Chiropractic Management

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

By Frank M. Painter|January 18, 2022|Chiropractic Management, Cost-Effectiveness, Veterans|

Care Outcomes for Chiropractic Outpatient Veterans (COCOV): A Qualitative Study with Veteran Stakeholders From a Pilot Trial of Multimodal Chiropractic Care

SOURCE: Pilot Feasibility Stud 2022 (Jan 14); 8 (1): 6

Stacie A. Salsbury, Elissa Twist, Robert B. Wallace, Robert D. Vining, Christine M. Goertz & Cynthia R. Long

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street,
Davenport, Iowa, 52803, USA.

Background: Low back pain (LBP) is common among military veterans seeking treatment in Department of Veterans Affairs (VA) healthcare facilities. As chiropractic services within VA expand, well-designed pragmatic trials and implementation studies are needed to assess clinical effectiveness and program uptake. This study evaluated veteran stakeholder perceptions of the feasibility and acceptability of care delivery and research processes in a pilot trial of multimodal chiropractic care for chronic LBP.

Methods: The qualitative study was completed within a mixed-method, single-arm, pragmatic, pilot clinical trial of chiropractic care for LBP conducted in VA chiropractic clinics. Study coordinators completed semi-structured, in person or telephone interviews with veterans near the end of the 10–week trial. Interviews were audiorecorded and transcribed verbatim. Qualitative content analysis using a directed approach explored salient themes related to trial implementation and delivery of chiropractic services.

Results: Of 40 participants, 24 completed interviews (60% response; 67% male gender; mean age 51.7 years). Overall, participants considered the trial protocol and procedures feasible and reported that the chiropractic care and recruitment methods were acceptable. Findings were organized into 4 domains, 10 themes, and 21 subthemes. Chiropractic service delivery domain encompassed 3 themes/8 subthemes: scheduling process (limited clinic hours, scheduling future appointments, attendance barriers); treatment frequency (treatment sufficient for LBP complaint, more/less frequent treatments); and chiropractic clinic considerations (hire more chiropractors, including female chiropractors; chiropractic clinic environment; patient-centered treatment visits). Outcome measures domain comprised 3 themes/4 subthemes: questionnaire burden (low burden vs. time-consuming or repetitive); relevance (items relevant for LBP study); and timing and individualization of measures (questionnaire timing relative to symptoms, personalized approach to outcomes measures). The online data collection domain included 2 themes/4 subthemes: user concerns (little difficulty vs. form challenges, required computer skills); and technology issues (computer/internet access, junk mail). Clinical trial planning domain included 2 themes/5 subthemes: participant recruitment (altruistic service by veterans, awareness of chiropractic availability, financial compensation); and communication methods (preferences, potential barriers).

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Doctors of Chiropractic Working with or within Integrated Healthcare Delivery Systems: A Scoping Review Protocol

By Frank M. Painter|January 11, 2022|Chiropractic Management, Integrative Care|

Doctors of Chiropractic Working with or within Integrated Healthcare Delivery Systems: A Scoping Review Protocol

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SOURCE: BMJ Open 2021 (Jan 25); 11 (1): e043754

Eric J Roseen, Bolanle Aishat Kasali, Kelsey Corcoran, Kelsey Masselli, Lance Laird, Robert B Saper, Daniel P Alford, Ezra Cohen, Anthony Lisi, Steven J Atlas, Jonathan F Bean, Roni Evans, André Bussières

Department of Family Medicine,
Boston University School of Medicine and
Boston Medical Center,
Boston, MA, USA

Introduction: Back and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international clinical practice guidelines. Although DCs practice in over 90 countries, chiropractic care is rarely available within integrated healthcare delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improving collaboration between medical providers and community-based DCs, or embedding DCs

Methods and analyses: This scoping review will map studies of DCs working with or within integrated healthcare delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (eg, shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention, implementation strategies and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based

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Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

By Frank M. Painter|December 27, 2021|Chiropractic Management, Nonpharmacologic Therapies|

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976) 2019 (Oct 15); 44 (20): 1456–1464

Patricia M. Herman, ND, PhD; Tara A. Lavelle, PhD; Melony E. Sorbero, PhD; Eric L. Hurwitz, DC, PhD; Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA

Study design: Markov model.

Objective: Examine the 1-year effectiveness and cost-effectiveness (societal and payer perspectives) of adding nonpharmacologic interventions for chronic low back pain (CLBP) to usual care using a decision analytic model-based approach.

Summary of background data : Treatment guidelines now recommend many safe and effective nonpharmacologic interventions for CLBP. However, little is known regarding their effectiveness in subpopulations (e.g., high-impact chronic pain patients), nor about their cost-effectiveness.

