Factors that influence scope of practice of the chiropractic profession in Australia: a scoping review
Chiropractic & Manual Therapies volume 30, Article number: 19 (2022)
The World Health Organization describes chiropractic as a health profession that treats the musculoskeletal system and the effects of that system on the function of the nervous system and general health. Notwithstanding such descriptions, scope of practice remains a contentious issue in Australia chiropractic with various authors defining it differently. To date, the peak governing body, the Chiropractic Board of Australia, has focused on title protection rather than defining a scope of practice for the profession. A well-defined scope of practice is important, as it helps to identify what is acceptable in the profession and the role chiropractic has in the broader healthcare system.
The objective of this scoping review was to explore the literature on the factors that influence scope of practice of chiropractic in Australia.
This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the chiropractic profession in Australia.
A total of 1270 articles were identified from the literature search. Six studies fulfilled the inclusion criteria and were included in the final analysis. Four factors that influence scope of practice were identified: education, professional identity, patient safety, and organisational structure.
The results of this study will inform future discussions around establishing a framework for a more comprehensive scope of practice for the chiropractic profession in Australia. Such a framework has the potential to benefit patient safety, professional identity, public perception, education, and regulation of the profession.
Recent estimates highlight a global shortage of healthcare professionals  including in the field of musculoskeletal (MSK) medicine . Musculoskeletal conditions are the primary cause of disability and the number one contributor to years lived with disability worldwide [3, 4]. In light of this, allied health professions that provide care for MSK conditions, such as chiropractic, have a role to play in preventing disability and reducing the burden of disease related to these conditions [2, 5].
In Australia, back and neck pain cause significant disability and loss of productivity and account for more than 21 million patient visits per year . This represents a considerable portion of the country’s total healthcare expenditure, part of which is spent on chiropractic services [7,8,9]. Chiropractic is the eleventh largest (out of sixteen) regulated health care professions in Australia with 5582 practitioners as of September 2021 . While the profession contributes to various levels of the Australian healthcare system, there is little that delineates the magnitude or extent of those contributions.
The World Health Organization (WHO) describes chiropractic as a health profession that treats the musculoskeletal system and the effect it has on the function of the nervous system and general health . Notwithstanding such definitions, debate has continued in Australia about scope of practice of the profession  with various authors defining it differently .
‘Scope of practice’ comprises three separate, but interrelated levels: ‘jurisdictional’ (legislative/regulatory) [14,15,16], ‘professional’ (the profession) [14, 15, 17]; and ‘personal’ (individual practitioner) [14, 18,19,20]. Jurisdictional scope of practice is founded on Government practice acts that contain regulations to ensure patient safety [14, 16, 21]. Professional scope of practice is grounded in a unique body of evidence, supported by educational preparation, and linked to an existing or emerging practice framework . Moreover, it is based on the rules, regulations and boundaries that convey the role of the profession and provide protection to the public [17, 18]. Personal scope of practice is centred on the activities that an individual health care practitioner is educated and trained for, and that they can perform  in a way that does not pose any danger to the public or themselves [15, 17]. Currently, personal scope of practice is more clearly defined than professional scope of practice .
Despite having the authority to develop a single scope of practice for the chiropractic profession in Australia , the peak regulatory authority, the Chiropractic Board of Australia (CBA), has focused on title protection rather than clearly defining scope of practice for the profession . A well-defined scope of practice in a health profession is important, as it helps to identify what is acceptable in that profession and the role it has in the broader healthcare system [24,25,26]. A clearly defined scope of practice for the chiropractic profession would be valuable to a variety of stakeholders including patients, health care providers, professional associations and policymakers .
As innovative technology and new treatment modalities emerge, the importance of understanding scope of practice is increasing for professions as they are called upon to navigate the increasingly complex realm of patient care . This is true for chiropractic. We recognise that a broader picture of scope of practice exists within health professions in Australia (e.g. nursing and midwifery and physiotherapy), but the objective of this scoping review is to explore the literature on the factors that influence scope of practice of chiropractic in Australia.
