Work-related acute physical injuries, chronic overuse complaints, and the psychosocial work environment in Danish primary care chiropractic practice – a cross-sectional study

The aim of this study was to describe work-related physical acute injuries and overuse complaints as well as psychosocial stress among chiropractors in primary care chiropractic practice in Denmark during the previous year.

A descriptive cross-sectional study was undertaken.

We designed the questionnaire used in this survey by identifying relevant domains based on surveys used previously by the Danish National Research Centre for the Working Environment, and we subsequently populated the domains with specific questions from these surveys [14]. In addition, we took relevant questions from other surveys on work-related injuries in chiropractors (Table 1). The questionnaire was delivered electronically via SurveyXact (Aarhus, Denmark) and potential participants were invited via email to participate by clicking on a person-unique link provided in the email. Care was taken to minimize the time it took to fill in the questionnaire by including skipping functions wherever feasible so that participants only answered questions related to their complaints. It was possible to pause in the filling out of the questionnaire and return to completing the remaining parts at a later time. All questions pertained to physical and mental complaints during the previous year. We initially tested the feasibility and face-validity of the questionnaire by asking four chiropractors to fill in the electronic questionnaire and provide feedback. We subsequently performed minor modifications and clarifications. The questionnaire was sent out in August 2016. We sent reminders to potential participants after 7 and 14 days, if they had only filled out part of the questionnaire or had not responded at all. After 19 days, the data collection was closed, after which the data analysis was started. Data collection was administered by a research assistant from the Nordic Institute of Chiropractic and Clinical Biomechanics, where data were also stored on a secure server.

This survey was conducted through the Danish Chiropractors’ Association. All responses were anonymous and individual chiropractors or their clinics could not be identified by the researchers. According to Danish law, anonymous surveys protect the anonymity of the population and therefore do not require ethical approval.

Work-related overuse complaints during the previous year were most commonly reported in the low back, wrist, thumb, and shoulder, and were more common among women (62%, 95% CI 56–70) than men (51%, 95% CI 43–59) (Fig. 2).

When asked about the situation in which pain occurs, in the case of overuse complaints, most chiropractors indicated that manual treatment of myofascial trigger points caused pain in the thumb (90.3%) and wrist (66.7%). Fifty-nine per cent also reported pain in the wrist when doing manipulation treatment with the patient in the prone position. Shoulder pain (76.8%) and low back pain (68.9%) were most frequently associated with manipulating the spine of patients in side-lying position (Fig. 3).

Of those reporting overuse complaints in one of the four most common body parts (low back, wrist, thumb, and shoulder), 50% of chiropractors reported mostly receiving treatment from colleagues in the clinics. Less than 5% received treatment in the secondary care sector, and less than 7% used analgesics as the primary treatment for their pain.

When looking at treatment positions, chiropractors who often treated patients’ low back in a side-lying position reported pain in the shoulder (34%) and the low back (30%).

Work-related acute physical injuries during the previous year were uncommon and similar between women (6% (95% CI 3–11)) and men (4% (95% CI 2–9)).

The low back (3.4% women; 0.7% men) was the most commonly injured site followed by the shoulder (2.4% women; 2.0% men), and midback (1.5% women; 2.7% men) (Fig. 4). Most acute injuries had occurred when treating patients in a side-lying position doing manipulation or mobilization treatment of the low back or pelvis.

Chiropractors with more than five years in practice (59%, 95% CI 52–64) reported fewer work-related acute injuries and overuse complaints during the previous year compared with chiropractors with less than five years in practice (83%, 95% CI 73–91).

A work-related acute injury or overuse complaint during the previous year, was reported by 67% of chiropractors who saw patients 26–30 h per week, 56% of chiropractors who saw patients 31–35 h per week, and 43% of chiropractors who saw patients >40 h per week.

Slightly more clinic owners (15% (95% CI 11–20)) than associates in primary care practice (8% (95% CI 4–14)) had been unable to work because of acute physical injuries or overuse complaints during the previous year.

Generally, practicing Danish chiropractors reported that they had a good psychosocial work environment. Fifty-seven percent of clinic owners and 55% of associates indicated that they “rarely” or “never” experienced emotionally stressful situations because of their work. Almost 90% (88%) of clinic owners felt “always” or “often” that problems at work were also their personal problems compared with around 40% (38%) of associates. More than 60% of the respondents indicated that they “rarely” or “never” expressed their opinion on work-related psychosocial issues (Table 3).

Sixty percent of associates compared with 53% of all clinic owners indicated that they “rarely” or “never” experienced that their workload was unevenly distributed causing their tasks to pile up. More than 50% of both clinic owners and associates indicated that they were “often” or “sometimes” behind schedule during a normal work day. Only about 10% of clinic owners and 4% of associates indicated that they “often” did not get all their tasks done. Almost 80% of clinic owners and associates reported that they “always” or “often” had influence over their workload. On the slightly negative side, 34% of associates indicated that they “sometimes” or “rarely” got timely information at work about important decisions affecting their work compared with 6% of clinic owners. Importantly, 90% of all clinic owners as well as 90% of all associates “always” or “often” felt that they were motivated and committed to their work. Consequently, 80% of all associates and almost 90% of all clinic owners “rarely” or “never” looked for work elsewhere (Table 3).

A similar proportion of clinic owners (10% (95% CI 6–14)) and associates (12% (95% CI 7–19)) had been unable to work because of mental health problems during the previous year.

For those who had been unable to work because of mental health problems (n = 36), 75% had talked about these problems with colleagues, approximately 30% (n = 11) had consulted a psychologist, and approximately 30% did meditation or mindfulness regularly.

Nine participants indicated that their current pain was connected to a previous lumbar disc prolapse. Seven indicated that they had a previous shoulder injury or overload pain which still gave them pain.