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The World Health Organization defines health as being “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”. [ 1 ]
Given this broad definition of health, epistemological constructs borrowed from the social sciences may demonstrate health benefits not disclosed by randomized controlled trials. Health benefits, such as improvement in self-reported quality-of-life (QOL), behaviors associated with decreased morbidity, patient satisfaction, and decreased health care costs, are reported in the following articles, and they make a compelling statement about the effects of chiropractic on general health.
Despite the historic emphasis on treatment, prevention and health promotion are receiving increased attention within the US health care system. These same health promotion tasks are considered by the National Academy of Science and others as essential components of health services delivered by primary care providers. Chiropractors are viewed by many as capable of and actively delivering prevention and health promotion in addition to providing other primary care services.
Prevention and health promotion activities administered by chiropractors fall into 2 general categories: those considered orthodox by the medical community (eg, weight loss, exercise, smoking cessation) and those that are not (eg, soft-tissue and osseous manual procedures and some dietary supplementation). Previous research demonstrates that the orthodox activities used by primary care medical providers are also used by chiropractors. The concept that chiropractic care is of value in maintaining health and preventing disease began with the work of Palmer. This preventive treatment is traditionally referred to as maintenance care (MC). MC has been defined as “a regimen designed to provide for the patient's continued well-being or for maintaining the optimum state of health while minimizing recurrences of the clinical status.” Many chiropractors believe that periodic patient visits permit the doctor to identify joint dysfunction or subluxations and make corrections with spinal manipulation or other manual procedures. These treatments are believed to prevent disease of both neuromusculoskeletal and visceral origin. [ 2 ]
Chiropractic Care of Musculoskeletal Disorders in a Unique Population Within Canadian Community Health Centers
J Manipulative Physiol Ther 2007 (Mar); 30 (3): 165–170
Patients of low socioeconomic status face barriers to accessing chiropractic services.
This study suggests that chiropractic care reduces pain and disability as well as improves general health status in patients with MSK conditions. Further studies using a more robust methodology are needed to investigate the efficacy and cost-effectiveness of introducing chiropractic care into publicly funded health care facilities.
Fostering Critical Thinking Skills: A Strategy for Enhancing Evidence Based Wellness Care
Chiropractic & Osteopathy 2005 (Sep 8) Volume 13 (1): 19 ~ FULL TEXT
Chiropractic has traditionally regarded itself a wellness profession. As wellness care is postulated to play a central role in the future growth of chiropractic, the development of a wellness ethos acceptable within conventional health care is desirable. This paper describes a unit which prepares chiropractic students for the role of "wellness coaches". Emphasis is placed on providing students with exercises in critical thinking in an effort to prepare them for the challenge of interfacing with an increasingly evidence based health care system.
Quality of Life Changes in a Disadvantaged, Underserved Chiropractic Patient Population: A Retrospective Case Series Report
Journal of Vertebral Subluxation Research 2005 (Apr 15): 1–3
SF-36 mean scores of patients from the shelter increased in each of the scales and summary scores. Results must be interpreted cautiously because of the small number of participants, but it is interesting to note that the vitality scale (VT) score improved 22 points. This increase was enough to achieve statistical significance (p equals 0.02) despite the small numbers of patients involved. It appears that chiropractic care holds promise and merits further investigation as one means of enhancing the quality of life in the homeless population studied in this case series report.
Chiropractic Maintenance Care and Quality of Life of a Patient Presenting with Chronic Low Back Pain
J Manipulative Physiol Ther 2005 (Feb); 28 (2): 136–142
The patient appeared to experience improvement in quality of life while showing signs suggestive of improved spinal function. The relationship between indicators of vertebral subluxation and quality of life deserves further investigation using a research design that allows for exploration of possible causal relationships.