Scoping review methodology was chosen as the most appropriate way to collect and organise relevant information to address our broad research question and provide a thorough examination of the existing literature. Unlike other reviews (e.g. systematic reviews), that typically focus on specific questions, scoping reviews provide an overview of the developing evidence when it is uncertain what specific questions can be posed for evidence synthesis .
The review has been reported against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The 5-step framework of Arksey and O’Malley , as well as additional recommendations for conducting and reporting scoping reviews were used [31,32,33]. Arksey and O’Malley refined Mays’ definition of a scoping review which focused on mapping the key concepts and types of evidence underpinning a research area. A scoping review could be undertaken as a standalone project, especially where an area is complex or has not been previously comprehensively reviewed . Their completed framework consists of five pivotal stages for conducting this type of review.
Step 1: Identifying the research question
Our scoping review was guided by the following broad research question: what is known about the factors that influence scope of practice of chiropractic in Australia?
Step 2: Identifying relevant studies
The search strategy was developed in collaboration with a university librarian and conducted using the following databases: AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE (Excerpta Medica Database), ICL (Index to Chiropractic Literature), MANTIS (Manual, Alternative and Natural Therapy Index System) MEDLINE, PubMed and SCOPUS. The search included all articles published between January 2011 and July 2021. This date range was selected as Australia introduced the National Registration and Accreditation Scheme (the National Scheme), to regulate practitioners of ten health professions, including chiropractic, in late 2010. Thus, 2011 was the first year dialogue around a national scope of practice could be undertaken .
Additional data sources were searched from Google and ProQuest. A combination of indexing terms (MeSH and non-MeSH) relevant to the research theme were used: scope AND practice AND chiropractic OR chiropractor AND Australia AND determinant/s OR barrier/s OR enabler/s OR influencer/s OR facilitator/s. (For the purpose of this study these latter terms are used synonymously). An example of the search strategy for the PubMed and CINAHL databases is included in Additional file 1: Appendix 1. Forward/reverse citation tracking was also undertaken on eligible studies. All citations were imported into Endnote (version X9.3.3, Clarivate Analytics©, Boston MA, USA).
Step 3: Study selection
Inclusion and exclusion criteria
The review used the Joanna Briggs Institute’s (JBI) Population, Concept, Context framework for scoping reviews (PCC)  to align the study selection with the research question (Table 1). To be included in the study, articles had to be published in English and related to factors that influence scope of practice of chiropractic in Australia. Articles were excluded if they related to another country, referred to another regulated (e.g. pharmacy) or unregulated (e.g. massage therapy) health profession, were based on cadaveric or animal studies, or were related to topics not pertinent to scope of practice.
Screening and agreement
Two reviewers (DW, BB) independently screened the search results. Initially, records were screened by title and abstract to identify relevant, possibly relevant and irrelevant citations. As grey literature does not typically contain an abstract , vetting of these results was conducted using the full text version of the citation. In keeping with scoping review methodology , the number of studies included and excluded at each stage, along with the reasons for exclusion, were presented in a PRISMA flow diagram.
Step 4: Charting the data
To collate information from the relevant literature, a Word® table (Additional file 2: Appendix 2) was created that included the following items: category; year of publication; author/s; country of origin; aim/purpose; method/study design; and factors that influence scope of practice. Data extraction was completed independently by two investigators (DW, RE).
Step 5: Collating, summarising, and reporting results
An analysis was made of the research results including the number of papers included in the analysis, year of publication, and study design. Each eligible article was assessed for potential factors that influence scope of practice of chiropractic. During the assessment process, if information relating to factors that influence scope of practice was not available, the study was rated as unsuitable and excluded.
