Patient Satisfaction With Chiropractic

This section was compiled by Frank M. Painter, D.C.
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Conditions That Respond Alternative Medicine Approaches to Disease

What Would it Take to Put a Chiropractor in Khakis?
Effecting Chiropractors as Commissioned Officers
in the U.S. Military - A Historical Brief

Military Medicine 2021 (Jul 31);   usab324 ~ FULL TEXT

Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.

Experiences and Attitudes About Chiropractic Care and
Prescription Drug Therapy Among Patients With Back Pain:
A Cross-Sectional Survey

J Chiropractic Medicine 2021 (Mar);   20 (1):   1–8 ~ FULL TEXT

Patients treated by both DCs and PCPs reported high overall satisfaction with chiropractic care received for low back pain with no significant differences between groups. The majority in both groups reported that seeing a DC for back pain made sense to them (95% of patients treated by a DC and 75% of patients treated by a PCP) whereas the minority reported that taking prescription drugs for back pain made sense (25% of patients treated by a DC and 41% of patients treated by a PCP).

Ratings of Perceived Effectiveness, Patient Satisfaction and Adverse Events
Experienced by Wellness Chiropractic Patients in a Practice-based Research Network

Complement Ther Clin Pract. 2019 (Aug);   36:   82–87 ~ FULL TEXT

Wellness patients are predominantly female, rating their care as effective/very effective and with high satisfaction. Adverse events reported were minor (i.e., self-limiting) with a prevalence ranging from 6.3% to 11.3%. Experiencing an AE and the chiropractor providing care had a significant effect on patient satisfaction ratings. We support continued research in characterizing the patterns and utilization of chiropractic services for wellness chiropractic patients.

Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain
J Manipulative Physiol Ther. 2018 (Aug 15) [Epub] ~ FULL TEXT

This study provides insight into the characteristics of patients who are successfully managing their chronic low back pain (CLBP) and chronic neck pain (CNP). Findings of this descriptive study of a large sample of chiropractic patients with CLBP or CNP reveal this sample to be similar to those found in other studies of chiropractic patients: highly-educated, non-Hispanic, white women, with at least partial insurance coverage for chiropractic. These individuals have also been in pain and using chiropractic care for years. Most came to chiropractic after trying other types of care, and just under a third continued to receive other concurrent care for their pain. Prior to chiropractic, they saw the best results with massage therapy and acupuncture and reported high levels of belief in the success of chiropractic in reducing their pain.

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25:
Results from a Practice-Based Research Network

J Altern Complement Med. 2017 (Dec 20) [Epub] ~ FULL TEXT

The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains. Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression, anxiety, fatigue, and pain interference after a trial of chiropractic care.

The Use of the Patient Reported Outcomes Measurement Information System
and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific
Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing
the Webster Technique

J Altern Complement Med. 2017 (Dec 20) [Epub] ~ FULL TEXT

A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks and parity (i.e., the number of live births) of 0.92 live births. From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects. The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 and 3.30, respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue, pain interference, sleep disturbance, and an improvement in satisfaction with social roles. A significant decrease was also found with pain interference. No evidence was found that anxiety or depression.

Management of Back Pain-related Disorders in a Community With Limited
Access to Health Care Services: A Description of Integration of
Chiropractors as Service Providers

J Manipulative Physiol Ther. 2017 (Nov);   40 (9):   635–642 ~ FULL TEXT

Questionnaire data were obtained from 93 patients. The mean age of the sample was 49.0 ± 16.27 years, and 66% were unemployed. More than three-quarters (77%) had had their back pain for more than a month, and 68% described it as constant. According to the Bournemouth Questionnaire, Bothersomeness, and global improvement scales, a majority (63%, 74%, and 93%, respectively) reported improvement at discharge, and most (82%) reported a significant reduction in pain medication. More than three-quarters (77%) did not visit their primary care provider while under chiropractic care, and almost all (93%) were satisfied with the service. According to the EuroQol 5 Domain questionnaire, more than one-third of patients (39%) also reported improvement in their general health state at discharge. Implementation of an integrated chiropractic service was associated with high levels of improvement and patient satisfaction in a sample of patients of low socioeconomic status with subacute and chronic back pain.

Patient-centered Professional Practice Models for Managing Low Back Pain in Older Adults:
A Pilot Randomized Controlled Trial

BMC Geriatr. 2017 (Oct 13);   17 (1):   235 ~ FULL TEXT

Professional practice models that included primary care and chiropractic care led to modest improvements in low back pain intensity and disability for older adults, with chiropractic-inclusive models resulting in better perceived improvement and patient satisfaction over the primary care model alone.

