News / Publications

July 26, 2019

For immediate release

Toronto, July 24, 2019. The results of a global survey of the chiropractic profession have revealed a significant lack of provision in low- and middle-income countries, according to a new paper published today in Chiropractic and Manual Therapies.

The survey, undertaken by the World Federation of Chiropractic, gathered data from its constituent national associations, government websites, internet searches and personal correspondence. Information was sourced from all 193 United Nations member nations, including 90 countries where at least one chiropractor was practising.

The results showed that overwhelmingly chiropractors were mostly located in North America (United States and Canada).

The survey also revealed that of the 48 educational institutions offering chiropractic programs, the majority were in high-income countries with almost 60% located in North America or Europe.

The World Health Organization’s (WHO) Global Strategy on Human Resources for Health: Workforce 2030 has targeted universal availability, accessibility, acceptability, coverage and quality of health systems within strengthened health systems. The WFC’s mission statement (to advance awareness, utilization and integration of chiropractic internationally) aligns with this strategy.

WFC Secretary-General Richard Brown comments: “With low back pain being the biggest single cause of years lived with disability and an increasing ageing population, it is clear that there is a shortfall in the numbers of health workers globally who are trained to effectively manage spinal pain and disability. Chiropractors, as non-surgical experts in spine care, are well placed to make a positive impact, yet numbers need to rise. Expansion of educational provision in low- and middle- income countries and increased awareness by health policy makers are instrumental factors in meeting the needs of underserved populations.”

As with many global surveys, responses were mixed and the authors highlighted the need for further information gathering, monitoring and reporting of data. Despite this, the message is clear: health inequities seen throughout the world are reflected in the provision of chiropractic and more needs to be done to ensure adequate numbers of chiropractors in countries where the impact of spinal pain and disability is profound.

The full paper can be downloaded from Chiropractic and Manual Therapies at http://bit.ly/ChiroWorkforce

June 28, 2019

PRESS RELEASE

Following the publication in Australia earlier this year of a video showing a chiropractor treating a baby, the Health Minster for the state of Victoria called for the prohibition of chiropractic spinal manipulation for children under the age of 12 years. As a result, an independent panel has been appointed by Safer Care Victoria to examine the evidence and provide recommendations for the chiropractic care of children.

The role of the panel is to (a) examine and assess the available evidence, including information from consumers, providers, and other stakeholders, for the use of spinal manipulation by chiropractors on children less than 12 years of age and (b) provide recommendations regarding this practice to the Victorian Minister for Health.
Members of the public and key stakeholders, including the WFC’s member for Australia, the Australia Chiropractors Association (AusCA), were invited to submit observations. The AusCA’s submission can be read here.

The AusCA has drawn heavily in its response on the principles of evidence-based, people-centered, interprofessional and collaborative  (EPIC) care.

Points to note are as follows:

1.    The AusCA has taken a strongly evidence-based approach to its response, emphasising the safety and protection of the public, while setting out its position on the role of chiropractors in the Australian health care system.

2.    The document draws attention to the need for chiropractors to practice ethically, competently and professionally and in line with the code of conduct as drafted by the Chiropractic Board of Australia.

3.    The need for chiropractors to possess an approved qualification from an approved educational institution is emphasised.

4.    The AusCA has clearly defined spine care as the major or defining clinical purpose, with chiropractors being defined as community-based primary care health providers.

5.    The international, interdisciplinary evidence base for chiropractic is emphasised. The challenges of effective knowledge translation are described (noting that in general medicine, knowledge translation can sometimes take 15 years or more).

6.    Integration into the health care system is described, with chiropractic being described as a popular, highly utilised profession.

7.    In respect of infants, children and adolescents, evidence-based prevention and treatment strategies for musculoskeletal conditions are emphasised.

8.     The report describes 30,000 treatments per week (8-10% of all treatment provided) being provided to the paediatric population in Australia.

9.     The report emphasises the safety of chiropractic treatment by reference to 2 systematic reviews and insurance data from Scandinavia.

