Chiropractic Agreement by srs20437

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									 Chiropractic Utilization Within
NCAA Division I-A, Division I-AA,
and NFL Football Medical Staffs

       Toby Brooks, PhD, ATC, CSCS, PES
                 Overview

•   Objectives
•   Rationale and background
•   Research methods
•   Results
•   Limitations
•   Conclusions and implications
                 Objectives

•   Briefly discuss the history and theoretical
    underpinnings of chiropractic services.
•   Briefly discuss the utilization of chiropractic
    services among sports medicine teams
    associated with NCAA Division I-A, Division I-
    AA, and NFL football programs.
•   Briefly discuss the perceptions of head athletic
    trainers with respect to the implementation of
    chiropractic services within their area of
    practice.
    Rationale and Background

• Increased scrutiny from coaching staffs as
  well as sports medicine team members to
  ensure “no stone unturned”
• Recent changes in the composition of the
  sports medicine team nationwide
• Widespread disagreement, exaggerated
  claims, half-truths, and misinformation on
  both sides of the debate
    Rationale and Background

• History of chiropractic
  – cheir (hand) + praxis (action)
  – Alternative medicine technique focused upon
    “normalizing the relationship between
    structure and function within the body”
                                          -NCCAM, 2006



  – Origins traced back to Hippocrates in ancient
    Greece
  – Modern chiropractic founded in 1895 by
    Daniel David Palmer in Davenport, IA
    Rationale and Background

• Utilization
  – 1997, estimated 192 million visits by
    Americans to chiropractors
     • 88 million to treat neck and back pain –NCCAM, 2006
• Controversy
  – Empirical studies consistently fail to
    demonstrate significant differences in
    outcomes of chiropractic compared to more
    traditional conservative management
    techniques
    Rationale and Background

• Controversy (cont.)
  – Founder was a self-proclaimed
    magnetic healer          –Palmer, 1910



  – Restoring nerve disruption caused
    by luxations touted to heal/treat
    anything from back pain to
    deafness –Palmer, 1910
    Rationale and Background

• Controversy (cont.)
  – Widespread and well-known rift between
    proponents of chiropractic and traditional
    healthcare professionals
  – Despite differences, utilization has continued
    to increase steadily, notably among elite
    athletes–White, 1998; Baron, 2005
    Rationale and Background

• Perhaps due to pseudo-science
  perception of the field, many athletic
  trainers seem hesitant to either utilize
  chiropractic or to admit that it is utilized in
  their settings despite oft-cited pressures
  from athletes and coaches to offer such
  services for pain management
   Rationale and Background
• Guiding questions
  – To what extent is chiropractic utilized in the
    most successful NCAA Division I-A, Division
    I-AA, and NFL football programs?
  – What is the rationale guiding that decision?
• Related question
  – Is there a relationship between the size
    and/or composition of the sports medicine
    staff and the utilization of chiropractic?
        Research Methods

• Identified NCAA I-A top 25, NCAA I-AA top
  10, and NFL top 10 (best records) for
  2003-2004 season
• Telephoned head athletic trainer from
  each team
• Participants considered unresponsive if
  failed to return two telephone messages
  within five days
         Research Methods

• Conducted semi-structured interviews to
  determine:
  – Utilization of chiropractic within the sports
    medicine team
  – Fee/compensation agreement for chiropractic
    services
  – Composition of sports medicine staff and total
    staff size
                   Results

• Response rate
  – Total (n=30) (66.67%)
     • NCAA I-A (n=19; 76.0%)
     • NCAA I-AA (n=6; 60.0%)
     • NFL (n=5; 50%)
• Descriptive statistics used to present data
  due to small sample and ordinal nature of
  data
            Results: Mean Staff Size
               ATC          PT          ATC/PT          Total          DC



NCAA I-A             3.16        0.37            0.68           4.21        0.68
(n=19)


NCAA I-AA            1.67        0.17            0.33           2.17        0.17
(n=6)


NFL (n=5)             3.2          0              0.6            3.8         1.0


Total (n=30)         2.87        0.27            0.60           3.73        0.63
       Results: Level of Chiropractic
                 Utilization
                  Utilize DC            Utilize DC           Do not utilize DC
                  extensively           moderately


NCAA I-A (n=19)                 42.1%                31.6%               26.3%


NCAA I-AA (n=6)                 0.0%                 66.6%               33.3%


NFL (n=5)                       60.0%                40.0%                 0.0%


Total (n=30)                    36.7%                40.0%               23.3%
                         Results

 • Compensation

               Free/exchange      Institution or        Athlete billed
                                  organization billed



Total (n=23)              73.8%                17.4%                     0.8%
         Results: Perceptions of
              Chiropractic
• Perceptions
  – Grounded theory qualitative analysis
     • Heavy utilization (n=11)
         – Do no harm
             » “Can’t hurt.”
         – Athlete preference
             » “The guys seem to like it.”
         – Coach preference and/or perception
             » “I want to make sure he knows we are doing everything we
                can.”
         – Access
             » “It is available and free, so why not use it?”
         Results: Perceptions of
              Chiropractic
• Perceptions
  – Grounded theory qualitative analysis
     • Moderate utilization (n=12)
         – Philosophical differences
             » “I don’t really believe in it, but…”
         – Previous experiences & history
             » “It was here when I got here”
             » “We used it when I was at…”
         – Exception rule
             » “________ works well with our staff and understands his
                role”
             » Dual credentialed DC’s
        Results: Perceptions of
             Chiropractic
• Perceptions
  – Grounded theory qualitative analysis
    • No utilization (n=7)
       – Sports med team issues
          » “We would lose our orthopaedic group”
          » “Conflicts with foundations of physical therapy”
       – Personal beliefs
          » “Not a big fan”
          » “Not used anywhere on campus”
       – Access
          » Cannot afford/no qualified personnel
                   Limitations

• Sample size
   – Particularly problematic for NCAA I-AA & NFL data
• Response rate
   – Procedures to enhance
• Sport specificity
   – Results may differ significantly in non-revenue sports,
     particularly because majority of programs that utilize
     chiropractic are provided staffing/services free of
     charge in exchange for advertising, exposure, and
     exclusivity rights
  Conclusions and Implications

• In general, higher profile programs (NFL,
  major conference I-A teams) tended to
  utilize chiropractic more heavily than
  smaller profile programs
• A majority of programs obtained
  chiropractic services either entirely free or
  in exchange for advertising or comparable
  non-cash reimbursements (exclusivity
  rights, etc.)
  Conclusions and Implications

• Although utilization of chiropractic services
  within elite football programs varies
  considerably, the decision is ultimately that
  of the head athletic trainer and other
  prominent members of the sports medicine
  team and is influenced by many factors
                          References
1.   National Center for Complimentary and Alternative Medicine (2006). About
     chiropractic and its use in treating low back pain.
     http://nccam.nih.gov/health/chiropractic
2.   Palmer DD. (1910). The Chiropractor’s Adjuster: A Textbook of the Science, Art
     and Philosophy of Chiropractic for Students and Practitioners. Portland, OR:
     Portland Printing House.
3.   White, J. (1998). Alternative sports medicine. The Physician and Sportsmedicine,
     26 (6).
4.   Baron, SH. (2005). A look at the role of chiropractors in the NFL. Chiropractic
     Economics, 14. http://www.chiroeco.com/article/2005/issue14/SP1.php

								
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