This section was compiled by Frank M. Painter, D.C. Send all comments or additions to:Frankp@chiro.org
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Characteristics of Chiropractic Patients Being Treated for
Chronic Low Back and Neck Pain
J Manipulative Physiol Ther. 2018 (Aug 15) [Epub] ~ FULL TEXT
This study provides insight into the characteristics of patients who are successfully managing their chronic low back pain (CLBP) and chronic neck pain (CNP). Findings of this descriptive study of a large sample of chiropractic patients with CLBP or CNP reveal this sample to be similar to those found in other studies of chiropractic patients: highly-educated, non-Hispanic, white women, with at least partial insurance coverage for chiropractic. These individuals have also been in pain and using chiropractic care for years. Most came to chiropractic after trying other types of care, and just under a third continued to receive other concurrent care for their pain. Prior to chiropractic, they saw the best results with massage therapy and acupuncture and reported high levels of belief in the success of chiropractic in reducing their pain.
The Quality of Life of Children Under Chiropractic Care Using PROMIS-25:
Results from a Practice-Based Research Network
J Altern Complement Med. 2017 (Dec 20) [Epub] ~ FULL TEXT
The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains. Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression, anxiety, fatigue, and pain interference after a trial of chiropractic care.
The Use of the Patient Reported Outcomes Measurement Information System
and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific
Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing
the Webster Technique
J Altern Complement Med. 2017 (Dec 20) [Epub] ~ FULL TEXT
A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks and parity (i.e., the number of live births) of 0.92 live births. From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects. The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 and 3.30, respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue, pain interference, sleep disturbance, and an improvement in satisfaction with social roles. A significant decrease was also found with pain interference. No evidence was found that anxiety or depression.
What Do Patients Value About Spinal Manipulation and Home Exercise for
Back-related Leg Pain? A Qualitative Study Within a Controlled Clinical Trial
Man Ther. 2016 (Dec); 26: 183191 ~ FULL TEXT
This qualitative study illustrates that patient satisfaction is rooted in the quality of the patienteprovider relationship, although perceived symptom improvements, relevant clinical information about sciatica and its treatment, and the distinct qualities of those treatments are important drivers of satisfaction for patients who received non-pharmacological treatments for their back-related leg pain. Global measures of satisfaction may not adequately represent the range of patients' experiences and perceptions of spinal manipulative therapy or home exercise. In addition to providing insight to the quantitative results of the parent trial, these findings suggest that tailored interventions to enhance patienteprovider relationships may facilitate compliance and enhance satisfaction with care.
Integration of Chiropractic Services in Military and Veteran
Health Care Facilities: A Systematic Review of the Literature
J Evid Based Complementary Altern Med. 2016 (Apr); 21 (2): 115130
This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria. Studies reporting utilization and policy show that chiropractic services are successfully implemented in various military and veteran health care settings and that integration varies by facility.
First-Contact Care With a Medical vs Chiropractic Provider
J Manipulative Physiol Ther. 2015 (Sep); 38 (7): 477483 ~ FULL TEXT
Spinal, hip, and shoulder pain patients had clinically similar pain relief, greater satisfaction levels, and lower overall cost if they initiated care with DCs, when compared with those who initiated care with MDs.
A Survey of Parent Satisfaction with Chiropractic Care
of the Pediatric Patient
Journal of Clinical Chiropractic Pediatrics 2014 (Nov); 14 (3): 11671171 ~ FULL TEXT
This study showed that parents generally were very satisfied with chiropractic care of their child. Correlations between high satisfaction and improvement of the infants presenting complaint, improved sleep quality, and lower levels of parental distress were observed.
Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction
Associated with Upper Cervical Chiropractic Care:
A Prospective, Multicenter, Cohort Study
BMC Musculoskelet Disord. 2011 (Oct 5); 12: 219 ~ FULL TEXT
A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had symptomatic reactions (SRs) meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.
The Trials of Evidence:
Interpreting Research and the Case for Chiropractic
The Chiropractic Report ~ July 2011 ~ FULL TEXT
For the great majority of patients with both acute and chronic low-back pain, namely those without diagnostic red flags, spinal manipulation is recommended by evidence-informed guidelines from many authoritative sources whether chiropractic (the UK Evidence Report from Bronfort, Haas et al. ), medical (the 2007 Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society ) or interdisciplinary (the European Back Pain Guidelines ).