We did not determine a priori what the factors were, rather we considered what the authors of included studies found to influence the scope of practice, then distilled these into the key factors used in our review. A total of 1270 articles were identified from the literature search. Following the removal of duplicates, 1261 papers were screened, of which 1241 articles were excluded. The full text of 20 studies were then assessed for eligibility (see PRISMA flow chart—Fig. 1). Fourteen studies were excluded based on lack of reporting factors that influence scope of practice. Six studies were included in the final analysis. No additional articles were discovered following forward/reverse citation tracking. The six studies consisted of one scoping review, one qualitative study, two cross-sectional studies, and two news articles. Within the studies we found, the factors were not always classified as either jurisdictional, professional, or personal scopes, but where an author mentioned a specific scope, it was mentioned in this review.
Reported factors that influence scope of practice
Four factors were reported in the literature that influenced scope of practice of chiropractic in Australia:
Two of the included studies reported that chiropractic education was an influencing factor on scope of practice. For example, de Luca et al.  surveyed students in chiropractic programs in Australia and New Zealand about their views on several elements within chiropractic including scope of practice, as it relates to chiropractic education. The authors reported that a divergence existed between individual chiropractic educational institutions regarding scope of practice. Despite de Luca et al.  not describing a defininitve reason for the variance, they suggested a combination of the chiropractic institution and the level of education before chiropractic study, may explain much of the variance. Similarly, Innes et al.  found chiropractic education was a “focal element influencing the scope of practice of chiropractic in Australia”.
One study undertook a cross-sectional survey of graduates from Australian and New Zealand chiropractic universities . The study found that Australian graduates had divergent opinions about what comprised professional identity depending on the institution they had attended. For example, approximately 75% of respondents felt that chiropractors should be considered complementary/alternative health care practitioners, while the remainder stated they should be viewed as allied health care practitioners .
Two news articles, McArthur  and ABC Premium News , identified patient safety as a factor that influenced scope of practice, particularly when SMT was being utilised in paediatric populations. An Australian study by Engel et al.  found that GPs views about scope of practice of chiropractors was influenced by a perceived notion that chiropractic is unsafe. As a result, GPs reported hesitancy in referring patients to chiropractors.
One study found that an organisational structure could influence scope of practice of chiropractic. Netto et al.  reported that 78% of Fast Jet Aircrew in the Royal Australian Air Force (RAAF) experienced flight-related neck pain during or after a flight. Despite some participants reporting that chiropractic was effective, physicians within the structure were hesitant to refer patients for chiropractic treatment, as it was not part of the standard on-base healthcare services .
The objective of this study was to explore the literature on the factors that influence scope of practice of chiropractic in Australia. Four factors were highlighted by the authors of the retrieved articles: education, professional identity, patient safety and organisational structure.
Chiropractic education in Australia has two components: pre-and post-professional. Pre-professional training involves a 5-year program at one of four universities accredited by the Council on Chiropractic Education Australasia (CCEA) . Training involves studies in anatomy, neuroanatomy, physiology, microbiology, histology, pathology, diagnosis, and management, including joint manipulation, of MSK conditions of the spine and extremities. In keeping with government and CCEA guidelines, protection of the public is prominent in Australian chiropractic educational programs . Our study highlights that dissimilar or diverse teachings among educational institutions impact a students’ attitudes and ideologies regarding scope of practice .
For example, despite receiving a mostly science-based education, Australian chiropractic students were divided on the issue of whether the historical rationale for chiropractic intervention was as important as ‘science-based’ clinical reasoning . Innes et al.  propose that the heterogeneity of teachings between chiropractic educational institutions raises two important questions. First, who decides what is chiropractic and its attendant scope of practice? Second, what is the best model to deliver the most relevant education for those seeking to become chiropractors in the twenty-first century ?
We could find no definitive mechanism as to how education interacts with scope of practice. de Luca et al.  argued that it may be the result of a combination of chiropractic institution and level of education before commencing chiropractic study. It is possible that the of scope of practice is influenced by (1) content from both delivered and hidden curricula with pre- and post graduate education ; (2) guidance (or lack of thereof) provided by the accreditation bodies (e.g. CCEA) in relation to graduate capabilities ; and more broadly, (3) an education institiution’s health care ideology may influence (or support) student views on future scope of practice . This is a complex area that requires exploration in a future study.
