Original Research
Functional Limitations in Adults Who Utilize Chiropractic or Osteopathic Manipulation in the United States: Analysis of the 2012 National Health Interview Survey

https://doi.org/10.1016/j.jmpt.2017.07.015Get rights and content

Abstract

Objectives

The goals of this study were to identify self-reported differences in function, comorbidities, and medical service utilization among adults who reported using chiropractic and/or osteopathic manipulation in the 2012 National Health Interview Survey, and to compare these between older and younger adults.

Methods

We conducted a descriptive study of adults aged 18 or older who were included in the 2012 National Health Interview Survey and the Alternative Medicine Questionnaire. We included those who reported using chiropractic and/or osteopathic manipulation in the past 12 months. Responses were analyzed using SAS software. Weighted estimates were reported as percentages of chiropractic/osteopathic users overall and by age group (<65 years vs ≥65 years).

Results

Among the 8.5% of US adults who reported receiving manipulation, 97.6% saw chiropractors. Most adults were under age 65 (83.7%), female (56.6%), and white (85.1%). Except for sitting tolerance, functional limitations were significantly higher among older manipulation users compared with younger manipulation users (all P < .001). Older (vs younger) chiropractic/osteopathic users more often reported functional limitations (65.7% vs 37.2%), had difficulty walking without equipment (14.7% vs 2.8%), found it very difficult or were unable to walk one-quarter mile (15.7% vs 3.8%) or climb 10 steps (11.4% vs 2.5%), and needed help with instrumental activities of daily living (6.9% vs 2.0%). Comorbidities differed by age: cardiovascular events/conditions, cancer, diabetes, and arthritis were more common among older adults, and headaches, neck pain, and depression were more frequent in younger adults. Similar proportions of older and younger adults had emergency room visits (23.0% vs 21.7%); older adults reported more surgeries (26.1% vs 15.4%).

Conclusions

Notable differences exist in functional limitations and comorbidities between older and younger chiropractic and osteopathic manipulation users. This information could inform clinical practice, education, and policy.

Introduction

Spinal manipulation is one of the most utilized, provider-delivered complementary and alternative medicine (CAM) therapies in the United States.1, 2, 3, 4 At least 8.4% of US adults reported seeing a doctor of chiropractic (DC) and/or doctor of osteopathy (DO) for manipulation in 2012,3 and this proportion has remained relatively stable over the last decade.1, 3, 4, 5

The National Health Interview Survey (NHIS)6 is a data source for CAM utilization trend estimates in the United States. Although recent NHIS studies have focused on general CAM use relative to modifiable health habits,1 comorbidities,7 and low back pain,2 few studies have focused exclusively on the subset of adults who received chiropractic and/or osteopathic manipulation. Moreover, utilization trends have provided little specific information on chiropractic users in terms of functional limitations, comorbidities, and recent major medical service use that may have considerable impact on chiropractic treatment decisions and recovery potential, particularly in older adults.

Given the national interest in effective care delivery options to support the aging US population, knowledge of functional limitations, comorbidity burden, and major medical service use in manipulation users could better define the adult chiropractic patient population to inform chiropractic provider training needs, generate hypotheses for future research, and potentially inform health care policy.

The goals of this study were to identify self-reported differences in function, comorbidities, and major medical service utilization among adults who reported using chiropractic and/or osteopathic manipulation in the 2012 NHIS and to compare these between older and younger adults. Our hypotheses were that functional limitations and significant medical issues are prevalent in adult manipulation users, and that adults aged ≥65 report greater levels of functional limitation than adults <65.

Section snippets

Methods

We used the 2012 NHIS data for this descriptive study. The NHIS is a nationally representative, multistage household interview survey of the non-institutionalized US civilian population regarding health status and health care utilization.6 Supplemental questions about CAM use are asked of all NHIS sample adults every 5 years; 2012 was the most recent CAM survey for which data are available. Unequal weights are provided for each record in the data set so that national population estimates can be

Results

The final weighted sample of US adults who reported seeing a DC, DO, or both for manipulation during the past 12 months in the 2012 NHIS was just over 19 million, or 8.48% (95% confidence limits: 8.08%, 8.89%) of US adults.

Discussion

We identified numerous differences in functional limitations, comorbidities, and major medical service use between older and younger adults who utilized chiropractic and/or osteopathic manipulation. Not unexpectedly, older adults reported greater prevalence and severity of functional limitations,11 heavier comorbidity burden,7, 11, 12 and more frequent surgeries and hospital admissions after emergency room visits13, 14 than did adults <65 years of age.

The prevalence of functional limitations in

Conclusion

Notable differences exist in functional limitations and comorbidities between older and younger users of manipulative therapy. These differences have the potential to inform clinical practice, education, and policy.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): M.L.F., M.M.

  • Design (planned the methods to generate the results): M.L.F.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): M.L.F.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): M.L.F.

  • Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): M.L.F., M.M.

  • Literature search

Practical Applications

  • A majority of those who participated in the survey received manipulation from a doctor of chiropractic.

  • Functional limitations were significantly higher for older adults compared with younger adults in this group.

References (22)

  • National Center for Health Statistics

    National Health Interview Survey, 2012. Public-use data files and documentation

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