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Public Perceptions of Doctors of Chiropractic: Results of a National Survey and Examination of Variation According to Respondents' Likelihood to Use Chiropractic, Experience With Chiropractic, and Chiropractic Supply in Local Health Care Markets
Chair, Clinical and Health Services Research Program, Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IAProfessor, The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Hanover, NH
The purpose of this study was to determine whether general perceptions of doctors of chiropractic (DCs) varied according to likeliness to use chiropractic care, whether particular demographic characteristics were associated with chiropractic care use, and whether perception of DCs varied according to the per-capita supply of DCs in local health care markets.
Methods
We performed a secondary analysis of results from a 26-item nationally representative survey of 5422 members of The Gallup Panel that was conducted in the spring of 2015 (response rate, 29%) that sought to elicit the perceptions and use of DCs by US adults. We compared survey responses across: (1) respondents who had different likelihoods to use DCs for treatment of neck or back pain and (2) respondents who had different experiences using DCs. We linked respondents' zip codes to hospital referral regions for which we had the per-capita supply of DCs. Using the χ2 test, we examined relationships between likeliness to use a DC, experience using a DC, respondent demographic variables, perceptions of DCs, and the per-capita supply of DCs in the local health care market.
Results
Most (61.4%) respondents believed that chiropractic care was effective at treating neck and back pain, 52.6% thought DCs were trustworthy, and 24.2% thought chiropractic care was dangerous; however, as respondents' likelihood to use a DC increased, perceptions of effectiveness and trustworthiness increased, and perceptions of danger decreased. Of all 5422 survey respondents, 744 or 13.7% indicated that they had seen a DC within the last 12 months. As one moved from distant to more recent experience using a DC, respondents were more likely to be female, married, white, and employed; those who had a distant history of using a DC were older and more likely to be retired than the other groups. A higher per-capita supply of DCs was associated with higher utilization rates and showed a more favorable regard for DCs.
Conclusions
US adults often use chiropractic care, generally regard DCs favorably, and largely perceive that chiropractic care is safe. Where there is a higher per-capita supply of DCs in the local health care market, utilization and positive perceptions of chiropractic are higher.
In the general US population, back and neck problems are among the symptoms most commonly encountered, and expenditures for patients with spine problems are substantially higher and are growing more rapidly, than those for patients without spine problems.
Compared to matched controls, patients with back pain have more comorbidities (including musculoskeletal and neuropathic pain conditions, common sequelae of pain, and depression) and greater pharmacotherapy use
In addition, the problem of back pain has been accelerating, perhaps because of the combination of the graying of America, the fact that patients are more likely to experience back pain with age, and differences in how providers treat back pain.
Aging baby boomers and the rising cost of chronic back pain: secular trend analysis of longitudinal Medical Expenditures Panel Survey data for years 2000 to 2007.
Randomized controlled clinical trials have demonstrated that chiropractic spinal manipulation is an effective, conservative treatment option for certain types of low back and neck pain and for some headaches.
A meta-analysis indicates that combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute and subacute low back pain.
Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations.
recommend spinal manipulation for the treatment of certain spinal pain conditions. In addition, there is some evidence that use of chiropractic spinal manipulation is associated with lower health care costs.
Cost of care for common back pain conditions initiated with chiropractic doctor vs. medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer.
In the context of rising health care costs and suggestions that chiropractic is a relatively effective and inexpensive treatment for an increasingly common disorder, the use and perceptions of chiropractic care are of national interest. Over the last 15 years, a number of studies have estimated the use of chiropractic care services by US adults. A literature review examining reports published between 1965 and 2005 found that the prevalence of chiropractic care use varied between 6% and 12%.
More recent analyses of the National Health Interview Study (NHIS) found that the prevalence of chiropractic care use among US adults remained relatively stable, fluctuating between 7.5% and 8.6%.
Analyses of 2012 NHIS data found substantial geographic variation in prevalence of chiropractic use across US districts that ranged from 16.4% in the West North Central district of the United States to 6.2% in West South Central district.
