Dynamic Chiropractic – June 15, 1998, Vol. 16, Issue 13

Paper Authored Primarily by Chiropractors is First Published in APHA Journal

By Editorial Staff

There is a lack of data on chiropractic use, and the best of that data is a decade old.1 Now the American Journal of Public Health has published a paper authored predominantly by doctors of chiropractic, a first for that publication.

The study, "Use of Chiropractic Services from 1985 through 1991 in the United States and Canada," reveals that the number of visits to chiropractors at the sites studied is twice that of estimates made 15 years ago.2

This paper presents "demographic and clinical characteristics" of chiropractic patients, documenting chiropractic visits in San Diego, CA; Portland, OR; Vancouver, WA; Minneapolis-St. Paul, MN; Miami, FL; and Toronto, Ontario, Canada.

The study presents these interesting particulars:

  • Patients were primarily middle-aged (30-50) and married, with a "slight preponderance of women."

  • About two-thirds of the patients had low-back pain; head/neck pain and extremity problems were the other predominant complaints.
Patients presenting with nonmusculoskeletal symptoms represented less than 10% of all patients in the sample. (Please see the graph on the front page of this issue for a complete breakdown.)
  • "More than 40% of the patients with low-back pain had acute (<3 weeks) episodes; about 20% and chronic (>6 months) episodes."

  • "Patients with low-back pain had a mean of 14 visits (median=7) per episode of care, which lasted a mean of 60 days (median=29)."

  • Visit rates among the U.S. sites "were not appreciably different form each other."

  • "A small proportion of patients who are frequent or long-term users of chiropractic services cause the distributions of visits and episode length to be skewed to the right."
The research was conducted by doctors from both Los Angeles College of Chiropractic and the RAND Corporation in Santa Monica, California. Researchers Eric Hurwitz, DC, PhD, Ian Coulter, PhD, Barbara Genovese, MA, and Paul Shekelle, MD, PhD, are with the RAND Corp. Drs. Hurwitz and Coulter are also associated with the Los Angeles College of Chiropractic, and Dr. Hurwitz with the Dept. of Epidemiology, UCLA School of Public Health. Dr. Shekelle is also with the Veterans Affairs Health Services Research and Development Service of Los Angeles. Dr. Adams is with the Los Angeles College of Chiropractic.

The American Journal of Public Health (AJPH) is published by the American Public Health Association, which has an aggregate membership of over 50,000 worldwide. The AJPH has a circulation of over 36,000. This is apparently only the third or fourth paper regarding chiropractic published in the AJPH's 88 year history.


  1. Shekelle PG, Brook RH. A community-based study of the use of chiropractic services. Am J Public Health. 1991;81:439-442.
  2. Hurwitz E, Coulter I, Adams A, Genovese B, Shekelle P. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health. 1998;88(5);771-776. This paper was supported in part by grants from the Consortium for Chiropractic Research and the Foundation for Chiropractic Education and Research.


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