In Australia, post-professional training falls under the heading of ‘continuing professional development’ (CPD). To maintain registration, a chiropractor is required to complete a minimum number of CPD activities or hours that fulfil the following goals:
Seek to improve patient health outcomes, safety and experiences;
Draw on best available evidence, including well-established and accepted knowledge that is supported by research where possible, to inform good practice and decision-making;
Contribute directly to maintaining and improving competence (performance and behaviour) and keeping up to date in the chosen field or setting of practice; and
Build on the existing knowledge .
In 2019, the criteria for the types of CPD activities that could be considered acceptable for chiropractors were relaxed. A more flexible approach has been adopted which allows a practitioner to plan their CPD activities so that they meet the specified CPD goals and reflect on how they will improve their practice based on what they have learned . Given the influence of heterogeneity between chiropractic schools regarding professional identity and scope of practice in pre-professional training , a high degree of flexibility in the post-professional area has the potential to promote further disparity .
Although a clear understanding of professional identity is paramount for the progression of any healthcare profession , the problem of conflicting professional identity is well reported in the chiropractic literature . However, since its inception, professional identity within chiropractic has been a source of controversy [48, 49]. Attempts to establish a single professional identity for the profession have been met with resistance based on disagreements over terminology , philosophy (e.g. approach to care) , technique (e.g. intervention) , and the role of chiropractic within the broader healthcare framework .
The Australian profession continues to be beleaguered by more than one intra-professional group, with each asserting differing views on identity . For example, the majority of chiropractors identify with, and practice within an evidence-based ‘biopsychosocial’ model of care . This is in contrast to a vocal minority of chiropractors who identify with a historical ‘vitalistic’ model of care which is based around diagnosis of the ‘vertebral subluxation’ , a concept unique to the chiropractic profession. This diversity appears to exist across chiropractic educational institutions [38, 45]. This situation has been exacerbated by some within the profession seeking to operate outside the accepted framework [45, 55]. As a result, the chiropractic profession has failed to establish a clear professional identity due primarily to the absence of a formulated scope of practice .
Simply stated, scope of practice is in part defined by whether chiropractors model their behaviour on a ‘subluxation-based’ model, where misaligned vertebrae are viewed as the cause of disease, or on an ‘evidence-based’ model where decision making around the diagnosis and management is based on current best evidence . The situation is further complicated where there is direct evidence of efficacy and/or biological plausibility around the effect of one, but not the other .
The lack of clarity regarding professional identity was one of the drivers for developing accreditation standards that acknowledge both models . It has been suggested that chiropractic educational institutions and the national accrediting body (CCEA) review their procedures for evaluating program curricula and accreditation standards to create a consistent standard across institutions, a strategy that may alleviate the incongruity that exists among students regarding professional identity .
Confusion around professional identity within the chiropractic profession is well reported in the literature . This circumstance is contrary to other health professions. For example, in nursing, professional identity is clearly defined as a sense of oneself that is ‘influenced by the characteristics, norms and values of the discipline, resulting in the individual thinking, acting and feeling like a nurse’ . The lack of clarity regarding chiropractic’s professional identity may be driving recent concerns raised by government , and the media , around patient safety.
Patient safety aims to prevent injury, and reduce risks, errors and harm that can occur to a patient during the provision of a healthcare service. This is true for all healthcare professions, including those that use spinal manipulation as a therapeutic intervention, particularly in the field of paediatrics [13, 25, 58].
At first glance, it may not be easy to see how patient safety influences scope of practice, but international and Australian data help to clarify the issue. For example, the Nursing and Midwifery Board of Ireland  asserts that an “individual nurse’s scope of practice [the ‘personal scope’ mentioned previously] is dynamic, and is influenced by a number of factors including patient safety, patient needs, and care outcomes”. Additionally, the Federation of State Medical Boards of the United States contends that the concept of “patient safety should be considered by health care regulatory boards and legislative bodies when making decisions about changes in scope of practice” .
