Introduction to IJPC

 

      The IJPC has been established to provide an online platform to publish well researched and referenced, peer reviewed case studies and reports related to chiropractic health care.  Such studies offer a unique addition to the body of chiropractic health care knowledge and remain a primary mechanism to demonstrate chiropractic therapeutic approaches, presentation of symptoms and outcomes.

      The IJPC recommends that drafting of all case studies utilise CARE protocols and guidelines. These are summarised lower on this webpage. CARE provides an internationally accepted framework ensuring completeness and transparency in case reports and importantly include a patient perspective and acknowledgement of the case description and outcomes.

      Unfortunately, few chiropractic journals accept case reports for publication, which now appears out of step with the majority of other healing arts. There has been mounting pressure within the chiropractic profession to publish data and clinical evidence based on requirements and hierarchy of evidence based medicine (EBM) and to only disseminate facts and procedures within the chiropractic educational institutions that meet these somewhat irrelevant criteria. EBM has after all been developed for the practice of medicine and its hierarchy structured primarily to meet the standards of pharmaceutical testing.

Conversely, while accepting the merits of large, case controlled, randomised studies that are able to be conducted in the public hospital and clinical settings, medicine is beginning to recognize greater value of case reports.  The case-based nature of clinical practice often is at odds with the population-based nature of EBM research studies, where the findings may have little relevance to an individual patient. Additionally, the vast majority of surgical procedures develop from expert opinion and case studies, deemed the lowest form of evidence by the proponents of EBM.

      Accordingly, in response to the renewed interest and acknowledgement of the value of case reports, the number of peer reviewed medical journals that publish case reports has dramatically increased from a few in 2003 to 160 by 2015. This rapid expansion of case study journals happened to coincide with the myopic drive for the higher research standards described by EBM in the sampling, preparation and publishing of papers by medical researchers and academics. Some in the chiropractic profession even began to insist on this standard to justify the efficacy of specific clinical procedures or scope.

IJPC recognises that the chiropractic profession is largely made up of sole practitioners with limited access to public hospitals and clinical facilities. Therefore, more relevant forms of evidence are required to confirm clinical outcomes and efficacy in chiropractic; evidence based chiropractic (EBC). IJPC offers a forum for individual chiropractic practitioners to record and publish case studies using CARE protocols to present successful or unsuccessful clinical outcomes. Such studies, combined with expert opinion, will provide the foundation of evidence required by the chiropractic profession in the same manner as most surgical procedures develop, are approved and adopted.

      Field practitioners and researchers will have unfettered access to case studies published in the IJPC that will describe the presenting symptoms, patient findings, the treatment of the identified biomechanical disturbance, the possible neurological pathways affected and the coincidental reduction or resolution of the patients complaints.  As the volume of such case studies becomes significant, chiropractic researchers will be able to draw on these case studies to conduct systematic reviews establishing a consilience of outcomes to demonstrate not only the scope of chiropractic, but its subsequent impacts to healthcare and practice procedures.

      IJPC will be the first chiropractic journal specifically dedicated to publication of case studies and reports generated by field practitioners. The IJPC is sponsored by Patrons of Chiropractic Science (PCS), an organisation established to raise funds for relevant research, encourage and sponsor such research, provide a platform to publish the research and to educate the public and law makers. PCS also aims to establish balance in the health care delivery debate that has for too long been dominated by the medical profession.

The IJPC editorial panels include academics, researchers and specific chiropractic technique experts from around the world.

 

The IJPC is an open access publication.

CHIROPRACTIC AT A CROSSROAD:

      After 124+ years of the chiropractic profession's formal existence, limited neurological research and clinical evidence of efficacy has been compiled. While the scope of chiropractic is highly focussed on the restoration of optimal neurological function, the list of health problems that resolve concomitant during, or immediately following chiropractic care remains staggering.

      Chiropractors understand this parallel relationship as they accept the premise of supremacy of the neurological system to directly or indirectly control and maintain every organ, structure and bodily function.  When this neurological function is compromised in any way, dis-ease can result. Chiropractic primarily focuses on one major cause of neurological dysfunction; where joint dysfunction may alter normal neurological function by combinations of insults including, mechanical compression, inflammatory reactions, localised ischemia, compromised nutrient flows, auto-immune responses and disturbances to proprioception or nociception pathways.  These circumstances most commonly occur within the spinal column and pelvis, but also other joints of the body.

