A chiro, a arms dealer and a Brexit donor meet in a bar.
The arms dealer: my job is so secret, I cannot tell my neighbour what I do.
The Brexit donor: I have to keep things so close to my chest that not even my wife knows what I am doing.
The chiro: that’s nothing; my work is so secret that not even I know what I am doing.
CHILDISH, I KNOW!
But I am yet again intrigued by a survey aimed at finding out what chiropractors are up to. One might have thought that, after 120 years, they know what they are doing.
This survey described the profiles of chiropractors’ practice and the reasons, nature of the care provided to their patients and extent of interprofessional collaborations in Ontario, Canada. The researchers randomly recruited chiropractors from a list of registered chiropractors (n=3978) in active practice in 2015. Of the 135 randomly selected chiropractors, 120 were eligible, 43 participated and 42 completed the study.
Each chiropractor recorded information for up to 100 consecutive patient encounters, documenting patient health profiles, reasons for encounter, diagnoses and care provided. Descriptive statistics summarised chiropractor, patient and encounter characteristics, with analyses accounting for clustering and design effects. Thus data on 3523 chiropractor-patient encounters became available. More than 65% of participating chiropractors were male, mean age 44 years and had practised on average 15 years. The typical patient was female (59% of encounters), between 45 and 64 years (43%) and retired (21%) or employed in business and administration (13%). Most (39.4%) referrals were from other patients, with 6.8% from physicians. Approximately 68% of patients paid out of pocket or claimed extended health insurance for care. Most common diagnoses were back (49%, 95% CI 44 to 56) and neck (15%, 95% CI 13 to 18) problems, with few encounters related to maintenance/preventive care (0.86%, 95% CI 0.2 to 3.9) and non-musculoskeletal problems (1.3%, 95% CI 0.7 to 2.3). The most common treatments included spinal manipulation (72%), soft tissue therapy (70%) and mobilisation (35%).
The authors concluded that this is the most comprehensive profile to date of chiropractic practice in Canada. People who present to Ontario chiropractors are mostly adults with a musculoskeletal condition. Our results can be used by stakeholders to make informed decisions about workforce development, education and healthcare policy related to chiropractic care.
I am so sorry to have mocked this paper. I shouldn’t have, because it actually does reveal a few interesting snippets:
- Only 7% of referrals come from real doctors.
- The vast majority of all patients receive spinal manipulations.
- About 6% of them are under 14 years of age.
- Chiropractors seem to dislike surveys; only 35% of those asked complied.
- 23% of all consultations were for general or unspecified problems,
- 8% for neurologically related problems,
- 5% for non-musculoskeletal problems (eg, digestive, ear, eye, respiratory, skin, urology, circulatory, endocrine and metabolic, psychological).
- Chiropractors rarely refer patients to other clinicians; this only happened in less than 3% of encounters.
- Apart from manipulation, chiropractors employ all sorts of other dubious therapies (ultrasound 3%, acupuncture 3%, , traction 1%, interferential therapy 3%, soft laser therapy 3%).
- 68% of patients pay out of their own pocket…
… NO WONDER, THEY DO NOT SEEM TO BE IN NEED OF ANY TYPE OF TREATMENT: 54% of all patients reported being in “excellent/very good overall health”!