{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:30:24Z","timestamp":1790368224948,"version":"4.1.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015224","name":"European Centre for Chiropractic Research Excellence","doi-asserted-by":"publisher","award":["01-20160NL\/MvT"],"award-info":[{"award-number":["01-20160NL\/MvT"]}],"id":[{"id":"10.13039\/100015224","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Nederlandse Chiropractoren Associatie"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We interviewed 11 older adults with low back pain. During this process four themes emerged that captured their perception and experiences in either seeking or dismissing chiropractic care for their LBP; these being \u2018generic\u2019, \u2018financial\u2019, \u2018expectation\u2019, and \u2018the image of the chiropractor\u2019. The focus group members largely confirmed the identified themes, highlighting a lack of awarenes and accessibility as key barriers to care. On the other hand, whe chiropractior as an alternative care provider, with a focus on manual interventions, was seen as a facilitator.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The lack of knowledge about chiropractic care was found to be the most important barrier to seeking care. The most important facilitator was insufficient resolution of their symptoms following previous care, making patients look further for a solution for their problem. These barriers and facilitators seem not to differ greatly from barriers and facilitators found among younger patients with neck pain. Age and health condition may therefore be weak determinants of care. This new information may help us optimize accessibility for older adults to the chiropractor.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283661","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T17:28:15Z","timestamp":1681320495000},"page":"e0283661","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The perceived barriers and facilitators for chiropractic care in older adults with low back pain; insights from a qualitative exploration in a dutch context"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1696-1335","authenticated-orcid":true,"given":"Lobke P.","family":"De la Ruelle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"de Zoete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7741-1313","authenticated-orcid":true,"given":"Cornelius","family":"Myburgh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hella E.","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4819-994X","authenticated-orcid":true,"given":"Sidney M.","family":"Rubinstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"issue":"13","key":"pone.0283661.ref001","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1097\/BRS.0b013e3181e70488","article-title":"The trend in total cost of back pain in The Netherlands in the period 2002 to 2007","volume":"36","author":"LC Lambeek","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"pone.0283661.ref002","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1111\/pme.12397","article-title":"Illness representations of restricting back pain: the older Person\u2019s perspective","volume":"15","author":"UE Makris","year":"2014","journal-title":"Pain Med"},{"key":"pone.0283661.ref003","doi-asserted-by":"crossref","first-page":"920387","DOI":"10.3389\/fresc.2022.920387","article-title":"Experiences of community-dwelling older adults with chronic low back pain in Hong Kong and Switzerland\u2014A qualitative study","volume":"3","author":"V Schoeb","year":"2022","journal-title":"Front Rehabil Sci"},{"issue":"9","key":"pone.0283661.ref004","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1097\/00005650-200109000-00006","article-title":"The treatment of neck and low back pain: who seeks care? 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