title: Survey based investigation into general practitioner referral patterns for spinal manipulative therapy.
abstract: BACKGROUND
  In the UK Physiotherapy, Chiropractic and Osteopathy are all statutory regulated professions. Though guidelines have supported the use of Spinal Manipulative Therapy (SMT) for low back pain (LBP), General Practitioners (GP) referral patterns to the 3 registered professions that perform SMT are generally unknown.
  
  
  METHODS
  A short questionnaire was designed and piloted. Demographic information, patient referral to SMT and the GPs own personal utilisation of SMT were obtained. 385 GP's were contacted representing approximately 20% of the GP's in Wales Autumn 2007.
  
  
  CONCLUSIONS
  182 (50.8%) completed questionnaires were returned. Profile characteristics: 2/3 of respondents were male, 79% were 40 years old or older (statistically reflective of the total population of GPs in Wales at that time) and 62% had 20 years or less in practise. Personal use of SMT by GP's: 48 respondents had sought SMT treatment and a further 56% of those that had not previously sought SMT indicated that they would consider doing so. Patient referral to SMT by GP's: 131 respondents (72%) had referred patients to SMT and of those who had not a further 13% would consider referring. The general referral pattern and utilisation pattern was Physiotherapy: Osteopathy: Chiropractic. 21% who had never referred patients neither had, nor would consider it for themselves. A small subgroup appeared to manage personal choice differently from patient referral: 5 individuals who had not referred patients either had or would consider it for themselves and 23 of the group that would refer patients neither had nor would seek it for themselves.
  
  
  CONCLUSIONS
  This limited investigation indicates that GP's do practise consistently with guidelines on back pain and utilise SMT as a care option. Although the main option for referral was physiotherapy, slightly over 40% of respondents who expressed a preference would refer to either osteopathy or chiropractic, or both in preference to physiotherapy. There was a small proportion that did not and would not refer patients for SMT regardless of personal use of SMT; these suggested use of acupuncture. Further investigation is needed to determine the alternatives to SMT offered to patients and the decision-making criteria for patient referral to subtypes of SMT practitioner.
authors.affiliation: Welsh Institute of Chiropractic, University of South Wales, Treforest, Pontypridd CF38 2TE, UK.
authors.forename: Annabel
authors.initials: A
authors.lastname: Kier
authors.affiliation: Private Practice, Worthing BN11 1PS, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: George
authors.affiliation: Welsh Institute of Chiropractic, University of South Wales, Treforest, Pontypridd CF38 2TE, UK.
authors.forename: Peter W
authors.initials: PW
authors.lastname: McCarthy
keywords: Referral and personal usage by general practitioners; Spinal manipulative therapy