10.    The duty binding on chiropractors to obtain informed consent to care is supported.

11.    The report sets out the levels of effectiveness for manual therapies for paediatric conditions, noting its variable quality (in line with other professions) but stating that it is mostly ‘moderate-positive’ or ‘inconclusive-favourable’.

12.    The document states that there is no evidence that would support restriction of parental or patient choice when seeking chiropractic care for children under 12 years as there is no evidence of harm. There is, however, expressed outcome of benefit.

13.    The submission calls for a considered response by the Victoria government, noting that similar restrictions on the provision of care to those proposed have never been implemented. Instead, guidelines that minimise harm and define good practice have helped to ensure that consumers make informed choices about the care they receive have been introduced.

14.    The AusCA calls for:

a.    A trial of monitoring care, including outcomes, for children under 12 years;
b.    Refinement of industry-led standards and clinical guidelines informed by best practice, including CPD/CE and consensus approaches to care including interprofessional understanding;
c.     A commitment to knowledge translation;
d.    A call for greater support of research in investigating the role of chiropractors in the treatment of children.

Australian Chiropractors Association

The Australian Chiropractors Association is the peak body for the chiropractic profession in Australia. Representing over 3000 members, it provides a strong, unified voice for chiropractors in Australia. Its work involves advocacy, membership services, research, public engagement and governance. Its current president is Dr Anthony Coxon.

The Australian Chiropractors Association is the WFC member for Australia and is located in the WFC’s Pacific Region.

June 24, 2019

PRESS RELEASE

The United Kingdom will soon have another new university-based chiropractic program, adding to four existing programs and the announcement of a fifth earlier this year. The University of Central Lancashire (UCLan) is located in the North West of England and last week announced that it was recruiting a senior lecturer to serve as a course leader within UCLan’s School of Health Sciences.

The launch of the new chiropractic program, which will be offered as an integrated Masters program, is the third to have been launched since the establishment of the Society for Promoting Chiropractic Education (SPCE), following the announcement of new programs at London South Bank University and Teeside University.

Chief Executive of SPCE, Satjit Singh, said: “We are delighted that UCLan are developing a new chiropractic programme. It will be of immense benefit to students, especially in the North-West, as well as help improve access to chiropractic care in the area. Students will enjoy a wonderful all-round experience, benefitting from UCLan’s excellent campus and teaching facilities. We look forward to supporting UCLan in developing the programme, which will meet the aspirations of the patients, profession and students.”

UCLan is a large provider of multi-professional healthcare education, traiing and development, offering a range of taught undergraduate and postgraduate modular based courses, research degrees and credit recognition. The School develops its portfolio collaboratively with partners in response to national policy and local requirements and needs, providing professional courses, short courses and continuing professional development. The focus is on students developing evidence-based knowledge, skills and person-centred values in preparation for employment. 

In addition to its newly-announced chiropractic provision, the School of Health Sciences at UCLan offers courses in: Physiotherapy, Sports Therapy, Paramedic Practice, Occupational Therapy, Operating Department Practice, Health Informatics, and Acute and Emergency Care.

Commenting on the announcement, WFC Interim President Dr Vivian Kil said: “The announcement of yet another chiropractic program at a mainstream UK university shows an exciting development in the provision of comprehensive, evidence-based chiropractic education. This will expand workforce capacity, increase access to and awareness of chiropractors and help in tackling the burden of spinal and joint pain and disability in the UK and Europe.”

The university is currently recruiting a Senior Lecturer to lead the chiropractic program. Applications are welcomed and further information can be found at http://bit.ly/UCLan_job.

June 5, 2019

PRESS RELEASE

Toronto, June 5, 2019 The World Health Organization has published a paper in its Bulletin that warns of the risks of over-medicalizing the management of low back pain, instead advocating care that chiropractors are highly qualified to provide.
 
The paper (1), authored by leading experts from Australia and the UK, proposes non-drug, non-surgical approaches as the first line treatments for low back pain. They include advice, education and reassurance with manual therapies including spinal manipulation for patients at risk of developing chronicity.
 