Furthermore, a small Australian study undertaken by Engel et al. , found that personal scope of practice of chiropractors can be negatively influenced by a perceived notion amongst surveyed GPs that chiropractic is unsafe. As GPs are a primary contact point for many MSK presentations, negative views of the chiropractic profession could translate into reduced referrals (number and type) from GP’s to chiropractors.
Healthcare organisational structures (e.g. a hospital) are social systems purposely designed for the delivery of necessary healthcare services by specialised workforces within the system [61,62,63]. When the structure, or more correctly the health professionals within the structure, are unable to provide suitable care, it is the responsibility of those within the structure to co-ordinate care from other providers outside of the primary care setting . However, Netto et al’s. study  highlighted that Royal Australian Air Force (RAAF) physicians showed little interest in referring fighter jet pilots who commonly suffered from acute or chronic neck pain from aerial manoeuvres, for chiropractic treatment, until the on-base medical care had failed, a situation that potentially limited chiropractors from utilising and/or further developing their scope of practice.
There are several limitations associated with this study. It is possible that some articles may have been missed or excluded due to the chosen search parameters. Additionally, while relevant journal databases and grey literature were searched extensively, the number of included studies was small and varied in both aim and methodology. Therefore, the factors identified within this review may be incomplete.
As innovative technology and new treatment modalities emerge, the importance of understanding scope of practice is increasing for health care professions, as they are called upon to navigate the increasingly complex realm of patient care. This is true for chiropractic. Although this review was limited to the scope of practice of chiropractic in Australia, we recognise that a broader picture exists across the spectrum of health professions in the country. Future research could address whether the regulated professions function better without a defined scope of practice as in medical practice, or whether the approach seen in dentistry with a formal, defined scope of practice is more acceptable for a profession and its patients. Such studies may help determine if it is necessary to have a common defined scope of practice for the various professions. This would assist in determining the best framework for guaranteeing competency and patient safety.
This scoping review investigated the current state of literature on factors that influence scope of practice of chiropractic in Australia. Four factors were found: education, professional identity, and organisational structures. Recognising these factors in the literature provides the foundation for identifying what is acceptable in the profession, and the role chiropractic has in the broader healthcare system. Understanding these factors will help inform future discussions between stakeholders such as educators, employers, consumers, funding bodies, policy makers, and practitioners around establishing a readily acceptable scope of practice of chiropractic in Australia. Such a framework has the potential to benefit patient safety, professional identity, public perception, education, and regulation of the profession.
Availability of data and materials
All data generated or analysed during this study are included in this published article.
Australian Broadcasting Corporation
Australian Health Practitioner Regulation Agency
Chiropractic Board of Australia
Council on chiropractic education of Australasia
Continuing professional development
Joanna Briggs Institute
Open science framework
Population, concept, context
Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews
Spinal manipulative therapy
World Health Organization
United Nations—UN News. Global shortage of health workers expected to keep growing, UN agency warns. https://news.un.org/en/story/2013/11/455122-global-shortage-health-workers-expected-keep-growing-un-agency-warns. Accessed 27 Nov 2021.
Stochkendahl MJ, Rezai M, Torres P, Sutton D, Tuchin P, Brown R, et al. The chiropractic workforce: a global review. Chiropr Man Therap. 2019;27(36):1–9.
Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease. Ann Rheum Dis. 2010;73(7):1323–30.
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.
WHO guidelines on basic training and safety in chiropractic. Geneva: World Health Organization; 2005. https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf. Accessed 27 Oct 2021.
Adams J, Lauche R, Peng W, Steel A, Moore C, Amorin-Woods LG, et al. A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors. BMC Complement Med Ther. 2017;17(1):1–8.
Engel RM, Brown BT, Swain MS, Lystad RP. The provision of chiropractic, physiotherapy and osteopathic services within the Australian private health-care system: a report of recent trends. Chiropr Man Therap. 2014;22(3):1–7.
