The management of non-musculoskeletal disorders by chiropractors in the eThekwini District

Abstract

BACKGROUND: The management of non-musculoskeletal disorders (NMSDs) by chiropractors is gaining more popularity among patients who are leaning towards complementary and alternative medicine (CAM) to optimise their health. Patients are made aware that chiropractors offer care holistically, rather than solely treating musculoskeletal disorders (MSDs). However, due to the paucity of evidence-based research in the chiropractic management of NMSDs, it is unclear whether chiropractors are actually treating the source of a NMSD or merely providing symptomatic relief of NMSDs. The study’s objectives was to determine the types of NMSDs presenting to chiropractors in the eThekwini District; the management protocols of chiropractors for NMSDs and the association between selected demographic characteristics of chiropractors (e.g. age, gender, qualification, institute of study, number of years in practice, philosophical orientation) and the management of NMSDs. AIM: To determine the nature and extent of the management of NMSDs by chiropractors in the eThekwini District. METHODOLOGY: The study was designed as a cross-sectional survey-based study with a quantitative paradigm. Information was obtained through questionnaires completed by registered chiropractors practicing full-time and part-time in the eThekwini District. A prevalidated questionnaire was adapted for this study. Outcome measures included the frequency of NMSDs being treated by chiropractors as a primary and as a secondary complaint; patient demographics of those who presented to the chiropractor with NMSDs, the chiropractor’s management protocols utilised to manage NMSDs and the association between the chiropractors’ demographic characteristics and the choice of management methods of NMSDs. A focus group was held, followed by a pilot study to determine the validity of the questionnaire. A total of 73 chiropractors returned completed questionnaires with a response rate of 82%. The data was then coded on a Microsoft Excel spreadsheet and transferred to SPSS for statistical analysis. RESULTS: Seventy-three of 89 chiropractors responded. The primary NMSDs garnering the greatest positive ratings include headache of NMSK origin (89%), infantile colic (80.8%), dizziness (67.1%), vertigo (61.6%), sinus-related disorders (58.9%) and tinnitus (54.8%). Of the secondary NMSK complaints, headache (82.2%), dizziness (72.6%), constipation (68.5%), sleep disorders (64.4%), fatigue (63%), sinus-related disorders (61.6%), vertigo (57.5%), bowel disorders (56.2%), infantile colic (52.1%) and tinnitus (52.1%) were the most frequent NMSDs with symptomatic improvement, following treatment of MSK conditions seen by participants. For the management of primary and secondary NMSDs, the most common treatment modalities reported were auxiliary therapies, patient education and manipulative therapy. The majority of participants used a variety of treatment methods (no single treatment method was exclusive to a particular disorder) to manage NMSDs. A significant positive association (p < 0.001) was found between female chiropractors and the more frequent use of auxiliary therapy to manage NMSDS than their male counterparts. No other associations (for age, qualification, institute of study, number of years in practice and philosophical orientation) were observed between the chiropractors’ demographic characteristics and the management of NMSDS. CONCLUSION: The majority of chiropractors in the eThekwini District report managing some NMSDs in clinical practice. When the results of NMSDs treated collectively (as primary and secondary complaints) were combined, it was found that the most common NMSDs - garnering the greatest positive ratings - were headache of NMSK origin (most commonly migraine), infantile colic, dizziness, vertigo, sinus-related disorders and tinnitus. Future studies should use stringent criteria to investigate a larger representation of chiropractors across the country for the management of NMSDs.