• Chiropractors adapt care for aging adults based on health, not age alone. • Manual therapy choices vary widely among chiropractors treating aging patients. • Safety concerns drive modifications, despite serious adverse events are rare. • Findings support need to validate self-reported practices through observation. As the population ages, chiropractors are increasingly likely to treat aging patients. Recommendations have been issued to adapt chiropractic care to the comorbidities and musculoskeletal changes associated with aging. However, the specific practices and implementation of these guidelines by individual chiropractors remain unclear. This qualitative study aimed to explore and understand the beliefs, practices, and behaviors of chiropractors in adapting manual therapy care for aging patients. French Canadian chiropractors with at least five years of clinical experience treating adult and aging patients were recruited. Participants completed a preliminary questionnaire to prepare for a one-hour interview conducted via video conference. Interview data were analyzed using thematic analysis. Data sources preliminary questionnaires, researcher notes, interview transcripts, and participants' comments on the interview summaries. The analysis considered both predetermined themes from current guidelines, as well as emerging themes. Nine chiropractors participated in the study. Three key themes emerged: (1) patient-related factors prompting care modification, (2) specific strategies used to modify manual therapy procedures, and (3) underlying motivation and goals. Participants indicated that they adapted care not solely based on age but primarily based on the health conditions of the patient. While some conditions consistently warranted adaptations, other conditions were perceived differently among participants concerning the need for modifications. Although there was general agreement about which techniques applied the highest and lowest forces, there was no consensus on the specific techniques to use when care adaptations were required. Despite this variability, participants shared common goals: preventing adverse events and minimizing potential legal repercussions. Chiropractors demonstrated significant variability in their rationale for care modifications and choice of manual therapy techniques despite shared safety goals. Further research is needed to assess how closely these self-reported practices align with actual clinical care, potentially improving the consistency and evidence base of chiropractic treatment for aging patients and to develop standardized approaches that balance clinical judgment with evidence-based practice.
Caissy et al. (Fri,) studied this question.