The paper’s authors were particularly critical of the overuse of spinal surgery, hospitalization, injections, complex pharmaceuticals and diagnostic imaging. This mirrored the strong evidence cited in a series of articles on low back pain published last year in The Lancet.
 
The WHO Bulletin paper found that despite international recommendations, it was conservatively estimated that 32% of care provided for low back pain in the USA was inconsistent with clinical guidelines, including a rise of 62% in elective spinal fusion surgery (2004-2015) in the USA, despite no good evidence of benefit over non-surgical care.
 
“As spine care specialists, chiropractors are perfectly positioned to provide evidence-based, people-centered care for low back pain,” said WFC President Dr Vivian Kil. “All of the top guidelines published in the past few years are telling us that non-surgical, non-drug care is the preferred approach. Spinal manipulation is increasingly being seen as the treatment of choice. Chiropractors are highly skilled in this technique but can also deliver many of the other recommended interventions, such as patient education, soft tissue techniques and self-management advice.”
 
For chronic persistent low back pain, the guidelines recommend a multidisciplinary approach. As part of its #BeEPIC campaign, the WFC recommends interprofessional and collaborative care and increasingly chiropractors are engaging positively with spine care professionals from other disciplines.
 
WFC Secretary-General Richard Brown commented: “As well as meeting demand in high-income countries, more chiropractors are needed around the world to deliver evidence-based care to underserved communities. We know that in low- and middle-income countries many people have no access to health care, let alone spine care. Chiropractors have all the skills to make a real difference to the lives of those suffering from spinal pain and disability.”
 
The WHO Bulletin paper criticizes the persistent use of opiate painkillers for chronic back pain despite research showing limited benefit and the US Center for Disease Control being very clear that they should not be used for chronic, non-cancer pain. Yet many health systems remain non-compliant with guidelines at the expense of patient outcomes and huge costs.
 
As spine care experts, chiropractors are well-placed to re-educate patients around the many myths and misconceptions surrounding back pain management. Dr Kil continues, “Back pain is one of those conditions where everyone wants to give advice, but the reality is that it is not always grounded in evidence. Staying active and mobile may seem unnatural when you’re in pain, but it works and the guidelines support this approach.”

Reference
1.    Traeger AC, Buchbinder R, Eishaug AG, Croft PR, Maher CG. Bulletin of the World Health Organization 2019;97:423-433. doi: http://dx.doi.org/10.2471/BLT.18.226050
Notes
•    The WFC is the only chiropractic organization to be a non-state actor in official relations with WHO.
•    It represents the national chiropractic organisations of over 90 countries in 7 global regions.
•    Headquartered in Toronto, Canada, its current Interim President is Dr Vivian Kil of the Netherlands.

May 30, 2019

For immediate release

PRESS RELEASE

Low back pain is the leading cause of years lived with disability on the planet. Neck pain is the sixth most common. According to the World Health Organization (WHO), 74% of years lived with disability are the result of health conditions that may benefit from rehabilitation, yet the global need for rehabilitation is unmet, especially in low- and middle- income countries (1).  

The WFC’s Disability and Rehabilitation Committee (DRC) encourages the engagement of chiropractors in matters relating to disability prevention and rehabilitation. As spine and musculoskeletal care experts, chiropractors are well-placed to assess the needs of patients and support them in self-management, lifestyle advice and dedicated rehabilitation.

Following a call from WHO to contribute to the Rehabilitation 2030: A Call To Action campaign, the WFC DRC created and submitted a rehabilitation competency framework. This has now been published in Chiropractic and Manual Therapies.

Chair of the WFC DRC, Professor Pierre Côté (pictured) commented: “Chiropractors have an important role to play in both preventing disability and actively engaging in rehabilitation for their patients. We hope that this new framework will be adopted by chiropractic educational institutions and organizations as a model for empowering clinicians in the care of their patients.”  

Reference:
(1) World Health Organization (2018) Need to scale up rehabilitation. https://www.who.int/disabilities/care/Need-to-scale-up-rehab-July2018.pdf?ua=1