Support Chiropractic Research!
Facebook

Frank M. Painter

About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.
FacebookXEmail

Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

By |April 24, 2025|Chiropractic Care, Cost-Effectiveness, Low Back Pain|

Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018

The Chiro.Org Blog

SOURCE:   J Gen Intern Med. 2023 (Oct 19); 39 (4): 578–586

Eric J Roseen • Kushang V Patel • Rachel Ward • Xinyao de Grauw
Steven J Atlas • Stephen Bartels • Julie J Keysor • Jonathan F Bean

Section of General Internal Medicine,
Department of Medicine, Boston University,
Chobanian & Avedision School of Medicine and
Boston Medical Center,
Boston, MA, USA.

Background   While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable.

Objective   Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP.

Design/Setting   Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018.

Participants   146,087 adults reporting LBP in prior 3 months.

Methods   We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents.

Results   Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016–2018 vs 2002–2015, OR` =` 1.15; 95% CI: 1.10–1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions` >` 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR` =` 0.62, 95% CI: 0.65–0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR` =` 0.98; 95% CI: 0.94–1.03) but lower for chiropractic care use (OR` =` 0.50; 95% CI: 0.47–0.53).

There are more articles like this @

LOW BACK PAIN Section

(more…)

Read More
 0

Identifying Patient-Reported Outcome Measure Documentation in Veterans Health Administration Chiropractic Clinic Notes: Natural Language Processing Analysis

By |April 13, 2025|Outcome Assessment, Patient Satisfaction, Veterans|

Identifying Patient-Reported Outcome Measure Documentation in Veterans Health Administration Chiropractic Clinic Notes: Natural Language Processing Analysis

The Chiro.Org Blog

SOURCE:   JMIR Medical Informatics 2025 (Apr 2): 13: e66466

Brian C Coleman • Kelsey L Corcoran • Cynthia A Brandt
Joseph L Goulet • Stephen L Luther • Anthony J Lisi

Pain Research, Informatics, Multimorbidities, and Education Center,
VA Connecticut Healthcare System,
950 Campbell Ave,
West Haven, CT, 06516

Background:   The use of patient-reported outcome measures (PROMs) is an expected component of high-quality, measurement-based chiropractic care. The largest health care system offering integrated chiropractic care is the Veterans Health Administration (VHA). Challenges limit monitoring PROM use as a care quality metric at a national scale in the VHA. Structured data are unavailable, with PROMs often embedded within clinic text notes as unstructured data requiring time-intensive, peer-conducted chart review for evaluation. Natural language processing (NLP) of clinic text notes is one promising solution to extracting care quality data from unstructured text.

Objective:   This study aims to test NLP approaches to identify PROMs documented in VHA chiropractic text notes.

Methods:   VHA chiropractic notes from October 1, 2017, to September 30, 2020, were obtained from the VHA Musculoskeletal Diagnosis/Complementary and Integrative Health Cohort. A rule-based NLP model built using medspaCy and spaCy was evaluated on text matching and note categorization tasks. SpaCy was used to build bag-of-words, convoluted neural networks, and ensemble models for note categorization. Performance metrics for each model and task included precision, recall, and F-measure. Cross-validation was used to validate performance metric estimates for the statistical and machine-learning models.

Results:   Our sample included 377,213 visit notes from 56,628 patients. The rule-based model performance was good for soft-boundary text-matching (precision=81.1%, recall=96.7%, and F-measure=88.2%) and excellent for note categorization (precision=90.3%, recall=99.5%, and F-measure=94.7%). Cross-validation performance of the statistical and machine learning models for the note categorization task was very good overall, but lower than rule-based model performance. The overall prevalence of PROM documentation was low (17.0%).

Conclusions:   We evaluated multiple NLP methods across a series of tasks, with optimal performance achieved using a rule-based method. By leveraging NLP approaches, we can overcome the challenges posed by unstructured clinical text notes to track documented PROM use. Overall documented use of PROMs in chiropractic notes was low and highlights a potential for quality improvement. This work represents a methodological advancement in the identification and monitoring of documented use of PROMs to ensure consistent, high-quality chiropractic care for veterans.

There is more like this @ our

NON-PHARMACOLOGIC THERAPY Section and the

CHIROPRACTIC CARE FOR VETERANS Section

(more…)

Read More
 0

Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP):
Protocol for a Healthcare Systems Embedded Multisite Pragmatic Cluster-randomized Trialal

By |March 30, 2025|Initial Provider, Low Back Pain|

Implementation of the American- College of Physicians Guideline for Low Back Pain (IMPACt-LBP):
Protocol for a Healthcare Systems Embedded Multisite Pragmatic Cluster-randomized Trial

The Chiro.Org Blog

SOURCE:   BMJ Open 2025 (Mar 26); 15 (3): e097133
Adam P Goode • Christine Goertz • Hrishikesh Chakraborty • Stacie A Salsbury • Samuel Broderick
Barcey T Levy • Kelley Ryan • Sharon Settles • Shoshana Hort • Rowena J Dolor, et al.