Consumer Reports Lists Chiropractic Patients As Most Satisfied
Consumer Reports ~ May 2009
A study in the May issue of Consumer Reports shows that hands-on therapies were tops among treatments for relief of back pain. The study, which surveyed more than 14,000 consumers, was conducted by the Consumer Reports Health Ratings Center. The report states that, eighty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were completely or very satisfied with their chiropractor.
Chiropractic Services in the Canadian Armed Forces: A Pilot Project
Military Medicine 2006 (Jun); 171 (6): 572576
This article reports on satisfaction associated with the introduction of chiropractic services within a military hospital, through a Canadian Armed Forces Pilot Project. We distributed a 27-item survey that inquired about demographic information and satisfaction with chiropractic services to 102 military personnel presenting for on-site chiropractic services at the Archie McCallum Hospital in Halifax, Nova Scotia. The majority of military personnel (94.2%) and referring physicians (80.0%) expressed satisfaction with chiropractic services.
Factors Associated With Patient Satisfaction With Chiropractic Care: Survey and Review of the Literature
J Manipulative Physiol Ther 2006 (Jul); 29 (6): 455462 ~ FULL TEXT
The results here generally confirm the findings elsewhere in the literature. Of the 23% of the adult population who have ever visited a chiropractor, overall rates of satisfaction are once again found to be quite high (83% satisfied or better) and the number dissatisfied is quite low (less than 10% dissatisfied or very dissatisfied). This is remarkable given the fact that much of the financial burden of the care is borne by patients, and the preponderance of care is for difficult chronic problems of back and neck.
History and Overview of Theories and Methods of Chiropractic:
Clin Orthop Relat Res 2006 (Mar); 444: 243249
As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Other studies have shown that chiropractic care compared with medical care is safer, costs no more and often costs much less, and has consistently greater patient satisfaction for treatment of similar conditions.
Back Pain and Satisfaction with Chiropractic Treatment:
What Role Does the Physical Outcome Play?
Clin J Pain 2005 (Jul); 19 (4): 263268
Patients were asked about effects on pain, anxiety, normal activity, work, depression, lifestyle, satisfaction, and overall improvement. Stepwise multiple regression analyses were used to evaluate the contribution of change scores to overall improvement and satisfaction. There are initial indications in the literature that information giving, and the reconfiguration of patients' perceptions of the problem, may contribute to patient satisfaction generally.
From a number of studies, there is little to contradict the assertion that patient satisfaction with chiropractic care, in a variety of settings, has consistently been high. [1,
Indeed, for matched back pain conditions, patient satisfaction with chiropractic treatment has invariably been shown to be significantly greater than that with conventional management [administered by a primary care physician, an orthopedist, or an HMO provider].
Satisfied patients are far more likely to be compliant in their treatment,
 theoretically bestowing chiropractic patients with yet another advantage over treatment by other providers in terms of outcomes.
Patient Satisfaction With Chiropractic Physicians In An
Independent Physicians' Association
J Manipulative Physiol Ther 2001 (Nov); 24 (9): 556559 ~ FULL TEXT
Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.
Pain, Disability, and Satisfaction Outcomes and Predictors of Outcomes:
A Practice-based Study of Chronic Low Back Pain Patients Attending
Primary Care and Chiropractic Physicians
J Manipulative Physiol Ther. 2001 (Sep); 24 (7): 433439
Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P <.002). A greater proportion of chiropractic patients were satisfied with all aspects of their care (P =.0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study.
Patient Satisfaction With the Chiropractic Clinical Encounter
The 129th Annual Meeting of APHA Atlanta, GA (Oct 2125, 2001)
Data were collected from 2986 adult patients of 172 U.S. and Canadian chiropractors in a practice-based research program over a one-week period in November 1999. Of the 1822 patients reporting pain, 56.2% rated the care they received for it as "excellent," 30.6% "very good;" 9.3% "good;" 1.3% "fair;" and 0.2% "poor;" 2.0% did not respond. Patients were quite satisfied with the care they received with 83% reporting that their chiropractor always listened carefully to them and always explained things in a way they could understand; 88% reported their chiropractor always showed respect for what they had to say; 78% felt their chiropractor always spent enough time with them.
