Primary Prevention in Chiropractic Practice: A Systematic Review

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SOURCE:   Chiropractic & Manual Therapies 2017 (Mar 14); 25: 9

Guillaume Goncalves, Christine Le Scanff1, and
Charlotte Leboeuf-Yde

University of Paris-Sud,
University of Paris-Saclay

Background   Chiropractors are primarily concerned with musculoskeletal disorders but have the responsibility to deal also with prevention in other areas.

Objectives   To establish the prevalence of chiropractors who have a positive opinion on the use of primary prevention (PP), their actual use of PP, and the proportion of patients who consult for PP in relation to

(i)   musculoskeletal disorders,
(ii)   public health issues, or
(iii)   chiropractic treatment for wellness.

Method   A systematic search for literature was done using PubMed, Embase, Index to Chiropractic Literature, and and updated on February 15th 2017. Inclusion criteria were: surveys on chiropractors and/or chiropractic patients, information had to be present on PP in relation to the percentage of patients who consult for PP in chiropractic practice or in a chiropractic student clinic, and/or the percentage of chiropractors who reported using PP, and/or information on chiropractors’ opinions of the use of PP, in the English, French, or Scandinavian languages. The review followed the PRISMA guidelines. Articles were classified as ‘good’, ‘acceptable’ and ‘unacceptable’ based on scores of quality items. Results from the latter group were not taken into account.

Results   Twenty-five articles were included, reporting on twenty-six studies, 19 of which dealt with wellness. The proportion of chiropractors who stated that they had a positive opinion on primary prevention (PP) was generally higher than the proportion of chiropractors offering PP. Most chiropractors offered some type of PP for musculoskeletal disorders and more than a half stated that they did so in the public health area but also for wellness. For all types of PP, however, it was rarely stated to be the reason for patients consulting. Regardless the type of PP, the proportion of patients who actually consulted specifically for PP was much smaller than the proportion of chiropractors offering PP.

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Conclusion   More research efforts have been put into wellness than into prevention of musculoskeletal disorders or public health-related disorders. It therefore seems that parts of the chiropractic profession are in search of an understanding of various aspects of clinical practice over and above its traditional musculoskeletal role. Interestingly, only a small proportion of chiropractic patients consult for primary prevention (PP), despite the readiness of the profession to offer such services.

Keywords   Chiropractic Primary prevention Public health Prevention of musculoskeletal disorders Wellness


From the Full-Text Article:


It is well accepted that non-communicable diseases, whether musculoskeletal or not, represent a social and economic burden, because they can be the source of long-term morbidity, and with increasing longevity they are expected to become increasingly common [1]. The prevention of such diseases can therefore minimize costs of health care, improve quality of life, and decrease both morbidity and mortality. Guidelines exist on how to approach this, such as the “Healthy People 2020”, which promotes modification of individual behaviour with a multidisciplinary approach [2].

Prevention can be performed at three stages of disease. Primary prevention (PP) deals with the prevention of disease in healthy people, secondary prevention is used to prevent a condition from recurring, whereas tertiary prevention is often defined as maintaining at a reasonable level a chronic condition that cannot be reversed [3]. In this review, we shall deal with PP only.

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