Pregnancy is a time of massive change – mentally, emotionally, hormonally and biomechanically. It is also a time when many women look for other options in order to manage various health challenges during their pregnancy. Of course, chiropractic care rates among the many, women choose during this time. Therefore a recently-published report, which examined the quality of life and visit-specific satisfaction of pregnant women receiving chiropractic care, will be of interest to chiropractors who support expectant parents during this challenging and exciting period of their lives.
It was a quality-of-life focused project undertaken by Dr Joel Alcantara and his colleagues for a number of reasons. They wanted to better understand the population (pregnant women seeking chiropractic care during pregnancy) and to understand whether these women “report less problems with emotional disturbances (i.e, depression, anxiety), sleep disturbance, fatigue, pain and physical functioning before and after receiving chiropractic care [1].”
The survey-based study took place in a practice-based research network and looked specifically at the Webster Technique. This technique is often used with pregnant patients due to its goal – to reduce the effects of sacral subluxation & facilitate neuro-biomechanical function in the pelvis [2].
For the purpose of this particular paper, the PROMIS-29 questionnaire was used alongside the RAND VSQ9 (or visit-specific satisfaction instrument). The PROMIS-29 survey contains seven domains, which cover the “most relevant areas of self-reported health for the greatest majority of people with chronic illness.” Each of the seven domains contains 4 questions rated on a Likert scale [3].
Gaining an understanding of the cohort
The first part of the report focused on the important task of gleaning more understanding of the cohort. It was interesting to note that, of the 343 pregnant participants, the average age was 30.96 and the participants were found to be “highly educated with the vast majority attaining a college education or above [1].” This education status statistic accounted for 76% of respondents with the remaining 24% having some college education or having graduated from high school. On average, they presented for care in their 25th week of pregnancy. This gives a little insight into the type of person who seeks out chiropractic care during these expectant months.
75% of respondents “indicated that their primary provider was aware of their consultation and care with a chiropractor. This includes women (N = 48; 14%) who reported that their provider was aware and referred them to chiropractic. The referral came from midwives (N = 28; 8%) followed by nurse-midwife (N = 11; 3%), obstetrician/gynaecologists (N =7; 2%), and medical physicians (N = 2; < 1%).” While the lowest referral types came from OB/GYN’s and medical doctors, perhaps an unsurprising fact, the researchers noted a significant relationship between the provider types and the knowledge of chiropractic.
While the full report gives a far more detailed statistical breakdown of the reasons patients presented for chiropractic care, it is a worthy note that 41% of them presented for both musculoskeletal pain and wellness care.
The study was based in America and Canada, yet it gives us an indication of where our lowest and highest referrers are likely to be, and thus where our partnership and promotion efforts would do best when it comes to getting the word out about the benefits of chiropractic care during pregnancy. More broadly speaking, the survey data captured a good picture of the “who” and “why” behind pregnant patients use of chiropractic care, making this paper an invaluable tool for chiropractic communicators.
Quality of life results
The quality of life results of the study also contained some revealing findings. The authors noted “This is the first study to systematically evaluate the changes in a number of domains of QoL [quality of life] among pregnant women [1].” This alone makes the paper a significant one.
Another interesting note was that the patients presented with “fairly good” quality of life across all domains, yet still there were variances. Encouragingly, the study showed significant differences between the baseline data and the data captured at re-evaluation following a course of chiropractic care. Among the significant improvements reported by participants was:
- Statistically significant reductions in scores associated with fatigue, pain interference, and sleep disturbance, and;
- an increase in scores associated with participation in social roles following a course of chiropractic (despite a lack of evidence that anxiety and depression had changed).
The researchers noted, “Their use of the PROMIS-29 instrument demonstrated statistically significant changes in mean T scores from baseline to comparative measures suggesting that overall, the QoL of pregnant patients under chiropractic care improved [1]. “
The sample was a convenience sample, and the self-reported nature of it allows for some recall bias. Still the authors put a number of strategies in place to mitigate the risks associated with the study’s limitations. Their confidence in the process lead them to state that they found participants to be “highly satisfied with their visit [to a chiropractor] and following a course of chiropractic care, their QoL measures improved beyond statistical significance. [1] “
It’s a strong statement, but encouragingly, its one backed by data.
The issue of chiropractic care and quality of life is one that is seems to be gaining attention. While it may have been a vague construct in the past, survey’s like this (along with the other studies contributing to this conversation) are helping to clear up what is meant by “quality of life” and give strong indications of how chiropractic care for the removal of subluxations can impact it.
We have to say, we like where this conversation seems to be going.
References
[1] Alcantara J, Nazarenko AL, Ohm J, Alcantara J (2018), “The use of the patient reported outcomes measurement information system and the RAND VSQ9 to measure the quality of life and visit specific satisfaction of pregnant patients under chiropractic care utilizing the webster technique,” Journal of Alternative and Complementary Medicine, Vol. 24 Number 1, 2018, pp. 90-98, DOI: 10.1089/acm.2017.0162, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779240/ retrieved 13 June 2-18
[2] Staff Writer, “About the Webster Technique,” ICPA 4 Kids, https://icpa4kids.com/training/webster-certification/webster-technique/ retrieved 2 July 2018
[3] Staff Writer (2018), “PROMIS-29 Overview” https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/402087/Overview-of-the-PROMIS-29_EH-140817.pdf Retrieved 2 July 2018.
