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Characteristics, Expectations, Experiences of Care, and Satisfaction of Patients Receiving Chiropractic Care in a French University Hospital in Toulouse (France) Over One Year: A Case Study

By |June 10, 2022|Cost-Effectiveness of Chiropractic, Patient Satisfaction|

Characteristics, Expectations, Experiences of Care, and Satisfaction of Patients Receiving Chiropractic Care in a French University Hospital in Toulouse (France) Over One Year: A Case Study

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord 2022 (Mar 9); 23 (1): 229

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Mallard F, Lemeunier N, Mior S, Pecourneau V, and Côté P

Division of Graduate Studies,
Canadian Memorial Chiropractic College (CMCC),
Toronto, Ontario, Canada.



FROM: ChiroUp (2021)


Background:   In October 2017, a partnership was established between the University Hospital of Toulouse and the French Chiropractic College, “Institut Franco-Européen de Chiropraxie” (IFEC). Before 2017, chiropractors did not practice in hospitals in France. Chiropractic students and chiropractors are now integrated in an interdisciplinary medical team at University Hospital. Our study aimed to describe the characteristics of patients who received chiropractic care at the University Hospital of Toulouse, their expectations, experiences of care, and satisfaction.

Method:   A prospective case study was conducted. Patients referred for chiropractic care in the French University Hospital of Toulouse from January to December 2020 were eligible to participate. Participants provided the following data: demographics, previous chiropractic care treatments, pain location, intensity (NRS) and duration, disability (NDI, ODI), health-related quality of life (SF-12) and depressive symptomatology (PHQ-9). We conducted semi-structured interviews to explore their expectations, barriers and facilitators impacting their experience of care, and satisfaction.

Method:   Seventeen participants were recruited and seven were interviewed. All participants had chronic pain with a median pain intensity of 05/10 (IQR 04-06) on the NRS scale. Nine of 17 participants presented with multiple pain locations. Thirteen of seventeen participants presented with low back pain and eight with neck pain. The median SF-12 health-related quality of life score was 50/100 (IQR 28.5-60.5) for physical health, and 52/100 (IQR 43-62) for mental health. The PHQ-9 median score of depressive symptomatology was 7.7/27 (IQR 2.0-12.5). Overall, participants were satisfied with their care and the collaboration between chiropractors and physicians. Participants expected a caring communication with the chiropractic team. Their experience was facilitated by their trust in their physician. Patients perceived the turnover of chiropractic students as a barrier to their satisfaction.

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Where to Start? A Two Stage Residual Inclusion Approach to Estimating Influence of the Initial Provider on Health Care Utilization and Costs for Low Back Pain in the US

By |May 28, 2022|Cost-Effectiveness of Chiropractic, Initial Provider|

Where to Start? A Two Stage Residual Inclusion Approach to Estimating Influence of the Initial Provider on Health Care Utilization and Costs for Low Back Pain in the US

The Chiro.Org Blog


SOURCE:   BMC Health Serv Res 2022 (May 23); 22 (1): 694

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Kenneth J. Harwood, Jesse M. Pines, C. Holly A. Andrilla & Bianca K. Frogner

College of Health and Education,
Marymount University,
Arlington, VA, USA.



Background:   Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.

Methods:   Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics.

Results:   Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5,093) or primary care physician ($5,660), and highest when starting with an orthopedist ($9,434) or acupuncturist ($9,205).

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Attitudes Towards Chiropractic: A Repeated Cross-sectional Survey of Canadian Family Physicians

By |January 19, 2022|All About Chiropractic, Cost-Effectiveness of Chiropractic|

Attitudes Towards Chiropractic: A Repeated Cross-sectional Survey of Canadian Family Physicians

The Chiro.Org Blog


SOURCE:   BMC Family Practice 2021 (Sep 15); 22 (1): 188

Jason W. Busse, DC, PhD; Sushmitha Pallapothu, BSc; Brian Vinh, BSc; Vivienne Lee, BSc; et. al.

Department of Health Research Methods,
Evidence, and Impact,
McMaster University,
Hamilton, ON, Canada.



Background:   Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes.

Methods:   A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores.

