaat bagi pukulan cemeti dari alternatif; bahwa SM, mobilisasi, latihan diawasi, tingkat rendah dan mungkin terapi laser akupunktur lebih efektif untuk pukulan cemeti nyeri leher non dari alternatif namun tidak satupun dari perawatan ini secara jelas superior, dan bahwa ada ada bukti bahwa intervensi meningkatkan prognosis . [121] Review 2007 menemukan bahwa SM dan mobilisasi yang efektif untuk nyeri leher. [119] Dari tiga tinjauan sistematis pada SM diterbitkan antara 2000 dan Mei 2005, salah satu mencapai kesimpulan yang positif, dan 2004 Cochrane review [122] menemukan bahwa SM dan mobilisasi yang hanya menguntungkan bila dikombinasikan dengan olahraga. [104] Review 2005 menemukan bukti yang konsisten mendukung mobilisasi untuk whiplash akut, dan bukti terbatas yang mendukung SM untuk pukulan cemeti. [123]
* Headache . Headache . A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache . [ 124 ] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine . [ 125 ] A 2004 review found that SM may be effective for migraine and tension headache, and SM and neck exercises may be effective for cervicogenic headache. [ 126 ] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SM. [ 104 ] Review 2006 tidak menemukan bukti pendukung yang ketat SM atau terapi manual lain untuk sakit kepala tegang . [124] Review 2005 menemukan bahwa bukti yang lemah untuk efektivitas manipulasi chiropractic untuk sakit kepala ketegangan, dan itu mungkin lebih efektif untuk sakit kepala ketegangan daripada migrain . [125] Review 2004 menemukan bahwa SM mungkin efektif untuk migrain dan sakit kepala ketegangan, dan SM dan latihan leher mungkin efektif untuk sakit kepala cervicogenic. [126] Dua tinjauan sistematis lain yang diterbitkan antara tahun 2000 dan Mei 2005 tidak menemukan bukti mendukung SM. [104]
* Other . Lainnya. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs , [ 127 ] and limited or fair evidence supporting chiropractic management of leg conditions. [ 128 ] There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) [ 129 ] and no scientific data for idiopathic adolescent scoliosis. [ 130 ] A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) provides benefit to patients with cervicogenic dizziness, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD / learning disabilities , dizziness , high blood pressure , and vision conditions. [ 131 ] Other reviews have found no evidence of significant benefit for asthma , [ 132 ] baby colic , [ 106 ] [ 133 ] bedwetting , [ 134 ] carpal tunnel syndrome , [ 135 ] fibromyalgia , [ 136 ] kinetic imbalance due to suboccipital strain (KISS) in infants, [ 106 ] [ 137 ] menstrual cramps , [ 138 ] or pelvic and back pain during pregnancy . [ 139 ]
[ edit ] Safety [ sunting ] Keselamatan
Chiropractic care in general is safe when employed skillfully and appropriately. perawatan Chiropractic pada umumnya adalah aman saat bekerja terampil dan tepat. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Manipulasi dianggap sebagai relatif aman, tetapi karena dengan semua intervensi terapi, komplikasi bisa timbul, dan telah dikenal efek samping, risiko dan kontraindikasi. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Absolute kontraindikasi untuk terapi manipulatif tulang belakang adalah kondisi yang tidak boleh dimanipulasi; ini kontraindikasi termasuk rheumatoid arthritis dan kondisi dikenal mengakibatkan sendi tidak stabil. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis . [ 22 ] Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services ; these include sudden and severe headache or neck pain unlike that previously experienced. [ 21 ] kontraindikasi relatif adalah kondisi dimana peningkatan risiko yang dapat diterima dalam beberapa situasi dan di mana kekuatan rendah dan jaringan lunak teknik pengobatan pilihan; ini kontraindikasi termasuk osteoporosis . [22] Meskipun kebanyakan kontraindikasi hanya berlaku untuk manipulasi dari wilayah yang terkena dampak, beberapa tanda-tanda neurologis mengindikasikan rujukan ke layanan darurat medis ; ini termasuk mendadak dan parah sakit kepala atau nyeri leher tidak seperti yang sebelumnya mengalami. [21]
