Understanding Chiropractic Care

How Chiropractic Is Actually Practiced 

Spinal manipulation and other manual therapies are the main treatment methodology (1)

Average number of visits for chiropractic care is <8

Average for studied IPA 6.81 (1)

Top 10 treatment procedures 2001 (1) Rank Code % of Total Services 1. 98940 24.2% 2. 97014 20.0% 3. 98941 12.9% 4. 97012 12.9% 5. 97010 6.7% 6. 97035 4.2% 7. 97140 2.7% 8. 97032 2.0% 9. 99212 1.3% 10. 97124 1.2%	2001 Data Summary SMT 37.1% Modalities 41.6% Procedures 3.9% E/M 1.2%
Top 10 treatment procedures 2005 (1)
Rank Code % of Total Services 1. 98941 22.5% 2. 98940 14.8% 3. 97014 12.6% 4. 97012 12.2% 5. 97140 5.8% 6. 98943 2.9% 7. 97010 2.6% 8. 97530 2.2% 9. 97110 2.1% 10. 99203 2.1%	2005 Data Summary SMT 40.1% Modalities 27.4% Procedures 10.1% E/M 2.1%

There is a growing understanding and use of treatment techniques addressing soft tissue complaints.

The Patient
Chiropractors See 

Most chiropractic patients are white, middle aged, married, and have high school as their highest level of education. The great majority of care is for musculoskeletal conditions-particularly back pain. (2)

60% women (3)

70.5% were female who
completed the survey, 27.3% were male.  87.5% were Caucasian (4)

45.4% had a college
degree, 29.9% had vocational training.(4)

6.3% were referred by
a medical doctor, 59.0% were referred by a friend,  3% by the medical plan’s provider directory and 10.3% by advertising (4)

68% of patients make
$50,000 or more with 26.1% 80,000 or more. (4)

Chiropractic patients are very
satisfied with their care. Results of this study suggest that the
current role of chiropractic in the health care system is a highly
focused one, not a broad-based alternative. (2)

The Conditions
Chiropractors Treat

The great majority of care is for musculoskeletal conditions-particularly back pain. (5)

Greater than 95% are
for somatic complaints. (5)

5% Headache is the
primary complaint    (5)

Less than 1% is
outside of these categories (5)

70.8% Low back pain,
62.4% had neck pain, 25.8% had shoulder pain and 24.4% had headaches.
(4)

Top 10 Conditions
treated by Chiropractic in an Oklahoma Managed Care IPA of 210
Chiropractors. (1)

OSCIPA Data for
2001

What the Scientific Evidence Shows About Chiropractic

Chiropractic is
cost effective

Comparative
Analysis of Individuals With and Without Chiropractic Coverage: Patient
Characteristics, Utilization, and Costs

A 4-year
retrospective claims data analysis comparing more than 700,000 health
plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399, P<.001). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. (6)

            Clinical and Cost Outcomes of an Integrative Medicine IPA

Analysis of
clinical and cost outcomes on 21,743 member months over a 4-year period
demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4%
hospital days per 1000, 43.2% outpatient surgeries and procedures per
1000, and 51.8% pharmaceutical cost reductions when compared with
normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame. (7)

Chiropractic
Care: Is It Substitution Care or Add-on Care in Corporate Medical Plans?

An analysis of
claims data from a managed care health plan was performed to evaluate
whether patients use chiropractic care as a substitution for medical
care or in addition to medical care. For the 4-year study period, there
were 3,129,752 insured member years in the groups with chiropractic
coverage and 5,197,686 insured member years in the groups without
chiropractic coverage. These results (of this file review) indicate
that patients use chiropractic care as a direct substitution for medical care. (8)

Efficacy

Over the past several decades, a substantial body of evidence has accumulated regarding the value of chiropractic manipulation for low back, neck and headache complaints. 

