The scope of chiropractic practice: A survey of chiropractors in the UK

Abstract

In the UK, chiropractic has undergone significant change in recent years, particularly with the advent of statutory regulation and an increasing emphasis on evidence-based and multidisciplinary health care. Little is known about what effect, if any, such changes have had on the profession's view of its scope of practice. To ascertain the opinion of UK chiropractors regarding chiropractic beliefs and philosophy, the benefit of chiropractic intervention in paediatric, adolescent and adult conditions and its relationship with the National Health Service (NHS). Differences in opinion between chiropractors from different UK chiropractic associations – the British Chiropractic Association (BCA), McTimoney Chiropractic Association (MCA), the Scottish Chiropractic Association (SCA) and the United Chiropractic Association (UCA) – were also investigated. A one-shot postal questionnaire was sent to 490 randomly selected chiropractors in the UK registered with the General Chiropractic Council (GCC) (Sample 1). Subjects were selected by a simple random probability sample design. Sample 2 comprised a further 45 randomly chosen subjects from the same sampling frame and was used to test whether Sample 1 was representative of the population. Data were subjected to descriptive analysis using SPSS v10. Differences between groups were investigated by Chi-square analysis and the Kruskal–Wallis H -test. The response rate for Samples 1 and 2 was 54% and 53%, respectively. There was no difference between the two samples in terms of gender, age, college of graduation and chiropractic association membership. Internal consistency of the questionnaire was proven to be weak-moderate ( r = −.265 [interclass correlation (IC): −256; 95% confidence interval (CI): −368 to −.136] to .591 [IC: 583; 95% CI: .494–.659]). Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents. Statistically significant differences between chiropractors of different associations in the UK were present, particularly regarding the benefits of chiropractic treatment for non-musculoskeletal conditions. The chiropractors in this study may not view themselves as neuromusculoskeletal (NMS) specialists only. Respondents reported treating visceral/organic conditions and expressed a belief that patients with these complaints can benefit from chiropractic. Differences in opinion appear to remain between the professional associations, particularly in relation to treatment benefits for viscero-somatic conditions and philosophical relevance. However, these findings need to be explored in a more representative sample.