Salehi A, Hashemi M, Imanieh M, Saber M. Chiropractic: is it efficient in treatment of diseases? Review of systematic reviews. Int J Community Based Nurs Midwifery. 2015;3(4):244–54.
LeFebvre R, Peterson D, Haas M. Evidence-based practice and chiropractic care. J Evid Based Integr Med. 2012;18(1):75–9.
The regulated health workforce in 2019/20. Canberra. ACT: Australian Health Practitioner Regulation Agency; 2021. https://www.ahpra.gov.au/Publications/Annual-reports/Annual-Report-2020/Overview.aspx. Accessed 27 Nov 2021.
World Health Organization. WHO guidelines on basic training and safety in chiropractic. Geneva: World Health Organization; 2005. https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf. Accessed 27 Oct 2021.
Glucina TT, Krägeloh CU, Farvid P, Holt K. Moving towards a contemporary chiropractic professional identity. Complement Ther Clin Pract. 2020;39:1–14.
Submission to the Safer Care Victoria independent review on spinal care for children under 12 years. Melbourne, VIC: Australian Chiropractor's Association; 2019. https://www.chiro.org.au/patients/campaigns/chiro-review/. Accessed 8 Aug 2021.
Scope of practice. American Physical Therapist Association; 2021. https://www.apta.org/your-practice/scope-of-practice. Accessed 5 May 2021.
A new approach to defining scope of practice for orthotist/prosthetists in Australia. Australian Orthotic Prosthetic Association; 2019. Accessed 10 Feb 2021.
Leslie K, Moore J, Robertson C, Bilton D, Hirschkorn K, Langelier MH, et al. Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK. Hum Resour Health. 2021;19(15):1–12.
Decision-making framework for nurses and midwives. Nursing and Midwiery Board of Australia; 2019. https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD19%2F28198&dbid=AP&chksum=oKkJEIeNcDEKh1FXSSch6g%3D%3D. Accessed 20 Feb 2022.
A new approach to defining scope of practice for orthotist/prosthetists in Australia. Australian Orthotic Prosthetic Association; 2019. https://www.aopa.org.au/documents/vitem/525. Accessed 20 June 2021.
Kusler D, Sims M. The scoop on scope of practice—it’s not just for nurses. Everything Matters Patient Care. 2012;25(3):5–7.
Is it advanced or expanded practice? Australian Nursing & Midwifery Federation; 2014. https://www.anmf.org.au/pages/professional-july-2014. Accessed 18 May 2021.
Scope of practice. Australian Physiotherapy Association; 2014. https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjMsNDBjZz1AhUbSGwGHVieArMQFnoECAMQAQ&url=https%3A%2F%2Faustralian.physio%2Fsites%2Fdefault%2Ffiles%2FRESOURCES%2FAdvocacyPositionScope_ofPractice2009.pdf&usg=AOvVaw2LF1o6rm65A-4DzViG40or. Accessed 6 Jan 2022.
Chiropractic Board of Australia—background information. Canberra, ACT: Chiropractic Board of Australia; 2016. https://www.abc.net.au/cm/lb/7351754/data/statement-from-ahpra-data.pdf. Accessed 14 Oct 2021.
Chiropractic Board of Australia. Title protection and scope of practice. Canberra, ACT: Australian Health Practitioner Regulation Agency; 2014. https://www.chiropracticboard.gov.au/news/newsletters/march-2014.aspx#title. Accessed 30 Sept 2020.
Chang M. Chiropractic scope of practice update. ACA News. 2013;9(9):16–20.
McArthur G. Chiro cops ban. Herald Sun. 5 May, 2016.
Woodley M. Banned chiropractor could be treating infants again by 2021. News GP. 22 Feb 2019. https://www1.racgp.org.au/newsgp/clinical/banned-chiropractor-could-be-treating-infants-agai. Accessed 24 Oct 2021.
