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Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Single-arm, Pragmatic, Pilot Trial of Multimodal Chiropractic Care for U.S. Veterans with Chronic Low Back Pain

By |March 11, 2022|Chiropractic Management, Chronic Low Back Pain|

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Single-arm, Pragmatic, Pilot Trial of Multimodal Chiropractic Care for U.S. Veterans with Chronic Low Back Pain

The Chiro.Org Blog


SOURCE:   Pilot and Feasibility Studies 2022 (Mar 7); 8 (1): 54

Cynthia R. Long, PhD, Stacie A. Salsbury, PhD, RN, Robert D. Vining, DC, Anthony J. Lisi, DC, et al.

Palmer Center for Chiropractic Research, Davenport,
Palmer College of Chiropractic,
741 Brady St, Davenport, IA, 52803



Background:   Over 25% of veterans seeking care at U.S. Veterans Health Administration facilities have chronic low back pain (LBP), with high rates of mental health comorbidities. The primary objective of this study was to assess the feasibility of participant recruitment, retention, and electronic data collection to prepare for the subsequent randomized trial of multimodal chiropractic care for pain management of veterans with chronic low back pain. The secondary objectives were to estimate effect sizes and variability of the primary outcome and choose secondary outcomes for the full-scale trial.

Methods:   This single-arm pilot trial enrolled 40 veterans with chronic LBP at one Veterans Health Administration facility for a 10–week course of pragmatic multimodal chiropractic care. Recruitment was by (1) provider referral, (2) invitational letter from the electronic health record pre-screening, and (3) standard direct recruitment. We administered patient-reported outcome assessments through an email link to REDCap, an electronic data capture platform, at baseline and 5 additional timepoints. Retention was tracked through adherence to the treatment plan and completion rates of outcome assessments. Descriptive statistics were calculated for baseline characteristics and outcome variables.

Results:   We screened 91 veterans over 6 months to enroll our goal of 40 participants. Seventy percent were recruited through provider referrals. Mean age (range) was 53 (22–79) years and 23% were female; 95% had mental health comorbidities. The mean number of chiropractic visits was 4.5 (1–7). Participants adhered to their treatment plan, with exception of 3 who attended only their first visit. All participants completed assessments at the in-person baseline visit and 80% at the week 10 final endpoint. We had no issues administering assessments via REDCap. We observed clinically important improvements on the Roland-Morris Disability Questionnaire [mean change (SD): 3.6 (6.1)] and on PROMIS® pain interference [mean change (SD): 3.6 (5.6)], which will be our primary and key secondary outcome, respectively, for the full-scale trial.

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Multidisciplinary Integrative Care Versus Chiropractic Care for Low Back Pain: A Randomized Clinical Trial

By |March 9, 2022|Chiropractic Management, Low Back Pain|

Multidisciplinary Integrative Care Versus Chiropractic Care for Low Back Pain: A Randomized Clinical Trial

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2022 (Mar 1); 30: 10

Gert Bronfort, Michele Maiers, Craig Schulz, Brent Leininger, Kristine Westrom, Greg Angstman & Roni Evans

University of Minnesota,
Mayo Building C504,
420 Delaware Street SE,
Minneapolis, MN, 55455, USA.

Read the 2 previous papers associated with this study:

Maiers et. al.; BMC Health Serv Res. 2010 (Oct 29) and

Westrom et al.; Trials. 2010 (Mar 8)



Background:   Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients’ needs more comprehensively.

Methods:   This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes.

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LOW BACK PAIN Section

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Utilization of Chiropractic Services in Patients with Osteoarthritis and Spine Pain at a Publicly Funded Healthcare Facility in Canada: A Retrospective Study

By |March 8, 2022|Chiropractic Management, Spinal Pain Management|

Utilization of Chiropractic Services in Patients with Osteoarthritis and Spine Pain at a Publicly Funded Healthcare Facility in Canada: A Retrospective Study

The Chiro.Org Blog


SOURCE:   J Back Musculoskelet Rehabil 2022 (Feb 25) [EPUB]

Amber Reichardt, Steven R Passmore, Audrey Toth, Gerald Olin

Faculty of Kinesiology and Recreation Management,
University of Manitoba,
Winnipeg, MB, Canada.



Background:   Osteoarthritis (OA) is one of the most prevalent and disabling musculoskeletal diseases worldwide. There is preliminary evidence from experimental studies and consensus documents that chiropractic management may alleviate spine and/or extremity OA related pain in the short term.

Objective:   This research explores the potential relationship of a pragmatic course of care, including soft tissue therapy, spinal manipulation, and other treatments commonly delivered by chiropractors, to spine and extremity pain in patients with OA.

Methods:   A retrospective analysis of prospectively collected data from the chiropractic program at a publicly funded healthcare facility was conducted. The primary outcome measures for patients diagnosed with spine and/or extremity OA (n= 76) were numeric pain scores of each spinal and extremity region at baseline and discharge, and a change score was determined.