Objective Physiologic Changes and Associated Health Benefits of Chiropractic Adjustments in Asymptomatic Subjects: A Review of the Literature
Journal of Vertebral Subluxation Research 2004 (Apr 26): 1–9
The data reviewed lend support to the contention that chiropractic adjustments, often for the purpose of correcting vertebral subluxation, confer measurable health benefits to people regardless of the presence or absence of symptoms. A significant amount of preliminary evidence supports that people without symptoms can benefit from chiropractic care. Improved function can be objectively measured in asymptomatic individuals following chiropractic care in a number of body systems often by relatively non-invasive means. It is plausible that chiropractic care may be of benefit to every function of the body and have the potential for long-term, overall health benefit to those receiving chiropractic care.
Chiropractic Care of the Older Patient: Developing an Evidence-based Approach
Proceedings of the World Federation of Chiropractic Congress 2001 (May); 6: 245–246
This study indicated that, as a profession, chiropractic has recognized the importance of geriatric education. Several articles indicate that the utilization of chiropractic services of older patients is increasing, and other articles indicate that many different conditions have been successfully resolved by chiropractic care. Although the results of this article are encouraging, continued research is necessary to further develop an evidence-based approach to chiropractic geriatric care, especially in the areas of maintenance care and the management of non-musculoskeletal conditions.
A Survey of Practice Patterns and the Health Promotion and Prevention Attitudes of US Chiropractors. Maintenance Care: Part I
J Manipulative Physiol Ther 2000 (Jan); 23 (1): 1–9
Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.
Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
J Manipulative Physiol Ther 2000 (Jan); 23 (1): 10–19
Rupert, Manello, and Sandefur surveyed 311 chiropractic patients, aged 65 years, who had received “maintenance care” for 5 years. Chiropractic patients receiving maintenance care, when compared with US citizens of the same age, spent only 31% of the national average for health care services and reported a 50% reduction in medical provider visits. The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and nonprescription drugs. Furthermore, 95.8% believed the care to be either “considerably” or “extremely” valuable.
Stress: The Chiropractic Patients Self-perceptions
J Manipulative Physiol Ther 1999 (Jul); 22 (6): 395–398
Of the 138 patients attending 1 of 10 participating chiropractic clinics, more than 30% regarded themselves as moderately to severely stressed, and over 50% felt that stress had a moderate or greater effect on their current problem. Some 71% of patients felt it would be helpful if their chiropractic care included strategies to help them cope with stress, and 44% were interested in taking a self-development program to enhance their stress management skills. Patient perceptions are known to be important in health care. A number of chiropractic patients perceive they are moderately or severely stressed. Interventions that reduce stress, or even the patient's perception of being stressed, may be construed as valid, non-specific clinical interventions. It may be timely for chiropractors to actively contemplate including stress management routinely in their clinical care protocols.
Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program
Topics In Clinical Chriopractic 1996 (Jun): 3 (2): 46–55
Coulter et al performed an analysis of an insurance database, comparing persons receiving chiropractic care with nonchiropractic patients. The study consisted of senior citizens >75 years of age. Recipients of chiropractic care reported better overall health, spent fewer days in hospitals and nursing homes, used fewer prescription drugs, and were more active than the nonchiropractic patients.
A Comparative Study of the Health Status of Children Raised Under the Health Care Models of Chiropractic and Allopathic Medicine
J Chiropractic Research 1989 (Summer); 5: 101–103
This study, published in the Journal of Chiropractic Research, found that there is a “definite correlation between chiropractic care and superior health.” In fact, this study “has shown that children raised under chiropractic care are less prone to infectious processes such as otitis media and tonsillitis, and that their immune systems are better able to cope with allergens such as pollen,weeds, grasses, etc. compared to children raised under allopathic care. There is also a significant decreased history of antibiotic use among the ‘Chiropractic’ children, indicating a lower susceptibility to bacterial infections as a result of their greater immune system response.”
Changes in Wellness and Quality of Life During Subluxation-Centered Chiropractic Care
Most studies of chiropractic efficacy have been limited to low back pain, neck pain or headaches. The notion that chiropractic may enhance one's life experience if used on an ongoing basis has been largely ignored in the literature. In that sense, chiropractic care, aimed at the removal of vertebral subluxation, may be of benefit to a wider proportion of the population, besides those complaining of specific illness or pain. Evidence is needed to justify the use of long-term chiropractic care in a population in which the main goals of care are the advancement of health and human potential rather than the treatment of disease or the alleviation of pain.
