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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
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
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.
Patient Satisfaction With the Chiropractic Clinical Encounter
The 129th Annual Meeting of APHA Atlanta, GA (Oct 21-25, 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): 509-516
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.
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."
Studies on Chiropractic: Patient Satisfaction
British Columbia Chiropractic Association
In todays consumer driven health care environment, patient satisfaction is an important health outcome measure. There have been several surveys conducted in recent years assessing patient satisfaction with chiropractic care, which was found to be extremely high. In addition, these surveys invariably found that the level of satisfaction was significantly higher for care received from chiropractors in comparison to the medical profession. Surveys have also indicated that chiropractic patients are willing to return for chiropractic treatment for a similar condition and would recommend chiropractic treatment to friends, family and colleagues.