Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? - a comparative qualitative case study in the Scandinavian context

Abstract

BackgroundDespite extensive publication of clinical guidelines on how to manage musculoskeletal pain and back pain in particular, these efforts have not significantly translated into decreases in work disability due to musculoskeletal pain. Previous studies have indicated a potential for better outcomes by formalized, early referral to allied healthcare providers familiar with occupational health issues. Instances where allied healthcare providers of comparable professional characteristics, but with differing practice parameters, can highlight important social and organisational strategies useful for informing policy and practice. Currently, Norwegian chiropractors have legislated sickness certification rights, whereas their Danish and Swedish counterparts do not. Against the backdrop of legislative variation, we described, compared and contrasted the views and experiences of Scandinavian chiropractors engaging in work disability prevention and sickness absence management.MethodsThis study was embedded in a two-phased, sequential exploratory mixed-methods design. In a comparative qualitative case study design, we explored the experience of chiropractors regarding sickness absence management drawn from face-to-face, semi-structured interviews. We subsequently coded and thematically restructured their experiences and perceptions.ResultsTwelve interviews were conducted. Thematically, chiropractors’ capacity to support patients in sickness absence management revolved around four key issues: issues of legislation and politics; the rationale for being a sickness absence management partner; whether an integrated sickness absence management pathway existed/could be created; and finally, the barriers to service provision for sickness absence management.ConclusionAllied health providers, in this instance chiropractors, with patient management expertise can fulfil a key role in sickness absence management and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of work disability prevention practices.

Physiotherapy for injured workers in Canada: are insurers’ and clinics’ policies threatening good quality and equity of care? Results of a qualitative study

“…Allied health professionals responsible for injured workers’ care such as physiotherapists and chiropractors have also developed and published position papers and best practices articles to help improve care for injured workers [8–12]. Increased attention towards factors that could facilitate or hinder the care of injured workers has also been noted [13–15]. …”

So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies

“…Papers in this series have again revealed deeply rooted disagreements within the chiropractic profession about what chiropractic is, and what it should be, as a profession [13,19,20], as well as disagreements and variation in relation to education of chiropractors [14,15] and chiropractic clinical practice [11]. In our opinion, it is ironic that while chiropractic has a strong presence in large parts of the world [3], is taking on increasingly important roles in disability prevention [6,7,17], in the military [5] and in interprofessional care [8] as well as growing research capacity [16], discussions about fundamental values and direction of the profession are unresolved. This unresolved issue creates confusion for stakeholders and threatens to impede professionalization and cultural authority.…”

“…disability prevention both informally and as part of system-supported pathways [6,7]. Another example of chiropractors functioning in interprofessional collaboration was provided by Wirth et al who reported on outcomes and trajectories of patients referred from a surgical department to chiropractic care [8].…”

Managing sickness absence of patients with musculoskeletal pain – a cross-sectional survey of Scandinavian chiropractors

“…This paper presents a cross-sectional, population-based survey, which is the second phase of a two-phased sequential, exploratory mixed-methods study. The first phase of the study involved a qualitative case study [14]. The interviews reported in the qualitative phase identified perceived barriers and facilitators, as well as practice behaviours of a group of musculoskeletal practitioners (chiropractors) with regards to sickness absence management (SAM) of their patients.…”

“…But, the most noticeable difference is that since 2008, the Norwegian chiropractors have been licensed to certify sickness absence up to 12 weeks. A full overview of the differences is provided elsewhere [14].…”