Frank M. Painter

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

By Frank M. Painter|May 11, 2025|Chiropractic Care, Pediatrics|

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

SOURCE: J Bodyw Mov Ther 2025 (Jun): 42: 948–954

OPEN ACCESS

Jenna Duehr • Lona Cook • Amanda Blonigen • Alice Cade • Tanja Glucina • Monika Buerger
Stephanie Sullivan • Tyson Perez • Muhammed Samran Navid
Imran Khan Niazi • Heidi Haavik

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland, 1060, New Zealand

Background: Chiropractic care is utilized in school aged children for a variety of health complaints, including headaches, postural issues, nocturnal enuresis, neurodevelopmental disorders, and back pain. Chiropractic care, with its ability to impact sensorimotor integration, motor control and the prefrontal cortex, could therefore potentially benefit school aged children.

Methods: In this retrospective case series, records of patients presenting for chiropractic care at an onsite school chiropractic clinic were reviewed. Patients underwent 12 weeks of chiropractic care and completed three questionnaires and two sets of neurophysiological scans. The data from these questionnaires and scans were combined, averaged, and statistically analyzed.

Results: One hundred and eighty records of children aged 5-18 years from nine schools were included in the overall analyses. Statistically significant improvements were noted in the ‘health and activities’ sub-section and overall score of the Pediatric Quality of Life Inventory™ and in the hyperactivity domain of the Strengths and Difficulties questionnaire.

Conclusion: This retrospective review of case records from children attending an onsite school chiropractic clinic has demonstrated some changes in health-related quality of life following a period of 12 weeks of chiropractic care. Further research using a clinical trial design is needed to extrapolate the findings and to assess causation.

Keywords: Chiropractic; Heart-rate variability; Neurodevelopmental disorders; Neurophysiology; Quality of life; School children; Surface electromyography; Thermography.

From the Full-Text Article:

Introduction

Childhood is a period of huge growth and development. The health and experiences of children during this critical time can have long-term impacts on disease rates, mental health, and overall well-being for the rest of their lives(Drozdz et al., 2021; Goodman et al., 2011; Middlebrooks., 2007; Marcus et al., 2022; Bellis et al., 2019). However, the health and wellbeing of children today is showing some alarming areas of decline and concern (Lebrun-Harris et al., 2022). Data from the National Survey of Children’s health in the US from 2016 to 2020 showed an increase in rates of anxiety, depression, behavioral disorders, and obesity (Lebrun-Harris et al., 2022)). The survey also showed declining rates of preventative medical visits, daily physical activity, and parents mental health (Lebrun-Harris et al., 2022). The decline in key areas of health is also evident from more historical data from the 2007 and 2011/2012 National Survey of Children’s Health (Initiative et al., 2024) which showed higher rates in many of the domains related to good health (preventative medical visits, physical activity) and lower rates of obesity, suggesting that the decline in key areas of children’s health has been evident for nearly two decades.

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

By Frank M. Painter|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).

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

By Frank M. Painter|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.

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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 Frank M. Painter|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.

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

By Frank M. Painter|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.

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

By Frank M. Painter|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

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About Frank M. Painter

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

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

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

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

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

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

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

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

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

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

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

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

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