Chang M. The chiropractic scope of practice in the United States: a cross-sectional survey. J Manipulative Physiol Ther. 2014;37(6):363–76.
Western Australia Department of Health. Credentialing and defining the scope of clinical practice policy. 2019. https://ww2.health.wa.gov.au/About-us/Policy-frameworks/Clinical-Governance-Safety-and-Quality/Mandatory-requirements/Credentialing-and-Defining-Scope-of-Clinical-Practice-Policy. Accessed 27 Oct 2021.
Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute reviewers manual. Adelaide: The Joanna Briggs Institute; 2020. p. 407–50.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Sci Res. 2005;8(1):19–32.
Levac D, Coquhoun H, O’Brien K. Scoping studies: advancing the methodology. Implement Sci. 2010;5(69):1–9.
O’Brien KK, Colquhoun H, Levac D, Baxter L, Tricco AC, Straus S, et al. Advancing scoping study methodology: a web-based survey and consultation of perceptions on terminology, definition and methodological steps. BMC Health Serv Res. 2016;16(30):1–12.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Levac D, Moher D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–73.
Daudt H, Van Mossel C, Scott S. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. BMC Med Res Methodol. 2013;13(48):1–9.
Commonwealth Department of Health. National Registration and Accreditation Scheme; 2021. https://www.health.gov.au/initiatives-and-programs/national-registration-and-accreditation-scheme. Accessed 21 Mar 2022.
Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalid H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute reviewer’s manual. Adelaide: Joanna Briggs Institute; 2020. p. 407–51.
Godin K, Stapleton J, Kirkpatrick SI, Hanning RM, Leatherdale ST. Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Syst Rev. 2015;4(138):1–10.
de Luca KE, Gliedt JA, Fernandez M, Kawchuk G, Swain MS. The identity, role, setting, and future of chiropractic practice: a survey of Australian and New Zealand chiropractic students. J Chiropr Educ. 2018;32(2):115–25.
Innes SI, Cope V, Leboeuf-Yde C, Walker BF. A perspective on Chiropractic Councils on Education accreditation standards and processes from the inside: a narrative description of expert opinion Part 1: Themes. Chiropr Man Therap. 2019;27(57):1–12.
Melbourne chiropractor who cracked back of baby temporarily banned from treating children: a Melbourne chiropractor who cracked the back of a newborn baby in a video that went viral is temporarily banned from treating children. ABC Premium News; 2016. https://www.smh.com.au/healthcare/chiropractor-ian-rossborough-temporarily-banned-from-treating-children-20160516-gowkk0.htm.l. Accessed 27 Oct 2021.
Engel RM, Beirman R, Grace S. An indication of current views of Australian general practitioners towards chiropractic and osteopathy: a cross-sectional study. Chiropr Man Therap. 2016;24(37):1–10.
Netto K, Hampson G, Oppermann B, Carstairs G, Aisbett B. Management of neck pain in Royal Australian Air Force fast jet aircrew. Mil Med. 2011;176(1):106–9.
Become a chiropractor. Fitzroy, VIC: Chiropractic Australia; 2021. https://chiropracticaustralia.org.au/professional-development/become-a-chiropractor/. Accessed 6 Sept 2021.
Accreditation guidelines for chiropractic education programs. Canberra, ACT: Council on Chiropractic Education of Australasia; 2018. https://www.ccea.com.au/index.php/accreditation/accreditation-documentation/. Accessed 8 Aug 2021.
Swain MS, Gliedt JL, de Luca K, Newell D, Holmes M. Chiropractic students’ cognitive dissonance to statements about professional identity, role, setting and future: international perspectives from a secondary analysis of pooled data. Chiropr Man Therap. 2021;25(9):1–10.
Revised CPD guidelines published today. Canberra, ACT: Australian Health Practitioner Regulation Agency; 2019. https://www.chiropracticboard.gov.au/News/2019-10-24-CPD-guidelines.aspx. Accessed 3 Oct 2021.
