“Chiropractic is manual therapy, not talk therapy”: a qualitative analysis exploring perceived barriers to remote consultations by chiropractors

Abstract

Background Remote consultations (RCs) enable clinicians to continue to support patients when face-to-face appointments are not possible. Restrictions to face-to-face care during the COVID-19 pandemic has accelerated a pre-existing trend for their adoption. This is true for many health professionals including some chiropractors. Whilst most chiropractors in the UK have used RCs in some form during the pandemic, others have not. This study seeks to understand the views of chiropractors not using RCs and to explore perceived potential barriers. Methods A national online survey was completed by 534 registered practicing UK chiropractors on the use of RCs. Respondents had the opportunity of providing open-ended responses concerning lack of engagement in RCs during the COVID-19 pandemic. Textual responses obtained from 137 respondents were coded and analysed using thematic analysis. Results The use of RCs provided an opportunity for chiropractors to deliver ongoing care during the COVID-19 pandemic. However, many chiropractors expressed concern that RCs misaligned with their strong professional identity of providing ‘hands-on’ care. Some chiropractors also perceived that patients expected physical interventions during chiropractic care and thus considered a lack of demand when direct contact is not possible. In the absence of a physical examination, some chiropractors had concerns about potential misdiagnosis, and perceived lack of diagnostic information with which to guide treatment. Clinic closures and change in working environment led to practical difficulties of providing remote care for a few chiropractors. Conclusions The COVID-19 pandemic may have accelerated changes in the way healthcare is provided with RCs becoming more commonplace in primary healthcare provision. This paper highlights perceived barriers which may lead to reduced utilisation of RCs by chiropractors, some of which appear fundamental to their perceived identity, whilst others are likely amenable to change with training and experience.

Unpacking patient engagement in remote consultation

“…, 2021). Lack of internet access or poor internet connection has a similar effect (Derbyshire et al. , 2021; O'Donovan et al.…”

“…However, they are not affordable to every family, which acts as a major barrier to service adoption (Braune et al, 2021;Joughin et al, 2021;Stewart et al, 2021). Lack of internet access or poor internet connection has a similar effect (Derbyshire et al, 2021;O'Donovan et al, 2020). The availability of a private space to avoid distractions is another frequently mentioned factor because healthcare consultation is a personal/private activity; an appropriate environment The patient…”

“…Chang et al, 2021;Chu et al, 2022;Donaghy et al, 2019;Joughin et al, 2021;Stewart et al, 2021) Lack of or poor internet access(Chang et al, 2021;Darrat et al, 2021;Derbyshire et al, 2021;Gifford et al, 2021;Harris et al, 2021;Joughin et al, 2021;O'Donovan et al, 2020;Sosa et al, 2017;Stewart et al, 2021;Wherton et al, …”

The impact and public health response of chiropractors to the COVID-19 pandemic: a survey across four continents

“…While this increase may be considered substantial for a profession that has traditionally relied on doing things 'by hand', by comparison, a near tenfold uptake of telehealth has been reported within other healthcare professions, such as medicine [ 33 , 34 ] and physiotherapy [ 35 ]. Limited information does suggest that many chiropractors may have concerns that patient needs will not be met through telehealth [ 36 ]. However, evidence suggests the effectiveness of telehealth may be comparable to standard care for the management of spinal pain and other musculoskeletal conditions [ 37 – 40 ].…”