It is as expensive as seeing an orthopedist or an osteopath. See Figure 1. The average cost for a single chiropractic visit is less than the cost for other health care providers; however, patients require more visits to the chiropractor, and this drives up the per-episode cost.
For example, a patient being treated for back pain might have an average of 10 visits with a chiropractor, compared to 5 visits with an orthopedist and 2 visits with a general practitioner. In this study, the researchers found major cost variations at the different study sites, and they caution about generalizing the findings to all of the United States.
In a second study, RAND researchers found that people use chiropractors freely if their insurance covers all costs. However, if they have to pay a 25 percent or more co-payment, their use of this alternative health care drops by half. Chiropractic care is the most commonly used form of complementary and alternative medicine , or CAM. This field encompasses health care approaches that are neither taught widely in medical schools nor generally available in U. The following box shows the wide range of health care interventions considered to be part of CAM.
The use of alternative medicine is common and growing, and people go to alternative medicine practitioners more often than they see primary care physicians Figure 2. Nearly half of alternative medicine visits are to chiropractors. RAND's pioneering analysis of spinal manipulation for low-back pain stimulated a national reassessment of other forms of CAM.
Its goal is to advocate for good science, objective information, and open, rational inquiry about health practices that are outside of mainstream medicine. They are also currently evaluating SAMe S-adenosylmethionine —a popular dietary supplement—for the treatment of depression, osteoarthritis, and chronic liver disease.
Where chiropractic fits in today's health care system is still unclear. The lack of high-quality studies reported in the medical literature makes it difficult to arrive at comprehensive conclusions about the value of chiropractic care. For example, RAND researchers could say only that spinal manipulation benefits some people with acute low-back pain. They didn't find enough data from well-designed studies to say anything about chiropractic's value for chronic low-back pain or low-back pain that involves an irritated sciatic nerve; about the complication rate of chiropractic treatment; about the number of manipulations needed to get the maximum response; or about the cost-effectiveness of manipulation compared with other types of conservative care, such as some forms of physical therapy or even home self-care.
Rigorous, randomized, controlled trials are the key to understanding chiropractic's role in health care. These studies are the gold standard for producing unbiased data about a treatment. For these studies to be informative, patients in the trials should have the same kind of health problem, for example, clinically identical low-back pain. Researchers must use well-defined interventions and control treatments, and they should determine patient response to the treatment using the standard outcome measures used in other areas of medical research.
Furthermore, an accurate accounting of the costs of chiropractic care is needed in order to understand the cost-effectiveness of this health intervention compared to conventional medical care. Ian D. Coulter , Alan H. Adams , et al. Paul G.
Shekelle , Ian D. Coulter , et al. Shekelle , William H. Rogers , et al. As most studies assessed chiropractic utilization in the United States, Canada, or Australia, further research is needed to assess utilization in other countries. Reasons for attending chiropractic care varied between studies. Hestbaek and Stochkendahl conducted a systematic review of the literature pertaining to the reasons why patients aged between years attended chiropractic care. The authors concluded that musculoskeletal conditions, specifically spinal pain, were the main reasons for pediatric patients attending a chiropractor [ 16 ].
Our review findings show that musculoskeletal conditions, specifically those of the back and neck regions, are the main reasons for patients of all ages to consult chiropractors. Our review found that chiropractors offer many types of treatments to their patients, but spinal manipulation was the most common treatment provided.
The United States National Center for Health Statistics found that manipulation was the most commonly used provider-based CAM therapy among adults and children [ ]. While spinal manipulative therapy SMT is an effective strategy for managing back pain [ ], recent clinical practice guidelines [ — ] recommend clinicians use multimodal care including patient education and advice, manual therapy including SMT and mobilisation , supervised and home exercise to increase the likelihood of favourable health outcomes.
Our findings suggest that many chiropractors do provide multimodal care, consistent with clinical practice guidelines. Therefore, chiropractic care should not be considered consisting exclusively of spinal manipulation.
Stakeholders of the chiropractic profession need to be aware of the current state of knowledge to help inform their decision-making processes, promote evidence-based research informed practice, and to best serve those who seek chiropractic care. This review presents a comprehensive overview on the state of the chiropractic profession and has documented trends in the literature over time. A strength of our study was the systematic process used to collect and summarize the available evidence from a large and diverse body of literature.