Seaman D. Philosophy and science versus dogmatism in the practice of chiropractic. J Chiropr Humanit. 1998;8:55–6.
Schneider M, Murphy D, Hartvigsen J. Spine care as a framework for the chiropractic identity. J Chiropr Humanit. 2016;23(1):14–21.
Brown RA. Spinal health: the backbone of chiropractic’s identity. J Chiropr Humanit. 2016;23(1):22–8.
Budgell BS, Kwong A, Millar N. A diachronic study of the language of chiropractic. J Can Chiropr Assoc. 2013;57(1):49–55.
Mirtz TA. A treatise for a new philosophy of chiropractic medicine. Chiropr Man Therap. 2017;25(7):1–15.
Marcon AR, Caulfield T. Commenting on chiropractic: a YouTube analysis. Cogent Med. 2017;4(1):1–22.
Leboeuf-Yde C, Innes SI, Young KJ, Kawchuk GN, Hartvigsen J. Chiropractic, one big unhappy family: Better together or apart? Chiropr Man Therap. 2019;27(4):1–8.
Aubusson K, Spooner R. Chiropractors allegedly caught sneaking into maternity wards to treat newborns. Sydney Morning Herald; 2016.
Colvin M. More chiropractors sanctioned for sneaking into hospitals to treat babies. Australian Broadcasting Corporation; 2015. https://www.abc.net.au/pm/content/2015/s4281643.htm. Accessed 6 Sept 2021.
Innes SI, Leboeuf-Yde C, Walker BF. How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years. Chiropr Man Therap. 2018;26(8):1–9.
Brewington J, Godfrey N. The professional identity in nursing initiative. Nurs Educ Perspect. 2000;41(3):201.
Chiropractic spinal manipulation of children under 12: independent review. Melbourne, VIC: Safer Care Victoria; 2019. https://www.bettersafercare.vic.gov.au/publications/chiropractic-spinal-manipulation-of-children-under-12. Accessed 27 Oct 2021.
Scope of nursing and widwifery practice framework. Dublin, IE: Nursing and Midwifery Board of Ireland; 2015. https://www.nmbi.ie/COVID-19/Scope-of-Practice/Nursing-Practice-Scope-Definition.aspx. Accessed 1 Mar 2022.
Assessing scope of practice in health care delivery: critical questions in assuring public access and safety. Euless, TX: Federation of State Medical Boards of the United States; 2005. https://www.fsmb.org/siteassets/advocacy/policies/assessing-scope-of-practice-in-health-care-delivery.pdf. Accessed 1 Mar 2022.
Strengthening health systems to improve health outcomes. Geneva: World Health Organization; 2007. https://www.who.int/healthsystems/strategy/everybodys_business.pdf. Accessed 5 Sept 2021.
Bricknell M, Hinrichs-Krapels S, Ismail S, Sullivan R. Understanding the structure of a country’s health service providers for defence health engagement. BMJ Mil Health Month. 2020;6:1–3.
New Mexico Nursing Education Consortium. Health Care Delivery Systems; 2020. https://www.nmnec.org/wp-content/uploads/2020/06/Health-Care-Delivery-Systems.rev02.20.20-Final-Ed-Version.pdf. Accessed 21 Aug 2021.
Freeman G, Hughes J. Continuity of care and the patient experience. 2010. https://www.kingsfund.org.uk/sites/files/kf/field/field_document/continuity-care-patient-experience-gp-inquiry-research-paper-mar11.pdf. Accessed 30 Mar 2022.
The authors would like to acknowledge the contribution of Professor Sandra Grace in assisting with the final editing of the manuscript.
Ethics approval and consent to participate
Consent for publication
The authors declare that they have no competing interests.
There is no published protocol document for this research.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Wiggins, D., Downie, A., Engel, R. et al. Factors that influence scope of practice of the chiropractic profession in Australia: a scoping review. Chiropr Man Therap 30, 19 (2022). https://doi.org/10.1186/s12998-022-00428-2
- Scope of practice
- Scoping review