Analyses of the Medical Expenditure Panel Survey (MEPS) tend to generate slightly lower prevalence estimates, ranging from 5.1% among US adults in 1980
; differences in the prevalence of chiropractic use according where the patient lived, sex, age, race, and sex were evident in those studies. More recent MEPS studies indicated that 3.7% of US adults used a doctor of chiropractic (DC) in 1997,
are more likely to use chiropractic care. Virtually all studies have demonstrated that patients who use chiropractic care are more likely to be white and female.
Although the prevalence of chiropractic use has been estimated, few studies have examined how US adults perceive DCs. A 1998 study of 800 US adults found that an increased willingness to use DCs for routine care was associated with prior use of chiropractic care, but that both DC users and nonusers preferred physician assistants and nurse practitioners in the primary care role.
A 2002 study of medical claims in western Washington State found that insurance coverage and living in less populous counties were associated with being more likely to use chiropractic care.
In addition, a small (n = 163) 2004 survey of chiropractic patients from a single teaching chiropractic clinic in the US found that only 19% of patients saw their DC as their primary care physician: although virtually all of these patients thought that DCs could treat musculoskeletal conditions, many also thought that they could treat other conditions as well.
We sought to improve and update information on the prevalence of use and general perceptions of DCs by analyzing data from a national Gallup survey of US adults conducted in the spring of 2015. The objectives of this study were to determine whether general perceptions of DCs varied according to likeliness to use chiropractic care, whether demographic characteristics (such as age, sex, employment status, and the local per-capita supply of DCs) were associated with chiropractic care use, and whether perception of DCs varied according to the per-capita supply of DCs in local health care markets.
Methods
Design, Conduct, and Content of the Survey
Palmer College of Chiropractic (Palmer) contracted with The Gallup Organization (Gallup) to conduct a survey of US adults aged 18 years and older on their perceptions of and experiences with DCs. Informed by in-depth stakeholder interviews that Gallup conducted with 15 chiropractic professionals, participants from both organizations developed a 26-item survey to elicit those perceptions and experiences. Survey items were pretested to ensure items could be well understood by different types of respondents.
Gallup randomly selected a sample of members from The Gallup Panel, a probability-based longitudinal, representative panel of more than 60000 US adults whom Gallup has selected using a combination of random-digit-dial telephone interviews that cover landline and cellphone users and address-based sampling methods. Members of The Gallup Panel do not receive incentives for participation; their participation in any particular survey is voluntary. When becoming a member of The Gallup Panel, respondents are provided a packet of information discussing how results of the surveys will be used; included in that packet is the statement “results from Gallup research are featured in major news publications around the world and used to inform businesses, media, and government about Americans' opinions and preferences.”
Between February 16 and May 6, 2015, 18992 members of The Gallup Panel were invited to participate in the survey using e-mail invitations or mail surveys, according to the members' communications preference. A total of 5422 (28.7% response rate) members completed the survey using either a Web-based portal (95.1% of total completed surveys; 30.1% response rate) or mail-in survey (4.9% or total completed surveys; 14.8% response rate); there were no follow-up efforts to get mail respondents to complete the survey, but e-mail reminders were sent to Web respondents. As is typical in Gallup Panel surveys, the survey was designed so that respondents did not know that it was specifically about chiropractic until they were several questions into the survey; this is done to reduce nonresponse bias.
Gallup used preexisting information on respondents' reported age, sex, education level, race, and the region of the country in which respondents lived to generate weights that, when used, made the respondent group representative of the US adult population as reported in the 2012 Current Population Survey. The Gallup weighting methodology produces a ±2% margin of sampling error at a 95% confidence level when the overall sample is used; margins of error are higher for subsamples.
Once the survey was completed, Gallup provided Palmer with a data set that included coded responses to the survey questions and the following demographic information for each respondent: age, sex, educational level, annual income level, employment status, information on where the patient lived (zip code or state of residence), and race.
