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Source publication
Background
COAST (Chiropractic Observational and Analysis STudy) reported the clinical practices of chiropractors. The aims of this study were to: 1) describe the chiropractic patient demographic and health characteristics; 2) describe patient-stated reasons for visiting a chiropractor; 3) describe chiropractic patient lifestyle characteristics; 4)...
Context in source publication
Citations
... For people seeking care from chiropractors speci cally, not much is known about patterns of multimorbidity. In Australia, Charity et al. studied pro les of patients seeking care from chiropractors for multiple reasons and found that 24% reported circulatory, 24% reported endocrine and metabolic, and 12% reported respiratory comorbidities (19). These numbers are somewhat higher than ours, which might be explained by the fact that we included only patients presenting with a new episode of LBP and not consecutive patients such as in the Australian study. ...
Background
People with multimorbidity, defined as the co-existence of two or more chronic conditions in an individual, often suffer from pain and functional limitations caused by musculoskeletal disorders and the chronic conditions. In chiropractic practice, two thirds of patients are treated for low back pain (LBP). It is unknown to what extent LBP is accompanied with chronic conditions in chiropractic practice. The objective was to determine the prevalence of multimorbidity among patients with LBP in chiropractric practice and to investigate if multimorbidity affects pain intensity, self-rated health, physical and mental health. Finally, to explore if individuals with multimorbidity have a different recovery for the LBP.
Methods
Patients presenting with a new episode of LBP were recruited from 10 chiropractic clinics in 2016-18. Patient-reported data concerning socio-demographics, self-rated health, pain intensity, history of LBP, mental health and chronic conditions were collected at baseline. The prevalence of multimorbidity was determined. To evaluate differences in recovery from the LBP, we estimated changes in the Roland Morris Disability Questionnaire (RMDQ) score and use of pain medication at baseline, two weeks, three months and twelve months. The analyses were adjusted using regression models.
Results
2,083 patients were included at baseline and 71%, 68% and 64% responded to follow-up questionnaires at two weeks, three and twelve months. 1,024 (49%) participants reported to have at least one chronic condition and 421 (20%) had multimorbidity (≥ 2 chronic conditions). The presence of multimorbidity was associated with increased odds of poor self-rated health (OR 2.13), physical fitness (OR 1.79), poor muscular strength (OR 1.52), poor endurance (OR 1.51), and poor balance (OR 1.33). Patients with high LBP intensity combined with multimorbidity showed a poorer recovery than patients without chronic diseases (mean difference in RMDQ score 3.53 at 12 months follow-up). More patients with multimorbidity used pain medication for LBP at 12 months follow-up compared to those without chronic disease (OR 2.36).
Conclusions
Chiropractors should be aware that patients with LBP may suffer from multimorbidity with poor general health. Patients with multimorbidity also have poorer recovery from LBP than people without chronic disease and clinical follow-up may be indicated.
... Globally, the median annual utilisation of chiropractic services is 9% [16], which increases to 15% in older adults [17]. In Australia, 73% of chiropractors report regularly treating adults aged older than 65 years [18] and, of patients who present to a chiropractor, 12% are aged older than 65 years [19]. In Canada, there is a higher proportion of older chiropractic patients and 19% of patients are older than 65 years [20]. ...
Background
Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.
Methods
A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ² tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.
Results
A total of 6781 chiropractor–adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.
Conclusions
From 6781 chiropractor–adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.
... Chiropractors treat patients who have overlapping chronic pain conditions (OCPC) and medically unexplained symptoms (MUS) [1][2][3][4]. OCPC and MUS conditions reported in the scientific literature include: fibromyalgia (FM), chronic non-specific low back pain (CNSLBP), chronic non-specific neck pain (CNSNP), chronic tension-type headache (CTTH), unexplained dizziness (UD) and irritable bowel syndrome (IBS) amongst others [5][6][7][8]. Comorbid symptoms such as anxiety and depression, subjective dizziness/postural instability and autonomic dysfunction often accompany these conditions [9][10][11][12]. ...
... Links between obesity and CS have been proposed, and clinical nutritional management strategies to reduce the impact of obesity-related inflammation on CS have recently been recommended [77][78][79]. A recent large survey of chiropractic patients revealed a moderate degree of obesity amongst those surveyed [2]; chiropractors should include such considerations when confronted by obesity and CS within their patients. ...
Central Sensitization (CS) is postulated as a central explanation of chronic pain. Clinical researchers recommend that therapists screen for CS to avoid diagnostic confusion and improve the allocation of appropriate clinical resources in primary care settings when managing chronic pain patients. However, the percentage of patients presenting with CS to a chiropractic practice has not been found in the literature. This study had two objectives: to use the Central Sensitization Inventory (CSI) to screen for and identify the proportion and characteristics of consecutive new patients with chronic pain conditions and medically unexplained symptoms who are experiencing CS; and to determine if there were significant clinical relationships between patient characteristics (age, sex, BMI, complaint type and duration, balance issues and presence of comorbid overlapping CS syndromes) and CSI scores. Results indicated that 1 in 5 adult new patients may have experienced CS. ANOVA analysis revealed significant difference between fibromyalgia and chronic spinal pain patients; significant difference due to subjective dizziness; significant difference between the number of positive answers in the CSI-Part B for the CSI>40 subjects and subjects with 2 or more positive answers on CSI Part B compared to those with none/one positive answer. Chiropractors should consider using a validated CS screening tool, such as the CSI, for all new patients, and implementing adjunctive, evidence-based CS clinical management strategies.
