title: The chiropractic scope of practice in the United States: a cross-sectional survey.
abstract: OBJECTIVE
  The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998.
  
  
  METHODS
  A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability.
  
  
  RESULTS
  Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30).
  
  
  CONCLUSIONS
  The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.
authors.affiliation: Assistant Professor, Clinical Sciences, National University of Health Sciences-Florida, Pinellas Park, FL. Electronic address: mchang@Nuhs.edu.
authors.forename: Mabel
authors.initials: M
authors.lastname: Chang
mesh_terms: D002684:Chiropractic; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D014481:United States
keywords: Chiropractic; Health Resources; Health Services; Legislation; Licensure