Classification of Respondents Into Analytic Groups
Our analysis sought to examine respondents' use and perceptions of chiropractic care and to compare characteristics of respondents who had particular perceptions or utilization patterns of DCs. Toward that end, we used responses to survey questions to define analytic groups for comparison purposes.
First, we sought to compare respondents' perceptions of DCs and chiropractic care based on their likelihood to use a DC. Here, we used responses to 2 questions to generate 4 comparison groups: those who were expected to use a DC, likely to use a DC, unlikely to use a DC, or highly unlikely to use a DC. The “expected to use” group combined the 1398 respondents who said that they would choose to see a DC if they were experiencing neck or back pain and wanted to see a health care provider about it with the 324 respondents who indicated that they would be very likely to use a DC if they had neck or back pain.
Second, we sought to compare respondents' demographics (age, sex, employment status, and income) and perceptions of DCs and chiropractic care based on their actual experience with DCs. Here, we used respondents' answer to a survey question to assign them to 1 of 4 groups: those who had been to a DC as a patient within the last 12 months (“recent” users), within the last 5 years (but not within the last 12 months), more than 5 years ago, and never.
Of the 5442 survey respondents, 23 did not answer Q1; of those who answered Q1 and indicated they would not choose a DC first, 29 did not answer Q2; and of those who answered both Q1 and Q2, 57 did not answer Q8. These survey responses were eliminated, leaving 5333 (98%) of the 5442 returned surveys for analysis.
Analysis of Geographic Variation
For 4105 respondents, zip codes were available; these were used to link survey responses to 2012 data on the supply of DCs per 100000 fee-for-service Medicare beneficiaries and the mean expenditures on chiropractic care per Medicare beneficiary at the hospital referral region level (generally considered a local health care market) that was obtained from Medicare files using Dartmouth Atlas Project methodologies.
Describing and comparing propensity score methods for creating comparable cohorts of chiropractic users and non-users in older, multiply comorbid Medicare patients with chronic low back pain.
For analytic purposes, we categorized these per-capita supply and expenditure variables into 5 quintiles, from the lowest supply per 100000 Medicare beneficiaries (54.4) to the highest (237.0) and from the lowest mean annual expenditures on chiropractic care per Medicare beneficiary (US $6.16) to the highest (US $26.12).
Comparison of Divisional Survey Respondent Distributions and Chiropractic Care Utilization Rates From Our Study to Those From the 2012 National Health Interview Study
To determine whether our results might be influenced by the geographic distribution of respondents across US geographically defined divisions, we performed a counterfactual analysis in which we applied the weighted and unweighted distribution of survey respondents across those divisions to the prevalence of chiropractic care utilization in those divisions as estimated by an analysis of the 2012 NHIS.
This generated a counterfactual estimate of the population weighted mean 2012 rate for the United States, given our study's respondents' geographic distribution, which we could compare to the national rate of chiropractic care use found in the NHIS study.
Statistics
Ours was largely a descriptive study. We used SPSS version 23 (released 2013; IBM Corporation, Armonk, NY) to conduct all analyses. We analyzed ordinal data (including Likert-type data asking respondents to agree or disagree with a statement that used a 5-point scale and quintile-specific data on the per-capita supply and use of chiropractic care) using the χ2 test, and we analyzed continuous data using analysis of variance. Table 1 shows the effect of the weights on the numbers of respondents and their distribution across comparison groups.
Table 1Responses to Key Survey Questions, the Answers to Which Were Used to Define Analytic Groups for Comparing Respondents Across a Spectrum of Different Degrees of Likeliness to Use DC (Top) and Different Actual Experiences With DC (Bottom)
Table 1Responses to Key Survey Questions, the Answers to Which Were Used to Define Analytic Groups for Comparing Respondents Across a Spectrum of Different Degrees of Likeliness to Use DC (Top) and Different Actual Experiences With DC (Bottom)
DC, doctor of chiropractic.
