Exploration of Factors Influencing Chiropractors' Therapeutic Choices in the Management of Aging Patients: an Observational Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 12
- 试验地点
- 1
- 主要终点
- Care approaches
研究概览
简要总结
The goal of this observational study is to understand how chiropractors adjust their therapeutic approaches based on their beliefs, the patient's age, and patient-specific characteristics, with a particular focus on aging patients. The study population includes licensed chiropractors in Quebec treating adult and aging patients in real clinical settings. Patients involved are receiving their usual care and are not the primary focus of the study.
The main questions it aims to answer are:
- How do chiropractors modify their treatment strategies for aging patients?
- What contextual and clinical factors influence these therapeutic decisions?
Researchers will observe chiropractors during routine care to assess treatment characteristics. To do this, participants will:
- Use a sensor to measure the force applied during specific manual treatments.
- Complete brief questionnaires after each treatment to report contextual details.
- Allow for the presence of a researcher during treatment delivery for observational purposes.
Patients will:
- Fill out a short pre-treatment questionnaire.
- Receive their usual care with no interference in the treatment process.
- Be informed in advance and free to decline participation at any point.
This study aims to provide a detailed picture of current chiropractic practices in Quebec related to the care of aging patients, while minimizing disruption to clinical routines.
详细描述
Chiropractors play a key role in the management of musculoskeletal conditions in aging populations (Hawk et al., 2010). However, due to age-related physiological changes such as decreased bone density and increased tissue fragility, aging patients may face a higher risk of adverse effects from manual therapies-including fractures or hematomas. To ensure patient safety, clinical guidelines recommend adjusting both the selection and intensity of manual interventions for these individuals.
Although chiropractors report adapting their treatments based on age and perceived physical condition, the specific clinical and contextual factors influencing these therapeutic decisions remain poorly understood (Caissy et al., 2024). Perceived patient frailty, body type, and the chiropractor's own clinical experience may all play a role in guiding these choices. Furthermore, while it is assumed that adaptations in technique reflect a reduction in applied force, it is not yet established whether such adjustments result in measurable changes in treatment intensity compared to care provided to younger adults.
This observational study aims to address this gap by examining the factors that influence chiropractors' therapeutic decision-making when delivering manual therapies to both adult and aging patients. In parallel, it will assess whether clinical adaptations are associated with measurable differences in the force applied during treatment.
The primary objective is to identify clinical and contextual factors that influence chiropractors' therapeutic choices, especially when treating patients perceived as frail. The secondary objective is to compare the force applied during manual therapies between two age groups-patients aged 50 and older (aging group) and those aged 18-49 (younger adult group)-to determine if perceived adaptations correspond to actual reductions in applied force.
Hypotheses:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Cross Sectional
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •for chiropractors:
- •Be a practicing chiropractor working in a private clinic in Quebec located within approximately 150 km of the Université du Québec à Trois-Rivières.
- •Have a patient base mainly composed of younger adults (ages 18 to 49) and aging adults (50 years and older).
- •Use diversified manual therapy techniques on the spine and pelvis. This terminology is commonly used in chiropractic and refers to a range of techniques including spinal manipulation, spinal mobilization, instrument-assisted manipulation, and the use of pelvic blocks.
排除标准
- •for chiropractors:
- •Not having a treatment room large enough to accommodate the researcher and her equipment, in addition to the patient.
- •Having a schedule that does not allow extending the duration of multiple treatments within a single day.
- •Inclusion criteria for patients:
- •Be an adult aged between 18 and 49 years or 50 years and older.
- •Be a regular patient of the chiropractor.
- •Exclusion criteria for patients:
- •- New patients, defined as those attending their first or second appointment at the clinic. These visits are typically longer, and it is reasonable to expect that the patient may have more questions during these initial sessions. The presence of a third party could be uncomfortable for a patient who is still adapting to a new type of care or a new chiropractor. We do not wish to interfere with a patient-chiropractor relationship that is still being established.
结局指标
主要结局
Care approaches
时间窗: From the start of the clinician work day to the end of the clinician work day (1 day)
The researcher will take handwritten notes of all spinal manual therapies performed by the chiropractors on their patients during the data collection day.
次要结局
- Manual therapy force(From the start of the clinician work day to the end of the clinician work day (1 day))
研究者
Isabelle Pagé
Professor
Université du Québec à Trois-Rivières