Understanding patient profiles and characteristics of current chiropractic practice: a cross-sectional Ontario Chiropractic Observation and Analysis STudy (O-COAST)

Abstract

ObjectivesThere is no current detailed profile of people seeking chiropractic care in Canada. We describe the profiles of chiropractors’ practice and the reasons, nature of the care provided to their patients and extent of interprofessional collaborations in Ontario, Canada.DesignCross-sectional observational study.SettingPrimary care setting in Ontario, Canada.ParticipantsWe randomly recruited chiropractors from a list of registered chiropractors (n=3978) in active practice in 2015. Of the 135 randomly selected chiropractors, 120 were eligible, 43 participated and 42 completed the study.Outcome measuresEach chiropractor recorded information for up to 100 consecutive patient encounters, documenting patient health profiles, reasons for encounter, diagnoses and care provided. Descriptive statistics summarised chiropractor, patient and encounter characteristics, with analyses accounting for clustering and design effects.ResultsChiropractors provided data on 3523 chiropractor-patient encounters. More than 65% of participating chiropractors were male, mean age 44 years and had practised on average 15 years. The typical patient was female (59% of encounters), between 45 and 64 years (43%) and retired (21%) or employed in business and administration (13%). Most (39.4%) referrals were from other patients, with 6.8% from physicians. Approximately 68% of patients paid out of pocket or claimed extended health insurance for care. Most common diagnoses were back (49%, 95% CI 44 to 56) and neck (15%, 95% CI 13 to 18) problems, with few encounters related to maintenance/preventive care (0.86%, 95% CI 0.2 to 3.9) and non-musculoskeletal problems (1.3%, 95% CI 0.7 to 2.3). The most common treatments included spinal manipulation (72%), soft tissue therapy (70%) and mobilisation (35%).ConclusionsThis is the most comprehensive profile to date of chiropractic practice in Canada. People who present to Ontario chiropractors are mostly adults with a musculoskeletal condition. Our results can be used by stakeholders to make informed decisions about workforce development, education and healthcare policy related to chiropractic care.

Back Pain: Chiropractor’s View

“…Of the 30% private sector spending, out-of-pocket spending accounts for about 15%, EHC plans about 12%, and others about 3% (CIHI 2019). In a recent study of Ontario chiropractors, they reported most patient encounters (68%) were paid out of pocket, with about 31% and 1% paid by EHC or work injury plans (Mior et al 2019).…”

The safety of spinal manipulative therapy in children under 10 years: a rapid review

“…The treatment of children with spinal manipulative therapy (SMT) by chiropractors is controversial [1][2][3]. A recent study of Ontario chiropractors suggests that 5.5% of patients who consulted a chiropractor in the previous month are between the ages of 0 and 14 years [4]. A crosssectional survey of 140 chiropractors in Alberta indicates that all respondents treated children between 0 and 18 years of age and 13% of all visits in the previous month were with children [5].…”

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]. Specifically for chiropractors, SMT is the most common treatment provided during a patient encounter [2][3][4]. It is estimated that the 12-month utilization rate for chiropractic services is 9.1% and a lifetime utilization of 22.2% worldwide [4].…”