Ns and distribution for final analytic groups are in bolded boxes. Percentages may not add to 100 due to rounding.
a 23 survey respondents did not answer Q1; of those who answered Q1 and indicated they would not choose a DC first, 29 did not answer Q2; and of those who answered both Q1 and Q2, 57 did not answer Q8. These survey responses were eliminated, leaving 5,333 (98%) of the 5,442 surveys for analysis.
Funding and Institutional Review
Palmer College of Chiropractic funded the study, and Palmer's Institutional Review Board found the study exempt from further review (X2015-7-22-M).
Results
Perceptions of DCs According to Likeliness to Use a DC for Neck or Back Pain
Overall, more than half of survey respondents agreed or strongly agreed that chiropractic care was effective at treating back and neck pain (61.4%), that DCs were trustworthy (52.6%), and that they felt they had a good idea about what DCs do (69.6%) (Fig 1). However, respondents' perceptions varied considerably according to their likelihood of using a DC. Highly unlikely users were much less likely to strongly agree or agree that they think DCs are effective at treating neck and back pain and are trustworthy; as the likelihood to use a DC increased, perceptions became more positive. Although differences and trends were less pronounced when examining respondents' assessment of their own understanding of what DCs do, expected users perceived that they had a substantially better grasp of what DCs did than the other groups. Interestingly, for each of these perception questions, a much higher proportion of highly unlikely users responded that they did not know; as the likelihood of using a DC increased, the proportion of respondents who “did not know” dropped.
Fig 1Comparison of groups with different likelihoods of using a DC for treatment of neck or back pain on whether they believe DCs are effective at treating neck and back pain, their perception of the trustworthiness of most DCs, and their understanding of what DCs do. All results are statistically significant at P < .001. The dotted horizontal line indicates the overall proportion of respondents who agreed or strongly agreed to the question. DC, doctor of chiropractic.
Overall, 24.2% of respondents agreed or strongly agreed that chiropractic care was dangerous; 43.6%, that it required too many visits; and 42.7%, that it was expensive (Fig 2). Again, respondents' perceptions varied according to their likelihood of using a DC. Although 49% of highly unlikely users agreed or strongly agreed that chiropractic care is dangerous, only 10% of expected users did; a downward trend in the perception that chiropractic care is dangerous was evident as likeliness to use a DC increased. Interestingly, although expected users were less likely than the other groups to perceive that chiropractic care requires too many visits, they were somewhat more likely to perceive that chiropractic care is expensive. Again, for each of these questions, the proportion of respondents who “did not know” decreased as the likelihood to use a DC increased.
Fig 2Comparison of groups with different likelihoods of using a DC for treatment of neck or back pain on whether they believe chiropractic care is dangerous, requires too many visits, or is expensive. All results are statistically significant at P < .001. The dotted horizontal line indicates the overall proportion of respondents who agreed or strongly agreed to the question.
Characteristics of Respondents According to Experience With DCs
Of all 5422 survey respondents, 744 or 13.7% indicated that they had seen a DC within the last 12 months. After we eliminated 109 respondents who did not provide answers to questions necessary for assigning respondents to the analytic groups that we used, 14.0% of respondents indicated that they had seen a DC within the last 12 months, another 12.0% indicated that they had seen a DC within the last 5 years, although almost ½ of survey respondents indicated that they had never seen a DC (49.4%; Table 1, bottom). Approximately, 26% of respondents indicated that a DC would be their first choice for treatment of neck or back pain (Table 1, top). We found that respondents who had used a DC were more likely to be female, married, white, older, and employed than respondents who never had used a DC (Table 2). As one moved from distant to more recent experience using a DC, respondents were more likely to be female, married, white, and employed; those who had a distant history of using a DC were older and more likely to be retired than the other groups. Respondents who had used a DC in the last 12 months (recent users) were somewhat less likely to have a college degree and more likely to have a high school education or lower than respondents who had never used a DC, although self-reported income levels were somewhat higher among respondents who had recently used a DC than for those who had never done so.
Table 2Comparison of Demographics of Patients Across the Continuum of Actual Experience With a DC
Table 2Comparison of Demographics of Patients Across the Continuum of Actual Experience With a DC
DC, doctor of chiropractic.
