Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice

Simon D French, Melanie J Charity, Kirsty Forsdike, Jane M Gunn, Barbara I Polus, Bruce F Walker, Patty Chondros and Helena C Britt
Med J Aust 2013; 199 (10): 687-691. || doi: 10.5694/mja12.11851


Objectives: COAST (Chiropractic Observation and Analysis Study) aimed to describe the clinical practices of chiropractors in Victoria, Australia.

Design: Cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice.

Setting and participants: 180 chiropractors in active clinical practice in Victoria were randomly selected from the list of 1298 chiropractors registered on Chiropractors Registration Board of Victoria. Twenty-four chiropractors were ineligible, 72 agreed to participate, and 52 completed the study.

Main outcome measures: Each participating chiropractor documented encounters with up to 100 consecutive patients. For each chiropractor–patient encounter, information collected included patient health profile, patient reasons for encounter, problems and diagnoses, and chiropractic care.

Results: Data were collected on 4464 chiropractor–patient encounters from 52 chiropractors between 11 December 2010 and 28 September 2012. In most (71%) encounters, patients were aged 25–64 years; 1% of encounters were with infants (age < 1 year; 95% CI, 0.3%–3.2%). Musculoskeletal reasons for encounter were described by patients at a rate of 60 per 100 encounters (95% CI, 54–67 encounters) and maintenance and wellness or check-up reasons were described at a rate of 39 per 100 encounters (95% CI, 33–47 encounters). Back problems were managed at a rate of 62 per 100 encounters (95% CI, 55–71 encounters). The most frequent care provided by the chiropractors was spinal manipulative therapy and massage.

Conclusions: A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related. These results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

  • Simon D French1,2
  • Melanie J Charity1
  • Kirsty Forsdike1
  • Jane M Gunn1
  • Barbara I Polus3
  • Bruce F Walker4
  • Patty Chondros1
  • Helena C Britt5

  • 1 General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, VIC.
  • 2 School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada.
  • 3 Research and Innovation, RMIT University, Melbourne, VIC.
  • 4 Discipline of Chiropractic, School of Health Professions, Murdoch University, Perth, WA.
  • 5 Family Medicine Research Centre, Sydney School of Public Health, University of Sydney, Sydney, NSW.



This study was funded by the Chiropractors Registration Board of Victoria and the Chiropractors Association of Australia. The funding bodies provided general advice about the design of the project but had no role in the conduct of the study or in the decisions about publication of the results. We thank the members of the Advisory Committee of chiropractic professional organisations including: Amanda Kimpton (Chiropractic Board of Australia), Simon Floreani (Chiropractors Association of Australia), Navine Haworth (Discipline of Chiropractic, School of Health Sciences, RMIT University), John Reggars (Chiropractic and Osteopathic College of Australasia) and Margaret Nicholls (consumer). We thank Maria Potiriadis for project planning advice during the course of the project. We thank the chiropractor and patient participants for their efforts in participating in this study.

Competing interests:

No relevant disclosures.