Long-Term Follow-up of
a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes 

To assess the long-term benefits of medication, needle
acupuncture, and spinal manipulation as exclusive and standardized
treatment regimens in patients with chronic (>13 weeks) spinal pain
syndromes.

Study Design

Extended follow-up (>1 year) of a randomized clinical
trial was conducted at the multidisciplinary spinal pain unit of
Townsville's General Hospital between February 1999 and October 2001.

Patients and Methods

Of the 115 patients originally randomized, 69 had
exclusively been treated with the randomly allocated treatment during
the 9-week treatment period (results at 9 weeks were reported earlier).
These patients were followed up and assessed again 1 year after
inception into the study reapplying the same instruments (ie, Oswestry
Back Pain Index, Neck Disability Index, Short-Form-36, and Visual
Analogue Scales). Questionnaires were obtained from 62 patients
reflecting a retention proportion of 90%. The main analysis was
restricted to 40 patients who had received exclusively the randomly
allocated treatment for the whole observation period since
randomization.

Results

Comparisons of initial and extended follow-up
questionnaires to assess absolute efficacy showed that only the
application of spinal manipulation revealed broad-based long-term
benefit: 5 of the 7 main outcome measures showed significant
improvements compared with only 1 item in each of the acupuncture and
the medication groups.

Conclusions

In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed
regimens that provides broad and significant long-term benefit. (9)

A Randomized Controlled Clinical Trial of Stay-Active
Care Versus Manual Therapy in Addition to Stay-Active Care: Functional
Variables and Pain

Study Design
A randomized, controlled trial during 10 weeks.



Methods One hundred sixty outpatients with acute or subacute low
back pain were recruited from a geographically defined area. They were
randomly allocated to a reference group treated with the stay-active
concept and, in some cases, muscle stretching and an experimental group
receiving manual therapy and, in some cases, steroid injections in
addition to the stay-active concept. Pain and disability rating index
were used as outcome measures.



Results At baseline, the experimental group had somewhat more
pain, a higher disability rating index, and more herniated disks than
the reference group. After 5 and 10 weeks, the experimental group had
less pain and a lower disability rating index than the reference group.



Conclusions The manual treatment concept used in this study in
low back pain patients appears to reduce pain and disability rating
better than the traditional stay-active concept.



How to develop a
relationship with a chiropractor

• Identify a
  chiropractor that you can work with. 

• Use a chiropractor
  that sends a report to you. 

• Do not be afraid
  to interact with a chiropractor.Ask for patient feedback.

What is the Benefit of a Relationship with a Chiropractor? 

Patients with back
pain are often dissatisfied with standard medical care, especially in
comparison to care provided by alternative providers (11)

Chiropractic was ranked ahead of all
conventional treatments, including prescription drugs, by readers with
back pain.  (12)

More than half of

study participants who had chronic low back pain had tried chiropractic
care. (13)

Over the last half
century CAM treatment has continued to increase.  The most used,
non-medicinal type of CAM treatment is chiropractic. (14)

The use of
complementary and alternative medicine by primary care patients. ASURF*NET study

RESULTS: Approximately 21% of the patients reported using one or more forms of CAM therapy in conjunction with the most important health problem underlying their visit to the physician. The most common forms of therapy were visiting chiropractors (34.5%) of CAM users), herbal remedies and supplements (26.7%), and massage therapy (17.2%). Recommendations from friends or coworkers, a desire to avoid the side effects of conventional treatments, or failure of conventional treatments to cure a problem were the most frequently cited reasons for using these therapies. Use of practitioner-based therapies was significantly and independently associated with poor perceived health status, poor emotional functioning, and a musculoskeletal disorder, usually low back pain. (15)

Patient Satisfaction
with chiropractic is very high.  85% of patients were very satisfied. 15% of patients were satisfied. (16)

Patient’s are more
satisfied with chiropractic care than medical care. (17)

