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Change in sense of coherence in patients attending chiropractic care in a practice-based research network

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

Objective: To determine changes in patients’ sense of coherence (SOC) with chiropractic care.

Methods: In addition to socio-demographic data and clinical covariates, baseline and comparative SOC was measured using the SOC-29 survey. Statistical analysis utilized a bootstrap paired t-test with a linear mixed model approach with practitioner as random blocking factor to examine the effects of a number of covariates.

Results: A convenience sample of 1419 responders (1060 females; mean age =40.96 years) comprised our study population. They were highly educated with 87% (N=1240) attaining “some college education” or higher. The majority (N=720; 51%) indicated an MD/DO as their primary care provider. Wellness care and to improve symptoms were the major motivation for care (N=963; 68%). Baseline/comparative SOC scores were 148 (SD=22.19) and 150.70 (SD=23.59) with the observed mean for the bootstrap sample having a difference of 1.989 (95% CI:1.299, 2.759) at p=0.005 of the detected difference. We found minimal evidence (p>0.05) that covariates (i.e., age, gender, visit number, patient status, educational level, primary provider, motivation for care and duration of pain complaint) played a role in SOC change.

Conclusion: The SOC of patients significantly increased with a course of chiropractic care.

Highlights of Study

  • Patients under chiropractic care improve in their sense of coherence as measured by the SOC-29. The improvement in SOC was determined to increase beyond chance
  • The important co-variates to changing patients’ SOC were
  • Level of Education: Patients with higher levels of education suggest that patient’s very high and very low education have less potential to change their SOC.
  • Number of Visits - highest predicted change in SOC is found at approximately 15 prior visits. For more or less visits than 15, the predicted change in SOC decreases steeply. This would suggest that too few of visits has a weaker effect on changes in SOC and then there is a point where the change in SOC from visits plateaus.
  • To the Question in the SOC questionnaire that: When you talk to people, they don’t understand you - patients who mark 1 (i.e., Never) are predicted to have a drastically lower predicted change in SOC. Patient’s who mark 2 through 7 are not predicted to have notable differences from each other. In other words – patients that do not feel that they are not being listened have a larger change in their SOC with chiropractic care.
  • Age – with adult patient’s increasing age, the changes in their SOC is greater.
  • #Visits from T1-T2: With increasing number of visits, we see larger and larger changes (increases in SOC with chiropractic care). However, after 20 visits, we see smaller changes in SOC but with increasing patient age, we observe higher SOC measures.
  • SOC Subdomains: In terms of the subdomains of SOC, we find that Meaning > Manageability > Comprehensibility in terms of what contributes to changes in SOC. What does this mean: If patients understand the meaning of their care, its relatively more important than if they comprehend why they need care followed by how they will be managed with chiropractic.

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