BackgroundThe chiropractic profession emerged when scientific explanations for causes of health and disease were still in infancy and the co-existence of notions such as innate healing and vitalism were perhaps admissible within such a historical context. Notwithstanding, within the scientific culture of the 21st Century all healthcare paradigms require evidential support which in regard these early concepts are in large part, absent. Nevertheless, a large body of emerging scientific evidence supports the existence of innate healing phenomena that may explain a plethora of clinical outcomes observed during chiropractic care. However, in contrast to the notion that removing the putative subluxation constitutes the mechanism by which this healing is initiated, the evidentially supported explanation is one that invokes the impact of contextual factors inherent in the skilful care and authority of the healthcare provider. This perspective is presented here as the scientific model of Contextually Aided Recovery (CARe).Main bodyThis paper contends that;Contextual effects are powerful and desirable and are triggered by contextual factors present in all therapeutic encounters including those encountered in chiropractic practice.These factors can elicit large clinical effects with substantive evidence supporting pain, immune and motor modulation.The compartmentalisation of specific and non-specific effects is a biologically and scientifically false dichotomy, erroneously invoked to de-legitimise treatment approaches that expertly construct contextual healing scenarios.The use of factors to construct contextual healing scenarios that maximise positive (placebo) and minimize negative (nocebo) effects is a skilful clinical art within the multimodal approach that describes modern chiropractic care and should be presented and defended as a legitimate component of orthodox healthcare Clinical improvement during chiropractic care, beyond any biologically specific treatment effects of manipulation and other modalities, may be largely understood considering contextual factors as described by a Contextually Aided Recovery (CARe) model.

BackgroundIn 2009, the heads of the Executive Council of the European Chiropractors' Union (ECU) and the European Academy of Chiropractic (EAC) involved in the European Committee for Standardization (CEN) process for the chiropractic profession, set out to establish European guidelines for the reporting of adverse reactions to chiropractic treatment. There were a number of reasons for this: first, to improve the overall quality of patient care by aiming to reduce the application of potentially harmful interventions and to facilitate the treatment of patients within the context of achieving maximum benefit with a minimum risk of harm; second, to inform the training objectives for the Graduate Education and Continuing Professional Development programmes of all 19 ECU member nations, regarding knowledge and skills to be acquired for maximising patient safety; and third, to develop a guideline on patient safety incident reporting as it is likely to be part of future CEN standards for ECU member nations.ObjectiveTo introduce patient safety incident reporting within the context of chiropractic practice in Europe and to help individual countries and their national professional associations to develop or improve reporting and learning systems.DiscussionProviding health care of any kind, including the provision of chiropractic treatment, can be a complex and, at times, a risky activity. Safety in healthcare cannot be guaranteed, it can only be improved. One of the most important aspects of any learning and reporting system lies in the appropriate use of the data and information it gathers. Reporting should not just be seen as a vehicle for obtaining information on patient safety issues, but also be utilised as a tool to facilitate learning, advance quality improvement and to ultimately minimise the rate of the occurrence of errors linked to patient care.ConclusionsBefore a reporting and learning system can be established it has to be clear what the objectives of the system are, what resources will be required and whether the implementing organisation has the capacity to operate the system to its full advantage. Responding to adverse event reports requires the availability of experts to analyse the incidents and to provide feedback in a timely fashion. A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.

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Background Low back pain (LBP) is a very frequent cause for care seeking and often a long-lasting condition. However, little is known about individuals' care seeking patterns over time. Therefore the objectives of this study were 1) to describe care seeking patterns 1 year after an initial chiropractic consultation, and 2) to examine how care seeking patterns related to pain intensity trajectories. Methods Danish chiropractic clinics recruited 947 adult patients at the initial consultation for LBP. From this cohort, 617 (65%) responded to questions about care seeking within the last 2 weeks at all of the followups 2 weeks, 3 months and 12 months after inclusion. Based on these responses, we described care seeking patterns and investigated if care seeking was associated with trajectories of LBP severity. The LBP trajectories had previously been derived from weekly measures of pain intensity collected via SMS-tracking. Results Care seeking after the initial visit was reported by 95% of the patients. The most frequent care seeking pattern (51%) was to report care seeking at the 2-weeks follow-up and not later, 29% reported care seeking only 2 weeks and 3 months after the initial consultation, and 11% reported care seeking at all follow-up time points. Of those seeking care after 2 weeks, 3 months and 1 year, 98%, 76% and 50% respectively had chosen to see a chiropractor at those time points. At 1-year followup 18% of care seekers had visited a general practitioner and 27% a physiotherapist. Care seeking was associated with LBP trajectories: Most people who recovered from pain stopped care seeking, and those with persistent severe pain did most frequently seek care at all follow-ups. However, those with mild to moderate LBP had more diverse care seeking behaviours. For example in LBP trajectories of on-going moderate pain, 25% did not report care seeking after 2-weeks, and another 25% reported care seeking at all time points. Conclusions Most patients consulting Danish chiropractors for LBP are seen again within two weeks of the initial consultation and do not report continued care seeking after 3 months. One year after the initial visit, around half of the care seekers see other health care providers for their LBP instead of a chiropractor. Care seeking is related to LBP symptoms, but not in a uniform way, and it should be investigated why some people with on-going LBP continue to seek care while others do not. The study was presented to the local ethics committee. The committee found that it did not need approval, since there was no intervention involved, which is in line with Danish law (Danish National Committee on Biomedical Research Ethics. Guidelines about Notification. (http://www.nvk.dk/english/act-on-research). The project was approved by the Danish Data Protection Agency (J-no. 2004-41-4763 and J-no. 2010-41-5163 Introduction Degenerative lumbar spinal stenosis causing neurogenic claudication is a leading cause of pain, disability and loss of independence in older adults. Effective non-surgical approaches...