Spinal manipulation is associated with frequent, mild and temporary adverse effects , [ 20 ] [ 21 ] including new or worsening pain or stiffness in the affected region. [ 140 ] They have been estimated to occur in 33% to 61% of patients, and frequently occur within an hour of treatment and disappear within 24 to 48 hours. [ 141 ] Rarely, [ 22 ] spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults [ 20 ] and children. [ 142 ] Estimates vary widely for the incidence of these complications, [ 141 ] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, which is a particular concern. [ 20 ] Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. [ 121 ] [ 143 ] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke. [ 144 ] Manipulasi tulang belakang berhubungan dengan sering, ringan dan sementara dampak buruk , [20] [21] termasuk baru atau memburuk nyeri atau kekakuan di wilayah yang terkena dampak. [140] Mereka telah diperkirakan terjadi pada 33% menjadi 61% dari pasien, dan sering terjadi dalam satu jam pengobatan dan menghilang dalam waktu 24 hingga 48 jam. [141] Jarang, [22] manipulasi tulang belakang, terutama pada tulang belakang bagian atas, juga dapat mengakibatkan komplikasi yang dapat mengakibatkan cacat tetap atau kematian; ini dapat terjadi di dewasa [20] dan anak-anak. [142] Perkiraan bervariasi untuk kejadian ini komplikasi, [141] dan kejadian yang sebenarnya tidak diketahui, karena tingkat tinggi Pengurangan pelaporan dan kesulitan untuk menghubungkan manipulasi efek samping seperti stroke, yang merupakan perhatian khusus. [20] Beberapa laporan kasus menunjukkan hubungan temporal antara intervensi dan komplikasi serius. stroke arteri Vertebrobasilar adalah statistik yang terkait dengan layanan-layanan chiropractic orang di bawah usia 45 tahun, tetapi juga terkait dengan layanan dokter umum, menyarankan bahwa asosiasi ini mungkin dijelaskan dengan kondisi sudah ada sebelumnya. [121] [143] Lemahnya bukti cukup kuat untuk mendukung hal menyebabkan (sebagai lawan dari asosiasi statistik) antara terapi manipulatif serviks (apakah chiropractic atau tidak) dan stroke arteri vertebrobasilar. [144]
Chiropractors, like other primary care providers, sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation . [ 145 ] Although there is no clear evidence for the practice, some chiropractors may X-ray a patient several times a year. [ 36 ] Practice guidelines aim to reduce unnecessary radiation exposure, [ 145 ] which increase cancer risk in proportion to the amount of radiation received. [ 146 ]
[ edit ] Cost-effectiveness [ sunting ] efektivitas biaya
A 2006 qualitative review found that the research literature suggests that chiropractic obtains at least comparable outcomes to alternatives with potential cost savings. [ 147 ] A 2006 systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation in the United Kingdom compared favorably with other treatments for back pain, but that reports were based on data from clinical trials without sham controls and that the specific cost-effectiveness of the treatment (as opposed to non-specific effects ) remains uncertain. [ 148 ] A 2005 systematic review of economic evaluations of conservative treatments for low back pain found that significant quality problems in available studies meant that definite conclusions could not be drawn about the most cost-effective intervention. [ 149 ] The cost-effectiveness of maintenance chiropractic care is unknown. [ 19 ] Sebuah kualitatif review 2006 menemukan bahwa literatur penelitian menunjukkan bahwa paling tidak sebanding chiropractic memperoleh hasil di alternatif dengan potensi penghematan biaya. [147] A 2006 sistematis efektivitas biaya review menemukan bahwa biaya-efektivitas melaporkan manipulasi chiropractic di Britania Raya baik dibandingkan dengan perawatan lain untuk sakit punggung, tetapi bahwa laporan berdasarkan data dari uji klinis tanpa kontrol palsu dan bahwa efektivitas biaya spesifik-pengobatan (sebagai lawan dari efek non-spesifik ) masih belum pasti. [148] Sebuah tinjauan sistematis tahun 2005 evaluasi ekonomi dari perawatan konservatif untuk nyeri pinggang menemukan bahwa masalah kualitas yang signifikan dalam studi yang tersedia berarti bahwa kesimpulan yang pasti tidak dapat ditarik tentang biaya-intervensi yang paling efektif. [149] The efektivitas biaya perawatan chiropractic pemeliharaan tidak diketahui. [19]