What Do Patients Value About Spinal Manipulation and Home Exercise for
Back-related Leg Pain? A Qualitative Study Within a Controlled Clinical Trial

Man Ther. 2016 (Dec);   26:   183–191 ~ FULL TEXT

This qualitative study illustrates that patient satisfaction is rooted in the quality of the patienteprovider relationship, although perceived symptom improvements, relevant clinical information about sciatica and its treatment, and the distinct qualities of those treatments are important drivers of satisfaction for patients who received non-pharmacological treatments for their back-related leg pain. Global measures of satisfaction may not adequately represent the range of patients' experiences and perceptions of spinal manipulative therapy or home exercise. In addition to providing insight to the quantitative results of the parent trial, these findings suggest that tailored interventions to enhance patienteprovider relationships may facilitate compliance and enhance satisfaction with care.

Integration of Chiropractic Services in Military and Veteran Health Care Facilities:
A Systematic Review of the Literature

J Evid Based Complementary Altern Med. 2016 (Apr);   21 (2):   115–130

This literature review examined studies that described practice, utilization, and policy of chiropractic services within military and veteran health care environments. A systematic search of Medline, CINAHL, and Index to Chiropractic Literature was performed from inception through April 2015. Thirty articles met inclusion criteria. Studies reporting utilization and policy show that chiropractic services are successfully implemented in various military and veteran health care settings and that integration varies by facility.

First-Contact Care With a Medical vs Chiropractic Provider After Consultation With
a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and
Health Care Costs in Spinal, Hip, and Shoulder Pain Patients

J Manipulative Physiol Ther. 2015 (Sep);   38 (7):   477–483 ~ FULL TEXT

JMPT's Editor-in-Chief Claire Johnson, DC, MEd, emphasized the importance of the latest findings:
“Comparative studies – in other words, research that compares the outcomes between two different providers or modalities – are rare for chiropractic care,” she said.   “Thus, this study by Houweling, et al., is especially important if payers and policy-makers are to better understand the 'triple aim' as it relates to chiropractic. Specifically, this study helps us better understand what type of care provides better patient satisfaction, is more cost effective, and improves population health.”

A Survey of Parent Satisfaction with Chiropractic Care of the Pediatric Patient
Journal of Clinical Chiropractic Pediatrics 2014 (Nov);   14 (3):   1167–1171 ~ FULL TEXT

This study showed that parents generally were very satisfied with chiropractic care of their child. Correlations between high satisfaction and improvement of the infant’s presenting complaint, improved sleep quality, and lower levels of parental distress were observed.

Exploring Patient Satisfaction: A Secondary Analysis of a Randomized
Clinical Trial of Spinal Manipulation, Home Exercise,
and Medication for Acute and Subacute Neck Pain

J Manipulative Physiol Ther 2014 (Sep 5);   37 (8):   593–601 ~ FULL TEXT

Neck pain is one of the most commonly reported health complaints in primary care settings. [1, 2] As concern for costs and side effects related to treating spinal pain conditions continues to grow, the search for effective, patient-centered treatments has become paramount. Patient satisfaction has become a widely advocated means for measuring patients' preferences and views related to treatment quality in clinical practice. [3] Furthermore, it is recommended as a core outcome domain for chronic pain clinical trials by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials group. [4]

Symptomatic Reactions, Clinical Outcomes and Patient Satisfaction Associated with
Upper Cervical Chiropractic Care: A Prospective, Multicenter, Cohort Study

BMC Musculoskelet Disord. 2011 (Oct 5);   12:   219 ~ FULL TEXT

A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had symptomatic reactions (SRs) meeting the accepted definition. Intense SR (NRS ≥8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p <0.001) following care with a high level (mean = 9.1/10) of patient satisfaction. The 83 chiropractors administered >5 million career upper cervical adjustments without a reported incidence of serious adverse event.

The Trials of Evidence:
Interpreting Research and the Case for Chiropractic

The Chiropractic Report ~ July 2011 ~ FULL TEXT

For the great majority of patients with both acute and chronic low-back pain, namely those without diagnostic red flags, spinal manipulation is recommended by evidence-informed guidelines from many authoritative sources – whether chiropractic (the UK Evidence Report from Bronfort, Haas et al. [1]), medical (the 2007 Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society [2]) or interdisciplinary (the European Back Pain Guidelines [3]).

Patients in Medicare Demonstration Project Give Their Chiropractors High Marks
ACAOnline report of HHS's Final Demonstration Progect Report

When asked to rate their satisfaction on a 10-point scale: 87 percent of patients in the study gave their doctor of chiropractic a level of 8 or higher, and 56 percent of those patients rated their chiropractor with a perfect 10.