A scoping review is the most appropriate method to collect and organize diverse information and to develop a picture of the existing evidence base [ 17 ]. Rigorous scoping review methodology can be used to bring theory to practice, and to reduce bias when informing stakeholders [ , ].
Moreover, we conducted systematic searches of the literature using multiple databases, a combination of key words and subject headings, and without date restrictions. Study selection was based on a set of clear inclusion and exclusion criteria to ensure that consensus between review authors was transparent and reproducible.
Finally, we ensured that the charted data from each relevant study was accurate through a second check of the data. Our scoping review has limitations. While a robust methodology was used, scoping reviews are a relatively new approach for which there is not yet a universal study definition or established methods [ ].
Despite conducting independent screening of systematic searches of multiple databases to identify relevant studies, our review did not review reference lists of included studies or employ hand searching nor were searches conducted in EmBase or AMED. This may have resulted in relevant studies being missed. Studies were excluded if not published in English or French, which may have resulted in missing relevant studies. However, it has been noted that chiropractic journals publish in English, which is recognized as the standard language of science, thereby reducing this risk [ ].
However, several authors of scoping reviews have argued that by not addressing the issue of quality appraisal, scoping reviews are able to deal with a greater range of study designs and methodologies [ , ]. The emphasis of a scoping review is on comprehensive coverage rather than on a particular standard of evidence [ , ]. We employed rigorous scoping review methodology to document the current state of knowledge on the utilization rate of chiropractic services, demographic and health profiles of people receiving chiropractic care, and the assessment undertaken and treatment provided by chiropractors.
Our findings reaffirm that the profile of chiropractic services and patients are diverse, yet common trends emerged. Across different countries and regions, the average month utilization rate of chiropractic services was 9. Musculoskeletal conditions, such as back and neck pain, were the predominant reason for people attending chiropractic care. Typically, chiropractic patients were female, aged Four out of five patients who consulted a chiropractor received spinal manipulation; however, chiropractors also commonly provided other treatments including soft-tissue therapy and formal patient education.
The authors acknowledge the contributions of Kent Murnaghan at the Canadian Memorial Chiropractic College for his assistance with the search strategy. JJW received research project funding from the Ontario Chiropractic Association, outside the submitted work. SDF is Deputy Editor-in-Chief for Chiropractic and Manual Therapies; however, he did not have any involvement in the editorial process for this manuscript and was blinded from the editorial system for this paper from submission to decision.
PJHB contributed to the study conception and design, acquisition of data, and analysis and interpretation of data. In addition, PJHB wrote and edited the article. All authors give final approval for publication of the article. The authors of this publication have each given consent for publication. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Electronic supplementary material. Peter J. Beliveau, Email: ac. Jessica J. Wong, Email: ac.
Deborah A. Sutton, Email: ac. Nir Ben Simon, Email: moc. Silvano A. Mior, Email: ac. Simon D. French, Email: ac. National Center for Biotechnology Information , U.
Journal List Chiropr Man Therap v. Chiropr Man Therap. Published online Nov Beliveau , 1 Jessica J. Wong , 2, 3 Deborah A. Mior , 2, 3 and Simon D. French 1, 7, 8. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jul 26; Accepted Oct This article has been cited by other articles in PMC. Abstract Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide.
Results The literature search retrieved 14, articles; studies reported in articles were relevant and reported on chiropractic utilization studies , reason for attending chiropractic care 85 studies , patient demographics studies , and assessment and treatment provided 34 studies.
Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. Electronic supplementary material The online version of this article Keywords: Chiropractic, utilization, patient demographics, assessment, treatment, statistics, scoping review. Background Chiropractors practice in over countries, in which 90 have established national chiropractic associations [ 1 ].
Methods We used scoping review methodology to collect and organize relevant information to address our broad research question and provide a comprehensive examination of the existing body of literature [ 17 ]. STEP 1: Identifying the research question Our scoping review was guided by the following broad research question: What is known about the utilization rate of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided?
STEP 3: Study selection Inclusion and Exclusion Criteria We included studies: 1 published in the peer-reviewed literature in English or French; 2 were case series, descriptive, cross-sectional, or cohort studies; 3 described patients who received chiropractic services; and 4 reported at least one of the following: utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; and types of chiropractic assessment and treatment provided.
