J Manipulative Physiol Ther. 1997 Jul-Aug; 20(6): 382-8.
An interactive model of chiropractic practice: reconstructing clinical reality.
Department of Chiropractic, Osteopathy & Complementary Medicine, Faculty of Biomedical & Health Sciences, RMIT, Bundoora, Victoria, Australia.
OBJECTIVE: This study proposes an interactionist model of chiropractic care, uses practice observation to ascertain whether this framework is compatible with clinical reality and explores a novel explanation of how chiropractic clinical communication may contribute to healing. DESIGN: A constructivist inquiry paradigm based upon purposive sampling, grounded theory, inductive analysis and contextual interpretation was used. The compatibility of chiropractic clinical reality with an evolving interactionist model was ascertained through reflection on contemporary literature and practice observation of 208 consultations undertaken by 34 chiropractors working in geographically dispersed areas of Australia. Sample selection used a maximum variation strategy. Triangulation of data collected was undertaken by mailing the clinical communication scenario constructed by the investigator to participating chiropractors for comment and by having 144 patients complete a questionnaire. RESULTS: Interaction observed in chiropractic practice is bidirectional, is both task- and relationship-oriented, and seems to be verbal and nonverbal in nature. Touch, whether diagnostic or therapeutic, emerged as an fundamental feature of chiropractic care. CONCLUSION: Verbal and nonverbal communication in chiropractic practice, when analyzed within a interactionist framework, can be construed to create an environment conducive to healing by establishing a shared clinical reality. The ability of the consultation to change perceptions and reduce anxiety is presented as a substantial factor contributing to the potency of the chiropractic care. The interactionist model proposed for chiropractic care was found to provide a useful framework for reconceptualizing chiropractic clinical practice. By providing an additional perspective of chiropractic practice, this model enhances discourse on the variables contributing to the success of chiropractic care.