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Attitudes Toward Chiropractic
A Survey of North American Orthopedic Surgeons
Jason W. Busse, DC, PhD,*† Craig Jacobs, DC,‡ Trung Ngo, DC,‡ Robert Rodine, BSc, DC,‡ David Torrance, DC,‡ Janey Jim, DC, MSc,‡ Abhaya V. Kulkarni, MD, PhD, FRCPS,§ Brad Petrisor, MD, FRCPS,¶ Brian Drew, MD, FRCPS,¶ and Mohit Bhandari, MD, MSc, FRCPS†¶
Study Design. Questionnaire survey.
Objective. To elicit orthopedic surgeons’ attitudes toward chiropractic.
Summary of Background Data. Orthopedic surgeons and chiropractors often attend to similar patient populations, but little is known about the attitudes of orthopedic surgeons toward chiropractic.
Methods. We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopedic surgeons that inquired about demographic variables and their knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ).
Results. 487 surgeons completed the survey (response rate, 49%). North American orthopedic surgeons’ attitudes toward chiropractic were diverse, with 44.5% endorsing a negative impression, 29.4% holding favorable views, and 26.1% being neutral. Approximately half of respondents referred
patients for chiropractic care each year, mainly due to patient request. The majority of surgeons believed that chiropractors provide effective therapy for some musculoskeletal complaints (81.8%), and disagreed that chiropractors could provide effective relief for nonmusculoskeletal conditions (89.5%). The majority endorsed that chiropractors provide unnecessary treatment (72.7%), engage in overly-aggressive marketing (63.1%) and breed dependency in patients on short-term symptomatic relief (52.3%). In our adjusted generalized linear model, older age (_2.62 points on the CAQ for each 10 year increment; 95% confidence interval [CI]__3.74 to_1.50), clinical interest in foot and ankle (_2.77; 95% CI _ _5.43 to _0.10), and endorsement
of the research literature (_4.20; 95% CI__6.29 to _2.11), the media (_3.05; 95% CI _ _5.92 to _0.19), medical school (_7.42; 95% CI__10.60 to_4.25), or ‘other’ (_4.99; 95% CI__8.81 to _1.17) as a source of information regarding chiropractic were associated with more negative attitudes; endorsing a relationship with a specific chiropractor (5.05; 95% CI _ 3.00 to 7.10) or residency (3.79; 95% CI _ 0.17 to 7.41) as sources of information regarding
chiropractic were associated with more positive attitudes.
Conclusion. North American orthopedic surgeons’ attitudes toward chiropractic range from very positive to extremely negative. Improved iterprofessional relations may be important to ensure optimal care of shared patients.
Key words: orthopedics, chiropractic, attitude of health personnel, survey. Spine 2009;34:2818–2825
Chiropractic care is commonly sought in both the United States1,2 and Canada,3,4 predominantly for musculoskeletal complaints.5,6 A number of patients receive care from both an orthopedic surgeon and a chiropractor during the course of their complaint7,8; however, until 1983, the American Medical Association held that it was unethical for medical physicians to associate with chiropractors9 and there is reason to suspect that current interprofessional relationships between orthopedic surgeons and chiropractors are not optimal.
This may place patients in a difficult situation and expose them to inconsistent and even contradictory information regarding their care. A recent survey of 332 fracture patients (100% response rate) found that 35% were using complementary and alternative medicine, including chiropractic, and that most did not inform their orthopedic surgeon, in part over concerns of disapproval.
8 Understanding how orthopedic surgeons view chiropractic may provide opportunities to enhance interprofessional relations and improve patient care. The aim of the current study was to survey the attitudes of Canadian and American orthopedic surgeons toward chiropractic.
Materials and Methods
With the assistance of epidemiologists and content experts, and reference to the previous literature,10–14 we developed a 43-item, English language questionnaire to examine orthopedic surgeons’ attitudes toward chiropractic. The final questionnaire framed response options with a 5-point Likert scale (strongly agree, agree, undecided, disagree, and strongly disagree) as a previous report has shown that closed-ended questions result in fewer incomplete questionnaires than openended formats.15 We also included an option for surgeons to provide written comments regarding any other thoughts they may have on chiropractic. We pretested the final questionnaire on a group of 3 orthopedic surgeons, one with formal training in epidemiology, to evaluate if the questionnaire as a whole appeared to adequately measure attitudes toward chiropractic (face validity), and if the. individual questions adequately reflected the domains of for-