      This concept of a relationship between the osseous structures of the body and optimum nerve function is not new. The founder of modern medicine, Hippocrates, listed rachiotherapy (Greek word for back or spinal care) as a fundamental element of medicine alongside surgery and medicinal therapy. In Hippocrates’ treatise on joints, he speaks of parathremata, which is a concept corresponding to what chiropractic describes as the subluxation, where the vertebrae in the spine are minimally displaced, only to a very small extent. Hippocrates goes on to say that it is necessary to have a good knowledge of the spine because many disorders are associated with the spine and displacement of vertebrae, including pharyngitis, laryngitis, bronchial asthma, tuberculosis, nephritis, cystitis, inadequate gonadal development, constipation, enuresis, and many other diseases that the medical profession and some in the chiropractic profession strangely insist cannot be helped following chiropractic care and improvement to neurological function.

 

      Chiropractors for over 124 years have attended patients with joint dysfunction that triggered abnormal neurological function, and once corrected, have observed remarkable coincidental recovery of a vast array of human ailments. It is now well overdue that the entire chiropractic profession as individual practitioners begin to record these patient results with CARE case studies, demonstrating the analytical and corrective procedures that coincided with recovery of such ailments.

 

      IJPC recognises that chiropractors are sole practitioners, with no or little access to public funded multi-practitioner clinics and hospitals, so much of the future research must be conducted in each private practice by the individual chiropractor who over time has developed advanced skills and expertise necessary to effectively deliver chiropractic care. It is imperative that future research accommodates the fundamental mode of Chiropractic practice. Correctly structured case studies are the most appropriate, relevant, cost effective and valid mechanism to advance chiropractic research and confirm its efficacy.

 

      PCS and IJPC aim to encourage every practising chiropractor worldwide, regardless of technique, to record interesting cases following the CARE Guidelines, and publish with IJPC. All chiropractic techniques achieve wonderful results, primarily because they each focus in normalisation of neurological function or sensory stimuli.

 

CASE STUDIES & REPORTS

The IJPC presents case reports categorised into the separate chiropractic analytical and adjusting techniques utilised with the subject patient. Peer review for each technique will be undertaken by educators and experts in that specific approach. If multiple techniques are utilised, the report will be listed under the primary technique that was nominated by the author.

To search for published case reports related to a specific technique, press the appropriate Access Button below:

SUBMISSION OF PAPERS TO IJPC

Manuscripts must be written in English in a portrait layout. Papers can be submitted for review and published at no fee. Send manuscript and images in Word or Pages formats (not PDF) to: admin@ijpconline.org

File size including images should not exceed 2.5MB. All acronyms must be defined. Ensure file name includes the author(s) name(s) (last name then initials), date of the manuscript and the critical keywords most relevant to the study. A cover letter must accompany the manuscript providing full details of each author, including a full list of qualifications, contact (phone and email) and address details. The primary chiropractic analytical and adjusting technique must be nominated (Activator, Gonstead, SOT, etc.). This letter must confirm that the paper has not been published elsewhere and may be subject to a separate copyright.

 

Patient anonymity

       For ethical and legal reasons, it is important that the manuscript protects the patient's identity and that the author maintains appropriate records. Identifying information on the patient's personal history, x-rays, reports, consents and images such as names, initials, case numbers, addresses and specific dates must be avoided or masked.  Photographs are publishable only with the written consent of the patient or their legal guardian. Signed consent form and patient acknowledgment must accompany the manuscript and if published will be masked by IJPC to protect the patient's identity.

Conflict of interest

       Each author must declare to IJPC if they or any contributing party has financial or other interests that may influence his or her decisions, actions, manuscript drafting or conclusions. Authors should also declare to IJPC if they received any external funding in relation to the data collection or preparation of content for the manuscript.

Peer review

       Authors should ensure their manuscript has been carefully reviewed by a colleague to ensure grammatical quality, format and relevance. IJPC editors may reject and return a manuscript or suggest changes prior to re-submission. Upon initial submission acceptance, IJPC  will initiate review, which will be undertaken by at least two members of the editorial panel, one of who will have expertise in the specific chiropractic technique utilised by the author(s). IJPC will use the double blind review method (both reviewer and author are blinded). Reviewer’s comments may be passed on to the authors with recommendations for amendment or improvement. Authors will then have the opportunity to revise their manuscript and re-submit the paper.

Acceptance for publication and copyright

       Upon acceptance by IJPC, the author will be notified by email. The paper will be published online by IJPC within 7 days of this notification. Copyright resides with the author. Authors must ensure that use of any diagrams in their manuscript do not infringe existing copyright. IJPC does not limit reproduction of any accepted and published manuscript.

CARE GUIDELINES

The CARE guidelines were developed by an international group of experts to increase the accuracy, transparency, and usefulness of case reports.  Since the 2013 and 2017 CARE publications in the Journal of Clinical Epidemiology, these guidelines have been endorsed by multiple medical journals and translated into more than ten languages. Some of the following healthcare stakeholder groups may benefit when CARE informed case reports are written:

  • Patients can review transparent information on therapeutic options.      

  • Clinicians improve peer-to-peer communication.

  • Researchers use testable hypotheses from clinical settings.

