Chiropractic Treatment of Older Adults with Neck Pain with or without Headache or Dizziness: Analysis of 288 Australian Chiropractors’ Self-reported Views
SOURCE: Chiropractic & Manual Therapies 2019 (Dec 18); 27: 65
Dein Vindigni, Laura Zark, Tobias Sundberg, Matthew Leach, Jon Adams, and Michael F. Azari
School of Health and Biomedical Sciences,
BACKGROUND: Neck pain is a leading cause of individual and societal burden worldwide, affecting an estimated 1 in 5 people aged 70 years and older. The nature and outcomes of chiropractic care for older adults with neck pain, particularly those with co-morbid headaches, remains poorly understood. Therefore, we sought to ascertain: What proportion of Australian chiropractors’ caseload comprises older adults with neck pain (with or without headache); How are these conditions treated; What are the reported outcomes?
METHODS: An online survey examining practitioner and practice characteristics, clinical patient presentations, chiropractic treatment methods and outcomes, and other health service use, was distributed to a random nationally representative sample of 800 Australian chiropractors. Quantitative methods were used to analyze the data.
RESULTS: Two hundred eighty-eight chiropractors (response rate = 36%) completed the survey between August and November 2017. Approximately one-third (M 28.5%, SD 14.2) of the chiropractors’ patients were older adults (i.e. aged ≥65 years), of which 45.5% (SD 20.6) presented with neck pain and 31.3% (SD 20.3) had co-morbid headache. Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly:
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Chiropractors reported to combine a range of physical and manual therapy treatments, exercises and self-management practices in their care of these patients particularly: manipulation of the thoracic spine (82.0%); activator adjustment of the neck (77.3%); and massage of the neck (76.5%).
The average number of visits required to resolve headache symptoms was reported to be highest among those with migraine (M 11.2, SD 8.8). The majority of chiropractors (57.3%) reported a moderate response to treatment in reported dizziness amongst older adults with neck pain. Approximately 82% of older adult patients were estimated to use at least one other health service concurrently to chiropractic care to manage their neck pain.
CONCLUSION: This is the first known study to investigate chiropractic care of older adults living with neck pain. Chiropractors report using well-established conservative techniques to manage neck pain in older adults. Our findings also indicate that this target group of patients may frequently integrate chiropractic care with other health services in order to manage their neck pain. Further research should provide in-depth investigation of older patients’ experience and other patient-reported outcomes of chiropractic treatment.
Keywords: Chiropractic, Headache, Older adults, Neck pain, Survey
From the FULL TEXT Article:
Neck pain, with or without headache or dizziness, is a leading cause of disability affecting over 350 million people worldwide as of 2015. [1, 2] The prevalence of neck pain is also high among older people. In Denmark, for instance, the one-month prevalence of neck pain is reported to be as high as 22% amongst those aged 70 years and over.  Neck pain causes a substantial economic burden, attributable to healthcare and insurance costs, decreased work productivity, and work absenteeism.  Furthermore, it is associated with myriad other health problems , prominently co-morbid headaches [6–8], and decreased health-related quality of life. 
Neck pain in older adults is not extensively studied and this population is generally poorly represented in musculoskeletal research. [10–12] Many older adults are restricted in their pain medication use due to multiple co-morbidities and associated polypharmacy, and/or increased risk of harmful side effects due to age-related pharmacokinetic and pharmacodynamic changes. [13, 14] Therefore, non-pharmacological treatments including chiropractic methods may be a particularly valuable service for older adults, who face increased barriers to pain relief. 
Many older adults in Australia suffering from neck pain and associated conditions seek chiropractic treatment.  In fact, musculoskeletal complaints, most commonly back and neck pain, account for the vast majority of chiropractic consultations in Australia. [16–20] According to the latest survey of Australian chiropractic clinical activity, 93.6% of Chiropractors stated that neck pain was a common presenting complaint in their practices.  However, relatively little is known about the nature and effectiveness of chiropractic treatment for neck pain in older adults. This is particularly so in Australia. As ‘chiropractic care’ encompasses numerous and wide-ranging treatment modalities, information about the specific methods used and their outcomes, is critical to understanding what constitutes usual contemporary chiropractic care for older adults with neck pain.