Duke University School of Medicine,
Durham, North Carolina, USA

Introduction:   Low back pain (LBP) is a key source of medical costs and disability, impacting over 31 million Americans at any given time and resulting in US$100-US$200 billion per year in total healthcare costs. LBP is one of the leading causes of ambulatory care visits to US physicians; problematically, these visits often result in treatments such as opioids, surgery or advanced imaging that can lead to more harm than benefit. The American College of Physicians (ACP) Guideline for Low Back Pain recommends patients receive non-pharmacological interventions as a first-line treatment. Roadmaps exist for multidisciplinary collaborative care that include well-trained primary contact clinicians with specific expertise in the treatment of musculoskeletal conditions, such as physical therapists and doctors of chiropractic, as first-line providers for LBP. These clinicians, sometimes referred to as primary spine practitioners (PSPs) routinely employ many of the non-pharmacological approaches recommended by the ACP guideline, including spinal manipulation and exercise. Important foundational work has demonstrated that such care is feasible and safe, and results in improved physical function, less pain, fewer opioid prescriptions and reduced utilisation of healthcare services. However, this treatment approach for LBP has yet to be widely implemented or tested in a multisite clinical trial in real-world practice.

Methods and analysis:   The Implementation of the American College of Physicians Guideline for Low Back Pain trial is a health system-embedded pragmatic cluster-randomised trial that will examine the effect of offering initial contact with a PSP compared with usual primary care for LBP. Twenty-six primary care clinics within three healthcare systems were randomised 1:1 to PSP intervention or usual primary care.

Primary outcomes are pain interference and physical function using the Patient-Reported Outcomes Measurement Information System Short Forms collected via patient self-report among a planned sample of 1800 participants at baseline, 1, 3 (primary end point), 6 and 12 months. A subset of participants enrolled early in the trial will also receive a 24-month assessment. An economic analysis and analysis of healthcare utilisation will be conducted as well as an evaluation of the patient, provider and policy-level barriers and facilitators to implementing the PSP model using a mixed-methods process evaluation approach.

Ethics and dissemination:   The study received ethics approval from Advarra, Duke University, Dartmouth Health and the University of Iowa Institutional Review Boards. Study data will be made available on completion, in compliance with National Institutes of Health data sharing policies.

There are more articles like this @

LOW BACK PAIN Section

(more…)

Read More
 0

Clinical Course of Spinal Pain in Adolescents: A Feasibility Study in a Chiropractic Setting

By |February 21, 2025|Chiropractic Management, Pediatrics, Spinal Joint Pain|

Clinical Course of Spinal Pain in Adolescents: A Feasibility Study in a Chiropractic Setting

The Chiro.Org Blog

SOURCE:   BMJ Open 2025 (Jan 30); 15 (1): e088834
Laura RC Montgomery • Steven J Kamper • Anika Young • Amber Beynon • Katherine A Pohlman • Lise Hestbæk • Mark J Hancock • Simon D French • Christopher G Maher • Michael S Swain

Faculty of Medicine and Health,
The University of Sydney,
Sydney, New South Wales, Australia

Design:   Prospective feasibility study.

Objectives:   To inform the design and conduct of a large-scale clinical cohort study investigating adolescents with moderate-to-severe spinal pain.

Setting:   Chiropractic care in Sydney, Australia.

Participants:   Adolescents aged 12-17 years with spinal pain (≥4/10 pain intensity score).

Methods:   Adolescents and chiropractors completed baseline and week-12 follow-up questionnaires, with adolescents reporting pain intensity and recovery weekly via text messages during weeks 1-11. Questionnaire measures included spinal pain, pain coping, quality of life, physical activity, clinical assessment findings and care delivered. Chiropractors provided usual clinical care. We conducted a descriptive feasibility analysis.

Primary outcomes:   (1) Recruitment rate, (2) response rate to each data collection instrument and (3) retention rate.

Results:   From May 2021 to February 2023, 20 chiropractors from 10 clinics were enrolled (invited n=85). 10 chiropractors recruited 45 adolescents (15.4±1.4 years, 43% female) over 13.5 months, excluding an 8-month pause due to COVID-19 disruptions. The average recruitment rate was 0.6 adolescents/recruiting chiropractor/month. We achieved a 100% response to chiropractor baseline and follow-up questionnaires, 98% to adolescent baseline, 94% average response to combined weekly text messages and 93% retention of adolescents at study completion.

Conclusions:   Our high response and retention rates demonstrate feasible data collection methods in this population. Addressing low recruitment by expanding the number and type of clinicians is necessary for a successful larger study.

Keywords:   Adolescent; Back pain; Prognosis.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

  • This study used a prospective clinical cohort design to investigate the feasibility of studying adolescents with moderate to severe spinal pain in Australian chiropractic care.

