Dennis M. Marchiori

A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability.

Study Design A cross‐sectional design was used to correlate cervical radiographic findings of spinal degeneration to neck pain and disability. Objectives The results were correlated to assess the clinical importance of radiographic spinal degeneration. Summary of Background Data Past investigations suggest little association between clinical findings and radiographic evidence of spinal degeneration. However, changes in activities of daily living and chronicity of complaint have not been investigated. Methods Over a 5‐month period, data were collected on 700 consecutive patients referred for cervical radiographic examination as part of their clinical evaluation. While in the radiology department, all subjects completed a visual analog pain scale, neck disability index, and short questionnaire, all of which quantified various aspects of any neck complaint. Relationships between indices of patient complaint and the number of cervical degenerative intervertebral discs were evaluated using regression analysis. Results A significant relationship (P < 0.001) was noted between the number of levels of intervertebral disc degeneration and the chronicity of cervical complaint. No significant relationship was found between cervical degeneration and past trauma (P = 0.904) or gender (P = 0.213). Multiple‐regression analysis of visual analog pain scale scores revealed a significant two‐way interaction with chronicity and past trauma (P = 0.007) and a significant main effect with gender (P < 0.001). Cervical degeneration was not significant as a main effect or interaction with other factors. Multiple‐regression analysis of neck disability index scores demonstrated a significant three‐way interaction of chronicity, degeneration, and gender (P = 0.022) and a significant two‐way interaction for chronicity and trauma (P = 0.025). No additional information was gathered by multivariate multiple‐regression techniques. Conclusions Increasing levels of spinal degeneration are related to increasing chronicity of patient complaints. Spinal degeneration is not related to past trauma or gender. Women, but not men, report higher disability with increasing levels of degeneration. Subjects with past trauma reported more intense pain and disability. Overall, men reported less neck pain and disability than women.

Organizational commitment of a health profession faculty: dimensions, correlates and conditions

Health professions depend on their faculties to prepare new practitioners, conduct research and provide essential services. Organizational commitment is an important aspect of faculty effectiveness and job performance, and may impact on turnover, absenteeism and interpersonal trust. A survey of organizational commitment, including faculty demographics and workplace variables, was conducted. Respondents were full- and part-time chiropractic faculty working in the United States and Canada. More than 54% of the study population (n = 609) completed and returned the instrument. A large majority of the respondents were male (68.4%) and employed full-time (81.6%). Almost half (47.5%) of the respondents were assigned to the area of patient care at their institutions. This study provides an initial assessment of organizational commitment among chiropractic faculty. Tenure in higher education, gender and age were found to be the most important predictors of organizational commitment.

Empowerment and organizational commitment of chiropractic faculty

BACKGROUND Professionals in chiropractic education retain much of the authority over their work. Their work is impacted, negatively or positively, by their perceptions of their organizations value for their skills and knowledge. Specifically, empowerment and organizational commitment are 2 psychological constructs that may mediate work circumstances and therefore are the focus of this study. OBJECTIVE The purpose of this study is to explore associations between empowerment and organizational commitment among chiropractic faculty. Study design Full faculty survey utilizing descriptive statistics and multivariable analysis. METHODS Surveys were distributed to full- and part-time faculty working in the United States and Canada. The survey included Spreitzers multidimensional measure of psychological empowerment, Meyer and Allens multidimensional measure of organizational commitment, and additional survey items focusing on faculty demographics and workplace variables including sex, age, academic rank, employment status, and primary area of work assignment. RESULTS More than 54% of the study population (N = 609) completed and returned the instrument. A general profile of a chiropractic faculty member emerges as a middle-aged male employed full-time as a teacher in the academic program. Regression analyses suggest that the observed faculty characteristics and the workplace variables are not associated with fit between the faculty members work role and his/her own beliefs, norms, and behaviors regarding the value of the work-related tasks. CONCLUSIONS The level of institutional commitment experienced by the faculty member was associated with the fit between the task, goal or purpose of the job, and the internal standards held by the individual.

