The health care delivery system is undergoing drastic, if not revolutionary, change. And central to this change is the fact that patients are increasingly positioning themselves as partners in their own health care. The chiropractic profession has long emphasized strong collaborative relationships between DCs and their patients. We think the following addresses the kinds of information informed patients want to know:

Values of Chiropractic Care

Tens of millions of Americans routinely opt for chiropractic services. In 1993, more than 30 million consumers made chiropractic a regular part of their health care program. Studies find patients identifying the following values:

Cost Effectiveness of Chiropractic Care:

Reduced use of prescription drugs and inappropriate diagnostic imaging
Lower per-visit costs
Some studies show reduced hospitalization

Patient Satisfaction:

Surveys show satisfaction levels of 90% and greater
One survey of rural chiropractic patients found that 100% of them were satisfied; 69% were very satisfied
95.8% overall satisfaction in one staff-model HMO

Patients Give DCs High Marks for …

skill, friendliness, thoroughness; and
patient education and interest in patient problems

Information source: The American Chiropractic Foundation. (1997) “Chiropractic Professionals: Part of Your Managed Care Team.”

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Cost-Effectiveness of Chiropractic Care

A few chiropractic cost-effectiveness studies are outlined below:

A. Researchers evaluated the cost of care for members of the Community Health Network of Louisiana who had sought chiropractic care for back and neck pain and compared these with the costs of members who sought traditional medical care.

The cost of health care was lower for chiropractic patients.   ($539 over a one-year period vs. $744 for medical care.)

Use of prescription drugs and diagnostic imaging was significantly higher in the medical group, whereas surgical rates and level of patient satisfaction were identical.

The authors of the research concluded that properly managed chiropractic care can yield surgical rates and patient satisfaction equal to those of medical care, at a substantially lower cost per patient.

information source: Mosley CD, et al. (1996) “Cost-effectiveness of chiropractic care in a managed care setting.” American Journal of Managed Care 11(3):280-2.

B. Using two years of insurance claims data, researchers examined 6,183 patients with common lumbar and low back problems who visited either DCs or medical doctors for these problems.

The study compared health insurance payments and patient utilization patterns for episodes of care, and found that the first-episode cost was lower for patients who saw DCs than for those who visited medical providers.

The study found a mean total payment for a chiropractic episode of $518, while the mean total cost of a medical episode was $1,020. Patients choosing the two different types of care were comparable on measures of severity of condition and in lapse time between episodes, while chiropractic patients incurred significantly lower inpatient costs.

Information source: Stano, Miron, PhD, and Monica Smith, DC. (1996) “Chiropractic and medical costs of low back care.” Medical Care 34(3):191-204.

C. Clinical studies in the U.S., United Kingdom and Australia show that there would be highly significant cost savings if more management of low-back pain was transferred to chiropractors.

The literature shows savings from chiropractic management come from fewer and lower costs of auxiliary services, greatly reduced hospitalization, and a significant reduction in chronic problems as well as in levels and duration of disability.

Information source: Manga, P, Angus, D, Papadopolous, C, and Swan, WR. (1993) “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain.” Toronto, Canada: Ontario Chiropractic Association, 1993.

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Patient Satisfaction

Studies have consistently found that low back pain patients receiving chiropractic care, which typically includes (but is not restricted to) spinal adjustment (manipulation), are more satisfied than those receiving medical care. (Cherkin, 1989; Carey, 1995; Kane, 1974).

In addition to the outcomes patients enjoy from chiropractic care, they site other reasons why chiropractic is more satisfying than medical care. For example, chiropractors have more frequent and closer contact with their patients; they are more comfortable and confident dealing with back pain and provide patients with a clearer explanation of the cause of their problem (often documented with x-rays); DCs show a more personal interest in patient problems and offer more advice about ways to stay healthy. (Cherkin, 1988; Coulehan, 1985; Hansen, 1994)

Here are some particulars on patient satisfaction:

In a 1997 study by Group Health Cooperative of South Wisconsin, 95.8% of chiropractic patients surveyed indicated overall satisfaction with chiropractic care and services. Satisfaction levels with some specific aspects of care were as follows:
- Friendliness and courtesy shown by the DC: 97.9%
- Skill, experience, and training of the DC: 96.2%
- Explanation of tests and procedures: 95.7%
- Advice given about ways to stay healthy: 95.7%
- Personal interest in patient problems: 93.1% (Hansen, 1994) ·

In a study of rural areas, chiropractic patients reported 100% satisfaction with the care they received. 31% were satisfied, while 69% indicated they were very satisfied. As a result of chiropractic care, 74% reported that they definitely had less pain, and 21% reported some relief. (Maust, 1994)
In a follow-up study to a randomized comparison of chiropractic and hospital outpatient management for low back pain, more patients rated chiropractic care helpful (after 3 years) than hospital care. In addition to patients’ reported satisfaction with care, researchers measured outcomes in the two cohorts of patients. Scores on the Oswestry pain-disability questionnaire showed 29% more improvement for chiropractic patients vs. those treated at a hospital. (Meade, 1995)

Information sources:

Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker D. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. N Engl J Med 1995;333(14):913-7.

