Patient expectations and levels of satisfaction in chiropractic treatment for lumbar radiculopathy. A mixed methods study

Abstract

Background Chiropractic patients are generally satisfied with the care received. It is unclear if this also applies to Danish patients with lumbar radiculopathy included in a standardised chiropractic care package (SCCP). This study aimed to investigate patient satisfaction and explore perspectives on the SCCP for lumbar radiculopathy. Methods An explanatory sequential mixed methods design with three separate phases was used. Phase one was a quantitative analysis based on a survey in a prospective cohort of patients with lumbar radiculopathy in an SCCP from 2018 to 2020. Patients rated their satisfaction with the examination, information, treatment effect, and overall management of their problem on a 0–10 scale. In phase two, six semi-structured interviews conducted in 2021 were used to gain further explanatory insights into the findings from phase one. Data were analysed using systematic text condensation. In phase three, the quantitative and qualitative data were merged in a narrative joint display to obtain a deeper understanding of the overall results. Results Of 303 eligible patients, 238 responded to the survey. Of these, 80–90% were very satisfied (≥ 8) when asked about the examination, information, and overall management, whereas 50% were very satisfied with the treatment effect. The qualitative analysis led to the emergence of four themes: ‘Understanding the standardised care packages’, ‘Expectations regarding consultation and treatment effect’, ‘Information about diagnosis and prognosis’, and ‘Interdisciplinary collaboration’. The joint display analysis showed that high patient satisfaction with the examination could be explained by the patients’ feeling of being carefully and thoroughly examined by the chiropractor and by referrals to MRI. Advice and information given to patients on variations in symptoms and the expected prognosis were considered reassuring. Satisfaction with the chiropractor’s coordination of care and with referral to other healthcare professionals was explained by the patients’ positive experiences of coordinated care and their sense of alleviated responsibility. Conclusion Overall, patients were satisfied with the SCCP for lumbar radiculopathy. From a patient’s perspective, the consultation should include a thorough examination and a focus on communication and information relating to symptoms and prognosis, while expectations regarding the content and efficacy of the treatment should be addressed and aligned.

A qualitative analysis of free-text patient satisfaction responses in Care Response, a database of patient-reported outcome and experience measures

“…Respondents reported reduction in pain and improvements in function after treatment. This is consistent with other studies [ 20 , 38 , 43 ]. Herman [ 21 ], found high rates of satisfaction in chiropractic patients with chronic low back and neck pain with reasons including avoiding narcotics and surgery, which did not feature in our study.…”

“…We found that the respondents in this study generally reported a positive perception of their experiences. This is consistent with other chiropractic studies on a variety of populations [ 18 – 21 , 23 , 24 , 38 – 41 ]. In addition, Hurwitz in 2012 [ 42 ] reviewed the literature and found high satisfaction among patients of clinicians who employed spinal manipulation, including chiropractors.…”

“…This aligns with the findings of Jensen [ 38 ], who reported that patients in Denmark appreciated a thorough examination by a chiropractor, and also advice and information on symptoms and prognosis. The setting of Denmark for Jensen’s study makes it somewhat unusual, though, in that chiropractic is integrated into the national health system there and funded by the government.…”