A new explorative qualitative study published in BMC Pediatrics by Salome Keller of the Zurich University of Applied Science and colleagues at the Department of Chiropractic Medicine at University Hospital Balgrist and the University of Zurich has now documented, in parents’ own words, how attitudes toward chiropractic intervention evolve across the course of treatment for infants with suspected arthrogenic torticollis. The research team recruited families whose babies had been referred to chiropractic care with a suspected diagnosis of the condition and conducted semi-structured interviews at two points in time: a baseline round with twelve parents before or at the start of treatment, and a follow-up round with seven parents after they had experienced the therapy firsthand. The design allowed the investigators to compare expectations and fears before treatment with perceptions and judgments afterward, capturing a psychological trajectory that is rarely documented in this clinical population.

Methodologically, the study followed a deductive-inductive qualitative analysis based on Kuckartz’s approach, a structured framework for qualitative content analysis that combines theory-driven categories with themes emerging from the data themselves. All interviews were coded using MAXQDA 24, a widely used software platform for qualitative research, and the reporting was guided by the COREQ checklist, an international standard designed to improve the transparency and completeness of qualitative study reporting. From this analysis, four main themes crystallized: everyday life, perception of the infant’s health status, prior knowledge, and attitude toward chiropractic treatment. These themes formed an interpretive map of the parental experience, showing how the practical demands of caring for an affected infant, the parents’ reading of their child’s condition, whatever they knew beforehand about manual therapy, and their evolving stance toward the treatment all interacted to shape the overall journey.

The baseline interviews revealed a striking emotional landscape. Parents initially experienced considerable uncertainty and emotional strain, driven by two distinct sources. The first was simple unfamiliarity: chiropractic care for infants is not part of most parents’ medical vocabulary, and many did not know what the treatment would entail, how safe it was, or what evidence supported it. The second source was more visceral: watching a practitioner apply manual techniques to a tiny, fragile baby provoked anxiety that no amount of rational reassurance could entirely dispel. The researchers found that this ambivalence, a mixture of hope that the therapy would help and fear that it might somehow harm, was a defining feature of the pre-treatment mindset. Parents arrived at the clinic carrying questions they often felt hesitant to ask, and their first encounters with the treatment setting were colored by this underlying tension.

What happened next, according to the follow-up interviews, was a gradual transformation. As parents became familiar with the process, observing what the practitioner actually did, understanding the gentle nature of the techniques used on infants, and seeing how their baby responded during and after sessions, their emotional state shifted measurably. Confidence grew. Trust in the professionals deepened. Acceptance of the treatment, which had been tentative at best before the first session, solidified into genuine endorsement. Crucially, the researchers identified a powerful catalyst for this shift: observable improvement in the infant’s condition. When parents could see their child turning the head more freely, holding it more symmetrically, or feeding and sleeping more comfortably, their abstract anxieties about the therapy gave way to concrete, experience-based conviction that the intervention was working.

The study’s findings on the factors shaping parental attitudes carry practical weight for clinicians. Three elements stood out as decisive. Clear communication emerged as the foundation: parents who received thorough explanations of the diagnosis, the rationale for chiropractic treatment, and what each session would involve reported far less distress and far greater engagement than those left to guess. Observable health benefits formed the second pillar, providing the experiential evidence that no verbal reassurance could replace. Prior experience with therapeutic interventions for their infant constituted the third factor: families who had already navigated physiotherapy or other treatments for their child arrived with a framework for understanding a new therapy, which buffered the initial shock of the unfamiliar. Together, these factors suggest that the trajectory from skepticism to trust is not automatic but is actively constructed through information, demonstration, and results.

The clinical context makes these findings particularly significant. Arthrogenic torticollis, involving the upper cervical joints, is precisely the kind of diagnosis that prompts parents to seek specialized manual assessment, and chiropractic medicine in Switzerland, where the study was conducted, is an integrated, university-trained medical discipline rather than an alternative practice. At University Hospital Balgrist, chiropractic medicine operates within the hospital system, with practitioners trained to medical standards. Nevertheless, the researchers emphasize that the general public often does not distinguish between regulated, hospital-based chiropractic care and less formally grounded versions of the practice, which contributes to the initial wariness parents bring through the clinic door. The gap between the actual, regulated nature of the treatment and parental perceptions of it is exactly where communication interventions can do the most good.

The broader implications extend well beyond this single condition. The study offers a template for understanding how families engage with any unfamiliar treatment for infants, a situation that arises constantly in pediatrics, from osteopathy to novel physiotherapy protocols to emerging conservative orthopedic approaches. The central insight is that parental acceptance is dynamic, not fixed: it can be cultivated through structured communication and validated through visible outcomes. The authors highlight that supporting families through this psychological transition does more than improve satisfaction scores; it reduces stress during the infant’s care, and reduced parental stress is itself a meaningful clinical outcome, given how strongly caregiver anxiety can affect feeding, bonding, and the consistency with which families complete a treatment course.