Screening and Agreement Pairs of independent review authors screened the search results in two phases. STEP 4: Data Charting We extracted the following data from relevant studies when available : 1 description of the study study design, number of patients, country of origin, and study population ; 2 description of the patient population demographic information including age, sex, and occupation ; 3 reasons for attending chiropractic services clinical condition ; 4 utilization rate of chiropractic services; 5 diagnosis or assessment procedures used by chiropractors; and 6 chiropractic treatment provided.
STEP 5: Collating, summarizing, and reporting the results Analyzing the Data We descriptively summarized the charted data to include the following: Descriptive numerical analysis: The nature and distribution of the studies were analyzed with regards to the total number of studies, year of publication, study design, country where studies were conducted, and study population.
Results Descriptive numerical analysis The search conducted on January 14 th , yielded 14, publications, of which 12, were screened after removal of duplicates Fig.
Open in a separate window. Review findings Utilization rate of chiropractic services The utilization rate of chiropractic services at the regional or national levels over a month period was reported in 52 studies Fig. Table 1 Utilization of chiropractic services studies.
Reasons for attending chiropractic care In the general population, musculoskeletal conditions were the predominant reason for attending chiropractic care. Table 2 Reasons for attending chiropractic care reported by the pediatric population a 7 studies. Table 3 The ten most frequently reported reasons for attending chiropractic care and the percentage of patients who sought chiropractic care for each condition 78 studies.
Profiles of chiropractic patients People who sought chiropractic care were more likely to be female median Table 4 Characteristics of chiropractic patients studies. Types of chiropractic services assessment and treatment For diagnosis or assessment, static palpation was the most commonly used assessment procedure, reportedly used by Table 5 Use of diagnostic assessment procedures by chiropractors in patient care 17 studies.
IQR interquartile range a The study consisted of more than one sample and reported the proportion of use for a given assessment procedure within each sample. Table 6 Chiropractic treatment provided and proportion of use 34 studies. Chiropractic treatment provided Chiropractic treatment Percentage of treatment provided median, IQR Number of reporting studies Spinal manipulation a Discussion This scoping review of the chiropractic literature, the most comprehensive that we are aware of, identified discrete studies from articles related to the utilization rate of chiropractic services, reasons for attending chiropractic care, demographic and health profiles of chiropractic patients, and types of chiropractic assessment and treatment provided.
Strengths and Limitations A strength of our study was the systematic process used to collect and summarize the available evidence from a large and diverse body of literature. Conclusion We employed rigorous scoping review methodology to document the current state of knowledge on the utilization rate of chiropractic services, demographic and health profiles of people receiving chiropractic care, and the assessment undertaken and treatment provided by chiropractors.
Additional files Additional file 1: Appendix A. Additional file 2: Appendix B. Acknowledgements The authors acknowledge the contributions of Kent Murnaghan at the Canadian Memorial Chiropractic College for his assistance with the search strategy. Availability of data and materials Data has been made available see Additional file 2 : Appendix B. Notes Ethics approval and consent to participate Not applicable. Consent for publication The authors of this publication have each given consent for publication.
Footnotes Electronic supplementary material The online version of this article Contributor Information Peter J. References 1. Lester M. Chiropractic : An Introduction. Association between use of unconventional therapies and conventional medical services. Trends in alternative medicine use in the United States, results of a follow-up national survey. The chiropractic profession in Denmark — a descriptive report.
Arch Intern Med. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. J Manipulative Physiol Ther.
Trends in the use and cost of chiropractic spinal manipulation under Medicare Part B. Spine J. Arlington, VA; October Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II. Dunn A, Passmore S. Mil Med. Gleberzon BJ. A narrative review of the published chiropractic literature regarding older patients from J Can Chiropr Assoc.
Chiropractic and CAM utilization: a descriptive review. Chiropr Osteopat. Prevalence of visits to five types of complementary and alternative medicine practitioners by the general population: A systematic review.
Complement Ther Clin Pract. Hestbaek L, Stochkendahl MJ. J Public Health Bangkok ; 33 — Scoping studies: Towards a methodological framework. Int J Soc Res Methodol. Scoping studies: advancing the methodology. Implement Sci. Complementary and alternative medicine: a survey of its use in pediatric cardiology. C Open. J Pediatr Gastroenterol Nutr. A comparison of complementary and alternative medicine users and use across geographical areas: A national survey of women.
