Chiropractor’s PhD on Indigenous Health

To many chiropractors and osteopaths, Dein Vindigni requires no introduction. He has had an active role over the years within the chiropractic profession, the chiropractic department at RMIT and within the Hands-On-Health organisation. His kindness and humanitarian spirit has reached many practitioners in Australia. This article is to update the current major project that Dein is undertaking.

Dein is currently juggling the life of a father of two young children, a chiropractor in private practice in Lalor, Victoria and a PhD student. The aim of Dein’s PhD is to estimate the prevalence of musculoskeletal conditions among Aboriginal people living in rural communities. There is a paucity of reliable information on the burden of illness of musculoskeletal problems among Indigenous Australians, particularly those living in rural areas. Dein’s project is an extremely important step to improving the state of the health system in Australia.

Dein’s project begins by travelling to Indigenous communities where he will conduct a questionnaire and obtain data on the musculoskeletal health of the community. Dein has gained the participation of the Durri community, which is a community-based Aboriginal Medical Service in the Kempsey region of NSW, to run a prevalence study. The services of an Aboriginal population of approximately 5000 people will be utilised. To ensure the community needs of musculoskeletal conditions are accurately reflected, approximately 380 people will be randomly recruited from Durri to assess the prevalence of musculoskeletal conditions in the community.

There will be 2 measurement strategies for assessing the prevalence of musculoskeletal conditions. The first will involve the administration of the previously piloted musculoskeletal questionnaire. This questionnaire assesses the location of any current or past joint/muscle pain and how these may limit people’s activities of daily living.

The second strategy will be to undertake a clinical assessment, including history taking and musculoskeletal examination, among those people with problems identified through the questionnaire. The history will also identify the perceived barriers to treatment, such as social, financial or access to health professionals.

Deins’ project stands out from most in the ethical and humanitarian way he conducts his study. Often it is after the information is gained where researchers cease involvement. In Dein’s case, after gaining information to assess the musculoskeletal health of his study group, Dein is utilising the services of local practitioners to provide care to those in need. Dein sees the value in all manual therapies and has chiropractors, osteopaths, physiotherapists and masseurs working alongside him. When Dein is on field trips running his project, half of his own time is spent providing chiropractic care to the people in his study group.

Dein then plans to take his project a big step further by developing a manual therapy course which can be taught to the Aboriginal Health workers in the communities. The data generated from the prevalence study will be used to develop and evaluate an accredited massage-training course, which will include culturally appropriate interventions. These interventions will combine traditional Aboriginal healing methods with suitable western approaches. This will provide the much needed ongoing therapy which these communities lack due to location, education and economics.

Preliminary consultations with cultural elders and Aboriginal Health Workers in the region have enabled an initial draft of the course. This includes relaxation massage (for stress relief), infant massage (as applied and taught by maternal health workers), traditional healing methods, and remedial and sports massage (for managing conditions of pain and disability amongst people of all ages). The course was based, in part, on the discernment by Aboriginal Health Workers and on the results of a preliminary pilot involving the assessment of musculoskeletal conditions amongst 53 community members.

Baseline levels of knowledge and skills in the areas of anatomy, physiology and massage techniques will be measured prior to the course and on completion of the program. The massage course has the potential to be delivered throughout the country using local health professionals to deliver the practical components of the course.

The effectiveness of this community based Aboriginal Health Worker training program in musculoskeletal health will also be evaluated. The program will be targeted at the basic assessment and management of soft tissue conditions that are common presentations among Indigenous people in rural communities. The acceptability of the training program, both to the service delivery vehicles, that is, the Aboriginal Medical Services, and members of the communities which they serve will also be evaluated.

Dein’s project uses an action-oriented approach as a mechanism to address the scarcity of resources and culturally appropriate delivery mechanisms available for Indigenous people with musculoskeletal conditions. Dein should be applauded for his ability to see the benefits of such a wholistic and multidisciplinary study done with the best interests of his study group in mind.

COCA wishes Dein all the best as he conducts this groundbreaking study.

For more information on Dein’s study you can contact him on dein@teksupport.net.au