An article by Cote P et al in Med Care 2001 entitled, “The treatment of neck and low back pain: who seeks care? who goes where?” is quite interesting and definitely can impact our outcomes and results. You can access the abstract here

The authors performed a mail survey looking at the characteristics of individuals who seek care from healthcare professionals: medical doctors, chiropractors or both. They were looking to see if patients sought care in the previous month from a healthcare provider, which was 25%; but one particular conclusion jumped out at me:

Patients consulting chiropractors alone report fewer comorbidities and are less limited in their activities than those consulting medical doctors.

This can have many implications but the one that first comes to mind is that the patients we get from the usual referral patterns seen in the past several decades are worse off than ones who seek care from chiropractors. This can mean it will take longer to get them better and this definitely affects outcomesand results. Or, does this mean that individuals who seek chiropractic care are overall just healthier?? Do chiropractors keep them healthier and in return less comorbidities? Maybe so but I am hoping not.

I can tell you from working in a rural environment and with a population of older age and definitely more comorbidities (high blood pressure, obesity, type II diabetes mellitus); it does affect outcomes. It is more frustrating on the therapist (me) and harder to make goals. I can’t change lifestyle behaviors when all you do is sit on the couch, which in turn leads to having more comorbidites; and resulting in you seeking me for neck and back pain.

Continue to promote Direct Access and this can be another argument for its benefit in physical therapy profession. Patient can bypass the middle man.


  1. Hey Harrison,

    Great post. I agree that pt with many comorbidities have a worse PT prognosis.

    I spoke with a PT in Virginia Beach who uses FOTO (Focus On Therapeutic Outcomes). This program allows the PT to enter the body region, impairment data, functional data and comorbidities into the program and will provide a risk adjusted score, an average score for a similar pt, and expected change in outcome compared to similar pts. This allows the PT to compare his case to other PTs or clinics regardless if he sees healthier or sicker patients. This would be interesting way to analyze the data from the above study.

    1. Hey thanks for sharing this Eric. I know we have spoke about FOTO before.

      Does anyone out there use FOTO? Do you think this will be the future of our profession with insurance…getting paid for the outcomes?

  2. HV,

    I have a colleague who is a DC and Manual trained PT – we went to school together. His observations as both were that people who came to see him or DC colleagues were those who seemed to meet CPRs – as in overall healthier, acute, and rapid responders. He felt like the patients who did not come in for DA for PT were the chronic or lateral shifts with radiating pain and neuro signs… etc.. Seems like that was backed up in the study you reviewed.

    That’s why I market to my patients to come back if you flare up AND your HEP is not sufficient if you double down on compliance. Then I get them acute and d/c them back happy in 1-2 visits.

    1. E.,
      Thanks for the comment and I think what you speak of through your colleague is what we are seeing across the country. I should do it but just haven’t, but write down the days post-injury that come to me typically thru a MD and then do the same thing with my DA patients and compare the visits they have to have to get better. I don’t like to guarantee anything but will bet my bottom dollar it is half.

      We have this in the research…but just isn’t going anywhere.

      Wonder if we can get a project with PTs across the country to do them own statistics and post them?


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