Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088661 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6882 (Electronic) Linking ISSN: 14726882 NLM ISO Abbreviation: BMC Complement Altern Med Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-2019]

Delivery of Health Care, Integrated* ; Health Knowledge, Attitudes, Practice* ; Patient Satisfaction*; Manipulation, Chiropractic/*psychology ; Neurological Rehabilitation/*psychology; Adult ; Family ; Humans ; Interviews as Topic ; Longitudinal Studies ; Qualitative Research

Background: Few studies have investigated patient and provider expectations of chiropractic care, particularly in multidisciplinary settings. This qualitative study explored stakeholder expectations of adding a chiropractor to the healthcare team at a rehabilitation specialty hospital.
Methods: The research methodology was an organizational case study with an inpatient facility for persons recovering from complex neurological conditions serving as the setting. Sixty stakeholders, including patients, families, hospital staff, and administrators, were interviewed or participated in focus groups in June 2015. Semi-structured questions guided the interview sessions which were digitally audiorecorded and transcribed. Data were entered into a qualitative software program to conduct content analysis using an iterative approach to identify key themes.
Results: Expectations for the chiropractic program were mostly positive with themes consistently reported across stakeholder groups. The central domain, making progress, encompassed the organizational mission to empower patients to reach hospital discharge and return to life in the community. Higher order goals, characterized as achieving whole person healing, encompassed patients' quality of life, self-efficacy, and activities of daily living. Stakeholders expected the addition of chiropractic to help patients progress toward these goals by improving pain management and physical functioning. Pain management themes included pain intensity, medication use, and pain-related behaviors, while functional improvement themes included muscle tone, extremity function, and balance and mobility. In addition to these direct effects on clinical outcomes, stakeholders also expected indirect effects of chiropractic care on healthcare integration. This indirect effect was expected to increase patient participation in other providers' treatments leading to improved care for the patient across the team and facility-level outcomes such as decreased length of stay.
Conclusions: Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge. Understanding stakeholder expectations may allow providers to align current expectations with what may be reasonable, in an effort to achieve appropriate clinical outcomes and patient and staff satisfaction.

J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):150-7. (PMID: 26948180)
Spine (Phila Pa 1976). 2014 Jan 1;39(1):81-90. (PMID: 24108283)
Medicine (Baltimore). 2017 Aug;96(34):e7837. (PMID: 28834891)
Int J Qual Health Care. 1995 Jun;7(2):127-41. (PMID: 7655809)
Can J Pain. 2017 Oct 11;1(1):161-170. (PMID: 29521378)
Gerontologist. 2018 Mar 19;58(2):376-387. (PMID: 28082277)
Int J Pharm Pract. 2014 Feb;22(1):28-37. (PMID: 23750666)
Clin J Pain. 2014 Apr;30(4):279-85. (PMID: 23792343)
BMC Complement Altern Med. 2008 Jun 18;8:32. (PMID: 18564418)
J Manipulative Physiol Ther. 2002 Jun;25(5):300-5. (PMID: 12072850)
Man Ther. 2016 Dec;26:183-191. (PMID: 27705840)
Spine J. 2018 Apr;18(4):691-711. (PMID: 29373836)
Ann Fam Med. 2011 Sep-Oct;9(5):447-53. (PMID: 21911764)
J Altern Complement Med. 2010 Feb;16(2):157-63. (PMID: 20180688)
Chiropr Man Therap. 2018 Jun 22;26:29. (PMID: 29977521)
J Manipulative Physiol Ther. 2001 Sep;24(7):440-4. (PMID: 11562651)
J Adv Nurs. 2011 Jun;67(6):1178-90. (PMID: 21261696)
Phys Ther. 2010 Sep;90(9):1345-55. (PMID: 20592270)
Complement Ther Clin Pract. 2017 Nov;29:27-34. (PMID: 29122266)
BMC Complement Altern Med. 2012 Nov 27;12:234. (PMID: 23186539)
Qual Health Res. 2005 Nov;15(9):1277-88. (PMID: 16204405)
Nurse Res. 2013 Mar;20(4):12-7. (PMID: 23520707)
Chiropr Man Therap. 2015 Jan 16;23(1):3. (PMID: 25628858)
Sci Rep. 2017 Aug 29;7(1):9681. (PMID: 28851924)
Spine J. 2014 Aug 1;14(8):1769-80. (PMID: 24787355)
CMAJ. 2009 Apr 14;180(8):845-6. (PMID: 19364799)
J Multidiscip Healthc. 2018 May 03;11:223-231. (PMID: 29760552)
J Gen Intern Med. 2008 Feb;23(2):148-53. (PMID: 18066631)
J Electromyogr Kinesiol. 2012 Oct;22(5):670-91. (PMID: 22534288)
J Manipulative Physiol Ther. 2008 Jun;31(5):355-75. (PMID: 18558278)
BMC Complement Altern Med. 2015 Feb 05;15:12. (PMID: 25652396)
J Can Chiropr Assoc. 2010 Sep;54(3):147-54. (PMID: 20808614)
Med Care. 2014 Dec;52(12 Suppl 5):S97-104. (PMID: 25397831)
BMC Complement Altern Med. 2014 Jan 25;14:39. (PMID: 24460709)
J Altern Complement Med. 2016 Nov;22(11):936-946. (PMID: 27689427)
Neurorehabil Neural Repair. 2010 Jan;24(1):23-33. (PMID: 19723923)
J Altern Complement Med. 2018 Aug;24(8):792-800. (PMID: 30016118)
J Manipulative Physiol Ther. 2015 Oct;38(8):533-44. (PMID: 26362263)
BMC Complement Altern Med. 2014 Jul 30;14:276. (PMID: 25077732)

N/A The Kiernan Family Trust (US)

Keywords: Attitude of health personnel; Chiropractic; Complementary therapies; Hospitals, special; Integrative medicine; Musculoskeletal pain; Qualitative research; Rehabilitation; Treatment outcome

Date Created: 20181206 Date Completed: 20190115 Latest Revision: 20190115

20221213

PMC6278071

10.1186/s12906-018-2386-3

30514271