Barriers and facilitators to the delivery of rehabilitation in health systems by chiropractors: a SWOT analysis of perspectives from a world federation of chiropractic congress workshop

BACKGROUND: Global unmet need for rehabilitation remains substantial. Chiropractors commonly manage musculoskeletal conditions that may benefit from rehabilitation. However, barriers and facilitators to chiropractors' delivery of rehabilitation in health systems have yet to be well described. Therefore, this study aimed to identify local, regional, and global barriers and facilitators to the delivery of rehabilitation within health systems. METHODS: Data were collected from participants attending the 18th World Federation of Chiropractic (WFC) Biennial Congress, held in Copenhagen, Denmark, on May 10, 2025. A deductive, manifest-directed content analysis, framed by the Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework, was conducted on responses collected during a rehabilitation workshop. Participants completed free-text responses to four SWOT-based prompts on the delivery of rehabilitation by chiropractors within health systems. Responses were categorized into SWOT domains and coded according to an adaptation of predefined barriers and facilitators to rehabilitation delivery. RESULTS: A total of 369 responses were recorded and catalogued into strengths (n = 89), weaknesses (n = 103), opportunities (n = 84), and threats (n = 93). Commonly reported strengths included education, clinical, and leadership and policy categories. Weaknesses were primarily related to categories of facilities/logistics, finances, education, and leadership and policy. Opportunities primarily included facilities/logistics, leadership and policy, and education categories. Threats were primarily related to leadership and policy, cultural, and political categories. CONCLUSION: This study highlights local, regional, and global factors influencing the delivery of rehabilitation in health systems by chiropractors. Findings underscore the need for targeted implementation strategies, policy advocacy, and expanded professional training to optimize chiropractors' contributions to the global rehabilitation workforce.