Results:   Statistically significant improvements that exceed a clinically meaningful difference in pain numeric rating scale scores were demonstrated by point change reductions from baseline to discharge visits. Change scores exceeding a minimally clinically important difference of “2-points” were present in the sacroiliac (-2.91), extremity (-2.84), cervical (-2.73), thoracic (-2.61), and lumbar (-2.59) regions.

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Chiropractic in the United States Military Health System: A 25th-Anniversary Celebration of the Early Years

By |February 5, 2022|Nonpharmacologic Therapies, Veterans|

Chiropractic in the United States Military Health System: A 25th-Anniversary Celebration of the Early Years

The Chiro.Org Blog


SOURCE:   J Chiropractic Humanities 2020 (Dec); 27: 37-58

Bart N.Green DC, MSEd, PhD, Scott R.Gilford DC, Richard F.Beacham DC

Employer Based Integrated Primary Care Health Centers,
Stanford Health Care,
San Diego, California



Objective   The purpose of this report is to record noteworthy events that occurred during the early years of chiropractic in the United States Military Health System (MHS).

Methods   We used mixed methods to create this historical account, including documents, artifacts, research papers, and reports from personal experiences.

Results   Chiropractic care was first included in the MHS in 1995, after years of legislative activity. The initial program was a 3-year study of the feasibility and advisability of integrating chiropractic in the MHS. This period was called the Chiropractic Health Care Demonstration Project; 20 pioneering chiropractors began their MHS journeys at 10 military bases in fiscal year 1995. The Demonstration Project was extended for 2 more years to gather research data, and 3 additional military facilities were added during those years to accomplish that purpose. The Demonstration Project concluded in 1999. In 2000, Congress approved the development of permanent chiropractic services and benefits for members of the uniformed services. These new clinics opened in 2002.

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Health-related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care plus Chiropractic Care plus Usual Care vs Usual Care Alone

By |January 29, 2022|Nonpharmacologic Therapies, Veterans|

Health-related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care plus Chiropractic Care plus Usual Care vs Usual Care Alone

The Chiro.Org Blog


SOURCE:   Pain Medicine 2022 (Jan 21); pnac009 [EPUB]

UCLA Department of Medicine,
Los Angeles, CA.

Department of Epidemiology,
University of Iowa,
Iowa City, IA.



Objective:   This study examines Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to: 1) worst pain intensity from a numerical pain rating 0-10 scale, 2) 24-item Roland-Morris Disability Questionnaire (RMDQ); and 3) global improvement (modified visual analog scale).


Design:   A pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC).

Setting:   3 military treatment facilities.

Subjects:   750 active-duty military personnel with low back pain.

Methods:   Linear mixed effects regression models estimated the treatment group differences. Coefficient of repeatability to estimate significant individual change.

Results:   We found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the RMDQ score. Area under the curve estimates for global improvement for the PROMIS®-29 scales and the RMDQ, ranged from 0.79 to 0.83.

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LOW BACK PAIN Section and the:

NON-PHARMACOLOGIC THERAPY Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

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Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

By |January 20, 2022|Initial Provider, Medicare|

Characteristics of Older Adults with Back Pain Associated with Choice of First Primary Care Provider: A Cross-sectional Analysis from the BACE-N Cohort Study

The Chiro.Org Blog


SOURCE:   BMJ Open 2021 (Sep 17); 11 (9): e053229

Ørjan Nesse Vigdal, Kjersti Storheim, Rikke Munk Killingmo, Milada Cvancarova Småstuen, and Margreth Grotle

Department of Physiotherapy,
Oslo Metropolitan University,
Oslo, Norway



Objectives:   To describe characteristics of older adults with back pain in primary care, and to assess associations between patient characteristics and type of first primary care provider (general practitioner (GP), physiotherapist (PT) or chiropractor).

Design:   Cross-sectional analysis from the Back Complaints in the Elders-Norway cohort study.

Setting:   Norwegian GP, PT and chiropractic primary care centres.

Participants:   Patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain were invited to participate. Between April 2015 and February 2020, we included 452 patients: 127 first visited a GP, 130 first visited a PT and 195 first visited a chiropractor.

Primary and secondary outcome measures:   For the first objective, the outcome measure was descriptive statistics of patient characteristics, covering the following domains: sociodemographic, general health, current and previous back pain, psychological and clinical factors. For the second objective, first primary care provider was the outcome measure. Associations between patient characteristics and visiting a GP or PT compared with a chiropractor were assessed with multiple multinomial regression analyses.

Results:   Median (IQR) age was 66 (59-72) years. Levels of back-related disability was moderate to severe, with a median (IQR) Roland-Morris Disability Questionnaire (range 0-24) score of 9 (5-13). Recurring episodes were common, 301 (67%) patients had monthly or yearly recurrences. Patients with worse back-related disability, longer duration of symptoms, lower expectations for full recovery and worse physical performance measured with the Back Performance Scale had higher odds of visiting a GP or PT compared with a chiropractor (p<0.05).

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