Patient Satisfaction With the Chiropractic Clinical Encounter:
Report From a Practice-based Research Program
Journal of the Neuromusculoskeletal System 2001: 9 (4): 109117
The majority of patients were highly satisfied with their care; 85.0% reported that their chiropractor always listened carefully; 85.3% that the DC explained things understandably; 88.2% that the DC showed respect for what they had to say; and 75.6% that he/she involved them in decisions as much as they wanted. The median proportion of patients, per DC, with a chief
complaint who said their doctor always spent enough time with them was 82% (IQR: 19%) and 82.3% reported that their chiropractors never recommended more visits than necessary.
The Chiropractic Outcome Study:
Pain, Functional Ability and Satisfaction With Care
J Manipulative Physiol Ther 1997 (May); 20 (4): 235240
Based on these results, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.
The Outcomes and Costs of Care for Acute Low Back Pain Among Patients
Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons
N Engl J Med 1995 (Oct 5); 333 (14): 913917
The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all six groups of practitioners, but there were marked differences in the use of health care services. The mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients seen by HMO and primary care providers. Satisfaction was greatest among the patients who went to the chiropractors.
Patient Satisfaction: A Valid Concept?
Social Science and Medicine 1994 (Feb); 38 (4): 509516
Over the past 10 yr consumer satisfaction has gained widespread recognition as a measure of quality in many public sector services. This has become manifest in the NHS in the call by the 1983 NHS Management inquiry to ascertain how well the service is being delivered at local level by obtaining the experience and perceptions of patients and the community. Patient satisfaction is now deemed an important outcome measure for health services; however, this professed utility rests on a number of implicit assumptions about the nature and meaning of expressions of 'satisfaction'.
Patient Satisfaction With Chiropractic Care in Los Angeles
AHSR FHSR Annu Meet Abstr Book 1994; 11: 11
This RAND Corporation Study found For overall care, 92% of the patients choose the care as either excellent or the best. Although the ratings on all the items are high the highest ratings were given to the more personal qualities of the practitioner: courtesy, politeness, and respect shown to the patient (92%); interest shown in the patient as a person (91%); willingness to listen (89%); ability to put the patient at ease (89%). These results support those of previous studies on chiropractic that suggest that the high satisfaction with chiropractic care is a result more of the personal health encounter than the therapeutic outcome. They also suggest that other providers could learn much from the interpersonal art of chiropractors.
Patient Satisfaction With Chiropractic Care
J Manipulative Physiol Ther 1993 (Jan); 16 (1): 2532
Patients expressed high levels of satisfaction with their doctors and the care they received. Although women were slightly more satisfied than men, other patient characteristics such as level of education, income, employment status or previous chiropractic care did not influence response means.
Patient Evaluations of Low Back Pain Care
From Family Physicians and Chiropractors
West J Med 1989 (Mar); 150 (3): 351355 ~ FULL TEXT
Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem.
Other Patient Satisfaction Surveys
The Gallup Study
In 1991 the Gallup Organization performed a nationwide demographic study to determine the attitudes, opinions, and behaviors of both users and nonusers of chiropractic services.
Overall, 90% felt that chiropractic health care was effective: more than 80% were satisfied with the treatment they received; nearly 75% felt that most of their expectations were met during the last visit or series of visits; 68% said they would likely see a doctor of chiropractic again for treatment of a similar condition, and 50% would likely be willing to see a doctor of chiropractic for some other problem chiropractors treat. Nearly 80% of the chiropractic users felt that the cost of chiropractic treatment was reasonable.
Demographic Characteristics of Users of Chiropractic Services.
The Gallup Organization, Princeton, New Jersey - 1991
The Harris Poll
According to this 1994 Harris Poll, patients were more satisfied with chiropractic care than care from medical doctors and other health care professionals.
Those who sought care from a chiropractor were more likely to be very satisfied with their care than those who visited any other practitioner. (Choices were between Chiropractic Doctors, Medical Doctors, Physical Therapists, or Osteopathic Doctors) Of those who have seen both types of practitioner, the majority were more likely to be satisfied with the care of the chiropractor than with that of the medical doctor.
1994 Harris Poll
Patient Evaluations of Care from Family Physicians and Chiropractors
Findings from this study indicate that patients under chiropractic care had 3 times the satisfaction rate as did patients under the care of Family Physicians. In addition, the patient's perception of the doctor's confidence in diagnosing and treating low back pain was almost 3 times higher in patients receiving chiropractic care compared with those receiving care from family physicians.
As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.
Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.
According to lead investigator Pran Manga, Ph.D., "There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical physician management."