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. 2025 May 27;20(5):e0324245.
doi: 10.1371/journal.pone.0324245. eCollection 2025.

Manual therapists in Sweden during the COVID-19 pandemic -they remained in business, but how was their work environment and practice impacted?

Iben Axen  1   2 , Nathan Weiss  1   3 , Eva Skillgate  1   3   4
Affiliations

Manual therapists in Sweden during the COVID-19 pandemic -they remained in business, but how was their work environment and practice impacted?

Iben Axen et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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 (60-65%) rated their knowledge of viral infections and their spread, of vulnerable patient groups, and of protective gear as fairly good or good. Most (68-70%) 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.

Conclusion: 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's 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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Manual therapists in Sweden are rating their ability to follow the official recommendations in November 2020, February 2021, May 2021 and in November 2021.
Fig 2
Fig 2. Manual therapists in Sweden are rating the availability of protective equipment in November 2020, February 2021, May 2021 and in November 2021.
Fig 3
Fig 3. Manual therapists in Sweden are rating if the official recommendations led to disturbances in the clinic in November 2020, February 2021, May 2021 and in November 2021.
Fig 4
Fig 4. Manual therapists in Sweden are rating if the official recommendations led to changes in patient care in November 2020, February 2021, May 2021 and in November 2021.
Fig 5
Fig 5. Manual therapists in Sweden are rating if the official recommendations left them unable to deliver patient care as they wanted in November 2020, February 2021, May 2021 and in November 2021.
See this image and copyright information in PMC

References

    1. Giovanetti M, Branda F, Cella E, Scarpa F, Bazzani L, Ciccozzi A, et al.. Epidemic history and evolution of an emerging threat of international concern, the severe acute respiratory syndrome coronavirus 2. J Med Virol. 2023;95(8):e29012. doi: 10.1002/jmv.29012 - DOI - PubMed
    1. Myndigheten, för, Arbetsmiljökunskap, Expertise) SAfWE. Arbetsmiljön för personal som arbetade på sina ordinarie arbetsplatser under coronapandemin – handel, transport och omsorg. Gävle; 2023.
    1. Winblad U, Swenning A-K, Spangler D. Soft law and individual responsibility: a review of the Swedish policy response to COVID-19. Health Econ Policy Law. 2022;17(1):48–61. doi: 10.1017/S1744133121000256 - DOI - PMC - PubMed
    1. Lindström M. The New Totalitarians: The Swedish COVID-19 strategy and the implications of consensus culture and media policy for public health. SSM Popul Health. 2021;14:100788. doi: 10.1016/j.ssmph.2021.100788 - DOI - PMC - PubMed
    1. Leboeuf-Yde C, Hennius B, Rudberg E, Leufvenmark P, Thunman M. Chiropractic in Sweden: a short description of patients and treatment. J Manipulative Physiol Ther. 1997;20(8):507–10. - PubMed