The researchers are careful about the scope of their conclusions. As an explorative qualitative study with twelve baseline and seven follow-up participants, it cannot quantify how common each attitude pattern is, nor can it speak to the clinical efficacy of chiropractic treatment for arthrogenic torticollis itself, which was not the object of investigation. What it does establish, with methodological transparency, is the shape of the parental experience: an arc that begins in uncertainty and emotional strain, passes through familiarization and observation, and ends, for the families studied, in confidence and acceptance. The deductive-inductive coding framework and adherence to the COREQ checklist strengthen the trustworthiness of the thematic findings, and the two-timepoint design gives the study a longitudinal dimension that most qualitative work in this area lacks.

For parents facing a torticollis diagnosis, the study’s message is quietly reassuring: the fear and ambivalence they may feel before their infant’s first chiropractic session are common, documented, and, according to the families interviewed, likely to fade as understanding and visible progress replace the unknown. For clinicians, the message is more actionable. Every explanation offered before a session, every question answered patiently, and every improvement pointed out explicitly is not merely courtesy but an active ingredient in the therapy’s acceptance. In a field where the youngest patients cannot voice their own experience and their caregivers hold the decision-making power entirely, the psychology of the parent may be as important to a treatment’s success as the technique applied to the infant’s neck. This Swiss study makes that psychology visible, and in doing so, offers both families and practitioners a clearer map of the emotional terrain they must cross together.

Subject of Research: Parental attitudes toward chiropractic treatment of infants with arthrogenic torticollis

Article Title: Parental attitude towards chiropractic intervention before and after treatment in infants with an arthrogenic torticollis: an explorative qualitative study

Article References: Keller, S., Paravicini, I., Wirth, B., Schweinhardt, P., & Langenfeld, A. (2026). Parental attitude towards chiropractic intervention before and after treatment in infants with an arthrogenic torticollis: an explorative qualitative study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07760-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07760-z

Keywords: arthrogenic torticollis, chiropractic care, parental attitude, infants, manual therapy, parental stress, healthcare communication, pediatrics, qualitative research, congenital muscular torticollis, cervical spine, physiotherapy

The study, conducted by Scott Siegel of City of Hope Atlanta along with Karina Szymulanska-Ramamurthy and Digant Gupta of City of Hope Chicago, set out to fill a striking gap in the literature. Although integrative medicine is increasingly woven into oncology care, and the World Health Organization defines it as an interdisciplinary, evidence-based approach combining biomedical and complementary practices, virtually no published research has evaluated the impact of spinal manipulation and chiropractic care on functional outcomes in cancer patients. A literature search by the team found no prior studies analyzing outcomes on the Patient-Specific Functional Scale, a validated instrument that tracks activities each patient personally identifies as difficult, in this population. The researchers hypothesized that oncology patients receiving chiropractic care would show improvements in both function and pain intensity between a baseline visit and two subsequent follow-up visits.

Technically, the investigation took the form of a single-arm retrospective observational study, a chart review of 97 adult oncology patients treated within the Integrative Medicine Department at City of Hope Cancer Center Atlanta in Newnan, Georgia, during a 12-month window from June 1, 2024, to June 1, 2025. To be included, patients needed a documented cancer diagnosis, musculoskeletal complaints appropriate for chiropractic intervention, and Patient-Specific Functional Scale and pain intensity scores recorded before treatment at baseline and at the next two eligible visits. The exclusion criteria were extensive and clinically meticulous: patients were removed from consideration if they received only one chiropractic visit, lacked eligible follow-up within three months, or were undergoing concurrent interventions such as physical therapy, massage, acupuncture, orthopedic surgery, pain medication, or recent corticosteroid injections that could confound results. Manual chiropractic care was also ruled out where contraindicated, including in cases of severe osteoporosis, extremely low platelet counts, acute compression fracture, recent surgery, vertebral artery stenosis, blood clots, or cauda equina syndrome. Charts were additionally screened for indwelling devices and osseous metastases identified on imaging.

The intervention itself was deliberately adapted for oncology. Rather than traditional high-velocity, low-amplitude spinal manipulation, which could pose risks given cancer-related structural vulnerabilities, clinicians delivered low-force or instrument-assisted spinal and extremity manipulation, myofascial techniques, flexion-distraction, therapeutic exercise instruction, ergonomic advice, and counseling on activities of daily living. Each treatment plan was individualized and delivered by a licensed chiropractor embedded in the oncology clinic, reflecting the growing recognition that comprehensive cancer centers must offer a wide range of services to address the interrelated physical needs of their patients.