Consumer Reports Lists Chiropractic Patients As Most Satisfied
Consumer Reports ~ May 2009

A study in the May issue of Consumer Reports shows that hands-on therapies were tops among treatments for relief of back pain. The study, which surveyed more than 14,000 consumers, was conducted by the Consumer Reports Health Ratings Center. The report states that, “eighty-eight percent of those who tried chiropractic manipulation said it helped a lot, and 59 percent were ‘completely’ or ‘very’ satisfied with their chiropractor

Chiropractic Services in the Canadian Armed Forces: A Pilot Project
Military Medicine 2006 (Jun);   171 (6):   572–576

This article reports on satisfaction associated with the introduction of chiropractic services within a military hospital, through a Canadian Armed Forces Pilot Project. We distributed a 27-item survey that inquired about demographic information and satisfaction with chiropractic services to 102 military personnel presenting for on-site chiropractic services at the Archie McCallum Hospital in Halifax, Nova Scotia. The majority of military personnel (94.2%) and referring physicians (80.0%) expressed satisfaction with chiropractic services.

Factors Associated With Patient Satisfaction With Chiropractic Care:
Survey and Review of the Literature

J Manipulative Physiol Ther 2006 (Jul);   29 (6):   455–462 ~ FULL TEXT

The results here generally confirm the findings elsewhere in the literature. Of the 23% of the adult population who have ever visited a chiropractor, overall rates of satisfaction are once again found to be quite high (83% satisfied or better) and the number dissatisfied is quite low (less than 10% dissatisfied or very dissatisfied). This is remarkable given the fact that much of the financial burden of the care is borne by patients, and the preponderance of care is for difficult chronic problems of back and neck.

Symptomatic Outcomes and Perceived Satisfaction Levels of Chiropractic
Patients with a Primary Diagnosis Involving Acute Neck Pain

J Manipulative Physiol Ther 2006 (May);   29 (4):   288–296 ~ FULL TEXT

A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years (SD, 15.7). The mean number of visits was 24.5 (SD, 21.2). Pain levels improved significantly from a mean of 7.6 (median, 8.0) before treatment to 1.9 (median, 2.0) after treatment (P < .0001). The overall patient satisfaction rate was 94%.

History and Overview of Theories and Methods of Chiropractic: A Counterpoint
Clin Orthop Relat Res 2006 (Mar);   444:   243–249

As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Other studies have shown that chiropractic care compared with medical care is safer, costs no more and often costs much less, and has consistently greater patient satisfaction for treatment of similar conditions.

Back Pain and Satisfaction with Chiropractic Treatment:
What Role Does the Physical Outcome Play?

Clin J Pain 2005 (Jul);   19 (4):   263–268

Patients were asked about effects on pain, anxiety, normal activity, work, depression, lifestyle, satisfaction, and overall improvement. Stepwise multiple regression analyses were used to evaluate the contribution of change scores to overall improvement and satisfaction. There are initial indications in the literature that information giving, and the reconfiguration of patients' perceptions of the problem, may contribute to patient satisfaction generally.

From:   Testimony to the Department of Veterans Affairs'
Chiropractic Advisory Committee

George B. McClelland, D.C., Foundation for Chiropractic Education and Research ~ March 25, 2003

From a number of studies, there is little to contradict the assertion that patient satisfaction with chiropractic care, in a variety of settings, has consistently been high. [1,   2,   3,   4]   Indeed, for matched back pain conditions, patient satisfaction with chiropractic treatment has invariably been shown to be significantly greater than that with conventional management [administered by a primary care physician, an orthopedist, or an HMO provider]. [5,   6,   7] Satisfied patients are far more likely to be compliant in their treatment, [8] theoretically bestowing chiropractic patients with yet another advantage over treatment by other providers in terms of outcomes.

Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive
Medical or Chiropractic Care: Results From the UCLA Low-back Pain Study

Am J Public Health 2002 (Oct);   92 (10):   1628–1633 ~ FULL TEXT

Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.

Patient Satisfaction With Chiropractic Physicians In An
Independent Physicians' Association

J Manipulative Physiol Ther 2001 (Nov);   24 (9):   556–559 ~ FULL TEXT

Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.

Pain, Disability, and Satisfaction Outcomes and Predictors of Outcomes: A Practice-based Study
hronic Low Back Pain Patients Attending Primary Care and Chiropractic Physicians

J Manipulative Physiol Ther. 2001 (Sep);   24 (7):   433–439 ~ FULL TEXT

Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P <.002). A greater proportion of chiropractic patients were satisfied with all aspects of their care (P =.0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study.

