Chiropractic Students Versus Emergency Care Practitioners in Simulated Musculoskeletal Emergencies
SOURCE: Health SA 2025 (Oct 31): 30: 3195
Ivanna Balanco • Helen Slabber • Christopher Yelverton
Department of Chiropractic,
Faculty of Health Sciences,
University of Johannesburg,
Johannesburg, South Africa.
Background: As primary contact practitioners, chiropractors and emergency care practitioners (ECPs are first points of access for patients with musculoskeletal (MSK) complaints. A comparison of their diagnostic competency in distinguishing these presentations from underlying emergency pathologies remains an understudied area.
Aim: To compare the diagnostic abilities of Master of Health Science (MHSc) chiropractic students and ECPs in distinguishing MSK from emergency conditions.
Setting: The research was conducted at the University of Johannesburg, Faculty of Health Sciences, simulation laboratory.
Methods: First-year (n = 10) and second-year Master’s (n = 10) chiropractic students and ECPs (n = 10) were assessed using standardised patient scenarios: meningitis, disc herniation and stroke, and assessed on diagnostic assessment, diagnosis and clinical and diagnostic investigation referrals.
Results: Second-year MHSc students outperformed ECPs in the clinical management of a disc herniation case (Case 2; p < 0.01). Diagnostic accuracy was high (> 90%) for meningitis and stroke across all groups. Differences in investigation preferences emerged, with chiropractic students favouring advanced imaging and ECPs recommending more basic tests. No significant performance differences were found in the other two cases.
Conclusion: Based on a simulated assessment, chiropractic students demonstrated equivalent competence to emergency care practitioners (ECPs) in diagnosing emergencies, but outperformed them in managing an MSK condition. These preliminary findings suggest chiropractors could contribute to the management of MSK burden in emergency departments.
Contribution: MHSc chiropractic training enhances diagnostic proficiency in differentiating MSK disorders from emergent pathologies, an important competency for safe and effective practice as primary contact practitioners.
Keywords: chiropractic; clinical competence; diagnosis; emergency medical services; musculoskeletal disease; simulation.
From the FULL TEXT Article:
Introduction
Musculoskeletal (MSK) conditions represent a significant global health burden, ranking as the second leading cause of disability worldwide and affecting approximately one in five working-age adults (Lowe, Taylor & Hill 2017; Weinstein 2016). Back pain, a prevalent MSK complaint, contributes substantially to reduced work productivity, absenteeism and healthcare costs (Ingram & Symmons 2018; Menke 2003). This high prevalence strains healthcare systems, leading to long wait times for specialist care, including surgery (Joshipura & Gosselin 2020).
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Internationally, MSK conditions account for approximately 13.8% – 25% of all emergency department (ED) visits, with low back pain being the most common complaint. In South Africa, the prevalence is comparably high or higher: non-traumatic MSK complaints are reported in 36% of primary care attendees, and trauma-related MSK injuries (from violence, road accident and gunshot wounds) constitute a large portion of ED presentations. The lifetime prevalence of low back pain in South Africa is as high as 62%, and trauma-related MSK injuries are a leading cause of ED visits (Fialho et al. 2011; Louw, Morris & Grimmer-Somers 2007; Parker & Jelsma 2010; Pasta et al. 2022; Taljaard, Maharaj & Hendrikse 2022).
Despite their frequent encounter with MSK complaints, many general practitioners and emergency care providers lack adequate training in MSK assessment and management (Denq et al. 2023; Suter et al. 2016; Woolf & Åkesson 2001). This shortfall may result in excessive imaging, unnecessary referrals and delayed care (Comer, Liang & Bishop 2014; Gagnon et al. 2022). Recent evidence also indicates that new graduates and emergency staff in emergency medical care (EMC) positions often feel unprepared to manage these conditions, underscoring the need for improved education (Denq et al. 2023).
Internationally, programmes have been established where physiotherapists have been included within ED to specifically address MSK conditions (Cassar et al. 2022; Harding et al. 2015; Matifat et al. 2023; Taylor et al. 2011). Chiropractors are well-positioned to fulfil a role of assisting in these environments, given their focused training in MSK diagnosis and management, including identifying serious pathologies mimicking MSK disorders (Haldeman et al. 2015; Murphy et al. 2011; University of Southern Denmark 2023). Studies suggest that integrating chiropractors into mainstream healthcare and potentially EDs, can reduce unnecessary imaging and referrals, lower costs and improve patient satisfaction (Kindermann, Hou & Miller 2014; Lisi et al. 2018).
his study addresses a critical gap in the literature by comparing the diagnostic acuity of chiropractors and emergency care practitioners (ECPs) in distinguishing nonurgent MSK disorders from emergent pathologies within a simulated environment. As primary contact clinicians, both groups are tasked with the initial assessment of potentially undifferentiated patients; however, their training pathways differ significantly. By benchmarking chiropractors against
ECPs (a group specifically trained to recognise and triage medical emergencies), this research directly evaluates a core competency required for chiropractors to function safely in first-point-of-contact roles, such as ED settings, where the risk of misdiagnosing emergency pathologies which present similarly to MSK pathologies exists.
This study aimed to compare the diagnostic competencies of Master of Health Science (MHSc) chiropractic students in distinguishing MSK and emergency pathologies with those
of ECPs.
Study setting
The study was conducted in the University of Johannesburg, Faculty of Health Sciences, simulation laboratory, on the Doornfontein Campus.
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