Lessons From COVID: What We Learned as It Relates to Chiropractic

Two new retrospective, cohort studies look at the impact of the COVID pandemic on low back pain (LBP) care and management. The studies follow LBP patients in two cohorts: 222,043 commercially insured (CI) patients and 466,125 with Medicare Advantage (MA).^1-2 Here’s what they tell us about chiropractic during COVID – and the lessons we can take with us moving forward.

Staying Open Made a Difference (Although It Didn’t Last)

In the first study, DCs saw over a quarter (26.6%) of LBP patients in the CI cohort during the pre-COVID period; more than primary care providers (PCPs, 20.4%), hospitals (10.2%), orthopedic surgeons (OS, 8.5%), radiologists (8.2%), nurse practitioners (5.6%), or physician assistants (5.1%). PCPs led in the MA cohort, seeing 31.5%; followed by hospitals (15.4%), radiologists (11.6%), DCs (9.6), OS (6.5%) and nurses (6.1%).

In fact, in the early COVID period, the percentage of CI patients who saw doctors of chiropractic actually increased slightly, along with PCPs and nurses. Most other providers saw a decrease between pre-COVID and early COVID.

This is consistent with surveys conducted by Dynamic Chiropractic in 2020 and speaks to the resilience of DCs who chose to keep their clinics open and continue seeing patients.³ DCs continuing to serve patients during COVID put chiropractic care in a utilization profile different from other first-line services, but similar to medical services.

However, the first study also found that “during COVID a greater proportion of CI and MA individuals with LBP initially contacted PCPs, nurses, and non-operative physician specialists while initial contact with DCs, PTs, OS, emergency medicine, and urgent care decreased. Early and late in the COVID pandemic fewer episodes included guideline concordant first-line services.” This apparently contributed to an increase in the total episode cost in the late COVID period.

Female LBP Patients Don’t See DCs as Much as You Think They Do

In the second study, women had a higher prevalence of LBP than men. In this study, 51.5% of CI patients and 60.4% of MA patients were female. However, while women make up about 57% of the average chiropractic practice,⁴ females were significantly less likely than males to initially contact a DC in both the CI (10% less likely) and MA (30% less likely) cohorts during all time periods; and less likely to receive chiropractic manipulative therapy (CMT) at all.

Females were more likely to initially contact a rheumatologist, acupuncturist (LAc), neurologist or physical therapist (PT) in the CI cohort; and more likely to initially contact a rheumatologist In the MA cohort.

The authors note that “with DCs being a common type of HCP (health care provider) initially contacted by individuals with LBP and having total episode attributes aligned with LBP CPGs (clinical practice guidelines), the finding that females are less likely than males to initially contact a DC, a finding amplified in low-income, non-white zip codes, is important. Similarly, females with LBP initially contacting a PCP or OS are less likely than males to receive CMT. The degree to which these and other findings are associated with variation in the proportion of female practitioners making up a type of HCP warrants further study to examine HCP gender concordance preference in the management of LBP. This seems particularly plausible for the non-pharmaceutical ‘hands-on’ HCP types like DC, PT and LAc.”

Most DCs see more female than male patients. This has given rise to the notion that a greater percentage of female LBP patients are choosing chiropractic care. Sadly, this study shows that an even larger percentage of chiropractic patients should be women. This is motivation for DCs to encourage more female patients, particularly those in low-income, non-white communities.

Editor’s Note: As is the case with other recent research by Dr. Elton and colleagues reported in Dynamic Chiropractic in the past,^5-11 this latest study is a preprint and has not yet been certified by peer review. They report new medical research that has yet to be evaluated and thus should not be used yet to guide clinical practice.

References

1. Elton D, Zhang M. Impact of the COVID-19 pandemic on low back pain management in commercially insured and Medicare Advantage cohorts. A retrospective cohort study. David Elton, Meng Zhang medRxiv 2023.05.15.23289993. Read Here
2. Elton D, Zhang M. Impact of patient gender on low back pain management before and after the COVID-19 pandemic in commercially insured and Medicare Advantage cohorts. A retrospective cohort study. David Elton, Meng Zhang medRxiv 2023.06.05.23290968. Read Here
3. “Emerging From the Pandemic: Chiropractic Comes on Strong.” Dynamic Chiropractic, June 1, 2020. Read Here
4. Practice Analysis of Chiropractic 2020. National Board of Chiropractic Examiners, 2020.
5. Emerging, Op Cit.
6. “Insurers Are Finally Figuring It Out.” Dynamic Chiropractic, September 2022. Read Here
7. “Exciting New Research Moves Chiropractors From Last to First.” Dynamic Chiropractic – November 2022. Read Here
8. “The Burden on the Chiropractic Disadvantaged.” Dynamic Chiropractic, November 2022. Read Here
9. “Moving the Needle in Chiropractic's Direction for Low Back Pain Care.” Dynamic Chiropractic, March 2023. Read Here
10. “New Neck Pain Studies Support Chiropractic First.” Dynamic Chiropractic, May 1, 2023. Read Here
11. “Physician Specialists Fail at Managing Low Back Pain, Too.” Dynamic Chiropractic, June 2023. Read Here