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The purpose of this paper is to examine the outcomes of chiropractic manipulative and manual therapy (MMT) provided to residents experiencing spinal pain in a substance misuse therapeutic community (TC).

Clinical audit to explore the potential benefits of the interventions offered to residents experiencing spinal pain in a TC. Residents seeking care underwent an assessment by either general practitioner or chiropractic intern. Eligible participants could choose one of the four interventions: usual care without any additional treatment (Group 1), usual care with simple analgesics (Group 2), usual care plus MMT without simple analgesics (Group 3), or usual care plus MMT with simple analgesics (Group 4). Outcome measures were the RAND-36-item short form health-related quality-of-life survey and the patient satisfaction questionnaire (PSQ). Data were collected at baseline and after six weeks for each participant, with those participants choosing MMT receiving up to six treatments over the study period. Two cycles of six weeks of data collection was used. Data were analysed for statistically significant (repeated measures ANOVA with Bonferroni correction) and clinically meaningful changes in scores.

Of 71 self-presenting residents seeking care, 68 were eligible to participate. Of these, 32 chose usual care with simple analgesics (Group 2) and 36 chose usual care plus the package of MMT but without simple analgesics (Group 3). None chose usual care without additional treatment or usual care plus the package of MMT with analgesics, thus offering only the data from two groups for analysis. Group allocation was non-random and based on patient choice. Between-group analysis of the cumulative and component RAND-36 data indicated a significant difference between the two groups (p=0.034), particularly in the physical outcomes (p=0.012), indicating that Group 3 had improved scores over Group 2. Group 3 showed a significant change in RAND-36 scores (p<0.01) when compared with Group 2 (p=0.23) over the six-week treatment period. The PSQ scores of the two groups showed a statistically significant difference (p=0.0093), suggesting that Group 3 had greater patient satisfaction with care. The outcomes suggest that the package of MMT in Group 3, delivered by an appropriately trained clinician may have added to therapeutic effect that extended beyond physical outcomes but also influenced psychological outcomes.

The results of this clinical outcome-based audit suggest that the addition of a package of chiropractic MMT to usual care may be of benefit over usual care with simple analgesics for residents of a TC with spinal pain. The results intimate that benefits may extend across both the physical and psychological components of the pain experience, although a confirmatory study is recommended to substantiate these insights.

As far as the authors are aware, this trial is the first of this type in a TC, with the insights and experience gained supporting a definitive trial.

The purpose of this paper is to work with Aboriginal and Torres Strait Islander people (ATSI), it is expected that non-ATSI health-care professionals become culturally aware; however, participants’ perceptions of the relative merit of cultural awareness training (CAT) formats is uncertain.

The authors compared undergraduate students’ perceptions of an asynchronous online format with onsite delivery formats of CAT using a mixed-method design. Students from five successive cohorts (n = 64) in an undergraduate programme were invited to complete a post-training survey which gathered quantitative and qualitative data.

Whilst feedback was positive regarding both formats, the onsite format was preferred qualitatively with several valuable learning outcome themes emerging from the results. These themes included; “perceived benefits of self-evaluation of students’ own culture whilst learning about Aboriginal culture”; “encouraging to be provided with scenarios, examples and exercises to enhance cultural awareness” and “engagement with the interactive facilitator approach”. There were differing views about the benefits of learning the history of oppression which warrant further research.

Results may be applicable to undergraduate allied health students who participate in clinical immersion placements (CIPs) who participate in Aboriginal CAT.

Given the changing dynamic in education forced by the COVID-19 pandemic, more resources may need to be directed to improving online training and possibly combining formats in course delivery.

The strength of the study is that the authors achieved a response rate of 100%, thus the results are highly significant for the sample. This sample represents 41.3% of chiropractic students who attended CAT and CIPs at this university over the course of 9 years, thus the results could be generalized to chiropractic students who participated in these types of placements.

To the best of the authors’ knowledge, this is the first study to compare student perceptions of different formats of Aboriginal CAT for final year chiropractic undergraduate students in Australia.