Background: An increasing number of mixed methods studies have been conducted across health care professions in recent years. However, little is known about the methodological reporting quality among mixed methods studies involving chiropractic research.
Objective: To examine the methodological quality of published chiropractic mixed methods studies, provide recommendations for improving future chiropractic mixed methods research, and apply these recommendations in two mixed methods health services evaluations of chiropractic integration and prescription opioid use for spinal pain. Methods: We conducted a meta-epidemiological review of the chiropractic mixed methods literature and examined reporting quality using the Good Reporting of A Mixed Methods Study guideline and risk of bias using the Mixed Methods Appraisal Tool. We used generalized estimating equations to explore factors associated with higher methodological quality. We applied our findings in two sequential explanatory mixed methods investigations of the association between chiropractic care and opioid prescribing for non-cancer spinal pain.
Results: Among eligible mixed methods studies, we found that many were both poorly reported and at risk of bias. Publication in journals with an impact factor and/or more recent publication were significantly associated with higher methodological quality. In our sequential explanatory analyses, we found that receipt of chiropractic care was associated with decreases in initial opioid prescribing and long-term opioid use, and our qualitative results suggested these relationships were multi-factorial. Conclusion: We identified areas for improvement in the methodological reporting quality of chiropractic mixed methods research. Our mixed methods studies suggest that integration of chiropractic services into primary care centres may reduce the use of opioids for spinal pain. / Thesis / Doctor of Philosophy (PhD) / We reviewed the literature to assess the methodological reporting quality of mixed methods studies involving chiropractic research and found that most studies had important omissions. We applied these results to optimize methodologic reporting of two mixed methods studies on the association between chiropractic care and opioid prescribing. We found that patients with non-cancer spinal pain were less likely to receive an initial prescription for opioids if they accessed chiropractic care. Further, among chronic pain patients receiving opioids, we found that providing access to chiropractic care reduced their chances of continuing to receive opioids. The qualitative aspect of our studies provided important context to inform how patients and their primary care providers felt access to chiropractic care had reduced reliance on prescription opioids. These findings will increase awareness among researchers for opportunities to improve reporting quality of mixed methods research and highlight the potential role of chiropractic care in helping to address the opioid crisis.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/27846 |
| Date | January 2022 |
| Creators | Emary, Peter |
| Contributors | Busse, Jason W, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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