Abstract

The predictive relationship between quality of life domains and sense of coherence among chiropractic patients presenting for care in a practice-based research network.

Joel Alcantara, DC, Andrew Whetten, MS, Jeanne Ohm, DC, and Joey Alcantara

Objective: To assess the predictive relationship between various quality of life (QoL) domains and sense of coherence (SOC).

Methods: We measured the SOC and QoL of patients using the SOC-29 and the Patient-Reported Outcomes Measurement Information System, respectively. Predictive relationships utilized random forest regression analysis.

Results:
Our convenience sample consisted of 1980 responders (average age=40.72 years; 1494 females). The mean SOC score was 148.3 (SD=22.37). The mean PROMIS T scores were: physical functioning (50.97), anxiety (52.03), depression (47.47), fatigue (51.15), sleep disturbance (49.85), ability to participate in social roles and activities (54.44), pain interference (51.27), global physical health (GPH) (49.34) and global mental health (GMH) (50.7). The variable importance plots indicated that GMH, anxiety, and depression were several magnitudes higher as predictors for SOC compared to physical domains (i.e., physical functioning, pain interference). However, multi-dimensional partial dependence plots demonstrated an interaction between physical domains such as fatigue and sleep disturbance to SOC. Therefore, physical domains of QoL cannot be discredited as nonessential in the prediction and understanding of a person’s SOC.

Conclusion
Despite the strong predictive relationship of mental health domains to SOC, physical domains cannot be discounted as playing a role.

Highlights of Study

• Patients presenting for chiropractic care have relative low Sense of Coherence as measured by the SOC-29. In other words, their ability to handle stress (traumas, thoughts, and toxins) is more compromised
• The quality of life of patients presenting for chiropractic care are compromised as measured by PROMIS-29 and PROMIS Global Health. Their quality of life is similar to other chiropractic patients presenting with chronic problems and compromised quality of life.
• Although chiropractors are effective in addressing the physical complaints of their patients, we found that to increase patients’ sense of coherence, you need to address their mental health. Using a machine learning technique called Random Forest Analysis, we were able to determine that mental health quality of life domains such as General Mental Health, anxiety and depression were several magnitudes higher as important predictors for improving SOC compared to physical domains (i.e., physical functioning, pain interference). However, multi-dimensional partial dependence plots demonstrated interaction between physical domains such as fatigue and sleep disturbance to SOC.

Presented at ACC-RAC 2019: Baltimore, MD Mar 14-16, 2019