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

2 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

3 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

4 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.

5 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

6 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

7 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

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9 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)

10 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

11 The number of visits among patients was variable CountCumulativePercent % of the patients received 60 or less visits

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13 Variability of visits was related to associated trauma TraumaNo Trauma Valid N5540 Mean total visits Minimum11 Maximum11757 Standard deviation

14 Point-biserial r = 0.58

15 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

16 Outlier Extreme Studentized Deviate (ESD) z = 4.38, P < 0.05 Rho = (without outlier)

17 Rho =

18 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)

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20 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

21 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

22 DC Number Valid N Visits - mean Finished treatment % Trauma % Satisfaction Pain after treatment Likely to return %

23 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

24 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