Developing a clinical competency examination in radiology: Part I—Test structure ☆ ☆☆ ★ ★★

BACKGROUND There is a need for radiology educational outcome measures that evaluate clinical competency. This is the first of two articles introducing a clinical competency examination in radiology. This first article describes the evolution and structure of the examination. The second article presents the results of two administrations of the examination and evaluates possible outcome predictors. OBJECTIVE To develop a measure of clinical competency in radiology. DESIGN Descriptive. METHODS A test was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Students were timed as they responded to questions regarding the localization, categorization, management, and identification of pathologic conditions presented on plain film images of the spine and chest. Twenty-five radiographic cases were displayed at individual viewbox stations, and student responses to the 4 questions were compared with the consensus responses of 2 radiology instructors. RESULTS Two versions of the test, using different cases, were given to the same ninth trimester class of 210 chiropractic students in a 10-trimester program. Of the 210 students, 116 (55.2%; 86 men and 30 women) took version 1 of the examination, and 1 month later 181 (86.2%: 138 men and 43 women) took version 2 of the examination. Student comments after each examination were favorable. CONCLUSION The test structure uniquely provides information related to the students ability to localize, categorize, manage, and identify pathologic conditions on imaging studies. At present the examination is instructor time intensive; further refinement is needed before wide implementation can occur.

Social Communication Skills of Chiropractors: Implications for Professional Practice

OBJECTIVE Social communication skills are critical in the health professions. The aim of this study was to measure and identify professional practice predictors of social communication skills of practicing chiropractors. METHODS The study population was derived from a group of doctors of chiropractic who participated in a practice-based research program. Participating chiropractors agreed to complete a survey detailing the chiropractors sex, years in practice, practice type, size of the practice community, typical weekly practice volume, and an instrument to measure skills of social communication. Regression analysis was applied to identify associations between independent variables and responses to the social skills instrument. RESULTS Results suggested that selected characteristics of clinical practice may be associated with clinicians social skills of communication. The weekly volume of patients to the practice emerged as a salient explanatory factor of overall social communication skills and as a factor individually for dimensions of social expressivity and social control. The practice arrangement (solo vs group) proved important in terms of respondent emotional control scores. Similarly, the solo vs group practice variable was associated with higher levels of emotional sensitivity; however, this association was mediated by the sex of the doctor of chiropractic; men reported lower levels of emotional sensitivity than women. CONCLUSIONS The findings of this study suggest associations between dimensions of social communication skills, practice characteristics, practice arrangements, and sex that may inform the efforts of educators as they endeavor to better prepare health professionals for practice in a wide spectrum of settings.

Association Among Opioid Use, Treatment Preferences, and Perceptions of Physician Treatment Recommendations in Patients With Neck and Back Pain

Objective The purpose of this study was to explore the relationship between self‐reported use of opioids by patients with neck and back pain and their demographics, pain characteristics, treatment preferences, and recollections of their physicians’ opinions regarding treatment options. Methods We analyzed 2017 Gallup Poll survey data from 1680 US adults who had substantial spine pain in the past year and used logistic regression to explore the aforementioned relationships. Results Our multiple regression analysis indicated that adults with neck or back pain severe enough to have sought health care within the last year were more likely to have used opioids in the last year if they (in descending order of marginal impact) had pain that had lasted 1 year or less (adjusted odds ratio [OR] = 34.35, 90% confidence interval [CI] 17.56‐74.32); concurrently used benzodiazepines (OR = 6.02, 90% CI 2.95‐12.33); had Medicaid as an insurance source (OR = 3.29, 90% CI 1.40‐7.48); indicated that they preferred to use pain medications prescribed by a doctor to treat physical pain (OR = 3.24, 90% CI 1.88‐5.60); or were not college educated (OR = 1.83, 90% CI 1.05‐3.25). Compared with patients aged 65 years and older, those aged 18 to 34 years were less likely to have used opioids in the past year (OR = 0.09, 90% CI 0.01‐0.40, 0.50 for 95% CI). Respondents’ perceptions of medical doctors’ positive or negative opinions regarding a variety of neck and back pain treatment options were not significantly associated with opioid use. Conclusions Patients with neck and back pain who use opioids differ from those who do not use opioids in that they are more likely to have pain that is of shorter duration, to use benzodiazepines, to have Medicaid as an insurance source, and to prefer to use pain medications. Those characteristics should be considered when developing opioid use prevention strategies.