Cherkin DC, MacCornack FA, Berg AO. The management of low back pain: a comparison of the beliefs and behaviors of family physicians and chiropractors. West J Med 1988;149:475-80.

Cherkin DC, MacCornack FA. Patient evaluations of low back pain care from family physicians and chiropractors. West J Med 1989;150:351-5.

Coulehan JL.Adjustment, the hands and healing. Cult Med Psychiatry 1985;9:353-82.

Hansen, Daniel T., DC, FICC. (1994)“Back to basics: determining how much care to give and reporting patient progress.” Topic in Clinical Chiropractic 1(4): 1-8.

Kane RL, Leymaster C, Olsen D, Woolley FR, Fisher FD. Manipulating the patient: a comparison of the effectiveness of physician and chiropractor care. Lancet 1974;1:1333-6.

Meade TW, Dyer S et al.“Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow-up” British Medical Journal, Aug 5, 1995. 311(7001):349-351.

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A Typical First Visit

Here are the components of a typical first visit to a doctor of chiropractic:

Patient History
A clear understanding of the nature and extent of the illness helps the DC decide whether chiropractic care is an appropriate reatment for the condition, and if additional examination procedures are necessary. Like other health professionals, doctors of chiropractic have a network of health providers available for referral when non-chiropractic care is indicated.
Physical Examination
Neurological, spinal, and orthopedic examination, as well as postural analysis, are performed to determine the patient’s general health status and specific problem(s).
X-rays/Lab tests
May be utilized to further assess the patient’s health condition.
Diagnosis
Based on history, examination, and x-ray/lab findings.
Treatment Plan
Along with spinal adjustment (manipulation), treatment methods may include ultrasound, electrical stimulation, controlled exercise, and lifestyle/wellness counseling.

Information source: The American Chiropractic Foundation. (1997) “Chiropractic Professionals: Part of Your Managed Care Team.”

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Subluxation, Adjustment, & Manipulation Defined

Chiropractic treatment is gentle, comfortable, and highly effective. The following is intended to familiarize you with terms and methods used by DCs when caring for a patient:

Subluxation

“Subluxation” is defined as being a complex of functional and/or pathological articular changes that compromise the neural integrity and may influence organ system function and general health.

The doctor of chiropractic focuses particular attention on the “subluxation” in his/her concern with the preservation and restoration of the patient’s health. The subluxation is evaluated, diagnosed, and managed through the use of chiropractic diagnosed, and managed through the use of chiropractic evidence.

Information source: "The Chiropractic Paradigm" as developed by the Association of Chiropractic Colleges -- http://www.chirocolleges.org
Chiropractic Adjustment (or Manipulation)

A chiropractic “adjustment” or “manipulation” is the art of using a specific force in a precise direction, applied to a spinal joint that is "fixated”, out of alignment, or not moving properly. Particular attention is paid to that area of the spine where a "subluxation" has been detected.

There are many ways to adjust the spine. Doctors of chiropractic are educated and trained to use several sophisticated and varied techniques — spending years learning motion palpation (the art of examination by movement or touch) and other forms of spinal procedures, so that they can administer specific and appropriate spinal adjustments.

Some adjusting methods are quick, whereas others require a slow and constant pressure. Usually the doctor’s hands or a specially designed instrument delivers a brief and highly- accurate thrust. The purpose of this safe and natural procedure is improved spinal function, improved nervous system function, and improved health.

Information sources:

Plaugher, G., DC, Anrig-Howe, C., DC, Textbook of Clinical Chiropractic, Williams and Wilkins, 1993.

States, A., DC, States’ Manual of Spinal, Pelvic and Extra Vertebral Technics, 2^nd edition, edited by Kirk, DC, Lawrence, D, DC, WaverlyPress, 1985, reprinted 1991.

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Conditions that Chiropractic Treats

Click here to view health conditions that chiropractors routinely, often, or sometimes care for in their practice.

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