title: Perceived value of spinal manipulative therapy and exercise among seniors with chronic neck pain: a mixed methods study.
abstract: OBJECTIVE
  To explore perceptions of spinal manipulative therapy and exercise among adults aged 65 years and older with chronic neck pain.
  
  
  METHODS
  Mixed methods study embedded within a randomized clinical trial.
  
  
  METHODS
  Interviews were conducted with 222 of 241 randomized clinical trial participants. They had a mean age of 72.2 years and they had neck pain of moderate severity and of 6 years mean duration.
  
  
  METHODS
  Semi-structured interviews were conducted at the completion of the 12 week intervention phase, during which participants received spinal manipulative therapy and exercise interventions. Interviews explored determinants of satisfaction with care, whether or not therapy was worthwhile, and what was liked and disliked about treatment. Interviews were recorded and transcribed; content analysis was used to identify themes within responses.
  
  
  RESULTS
  Participants placed high value on their relationships with health care team members, supervision, individualized care, and the exercises and information provided as treatment. Change in symptoms did not figure as prominently as social and process-related themes. Percpetions of age, activities, and co-morbities influenced some seniors' expectations of treatment results, and comorbidities impacted perceptions of their ability to participate in active care.
  
  
  CONCLUSIONS
  Relationship dynamics should be leveraged in clinical encounters to enhance patient satisfaction and perceived value of care.
authors.affiliation: Northwestern Health Sciences University, Wolfe-Harris Center for Clinical Studies, Bloomington, MN, USA. mmaiers@nwhealth.edu.
authors.forename: Michele
authors.initials: M
authors.lastname: Maiers
authors.forename: Corrie
authors.initials: C
authors.lastname: Vihstadt
authors.forename: Linda
authors.initials: L
authors.lastname: Hanson
authors.forename: Roni
authors.initials: R
authors.lastname: Evans
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D059350:Chronic Pain / Q000534:rehabilitation*; D015897:Comorbidity; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000534:rehabilitation*; D017060:Patient Satisfaction; D036301:Qualitative Research; D016896:Treatment Outcome