Complaints about chiropractors, osteopaths, and physiotherapists: a retrospective cohort study of health, performance, and conduct concerns.

Background: Recent media reports have highlighted the risks to patients that may occur when practitioners in the chiropractic, osteopathy and physiotherapy professions provide services in an unethical or unsafe manner. Yet research on complaints about chiropractors, osteopaths, and physiotherapists is limited. Our aim was to understand differences in the frequency and nature of formal complaints about practitioners in these professions in order to inform improvements in professional regulation and education. Methods: This retrospective cohort study analysed all formal complaints about all registered chiropractors, osteopaths, and physiotherapists in Australia lodged with health regulators between 2011 and 2016. Based on initial assessments by regulators, complaints were classified into 11 complaint issues across three domains: performance, professional conduct, and health. Differences in complaint rate were assessed using incidence rate ratios. A multivariate negative binomial regression model was used to identify predictors of complaints among practitioners in these professions. Results: Patients and their relatives were the most common source of complaints about chiropractors, osteopaths and physiotherapists. Concerns about professional conduct accounted for more than half of the complaints about practitioners in these three professions. Regulatory outcome of complaints differed by profession. Male practitioners, those who were older than 65 years, and those who practised in metropolitan areas were at higher risk of complaint. The overall rate of complaints was higher for chiropractors than osteopaths and physiotherapists (29 vs. 10 vs. 5 complaints per 1000 practice years respectively, p < 0.001). Among chiropractors, 1% of practitioners received more than one complaint - they accounted for 36% of the complaints within their profession. Conclusions: Our study demonstrates differences in the frequency of complaints by source, issue and outcome across the chiropractic, osteopathic and physiotherapy professions. Independent of profession, male sex and older age were significant risk factors for complaint in these professions. Chiropractors were at higher risk of being the subject of a complaint to their practitioner board compared with osteopaths and physiotherapists. These findings may assist regulatory boards, professional associations and universities in developing programs that avert patient dissatisfaction and harm and reduce the burden of complaints on practitioners.

Fisioterapia y ocio: la presencia del fisioterapeuta en el llamado turismo saludable / Physiotherapy and leisure: the presence of physiotherapists in health tourism

El problema del intrusismo en las profesiones sanitarias como es el caso de la fisioterapia es un problema frecuente que se ve agravado por la importante oferta y demanda que existe del llamado "turismo saludable" donde dentro de las ofertas de ocio se encuentran tratamientos relajantes, antiestrés o antifatiga que aplican en muchos casos técnicas de masaje, aquaterapia, fangoterapia etc, tratamientos donde en la mayoría de los casos no se dispone de los profesionales necesarios para realizarlos. Hemos analizado las ofertas de ocio en las que se incluyen técnicas encuadrables dentro de la capacitación profesional específica del fisioterapeuta presentes en la red y en cuatro oficinas de diferentes agencias de viajes para conocer en que medida estas ofertas terapéuticas están respaldadas por la actuación de un fisioterapeuta. El numero de resultados en la búsqueda en la red utilizando la entrada "Turismo y salud" es de 1.770.000 y si nos ceñimos exclusivamente a las paginas Web de España el número de resultados es de 676.000. Hemos realizado un muestreo aleatorio utilizando como número de selección el número de orden, y hemos estudiado 250 páginas Web. Sólo en el 24 % se hace referencia expresa a la existencia de la fisioterapia como una realidad sustentada por los profesionales correspondientes, mientras que en el 96 % se hace referencia al uso de técnicas como: Cinesiterapia, Masaje, Electroterapia, Magnetoterapia, Ergoterapia, Hidroterapia, Balneoterapia, Climatoterapia, Talasoterapia, Termoterapia, Crioterapia, Vibroterapia, Fototerapia o Presoterapia. Cuando hemos comprobado telefónicamente si existía un fisioterapeuta encargado de realizar estos tratamientos únicamente hemos encontrado respuestas positivas en un 45 % de los centros que los ofertaban