The Use of Chiropractic by Special Populations.

Chiropractic care, known best for its emphasis on spinal manipulative therapy, is the most commonly used provider-based complementary and alternative medicine therapy in the United States. It has accumulated a substantial body of evidence for the management of low back pain and other musculoskeletal complaints in adults. However, at this time, fewer studies have focused on its use in different populations who may have different needs, risk factors, and response to treatment. Current recommendations and guidelines are based, for the most part, on research investigating chiropractic care for primarily white adults with uncomplicated nonspecific musculoskeletal complaints. This is congruent with current patterns of use of chiropractic. A recent population-based survey indicated that 93% of current chiropractic users are white, and 18% were 65 years or older. A 2015 report using National Health Interview Survey data found that only 3% of children ages 4 to 17 years had used chiropractic or osteopathic manipulation within the past year; infants were not included. However, it is important to investigate the use of chiropractic among special populations in order to gather evidence on whether the general findings may appropriately be extrapolated to diverse population groups. This issue presents articles addressing issues related to chiropractic care for special population groups. Broadly, the population groups targeted were children and older adults. However, military populations and racial/ethnic minorities were also addressed. It is important to note that an overarching theme throughout this issue is the importance of interdisciplinary collaboration, particularly for populations who need complex management strategies. Four of the articles specifically focus on chiropractic care for children, including infants. Miller and colleagues report significant improvement in rates of breastfeeding after parents attended an interdisciplinary clinic of midwifery and chiropractic. Weis and colleagues surveyed a sample of Canadian obstetricians and found that, even though there is some evidence that manipulation may benefit low back pain in pregnancy, referrals by obstetricians to doctors of chiropractic is limited. They conclude that better interprofessional communication may be helpful in caring for pregnant women with low back pain. Pohlman and colleagues report on their efforts to establish a reporting system for adverse effects, to be used by doctors of chiropractic treating children, toward optimizing safety. Finally, Hewitt and colleagues described a consensus process to establish a set of core competencies for doctors of chiropractic treating children. Their recommendations reinforced the importance of interdisciplinary collaboration and communication, for the benefit of the patient. The other 3 articles emphasize the older adult population. Green and colleagues present a systematic review of the integration of chiropractic services into both the active military and veterans’ health care systems in the United States. Their findings suggest that the integration of chiropractic into these systems could provide guidance for its integration into other settings as well. Whedon and colleagues’ analysis of local Medicare data is similar to that of the general population, in finding that among older adults, chiropractic patients are predominantly white. Finally, Ndetan and colleagues’ brief report explores the use of chiropractic for patients with dizziness or balance disorders, using National Health Interview Survey data. They found that the number of respondents using chiropractic for these types of disorders was very small—which is consistent with the trend to use chiropractic primarily for spinerelated pain. Those who did use it tended to be aged 65 years or older, and the odds ratio of being helped was very high for those reporting symptoms arising from head or neck trauma or neurological or muscular conditions. In summary, these articles indicate that the chiropractic profession is making efforts to develop effective interdisciplinary communication and collaboration, and beginning to explore issues of use and effectiveness among special populations.