Background
Identifying IPP initiatives involving chiropractors
Search strategy
Study selection and inclusion criteria
An example of study exclusion
Scoping the evidence
Studies describing interprofessional practice involving chiropractors
Study characteristics
Author and origin | Stated purpose | Context | Unit(s) of observation | Health care challenge | Design an Methods | IPP partners |
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[9] Canada | To investigate the effect of integrating chiropractic on the practice and attitudes of providers | Multidisciplinary healthcare teams at two community health centers | Service providers | None specified | Design: Mixed methods Quantitative methods-Provider Questionnaire regarding opinions, experiences with collaboration, and perceptions of chiropractic care Qualitative methods- Focus group interviews, individual interviews | MD Nurse practitioner Registered nurse |
[24] Canada | To examine the integration of chiropractors into multi-disciplinary healthcare teams in the specialisation of sport medicine | High-performance sport work sites (e.g., major games, on tour with teams, at training centers) | Service providers | None specified | Design: Qualitative case study Qualitative methods- Individual interviews | MD PT Athletic therapist |
[13] Canada | To evaluate if: Chiropractic could be integrated successfully within a hospital system The integration would reduce MSK pain and disability The level of satisfaction of patients and collaboration providers/administrators with the model of care | Hospital system of care- Department of Family and Community Medicine | Service providers and patients | Adults suffering from MSK pain and disability | Design: Prospective observational Quantitative methods- Self-reported pain, disability, general health, function, satisfaction Qualitative methods- Individual interviews | MD PT Administrators |
[10] USA | To compare clinical outcomes of older adults receiving back pain treatment under three professional practice models that included primary medical care with or without chiropractic care | A family medicine residency and a chiropractic research center | Older adults (> 65) | LBP | Design: Pilot randomized controlled trial Quantitative methods- Primary outcomes: Self-reported LBP intensity & disability Secondary clinical outcomes: LBP bothersomeness, Fear Avoidance Beliefs, Timed Up and Go Test, perceived global improvement of LBP, overall health and quality of life and satisfaction with 6 domains of LBP care | MD |
[22] USA | To evaluate the perceived feasibility of a patient-centered practice model for back pain, including facilitators for interprofessional collaboration between family MDs and chiropractors | A family medicine residency and a chiropractic research center located in Davenport, Iowa, USA | Service providers | LBP | Design: Qualitative evaluation Qualitative methods- individual interviews, chart abstractions, fieldnotes | MD |
[21] USA | To investigate the aspects of interprofessional collaboration occurring in a sample of complementary and integrative health (CIH) providers | Private practice and community health centers | Service providers | None specified | Design: Qualitative health service case study Qualitative methods- Individual interviews | AOM practitioner Midwife Massage therapist Naturopath |
[12] | Explore the role and perceived value of chiropractors to Danish elite football clubs. And additionally explore the barriers and facilitators to interprofessional practice involving chiropractors | Danish premier league (Superliga) clubs | Service coordinators | None specified | Design: Qualitative case study Qualitative methods- Individual interviews | None specified |
Barriers and facilitators and core findings relating to IPP
Reference | Key IPP-related findings | Facilitators | Barriers |
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[9] | Integrating chiropractic care into an established conventional medical setting, specifically a community health center, can be achieved over a relatively short period and with a high degree of comfort Integration had a positive impact on provider’s individual practices and changed opinions and views of healthcare practitioners towards chiropractic | The ‘right’ type of chiropractor that can integrate in an IPP setting IPE to ground the understanding of professional practice, roles and functions Collaborative practices such as team meetings and the clinic’s physical location Chiropractic care as a free service | Lingering concerns about ‘chiropractic’ |
[24] | The incorporation of chiropractic into the system of sport medicine professions derives from a clearly defined and commonly accepted understanding of the purpose of sport medicine Consumer demand (not professional acceptance) represents the main driver for the integration of chiropractors into high level athletics | A structural hierarchy that clarifies roles and responsibilities Clear understanding of professional boundaries and complementarity in each profession’s scope of practice Chiropractor’s accepting role limitations | Inability to work within a team framework Misaligned views regarding primary care status Misunderstandings about treatment provided by the chiropractor Clashes in philosophy of health stances |
[13] | Even in the highly systematized settings of primary care hospital clinics, the addition of chiropractors, offers a useful addition to the management of MSK pain-related conditions | Credible champions leading the change towards IPP Thorough preparation of the IPP environment implementing IPP Clear support by senior level administration Chiropractor demonstrates a high level of profession expertise | Poor knowledge and of awareness of ‘the chiropractic service’ Perception of risk of chiropractic treatment Unstable funding model |
[10] | Chiropractic services for back pain, offered either concurrently (dual care) or integrated (shared care) with standard medical care offers additional benefits beyond standard medical care alone with respect to patients global perceived improvement and satisfaction with care | Not reported | Not reported |
[22] | Family medicine residents and Doctor of Chiropractic viewed collaborative care as a useful practice model for older adults with low back pain | IPE to establish, improve and maintain collaborative back pain care A team-based, patient-centered system of management practices An effective time scheduling and clinical records exchange platform Care facilities supportive of collaborative management | Care options unacceptable to patient due to high co-payment Inefficiencies in electronic journaling system Clinicians not participating in IPE are unlikely to refer patients to chiropractors |
[21] | Complementary and integrative health providers collaborate both formally and informally with each other and other providers, and operate from a patient-centered perspective Providers overwhelmingly reported that interprofessional collaboration had a positive impact on patient care, professional satisfaction, and their practice | Collaborative practices such as interprofessional meetings Sharing supportive research for interventions with other providers and the target community Being present in a teaching hospital settings Creating clinical-experiential training sites allowing access to students from different disciplines Previous exposure to IPE Being in physical proximity of other providers Licensure, when required advised to consult with a medical doctor | The use of exclusive, discipline-specific language and nomenclature Clashes in professional opinions Poor of understanding about other disciplines Multiple electronic health records platforms Loss of income due to the extra time required to include collaborative practices Loss of income due to delays in treatment Licensure, when an obstacle to having hospital rights or limited the ability to bill third-party payers |
[12] | Chiropractors are engaged in the role of a spine-related MSK health care expert, as part of a provider team. The rationale for adding a chiropractor is to broaden the shared pool of knowledge. However, when not utilized, the role of chiropractor as spinal health experts is challenged | Chiropractors shifting from external to in-house practitioners Perceived need for a (spinal) MSK expert Athlete demand for services provided by chiropractors | No clear niche for a Back Pain expert (Back pain perceived as self-remitting) Competition from existing provider groups Financial limitations to adding a chiropractor to the team |
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IPP is achievable and impacts positively on collaborative practices in a community health care context;
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IPP potentially provides improved quality of life and care-related satisfaction outcomes for older adults with LBP, and;
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IPP in the sports medicine domain perceived as potentially desirable as long as the purpose is clear.