... Patients attend manual therapy practitioners for treatment of a wide variety of health concerns but mainly for musculoskeletal pain. [39][40][41][42][43] The practitioner's clinical reasoning includes consideration of pain if not of muscular or neurological origin. Both professions are trained to undertake an extensive array of clinical assessments, but there are cases where further information from other health professionals needs to be gathered prior to starting or continuing treatment. ...
Objective
The objective was to determine final-year students' self-perceptions of readiness for transition to practice, professional identity, and experiences of interprofessional clinical practice. Findings will inform the clinical education curriculum.
Methods
We used repeated measures individual case studies with a self-selecting sample from the total final-year student population at 2 chiropractic and 2 osteopathic programs offered by Australian universities. Cases were not compared. Amalgamated data are presented.
Results
There were interviews with students in 2 chiropractic programs ( n = 15) and 2 osteopathic programs ( n = 13). Perceptions indicate that clinical education in university health clinics prepares them for transition to practice through scaffolded supervision of their consultations with reasonably healthy patients. Students perceived that other clinics (community clinics or private practices) prepared their readiness for transition to practice substantially better. Community clinics and private practices allowed students to consult people from diverse socioeconomic and cultural backgrounds and treat complex health care issues, and the model of supervision allows students a degree of autonomy. Students lacked a clear understanding of the behaviors that demonstrate their professionalism. Interprofessional learning activities were ad hoc and opportunistic.
Conclusion
University health clinics, private practices, and community clinics prepare students for transition to practice in different ways. Most students feel prepared. There is a clear indication that a focused discussion related to the development of students' understanding of competencies related to professionalism and another related to interprofessional clinical education in curriculum are needed.
... An estimated 71% of men and 53% women who seek chiropractic care are overweight or have obesity. 7 As practitioners with a holistic approach to care, chiropractors have a unique opportunity to provide dietary and exercise advice to overweight and obese patients. ...
Objective:
The purpose of this study was to investigate weight-loss interventions offered by Canadian doctors of chiropractic to their adult patients.
Methods:
This paper reports a secondary analysis of data from the Ontario Chiropractic Observation and Analysis STudy (Nc = 42 chiropractors, Np = 2162 patient encounters). Multilevel logistic regression was performed to assess the odds of chiropractors initiating or continuing weight management interventions with patients. Two chiropractor variables and 8 patient-level variables were investigated for influence on chiropractor-directed weight management. In addition, the interaction between the effects of patient weight and comorbidity on weight management interventions by chiropractors was assessed.
Results:
Around two-thirds (61.3%) of patients who sought chiropractic care were either overweight or had obesity. Very few patients had weight loss managed by their chiropractor. Among patients with body mass index equal to or greater than 18.5 kg/m2, guideline recommended weight management was initiated or continued by Ontario chiropractors in only 5.4% of encounters. Chiropractors did not offer weight management interventions at different rates among patients who were of normal weight, overweight, or obese (P value = 0.23). Chiropractors who graduated after 2005 who may have been exposed to reforms in chiropractic education to include public health were significantly more likely to offer weight management than chiropractors who graduated between 1995 and 2005 (odds ratio 0.02; 95% CI [0.00-0.13]) or before 1995 (odds ratio 0.08; 95% CI [0.01-0.42]).
Conclusion:
The prevalence of weight management interventions offered to patients by Canadian chiropractors in Ontario was low. Health care policy and continued chiropractic educational reforms may provide further direction to improve weight-loss interventions offered by doctors of chiropractic to their patients.
Background
People with multimorbidity, defined as the co-existence of two or more chronic conditions in an individual, often suffer from pain and functional limitations caused by musculoskeletal disorders and the chronic conditions. In chiropractic practice, two thirds of patients are treated for low back pain (LBP). It is unknown to what extent LBP is accompanied with chronic conditions in chiropractic practice. The objective was to determine the prevalence of multimorbidity among patients with LBP in chiropractric practice and to investigate if multimorbidity affects pain intensity, self-rated health, physical and mental health. Finally, to explore if individuals with multimorbidity have a different recovery for the LBP.
Methods
Patients presenting with a new episode of LBP were recruited from 10 chiropractic clinics in 2016–2018. Patient-reported data concerning socio-demographics, self-rated health, pain intensity, history of LBP, mental health and chronic conditions were collected at baseline. The prevalence of multimorbidity was determined. To evaluate differences in recovery from the LBP, we estimated changes in the Roland Morris Disability Questionnaire (RMDQ) score and use of pain medication at baseline, 2 weeks, 3 months and 12 months. The analyses were adjusted using regression models.
Results
2083 patients were included at baseline and 71%, 68% and 64% responded to follow-up questionnaires at 2 weeks, 3 and 12 months. 1024 (49%) participants reported to have at least one chronic condition and 421 (20%) had multimorbidity (≥ 2 chronic conditions). The presence of multimorbidity was associated with increased odds of poor self-rated health (OR 2.13), physical fitness (OR 1.79), poor muscular strength (OR 1.52), poor endurance (OR 1.51), and poor balance (OR 1.33). Patients with high LBP intensity combined with multimorbidity showed a poorer recovery than patients without chronic diseases (mean difference in RMDQ score 3.53 at 12 months follow-up). More patients with multimorbidity used pain medication for LBP at 12 months follow-up compared to those without chronic disease (OR 2.36).
Conclusions
Chiropractors should be aware that patients with LBP may suffer from multimorbidity with poor general health. Patients with multimorbidity also have poorer recovery from LBP than people without chronic disease and clinical follow-up may be indicated.
