1 Chiropractic visit observations among a group of patients who received chiropractic care for acute neck pain.

1Palmer College of Chiropractic WestPalmer College of Chiropractic West

Chiropractic visit observations among a group of patients who received chiropractic care for

acute neck pain


Introduction

• Very little information is available regarding the duration of chiropractic care or visit frequency for acute neck pain patients

• Chiropractic utilization guidelines are available, but are only based on a consensus of opinion


Neck pain–manipulation Cochrane Review Gross et al

• 33 trials regarding acute, subacute, and chronic mechanical neck pain – 42% were of high quality

• Involved single sessions of manipulation or multiple sessions of manipulation or mobilization over 3 to 11 weeks

• Multimodal manual therapy care including exercise was most beneficial

• Total visits were specified in study designs


Purpose of this study

• To discover how doctors of chiropractic (DCs) manage patients with acute neck pain with regard to the total number of visits involved

• To find out if there were any apparent relationships between total visits and other variables, such as pain levels, etiology, age, gender, etc.


Methods

• A two-part survey was administered to participating DCs and their patients who were seen for an episode of acute neck pain (retrospective)

• DCs collected information from patient files

• Patients responded to a telephone survey– Informed consent was obtained orally


Results

• 115 patients were contacted and asked to participate in the survey

• 20 declined

• One case was not included because responses were provided by the mother of a child patient

• Ultimately, 94 acute neck pain patients participated


Demographics

• 60 females (64%) and 34 males (36%)

• Mean age 39.6 years (SD = 15.7)

• 7 participating DCs– Primarily from the San Diego, CA area – 3 were from Idaho, Utah, or Arkansas


0 10 20 30 40 50 60 70 80 90

Age

0

5

10

15

20

25

Obs

serv

atio

ns


Visits

• The total number of visits provided to each patient ranged from 1 to 117

• The mean number of visits was 24.3 (SD = 21.16) – Females 24.5 (SD = 20.2) – Males 24.1 (SD = 23.0)

• Mean number of visits varied among DCs – Ranging from 5.5 (SD = 3.7) to 41.6 (SD =

25.0)


Visits cont.

• Injury-related patients received more visits than non-injured– Mean 34.7 (SD = 21.1) visits for injured– Mean 10.1 (SD = 10.1) for non-injured

• Patients who were injured in motor vehicle crashes received the most visits– Mean 46 (SD = 19.1) visits


The number of visits among patients was variable

Count Cumulative Percent

1-20 50 50 52.6

21-40 23 73 24.2

41-60 20 93 21.1

61-80 0 93 0.0

81-100 1 94 1.1

101-120 1 95 1.1

97.9% of the patients received 60 or less visits


35%

18%

12%13% 13%

8%

0% 0%1%

0% 0%1%

0 10 20 30 40 50 60 70 80 90 100 110 120

Visits

0

5

10

15

20

25

30

35O

bse

rva

tion

s


Variability of visits was related to associated trauma

Trauma No Trauma

Valid N 55 40

Mean total visits 34.7 10.1

Minimum 1 1

Maximum 117 57

Standard deviation 21.2 10.1


N Y

Trauma

0

20

40

60

80

100

120V

isit

s

Point-biserial r = 0.58


Weak correlations

• Initial pain levels did not appreciably influence the total number of visits – Although it was expected

• The level of patient satisfaction was not correlated to total visits

16Palmer College of Chiropractic WestPalmer College of Chiropractic West0 2 4 6 8 10

Initial Pain

0

20

40

60

80

100

120N

um

be

r o

f V

isit

s

Outlier

Extreme Studentized Deviate (ESD) z = 4.38, P < 0.05

Rho = 0.2 0.24 (without outlier)


DissatisfiedSomewhat dissatisfied

Somewhat satisfiedSatisfied

Very Satisfied

Satisfaction

-20

0

20

40

60

80

100

120V

isit

s

Rho = -0.0951


Weak correlations cont.

• Patients without a history of neck pain were seen more often than those with– Without history 26.1 (SD = 22.6)

• 25.0 (SD = 19.8) when 117 visit outlier is removed

– With history 19.9 (SD = 16.7)

19Palmer College of Chiropractic WestPalmer College of Chiropractic WestWithout With

Neck Pain History

0

20

40

60

80

100

120

Vis

its


More vs. fewer visits

• Comparing the two DCs with the highest total visits with the two DCs with the lowest, several things were evident regarding patients who received fewer visits

1. They were more satisfied with their care

2. Their improvements with regard to pain levels were comparable to those with higher visits


More vs. fewer visits cont.

3. They were more likely to choose chiropractic again in the future if they had a similar problem

4. They were much less likely to report continuing disability

• May be related to – A higher proportion of trauma cases among

DCs who provided more visits– Disability patients required more visits


DC Number 1 2 3 4 5 6 7

Valid N 13 5 6 25 11 20 15

Visits - mean 31 37.6 11.5 41.6 5.5 22.6 6.6

Finished treatment % 85 60 17 88 55 60 40

Trauma % 100 100 67 72 36 35 27

Satisfaction 5.4 5.2 5.3 5.6 5.9 5.8 5.7

Pain after treatment 0.85 1.8 1.4 2.3 1.1 2.3 2.5

Likely to return % 69 80 50 88 100 95 100

5.541.6


Conclusions

• There was wide divergence in the number of chiropractic visits provided to acute neck pain patients in this study

• Patient satisfaction and pain levels after care were similar between high and low total visit subgroups


Further research is necessary

• To determine optimal total visits for acute neck pain patients with regard to:– Varying degrees of initial subjective and

objective findings– The presence of trauma and types of trauma– Demographic factors

• Involving more DCs• Much larger sample of patients• Prospective design

1 Chiropractic visit observations among a group of patients who received chiropractic care for acute neck pain.

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