The measurement strategy centered on two patient-reported tools with established reliability, validity, and responsiveness in musculoskeletal and rehabilitation populations. The Patient-Specific Functional Scale asks patients to name an activity they find difficult and then rate their ability to perform it from 0, meaning unable to perform, to 10, meaning able to perform at their prior level. In this study, one patient-selected activity was tracked per patient across three ordered visits. Pain intensity was captured on an 11-point numerical rating scale from 0, no pain, to 10, worst pain. Importantly, the authors emphasize that the first and second follow-up visits, labeled FU1 and FU2, represent visit order rather than standardized elapsed-time points, because clinical scheduling was not protocolized. The mean interval from baseline to FU1 was 18.3 days, while the mean interval from baseline to FU2 was 37.5 days, with wide individual variation.

The statistical analysis was appropriately sophisticated for repeated-measures data. Linear mixed-effects models were used to account for within-subject correlation across the three visits, with visit as a categorical fixed effect and subject as a random intercept. Pairwise comparisons between baseline, FU1, and FU2 were adjusted using the Holm-Bonferroni method, and clinically meaningful change was evaluated through responder analyses using a minimal clinically important difference of at least 2.0 points for both outcomes. The models were further extended with interaction terms to test whether patterns of change differed by gender or race.

The results were statistically striking. Mean Patient-Specific Functional Scale scores rose from 4.45 at baseline to 5.13 at FU1 and 5.53 at FU2, while mean pain intensity fell from 6.07 at baseline to 5.10 at FU1 and 4.64 at FU2. All pairwise comparisons were significant at adjusted p values below 0.001. For function, the mean difference from baseline to FU2 was 1.077 points, and for pain the baseline-to-FU2 difference was 1.423 points. Clinically meaningful improvement, defined as at least a 2-point change, was achieved by 13.4 percent of patients for function and 22.7 percent for pain at FU1, rising to 26.8 percent and 44.3 percent respectively at FU2. The cohort had a mean age of 57.4 years, was predominantly female, and breast cancer was the most common diagnosis category.

Equally notable was the consistency of the response across demographic subgroups. Both males and females showed comparable patterns of functional gain and pain reduction, and the visit-by-gender interactions were not statistically significant for either outcome. Similarly, White and African American patients demonstrated parallel improvements, with no significant visit-by-race interactions, suggesting that the observed benefits did not diverge across these key patient characteristics. The authors argue that this consistency across subgroups supports the robustness of the observed patterns, even though the study could not establish causation.

The clinical implications are considerable. If the findings hold up under more rigorous testing, modified chiropractic care could become a nonpharmacological option for managing the musculoskeletal symptom burden of cancer treatment, potentially improving mobility, daily functioning, and quality of life alongside standard medical management. The authors stress that careful patient selection and coordination with the oncology care team remain essential for safety and appropriateness, particularly given the structural and hematologic vulnerabilities many cancer patients carry. This caution is well founded: the retrospective, single-arm, pre-post design without a concurrent control group means the improvements could reflect natural recovery, regression to the mean, expectations, or concurrent oncologic and supportive treatments such as analgesics, rehabilitation therapy, or palliative care, none of which could be fully controlled. The modest single-center sample, self-reported outcomes vulnerable to reporting bias, and heterogeneous follow-up intervals further limit the strength of any causal claim.

Nevertheless, the study has real strengths. It employed repeated, patient-centered outcome measures capturing both function and pain, evaluated clinically meaningful thresholds in addition to statistical significance, used two follow-up measurements rather than a single post-intervention assessment, and applied analytical methods that account for within-subject correlation. The authors are clear about the path forward: a properly powered prospective randomized trial with an appropriate comparison group, standardized assessment windows, documentation of co-interventions, and evaluation of the durability of changes, followed by multicenter studies to assess generalizability across oncology settings and cancer types. Mixed-methods and pragmatic research could further illuminate patient experience, optimal treatment frequency, and how such services might be implemented within comprehensive cancer care pathways. For now, the study stands as a provocative first quantification of functional improvement in cancer patients receiving chiropractic care, and a signal that one of the most common forms of complementary medicine may deserve a rigorously tested place in modern supportive oncology.

Subject of Research: Chiropractic care and functional outcomes in cancer patients

Article Title: Functional outcomes in oncology patients receiving chiropractic care: a retrospective chart review

Article References: Functional outcomes in oncology patients receiving chiropractic care: a retrospective chart review. (n.d.). https://doi.org/10.1007/s00520-026-11248-y

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11248-y

Keywords: chiropractic care, oncology, cancer rehabilitation, pain management, musculoskeletal disorders, integrative medicine, supportive care, patient-specific functional scale, cancer survivors, retrospective study, spinal manipulation, quality of life