Although most respondents who had used a DC within the last 12 months or within the last 5 years would choose to use a DC first for neck or back pain or would be very likely to do so, a substantial proportion of respondents who had used a DC more than 5 years ago reported that they would not be likely to use a DC for treatment of neck or back pain (Table 3). Furthermore, although most respondents who had seen a DC in the past 12 months or 5 years knew that their insurance covered chiropractic services, most respondents who had never seen a DC did not know whether their insurance did so. Among recent DC users, respondents who indicated that they knew that chiropractic care was covered by their insurance were less likely to agree or strongly agree that they would visit a DC more often if it did not cost so much (38.7% vs 53.3%; P < .001, unweighted analysis, data not shown). As one moves across the spectrum of chiropractic use, from never to recent, respondents' knowledge of insurance coverage of chiropractic care increased. Generally, as the 2012 per-capita Medicare expenditures on chiropractic care and the 2012 supply of DCs per 100000 Medicare fee-for-service beneficiaries increased, the likelihood of a respondent having seen a DC in the last 12 months or 5 years increased.
Table 3Comparison of Characteristics of Patients Across the Continuum of Actual Experience With a DC That May Influence Use of Chiropractic Services
Table 3Comparison of Characteristics of Patients Across the Continuum of Actual Experience With a DC That May Influence Use of Chiropractic Services
DC, doctor of chiropractic.
aSupply and spending assignment of health care markets were based on 2012 Medicare utilization. These data represent the 4105 survey respondents who had a valid zip code that could be assigned to a health care market.
Among recent users of chiropractic care, 40.8% agreed or strongly agreed that they wanted to use a DC only for treatment of neck or back pain; 9.5%, that they wanted a DC to be the first health provider that they talked to about their health; 21.4%, that they wanted to talk to a DC about general health and wellness issues; and 46.3%, that they would visit a DC more often if it did not cost so much (Fig 3). When compared to respondents who had seen a DC within the last 12 months, those who had seen a DC within the past 5 years were more likely to agree that they wanted to see a DC only for neck or back issues and less likely to agree that a DC was the first health provider that they wanted to talk to about their health or that they wanted to talk to a DC about general health and wellness issues. Differences between the recent and less recent chiropractic users were not statistically significantly different when considering concern regarding chiropractic care costs.
Fig 3Comparison of groups with different experiences using a DC on how they want to interact with DCs. P values are provided within the figure. The dotted horizontal line indicates the overall proportion of respondents who agreed or strongly agreed to the question. DC, doctor of chiropractic.
Relationship Between Perceptions of DCs and the Per-Capita Supply of DCs in Local Health Care Markets
When compared to respondents who lived in health care markets that had lower per-capita supplies of DCs, those who lived in markets with higher per-capita supplies of DCs were less likely to agree or strongly agree that chiropractic care is dangerous and more likely to agree or strongly agree that most DCs are trustworthy and that DCs are effective at treating neck and back pain (although the latter was not statistically significant) (Fig 4). The proportion of respondents answering that they did not know the answer to each question decreased with increasing per-capita supplies of DCs.
Fig 4Comparison of respondents' perceptions of DCs according to whether they lived in health care markets with lower or higher per-capita supplies of DCs. Unweighted results showing respondents' perceptions as to whether chiropractic care is dangerous, whether most DCs are trustworthy, and whether DCs are effective at treating neck and back pain are shown; P values are provided within the figure. The dotted horizontal line indicates the overall proportion of respondents who agreed or strongly agreed to the question. Results are based on unweighted data.
Our counterfactual application of the distribution of survey respondents to the prevalence of chiropractic care use in 2012 in different US divisions generated a national estimate of chiropractic care use of 8.6% using the weighted respondent distribution and 8.8% using the unweighted respondent distribution (Table 4). This result was within 4% of the NHIS-based national estimate. This analysis served as a quality check to determine whether the relatively high prevalence that we found might be attributable to the distribution of survey responses across US divisions; oversampling of divisions with a high prevalence of chiropractic care could have accounted for our findings. The analysis indicates that our relatively high prevalence of chiropractic care use was not attributable to a bias in the distribution of the sample across US divisions.