  • Weekly data collection tracked pain intensity and recovery, providing valuable insight into the clinical course of spinal pain in adolescents.

    There are more articles like this @

    SPINAL PAIN IN CHILDREN Section

    (more…)

Read More
 0

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

By |February 19, 2025|Cost-Effectiveness of Chiropractic, Integrative Care, Nonpharmacologic Therapies|

Addressing The Burden Of Spine-Related Disorders Through Integrated Value-Based Care

The Chiro.Org Blog

SOURCE:   Health Affairs Forefront, February 12, 2025

Ryan Burdick • Christian Péan Sara • Holleran Inga Morken • Christine Goertz

Faculty of Health Sciences,
Ontario Tech University.

Editor’s Note:

This article is the latest in the Health Affairs Forefront series, Accountable Care for Population Health, featuring analysis and discussion of how to understand, design, support, and measure patient-centered, cost-efficient care under the umbrella of accountable care. Readers are encouraged to review the Call for Submissions for this series. We are grateful to Arnold Ventures for their support of this work.

The unsustainable rise of health care costs in the US, coupled with suboptimal health outcomes, is driving both conversation and real action toward value-based care (VBC) models in this country. There is no more low-hanging fruit for this effort than spine-related disorders. Low back and neck pain cost us more than $134 billion annually and continues to rise at a rate more than twice that of overall health spending despite the fact that it is already at or near the top of all direct health care expenditures.

Despite aggressive and often invasive treatment approaches, low back pain remains the leading cause of physical disability worldwide with neck pain not far behind. This divergence between cost and outcomes is driven largely by the sustained use of expensive and ineffective treatments that can lead to more harm than benefit. Overreliance on prescription opioids began in the early 2000s, based on weak evidence suggesting that these medications were safe and effective treatments. In addition, the US maintains a higher rate of surgical interventions, more frequent specialist consultations for initial diagnoses, and consistently higher use of medically unnecessary advanced imaging.

Recognizing the profound impact of spine-related disorders, organizations including the

American College of Physicians, the

Centers for Disease Control and Prevention, the

World Health Organization

There is more like this @ our

INTEGRATED HEALTH CARE Section and the

NON-PHARMACOLOGIC THERAPY Section

(more…)

Read More
 0

Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

By |February 9, 2025|Chiropractic Care, Medicare|

Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2021 (Mar)

James M Whedon • Scott Haldeman • Curtis L Petersen • William Schoellkopf • Todd A MacKenzie • Jon D Lurie

Health Services Research,
Southern California University of Health Sciences,
Whittier, California.

FROM:   Davis ~ J Am Board Fam Med. 2015 (Jul)

Objective:   Spinal manipulation (SM) is recommended for first-line treatment of patients with low back pain. Inadequate access to SM may result in inequitable spine care for older US adults, but the supply of clinicians who provide SM under Medicare is uncertain. The purpose of this study was to measure temporal trends and geographic variations in the supply of clinicians who provide SM to Medicare beneficiaries.

Methods:   Medicare is a US government-administered health insurance program that provides coverage primarily for older adults and people with disabilities. We used a serial cross-sectional design to examine Medicare administrative data from 2007 to 2015 for SM services identified by procedure code. We identified unique providers by National Provider Identifier and distinguished between chiropractors and other specialties by Physician Specialty Code. We calculated supply as the number of providers per 100,000 beneficiaries, stratified by geographic location and year.

Results:   Of all clinicians who provide SM to Medicare beneficiaries, 97% to 98% are doctors of chiropractic. The geographic supply of doctors of chiropractic providing SM services in 2015 ranged from 20/100,000 in the District of Columbia to 260/100,000 in North Dakota. The supply of other specialists performing the same services ranged from fewer than 1/100,000 in 11 states to 8/100,000 in Colorado. Nationally, the number of Medicare-active chiropractors declined from 47 102 in 2007 to 45 543 in 2015. The count of other clinicians providing SM rose from 700 in 2007 to 1441 in 2015.

Conclusion:   Chiropractors constitute the vast majority of clinicians who bill for SM services to Medicare beneficiaries. The supply of Medicare-active SM providers varies widely by state. The overall supply of SM providers under Medicare is declining, while the supply of nonchiropractors who provide SM is growing.

Keywords:   Chiropractic; Manipulation, Spinal; Medicare; Musculoskeletal Manipulations.

From the FULL TEXT Article:

Introduction

Low back pain is highly prevalent in the United States, and management of it can be particularly challenging in the Medicare beneficiary population, which is older and has disabilities and frequently comorbidities. [1, 2]

There are more articles like this @

MEDICARE Section

(more…)

Read More
 0
Copyright 1995 - 2025 Chiropractic Resource Organization | All Rights Reserved | Powered by Chirowebs.net | Disclaimer
Facebook