What is known about experiences, perceptions, and impacts on practitioners and patients due to sex and gender in the chiropractic, osteopathy and physiotherapy professions: a scoping review

Abstract

BACKGROUND: There are complex expressions of gender and sex inherent within the three professions of chiropractic, osteopathy, and physiotherapy. These professions commonly use the body of the practitioner to provide treatment for the body of the patient (more so than most other regulated healthcare modalities), yet the application of a sex and gender lens in this context seems to have received scant attention within the literature.

OBJECTIVES: To examine the nature, range and extent of research investigating the impacts of sex and/or gender on patients and practitioners within the professions of chiropractic, osteopathy and physiotherapy, to identify areas for further research.

METHOD: A scoping review based on the Arksey and O’Malley (2005) framework was conducted. Sixteen online databases were searched, with no date or geographical restrictions.

RESULTS: Forty-eight papers from eight countries, including peer reviewed publications and grey literature, were selected for inclusion. Thirty-five of the papers used related to physiotherapy, nine to chiropractic, one to osteopathy, and three to a combination of these professions. Ten themes were identified. Thirteen textbooks used to teach technique skills to student chiropractors, osteopaths and physiotherapists in New Zealand were also included. Technique textbooks used within these three professions in New Zealand demonstrate a significant under-representation of females as practitioners, compared to males.

CONCLUSION: There are numerous opportunities to address significant gaps in research utilising various methodologies and covering a wide range of topics applying a sex and gender lens, relating to the professions of chiropractic, osteopathy and physiotherapy. It seems the proportions of males and females employed within chiropractic, osteopathy and physiotherapy have greatly influenced the volume and direction of research undertaken to date. This scoping review has also highlighted a need for a comprehensive audit of teaching resources for chiropractic, osteopathy and physiotherapy as there are currently few textbooks showing female practitioners demonstrating techniques, particularly high-velocity, low-amplitude thrusts (HVLATs).