  • 1. Chiropractic Board of Australia, Australian Health Practitioner Regulation Agency. Chiropractic registrant data: March 2013. (accessed Oct 2013).
  • 2. Australian Health Practitioner Regulation Agency. 2011–12 annual report: AHPRA and national boards. (accessed Oct 2013).
  • 3. Xue CC, Zhang AL, Lin V, et al. Complementary and alternative medicine use in Australia: a national population-based survey. J Altern Complement Med 2007; 13: 643-650.
  • 4. Xue CC, Zhang AL, Lin V, et al. Acupuncture, chiropractic and osteopathy use in Australia: a national population survey. BMC Public Health 2008; 8: 105.
  • 5. MacLennan AH, Morrison RG. Tertiary education institutions should not offer pseudoscientific medical courses. Med J Aust 2012; 196: 225-226. <MJA full text>
  • 6. Report of the Committee of Inquiry into Chiropractic, Osteopathy, Homoeopathy and Naturopathy. Canberra: Australian Government Publishing Service, 1977.
  • 7. Ebrall PS. A descriptive report of the case-mix within Australian chiropractic practice, 1992. Chiropr J Aust 1993; 23: 92-97.
  • 8. Ebrall PS. A description of chiropractic and osteopathic practice in the state of Victoria, Australia, for 1989. Chiropr J Aust 1992; 22: 92-97.
  • 9. Leboeuf C. A survey of registered chiropractors practising in South Australia in 1986. J Aust Chiropr Assoc 1988; 18: 105-110.
  • 10. Leboeuf C, Webb MN. Recently graduated chiropractors in Australia, part 1: personal and professional demographic profile. J Aust Chiropr Assoc 1987; 17: 99-102.
  • 11. Leboeuf C, Webb MN. Recently graduated chiropractors in Australia, part 2: certain professional attitudes and practice characteristics. J Aust Chiropr Assoc 1987; 17: 151-154.
  • 12. Leboeuf C, Webb MN. Recently graduated chiropractors in Australia, part 4: diagnostic procedures. J Aust Chiropr Assoc 1988; 18: 60-62.
  • 13. Leboeuf C, Webb MN. Recently graduated chiropractors in Australia, part 5: therapeutic procedures. J Aust Chiropr Assoc 1988; 18: 128-130.
  • 14. Mootz RD, Cherkin DC, Odegard CE, et al. Characteristics of chiropractic practitioners, patients, and encounters in Massachusetts and Arizona. J Manipulative Physiol Ther 2005; 28: 645-653.
  • 15. Blum C, Globe G, Terre L, et al. Multinational survey of chiropractic patients: reasons for seeking care. J Can Chiropr Assoc 2008; 52: 175-184.
  • 16. Coulter ID, Hurwitz EL, Adams AH, et al. Patients using chiropractors in North America: who are they, and why are they in chiropractic care? Spine (Phila Pa 1976) 2002; 27: 291-296; discussion 297-298.
  • 17. Dunn AS, Passmore SR. Consultation request patterns, patient characteristics, and utilization of services within a Veterans Affairs medical center chiropractic clinic. Mil Med 2008; 173: 599-603.
  • 18. Hurwitz EL, Coulter ID, Adams AH, et al. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health 1998; 88: 771-776.
  • 19. Leboeuf-Yde C, Hennius B, Rudberg E, et al. Chiropractic in Sweden: a short description of patients and treatment. J Manipulative Physiol Ther 1997; 20: 507-510.
  • 20. Rubinstein S, Pfeifle CE, van Tulder MW, Assendelft WJ. Chiropractic patients in the Netherlands: a descriptive study. J Manipulative Physiol Ther 2000; 23: 557-563.
  • 21. Assendelft WJ, Pfeifle CE, Bouter LM. Chiropractic in The Netherlands: a survey of Dutch chiropractors. J Manipulative Physiol Ther 1995; 18: 129-134.
  • 22. Christensen MG, Kollasch MW, Martin W, Hyland JK. Practice analysis of chiropractic: a project report, survey analysis and summary of the practice of chiropractic within the United States — 2010. Greeley, Colo: National Board of Chiropractic Examiners, 2010.
  • 23. Britt H, Miller G, Henderson J, et al. General practice activity in Australia 2011–12. General practice series no. 31. Sydney: Sydney University Press, 2012.
  • 24. Britt H, Miller G, Bayram C. The quality of data on general practice - a discussion of BEACH reliability and validity. Aust Fam Physician 2007; 36: 36-40.
  • 25. Dillman DA. Mail and internet surveys: the tailored design method: with new internet, visual, and mixed-mode guide. 2nd ed. Hoboken, NJ: John Wiley & Sons, 2007.
  • 26. Classification Committee of the World Organization of Family Doctors (WONCA). ICPC-2. International Classification of Primary Care, 2nd ed. Oxford: Oxford University Press, 1998.
  • 27. University of Sydney Family Medicine Research Centre. ICPC-2 Plus: the BEACH coding system. (accessed Oct 2013).
  • 28. Hawk C, Schneider M, Evans MW Jr, Redwood D. Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness. J Manipulative Physiol Ther 2012; 35: 556-567.
  • 29. Leboeuf-Yde C, Hestbaek L. Maintenance care in chiropractic–what do we know? Chiropr Osteopat 2008; 16: 3.
  • 30. Charity MJ, French SD, Forsdike K, et al. Extending ICPC-2 PLUS terminology to develop a classification system specific for the study of chiropractic encounters. Chiropr Man Therap 2013; 21: 4.
  • 31. Knox SA, Chondros P. Observed intra-cluster correlation coefficients in a cluster survey sample of patient encounters in general practice in Australia. BMC Med Res Methodol 2004; 4: 30.
  • 32. World Health Organization. WHO guidelines on basic training and safety in chiropractic. Geneva: WHO, 2005. (accessed Oct 2013).
  • 33. Eaton S, Bonello R, Fernandez-Caamano R, et al. Demographic characteristics and perceptions of supply and demand of chiropractic services in Australia: results from stage 1 of the work force study survey. Chiropr J Aust 2012; 42: 82-90.
  • 34. Walker BF, French SD, Page MJ, et al. Management of people with acute low-back pain: a survey of Australian chiropractors. Chiropr Man Therap 2011; 19: 29.
  • 35. Bridges-Webb C. The Australian general practice morbidity and prescribing survey, 1969 to 1974. 2. Method, analysis and limitations. Med J Aust 1976; 2 (I Suppl): 6-7.
  • 36. Bridges-Webb C. The Australian general practice morbidity and prescribing survey, 1969 to 1974. The Royal Australian College of General Practitioners. 1. Introduction. Med J Aust 1976; 2 (I Suppl): 5-6.
  • 37. Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009; 9: 160.


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