The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

Abstract

BackgroundPrevious research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.MethodsSystematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition.ResultsThe literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).ConclusionsThis comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.Electronic supplementary materialThe online version of this article (10.1186/s12998-017-0165-8) contains supplementary material, which is available to authorized users.

So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies

“…Although chiropractors are legally recognized in 75% of those countries, and chiropractic treatment is fully or partially subsidized by national healthcare systems in around 50%, in some countries chiropractic does not fall under any law or may even be illegal [3]. Beliveau et al reviewed 52 studies dealing with utilization of chiropractic and found that, generally, utilization was highly variable and population dependent, with no clear change in utilization of chiropractors globally between 1980 and 2015 [4]. They found that the typical chiropractic patient is seeking care for a musculoskeletal The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided.…”

“…To describe the chiropractic workforce worldwide in terms of the number of chiropractors, education, access, reimbursement schemes, scope of practice, and legal rights. problem, most commonly low back pain (50%) and neck pain (23%), is female, middle-aged and employed [4]. Although there is some variation in practice styles, most people seeking care from chiropractors will receive spinal manipulation with around one third also receiving patient education, exercises and soft-tissue therapy [4].…”

BAck complaints in the elders - chiropractic (BACE-C): protocol of an international cohort study of older adults with low back pain seeking chiropractic care

“…Chiropractors provide a significant portion of care for patients with low back pain [10], and care from chiropractors in the younger and older population appears to be safe and effective [11][12][13]. Unfortunately, existing trials have typically included only younger adults with low back pain, and exclude older adults for various complicating reasons, such as comorbidity and polypharmacy [14,15].…”

Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

“…It is used to treat many musculoskeletal conditions, especially low back and neck pain [1]. Speci cally for chiropractors, SMT is the most common treatment provided during a patient encounter [2][3][4]. It is estimated that the 12month utilization rate for chiropractic services is 9.1% and a lifetime utilization of 22.2% worldwide [4].…”

“…Speci cally for chiropractors, SMT is the most common treatment provided during a patient encounter [2][3][4]. It is estimated that the 12month utilization rate for chiropractic services is 9.1% and a lifetime utilization of 22.2% worldwide [4]. Between 1980 and 2015, the use of chiropractic services has reportedly increased from 10.0% to 11.7% in Canada and from 7.2% to 10.7% in the United States [4].…”