Complementary and alternative medicine consultations in urban and nonurban areas: A national survey of Australian women. The use of complementary and alternative medicine during pregnancy: a longitudinal study of Australian women. Description of a clinical stream of back-pain patients based on electronic medical records. Characteristics of chiropractors and their patients in Belgium.
Alcantara J. The presenting complaints of pediatric patients for chiropractic care: Results from a practice-based research network. Clin Chiropr. Chiropr J Aust. Al-Windi A. Determinants of complementary alternative medicine CAM use.
Complement Ther Med. Using factor analysis to create complementary and alternative medicine domains: an examination of patterns of use. Bartlett E. Top Clin Chiropr. Reduction in health service use for whiplash injury after motor vehicle accidents in Results from a defined population. J Rehabil Med. Multinational survey of chiropractic patients: reasons for seeking care.
Am Soc Clin Oncol. Branson RA. Breen AC. Chiropractors and the Treatment of Back Pain. Rheumatol Rehabil. Observations and patient questionnaires. Back pain amongst mid-age Australian women: A longitudinal analysis of provider use and self-prescribed treatments.
Use of complementary and alternative medicine by mid-age women with back pain: a national cross-sectional survey. Consumer characteristics and perceptions of chiropractic and chiropractic services in Australia: Results from a cross-sectional survey. Brunelli B, Gorson KC. The healthcare revolution is underway. Strengthened by increased recognition, we must now direct our efforts toward an increased awareness of why we sought that recognition.
The pendulum must swing toward a renewed commitment to that which is uniquely chiropractic. As Dr. July, Page July 13, Chicago, IL. Journal of the ACA. April, June 21, He is widely recognized for his ability to share his expertise in compelling and easy to understand ways.
Dr David is a renowned chiropractor who practiced for many years with his associates in a scan-centric thriving principled family-based practice in Toronto.
He is a sought after teacher mentor and keynote speaker who takes every opportunity to share the wisdom and the power of chiropractic as it is meant to be. Join 23, other Chiropractors and receive topics covering day to day challenges of running your practice.
Prospective chiropractors are required to have a Doctor of Chiropractic D. In , there were 15 Doctor of Chiropractic programs on 18 campuses accredited by The Council on Chiropractic Education. Admission to D. Schools have specific requirements for their chiropractic programs, but they generally require coursework in the liberal arts and in sciences such as physics, chemistry, and biology. Candidates should check with individual schools regarding their specific requirements.
Chiropractic students also get supervised clinical experience in which they train in spinal assessment, adjustment techniques, and making diagnoses. Most D. Some chiropractors complete postgraduate programs that lead to diplomate credentials. These programs provide additional training in specialty areas, such as orthopedics and pediatrics.
Classes are taken at chiropractic colleges. All states and the District of Columbia require chiropractors to be licensed. Although specific requirements vary by state, all require the completion of an accredited Doctor of Chiropractic D.
Many states also require applicants to pass a background check and state-specific law exams, called jurisprudence exams. All states require a practicing chiropractor to take continuing education classes to maintain his or her chiropractic license. Decisionmaking skills. Chiropractors must determine the best course of action when treating a patient.
They must also decide when to refer patients to other healthcare professionals. Detail oriented. Chiropractors must be observant and pay attention to details so that they can make proper diagnoses and avoid mistakes that could harm patients. Because they use their hands to perform manual adjustments to the spine and other joints, chiropractors should have good coordination to perform therapy effectively.
Chiropractors often care for people who are in pain. Interpersonal skills. Chiropractors must be personable in order to keep clients coming to their practice. Also, because chiropractors frequently touch patients in performing therapy, they should be able to put their patients at ease. Organizational skills. Good recordkeeping and other organizational skills are critical in running a successful business.
Note: All Occupations includes all occupations in the U. Source: U. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. In May , the median annual wages for chiropractors in the top industries in which they worked were as follows:.
Chiropractors tend to earn more as they build a client base and become owners of, or partners in, a practice. Bureau of Labor Statistics, Employment Projections program. Demand is expected to increase for chiropractic services as a nonsurgical, drug-free way to treat pain and improve overall wellness.
Rising interest in integrative or complementary healthcare has led to more acceptance of chiropractic treatment of the back, neck, limbs, and involved joints.
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