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

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In a previous paper, we presented some important weaknesses of and threats to the chiropractic profession as we see them. We further argued that the chiropractic profession’s relationship with its principal clinical tool (spinal manual therapy) is at the core of the ideological divide that fractures the profession and prevents professional development towards greater integration in the healthcare landscape. In this manuscript, we shall argue that the historical predilection for spinal manipulation also gifts the profession with some obvious strengths and opportunities, and that these are inextricably linked to the management of musculoskeletal disorders. The onus is now on the chiropractic profession itself to redefine its raison d’être in a way that plays to those strengths and delivers in terms of the needs of patients and the wider healthcare system/market. We suggest chiropractors embrace and cultivate a role as coordinators of long-term and broad-focused management of musculoskeletal disorders. We make specific recommendations about how the profession, from individual clinicians to political organizations, can promote such a development.

Section: Where To Next and How To Get There?mentioning

confidence: 99%

A new role for spinal manual therapy and for chiropractic? Part II: strengths and opportunities

O’Neill,

Nim,

Newell

et al. 2024

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“…Finally, the findings of this study explained less than 30% of the total variance, and this means that other factors are at play in determining clinical decisions that will require further investigation. Ivanova D, Bishop FL, Newell D, Field J, Wals M. Mixed methods systematic review of the literature base exploring working alliance in the chiropractic profession [ 5 ]. Mixed methods systematic review This mixed methods systematic review aimed to synthesise qualitative and quantitative evidence to study the nature and the role of working alliance within chiropractic consultations.…”

Section: Which Topics Were Addressed?mentioning

confidence: 99%

“…Belton and colleagues provide additional insights on the patient’s perspective of care by exploring the narrative of one patient and her experience with seeking care for persistent pain [ 4 ]. The critical nature of the patient-provider relationship, or working alliance, is further explored in the mixed methods systematic review by Ivanova and colleagues [ 5 ]. Advances in technology and changes in response to the COVID pandemic are accelerating the use of telehealth, which raises unique challenges for developing an effective patient-provider relationships.…”

Section: Which Topics Were Addressed?mentioning

confidence: 99%

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A new paradigm for musculoskeletal pain care: moving beyond structural impairments. Conclusion of a chiropractic and manual therapies thematic series

Fritz

Kongsted

2023

This commentary closes the thematic series “A new paradigm for musculoskeletal pain care: moving beyond structural impairments”. The papers published in the series point to key aspects of shifting the paradigm of musculoskeletal care from clinician-led management often focused on addressing presumed structural anomalies to partnering with patients to find individual strategies that empower patients towards self-management. Several papers in the series highlighted the need for developing patient-centred models of care that respect individual patient’s needs and preferences. Also, the series pointed to different options for modes of delivery including mHealth and the challenges and opportunities they present for developing person-centred strategies. For health care to provide effective support for people with musculoskeletal pain conditions, there is a need to recognise that contextual factors, including a strong patient-provider alliance, clearly play an important, perhaps primary, role. Health care professions dealing with musculoskeletal pain conditions should engage in research to investigate effective ways to move this understanding into practice including how to train providers. We hope the work collected in this series will stimulate further questions and more research as musculoskeletal pain providers seek to make their care more person-centred.

“…Chiropractors use a range of techniques such as hands-on manipulation of the spine, ice, heat, ultrasound, exercise, acupuncture, and advice about posture and lifestyle [17]. The qualitative component of a recent mixed methods systematic review found that both patients and chiropractors consider the features of WA to be crucial factors during care [18]. Jamison was the first to study chiropractor-patient WA: she explored the interplay between the established WA and patients' expectations [19].…”

Section: Introductionmentioning

confidence: 99%

The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic

Ivanova,

Newell,

Field

et al. 2024

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Background The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as “Working Alliance,” which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients’ care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients’ perspective to inform evidence-based practice. Methods Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. Results The findings highlight that an early working alliance entails the gradual development of patients’ confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients’ expectations, the trainee chiropractors’ qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. Conclusions Establishing an early trainee chiropractor-patient working alliance involves a process of building patients’ confidence in the trainee chiropractors’ expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients’ perceptions of trainee chiropractors’ qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors’ explanations.