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Comparing the safety and effectiveness of Australian physiotherapists, chiropractors and osteopaths

Photo: Jesper Aggergaard on Unsplash
In a six-year study comparing complaints against physiotherapists, chiropractors and osteopaths in Australia, researchers at the University of Melbourne found the majority of practitioners not receiving any complaints registered with regulators – all three fields achieving a rate of higher than 90% satisfaction.

All 39,225 registered Australian practitioners across the three musculoskeletal therapies were included in the study: 31,534 physiotherapists; 5,450 chiropractors; and 2,241 osteopaths.

Chiropractors amassed the highest rate of complaints (at 29 complaints per 1000 practice years) compared to osteopaths (10 complaints per 1000 practice years) and physiotherapists (5 complaints per 1000 practice years), however the research indicated these complaints were clustered around a small number of practitioners, approximately 1.3% of those included in the study.
The types of complaints studied were categorised into professional conduct, performance issues and health concerns.

Performance Concerns
  • Procedures
  • Treatment ie. exacerbation of condition, incompetent administration of treatment
  • Communication
  • Assessment/diagnosis

Professional Conduct
  • Advertising/professional titles/anti-competitive behaviour
  • Sexual boundaries
  • Fees/honesty
  • Interpersonal behaviour ie. bullying
  • Records/reports
  • General conduct

Health Concerns
  • Impairment affecting work ability

Across all three professions, around one fifth of complaints raised concerns about the treatment provided (chiropractors: 19.9% vs osteopaths: 19.7% vs physiotherapists: 21.7%). The researchers linked this finding to a UK study of osteopathic complaints found clinical care concerns were most commonly around inappropriate treatment, or treatment not justified, forceful treatment, treatment that caused new or increased pain or injury, and treatment administered incompetently.

Within the 11 specific complaint issues, chiropractors had a higher complaint rate for all classifications, though differences in rates of complaints about assessment/diagnosis and communication were not statistically significant.
Nearly 8% of physiotherapy complaints came from their employers, which may reflect the fact that physiotherapists are more likely to work as employees within public sector organisations in comparison to osteopaths and chiropractors.
Australian Physiotherapy Association (APA) National President Phil Calvert was quoted with the release of the report, saying,

“These figures illustrate the strong history of self-regulation that exists within the physiotherapy profession in this country. It is something we are proud of and regularly promote to our members, that if they are concerned about their colleagues’ professional standards, they should question it rather than turn a blind eye.”

Across all three professions, practitioners aged 66 years or older had a higher rate of complaints compared to those aged 35 years and younger. Male practitioners had 2.4 times the rate of being the subject of a complaint compared with their female peers.

The finding that older and male practitioners had a higher rate of complaints than female practitioners is consistent with Australian and international studies in medicine.

Given the differences in regulation between the professions, the researchers reflected on the opportunity to use such data in designing interventions to support musculoskeletal therapy professionals in improving their services and the experiences of their patients. While physiotherapy is an internally regulated profession, complaints against osteopaths were often referred to another agency, and chiropractor complaints took longer to resolve, and with more serious outcomes such as suspension of registration, than compared to the processes used in the physiotherapy industry.

In a statement provided to Allied Health Professionals Australia, a contact from Osteopathy Australia said,

Osteopathy Australia welcome such research as it demonstrates that Osteopathy continues to be a safe profession where the vast majority of our members maintain high professional standards of care. It also demonstrates that some special interest groups that have targeted osteopathy with AHPRA complaints should potentially focus their attention on other professions with higher number of complaints lodged, if they truly want to protect the public.

This study was funded by the National Health and Medical Research Council (1092933) and the Australian Health Practitioner Regulatory Agency.

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Sharon Smith

Sharon Smith writes freelance articles as a medical, science and technology specialist. She is researching health journalism at Griffith University and lives mostly on Twitter @smsmithwriter (and would love to hear from you).