Exploring approaches to patient safety: the case of spinal manipulation therapy

Rozmovits, Linda; Mior, Silvano; Boon, Heather

doi:10.1186/s12906-016-1149-2

Cited by 14 publications

(12 citation statements)

References 53 publications

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“…While some believe the concerns are overstated [ 12 - 15 ], other commentators point to possible serious health risks associated with treatment [ 16 - 23 ]. Complications are also evident in terms of establishing and evaluating the safety culture of SMT [ 24 ]. Further adding to the debate is the fact that many chiropractic clinics make claims about the health benefits of SMT for ailments for which there is little to no evidence such as for the treatment of attention deficit hyperactivity disorder (ADHD), asthma, and the boosting of the immune system [ 25 - 28 ].…”

Section: Introductionmentioning

confidence: 99%

Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates

Marcon

Klostermann²,

Caulfield³

2016

JMIR Public Health Surveill

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BackgroundSpinal manipulation therapy (SMT) is a popular though controversial practice. The debates surrounding efficacy and risk of SMT are only partially evident in popular discourse.ObjectiveThis study aims to investigate the presence of critiques and debates surrounding efficacy and risk of SMT on the social media platform Twitter. The study examines whether there is presence of debate and whether critical information is being widely disseminated.MethodsAn initial corpus of 31,339 tweets was compiled through Twitter’s Search Application Programming Interface using the query terms “chiropractic,” “chiropractor,” and “spinal manipulation therapy.” Tweets were collected for the month of December 2015. Post removal of tweets made by bots and spam, the corpus totaled 20,695 tweets, of which a sample (n=1267) was analyzed for skeptical or critical tweets. Additional criteria were also assessed.ResultsThere were 34 tweets explicitly containing skepticism or critique of SMT, representing 2.68% of the sample (n=1267). As such, there is a presence of 2.68% of tweets in the total corpus, 95% CI 0-6.58% displaying explicitly skeptical or critical perspectives of SMT. In addition, there are numerous tweets highlighting the health benefits of SMT for health issues such as attention deficit hyperactivity disorder (ADHD), immune system, and blood pressure that receive scant critical attention. The presence of tweets in the corpus highlighting the risks of “stroke” and “vertebral artery dissection” is also minute (0.1%).ConclusionsIn the abundance of tweets substantiating and promoting chiropractic and SMT as sound health practices and valuable business endeavors, the debates surrounding the efficacy and risks of SMT on Twitter are almost completely absent. Although there are some critical voices of SMT proving to be influential, issues persist regarding how widely this information is being disseminated.

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Section: Introductionmentioning

confidence: 99%

Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates

Marcon

Klostermann²,

Caulfield³

2016

JMIR Public Health Surveill

View full text Add to dashboard Cite

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“…Chiropractic students may benefit from participating in interprofessional educational programs about patient safety as have students in other health disciplines [26,28]. As evident in other healthcare environments [29], such interprofessional programs may alleviate the competing tensions between professions providing SMT and improve collaboration in advancing patient safety [11].…”

Section: Discussionmentioning

confidence: 99%

“…Similar to all healthcare specialties, professions offering SMT, most commonly chiropractic, physical therapy, osteopathy and naturopathy, often lack transparent patient safety cultures [ 9 , 10 ]. Competing narratives within these professions fuel the ongoing debates about the risks and benefits of SMT [ 11 ], which may have stalled broader efforts to investigate and improve patient safety culture and performance in clinical practice and educational settings.…”

Section: Introductionmentioning

confidence: 99%

Patient safety in chiropractic teaching programs: a mixed methods study

et al. 2020

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Background Patient safety research has lagged within academic settings, including chiropractic teaching institutions. To develop a robust patient safety culture, the Institute of Medicine emphasized the need for employee’s attitudes to be understanding and positive. To initiate the assessment of the current culture and future needs, this study evaluated patient safety attitudes among chiropractic teaching clinic stakeholders (supervising clinicians, student interns, and administrative staff) and compared their standardized survey scores to established medical survey databases. Methods We conducted a cross-sectional, mixed methods survey design with quantitative analytic priority. Chiropractic interns, clinical faculty, and clinic staff of 5 international chiropractic educational programs completed a modified version of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture for Medical Offices Survey with open-ended comment fields between 2014 and 2016. Composite means of positive responses were calculated and compared to patient safety, quality of care, and overall self-ratings benchmarks from Canadian providers and academic settings in the AHRQ database. Qualitative responses were thematically categorized for a convergent analysis of quantitative results for the chiropractic sample. Results Chiropractic survey response rate was 45.3% (n = 645). Quantitative survey results indicated moderate scores and ranges (57–85%) on all patient safety dimensions for the chiropractic samples. Academic medicine and chiropractic providers’ benchmarks scored higher positive responses than chiropractic teaching clinics on most quantitative dimensions, except for work pressure/pace. Teamwork, organizational learning, and patient tracking/follow-up were the most positively endorsed quantitative dimensions, with communication, staff training, office standardization, and leadership support considered areas for improvement in both settings. Qualitative responses for the chiropractic clinics identified a need for open communication; additional staff training and student involvement in creating safety cultures; standardization of office processes including information exchange, scheduling, and equipment maintenance; and leadership support that focused on decreasing work pressure/pace and setting safety priorities. Conclusion As the first report of patient safety attitudes from stakeholders in chiropractic teaching clinics, specific areas of improvement were identified. Chiropractic teaching programs might consider incorporating these and related patient safety concepts into their formal curricula. Mixed methods approach offers teaching clinics opportunities to assess stakeholders’ insights and enhance safe delivery of chiropractic care.

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“…Potential predictors of benign AEs post-SMT have been previously reported [8][9][10][11][12] such as sex, SMT technique, multiple treated locations, working status of patient, and duration of pain at presentation. Although benign AEs may be considered to be an expected consequence of care [13], it remains unknown if benign AEs represent inherent effects resulting from SMT itself, a component of the natural history of the patient's presenting condition, and/or inadequacies regarding the therapeutic encounter (such as inappropriate technique). Although post-SMT AEs are typically benign and self-limiting, their presence can influence patient perceptions, expectations, well-being and quality of life [14].…”

Section: Introductionmentioning

confidence: 99%

Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

et al. 2020

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Background Approximately 50% of patients who receive spinal manipulative therapy (SMT) experience some kind of adverse event (AE), typically benign and transient in nature. Regardless of their severity, mitigating benign AEs is important to improve patient experience and quality of care. The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them. Methods Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them. Responses were analyzed using descriptive statistics. Results A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. Most clinicians (97%) believed benign AEs occur, and 82% reported their own patients have experienced one. For patients, 55% reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness. While most clinicians (61.5%) reported trying a mitigation strategy with their patients, only 21.2% of patients perceived their clinicians had tried any mitigation strategy. Clinicians perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT. Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage. Conclusions This is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.

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Exploring approaches to patient safety: the case of spinal manipulation therapy

Cited by 14 publications

References 53 publications

Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates

Chiropractic and Spinal Manipulation Therapy on Twitter: Case Study Examining the Presence of Critiques and Debates

Patient safety in chiropractic teaching programs: a mixed methods study

Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

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