Chiropractic, Health Promotion and Wellness ~ A Series of Articles
Health and Wellness Promotion for Older Adults
Meridel I. Gatterman, MA, DC, MEd
Eighty-eight percent of older adults seek some form of complementary and alternative care. This is more than twice the national average of 42 percent reported by Eisenburg. [3] With the graying of the baby boomer generation, a large number of older adults will be seeking to promote health and wellness by continuing the fitness programs they started when they were in their 40s and 50s.
Health Promotion: Whose Job Is It?
Meridel I. Gatterman, MA, DC, MEd
Health promotion often is associated with disease prevention and considered a public health problem. [1] With the significant reduction in the prevalence of infectious diseases as a result of improved nutrition, sanitation and better living conditions in industrialized nations, chronic diseases related to self-imposed lifestyles have become increasingly important. These “lifestyle diseases,” including obesity, hypertension and chronic pain from arthritis, are as compromising to quality of life as are the more life-threatening conditions such as heart disease, stroke and cancer. So whose job is it to address “lifestyle diseases”?
Assessment of Community Needs for Health Promotion and Wellness
Meridel I. Gatterman, MA, DC, MEd
Chiropractic physicians as autonomous practitioners offer first-contact care. In addition to managing acute and chronic conditions, they are well-situated to promote the health and wellness of both patients (people seeking care for health problems) and clients (apparently healthy people). [1] Individuals increasingly are seeking active participation in their own health care. To effectively fulfill the role of health promotion and wellness practitioners, chiropractors must assess the needs for health promotion and wellness in their individual communities. Factors that should be considered when assessing a community’s health-promotion and wellness needs include: access to health-promotion and wellness resources, risk exposure, income levels, cultural norms, health insurance coverage and barriers to access.
Health Promotion and Wellness: A Paradigm Lost?
Meridel I. Gatterman, MA, DC, MEd
Following completion of a book for patients titled Chiropractic, Health Promotion, and Wellness, [1] I received a short description of the book from the publisher that stated, "Chiropractors have traditionally offered manipulation for neuromuscular skeletal problems. Today, many chiropractors are repositioning themselves as wellness providers." I promptly replied that chiropractors have traditionally counseled patients on health promotion and wellness. In mentioning this incident to a well-known research director, a non-chiropractor who has been involved with chiropractic for 14 years, he responded, with equal surprise, that practicing health promotion and wellness is not a new direction for chiropractors. [1]
CCE Adopts Health Promotion and Wellness Competencies
Meridel I. Gatterman, MA, DC, MEd
Counseling patients on habits and lifestyle has long been a part of chiropractic practice, identified by doctors of
chiropractic [1,2] and those who study what doctors of chiropractic say they do in practice. [3,4] Vear included counseling in the standards of chiropractic practice in 1992, stating that "chiropractic educational institutions place great emphasis on patient counseling." [1] The CCE standards recognize that health promotion and wellness are a part of the standards for chiropractic education and wellness. The 2003 CCE Standards for Doctor of Chiropractic Programs [5] state: "Doctors of chiropractic must be able to provide wellness care and to promote health maintenance to perform common screening procedures and wellness assessments in different age groups."
Health Promotion and Wellness
Meridel I. Gatterman, MA, DC, MEd
As primary-contact practitioners, chiropractors share the responsibility of licensed health professionals for promoting health and preventing disease. [2] This is consistent with the Association of Chiropractic Colleges (ACC) paradigm that includes health promotion in its statement of the scope of chiropractic practice. [3]
Access to Health Promotion and Wellness Care in the United States
Meridel I. Gatterman, MA, DC, MEd
If one considers that access to "sick care" in America is unequal, surely access to health promotion and wellness strategies are just as disparate. The attainment of a good standard of health promotion for the entire population is a reasonable goal. Access to health promotion should not be dependent on socioeconomic status, [1] cultural background [2] or bias against certain conditions such as learning disabilities, mental health problems and AIDS. [3]
