Tuesday, January 16, 2018

The prevalence, patterns, and predictors of chiropractic use among US adults

Adams J, Peng W, Cramer H, Sundberg T, Moore C, Amorin-Woods L, Sibbritt D, Lauche R. The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults: Results From the 2012 National Health Interview Survey. Spine (Phila Pa 1976). 2017 Dec 1;42(23):1810-1816.


Secondary analysis of a national survey.

The aim of this study was to investigate the prevalence, patterns, and predictors of chiropractic utilization in the US general population.

Chiropractic is one of the largest manual therapy professions in the United States and internationally. Very few details have been reported about the use of chiropractic care in the United States in recent years.

Cross-sectional data from the 2012 National Health Interview Survey (n = 34,525) were analyzed to examine the lifetime and 12-month prevalence and utilization patterns of chiropractic use, profile of chiropractic users, and health-related predictors of chiropractic consultations.

Lifetime and 12-month prevalence of chiropractic use were 24.0% and 8.4%, respectively. There is a growing trend of chiropractic use among US adults from 2002 to 2012. Back pain (63.0%) and neck pain (30.2%) were the most prevalent health problems for chiropractic consultations and the majority of users reported chiropractic helping a great deal with their health problem and improving overall health or well-being. A substantial number of chiropractic users had received prescription (23.0%) and/or over-the-counter medications (35.0%) for the same health problem for which chiropractic was sought and 63.8% reported chiropractic care combined with medical treatment as helpful. Both adults older than 30 years (compared to younger adults), and those diagnosed with spinal pain (compared to those without spinal pain) were more likely to have consulted a chiropractor in the past 12 months.

A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common. Studies on the current patient integration of chiropractic and conventional health services are warranted.

From the paper

Our analyses show that, among the US adult population, spinal pain and problems - specifically for back pain and neck pain - have positive associations with the use of chiropractic. This finding is in agreement with that identified in a number of previous studies conducted in the US and elsewhere showing the most common complaints encountered by a chiropractor are back pain and neck pain and is in line with systematic reviews identifying emerging evidence on the efficacy of chiropractic for back pain and neck pain.   Our analysis also shows that having mental health problems, coronary heart disease, and asthma are negatively associated with seeking chiropractic care. Indeed, no convincing rationale or evidence exists for the use of chiropractic for mental health disorders or cardiovascular conditions and systematic reviews have failed to identify sufficient evidence to support the efficacy of chiropractic treatment for asthma.

Our analyses indicate that a substantial proportion of chiropractic users also consume prescription medications and/or OTC medications for the same health problem for which they seek chiropractic care. Notably, in our analyses >60% of those in the United States who consulted a chiropractor did so because of a belief that chiropractic would be helpful in combination with their medical treatment. Such concurrent use of chiropractic care and conventional medications and health provision is in line with previous studies.  Furthermore, previous randomized controlled trials have suggested the comanagement of chiropractic and medical care is likely to show more improvement in pain relief than medical care alone.

Our study found that a recommendation for an adult to consult a chiropractor is rarely initiated by a conventional health care provider, and many respondents reported that their conventional health care provider failed to enquire about their possible chiropractic use. These results are similar to those identified in some previous studies, which have specifically investigated the referral patterns of chiropractors in the United States.  However, a recent national workforce survey of Australian chiropractic showed approximately half of the chiropractors initiate and/or receive referrals to/from general practitioners and one-third initiate and/or receive referrals to/from physiotherapists.  As such, further research examining the interface between chiropractors and conventional health providers is warranted to help tease out possible opportunities and challenges to safe, effective coordinated patient care.

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