Physical activity promotion in chiropractic: a systematic review of clinician-based surveys

Abstract

Background Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients. Methods Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the ‘Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices’ tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors’ views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported. Results From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.). Conclusion A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors’ own PA participation.

Insights into physical activity promotion among Australian chiropractors: a cross-sectional survey

“…For instance, the post-2015 American College of Sports Medicine questionnaire now primarily screens the individual’s current PA level [ 20 ]. As chiropractors knowingly obtain PA information from patients [ 15 ], implementing tools like the validated General Practice Physical Activity Questionnaire (GPPAQ) can enhance the screening process [ 21 ]. The GPPAQ can briefly assess PA levels in routine practice, grouping patients into inactive-to-active categories that can be easily conveyed to patients [ 21 ].…”

“…A recent systematic review found chiropractors recognise the importance of PA promotion and are prepared to routinely discuss and/or counsel patients on this health topic [ 15 ]. Additionally, previous research has shown that 85% of Australian chiropractors report often discussing PA as part of their patient management [ 16 ].…”

Insights into physical activity promotion among Australian chiropractors: A cross-sectional survey

“…For instance, the post-2015 American College of Sports Medicine questionnaire now primarily screens the individual's current PA level [19]. As chiropractors knowingly obtain PA information from patients [15], implementing tools like the validated General Practice Physical Activity Questionnaire (GPPAQ) can enhance the screening process [20]. The GPPAQ can brie y assess PA levels in routine practice, grouping patients into inactive-to-active categories and easily conveyed to patients [20].…”

“…A recent systematic review found chiropractors recognise the importance of PA promotion and are prepared to routinely discuss and/or counsel patients on this health topic [15]. Additionally, previous research has shown that 85% of Australian chiropractors report often discussing PA as part of their patient management [16].…”