A new chiropractic survey seems to avoid all the potentially embarrassing questions

Chiropractors like to promote themselves as primary healthcare professionals. But are they? A recent survey might go some way towards addressing this question. It was based on a cross sectional online questionnaire distributed to 4 UK chiropractic associations. The responses were collected over a period of two months from March 26th 2012 to May 25th 2012.

Of the 2,448 members in the 4 participating associations, 509 chiropractors (~21%) completed the survey. The results of the survey show that the great majority of UK chiropractors surveyed reported evaluating and monitoring patients in regards to posture (97.1%), inactivity/overactivity (90.8%) and movement patterns (88.6%). Slightly fewer provided this type of care for psychosocial stress (82.3%), nutrition (74.1%) and disturbed sleep (72.9%). Still fewer did so for smoking (60.7%) and over-consumption of alcohol (56.4%). Verbal advice given by the chiropractor was reported as the most successful resource to encourage positive lifestyle changes as reported by 68.8% of respondents. Goal-setting was utilised by 70.7% to 80.4% of respondents concerning physical fitness issues. For all other lifestyle issues, goal-setting was used by approximately two-fifths (41.7%) or less. For smoking and over-consumption of alcohol, a mere one-fifth (20.0% and 20.6% respectively) of the responding chiropractors set goals.

The authors of this survey concluded that UK chiropractors are participating in promoting positive lifestyle changes in areas common to preventative healthcare and health promotion areas; however, more can be done, particularly in the areas of smoking and over-consumption of alcohol. In addition, goal-setting to support patient-provider relationships should be more widespread, potentially increasing the utility of such valuable advice and resources.

When I saw that a new UK-wide survey of chiropractic has become available, I had great expectations. Sadly, they were harshly disappointed. I had hoped that, after going to the considerable trouble of setting up a nationwide survey of this nature, we would have some answers to the most urgent questions that currently plague chiropractic and are amenable to study by survey. In my view, some of these questions include:

• How many chiropractors actually see themselves as primary care professionals?
• What conditions do chiropractors treat?
• Specifically how many of them believe they can treat non-spinal conditions effectively?
• How many chiropractors regularly treat children?
• For which conditions?
• How many patients get X-rayed by chiropractors?
• How many are in favour of vaccinations?
• How many are aware of adverse effects of spinal manipulation?
• How chiropractors obtain informed consent before starting treatment?
• What percentage of chiropractors use spinal manipulation?
• What other treatments are used how often?
• How often do chiropractors advise their patients about medications prescribed by real doctors?
• How often do they refer patients to other health care providers?

All of these questions are highly relevant and none of them has recently been studied. But, sadly, the new paper does not answer them. Why? As I see it, there are several possibilities:

• Chiropractors do not find these questions as relevant as I do.
• They do not want to know the answers.
• They do not like to research issues that might shine a bad light on them.
• They view research mostly as a promotional exercise.
• They did research (some of) these questions but do not dare to publish the results.
• They will publish the results in a separate paper.

It would be interesting to hear from the authors which possibility applies.