“Like Peanut Butter and Jelly”: A Qualitative Study of Chiropractic Care and Home Exercise Among Older Adults With Spinal Disability

Abstract

Objective. A mixed-methods, randomized controlled trial comparing short-and long-term chiropractic care and exercise therapy for spinal disability in older adults found no between-group differences in the primary outcome. However, those who received long-term management reported greater improvement in neck pain, self-efficacy, function, and balance. This nested qualitative study explored participants' perceptions of the benefits and drawbacks of chiropractic care and exercise for spine-related outcomes, with an emphasis on understanding what makes treatment for spine-related problems worthwhile.Methods. Of 171 individual interviews conducted after completing study treatment, 50 participants (25 per treatment group) were randomly selected for this analysis. Qualitative descriptive analysis included dual coding of verbatim transcripts by 2 investigators (MM and SAS), which was further distilled into a consensus-derived codebook of themes and organized using NVIVO software.Results. Participants described trial interventions as complementary to one another for spine-related disability. Chiropractic care was viewed as improving spinal pain and controlling symptoms, while exercise therapy was noted for its long-term impact on self-efficacy and self-management. These older adults considered changes in pain, global sense of improvement, and improved biomechanical function as making treatment worthwhile.Conclusion. Older adults valued nonpharmacologic treatment options that aided them in controlling spine-related symptoms, while empowering them to maintain clinical benefit gained after a course of chiropractic spinal manipulation and exercise. The complementary nature of provider-delivered and active care modalities may be an important consideration when developing care plans. This study underscores the importance of understanding participants' values and experiences when interpreting study results and applying them to practice.The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services.

Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession

“…(p. 97). Patients also confirmed the importance of this notion of change [39]: "The only thing that would really make it [treatment] worthwhile is if I felt comforted from it, or I had a slight glimmer of hope that there's going to be improvement. Otherwise, I don't see the purpose in it" (p. 11).…”

“…Otherwise, I don't see the purpose in it" (p. 11). Patients also noted that their idea of the change they desire to see is individual and subjective [39]: as one participant emphasised "every patient here has their own story, so what is good for one person may not be good for another person. " (p. 6).…”

Investigating Functional Impairment in Chronic Low Back Pain: A Qualitative Study from the Patients and Specialists’ Perspectives

“…Relying solely on pharmacological therapy for cLBP is a hasty and ineffective approach [ 43 , 44 , 45 ]. Furthermore, in the therapeutic process, it is beneficial to involve professionals who specialize in the treatment of low back pain within an integrative medicine framework [ 46 ].…”

Association Between Psychosocial Parameters and Response to Chiropractic Care Among Older Adults With Chronic Low Back Pain: Secondary Analysis of a Randomized Clinical Trial

“…19 Although there were no between-group differences in back-and neck-related disability at 36 weeks, those in the 36-week treatment group reported greater improvement in self-efficacy at weeks 36 and 52, with objective improvement in functional ability and balance post-intervention. 20 Qualitative interviews embedded in the RCT revealed that participants experienced greater self-efficacy as a result of study treatments and valued improvement in functional ability when determining whether treatment was worthwhile. 20 It is unknown to what degree psychosocial measures, including self-efficacy and kinesiophobia, are associated with response to spinal manipulation and exercise among older adults with chronic spinal pain and disability.…”

“…20 Qualitative interviews embedded in the RCT revealed that participants experienced greater self-efficacy as a result of study treatments and valued improvement in functional ability when determining whether treatment was worthwhile. 20 It is unknown to what degree psychosocial measures, including self-efficacy and kinesiophobia, are associated with response to spinal manipulation and exercise among older adults with chronic spinal pain and disability. Understanding the impact of non-pharmacological treatments on improving self-efficacy and reducing kinesiophobia and how these are associated with reductions in spine-related disability could support spine care in older adults and help identify individuals most likely to respond to treatment.…”