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Table 4 The results in twenty-three articles on the use of primary prevention in chiropractic practice

From: Primary prevention in chiropractic practice: a systematic review

Articles
1st author Yr of publication
Country of study [Quality rating]
Chiropractors’ positive opinions on PP Chiropractors’ use of PP Patients’ reason for consulting (RfC)
MSK prevention General public health approach to PP unrelated to adjustments Wellness likely to include adjustments MSK prevention General public health approach to PP unrelated to adjustments Wellness likely to include adjustments MSK prevention General public health approach to PP unrelated to adjustments Wellness likely to include adjustments
1 2 3 4 5 6 7 8 9
Mootz (2005) [38]
USA
GOOD [100%]
         Primary RfC:
4% ‘wellness’ (Arizona)
10% ‘wellness’ (Massachusetts)
Malmqvist (2008) [35]
Finland
GOOD [100%]
      48% use ‘wellness’    
French (2013) [39]
Australia
GOOD [92%]
         RfC: 6% for ‘health maintenance or preventive care’
Allen- Unhammer (2016) [21]
Norway
GOOD [91%]
       RfC: 1% for ‘prophylactic examination’   
Leach (2011) [28]
USA
GOOD [90%]
  94% positive to physical activity prescription
66% on tobacco cessation advice
See Table 6
92% were ‘wellness-oriented’   86% prescribed physical activity or advised on this topic
60% advised on tobacco cessation
See Table 6
    
Stuber (2013) [19]
Canada
GOOD [87%]
     82% ‘’recommend dietary supplements (…) for general health and wellness”     
McGregor (2014) [20]
Canada
GOOD [87%]
   19% thought chiropractic subluxation is an obstruction to human health       
McDonald (2004) [34]
Several countries
GOOD [85%]
      94% included periodic MC/wellness care in their clinical routine    
Brown (2014) [40]
Australia
GOOD [85%]
         RfC: 21% for ‘general health and well-being’
Glithro (2015) [29]
UK
GOOD [85%]
  81%* agreed that screening patients for skin lesions was part of their clinical role
*Includes some DC students
   Skin lesions:
−94% screened each new patient
−53% screened regular patients at every visit
−73% screened regular patients at visits scheduled specifically for patient re-assessment.
    
Hawk (2004) [17]
USA
GOOD [80%]
  91% positive to nutritional advice
95% on the prescription of physical activity
69% on tobacco cessation advice
57% on skin lesion screening
See Table 6
93% had a positive attitude to subluxation
screening
90% of chiropractors provide information on MSK risk reduction 86% gave nutritional advice
89% prescribed physical activity or advised on this topic
65% advised on tobacco cessation
46% screened for skin lesion
See Table 6
    
Hestbaek (2009) [37]
Denmark
ACCEPTABLE
[77%]
       RfC: 7% for ‘prophylactic examination’   RfC: 2% for ‘general well being’
Pohlman (2016) [41]
Several countries
ACCEPTABLE
[75%]
         RfC: 18% for wellness
Fikar (2015) [31]
UK
ACCEPTABLE
[70%]
  62 to 97% considered lifestyle issues to be their responsibility to discuss   96% advised on poor posture
88% advised on ‘faulty movement patterns’
79% gave nutritional advice
92% prescribed physical activity or advised on this topic
57% advised on tobacco cessation
See Table 6
    
Blanchette (2015) [36]
Canada
ACCEPTABLE
[69%]
      For 59% of patients Maintenance/
Wellness was the main sector of activity
   
Blum (2008) [18]
Several countries
ACCEPTABLE
[64%]
       RfC in asymptomatic patients: 12% for ‘prevention’
See Table 5
RfC in asymptomatic patients: 16% for being ‘at risk’
See Table 5
RfC in asymptomatic patients: 14% for ‘wellness’
See Table 5
Walker (2000) [33]
USA
ACCEPTABLE
[62%]
     77% used nutrition for ‘general healthful eating/nutrition’     
Schneider (2015) [30]
USA
ACCEPTABLE
[62%]
   8% focused on ‘wellness/
prevention’
      
Allen- Unhammer (2016) [21]
Norway
(Part 2 – survey)
ACCEPTABLE
[62%]
       RfC: <5% for infants <3 mo
<10% for infants 4–23 mo
‘prophylactic examination’
  
Adams (2017) [32]
Australia
ACCEPTABLE
[62%]
    73% treated patients for ‘spinal health maintenance/prevention’.      
Hawk (2001) [22]
Several countries
UNACCEPTABLE
[57%]
     48% used ‘diet/nutrition counselling for general health’
46% used ‘exercise counseling’
   RfC: <1% for disease prevention/health promotion through nutrition RfC: 3% for disease prevention/health promotion through ‘subluxation correction’
Bussières (2015) [27]
Canada
UNACCEPTABLE
[56%]
   9% focused on ‘wellness/
prevention’
      
Marchand (2012) [26]
Several countries
UNACCEPTABLE
[55%]
       RfC: <1% for ‘posture
screening
Prevention’
  RfC: <1% for ‘advice/check up
birth check up’
Wellness
Alcantara (2008) [23]
Several countries
UNACCEPTABLE
[43%]
         RfC reported by DC
35% were reported as ‘wellness care’
RfC reported by patients
44% of parents gave ‘wellness care’ as the motivation to consult
Alcantara (2009) [24]
Several countries
UNACCEPTABLE
[43%]
         RfC reported by patients
35% ‘were reported as presenting for wellness care’
RfC reported by patients
47% ‘presented for wellness care’
Alcantara (2010) [25]
Several countries
UNACCEPTABLE
[43%]
      90%: used ‘wellness care’ RfC: 2% of DC have patients who consult for ‘postural improvement’   RfC: 17% of DC have patients who consult for ‘wellness care’
  1. MC: Maintenance Care/RfC: Reasons for Consulting/DC: chiropractors