Frequency and Indications of Non-Musculoskeletal Examinations: A Cross-Sectional Survey of South African Chiropractors

Background/Objectives: Chiropractors serve as first-contact practitioners in South Africa and frequently encounter patients with systemic conditions that may mimic musculoskeletal complaints. Non-musculoskeletal (non-MSK) examinations are essential for identifying red flags, ruling out serious pathologies, and facilitating timely referrals. Despite their importance for patient safety and integration into primary healthcare, limited research exists on the frequency with which South African chiropractors perform these assessments. This study aimed to describe the frequency and indications for non-MSK examinations performed by South African chiropractors and to explore variations across examination types, demographic factors, years of experience, and training institutions in secondary analyses. Methods: A cross-sectional online survey was distributed to 898 registered chiropractors, yielding 186 responses (20.7%). The questionnaire assessed the frequency of non-MSK examinations using a five-point Likert scale. Data were analysed using descriptive statistics (frequencies, percentages, medians, interquartile ranges). Exploratory subgroup comparisons were conducted using nonparametric tests, but these findings should be interpreted with caution due to small and uneven sample sizes in some subgroups. Ethical approval was obtained (REC-3366-2025). Results: Most respondents were female (57.5%) and practising in Gauteng (49.5%). Blood pressure (84.4%) and heart rate (81.2%) were the most frequently performed examinations, while respiratory rate (12.4%), oxygen saturation (9.7%), and temperature (11.8%) were the least frequently performed vital signs. Breast (3.8%), abdominal (10.2%), and genitourinary (1.1%) examinations were rarely conducted. Exploratory subgroup observations suggested provincial variation: chiropractors in KwaZulu-Natal performed non-MSK examinations more frequently than those in Gauteng and the Western Cape (mean differences ranging from 0.21 to 1.19 on a five-point scale), whereas no meaningful differences were found across years in practice. Conclusions: South African chiropractors perform a selective range of non-MSK examinations, supporting their role as first-contact practitioners. However, many systemic examinations are conducted infrequently, with observed provincial variation. These descriptive findings highlight the need for greater consistency and standardisation in non-MSK screening to enhance patient safety and interdisciplinary care. Future adequately powered studies are needed to confirm the exploratory subgroup observations.