The profile of older adults seeking chiropractic care: A secondary analysis

Background: Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care. Methods: A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger ( 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment. Conclusions: From 6781 chiropractor–adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions

Additional file 1: Table S1. of Workers’ characteristics associated with the type of healthcare provider first seen for occupational back pain

Part of Body and nature of injuries codes [51] used for claim selection. (DOCX 15 kb

Changes in the use practitioner-based complementary and alternative medicine over time in Canada: Cohort and period effects

<div><p>Background</p><p>The use of complementary and alternative medicine (CAM) is growing. However the factors contributing to changes over time and to birth cohort differences in CAM use are not well understood.</p><p>Setting</p><p>We used data from 10186 participants, who were aged 20–69 years at the first cycle of data collection in the longitudinal component of the Canadian National Population Health Survey (1994/95-2010/11). We examined chiropractic and other practitioner-based CAM use with a focus on five birth cohorts: pre-World War II (born 1925–1934); World War II (born 1935–1944); older baby boomers (born 1945–1954); younger baby boomers (born 1955–1964); and Gen Xers (born 1965–1974). The survey collected data every two years on predisposing (e.g., sex, education), enabling (e.g., income), behavior-related factors (e.g., obesity), need (e.g., chronic conditions), and use of conventional care (primary care and specialists).</p><p>Results</p><p>The findings suggest that, at corresponding ages, more recent cohorts reported greater CAM (OR = 25.9, 95% CI: 20.0; 33.6 for Gen Xers vs. pre-World War) and chiropractic use than their predecessors (OR = 2.2, 95% CI: 1.7; 2.8 for Gen Xers vs. pre-World War). There was also a secular trend of increasing CAM use, but not chiropractic use, over time (period effect) across all ages. Factors associated with cohort differences were different for CAM and chiropractic use. Cohort differences in CAM use were partially related to a period effect of increasing CAM use over time across all ages while cohort differences in chiropractic use were related to the higher prevalence of chronic conditions among recent cohorts. The use of conventional care was positively related to greater CAM use (OR = 1.8, 95% CI: 1.6; 2.0) and chiropractic use (OR = 1.2, 95% CI: 1.1; 1.4) but did not contribute to changes over time or to cohort differences in CAM and chiropractic use.</p><p>Conclusion</p><p>The higher CAM use over time and in recent cohorts could reflect how recent generations are approaching their healthcare needs by expanding conventional care to include CAM therapies and practice for treatment and health promotion. The findings also underscore the importance of doctors discussing CAM use with their patients.</p></div

<i>It might take a village</i>: developing a rehabilitation program of care for degenerative cervical radiculopathy from the patient perspective

The aim of our study is to inform the development of a rehabilitation program of care from the perspectives of those suffering from degenerative cervical radiculopathy (DCR). We conducted a qualitative study, purposefully recruiting individuals with DCR. Transcripts from virtual semi-structured interviews were iteratively analyzed using interpretative phenomenological methods. Eleven participants were recruited and depicted their ideal rehabilitation program of care. Participants described the importance of a patient centered-approach, health care providers who were validating, reassuring and attentive, easier access to health services, a supportive and collaborative team environment, and receiving peer support. Furthermore, participants expressed that they would expect the program of care to result in their symptoms being less intense and intermittent. In consideration of the participant perspectives, the ideal rehabilitation program of care can be conceptualized by the enactive-biopsychosocial model, which provides a theoretical framework for developing and implementing the program of care. We obtained valuable information from individuals living with DCR regarding their preferences and expectations of a rehabilitation program of care. The participant descriptions will provide the groundwork for its development to meet patient needs and expectations. Future research to guide implementation will also be explored. The lives of those suffering from cervical radiculopathy are significantly impacted. Incorporating patient perspectives in the development of care plans can lead to the inclusion of interventions considered patient-centered and may improve implementation, adherence, and outcomes. Participants described their preferences and expectations of a rehabilitation program of care that may assist in its future development to meet patient needs and expectations. From participants’ perspectives, the ideal rehabilitation program of care would be framed by the enactive-biopsychosocial model, thus providing a theoretical context for its development and implementation.</p

Results from logistic two-level growth model (1) and hierarchical age-period-cohort models (2–4) for CAM use.

<p>Canadian National Population Health Survey, 1994–2011.</p

Characteristics of users and non-users of CAM and chiropractic services.

<p>Canadian National Population Health Survey (NPHS), 1994–2011.</p

Age, period, and cohort effects for CAM use: Results from logistic growth models.

<p><b>Canadian National Population Health Survey, 1994–2011.</b> Notes: CAM, Complementary and Alternative Medicine; GenX, Generation X; YBB, Younger Baby Boomer; OBB, Older Baby Boomer; WW2, World War II; pre-WW, pre-World War II. Values for a) are predictions from the fixed part of model 1 in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177307#pone.0177307.t003" target="_blank">Table 3</a> and values for b) are predictions from the solution of the random effects in model 2 in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177307#pone.0177307.t003" target="_blank">Table 3</a>.</p

Use (%) of practitioners-based complementary and alternative medicine in 1994/95 and 2010/11 by birth cohort.

<p>Canadian National Population Health Survey (NPHS), 1994–2011.</p

Results from logistic two-level growth model (1) and hierarchical age-period-cohort models (2–4) for chiropractic use.

<p>Canadian National Population Health Survey, 1994–2011.</p