Chiropractic Management for US Female Veterans With Low Back Pain: A Retrospective Study of Clinical Outcomes
SOURCE: J Manipulative Physiol Ther. 2017 (Oct); 40 (8): 573–579
Kelsey L. Corcoran, DC, Andrew S. Dunn, DC, MEd, MS,
Lance R. Formolo, DC, MS, Gregory P. Beehler, PhD, MA
Chiropractic Department,
Medical Care Line,
VA Western New York,
Buffalo, New York
OBJECTIVE: The purpose of this study was to determine if female US veterans had clinically significant improvement in low back pain after chiropractic management.
METHODS: This is a retrospective chart review of 70 courses of care for female veterans with a chief complaint of low back pain who received chiropractic management through the VA Western New York Healthcare System in Buffalo, New York. A paired t test was used to compare baseline and discharge outcomes for the Back Bournemouth Questionnaire. The minimum clinically important difference was set as a 30% improvement in the outcome measure from baseline to discharge.
RESULTS: The average patient was 44.8 years old, overweight (body mass index 29.1 kg/m2), and white (86%). The mean number of chiropractic treatments was 7.9. Statistical significance was found for the Back Bournemouth Questionnaire outcomes. The mean raw score improvement was 12.4 points (P < .001), representing a 27.3% change from baseline with 47% of courses of care meeting or exceeding the minimum clinically important difference.
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CONCLUSION: For our sample of female veterans with low back pain, clinical outcomes from baseline to discharge improved under chiropractic care. Although further research is warranted, chiropractic care may be of value in contributing to the pain management needs of this unique patient population.
KEYWORDS: Chiropractic; Low Back Pain; Musculoskeletal Pain; Veterans; Women’s Health
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Introduction
Although female veterans have historically used Veterans Health Administration (VHA) medical services at low rates, they are becoming 1 of the fastest growing populations of VHA users. [1] Since 2000, female VHA users have more than doubled, [2] with 32% of female service members currently enrolling in VHA services after military seperation. [3] Women currently comprise 14% of those enlisted within the Department of Defense services (Army, Navy, Air Force, Marine Corps, Coast Guard), 17% of new recruits, and 16% of active duty officers. [3] Female veterans are younger, [4–10] less likely to be married, [5–9] more racially diverse, [4–8] and more educated than their male counterparts. [6–8] Female veteran VHA users also access VHA medical care more frequently than male veterans, [4, 7] have a higher outpatient cost per patient, [4] seek evaluation at the Emergency Department more often, [11] and have a higher rate of service-connected (SC) disability greater than 50%, [4] which entitles them to lifelong VHA care for their SC conditions.
Irrespective of sex, the majority of VHA patients experience pain. [10, 12] Painful musculoskeletal diagnoses are the most common ailments of all US veterans returning from Operation Iraqi Freedom and Operation Enduring Freedom, [13] with the back being the most common location of pain. [10, 12] The rate of musculoskeletal diagnoses increases annually after military separation, and this rate is even faster for women. [6] As a result, musculoskeletal conditions are the leading cause of morbidity for female veterans. [4]
Chiropractic management is 1 of the available conservative treatment options for veterans with painful musculoskeletal conditions. Research in the civilian population indicates that chiropractic care is an effective management strategy for low back pain (LBP). [14, 15] Currently 15.8% of VHA chiropractic patients are women, [16] but little is known specifically about female veterans’ outcomes under chiropractic management. Historically women have been underrepresented in Veterans Affairs (VA) research. [17] To our knowledge, this is the first study of female veterans presenting to VHA chiropractic services. [18] The objective of this retrospective study was to determine if female veterans had evident improvement for their LBP complaints after chiropractic management in a sample of VHA Medical Center patients. We hypothesized that there would be a clinically significant improvement to LBP after a trial of chiropractic care for these individuals.
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