Patient Satisfaction With the Chiropractic Clinical Encounter
The 129th Annual Meeting of APHA Atlanta, GA (Oct 21–25, 2001)

Data were collected from 2986 adult patients of 172 U.S. and Canadian chiropractors in a practice-based research program over a one-week period in November 1999. Of the 1822 patients reporting pain, 56.2% rated the care they received for it as "excellent," 30.6% "very good;" 9.3% "good;" 1.3% "fair;" and 0.2% "poor;" 2.0% did not respond. Patients were quite satisfied with the care they received with 83% reporting that their chiropractor always listened carefully to them and always explained things in a way they could understand; 88% reported their chiropractor always showed respect for what they had to say; 78% felt their chiropractor always spent enough time with them.

Patient Satisfaction With the Chiropractic Clinical Encounter:
Report From a Practice-based Research Program

Journal of the Neuromusculoskeletal System 2001:   9 (4):   109–117

The majority of patients were highly satisfied with their care; 85.0% reported that their chiropractor always listened carefully; 85.3% that the DC explained things understandably; 88.2% that the DC showed respect for what they had to say; and 75.6% that he/she involved them in decisions as much as they wanted. The median proportion of patients, per DC, with a chief complaint who said their doctor always spent enough time with them was 82% (IQR: 19%) and 82.3% reported that their chiropractors never recommended more visits than necessary.

Patient Characteristics, Practice Activities, and One-month Outcomes
for Chronic, Recurrent Low-back Pain Treated by Chiropractors and
Family Medicine Physicians: A Practice-based Feasibility Study

J Manipulative Physiol Ther 2000 (May);   23 (4):   239–245 ~ FULL TEXT

Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians. Nonclinical factors may play an important role in patient progress. Findings from the Health Resources and Services Administration-funded project will include a report on the influence of practice activities, including more frequent visits by chiropractic patients, on the clinical course of low-back pain and patient outcomes.

The Chiropractic Outcome Study:
Pain, Functional Ability and Satisfaction With Care

J Manipulative Physiol Ther 1997 (May);   20 (4):   235–240

Based on these results, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.

The Outcomes and Costs of Care for Acute Low Back Pain Among Patients
Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons

New England J Medicine 1995 (Oct 5);   333 (14):   913–917 ~ FULL TEXT

The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all six groups of practitioners, but there were marked differences in the use of health care services. The mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients seen by HMO and primary care providers. Satisfaction was greatest among the patients who went to the chiropractors.

Patient Satisfaction: A Valid Concept?
Social Science and Medicine 1994 (Feb);   38 (4):   509–516

Over the past 10 yr consumer satisfaction has gained widespread recognition as a measure of quality in many public sector services. This has become manifest in the NHS in the call by the 1983 NHS Management inquiry to ascertain how well the service is being delivered at local level by obtaining the experience and perceptions of patients and the community. Patient satisfaction is now deemed an important outcome measure for health services; however, this professed utility rests on a number of implicit assumptions about the nature and meaning of expressions of 'satisfaction'.

Patient Satisfaction With Chiropractic Care in Los Angeles
AHSR FHSR Annu Meet Abstr Book 1994;   11:   11

This RAND Corporation Study found For overall care, 92% of the patients choose the care as either excellent or the best. Although the ratings on all the items are high the highest ratings were given to the more personal qualities of the practitioner: courtesy, politeness, and respect shown to the patient (92%); interest shown in the patient as a person (91%); willingness to listen (89%); ability to put the patient at ease (89%). These results support those of previous studies on chiropractic that suggest that the high satisfaction with chiropractic care is a result more of the personal health encounter than the therapeutic outcome. They also suggest that other providers could learn much from the interpersonal art of chiropractors.

Patient Satisfaction With Chiropractic Care
J Manipulative Physiol Ther 1993 (Jan);   16 (1):   25–32

Patients expressed high levels of satisfaction with their doctors and the care they received. Although women were slightly more satisfied than men, other patient characteristics such as level of education, income, employment status or previous chiropractic care did not influence response means.

Patient Evaluations of Low Back Pain Care From Family Physicians and Chiropractors
Western Journal of Medicine 1989 (Mar); 150 (3): 351–355 ~ FULL TEXT

Patients of chiropractors were three times as likely as patients of family physicians to report that they were very satisfied with the care they received for low back pain (66% versus 22%, respectively). Compared with patients of family physicians, patients of chiropractors were much more likely to have been satisfied with the amount of information they were given, to have perceived that their provider was concerned about them, and to have felt that their provider was comfortable and confident dealing with their problem.

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