Chiropractic, Back Pain, Patient Satisfaction

This study conducted in the United Kingdom looked at factors that influence patient satisfaction after chiropractic treatment. The study looked at 965 new patients seeking chiropractic treatment for lower back pain who received a questionnaire at the time of initial treatment, and again six weeks later.

Members of the Great Britain Chiropractic Association were sent study packets and follow-up questionnaires, and asked to enroll 10 eligible clients from their practice. Eligible study participants were literate, new to chiropractic, seeking treatment for lower back pain, and had no recent back surgery or serious underlying pathology. The average age for participants was 45-47 years old, with equal rates of both genders represented. Most were employed.

During the study, the Bournemouth Questionnaire was given to subjects at their first visit to the chiropractor. The Bournemouth asked each subject to self-report using an 11-point scale on the following factors:

• Level of pain
• Degree of anxiety
• Effect on normal activity
• Effect of work on complaint
• Degree of depression
• Ability to control (reduce) pain
• Effect on lifestyle (social life)

The following two factors were added for assessment at 6 weeks, using a 7-point scale (-3 was the greatest deterioration and +3 was the greatest improvement):

• Satisfaction with care
• Overall improvement or deterioration over the care period

A correlation between the first 7 factors noted above, and satisfaction with treatment was present, but weak at the six-week follow up. Reduced pain level, reduced effect of work on pain, and the improved ability to control pain were the factors most strongly related to satisfaction and outcomes at 6 weeks. These 3, plus activity, were highly significant predictors of patient satisfaction with care.

A perception of overall improvement was highly related to improved treatment satisfaction scores (60%).

Overall improvement was most highly related (60%) to patient satisfaction with chiropractic care, with improved physical functioning (reduced pain, improved ability to work, and the ability to control pain) the next highest correlation (27%).

The study authors note that the ability of a chiropractor to reorient pain experience into a more positive framework may play a role in higher satisfaction ratings, and this component of treatment needs further study.
Physical functionality (increased activity/decreased pain) correlated more closely to satisfaction ratings for treatment than affective (emotional) improvements such as reducing anxiety or depression. But other unknown factors, which were unable to be measured with the tools in this study, also appeared to contribute to both patient improvement and satisfaction scores.

The study authors note that even though physical factors were more significant than emotional ones in satisfaction with treatment, that it is important to not ignore affective (emotional) factors in treatment, since other studies have shown that palliative coping (rest and nurturing) was related to more positive pain perception in clients when recent life stresses were high.

Interestingly, the study showed that in the U.K., patients are seeking chiropractic care for complaints much sooner than they did two decades ago; nearly half (47%) now seek initial care for a musculoskeletal complaint within a month of onset, compared to waiting over a year before seeking care in the 1970’s.

Breen A, Breen R. Back pain and satisfaction with chiropractic treatment: what role does the physical outcome play? The Clinical Journal of Pain 2003;19:263-268.