Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians

Abstract

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. Conclusions Although generally positive, Canadian family physicians’ attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.

A Guideline-Implementation Intervention to Improve the Management of Low Back Pain in Primary Care: A Difference-in-Difference-in-Differences Analysis

“…These results suggest that GPs have increased confidence in their own abilities to effectively manage LBP patients, and are consistent with qualitative and quantitative findings from the prior implementation study. There was no significant change in the use of allied health services other than physiotherapy; utilisation of these services is commonly driven by prior patient experience and beliefs rather than GP recommendation [ 20 , 21 ], and may therefore be less amenable to GP-level intervention.…”

Chiropractic pediatric patient management and interdisciplinary collaboration: a descriptive cross-sectional study of chiropractors in Quebec

“…Following the recommendation of Epstein et al [ 18 ], no back translation was performed due to its lack of added value compared with the sole use of expert committee review. The questionnaire was enhanced by adding concepts from previous studies in order to better reflect pediatric chiropractic practice in Quebec [ 5 , 7 – 13 , 19 , 20 ]. We added a section concerning the management of common pediatric red flags for chiropractic care, which were curated within a best practices document [ 21 ].…”

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

“…However, one week before the interviews, participants received an information letter containing examples from the interview questions. Lastly, chiropractors engaged to provide care at the Langs CHC were selected for their focus on evidence-based, timelimited management of musculoskeletal complaints [25,34]; practice variability among chiropractors in Canada [65] may reduce the generalizability of our findings in other settings.…”