Chiropractic and Public Health: Current State and Future Vision

doi:10.1016/j.jmpt.2008.07.001

Journal of Manipulative and Physiological Therapeutics

Volume 31, Issue 6, July 2008, Pages 397-410

https://doi.org/10.1016/j.jmpt.2008.07.001 Get rights and content

Abstract

This article provides an overview of primary chiropractic issues as they relate to public health. This collaborative summary documents the chiropractic profession's current involvement in public health, reflects on past barriers that may have prevented full participation within the public health movement, and summarizes the relationship of current chiropractic and public health topics. Topics discussed include how the chiropractic profession participates in preventive health services, health promotion, immunization, geriatrics, health care in a military environment, and interdisciplinary care.

Section snippets

Methods

Members of the chiropractic profession who have been active in areas of public health were invited to contribute concise summaries of topics of interest as they relate to chiropractic in public health (Fig 1).

Results

The following sections provide summaries of key areas that chiropractic has or may have the potential to contribute to public health.

Discussion

Chiropractic began in the United States as a conservative method of health care in 1895.³ With chiropractic being a profession that is more than 110 years old, one may ask why it appears that there have not been more concentrated efforts to be more overtly involved in public health. There are several possible explanations including sociological and political barriers.

One barrier may have been an earlier APHA policy that explicitly excluded chiropractors from participating in public health

Conclusion

Chiropractic has done much in a short amount of time. The chiropractic profession no longer has major external barriers that prevent participation in public health activities. Multiple opportunities are available for chiropractic colleges, chiropractic governing bodies, and practitioners to contribute. The question remains: will we enthusiastically embrace participation in public health practices and research or will we passively watch as this opportunity slips away into oblivion?

In its 2005

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For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings.
Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts.
A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.
Prevalence of Chiropractic-Specific Terminology on Chiropractors’ Websites in the United Kingdom With Comparison to Australia: An Analysis of Samples
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Citation Excerpt :
Some have suggested that the chiropractic profession should abandon historical terms and replace them with biomedical terminology for spine care.78,85,86 We propose that by updating its terminology, chiropractic could potentially improve its role in public health and health care.87 Our study adds to available information by comparing 5 chiropractic-specific terms used in a positive way on websites of practicing chiropractors in the United Kingdom to similar websites in Australia.
The purpose of this study was to compare the prevalence of 5 chiropractic-specific terms on UK chiropractic websites to findings in a previous study in Australia and to provide an argument against the use of these terms.
We searched websites belonging to chiropractors registered with the General Chiropractic Council for 5 terms: subluxation, vital(-ism/-istic), wellness, adjust(-ing/-ment), and Innate (Intelligence). Of 3239 websites, 326 were sampled. Each page was searched, and terms were counted only if used in a chiropractic-specific context. Term occurrence and frequency were recorded. The data were analyzed using a single-sample χ² goodness-of-fit test for unequal proportions. The results were compared to those of our prior Australian study, using the χ² test of homogeneity to determine the differences between samples.
At least 1 of the 5 chiropractic-specific terms was found on 245 (75%) of UK websites. Adjust(-ing/-ment) was found on 222 (68%) of UK websites compared to 283 (77%) in Australia; wellness on 67 (5%) of UK sites compared to 199 (33%) in Australia; vital(-ism/-istic) on 30 (9%) of UK sites compared to 71 (19%) in Australia; subluxation on 17 (5%) of UK sites compared to 104 (28%) in Australia; and Innate on 10 (3%) of UK sites compared to 39 (11%) in Australia. A χ² test found that the terms were not equally distributed in the two samples, $χ_{4}^{2}$  = 404.080, P < .001. In the discussion, we explain why we feel that chiropractic-specific terms should be abandoned and standard biomedical terms used.
In the sample of websites we evaluated in this study, the majority in the United Kingdom used the 5 chiropractic-specific terms that we searched for. The terms were used less frequently than on websites in Australia but were in a similar order of prevalence.
Income as a Predictor of Self-Efficacy for Managing Pain and for Coping With Symptoms Among Patients With Chronic Low Back Pain
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We conducted a cross-sectional study using survey data collected between June 2016 and February 2017 from n = 1364 patients with CLBP from chiropractic clinics in the United States to measure the relationship between income and both types of self-efficacy. We created 4 multivariate models predicting PSE and CSE scores. We used both a parsimonious set of covariates (age, sex) and a full set (age, sex, education, neck pain comorbidity, catastrophizing, and insurance). We also calculated effect sizes (Cohen's d) for unadjusted differences in PSE and CSE score by income.
Lower income was associated with lower PSE and CSE scores across all 4 models. In the full models, the highest-income group had an average of 1 point (1-10 scale) higher PSE score and CSE score compared to the lowest income group. Effect sizes for the unadjusted differences in PSE and CSE scores between the highest and lowest income groups were 0.94 and 0.84, respectively.
Our findings indicate that people with lower income perceive themselves as less able to manage their pain, and that this relationship exists even after taking into account factors like health insurance and educational attainment. There is a need to further investigate how practitioners and policymakers can best support low-income patients with chronic pain.
Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs
2020, Journal of Chiropractic Humanities
Citation Excerpt :
In attempting to address these issues, information may be found in recent large-scale epidemiologic inquiries involving the entire US Medicare database, in addition to multiple other studies from the past few years that have dealt with these and additional questions raised by the Medicare demonstration project and several that may even shed a different light on the Office of the Inspector General reports. Detractors of chiropractic expansion have argued that chiropractic is dangerous14,15 and that chiropractors refrain from endorsing and advocating for public health preventive measures.16 In response to these arguments, 2 large-scale epidemiologic studies in the United States have addressed the issue of association of chiropractic and stroke.
The purpose of this article is to discuss evidence that supports the resolution of inequities for Medicare beneficiaries who receive chiropractic care.
Medicare covers necessary examinations, imaging, exercise instruction, and treatments for beneficiaries with back pain when provided by medical doctors, osteopaths, and their associated support staff such as nurse practitioners, physician assistants, clinical nurse specialists, and physical therapists. However, if the same patient with back pain presents to a chiropractor, then the only service that is covered by Medicare is manipulation of the spine. Current evidence does not support this inequity in Medicare beneficiary service coverage. There is no evidence to show an increase in serious risks associated with chiropractic treatment of neck or back pain in Medicare beneficiaries. Chiropractors support national public health goals and endorse safe, evidence-based practices. Chiropractic care for Medicare beneficiaries has been associated with enhanced clinical outcomes such as faster recovery, fewer back surgeries a year later, reduced opioid-associated disability, fewer traumatic injuries and falls, and slower declines in activities of daily living and disability over time. Further evidence points to lower costs, fewer medical physician visits for low back pain, less opioid-related expense, and less back-surgery expense with chiropractic utilization. Use is lower among vulnerable populations: seniors, lower income women, and black and Hispanic beneficiaries who may be most affected by current inequities associated with the limited coverage. In this era of evidence-based and patient-centered care, beneficiaries who receive chiropractic care are very satisfied with the care they receive.
The current evidence suggests a need for change in US policy toward chiropractic in Medicare and support for HR 3654. Ending inequities by providing patients full coverage for chiropractic services has the potential to enhance care outcomes and reduce health disparities without increasing program costs.
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2020, Journal of Chiropractic Humanities
The purpose of this paper is to review and discuss historical concepts about the celebration of Chiropractic Day.
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The coronavirus disease-2019 (COVID-19) pandemic has strained all levels of healthcare and it is not known how chiropractic practitioners have responded to this crisis. The purpose of this report is to describe responses by a sample of chiropractors during the early stages of the COVID-19 pandemic.
We used a qualitative-constructivist design to understand chiropractic practice during the COVID-19 pandemic, as described by the participants. A sample of chiropractic practitioners (doctors of chiropractic, chiropractors) from various international locations were invited to participate. Each described the public health response to COVID-19 in their location and the actions that they took in their chiropractic practices from April 20 through May 4, 2020. A summary report was created from their responses and common themes were identified.
Eighteen chiropractic practitioners representing 17 locations and 11 countries participated. A variety of practice environments were represented in this sample, including, solo practice, mobile practice, private hospital, US Veterans Administration health care, worksite health center, and group practice. They reported that they recognized and abided by changing governmental regulations. They observed their patients experience increased stress and mental health concerns resulting from the pandemic. They adopted innovative strategies, such as telehealth, to do outreach, communicate with, and provide care for patients. They abided by national and World Health Organization recommendations and they adopted creative strategies to maintain connectivity with patients through a people-centered, integrated, and collaborative approach.
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^☆: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