[ edit ] Public health [ sunting ] kesehatan masyarakat
Further information: Vaccine controversy and alternative medicine and Opposition to water fluoridation Informasi lebih lanjut: kontroversi vaksin dan obat-obatan alternatif dan oposisi terhadap air fluoridasi
Some chiropractors oppose vaccination and water fluoridation , which are common public health practices. Beberapa chiropractors menentang vaksinasi dan fluoridasi air , yang umum kesehatan masyarakat praktik. Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment. [ 25 ] Within the chiropractic community there are significant disagreements about vaccination, [ 15 ] [ 77 ] one of the most cost-effective public health interventions available. [ 150 ] Most chiropractic writings on vaccination focus on its negative aspects, [ 15 ] claiming that it is hazardous, ineffective, and unnecessary. 'Kiropraktor upaya untuk membangun reputasi yang positif bagi peran kesehatan masyarakat mereka juga terancam oleh reputasi mereka untuk merekomendasikan-lama pengobatan chiropractic hidup berulang-ulang. [25] Di dalam komunitas chiropractic ada ketidaksepakatan yang signifikan tentang vaksinasi, [15] [77] salah satu yang-efektif biaya intervensi kesehatan masyarakat yang paling tersedia. [150] Kebanyakan tulisan chiropractic vaksinasi fokus pada aspek negatif, [15] mengklaim bahwa itu adalah berbahaya, tidak efektif, dan tidak perlu. Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of US chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. [ 77 ] The Canadian Chiropractic Association supports vaccination; [ 15 ] a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children. [ 151 ] The American Chiropractic Association dan International Association kiropraktor dukungan pengecualian individu untuk hukum vaksinasi wajib, dan survei 1995 dari chiropractors US menemukan bahwa sekitar sepertiga percaya tidak ada bukti ilmiah bahwa imunisasi mencegah penyakit. [77] The Canadian Chiropractic Association mendukung vaksinasi; [15] survei di Alberta pada tahun 2002 menemukan bahwa 25% dari chiropractors disarankan untuk pasien, dan 27% terhadap, memvaksinasi diri sendiri atau anak-anak mereka. [151]
Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Awal menentang fluoridasi air termasuk ahli tulang, beberapa di antaranya terus menentang itu sebagai tidak cocok dengan filosofi chiropractic dan pelanggaran dari kebebasan pribadi. Other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health. [ 152 ] chiropractors lain telah dipromosikan secara aktif fluoridasi, dan beberapa organisasi chiropractic mendukung prinsip-prinsip ilmiah kesehatan masyarakat. [152]
[ edit ] Criticism [ sunting ] Kritik
Main article: Chiropractic controversy and criticism Artikel utama: Chiropractic kontroversi dan kritik
Throughout its history chiropractic has been the subject of internal and external controversy and criticism. [ 9 ] [ 153 ] Daniel D. Palmer , the founder of chiropractic, claimed to have manipulated the spine of a man who was nearly deaf, allegedly curing him of deafness. In a critical evaluation of the profession, Professor Edzard Ernst stated: "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today." Dalam evaluasi kritis terhadap profesi, Profesor Edzard Ernst menyatakan: "Chiropractic berakar dalam konsep mistik.. Hal ini menyebabkan internal konflik dalam chiropractic profesi, yang terus berlangsung sampai sekarang" Chiropractors, including DD Palmer, were jailed for practicing medicine without a license . [ 14 ] For most of its existence, chiropractic has battled with mainstream medicine , sustained by what are characterized as antiscientific and pseudoscientific ideas such as subluxation. [ 30 ] Chiropractic has been controversial, though to a lesser extent than in past years. [ 12 ] Chiropractors, termasuk DD Palmer, yang dipenjara untuk mempraktikkan kedokteran tanpa lisensi . [14] Untuk sebagian besar keberadaannya, chiropractic telah berjuang dengan obat utama , ditopang oleh apa yang ditandai sebagai anti-ilmu dan keilmu-ilmuan ide seperti subluksasi. [30] Chiropractic memiliki sudah kontroversial, meskipun pada tingkat lebih rendah dari tahun-tahun terakhir. [12]