Table 4Counterfactual Estimate of National Prevalence of Chiropractic Care Use in 2012, Generated by Applying the Weighted and Unweighted Proportional Survey Responses in 9 Geographically Defined US Divisions to the Prevalence Chiropractic Care Use in Those Divisions as Obtained From the 2012 NHIS
This study is the first large, nationally representative study to report on a national survey of US adults' general perceptions of DCs. We found that approximately 14% of US adults reported that they had used chiropractic care in the prior 12 months. We also found that slightly over ½ of US adults had ever used a DC for health care and over ¼ would choose chiropractic care as a first treatment for neck or back pain. Most respondents thought that chiropractic care can effectively treat neck or back pain, believed they understood what DCs do, and thought that DCs are trustworthy; fewer patients thought that chiropractic care was dangerous, required too many visits, or was expensive. Among recent chiropractic users, 40.8% reported that they wanted to use their DC only for back and neck problems, whereas a much smaller proportion reported that they would choose to have DCs as a first contact when talking about their health or to discuss general health and wellness issues. This finding is consistent with a 2007 study of the NHIS that found that chiropractic patients use DCs in different ways: sometimes for treatment and sometimes for health promotion,
As has been reported previously in the literature, patients who use DCs are different than those who do not: we found that recent chiropractic care users were more likely to be female, white, and employed full time. We also found that chiropractic care users differed from nonusers when considering marital status and employment status. Intriguingly, we found that, when compared to more recent chiropractic users, patients who had used chiropractic care in the distant past were more like those who had never used chiropractic care when considering sex, marital status, race, employment status, and income levels. This suggests that the demographics of the chiropractic care market have changed in the recent past, perhaps due to increased market penetration of chiropractic, particularly in areas with relatively low rates of chiropractic use.
We found that respondents who indicated a high likelihood of using a DC were more likely to have used one previously, that knowledge that chiropractic care was covered by insurance was associated with a higher likelihood of using a DC, and that living in a health care market with a high per-capita supply of (or a high per-capita use of) DCs was associated with a greater likelihood of use. This finding is consistent with a 2008 Medicare study that found a correlation between the per-capita supply of DCs and the utilization and use intensity of chiropractic care services
and suggests that familiarity with chiropractic care increases positive perceptions of chiropractic.
Future Actions
Our findings suggest 4 actions that chiropractic professional associations should consider.
First, a large proportion of respondents who were not likely to use chiropractic care answered that they “did not know” about chiropractic care effectiveness, danger, utilization patterns, or expense. This suggests that educational outreach designed to inform the public on these aspects of chiropractic care may further improve perceptions and use of DCs for neck and back pain. Such educational outreach could also inform patients about whether their insurance covers chiropractic care, thereby eliminating a potential barrier to access to such care.
Second, our findings appear to indicate that familiarity with chiropractic is associated with increased trust and perceived knowledge of DCs. Therefore, efforts to increase the supply of DCs in areas of low per-capita supply might increase patients' likelihood to use DCs to treat neck or back pain. Professional organizations might provide incentives or support to practice in low-supply areas.
Third, we found that, although some patients want to see a DC for reasons other than neck or back pain, far fewer indicated that they wanted DCs to be the first provider that they talked to about their health or that they wanted to talk to a DC about general health and wellness issues. Although there has long been a division within the chiropractic profession about the role of DCs in overall health care management,
these findings suggest that a professional focus on spine care and treatment may best meet patients' expectations, thereby making the educational efforts recommended above easier.
Finally, a relatively high proportion of recent DC users indicated that they would visit a DC more often if it did not cost so much and that sentiment appeared to be related to whether chiropractic care was covered by insurance. This suggests that DCs might work to improve insurance coverage of chiropractic care to enhance access
; however, those who use chiropractic may be more likely to know that their insurance covers it. Nonetheless, almost 40% of DC users whose insurance does cover chiropractic care also report that expense is a barrier to higher utilization. Further study in this area is warranted.