Results:   Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (- 1.55 points for each 10-year increment from age 28; 95%CI – 2.67 to – 0.44), belief that adverse events are common with chiropractic care (- 1.41 points; 95% CI – 2.59 to – 0.23) and reported use of the research literature (- 6.04 points; 95% CI – 8.47 to – 3.61) or medical school (- 5.03 points; 95% CI – 7.89 to – 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic.

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Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

By |January 10, 2022|Chronic Neck Pain, Cost-Effectiveness of Chiropractic, Low Back Pain, Spinal Pain Management|

Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

The Chiro.Org Blog


SOURCE:   Frontiers in Pain Ressearch 2021 (Oct 25); 2: 765921

Carlos Gevers-Montoro, Benjamin Provencher, Martin Descarreaux, Arantxa Ortega de Mues and Mathieu Piche

Department of Anatomy,
Université du Québec à Trois-Rivières,
Trois-Rivières, QC, Canada



Spine pain is a highly prevalent condition affecting over 11% of the world’s population. It is the single leading cause of activity limitation and ranks fourth in years lost to disability globally, representing a significant personal, social, and economic burden. For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable. One of the conservative management options available is spinal manipulative

The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness (as it compares to other interventions in more pragmatic settings) and efficacy (as it compares to inactive controls under highly controlled conditions) of SMT for the management of neck pain and low back pain. Additionally, a perspective on the current recommendations on SMT for spine pain and the needs for future research will be

In summary, SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy. Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain. Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain. Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT.

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SPINAL PAIN MANAGEMENT Section

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Efficiency of Primary Spine Care as Compared to Conventional Primary Care: A Retrospective Observational Study at an Academic Medical Center

By |January 8, 2022|Cost-Effectiveness of Chiropractic, Primary Spine Care|

Efficiency of Primary Spine Care as Compared to Conventional Primary Care: A Retrospective Observational Study at an Academic Medical Center

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2022 (Jan 6); 30 (1): 1

Serena Bezdjian, James M. Whedon, Robb Russell, Justin M. Goehl & Louis A. Kazal Jr.

Southern California University of Health Sciences,
Whittier, CA, 90604, USA.




Opioid use was 389% higher in the Medical group than the PSC group,
who’s care was provided by a Doctor of Chiropractic.


Background:   Primary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and utilize evidence-based spine care pathways to improve outcomes and reduce escalation of care (EoC) [e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist]. The present study examined 6-month outcomes to evaluate the efficiency of care for patients who received PSC as compared to conventional primary care. We h

Methods:   This was a retrospective observational study. We evaluated 6-month outcomes for two groups seen and treated for an SRD between February 01, 2017 and January 31, 2020. Patient groups were comprised of N = 1,363 PSC patients (Group A) and N = 1,329 PC patients (Group B). We conducted Pearson chi-square and logistic regression (adjusting for patient characteristics that were unbalanced between the two groups) to determine associations between the two groups and 6-month outcomes.

Results:   Within six months of an initial visit for an SRD, a statistically significantly smaller proportion of PSC patients utilized healthcare resources for spine care as compared to the PC patients. When adjusting for patient characteristics, those who received care from the PSC clinician were less likely within 6 months of an initial visit to be

hospitalized (OR = .47, 95% CI .23-.97),
fill a prescription for an opioid analgesic (OR = .43; 95% CI .29-.65),
receive a spinal injection (OR = .56, 95% CI .33-.95), or
have a visit with a specialist (OR = .48, 95% CI .35-.67)

as compared to those who received usual primary care.

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The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

By |December 15, 2021|Cost-Effectiveness, Cost-Effectiveness of Chiropractic|

The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther 2021 (Aug 7)

Matthew Davis, Olga Yakusheva, Haiyin Liu, Brian Anderson, Julie Bynum

University of Michigan,
400 North Ingalls, Room 4347,
Ann Arbor, MI 48109



Objective:   The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

Methods:   We used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation. Using a difference-in-difference analysis (before versus after relocation), we compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

Results:   Among those who experienced a reduction in access to chiropractic care (versus those who did not), we observed an increase in the rate of visits to primary care physicians for spine conditions (an annual increase of 32.3 visits, 95% CI: 1.4-63.1 per 1,000) and rate of spine surgeries (an annual increase of 5.5 surgeries, 95% CI: 1.3-9.8 per 1,000). Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 beneficiaries on medical services ($391 million nationally).

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