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Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

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Abstract

Background

While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable.

Objective

Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP.

Design/Setting

Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018.

Participants

146,087 adults reporting LBP in prior 3 months.

Methods

We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents.

Results

Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016–2018 vs 2002–2015, OR = 1.15; 95% CI: 1.10–1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions > 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR = 0.62, 95% CI: 0.65–0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR = 0.98; 95% CI: 0.94–1.03) but lower for chiropractic care use (OR = 0.50; 95% CI: 0.47–0.53).

Conclusions

Although use of chiropractic care or OT/PT for LBP increased after the introduction of clinical guidelines in 2016, only about a third of US adults with LBP reported using these services between 2016 and 2018 and disparities in use have not improved.

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Funding

This work was supported in part by the National Institutes of Health (NIH) under award numbers K23 AT010487-04 and K24 AG069176-06.

Author information

Authors and Affiliations

  1. Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA

    Eric J. Roseen DC, MSc, PhD(c) & Julie J. Keysor PT, PhD

  2. New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA

    Eric J. Roseen DC, MSc, PhD(c), Rachel Ward PhD, MPH & Jonathan F. Bean MD, MPH

  3. Department of Rehabilitation Science, MGH Institute of Health Professions, Boston, MA, USA

    Eric J. Roseen DC, MSc, PhD(c)

  4. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Kushang V. Patel PhD, MPH & Xinyao de Grauw MD, PhD, MPH

  5. Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Steven J. Atlas MD, MPH & Stephen Bartels MD, MS

  6. Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA

    Julie J. Keysor PT, PhD

  7. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA

    Jonathan F. Bean MD, MPH

  8. Spaulding Rehabilitation Hospital, Boston, MA, USA

    Jonathan F. Bean MD, MPH

Authors
  1. Eric J. Roseen DC, MSc, PhD(c)
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  2. Kushang V. Patel PhD, MPH
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  3. Rachel Ward PhD, MPH
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  4. Xinyao de Grauw MD, PhD, MPH
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  7. Julie J. Keysor PT, PhD
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  8. Jonathan F. Bean MD, MPH
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Contributions

Authors Roseen and deGrauw had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Roseen, Patel, Ward, Bartels, Keysor, and Bean.

Acquisition, analysis, or interpretation of data: Roseen, Patel, Ward, deGrauw, Bartels, Keysor, and Bean.

Critical revision of the manuscript for important intellectual content: Roseen, Patel, Ward, Bartels, Keysor, and Bean.

Statistical analysis: Roseen, Patel, deGrauw, and Ward.

Obtained funding: n/a.

Administrative, technical, or material support: Roseen.

Study supervision: Roseen, Patel, and Bean.

Corresponding author

Correspondence to Eric J. Roseen DC, MSc, PhD(c).

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The authors declare that they do not have a conflict of interest.

Role of the Funder/Sponsor

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NIH, the Department of Veterans Affairs, or the United States Government.

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Roseen, E., Patel, K., Ward, R. et al. Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018. J GEN INTERN MED 39, 578–586 (2024). https://doi.org/10.1007/s11606-023-08438-3

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