title: Patients using chiropractors in North America: who are they, and why are they in chiropractic care?
abstract: OBJECTIVE
  Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why.
  
  
  METHODS
  The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors.
  
  
  RESULTS
  More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care.
  
  
  CONCLUSIONS
  These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.
authors.affiliation: RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, California 90407-2138, USA. coulter@rand.org.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Coulter
authors.forename: Eric L
authors.initials: EL
authors.lastname: Hurwitz
authors.forename: Alan H
authors.initials: AH
authors.lastname: Adams
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Genovese
authors.forename: Ron
authors.initials: R
authors.lastname: Hays
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D000328:Adult; D017677:Age Distribution; D001294:Attitude to Health / Q000208:ethnology; D001416:Back Pain / Q000628:therapy; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003469:Culture; D003710:Demography; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D008603:Mental Health / Q000706:statistics & numerical data; D009140:Musculoskeletal Diseases / Q000628:therapy; D019547:Neck Pain / Q000628:therapy; D009656:North America; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017678:Sex Distribution; D011795:Surveys and Questionnaires