A Survey of the Scope of Chiropractic Practice in South Africa: 2015
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Monday, January 15, 2018 08:47 AM

The purpose of this study was to identify characteristics specific to the chiropractic profession in South Africa and compare them with those of other countries where similar surveys have been conducted.  Compared with similar survey analyses from Switzerland, the United Kingdom, and the United States,  findings showed overlap, but some characteristics were unique to the chiropractic profession in South Africa.

This survey utilized a structured questionnaire designed to reflect chiropractic practice in South Africa. The questionnaire was made available online for completion by 714 chiropractic practitioners who were registered with the Allied Health Professions Council of South Africa in 2015. Participation was both voluntary and anonymous.

The response rate was 32%; of the respondents, 56% were males and 44% were females. The majority of the respondents had a master’s degree in chiropractic. Most participants worked between 31 and 40 hours and saw fewer than 50 patients per week, typically allocating 31 to 45 minutes for initial consultations and 16 to 30 minutes for follow-up visits. Participants saw more female patients than male patients, and most patients were between the ages of 31 and 50 years. Patients typically presented to chiropractors during the acute phase, the primary complaint was low back and pelvic pain/injury without leg pain, and overuse/repetitive stress was reported as being the common etiology. Chiropractors have developed interprofessional referral relationships with general practitioners and massage therapists.

The educational model implemented in SA consists of a 5-to-6-year master’s degree thus, 91.3% of the respondents in SA have master’s degrees in chiropractic. In comparison, accredited chiropractic programs in the US typically consist of 4 to 5 academic years, and graduates are awarded the Doctor of Chiropractic (DC) degree.

The majority of chiropractors in SA indicated also having other, nonchiropractic qualifications. The majority (56.9%) specified a first degree following completion of secondary school education, 16% indicated another master’s degree, 12.2% indicated a postgraduate qualification below the level of master’s, and 2.1% indicated a doctorate outside the field of chiropractic.

The source reported to yield the most new patients (>50% of patients) was by word of mouth, followed by the sign/practice location, and then referrals from medical doctors and other health care providers. The least likely sources of new patients were from the AHPCSA and the Chiropractic Association of South Africa (CASA) websites.

Practitioners spent most of their time on direct patient care and patient education. Almost half of chiropractors in SA reported that they were the sole practitioner in their practice, whereas the others practiced within a multidisciplinary setting or with other chiropractors. Practitioners typically practiced from only one office location and occasionally provided chiropractic care outside of the office setting.

The majority of respondents (82.5%) reported not taking radiographs in their practice environment, and the vast majority (95.8%) of these respondents referred patients to an imaging center or hospital when imaging was needed. Of the remaining 17.5% of practitioners who took radiographs in their practice environment, the majority (73.1%) did not delegate taking radiographs to nonchiropractic staff members.

The majority of chiropractors (60.6%) indicated that a radiologist normally interpreted radiographs, and the practitioner often also drew his or her own conclusions from the radiographs. Some chiropractors (37.1%) actively interpreted the radiographs even if they had a radiologist report. Radiographic examination was indicated for less than 20% of chiropractic patients, Advanced diagnostic imaging examination, such as magnetic resonance imaging and computed tomography scans, were indicated for less than 10% of their patients.

In terms of the development of the radiographs, of the 17.5% of practitioners who indicated that they did take radiographs in their practices, the majority (84.4%) stated that they developed the radiographs themselves, and the remainder delegated this activity to a nonchiropractic staff member. The majority of the practitioners (85.4%) also indicated that they did not delegate other activities, such as the administration of adjunctive therapies, to a nonchiropractic member of their staff.

Diversified adjusting techniques were the most common treatment protocol used, followed by advice on activities of daily living. The least common therapies include network technique and trigger point injections.

The most frequent referrals to chiropractors during 2014 were from general practitioners, followed by massage therapists. The least likely sources of professional referrals were from physiatrists, orthopedic technicians, and internists.  Chiropractors reported that during 2014, they most frequently referred patients to general practitioners, followed by referrals to massage therapists. Chiropractors were least likely to refer patients to physiatrists, orthopedic technicians, and internists.

The most prevalent complaint reported was low back pain and pelvic pain/injury without leg pain. Abdominal pain/injury and other nonmusculoskeletal conditions were the least common complaints presenting to chiropractic practices. Overuse/repetitive stress were the most common primary etiologies for patients’ chief complaints reported by practitioners.

Although chiropractic services in SA are covered by most of the medical aid schemes, as well as the Compensation for Occupational and Diseases Act in SA, by 2014, only 18.6% of the population of an estimated 54 million was covered by a medical aid scheme.  Furthermore, 61.2% of the population in SA was more likely to seek primary care from public sector doctors, clinics, and hospitals, and 38.8% had access to primary care from private sector doctors, clinics, hospitals, and other nonpublic facilities.