  • Educators have access to actual examples to support case-based learning.

  • Authors receive guidance on writing accurate and transparent case reports.

  • Journals data available for systematic evaluation of case reports.

There is a view amongst academics that field practitioners should not participate in research. This view is both self-serving and illogical. Historically, case reports have been important for (1) recognizing new or rare diseases, (2) evaluating the therapeutic effects, adverse events and costs of interventions; and (3) improving problem-based chiropractic or medical education. They provide evidence for effectiveness in a real-world setting, whereas clinical trials provide evidence for the average efficacy of interventions in a controlled setting.

CARE Checklist

The CARE guidelines and checklist provide authors the format and tools to write accurate and transparent case reports. They also provide editors and peer reviewers tools to critically evaluate case reports. It is recommended that points 1 to 14 are included in your study. However, not every sub-bullet point needs to be addressed.

  1. Title – The area of focus and “case report” should appear in the title

  2. Key Words – Two to five key words that identify topics in this case report. This can include the technique utilised.

  3. Abstract – (structured or unstructured)

    • Introduction – WHAT is unique and WHY this finding may be associated with a particular intervention?

    • The patient’s main concerns and important clinical findings.

    • The primary diagnoses, interventions, and outcomes.

    • Conclusion—What are one or more “take-away” lessons?

  4. Introduction – Briefly summarize why this case is unique with chiropractic, medical and scientific literature references recorded at point 14.

  5. Patient Information

    • De-identified demographic and other patient information.

    • Main concerns and symptoms of the patient.

    • Medical, family, and psychosocial history including genetic information.

    • History of injury or trauma.

    • Relevant past interventions and their outcomes.

  6. Clinical Findings – Relevant physical examination (PE) and other chiropractic clinical findings.

  7. Timeline – Relevant data from this episode of care organized as a timeline (figure or table).

  8. Diagnostic Assessment

    • Patients view of their previous medical diagnosis and confirmation of what medical diagnostic procedures and test results might be available.

    • Diagnostic methods (PE, ortho/neuro testing, imaging, surveys).

    • Diagnostic challenges.

    • Diagnostic reasoning including a differential diagnosis.

    • Prognostic characteristics when applicable.

  9. Therapeutic Intervention

    • Types of intervention (treatment approach, preventive, management and exercises, nutritional).

    • Administration of intervention (fully describe adjusting technique utilised, listing(s), line of correction, contact, the adjustment and equipment, duration of care).

    • Changes in the interventions with explanations.

  10. Follow-up and Outcomes

    • Clinician- and patient-assessed outcomes when appropriate.

    • Important follow-up diagnostic and other test results.

    • Intervention adherence and tolerability (how was this assessed?).

    • Adverse and unanticipated events.

    • Cost of treatment (optional).

    • Attachments or insertions- relevant x-ray images, postural assessments, other test results.

  11. Discussion

    • Strengths and limitations in your approach to this case.

    • Discussion of the relevant chiropractic and medical literature - references recorded at point 14.

    • Explanation of possible neurological links to the presenting symptoms and impacts of corrections and interventions.

    • The rationale for your conclusions.

    • The primary “take-away” lessons from this case report.

  12. Patient Perspective – The patient should share their perspective on their case study and acknowledge the stated case study descriptions, procedures and outcomes.

  13. Informed Consent – The patient should give informed consent to both the utilisation of their case, use of any images (x-ray or photographs) and to the patient perspective acknowledgement. However, the executed document will not be included in the published article, but will be held on file by the author and IJPC.

  14. References – Numerically list each reference in order of appearance in the case study with the reference number shown at the end of the sentence or paragraph to which it relates.  The recommended format for each reference is:

  • Papers: Author name & initials, author name & initials, etc., year of publication, title of article, subtitle if relevant, Title of Journal, vol. volume number, no. issue number, pp. page range.

  • Textbooks: Author or authors; name & initials, Year of publication (XXXX), Book title (italics), Edition (edn.), Publisher, place of publication.

REQUEST FOR ASSISTANCE IN DRAFTING AND SUPPORTING RESEARCH REFERENCING:

      IJPC has been advised that a number of international chiropractic colleges have offered to assist practitioners in the preparation of their manuscripts if they feel time constrained or ill-equipped to fully research and reference any discussion or neurology basis for their paper.

      In this instance, forward your written request for assistance and a summary of your case to IJPC, including the title, practitioner details (degrees, address, contact email and phone), keywords, the general abstract, details of the patient presentation, medical diagnosis if any, examination findings, copies of clinical testing reports or x-rays, your logic for the treatment approach, details of what and how the patient was treated, details of their responses and overall outcome.

 

      IJPC will then forward this summary to one of the participating colleges who will assign the case to an advanced student who will complete the study and be listed as a co-author. The completed draft will then be returned to you for final vetting and submission for peer review.