Abstract
Objective This study aimed to explore registered chiropractors' perceptions of the use of spinal manipulative therapy (SMT) by non-registered practitioners in Hong Kong, assessing the associated risks, adverse events, and patient management approaches. Method A cross-sectional survey was conducted among registered chiropractors in Hong Kong using an online questionnaire. The survey, distributed via chiropractic associations from January 26 to March 20, 2024, gathered data on the practitioners' experiences with patients previously treated by non-registered practitioners, including the types of adverse events observed and subsequent interventions required. Descriptive statistics were used to analyze the data. A total of 134 valid responses were received. Results Among respondents, a significant proportion (91%) of chiropractors reported observing adverse effects in patients treated by non-registered practitioners, with the most common issues being the aggravation of existing symptoms (95.5%) and new or unexpected complaints (82.8%). The most frequently required interventions included imaging (97%), medication (58.2%), and specialist referrals (59%). Respondents indicated that these adverse events could often have been prevented if proper training and certification were in place. Common reasons cited by patients for seeking care from non-registered practitioners included a lack of awareness about licensed care (90.3%) and cost considerations (80.6%). Conclusion The study highlights concerns reported by registered chiropractors regarding the safety of SMT performed by non-registered practitioners in Hong Kong. These concerns emphasize the need for enhanced public education on potential risks and stricter regulatory oversight. Although direct data on the occurrence of adverse events was not collected, the findings suggest that many risks could potentially be mitigated with proper training, underscoring the importance of credentialed care in ensuring patient safety.