{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T04:18:19Z","timestamp":1748405899275,"version":"3.41.0"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002706","name":"AFA F\u00f6rs\u00e4kring","doi-asserted-by":"publisher","award":["200140,"],"award-info":[{"award-number":["200140,"]}],"id":[{"id":"10.13039\/501100002706","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec010\">\n<jats:title>Background<\/jats:title>\n<jats:p>The Swedish governmental strategy during the COVID-19-pandemic was to impose voluntary recommendations to limit viral spread, but to keep health care and important societal functions running. The objective of this study was to describe the work environment and practice of manual therapists, who were challenged by this strategy, in Sweden during a year of the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec011\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The cohort study Corona And Manual Professions (CAMP) was studying chiropractors and naprapaths, registered in the public register of licensed manual therapists in Sweden, during the pandemic. Mixed methods were used to answer the research aims. Surveys were distributed in November 2020, during the second wave, and in February, May and November of 2021. The quantitative data were presented descriptively, with the development over time illustrated in graphs. The qualitative data from the free-text answers were analyzed using content analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec012\">\n<jats:title>Results<\/jats:title>\n<jats:p>In total, 816 manual therapists (47% of the invited sample) were included in the study, of which between 275 and 662 participants answered the free-text questions. At baseline, most (60\u201365%) rated their knowledge of viral infections and their spread, of vulnerable patient groups, and of protective gear as fairly good or good. Most (68\u201370%) were able to follow the official recommendations, but decreased numbers of patients and changes in clinic routines were reported. There was a positive trend in caring adequately for patients and having access to protective gear. Manual therapists reported that they were unable to care for vulnerable patient groups, had to adhere to routines perceived as onerous, and found care to be less personalized.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec013\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>At the time of the outbreak of the COVID-19 pandemic, manual therapists in Sweden encountered challenges regarding knowledge about pandemics and availability of protective equipment. Sweden\u2019s official recommendations were possible to implement by the manual therapists, but had adverse impacts on clinic activities and patient care. Despite this, over 50% were able to deliver adequate care for their patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324245","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T18:22:42Z","timestamp":1748370162000},"page":"e0324245","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual therapists in Sweden during the COVID-19 pandemic -they remained in business, but how was their work environment and practice impacted?"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5251-5995","authenticated-orcid":true,"given":"Iben","family":"Axen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Skillgate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"issue":"8","key":"pone.0324245.ref001","doi-asserted-by":"crossref","DOI":"10.1002\/jmv.29012","article-title":"Epidemic history and evolution of an emerging threat of international concern, the severe acute respiratory syndrome coronavirus 2","volume":"95","author":"M Giovanetti","year":"2023","journal-title":"J Med Virol"},{"key":"pone.0324245.ref002","volume-title":"Arbetsmilj\u00f6n f\u00f6r personal som arbetade p\u00e5 sina ordinarie arbetsplatser under coronapandemin \u2013 handel, transport och omsorg","author":"Myndigheten, f\u00f6r, Arbetsmilj\u00f6kunskap, Expertise) SAfWE","year":"2023"},{"issue":"1","key":"pone.0324245.ref003","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1017\/S1744133121000256","article-title":"Soft law and individual responsibility: a review of the Swedish policy response to COVID-19","volume":"17","author":"U Winblad","year":"2022","journal-title":"Health Econ Policy Law"},{"key":"pone.0324245.ref004","doi-asserted-by":"crossref","first-page":"100788","DOI":"10.1016\/j.ssmph.2021.100788","article-title":"The New Totalitarians: The Swedish COVID-19 strategy and the implications of consensus culture and media policy for public health","volume":"14","author":"M Lindstr\u00f6m","year":"2021","journal-title":"SSM Popul Health"},{"issue":"8","key":"pone.0324245.ref005","first-page":"507","article-title":"Chiropractic in Sweden: a short description of patients and treatment","volume":"20","author":"C Leboeuf-Yde","year":"1997","journal-title":"J Manipulative Physiol Ther"},{"issue":"1","key":"pone.0324245.ref006","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12943-020-01218-1","article-title":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a review","volume":"19","author":"W Feng","year":"2020","journal-title":"Mol Cancer"},{"key":"pone.0324245.ref007","doi-asserted-by":"crossref","first-page":"102433","DOI":"10.1016\/j.jaut.2020.102433","article-title":"The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak","volume":"109","author":"HA Rothan","year":"2020","journal-title":"J Autoimmun"},{"issue":"1","key":"pone.0324245.ref008","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s12998-023-00511-2","article-title":"Psychological distress and musculoskeletal pain in manual therapists during the second wave of the COVID-19 pandemic in Sweden: a cross-sectional study","volume":"31","author":"N Weiss","year":"2023","journal-title":"Chiropr Man Therap"},{"issue":"2","key":"pone.0324245.ref009","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.nedt.2003.10.001","article-title":"Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness","volume":"24","author":"UH Graneheim","year":"2004","journal-title":"Nurse Educ Today"},{"issue":"1","key":"pone.0324245.ref010","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12913-025-12337-0","article-title":"Maintaining operability at a high personal cost - a mixed method study on maternal healthcare workers\u2019 experiences during the COVID-19 pandemic","volume":"25","author":"M Akerstrom","year":"2025","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0324245.ref011","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1080\/10669817.2020.1782059","article-title":"COVID 19 and manual therapy: international lessons and perspectives on current and future clinical practice and education","volume":"28","author":"CW MacDonald","year":"2020","journal-title":"J Man Manip Ther"},{"issue":"3","key":"pone.0324245.ref012","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.surg.2024.04.045","article-title":"Survey results of COVID-19 pandemic on female surgical trainees: new normal work environment","volume":"176","author":"F Qamar","year":"2024","journal-title":"Surgery"},{"issue":"4","key":"pone.0324245.ref013","doi-asserted-by":"crossref","DOI":"10.1002\/pri.2015","article-title":"Physiotherapists\u2019 experiences on assisting physiotherapy users during the COVID-19 pandemic with lockdown measures in Spain","volume":"28","author":"H Fernandez-Lago","year":"2023","journal-title":"Physiother Res Int"},{"issue":"8","key":"pone.0324245.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0308945","article-title":"The impact of official recommendations during the COVID-19 pandemic on the clinical activity and business turnover of manual therapists in Sweden-The CAMP cohort study","volume":"19","author":"E Aboagye","year":"2024","journal-title":"PLoS One"},{"issue":"3","key":"pone.0324245.ref015","doi-asserted-by":"crossref","first-page":"214","DOI":"10.5014\/ajot.45.3.214","article-title":"Rigor in qualitative research: the assessment of trustworthiness","volume":"45","author":"L Krefting","year":"1991","journal-title":"Am J Occup Ther"},{"issue":"2","key":"pone.0324245.ref016","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3233\/EFI-2004-22201","article-title":"Strategies for ensuring trustworthiness in qualitative research projects","volume":"22","author":"AK Shenton","year":"2004","journal-title":"EFI"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T18:22:47Z","timestamp":1748370167000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324245"}},"subtitle":[],"editor":[{"given":"Adetayo","family":"Olorunlana","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324245","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]}}}