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      The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided

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          Abstract

          Background

          Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.

          Methods

          Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition.

          Results

          The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).

          Conclusions

          This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.

          Electronic supplementary material

          The online version of this article (10.1186/s12998-017-0165-8) contains supplementary material, which is available to authorized users.

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          Most cited references336

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          Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.

          A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
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            Unconventional medicine in the United States. Prevalence, costs, and patterns of use.

            Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States. The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.
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              Cochrane Update. 'Scoping the scope' of a cochrane review.

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                Author and article information

                Contributors
                peter.beliveau@queensu.ca
                jwong@cmcc.ca
                Deborah.Sutton@uoit.ca
                nir_ben_guy@yahoo.com
                Andre.Bussieres@mcgill.ca
                smior@cmcc.ca
                simon.french@queensu.ca
                Journal
                Chiropr Man Therap
                Chiropr Man Therap
                Chiropractic & Manual Therapies
                BioMed Central (London )
                2045-709X
                22 November 2017
                22 November 2017
                2017
                : 25
                : 35
                Affiliations
                [1 ]ISNI 0000 0004 1936 8331, GRID grid.410356.5, Department of Public Health Sciences, , Queen’s University, ; Kingston, Canada
                [2 ]ISNI 0000 0004 0473 5995, GRID grid.418591.0, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, , University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), ; Toronto, Canada
                [3 ]ISNI 0000 0004 0473 5995, GRID grid.418591.0, Department of Research, Canadian Memorial Chiropractic College, ; 6100 Leslie St, Toronto, ON M2H 3J1 Canada
                [4 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, School of Physical and Occupational Therapy, , McGill University, ; Montréal, Canada
                [5 ]ISNI 0000 0001 2197 8284, GRID grid.265703.5, Département chiropratique, , Université du Québec à Trois-Rivières, ; Trois-Rivières, Canada
                [6 ]ISNI 0000 0000 9810 9995, GRID grid.420709.8, Centre de recherche interdisciplinaire en réadaptation (CRIR), ; Montréal, Canada
                [7 ]ISNI 0000 0004 1936 8331, GRID grid.410356.5, School of Rehabilitation Therapy, , Queen’s University, ; Kingston, Canada
                [8 ]ISNI 0000 0001 2158 5405, GRID grid.1004.5, Department of Chiropractic, , Macquarie University, ; Sydney, Australia
                Article
                165
                10.1186/s12998-017-0165-8
                5698931
                29201346
                3e7ada92-26e4-4eb2-ad27-a4cd4beee9c4
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 July 2017
                : 31 October 2017
                Funding
                Funded by: Canadian national and provincial chiropractic organizations
                Funded by: Queen's University Department of Public Health Science
                Funded by: Canadian Chiropractic Guideline Initiative
                Funded by: Canadian Institutes of Health Research
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Complementary & Alternative medicine
                chiropractic,utilization,patient demographics,assessment,treatment,statistics,scoping review

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