Factors that contribute to the perceived effect of spinal manipulative therapy: A qualitative study

Abstract

Background: Despite the progress that has been made to better understand the potential mechanisms of SMT and its treatment effects, a knowledge gap continues to exist when it comes to identifying the specific factors that contribute to the effective utilization of SMT. The purpose of the study was to explore the perceptions of chiropractic clinicians, interns, and patients regarding what factors during a doctor-patient encounter contribute to the perceived treatment effect associated with SMT. Methods: Participants were recruited from a chiropractic teaching clinic in the United States using convenience sampling. Semi-structured interviews were used as the main form of data collection, which took place from January-April 2024. The data was subsequently analyzed using a grounded theory approach and organized into themes through an iterative open coding process. Results: Six rounds of interviews were conducted for a total of 18 interviews. Each round consisted of one patient who received treatment including SMT, one intern who performed the treatment, and one clinician who oversaw the treatment. After analyzing the interview data, the following five themes were identified: Psychomotor Skills, Treatment Outcome, Significance of Cavitation, Adjunctive Therapies, and Therapeutic Alliance. Conclusion: This qualitative study identified several themes which describe factors that may contribute to the perceived effect associated with SMT. In addition to the psychomotor skills required to perform SMT, educators and practitioners should consider factors such as the therapeutic alliance between patient and provider, use of adjunctive therapies, and assessment of the outcome associated with the intervention.