Methods: The model included four health states: high-impact chronic pain (substantial activity limitations); no pain; and two others without activity limitations, but with higher (moderate-impact) or lower (low-impact) pain. We estimated intervention-specific transition probabilities for these health states using individual patient-level data from 10 large randomized trials covering 17 nonpharmacologic therapies. The model was run for nine 6-week cycles to approximate a 1-year time horizon. Quality-adjusted life-year weights were based on six-dimensional health state short form scores; healthcare costs were based on 2003 to 2015 Medical Expenditure Panel Survey data; and lost productivity costs used in the societal perspective were based on reported absenteeism. Results were generated for two target populations: (1) a typical baseline mix of patients with CLBP (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) and (2) high-impact chronic pain patients.

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Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

By Frank M. Painter|December 22, 2021|Chiropractic Management, Pregnancy|

Manipulative Therapy for Pregnancy and Related Conditions: A Systematic Review

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SOURCE: Obstet Gynecol Surv 2009 (Jun); 64 (6): 416–427

Raheleh Khorsan, MA, Cheryl Hawk, DC, PhD, Anthony J. Lisi, DC, and Anupama Kizhakkeveettil, BAMS, MAOM

Military Medical Research and Integrative Medicine,
Samueli Institute,
Corona del Mar,
California 92625, USA

Objective: The objective of this review is to evaluate the evidence on the effects of Spinal Manipulative Therapy (SMT) on back pain and other related symptoms during pregnancy.

Data sources: A literature search was conducted using Pubmed, Manual, Alternative and Natural Therapy Index System, Cumulated Index to Nursing and Allied Health, Index to Chiropractic Literature, the Cochrane Library, and Google Scholar. In addition hand searches and reference tracking were also performed, and the citation list was assessed for comprehensiveness by content experts.

Methods of study selection : This review was limited to peer-reviewed manuscripts published in English from 1966 until September 2008. The initial search strategy yielded 140 citations of which 12 studies were reviewed for quality.

Tabulation, integration, and results: The methodological quality of the included studies was assessed independently using quality checklists of the Scottish Intercollegiate Guidelines Network and Council on Chiropractic Guidelines and Practice Parameters. The review indicates that the use of SMT during pregnancy to reduce back pain and other related symptoms is supported by limited evidence.

Conclusion: Overall, this body of evidence is best described as emergent. However, since effective treatments for pregnancy-related back pain are limited, clinicians may want to consider SMT as a treatment option, if no contraindications are present.

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Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

By Frank M. Painter|December 16, 2021|Chiropractic Management, Pregnancy|

Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2021 (Nov 23)

Carol Ann Weis, MSc, DC, Katherine Pohlman, DC, PhD, Jon Barrett, MBBch, MD, Maeve O’Beirne, MD, PhD, Kent Stuber, DC, MSc, Cheryl Hawk, DC, PhD

Department of Research,
Canadian Memorial Chiropractic College,
Toronto, ON, Canada.

Objective: The purpose of this project was to develop a best-practices document on chiropractic care for pregnant and postpartum patients with low back pain (LBP), pelvic girdle pain (PGP), or a combination.

Methods: A modified Delphi consensus process was conducted. A multidisciplinary steering committee of 11 health care professionals developed 71 seed statements based on their clinical experience and relevant literature. A total of 78 panelists from 7 countries were asked to rate the recommendations (70 chiropractors and representatives from 4 other health professions). Consensus was reached when at least 80% of the panelists deemed the statement to be appropriate along with a median response of at least 7 on a 9-point scale.

Results: Consensus was reached on 71 statements after 3 rounds of distribution. Statements included informed consent and risks, multidisciplinary care, key components regarding LBP during pregnancy, PGP during pregnancy and combined pain during pregnancy, as well as key components regarding postpartum LBP, PGP, and combined pain. Examination, diagnostic imaging, interventions, and lifestyle factors statements are included.

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Systematic Review of Self-Reported Prognosis

By Frank M. Painter|July 21, 2017|Chiropractic Management, Mild Traumatic Brain Injury|

Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

The Chiro.Org Blog

Arch Phys Med Rehabil. 2014 (Mar); 95 (3 Suppl): S132–151

J. David Cassidy, PhD, DrMedSc, Carol Cancelliere, DC, MPH,
Linda J. Carroll, PhD, Pierre Côté, DC, PhD,
Cesar A. Hincapié, DC, MHSc, Lena W. Holm, et al.

Institute of Sports Science and Clinical Biomechanics,
Faculty of Health, University of Southern Denmark,
Odense, Denmark

OBJECTIVE: To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004.

DATA SOURCES: MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than 30 adult cases.

STUDY SELECTION: Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess subjective, self-reported outcomes. After 77,914 titles and abstracts were screened, 299 articles were eligible and reviewed for scientific quality. This includes 3 original International Collaboration on MTBI Prognosis (ICoMP) research studies.

DATA EXTRACTION: Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed each study and tabled data from accepted articles. A third reviewer was consulted for disagreements.

DATA SYNTHESIS: Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress.

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