Limitations
Our study has several limitations. First, results are from an anonymous survey; to the degree that respondents did not answer questions accurately, our results are inaccurate. Second, the survey's response rate was 29%; it is possible that respondents who were either interested in chiropractic care or had strong views on chiropractic care services were more likely to answer the survey. As we were not able to compare the demographics (or key variables, such as experience using a DC) of our sample to those of nonrespondents, the possibility of selection bias cannot be eliminated; in part, such bias may explain the high rate of utilization that we found. However, our counterfactual analysis does not suggest that the high rates that we found were due to respondents living in geographic areas with high prevalence of chiropractic care use and the fact that survey respondents did not know that the survey was about chiropractic perceptions until they agreed to participate in the survey both mitigate against such bias. Third, our study was a cross-sectional, retrospective survey: our findings are associative, not causative. Longitudinal analyses that repeat measures over time are required to make causative claims. Fourth, our analysis of health care markets was limited to approximately 75% of respondents who provided a valid zip code; had we been able to include all respondents in this subanalysis, our results might have been different. Finally, our study relied on survey data from US adults; studies of adults in other countries may generate different results. Finally, our study relied on survey data from US adults; studies of adults in other countries may generate different results.
Strengths and Future Study
Our study's strength rests in its large size and its use of national, weighted data collected by a renowned, highly skilled survey research firm. The weighting process allowed us to generate robust national estimates of the perceptions of US adults. The size and scope of the dataset allowed us to examine multiple associations that warrant future study. Such studies should include efforts to determine whether particular interventions—such as increasing the per-capita supply of DCs, providing education on chiropractic, or changing payment structures—improve perceptions or increase use of DCs. In addition, analyses of future surveys would determine whether perceptions of DCs are changing over time.
Conclusions
Our findings suggest that US adults often use chiropractic care, that they generally perceive DCs in a positive manner, and that they think chiropractic care is safe. Where there is a higher per-capita supply of DCs in the local health care market, utilization and positive perceptions of chiropractic are higher.
Funding Sources and Potential Conflicts of Interest
No conflict of interest was reported for this study. Palmer College of Chiropractic funded the study.
Contributorship Information
Concept development (provided idea for the research): W.B.W., C.M.G., W.C.M., D.M.M.
Design (planned the methods to generate the results): W.B.W., C.M.G., W.C.M., D.M.M.
Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): C.M.G., W.C.M., D.M.M.
Data collection/processing (responsible for experiments, patient management, organization, or reporting data): C.M.G., W.C.M., D.M.M.
Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): W.B.W.
Literature search (performed the literature search): W.B.W.
Writing (responsible for writing a substantive part of the manuscript): W.B.W.
Critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking): C.M.G., W.C.M., D.M.M.
Practical Applications
•
A national sample of US adults showed that 14.0% of US adults have used chiropractic care in the prior 12 months.
•
A majority of US adults (61.4%) believed that chiropractic care was effective at treating neck and back pain.
•
Among survey respondents, 52.6% thought DCs were trustworthy, whereas 24.2% perceived chiropractic care as being dangerous.
•
As respondents' likelihood to use a DC increased, perceptions of effectiveness and trustworthiness increased and perceptions of danger decreased.
•
A higher per-capita supply of DCs in the local health care market was associated with a higher utilization rate and more positive perception of DCs.
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Aging baby boomers and the rising cost of chronic back pain: secular trend analysis of longitudinal Medical Expenditures Panel Survey data for years 2000 to 2007.
Clinical practice implications of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: from concepts and findings to recommendations.
Cost of care for common back pain conditions initiated with chiropractic doctor vs. medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer.
Describing and comparing propensity score methods for creating comparable cohorts of chiropractic users and non-users in older, multiply comorbid Medicare patients with chronic low back pain.
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