All ETDs from UAB

Advisory Committee Chair

Anne Turner-Henson

Advisory Committee Members

Diane Grimley

Rhonda McLain

Marti Rice

John Waterbor

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


The purpose of this study to was examine prevalence of physical therapy (PT) and chiropractic use in survivors of childhood cancer and which factors are associated with the use of these services. In addition, the health-related quality of life (HRQOL) of survivors with musculoskeletal and neurological chronic conditions who reported using either PT or chiropractic was compared to those survivors with the same conditions who did not use either service. This study was a secondary analysis of the Childhood Cancer Survivor Study (CCSS) and included a subset of 9289 survivors who completed both the baseline and 2003 follow-up questionnaires. In addition to those two measures, the Medical Outcomes Short Form-36 (SF-36) was used to measure HRQOL. The sample consisted of 4708 (51%) males and 4581 (49%) females who were an average age of 31 years old and were predominantly White (89%). More childhood cancer survivors reported using chiropractic (12.3%) than PT (9.3%). Survivors who were older, female and had health insurance were most likely to use PT or chiropractic. Survivors who had a grade three or four musculoskeletal or neurological chronic condition were more likely to use PT, as were those survivors who had been diagnosed with CNS tumors, soft tissue sarcomas, or bone cancer. Chronic disease status, diagnosis, and treatment type were not associated with chiropractic use. Survivors with musculoskeletal or neurological chronic conditions who reported using either PT or chiropractic reported poorer HRQOL compared to those who did not use either service. Mediation analysis revealed PT mediated the relationship between chronic condition and HRQOL.

Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.