Chiropractors’ perception of their role in the treatment of back pain

Problem

Chiropractic is a complementary and alternative medicine (CAM) that uses manual therapies to treat lower back pain (LBP) and is recommended in the National Institute of Care and Excellence (NICE) evidence-based guidelines. However, chiropractic use is very limited within the National Health Service (NHS) and LBP impacts on the UK economy considerably, with an estimated direct healthcare cost of £1.6 billion and indirect costs reaching £10 billion. There are very few studies exploring chiropractors’ views of their role in LBP treatment, but key findings reveal that chiropractors have increased confidence in their skills to treat LBP patients and lack trust in primary care to effectively manage patients. This study aims to understand how chiropractors perceive their role in the treatment of LBP within the current framework of primary care. It intends to identify similarities, differences, current professional interactions and factors that restrict and facilitate working with General Practitioners (GPs).

Approach

Purposive sampling was used to conduct four qualitative semi-structured interviews with chiropractors residing in Yorkshire, UK. Interviews were audio-recorded, verbatim transcribed and thematically analysed. The project aims to be exploratory in nature and therefore a qualitative design was preferred to a quantitative design such as questionnaires. The intention is to produce transferable findings that can help identify future research areas, rather than be generalizable and necessarily representative in a wider context.(8)(12)

Findings

Chiropractors viewed themselves as specialists in the management of back pain, treating patients who were dissatisfied with primary care treatment. Chiropractors felt they were able to provide extensive treatment and prevention advice to patients that perhaps primary care is unable to accommodate. Chiropractors viewed their practice as very separate to primary care, suggesting a lack of awareness and education causing GPs to view chiropractic negatively.

Consequences

Chiropractic being classed as a CAM and the resultant lack of education within primary care disconnects the practice from the NHS, a concept acknowledged in the literature. Referrals of patients are based upon personal connections rather than a clinical pathway, which restricts patient access to treatment. Improved communication addressing concerns and opening up dialogue could create a more multidisciplinary approach to LBP, beneficial for both professions and for patients. This study is innovative by focusing exclusively on chiropractors’ views, rather than collating views of several healthcare professionals at once, as previous literature has. Increasing awareness amongst GPs of what chiropractic can offer patients could increase referrals, improve patient outcomes and protect NHS resources through reducing the burden of LBP.