Orthopedic surgeons hold diverse views of chiropractors

In Brief

  • In a survey of 500 orthopedic surgeons in Canada and the United States, just over half held a favourable or neutral view or chiropractors. The rest had a negative view.
  • Half of the surgeons referred patients to chiropractors each year, often at the request of patients.
  • Most surgeons believed chiropractors provided effective therapy for musculoskeletal problems, such as low-back pain, but not for non-musculoskeletal problems or rehabilitation after surgery.

Why was this study done?

The relationship between orthopedic surgeons and chiropractors was once strained. For example, until 1983, the American Medical Association held that it was unethical for medical doctors to associate with chiropractors. Because these professions share patients with similar health issues, a poor relationship may mean patients get inconsistent and even conflicting information about their care. Understanding how orthopedic surgeons view chiropractors may help identify targets for improving relationships. This would optimize the care of shared patients.

How was the study done?

A survey was faxed to 500 Canadian and 500 American orthopedic surgeons. The survey asked about their knowledge of and referral practices for chiropractic care, and about their attitude toward chiropractors. Of the 1,000 surveys sent, 487 were completed, for a response rate of 49 per cent.

What did the researchers find?

Among the orthopedic surgeons surveyed:

  • In total, 29 per cent held a favourable view of chiropractors, 26 per cent held a neutral view and 45 per cent a negative view.
  • About half of the surgeons referred patients for chiropractic care each year, mainly because of patient requests.
  • A majority of surgeons believed chiropractors provided effective therapy for some musculoskeletal complaints (82 per cent), but not for non-musculoskeletal conditions (90 per cent) or rehabilitation after surgery (66 per cent).
  • Most surgeons felt that chiropractors provided unnecessary treatment (73 per cent), were too aggressive in their marketing (63 per cent) and made patients dependent on short-term relief (52 per cent).

Orthopedic surgeons who were older, who had a clinical interest in foot and ankle, and who got their information about chiropractors from research literature, the media or medical school expressed more negative views. Positive views were associated with surgeons who acquired information on chiropractic care from a relationship with a specific chiropractor or during their residency.

What are some strengths and weaknesses of the study?

The survey included a substantial number of orthopedic surgeons, and the response rate was acceptable for health-care professionals. However, it is possible that those who did not respond to the survey differed in some systematic way from those who did. If so, the results may not generalize to all North American orthopedic surgeons.

Publication Information

Title: 

Attitudes towards chiropractic: a survey of North American orthopaedic surgeons

Author(s): 

Busse JW, Jacobs C, Ngo T, Rodine R, Torrance D, Jim J, Kulkarni A, Petrisor B, Drew B, Bhandari M

Journal: 

Spine, 2009: vol. 34, no. 25, pp. 2818-2825