The Swiss chiropractic practice-based research network: a population-based cross-sectional study to inform future musculoskeletal research

www.nature.com/scientificreports OPEN The Swiss chiropractic practice‑based research network: a population‑based cross‑sectional study to inform future musculoskeletal research Rahim Lalji 1,2,3, Léonie Hofstetter 1, Alice Kongsted 4,5, Viktor von Wyl 2,6, Milo A. Puhan 2 & Cesar A. Hincapié 1,2,3* The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance musculoskeletal epidemiologic research. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collaboration. A population-based cross-sectional study was performed. PBRN clinician characteristics were described and factors related to motivation (operationalised as VAS score ≥ 70) to participate in a subsequent patient cohort pilot study were assessed. Among 326 eligible chiropractors, 152 enrolled in the PBRN (47% participation). The PBRN was representative of the larger Swiss chiropractic population with regards to age, language, and geographic distribution. Of those enrolled, 39% were motivated to participate in a nested patient cohort pilot study. Motivation was associated with age 40 years or older versus 39 years or younger (OR 2.3, 95% CI 1.0–5.2), and with a moderate clinic size (OR 2.4, 95% CI 1.1–5.7) or large clinic size (OR 2.8, 95% CI 1.0–7.8) versus solo practice. The Swiss chiropractic PBRN has enrolled almost half of all Swiss chiropractors and has potential to facilitate collaborative practice-based research to improve musculoskeletal health care quality. Trial registration: Swiss chiropractic PBRN (ClinicalTrials.gov identifier: NCT05046249); Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020). Musculoskeletal (MSK) pain conditions, such as neck pain and low back pain, are a leading cause of disability globally and are the most prevalent disease area which would benefit from r ehabilitation1. One factor which may contribute to this disability burden is a lack of MSK health care quality2,3. Examples of substandard clinical management of MSK pain include an overutilization of diagnostic imaging, the over prescription of opioids, and the potential underutilization of nonpharmacological approaches4–7. As a large proportion of MSK pain is managed in primary care, efforts to improve the quality of care in these settings, such as the development of practice-based research networks (PBRNs), may play an important role in identifying, studying, and addressing similar practice-based g aps8–10. PBRNs have been conceptualised as groups of at least 15 ambulatory practices or clinicians devoted to the care of patients and affiliated by a mission to investigate questions related to community-based p ractice11. The PBRN structure often transcends a single project, with participating clinicians/clinics engaged in research-related activities on an ongoing basis11. This form of participatory research offers distinct advantages for integrating research into practice and performing translational research10,12. For example, the Australian Chiropractic Research Network (ACORN) is a PBRN within the scope of chiropractic and MSK h ealth13,14. Since launching in 1 EBPI‑UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland. 2Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland. 3University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland. 4Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 5Chiropractic Knowledge Hub, Odense, Denmark. 6Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland. *email: Scientific Reports | (2023) 13:5655 | https://doi.org/10.1038/s41598-023-32437-3 1 Vol.:(0123456789) www.nature.com/scientificreports/ 2015 it has provided the necessary infrastructure to examine a range of questions related to chiropractic patient management15–17. The overarching aim of this study is to describe the characteristics of chiropractors recruited to a newly developed Swiss chiropractic PBRN and the representativeness of the PBRN in comparison to the larger Swiss clinician population to facilitate subsequent collaborative practice-based research. The specific clinical objectives were to assess (1) clinician self-perceived confidence in the management of low back pain; and (2) biomedical versus biopsychosocial treatment orientation in the management of MSK conditions. Our feasibility objectives were to describe (1) the proportion of clinicians opting in for participation in the PBRN; and (2) the proportion of PBRN clinicians who would be motivated to participate in the first nested study (Swiss chiropractic cohort (ChiCo) pilot study) to be conducted through this newly developed PBRN. Motivated PBRN participants will be contacted first to aid in patient recruitment for the Swiss ChiCo pilot study. The Swiss ChiCo pilot study is registered as a 12-week prospective patient cohort pilot study to assess the feasibility of PBRN longitudinal data collection. Methods Study setting and design. The 2020–2025 strategy report of the Swiss Chiropractic Association (Chiro- Suisse) outlines the development of a Swiss chiropractic PBRN as research p riority18. Chiropractic in Switzerland is a government-recognized health profession (alongside medicine, dentistry, veterinary medicine, and pharmacology) which focuses on the management of MSK conditions through primarily manual care19,20. Approximately 98% of all chiropractors in Switzerland are members of ChiroSuisse (personal communication, April 22, 2021), which corresponded to 326 clinician members as of December 2021. Development of the Swiss chiropractic PBRN began in August 2020 through consultation with multiple stakeholder groups including ChiroSuisse, the Swiss Chiropractic Patient Association (Pro Chiropractic Switzerland), a small group of interested Swiss chiropractors, and an international group of MSK health researchers. To promote clinician and patient participant recruitment, our stakeholders outlined the importance of setting both clinical and feasibility primary aims and outcomes during initial project phases. We reported this population-based cross-sectional study according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE for cross-sectional studies) statement (Supplemental Material 1)21. Ethics approval. The Swiss chiropractic PBRN was approved by the independent research ethics committee of Canton Zurich (BASEC-Nr: 2021-01479) and complies with international ethical standards as outlined by the Declaration of Helsinki. Study population and recruitment. All 326 registered active chiropractor members (full (...truncated)