93% of patients were
very satisfied with their care.  86.3 % agree that the chiropractic care they received was exceptional (4)

93.3% of patients feel their chiropractor is competent and well trained. (4)

90.8% would strongly
recommend their chiropractor to others. (4)

REFERENCES
 

1. Data from
   Oklahoma State Chiropractic Independent Physicians Association
   
2. Coulter ID, Hurwitz EL, Adams AH,
   Genovese BJ, Hays R, Shekelle PG: 
   
   Patients using chiropractors in North America: who are they, and why
   are they in chiropractic care? Spine 2002, 27:291-6
   

Cherkin DC, Deyo RA, Sherman KJ, Hart LG, Street JH, Hrbek A, Davis RB, Cramer E, Milliman B, Booker J, Mootz R, Barassi J, Kahn JR, Kaptchuk TJ, Eisenberg DM:  Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians. J Am Board Fam Pract 2002,


4. Narine L, Brower R  Oklahoma State Chiropractic Independent Physicians Association 2005 randomized questionnaire in press.
   
5. Nelson CF, Lawrence D, Triano J,
   Bronfort G, Perle SM, Metz D, Hegetschweiler K, LaBrot, T
   Chiropractic as Spine Care: A Model for the Profession
   Chiropractic & Osteopathy 2005, 13:9 23-24
   
6. Antonio P. Legorreta; R. Douglas Metz;
   Craig F. Nelson; Saurabh Ray; Helen Oster Chernicoff; Nicholas A.
   DiNubile 
   Comparative Analysis of Individuals With and Without
   Chiropractic Coverage: Patient Characteristics, Utilization, and Costs
   Arch Intern Med 2004 (Oct 11);   164 (18):   1985–1892
   
   
   
   
7. Sarnat RL, Winterstein J Clinical and Cost Outcomes of an Integrative Medicine IPA  J Manipulative Physiol Ther 2004 (Jun) ;   27 (5):  
   336–347
   
8. Metz RD, Nelson CF, LaBrot T, Pelletier KR Chiropractic Care: Is It
   Substitution Care or Add-on Care in Corporate Medical Plans?
   J Occup Environ Med. 2004 Aug;46(8):847-55



 

9. Muller R, Giles LG. Long-Term Follow-up of a Randomized Clinical
   Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal
   Manipulation for Chronic Mechanical Spinal Pain Syndromes J
   Manipulative Physiol Ther. 2005 Jan;28(1):3-11.
   
    
10. Grunnesjo MI, Bogefeldt JP, Svardsudd KF, Blomberg SI. A randomized
    controlled clinical trial of stay-active care versus manual therapy in
    addition to stay-active care: functional variables and pain. J
    Manipulative Physiol Ther. 2004 Sep;27(7):431-41.
    
     
11. [Consumers Reports]. How is your doctor treating you? Consumers
    Reports. 1995. pp. 81–8.
    
     
12. Consumers Reports August 2005 Press Release
    
     
13. Sherman KJ, Cherkin DC, Connelly MT, Erro J, Savetsky JB, Davis RB,
    Eisenberg DM: Complementary and alternative medical therapies for
    chronic low back pain: What treatments are patients willing to try?
    BMC Complement Altern Med 2004, 19;4:9
    
     
14. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M,
    Kessler RC. Trends in alternative medicine use in the United States,
    1990–1997: results of a follow-up national survey. JAMA. 1998;280:1569–75.
    
    
     
15. Palinkas LA, Kabongo ML and the San Diego Unified Practice Research in
    Family Medicine Network: The use of complementary and alternative
    medicine by primary care patients. ASURF*NET study. J Fam Pract
    2000, 49:1121-30
    
     
16. Gemmell HA. Hayes BM. Patient satisfaction with chiropractic
    physicians in an independent physicians' association. J Manipulative Physiol Ther. 2001 Nov-Dec;24(9):556-9.
    
     
17. Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, Kominski GF 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):1628-33