The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique
Joel Alcantara, DC,
Objective: To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women.
Design: A prospective cohort within a practice-based research network (PBRN).
Setting/Locations: Individual chiropractic offices.
Subjects: Pregnant women (age ≥18 years) attending chiropractic care.
Intervention(s): Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies).
Main outcome measures: The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL.
Results: A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate’s degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks (median = 28 weeks; range = 0–42 weeks) and parity (i.e., the number of live births) of 0.92 live births (median = 1; range = 0–6). From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects (i.e., the mean difference of baseline minus comparative measures = −0.7322; p < 0.005). The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 (standard deviation [SD] = 22.69) and 3.30 (SD = 22.71), respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue (p < 0.05), pain interference (p < 0.05), sleep disturbance (p < 0.05), and an improvement in satisfaction with social roles (p < 0.05). A significant decrease was also found with pain interference (p < 0.05). No evidence was found that anxiety (p = 0.1404) or depression (p = 0.8785) changed.
Conclusion: A PBRN study was successfully implemented among chiropractors to find pregnant patients highly satisfied and their QoL scores improving with care beyond chance.Keywords: : chiropractic, pregnancy, quality of life, Webster Technique, PROMISGo to:
According to the Centers for Disease Control and Prevention, the general fertility rate for the United States in 2013 was 62.5 births per 1000 women aged 15–44 years based on 3,932,181 registered births.1During pregnancy, the expectant mother is faced with many physiologic and biomechanical changes that affect her emotional, physical, and mental well-being. Complementary and alternative medicine (CAM) is popular for women of childbearing age with prior use as the most significant independent associated factor for CAM use during pregnancy.2,3 A review of the literature on the use of CAM by pregnant women found varying estimates from 1% to 87%.4 CAM use was to address a variety of complaints such as pregnancy-related musculoskeletal (MSK) pain, nausea and vomiting, problems with labor, postpartum perineal discomfort, lactation disorders, as well as to fulfill their spiritual and emotional needs.2,5–7
Of the various practitioner-based CAM therapies, chiropractic has been shown to be popular among women before, during, and after their pregnancy.8 Chiropractic’s holistic and vitalistic paradigm of care and its effectiveness in addressing the myriad of MSK complaints during pregnancy9,10 make it an attractive CAM option for pregnant women.11,12
As with all healthcare providers (i.e., conventional or alternative), chiropractors must implement and demonstrate effective healthcare interventions throughout a woman’s pregnancy, as well as during the postpartum period. There is anecdotal evidence indicating that pregnant women report improved quality of life (QoL) after receiving chiropractic care. Given societal problems related to overreliance on drugs (e.g., opioids)13 and high rates of postpartum depression and anxiety,14 there is a need to explore alternative solutions to improving maternal QoL. Toward these efforts and in the interest of evidence-informed practice, the authors examined the QoL and visit-specific satisfaction of pregnant women undergoing chiropractic care in a practice-based research network (PBRN). In particular, the authors aimed to: (1) better understand the population of pregnant women seeking chiropractic care during pregnancy; and (2) understand whether these women report less problems with emotional disturbances (i.e., depression, anxiety), sleep disturbance, fatigue, pain, and physical functioning before after receiving chiropractic care.