Prevalence of nonmusculoskeletal complaints in chiropractic practice: report from a practice-based research program

To identify patient and practice characteristics that might contribute to people's seeking chiropractic care for nonmusculoskeletal complaints.

This was a cross-sectional study conducted through the methods of practice-based research.

Data were collected in 1998--1999 in chiropractic offices in the United States, Canada, and Australia; data were managed by a practice-based research office operating in a chiropractic research center.

The subjects were new and established patients of all ages who visited the participating offices during a designated data collection week.

Multiple logistic regression was used to examine factors associated with patients' presenting for nonmusculoskeletal chief complaints. Pearson's chi(2) test was used to examine associations among practice variables and the proportion of patients with nonmusculoskeletal chief complaints.

A total of 7651 patients of 161 chiropractors in 110 practices in 32 states and 2 Canadian provinces participated; data from 2 Australian practices were included in the totals but not in the analysis. Nonmusculoskeletal complaints accounted for 10.3% of the chief complaints. The following characteristics made patients more likely to present with nonmusculoskeletal chief complaints: being less than 14 years of age (adjusted odds ratio [AOR], 6.9; 95% CI, 5.2--9.1); being female (AOR, 1.5; CI, 1.3--1.8); presenting in a small town/rural location (AOR, 1.9; CI, 1.3--2.7); reporting more than 1 complaint, especially nonmusculoskeletal complaints (AOR, 4.9; CI, 3.9--6.0); having received medical care for the chief complaint (AOR, 3.4; CI, 2.9--4.1); and having first received chiropractic care before 1960 (AOR, 1.7; CI, 1.1--2.4). Practices with the highest proportion of patients with nonmusculoskeletal chief complaints (>17%) were less likely to accept insurance and more likely to be in locations with populations greater than 100,000. They used the most common chiropractic adjustive techniques less frequently and used more nonadjustive procedures, especially diet/nutrition counseling, nutritional supplementation, herbal preparations, naturopathy, and homeopathy.

Drawing on practices with the patient and practice characteristics identified in this study to conduct outcomes studies on nonmusculoskeletal conditions is a possible direction for future research.