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EditorialChiropractic and Public Health: Current State and Future Vision☆

Abstract

Section snippets

Methods

Results

Discussion

Conclusion

J Chiropr Humanit

J Chiropr Med

J Manipulative Physiol Ther

Spine J

J Manipulative Physiol Ther

Arch Phys Med Rehabil

Vaccine

J Manipulative Physiol Ther

J Manipulative Physiol Ther.

Am J Emerg Med

J Manipulative Physiol Ther

Journal of Manipulative and Physiological Therapeutics,

J Prof Nurs

Soc Sci Med

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Manipulative Physiol Ther

J Chiropr Med

The chiropractor's adjuster: a textbook of the science, art and philosophy of chiropractic for students and practitioners

Chiropractic: a profession at the crossroads of mainstream and alternative medicine

Ann Intern Med

Chiropractic paradigm

A Dictionary of epidemiology

Healthy people 2010: understanding and improving health

Healthy people 2010: a provider guide: leading the way to health

Are we asking the right questions?

Chiropr J Aust

Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults

Cochrane Database Syst Rev

Shattuck Lecture. We can do better—improving the health of the American people

N Engl J Med

Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis

J Manipulative Physiol Ther

Chiropractic care for non-musculoskeletal conditions: a systematic review with implications for whole systems research

J Alternative Complementary Med

Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study

J Hum Hypertens

Reform in public health education in chiropractic

Top Clin Chiropr

A model course for public health education in chiropractic colleges: a users guide: US Health Resources and Services Administration through the Association of Schools of Public Health

The collaborative development of a model course in public health education

J Chiropr Educ

A cure for the curse of chiropractic, part two. Dynamic chiropractic

Expenditures and health status among adults with back and neck problems

JAMA

Pain among veterans of Operations Enduring Freedom and Iraqi Freedom

Pain Med

Presentations, diagnoses, mechanisms of injury, and treatment of soldiers injured in Operation Iraqi Freedom: an epidemiological study conducted at two military pain management centers

Anesth Analg

United States Department of Veterans Affairs

Editorial
Chiropractic and Public Health: Current State and Future Vision☆