title: Attitudes toward chiropractic: a survey of North American orthopedic surgeons.
abstract: METHODS
  Questionnaire survey.
  
  
  OBJECTIVE
  To elicit orthopedic surgeons' attitudes toward chiropractic.
  
  
  BACKGROUND
  Orthopedic surgeons and chiropractors often attend to similar patient populations, but little is known about the attitudes of orthopedic surgeons toward chiropractic.
  
  
  METHODS
  We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopedic surgeons that inquired about demographic variables and their knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ).
  
  
  RESULTS
  487 surgeons completed the survey (response rate, 49%). North American orthopedic surgeons' attitudes toward chiropractic were diverse, with 44.5% endorsing a negative impression, 29.4% holding favorable views, and 26.1% being neutral. Approximately half of respondents referred patients for chiropractic care each year, mainly due to patient request.The majority of surgeons believed that chiropractors provide effective therapy for some musculoskeletal complaints (81.8%), and disagreed that chiropractors could provide effective relief for nonmusculoskeletal conditions (89.5%). The majority endorsed that chiropractors provide unnecessary treatment (72.7%), engage in overly-aggressive marketing (63.1%) and breed dependency in patients on short-term symptomatic relief (52.3%). In our adjusted generalized linear model, older age (-2.62 points on the CAQ for each 10 year increment; 95% confidence interval [CI] = -3.74 to -1.50), clinical interest in foot and ankle (-2.77; 95% CI = -5.43 to -0.10), and endorsement of the research literature (-4.20; 95% CI = -6.29 to -2.11), the media (-3.05; 95% CI = -5.92 to -0.19), medical school (-7.42; 95% CI = -10.60 to -4.25), or 'other' (-4.99; 95% CI = -8.81 to -1.17) as a source of information regarding chiropractic were associated with more negative attitudes; endorsing a relationship with a specific chiropractor (5.05; 95% CI = 3.00 to 7.10) or residency (3.79;95% CI = 0.17 to 7.41) as sources of information regarding chiropractic were associated with more positive attitudes.
  
  
  CONCLUSIONS
  North American orthopedic surgeons' attitudes toward chiropractic range from very positive to extremely negative. Improved interprofessional relations may be important to ensure optimal care of shared patients.
authors.affiliation: Institute for Work & Health, Toronto, Ontario, Canada. jbusse@iwh.on.ca
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.forename: Craig
authors.initials: C
authors.lastname: Jacobs
authors.forename: Trung
authors.initials: T
authors.lastname: Ngo
authors.forename: Robert
authors.initials: R
authors.lastname: Rodine
authors.forename: David
authors.initials: D
authors.lastname: Torrance
authors.forename: Janey
authors.initials: J
authors.lastname: Jim
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: Brad
authors.initials: B
authors.lastname: Petrisor
authors.forename: Brian
authors.initials: B
authors.lastname: Drew
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002684:Chiropractic; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009656:North America; D009985:Orthopedics; D011795:Surveys and Questionnaires