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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.

There is more like this @ our:

NON-PHARMACOLOGIC THERAPY Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

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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.

There is more like this @ our:

LOW BACK PAIN Section and the:

NON-PHARMACOLOGIC THERAPY Section and the:

CHIROPRACTIC CARE FOR VETERANS Section

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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 |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.

There is more like this @ our:

LOW BACK PAIN Section and the:

COST-EFFECTIVENESS Section and the:

NON-PHARMACOLOGIC THERAPY Section

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Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

By |June 8, 2021|Nonpharmacologic Therapies|

Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

The Chiro.Org Blog


SOURCE:   Translational Research 2021 (Apr 24);

  OPEN ACCESS  

Steven Z George, Trevor A Lentz, Christine M Goertz

Department of Orthopaedic Surgery and
Duke Clinical Research Institute,
Duke University,
Durham, North Carolina.



Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain.

First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.

There are more articles like this @ our brand new:

NON-PHARMACOLOGIC THERAPY Page

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For Bad Backs, It May Be Time to Rethink Biases

By |May 1, 2017|Chiropractic Care, Nonpharmacologic Therapies|

For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

The Chiro.Org Blog


SOURCE:   The New York Times ~ 5-01-2017


Aaron E. Carroll, MD, MS

Indiana University School of Medicine


About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation.

It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer.

Most back pain resolves over time, so interventions that focus on relief of symptoms and allow the body to heal are ideal. Many of these can be nonpharmacological in nature, like the work done by chiropractors or physical therapists.

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine. Patients with back pain haven’t seemed as skeptical. A large survey of them from 2002 through 2008 found that more than 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.

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